Examination of a Clinical Prediction Rule to Identify Patients With Neck Pain Likely to Benefit From Thoracic Spine Thrust Manipulation and a General Cervical Range of Motion Exercise: Multi-Center Randomized Clinical Trial

Abstract

The results of the current study did not support the validity of the previously developed CPR. However, the results demonstrated that patients with mechanical neck pain who received thoracic spine manipulation and exercise exhibited significantly greater improvements in disability at both the short- and long-term follow-up periods and in pain at the 1-week follow-up compared with patients who received exercise only.

Effectiveness of Thoracic Manipulation on the Treatment of Patients With Mechanical Non-Specific Neck Pain

“…2 RCTs [40,47], with different qualities ranging from fair to high, used either exercise or exercise plus thoracic manipulation to investigate effectiveness of thoracic manipulation on patients with mechanical neck pain. Recent evidence supports using exercise for alleviating pain and improving dysfunction and disability [1,27,40,47].…”

Analysis of Thoracic Spine Thrust Manipulation for Reducing Neck Pain

“…In a study by Cleland et al 16) , one group was submitted to an exercise program and thoracic manipulation, and another group was submitted to the exercise program alone in five sessions over the course of four weeks. The group submitted to both manipulation and exercise demonstrated greater improvements in disability (initial NDI = 30 NDI in Week 1 = 16 NDI in Week 4 = 10 and NDI after six months = 8) than the group submitted to exercise alone (initial NDI = 29 NDI in Week 1 = 18 NDI in Week 4 = 15 and NDI after six months = 13).…”

“…Cleland et al 16) reported that an intervention often used by physiotherapists in the treatment of neck pain is the manipulation of the thoracic spine. In their study, thoracic manipulative treatment was performed in association with exercise in 140 patients, who were then evaluated by NDI at 1 week, 4 weeks and 6 months after treatment.…”

“…Higher scores represent increased levels of disability. The NDI has been reported to be a reliable and valid outcome measure for patients with neck pain 16) . Another form of measurement of pain is the patient's visual analogue pain scale (VAS).…”

Description of Common Clinical Presentations and Associated Short-Term Physical Therapy Clinical Outcomes in Patients With Neck Pain

“…3,4 Certain factors are known to be prognostic for the course of neck pain, and several interventions, including those provided by physical therapists, are likely to produce a favorable outcome. [5][6][7][8][9] Approximately 35% of persons with neck pain reported being seen by a physical therapist, the most frequently visited provider, 10 and evidence suggests that physical therapy can be an effective secondary prevention strategy for neck pain. 11 In recent years, organized efforts have been made to improve clinical outcomes and standardize physical therapy treatment, including using classification system approaches.…”