Related Articles:
Two-Year Follow-up of a Randomized Clinical Trial of Spinal Manipulation and Two Types of Exercise for Patients With Chronic Neck Pain
from Spine
Posted 11/21/2002
Roni Evans, DC, MS, Gert Bronfort, DC, PhD, Brian Nelson, MD, Charles H. Goldsmith, PhD
Abstract and Introduction
Abstract
Study Design: Randomized clinical trial.
Objectives: To compare the effects of spinal manipulation combined with low-tech rehabilitative exercise, MedX rehabilitative exercise, or spinal manipulation alone in patient self-reported outcomes over a two-year follow-up period.
Summary of Background Data: There have been few randomized clinical trials of spinal manipulation and rehabilitative exercise for patients with neck pain, and most have only reported short-term outcomes.
Methods: One hundred ninety-one patients with chronic neck pain were randomized to 11 weeks of one of the three treatments. Patient self-report questionnaires measuring pain, disability, general health status, improvement,
satisfaction, and OTC medication use were collected after 5 and 11 weeks of treatment and 3, 6, 12, and 24 months after treatment. Data were analyzed taking into account all time points using repeated measures analyses.
Results: Ninety-three percent (178) of randomized patients completed the 11-week intervention phase, and 76% (145) provided data at all evaluation time points over the two-year follow-up period. A difference in patient-rated pain
with no group-time interaction was observed in favor of the two exercise groups [F(2141) = 3.2; P = 0.04]. There was also a group difference in satisfaction with care [F(2143) = 7.7; P = 0.001], with spinal manipulation combined
with low-tech rehabilitative exercise superior to MedX rehabilitative exercise (P = 0.02) and spinal manipulation alone (P < 0.001). No significant group differences were found for neck disability, general health status, improvement,
and OTC medication use, although the trend over time was in favor of the two exercise groups.
Conclusion: The results of this study demonstrate an advantage of spinal manipulation combined with low-tech rehabilitative exercise and MedX rehabilitative exercise versus spinal manipulation alone over two years and are similar
in magnitude to those observed after one-year follow-up. These results suggest that treatments including supervised rehabilitative exercise should be considered for chronic neck pain sufferers. Further studies are needed to examine
the cost effectiveness of these therapies and how spinal manipulation compares to no treatment or minimal intervention.
Introduction: Compared to low back pain, neck pain has been poorly researched, even though it affects a large number of individuals and has an important socioeconomic impact. Surveys in Canada and Finland have found that neck pain afflicts
approximately 70% of adults at some point in their lives.[8, 25] Approximately 10% of respondents in a Canadian study reported having high neck pain levels, and an additional 5% were severely disabled because of neck pain.[8]
Almost 14% of respondents to Norwegian and Finnish surveys reported having neck pain that was chronic in nature.[2, 13]
A recent systematic review of the literature of common, nonsurgical treatments found few randomized clinical trials on neck pain that were of high methodologic quality. Furthermore, most reported only short-term outcomes, with
only 2 of 27 having at least a 1-year follow-up period.[20]
We conducted a randomized clinical trial comparing commonly used treatments for chronic neck pain: 1) spinal manipulation with low-tech rehabilitative exercise (SMT/Exercise); 2) high-tech MedX rehabilitative exercise (MedX);
and 3) spinal manipulation (SMT) alone. The two exercise groups were significantly better than the SMT group in terms of strength and range of motion after 11 weeks of treatment and in patient-rated outcomes one year after treatment.
These results have been presented in a previous publication.[3] The current paper describes the results of the two-year follow-up and addresses the hypothesis that the advantage observed over one year in both exercise groups would be sustained two years posttreatment.
Section 1 of 5
Roni Evans, DC, MS*, Gert Bronfort, DC, PhD*, Brian Nelson, MD,† and Charles H. Goldsmith, PhD‡*Northwestern Health Sciences University, Bloomington, Minnesota, †Physicians' Neck and Back Clinic, Roseville, Minnesota,
and ‡McMaster University, Hamilton, Ontario, Canada Spine 27(21):2383-2389, 2002. © 2002 Lippincott Williams & Wilkins