Manual Therapy, Physical Therapy, or Care by Primary Care Doctors for Patients with Neck Pain

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The summary below is from the full report titled "Manual Therapy, Physical Therapy, or Continued Care by a General Practitioner for Patients with Neck Pain. A Randomized, Controlled Trial." It is in the 21 May 2002 issue of Annals of Internal Medicine (volume 136, pages 713-722). The authors are JL Hoving, BW Koes, HCW de Vet, DAWM van der Windt, WJJ Assendelft, H van Mameren, WLJM Devillé, JJM Pool, RJPM Scholten, and LM Bouter.

What is the problem and what is known about it so far?

Neck pain is common and can interfere with daily activities. Neck pain usually goes away without treatment, but patients often seek treatment to speed recovery. Treatments include pain medications, rest, manual therapy, and physical therapy. In manual therapy, a trained therapist moves a patient's neck in specific ways to help improve neck mobility. In physical therapy, a trained therapist assists patients with exercises to improve neck mobility. The main difference between manual therapy and physical therapy is that the therapist moves the patient in manual therapy, while physical therapy requires the patient to do exercises. The best treatment for neck pain is not known.

Why did the researchers do this particular study?

To compare the effectiveness of three treatments for neck pain: routine care by a doctor (rest and medication), manual therapy, or physical therapy.

Who was studied?

183 adults who had had nonspecific neck pain for at least 2 weeks. Nonspecific means that the neck pain was due to strain of muscles and joints rather than to some serious problem such as a broken bone. Forty-two primary care doctors in the Netherlands referred patients to the study.

How was the study done?

The researchers used a computerized coin flip to assign patients to treatment with manual therapy, physical therapy, or continued care by their doctor. One of 6 manual therapists performed the manual therapy for 45 minutes, once per week, for up to 6 weeks. One of 5 physical therapists performed the physical therapy for 30 minutes, twice per week, for up to 6 weeks. The doctors used medications to treat pain and inflammation and gave advice about rest, hot compresses, and home exercises. All patients were allowed to use home exercises, nonprescription medicines, or medicines their doctors had prescribed before referring them to the study. Seven weeks after beginning treatment, patients rated their neck pain on a scale from "much worse" to "completely recovered." The researchers compared the number of patients in each group who reported feeling "much improved" or "completely recovered."

What did the researchers find?

In the manual therapy group, 68.3% of patients felt "much improved" or "completely recovered" compared with 50.8% of patients in the physical therapy group and 35.9% of doctor-treated patients. The differences between manual therapy and either physical therapy or treatment by a doctor were large enough to prove that there were true differences between the groups. The results suggested that physical therapy might also be better than treatment by a doctor, but the study was too small to prove this.

What were the limitations of the study?

The results could be different with different therapists or doctors.

What are the implications of the study?

Doctors should consider referring patients with neck pain to manual therapy.