Cervical Mobilization vs. Standard Physical Therapy for Chronic Neck Pain
Condition: Neck Pain
MeSH terms: Neck Pain
Study type: Interventional
Phase: Phase 2

Summary: 
      Neck pain is a common problem in our society, accounting for 20% of all chiropractic visits.
      Physical therapy interventions for chronic neck pain have been chosen based on the patient's
      symptoms and examination findings. These interventions include superficial and deep heat,
      massage, traction, manual therapy, and exercise programs. There is little controlled research
      addressing the efficacy of these therapies. Although many of these interventions provide some
      patients with pain relief and increased function, studies often utilize multiple
      interventions on the same subject such as heat, ultrasound, cervical traction, range of
      motion exercises, making interpretation of the results difficult. Much of the literature to
      date has focused on studies of subjects suffering from acute neck pain. Many of these studies
      suggest that subjects report decreased pain, decreased disability and increased cervical
      spine active range of motion. There are no controlled studies comparing the effects of spinal
      mobilization and standard physical therapy on subjects with chronic neck pain. The object of
      this study is two fold: 1) to determine the score variability of two neck disability
      questionnaires )both baseline and change scores) to be used in sample size calculations, and
      2) to establish the ability to recruit, treat and follow sufficient numbers of subjects
      needed for a full clinical trial. The ability to predict outcomes of neck pain treatment will
      lead to more appropriate therapies and an avoidance of unnecessary treatments.
    

Detailed description: 
      Background and Purpose: Chronic neck pain is a common problem. Studies of physical therapy
      for neck pain often utilize multiple interventions on the same subject making interpretation
      of the results difficult. The objectives of this study were two fold, 1) to establish the
      ability to recruit and treat subjects needed for a clinical trial of mobilization vs. massage
      for neck pain and 2) to estimate the variability of the Neck Disability Index (NDI) in a
      defined population of patients with neck pain and determine sample size for a trial. Subjects
      and

      Methods: Subjects were randomized to either sedative massage (SM) to the neck and upper back
      or joint mobilization to the cervical spine (JM). All subjects also received moist heat and a
      home exercise program. Outcomes tracked for establishing trial feasibility included the
      number of referrals, number of referrals meeting inclusion criteria, number of subjects
      declining to participate and reasons for their refusal, acceptance rate of randomization,
      number of dropouts, and reasons for dropout. Descriptive statistics and baseline data were
      analyzed with means and standard deviations when appropriate. Groups were compared in regard
      to demographic and clinical characteristics only. The Neck Disability Index scores were
      calculated for pre-treatment, post-treatment, and change scores within each group.
    

Intervention name(s): Spinal mobilization; Massage; Neck exercises
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): Non thrust mobilization to the cervical spine; Sedative massage to cervical paraspinal muscles; Range of motion exercises to include foraminal opening
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Neck pain; Spinal manipulation; Massage