THU0732-HPR Individual responder analysis of the effectiveness of manual therapy and exercise versus usual care in patients with chronic nonspecific neck pain: preliminary results of a randomised controlled trial
Authors: L.A. Domingues, F.M. Pimentel-Santos, E.B. Cruz, J.C. Branco
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Chronic nonspecific neck pain (CNP) is a common health problem worldwide. The physiotherapy approach is the second line of treatment and a large variety of modalities are frequently used. However, the mean effect of interventions is small and it is unknown if the patients achieving clinically important change. Individual responder analyses provide researchers with complementary information about the patterns of recovery and the proportion of patients achieving clinically important treatment responses. <h3>Objectives</h3> The aim of this study was to compare the effectiveness of a combined intervention of manual therapy and exercise (MET) versus usual care (UC), on pain intensity and global perceived recovery. <h3>Methods</h3> A randomised controlled trial was conducted on 62 participants with CNP lasting ≥3 months, assigned to MET and UC groups. Participants in the MET group (n=31) received 12 sessions of passive articular mobilisation and exercise (coordination, strength, endurance), whereas the UC group (n=31) received 15 sessions of usual physiotherapy care, combining electrotherapy, massage and stretching exercises. Patients were assessed at baseline, and then at 3 and 6 weeks (final of intervention). The Minimal Clinically Important Difference (MCID) in treatment response for pain intensity was defined as a decrease of &gt;2 point in the Numeric Rating Scale of Pain compared to the baseline score and for global perceived recovery a value of ≥5 in Patient's Global Impression of Change Scale. <h3>Results</h3> A significant difference between-groups was observed at 6 weeks on pain intensity (p≤0.001), favouring the MET group. No significant differences were found between-groups in pain intensity at the baseline (p≥0.626) and at 3 weeks (p≥0.777). At patient-level response, in the MET group, 58% of the participants experienced an MCID in the first 3 weeks of treatment and this proportion was increased to 94% at 6 weeks on pain intensity, and rose from 68% to 81% on global perceived recovery. In the UC group the proportion of patients that experienced an MCID rose from 55% to 61% on pain intensity, at 3 and 6 weeks, respectively, and 68% in global perceived recovery in both moments. The patients in MET group were 10% (RR=1,1) and 50% (RR=1,5) more likely to achieve the MCID on pain intensity than the UC group, at 3 and 6 weeks, respectively. In global perceived recovery, the MET group were 20% (RR=1,2) more likely to achieve an MCID response at the 6 weeks. No differences were found in chances of recovery at 3 weeks. <h3>Conclusions</h3> These findings suggest that participants of MET group had a pattern of recovery over 6 weeks and achieved a higher response rate to treatment, on pain intensity and a better global perceived recovery, compared to those receiving UC. <h3>Disclosure of Interest</h3> None declared