Table 2. Study characteristics.

Article	Control group	Experimental group	Intervention	Frequency	Assessment Post-Intervention	Follow-Up	Results
Cleland et al.8	n = 17	n = 19	Experimental: supine thoracic manipulation	One time treatment	VAS	Immediate	Manipulation: immediate reduction in pain over placebo. Experimental group averaged 15.5 mm change in VAS, placebo group averaged 4.2 mm change.
			Control: placebo thoracic manipulation
Cleland et al.3	None	n = 78	Six thoracic manipulations per session via three different techniques and CROM exercise	1–2 sessions maximum	GROC, NPRS, NDI	2–4 days	Established six predictor variables. If patient = 4/6, post-test probability of success = 93%. If 3/6, post-test probability = 86%
Cleland et al.14	n = 30	n = 30	Thoracic manipulation vs thoracic mobilization with both groups performing CROM exercise	One time treatment	NDI, NPRS	2–4 days	Manipulation: clinically and statistically significant reductions in disability and pain and statistically significant improvement in GROC scores.
Cleland et al.4	n = 70	n = 70	Experimental: thoracic manipulation and exercise	Experimental: two sessions of manipulation and CROM followed by three sessions of exercise	NDI, NPRS, GROC	1 week, 4 weeks, 6 months	Manipulation: clinically significant short and long-term reduction in disability, short-term (1 week) reduction in pain and improved perceived recovery at 4 weeks and 6 months
			Control: exercise only	Control: five sessions over 4 weeks
Fernández-de-las-Peñas et al.26	None	n = 7	Thoracic manipulation	One time treatment	NPRS, CROM	Immediate, 2 days	Manipulation: clinically and statistically significant decrease in pain immediately, which was sustained at 2-day follow-up. CROM: improvement in all motions but none were statistically significant at either follow-up.
Fernández-de-las-Peñas et al.9	n = 22	n = 23	Experimental: thoracic manipulation once per week (1st, 3rd, and 5th sessions)+control interventions	Five sessions over 3 weeks	VAS, CROM	Immediate	Manipulation: clinically meaningful and statistically significant reduction in pain, as well as significant improved CROM (all motions)
			Control: electrotherapy and thermotherapy program
González-Iglesias et al.10	n = 22	n = 23	Experimental: thoracic manipulation once per week for 3 weeks+control intervention	six sessions over three consecutive weeks	NPRS, CROM, NPQ	1 week	Manipulation: statistically significant and clinically meaningful reduction in pain and statistically significant decreased disability and improved CROM (all motions)
			Control: electrotherapy, superficial thermotherapy+STM
González-Iglesias et al.24	n = 22	n = 23	Experimental: thoracic manipulation once per week (1st, 3rd, and 5th session)+control intervention	five sessions over 3 weeks	VAS, CROM, NPQ	Immediate, 2 weeks, 4 weeks	Manipulation: statistically significant and clinically meaningful decrease in pain immediately and at 2 and 4 weeks. Also statistically significant improvement in CROM and disability immediately and at 2 weeks.
			Control: electro and thermotherapy program
Ko et al.27	n = 26	n = 27	Experimental: thoracic mobilizations+control intervention	Three times per week for 6 weeks	VAS, NDI, muscular endurance of deep cranio-cervical flexors	Immediate	Mobilization: statistically significant reduction in disability and pain as well as increased cervical muscle endurance
			Control: cranio-cervical flexor exercises
Krauss et al.17	n = 10	n = 22	Experimental: thoracic manipulation	One time treatment after initial evaluation	FPS, CROM	Immediate	Manipulation: statistically significant increase in bilateral cervical rotation and statistically significant improvement in pain
			Control: no intervention
Lau et al.20	n = 60	n = 60	Experimental: thoracic manipulation+control interventions	Two times per week for eight sessions	CV angle, NPRS, NPQ, SF36Q, CROM	Immediate, 3 months, 6 months	Manipulation: statistically significant and clinically meaningful decrease in pain immediately and up to 6 months. Statistically significant improvements in disability, CV angle and CROM at all follow-ups.
			Control: infrared radiation therapy and a standard set of education materials
Martínez-Segura et al.11	None	Cervical n = 57; Thoracic n = 33	Cervical: midcervical, midrange manipulation; Thoracic: AP end range upper thoracic manipulation	One time treatment	PPTs, CROM, NPRS	Immediate	Thoracic group: statistically significant and clinically meaningful decrease in pain. Improvements in PPT and CROM were shown, but were not significant.
Puentedura et al.2	None	Cervical n = 14; Thoracic n = 10	Cervical: cervical manipulation; Thoracic: thoracic manipulation;	five sessions over 2 weeks	NDI, NPRS, FABQ, GROC	1 week, 4 weeks, 6 months	Thoracic manipulation: 10% of patients met or exceeded the MDC/MCID at 4 weeks and 6 months for NDI. 40% of patients met or exceeded MDC/MCID for pain at 4 weeks whereas only 20% did so at 6 months. 20% of patients reported GROC scores equal to/greater than +5 at all follow-ups.
			Both groups: standard exercise program
Savolainen et al.25	None	Exercise group n = 32; Manipulation group n = 43	Exercise group: program instructed by a PT; Manipulation group: four thoracic manipulations by a physiatrist	Exercise group: not stated;	VAS	6 months, 12 months	Manipulation: statistically significant lower level of perceived worst pain at 12-month follow-up. Both groups demonstrated statistically significant decreases in muscular tenderness and tender thoracic levels at all follow-ups.
				Manipulation group: 1 week intervals

Note: NDI, Neck Disability Index; NPRS, Numeric Pain Rating Scale; FABQ, Fear Avoidance Beliefs Questionnaire; FABQPA, Fear Avoidance Beliefs Questionnaire physical activity subscale; GROC, Global Rating of Change; FPS, Faces Pain Scale; CROM, Cervical Range of Motion; VAS, Visual Analog Scale; NPQ, Northwick Park Neck Disability Questionnaire; CV Angle, Craniovertebral Angle; SF36Q, SF-36 Health Questionnaire; PPTs, Pressure Pain Thresholds.