Summary of findings 5. High dose of manipulation compared with low dose of manipulation for chronic neck pain.

High dose of manipulation compared with low dose of manipulation for chronic neck pain
Patient or population: patients with chronic neck pain with cervicogenic headache (CGH) Settings: ambulatory care or outpatient clinic setting Intervention: manipulation of cervical region Comparison: high dose vs low dose
Outcomes	Relative effect (95% CI)	Number of participants (studies)	Quality of the evidence (GRADE)	Comments
PAIN
Chronic neck pain and CGH Intermediate‐term follow‐up	SMD pooled: ‐0.40 (‐0.96 to 0.16)	50 (2 trials; Haas 2004; Haas 2010)	⊕⊕⊕⊝ Moderatea	Two trials showed no significant differences between groups
FUNCTION
Chronic neck pain and CGH Intermediate‐term follow‐up	SMD pooled: ‐0.61   (‐1.38 to 0.17)	50 (2 trials; Haas 2004; Haas 2010)	⊕⊕⊕⊝ Moderatea	Two trials showed no significant differences between groups
Moderate‐quality evidence shows that high‐dose (12 to 18 sessions) contrasted against low‐dose (3 to 8 sessions) cervical manipulation produced similar changes in pain and function at intermediate‐term follow‐up for individuals with chronic neck pain with cervicogenic headache.
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.

^aImprecision: ‐1.