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: Long-term results from a pragmatic randomized clinical trial

J.L. Hoving, H.C.W. de Vet, B.W. Koes, H. van Mameren, W.L.J.M. Deville, D.A.W.M. van der Windt, W.J.J. Assendelft, J.J.M. Pool, R.J.P.M. Scholten, I.B.C. Korthals-de Bos, L.M. Bouter

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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.

Original languageEnglish
Pages (from-to)370-377
Number of pages8
JournalThe Clinical Journal of Pain
Issue number4
Publication statusPublished - 1 May 2006


  • General practice
  • Long-term effects
  • Manual therapy
  • Neck pain
  • Physical therapy
  • Randomized clinical trial

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