TY - JOUR
T1 - Manual therapy, physical therapy, or continued care by the general practitioner for patients with neck pain - Long-term results from a pragmatic randomized clinical trial
T2 - Long-term results from a pragmatic randomized clinical trial
AU - Hoving, J.L.
AU - de Vet, H.C.W.
AU - Koes, B.W.
AU - van Mameren, H.
AU - Deville, W.L.J.M.
AU - van der Windt, D.A.W.M.
AU - Assendelft, W.J.J.
AU - Pool, J.J.M.
AU - Scholten, R.J.P.M.
AU - Korthals-de Bos, I.B.C.
AU - Bouter, L.M.
PY - 2006/5/1
Y1 - 2006/5/1
N2 - OBJECTIVES: The authors' goals were to compare the effectiveness of manual therapy (MT; mainly spinal mobilization), physical therapy (PT; mainly exercise therapy), and continued care by the general practitioner (GP; analgesics, counseling and education) over a period of 1 year. METHODS: One hundred eighty-three patients suffering for at least 2 weeks from nonspecific neck pain were randomized to receive a 6-week treatment strategy of MT once a week, PT twice a week, or GP care once every 2 weeks. The primary outcome measures were perceived recovery, severity of physical dysfunctioning, pain intensity, and functional disability. RESULTS: The differences between groups considered over 1 year were statistically significant (repeated measurements analyses P<0.001 to P=0.02) for all outcomes but borderline for the Neck Disability Index (P=0.06). Higher improvement scores were observed for MT for all outcomes, followed by PT and GP care. The success rate, based on perceived recovery after 13 weeks, was 72% for MT, which was significantly higher than the success rate for continued GP care (42%, P=0.001) but not significantly higher compared with PT treatment (59%, P=0.16). The difference between PT and GP approached statistical significance (P=0.06). After 1 year the success rates were 75%, 63%, and 56%, respectively, and no longer significantly different. CONCLUSIONS: Short-term results (at 7 weeks) have shown that MT speeded recovery compared with GP care and, to a lesser extent, also compared with PT. In the long-term, GP treatment and PT caught up with MT, and differences between the three treatment groups decreased and lost statistical significance at the 13-week and 52-week follow-up.
AB - OBJECTIVES: The authors' goals were to compare the effectiveness of manual therapy (MT; mainly spinal mobilization), physical therapy (PT; mainly exercise therapy), and continued care by the general practitioner (GP; analgesics, counseling and education) over a period of 1 year. METHODS: One hundred eighty-three patients suffering for at least 2 weeks from nonspecific neck pain were randomized to receive a 6-week treatment strategy of MT once a week, PT twice a week, or GP care once every 2 weeks. The primary outcome measures were perceived recovery, severity of physical dysfunctioning, pain intensity, and functional disability. RESULTS: The differences between groups considered over 1 year were statistically significant (repeated measurements analyses P<0.001 to P=0.02) for all outcomes but borderline for the Neck Disability Index (P=0.06). Higher improvement scores were observed for MT for all outcomes, followed by PT and GP care. The success rate, based on perceived recovery after 13 weeks, was 72% for MT, which was significantly higher than the success rate for continued GP care (42%, P=0.001) but not significantly higher compared with PT treatment (59%, P=0.16). The difference between PT and GP approached statistical significance (P=0.06). After 1 year the success rates were 75%, 63%, and 56%, respectively, and no longer significantly different. CONCLUSIONS: Short-term results (at 7 weeks) have shown that MT speeded recovery compared with GP care and, to a lesser extent, also compared with PT. In the long-term, GP treatment and PT caught up with MT, and differences between the three treatment groups decreased and lost statistical significance at the 13-week and 52-week follow-up.
KW - General practice
KW - Long-term effects
KW - Manual therapy
KW - Neck pain
KW - Physical therapy
KW - Randomized clinical trial
UR - http://www.scopus.com/inward/record.url?scp=33745906228&partnerID=8YFLogxK
U2 - https://doi.org/10.1097/01.ajp.0000180185.79382.3f
DO - https://doi.org/10.1097/01.ajp.0000180185.79382.3f
M3 - Article
C2 - 16691091
SN - 0749-8047
VL - 22
SP - 370
EP - 377
JO - The Clinical Journal of Pain
JF - The Clinical Journal of Pain
IS - 4
ER -