Summary of findings 2. Manipulation (thoracic) compared with inactive control for neck pain.
| Manipulation (thoracic) compared with inactive control for neck pain | ||||
|
Patient or population: patients with acute, subacute and chronic neck pain Settings: outpatient clinics, ambulatory care services Intervention: manipulation of thoracic region ‐ multiple sessions Comparison: inactive control | ||||
| Outcomes | Relative effect (95% CI) | Number of participants (studies) | Quality of the evidence (GRADE) | Comments |
| PAIN | ||||
| Acute and subacute neck pain Short‐term follow‐up |
SMD pooled ‐1.46 (‐2.20 to ‐0.71) |
242
(4 trials; Fernandez 2004 JWRD; Fernandez 2009; Gonzalez‐Iglesias 2009 JO; Masaracchio 2013) |
⊕⊕⊕⊝ Moderatea |
Favoured treatment; NNTB: 4 to 7; magnitude of effect: medium |
| Chronic neck pain Intermediate‐term follow‐up |
SMD ‐0.64 (‐1.04 to ‐0.25) |
111 (1 trial; Cheung Lau 2011) | ⊕⊕⊝⊝ Lowb,c |
Favoured treatment; NNTB 4; magnitude of effect: small |
| FUNCTION | ||||
| Acute and subacute neck pain Short‐term follow‐up |
SMD pooled ‐1.73 (‐2.68 to ‐0.78) |
258 (3 trials; Gonzalez‐Iglesias 2009 JO; Gonzalez‐Iglesias 2009 MT; Masaracchio 2013) | ⊕⊕⊕⊝ Moderatea |
Favoured treatment; NNTB 4 to 5; magnitude of effect: medium |
| Chronic neck pain Short‐term follow‐up |
SMD ‐0.50 (‐0.89 to ‐0.10) |
111 (1 trial; Cheung Lau 2011) | ⊕⊕⊝⊝ Lowb,c |
Favoured treatment; NNTB 5; magnitude of effect: small |
| Chronic neck pain Intermediate‐term follow‐up |
SMD ‐0.38 (‐0.77 to 0.01) |
111 (1 trial; Cheung Lau 2011) |
⊕⊕⊝⊝ Lowb,c |
Favoured treatment; NNTB 5; magnitude of effect: small |
| QUALITY OF LIFE (QoL) | ||||
| Chronic neck pain Short‐term follow‐up |
SMD ‐0.82 (‐1.23 to ‐0.42) |
111 (1 trial; Cheung Lau 2011) | ⊕⊕⊝⊝ Lowb,c |
Favoured treatment |
| Chronic neck pain Intermediate‐term follow‐up |
SMD ‐0.61 (‐1.01 to ‐0.22) |
111 (1 trial; Cheung Lau 2011) | ⊕⊕⊝⊝ Lowc |
Favoured treatment |
| Seven trials (428 participants) using multiple sessions of thoracic manipulation for acute to chronic neck pain were assessed at 3 time intervals. At short‐term follow‐up, moderate‐quality evidence favoured thoracic manipulation for pain reduction among participants with acute/subacute neck pain, and with acute to chronic neck pain, it improved function. These findings were consistent but small at intermediate follow‐up for pain, function and quality of life (low‐quality evidence). | ||||
| GRADE Working Group grades of evidence. High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||
bIndirectness: ‐1, immediate post‐treatment data have limited clinical relevance; single trials with only immediate‐ and short‐term follow‐up are downgraded (ceiling effect) because future research is likely to have an important impact on the direction of the reported effect, and a second independent trial is needed to clarify emerging short‐term data.
cImprecision: ‐1, small sample size.
aInconsistency: P value = 0.002; I² = 84%; sensitivity analysis: Statistical differences led us to explore heterogeneity by the following PICO factors: P: about the same; I: about the same; C: about the same; O: for pain, VAS, NPRS; for disability, NPQ, NDI; RoB: most often low RoB but when the trial of high RoB is removed, pooled SMD increases to ‐2.18 (‐2.71 to ‐1.65) for pain, but these data were derived from trials conducted in the same lab.