Please select the eligibility criteria that correspond to the clinical trial below.
Title: Preventive Care of Chronic Cervical Pain and Disabilities; Comparison of Spinal Manipulative Therapy and Individualized Home Exercise Programs
Brief Summary: The aim of this study is to determine which of tertiary prevention spinal manipulative therapy (SMT) or a home exercise program is the more efficient approach to reduce pain and increase functional capacity, quality of life and general health condition. To do so, 60 participants with chronic cervical pain, will be recruited and divided into 3 groups according to the intervention they will receive: control group, experimental group 1 who will receive preventive chiropractic care in the form of spinal manipulations and experimental group 2 will have to perform an individualized home exercise program on a daily basis. We hypothesize that a group of patient receiving SMT + a home exercise program will present less pain and functional disabilities over a 1 year period. The innovative value of this project is mainly related to the fact that it will generate new and potentially very useful data concerning the clinical significance of preventive chiropractic care. Moreover, such data will be beneficial to our profession as chiropractic makes a step towards prevention, wellness and public health.


Options:
A: Inclusion Criteria:

* Chronic mechanical neck pain (defined as current episode \> 12 weeks' duration).
* Quebec Task Force classifications 1, 2, 3 and 4. This includes patients with neck pain, stiffness or tenderness, with or without musculoskeletal and neurological signs.

Exclusion Criteria:

* Previous cervical spine surgery
* Neck pain referred from local joint lesions of the lower extremities or from visceral diseases
* Progressive neurological deficits due to nerve root or spinal cord compression
* Existing cardiac disease requiring medical treatment
* Blood clotting disorders
* Diffuse idiopathic hyperostosis
* Infectious and non-infectious inflammatory or destructive tissue changes of the cervical spine
* Presence of significant infectious disease, or other severe disabling health problems
* Substance abuse
* Ongoing treatment for neck pain by other health care providers
* Pregnant or nursing women
* Average neck pain score of less than 30 percentage points
* Pending or current litigation
B: Inclusion Criteria:

* Adults between 18 and 60 years old from the city and the surrounding Trois-Rivières with chronic cervical pain of non-traumatic origin (chronic or recurrent cervical pain that lasted at least 6 months)

Exclusion Criteria:

Exclusion criteria for the project are:

* Surgery to the cervical spine
* Neoplasms
* Severe osteoarthritis
* Ankylosing spondylitis
* Hypertension
* Referred pain in the cervical area
* Central or peripheric nervous system dysfunction
* Vascular disease
* Treated cardiovascular disease
* Inflammatory or infectious disease of the cervical spine
* Metabolic or endocrine diseases
* Pregnancy
* Specific rehabilitation training for the neck or already under manual therapy for neck pain
* Patient suffering from dizziness, vertigo or headache suspected to be cervicogenic or of unknown origin will not be involved in the study.
C: Inclusion Criteria:

* 65 years of age and older
* independent ambulation and community dwelling
* stable medication plan
* neck-related disability (minimal score of 10% on Neck Disability Index)
* back-related disability (minimal score of 10% on Oswestry Disability Index)
* minimum combined disability score (above) of 25% at first baseline screening
* at least 12 week duration of neck and back related disability

Exclusion Criteria:

* moderate or severe cognitive impairment
* untreated clinical depression
* surgical spinal fusion or multiple incidents of spinal surgery
* contraindications to spinal manipulation or exercise
* ongoing, non-pharmacological treatment for a spinal condition
D: Inclusion Criteria:

The following inclusion criteria will be used to determine eligibility for this study:

1. Primary complaint of neck pain with or without unilateral upper extremity symptoms
2. Age between 18-60 years old
3. NDI score greater than 10 points

Exclusion Criteria:

The following exclusion criteria will be used to determine ineligibility for this study:

1. Red flags noted in the patient's Neck Medical Screening Questionnaire (i.e. tumor, fracture, metabolic diseases, RA, osteoporosis, prolonged history of steroid use, etc.)
2. History of whiplash injury within the past six weeks
3. Diagnosis of cervical spinal stenosis or bilateral upper extremity symptoms
4. Evidence of central nervous system involvement, to include hyperreflexia, sensory disturbances in the hand, intrinsic muscle wasting of the hands, unsteadiness during walking, nystagmus, loss of visual acuity, impaired sensation of the face, altered taste, the presence of pathological reflexes (i.e. positive Hoffman's and/or Babinski reflexes), etc.
5. Two or more positive neurologic signs consistent with nerve root compression, including any two of the following:
6. Muscle weakness involving a major muscle group of the upper extremity
7. Diminished upper extremity muscle stretch reflex (biceps brachii, brachioradialis, or triceps reflex)
8. Diminished or absent sensation to pinprick in any upper extremity dermatome

Answer: B