Patients with neck pain who met 4 of 6 criteria of the clinical prediction rule (CPR) suggesting success of thoracic spine thrust joint manipulation (TJM) would have a different outcome if they were treated with a cervical spine TJM demonstrated a more favorable response when TJM was directed to the cervical spine rather than the thoracic spine, say authors of an article published online ahead of print February 18 in the Journal of Orthopaedic and Sports Physical Therapy. Patients receiving cervical TJM also demonstrated fewer transient side-effects, the authors add.
Researchers randomly assigned 24 consecutive patients presenting to physical therapy with a primary complaint of neck pain who met 4 out of 6 of the CPR criteria for thoracic TJM to 1 of 2 treatment groups. The cervical group received cervical TJM and a cervical range of motion (ROM) exercise for the first 2 sessions followed by a standardized exercise program for an additional 3 sessions. The thoracic group received thoracic TJM and the same cervical ROM exercise for the first 2 sessions followed by the identical exercises as the cervical group for the next 3 sessions. Outcome measures collected at 1 week, 4 weeks, and 6 months from start of treatment included Neck Disability Index (NDI), Numeric Pain Rating Scale (NPRS), and Fear Avoidance Beliefs Questionnaire (FABQ).
Patients who received cervical TJM demonstrated greater improvements in NDI and NPRS at all follow-up time periods. There also was significant improvement in the FABQ physical activity subscale score at all follow-ups for the cervical group. Number needed to treat to avoid an unsuccessful overall outcome was 1.8 at 1 week, and 1.6 at 4 weeks and also at 6 months.
APTA member Emilio J. Puentedura, PT, DPT, OCS, FAAOMPT, led the study, which was coauthored by association members Merrill R. Landers, PT, DPT, OCS, Josh A. Cleland, PT, PhD, OCS, Paul E. Mintken, PT, OCS, FAAOMPT, and Peter Huijbregts, PT, MHS, MS, OCS.