Evidence of Physiotherapy Interventions for Patients with Chronic Neck Pain: A Systematic Review of Randomised Controlled Trials

Table 3

Manual therapy—patients with chronic nonspecific neck pain.

Author	Participants	Interventions	Main outcome measures	Study results on effect* of intervention between groups
Bronfort et al. [56]	Patients with mechanical neck pain lasting > 12 wks, age 20–65 (𝑁=191)	(1) Spinal manipulation and low-technology rehabilitative neck exercise (𝑛=63); (2) High-technology MedX rehabilitative neck exercise (𝑛=60); (3) Spinal manipulation (𝑛=64); All: attended 20 one-hour visits during the 11 wk study	Pain rating scale (0–10), NDI, SF-36, global improvement of satisfaction with care, medication use	No statistically significant differences between groups in patient rated outcomes at 11 wk and at 12 mth followup
Lau et al. [57]	Patients with a diagnosis of chronic mechanical neck pain (>3 mths), age 18–55 (𝑁=120)	(1) Thoracic manipulations TM, anterior-posterior approach in supine lying (𝑛=60); (2) Control (𝑛=60); All: 8 sessions infrared radiation (2/wk) for 15 min over painful site. Educational pamphlet involving active neck mobilisation, isometric neck muscle stabilisation, stretching, postural correction exercise	NPRS, NPQ, SF-36, cervical ROM, craniovertebral angle	Statistically significant differences in favour of TM post-treatment on pain intensity (𝑃=0.043) and NPQ (𝑃=0.018). Improvements were maintained at 3 and 6 mths followup
Martel et al. [58]	Patients with pain of mechanical origin located in the anatomical region of the neck, with or without radiation to the head, trunk, or limbs > 12 wks; between 18 and 60 yrs (𝑁=98)	All: spinal manipulation 10–15 treatments in 5-6 wk (symptomatic phase) after that 3 different interventions (preventive phase).; (1) Spinal manipulation cervical and thoracic until Th4, once per month, 4 times (𝑛=36); (2) Spinal manipulation cervical and thoracic until Th4, once per mth, 4 times AND 20–30 min home exercises 3× per wk: including range of motion exercises, 4 stretching/mobilisation, and 4 strengthening exercises. Three series of each exercise. Ten mths (𝑛=33); (3) Attention control group: no treatment (𝑛=29)	VAS, cervical ROM, NPDI, Bournemouth questionnaire, SF-12 questionnaire, fear-avoidance behaviour questionnaire	No statistically significant differences were found between groups
Sherman et al. [59]	Patients with chronic neck pain (>3 mths), age 20–64 (𝑁=64)	(1) Therapeutic neck massage (𝑛=32), commonly used Swedish and clinical massage techniques, allowed typical self-care recommendations, up to 10 treatments over a 10 wk period; (2) Self-care book (𝑛=32), they were mailed a copy of a self-care book with information and recommendation	NDI, NRS	Statistically significant effect on massage after four wks measured by NDI, −2.1 (−4.00–0.03) (𝑃=0.047), but not in long-term followup at 10 and 26 wks
Sillevis et al. [60]	Patients between 18 and 65 from outpatients physiotherapy clinic with non-specific pain in the cervical and cervicothoracic region down to T4, provoked with neck movements, present for at least 3 mths (𝑁=100)	(1) One time thrust manipulation at T3-T4 (𝑛=50); (2) Placebo manipulation at T3-T4 (𝑛=50)	VAS, pupil diameter	No statistically significant differences between groups immediately after the treatment
Yaǧci et al. [61]	Patients with chronic cervical myofascial pain syndrome (>6 mths), age 21–44 (𝑁=40)	(1) Spray-stretch technique (𝑛=20), ethyl chloride sprayed on muscle with trigger point in muscle stretched position, 6 sessions.; (2) Connective tissue massage (𝑛=20), 15 sessions; All: followed active exercises to be carried out three times a day	VAS, pain threshold, ROM, strength, endurance	No statistically significant differences between groups were found on pain posttreatment

^∗In order to show an effect of an intervention and hereby support the intervention, it requires showing statistical significant difference between groups.
VAS: visual analogue scale; NRS: numerical rating scale; VNPS: verbal numeric pain scale; NPQ: Northwick Park neck pain questionnaire; NDI: neck disability index; NPDI: neck pain and disability index; NPDS: neck pain and disability scale; NPDVAS: neck pain and disability visual analogue scale; PSFS: patient-specific functional scale; NPI: Northwick Park neck pain index; SF-36: short-form 36; PPT: pressure pain threshold; ROM: range of movement; RPE: rating of perceived exertion; EMG: electromyographic, HRQoL: health-related quality of life.