Summary of findings 4. Manipulation compared with exercise for neck pain.
| Manipulation compared with exercise for neck pain | ||||
|
Patient or population: patients with acute and subacute neck pain Settings: ambulatory care or outpatient clinic setting Intervention: manipulation of cervical region Comparison: exercise | ||||
| Outcomes | Relative effect (95% CI) | Number of participants (studies) | Quality of the evidence (GRADE) | Comments |
| PAIN | ||||
| Acute and subacute neck pain Intermediate‐term follow‐up |
SMD: ‐0.16 (‐0.45 to 0.13) |
182 (1 trial; Bronfort 2012) | ⊕⊕⊕⊝ Moderatea |
No significant differences between groups |
| Acute and subacute neck pain Long‐term follow‐up |
SMD: 0.06 (‐0.23 to 0.35) |
182 (1 trial; Bronfort 2012) | ⊕⊕⊕⊝ Moderatea |
No significant differences between groups |
| FUNCTION | ||||
| Acute and subacute neck pain Intermediate‐term follow‐up |
SMD: ‐0.01 (‐0.30 to 0.28) |
182 (1 trial; Bronfort 2012) | ⊕⊕⊕⊝ Moderatea |
No significant differences between groups |
| Acute and subacute neck pain Long‐term follow‐up |
SMD: ‐0.02 (‐0.31 to 0.27) |
182 (1 trial; Bronfort 2012) | ⊕⊕⊕⊝ Moderatea |
No significant differences between groups |
| PARTICIPANT SATISFACTION | ||||
| Acute and subacute neck pain Long‐term follow‐up |
Not estimable | 182 (1 trial; Bronfort 2012) | ⊕⊕⊕⊝ Moderatea |
Improvement in participant satisfaction for manipulation over exercise |
| GLOBAL PERCEIVED EFFECT | ||||
| Acute and subacute neck pain Immediate post‐treatment follow‐up |
Not estimable | 182 (1 trial; Bronfort 2012) |
⊕⊕⊕⊝ Moderatea |
No significant differences between groups |
| QUALITY OF LIFE | ||||
| Acute and subacute neck pain Intermediate‐term follow‐up |
SMD: ‐0.05 (‐0.35 to 0.24) | 182 (1 trial; Bronfort 2012) | ⊕⊕⊕⊝ Moderatea |
No significant differences between groups |
| Acute and subacute neck pain Long‐term follow‐up |
SMD: 0.0 (‐0.29 to 0.29) | 182 (1 trial; Bronfort 2012) | ⊕⊕⊕⊝ Moderatea |
No significant differences between groups |
| Moderate‐quality evidence suggests no differences in pain, function, global perceived effect and quality of life when multiple sessions of cervical manipulation are compared with exercise at immediate‐, intermediate‐ and long‐term follow‐up. Moderate‐quality evidence indicates that use of cervical manipulation led to greater participant satisfaction when compared with an exercise programme at long‐term follow‐up. | ||||
| 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. | ||||
aIndirectness: ‐1.