Effectiveness of Manual Therapy in Patients With Neck Pain.
Condition: Neck Pain
MeSH terms: Neck Pain
Study type: Interventional

Summary: 
      Background of the study: Manual Therapy applied to patients with non-specific neck pain has
      been investigated several times, both internationally and nationally. In the Netherlands
      different types of manual therapy treatment exist. Manual Therapy, as practiced under the
      Utrecht School, has not been subject of a randomized controlled trial. There is a need to
      evaluate the effectiveness of this type of manual therapy.

      Objective of the study: This trial will investigate the effectiveness of Manual Therapy in
      the short and long-term up to 52 weeks in patient with (sub) acute (minimal two weeks) and
      chronic (maximum 52 weeks) since last episode of neck pain. Functional state, pain and global
      perceived effect are the outcome variables.

      Study design: The study is a single blind randomized controlled trial.

      Study population: Men and women aged 18 to 70 years old with neck pain for at least two
      weeks.

      Intervention: The experimental group will be treated with manual therapy for a period of six
      weeks. The control group will be treated with physical therapy (usual care) also for a period
      of six weeks.

      Primary study parameters / outcome of the study: Global Perceived Effect (GPE) and the Neck
      disability index (NDI-DV ) will be applied.

      Secondary study parameters / outcome of the study: Visual Analogue Scale (VAS) for pain and
      SF36 (Quality of life). The Multidimensional Health Locus of Control(MHLC ),
      Credibility/Expectancy Questionnaire, Fear Avoidance Beliefs Questionnaire (FABQ-DLV) will
      also be measured.
    

Detailed description: 
      Detailed information about Manual Therapy according to the Utrecht School Manual Therapy
      (MTU)

      MTU is based on assessing the patient's individual preference of functioning by documenting
      and interpreting their natural asymmetry in anatomical form, posture and movements. The
      normal asymmetry and variability of human form and movement function have been specified.
      Asymmetrical forms can be related to the asymmetrical movement function.

      In addition to the general diagnostics, MTU is characterized by specific diagnostics. By
      means of this specific manual-therapeutic analysis the individual preference of functioning
      model of the patient is drawn up through analysis and interpretation of the individual
      asymmetry in form, posture and movement. Some explanations of the measurements and movements
      are: (preferred) hand folding; (preferred) arm folding; which eye is master eye; leg use in
      (preferred) kicking of a ball. The purpose here is to describe the optimal direction and
      position of movement axes for all joints according to this model.

      When composing this model, firstly the individual characteristics (a number of preferred
      movements, a number of asymmetrical aspects of posture and form) are assessed. Documentation,
      notation and interpretation of these characteristics take place according to a protocol.

      The objective of MTU is to optimize the positioning of movement axes in the joints. To
      achieve this, three-dimensional movements in the joints are executed repeatedly. To purpose
      fully position the movement axes the therapist should (repeatedly) perform passive joint
      movements with low velocity and high accuracy. In addition to examining the individual
      preference of movement, exploratory examination is carried out to recognize possible red
      flags and to determine the treatment indication.

      Treatment is based on preferred movements found in the patient and the interpretation
      according to the protocol of these movements and not on the complaint of the patient. It is
      executed by applying passive articular movements in the spinal joints and the joints of the
      extremities. During this process physiological joint limitations are carefully observed;
      traction or high-velocity movements will not be applied, as may be the case in other forms of
      manual therapy.

      The diagnostic examination of other forms of manual therapy focuses on joint function,
      stability, movement patterns, range of movement, and the severity of disorders. To diagnose
      the patients complaints, palpation of passive accessory and passive intervertebral movements
      are used. The results yield information as to tenderness (pain), restricted intersegmental
      motion (stiffness), and spasm (muscle tension).
    

Intervention name(s): Manual Therapy Utrecht; Physical Therapy
Intervention type(s): Other; Other
Intervention description(s): Manual Therapy (6 weeks).; Physical Therapy (six weeks).
Other intervention name(s): joint mobilisation and manipulation; exercise therapy with instruction; exercise therapy with instruction; massagetherapy
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Neck Pain; Manuel Therapy Utrecht; Physiotherapy