NEW YORK (MedscapeWire) May 29 — Fueling the raging debate over which alternative care is best for pain, results of a randomized, controlled trial reported in the May 21 issue of the Annals of Internal Medicine suggest that manual therapy is better than physical therapy or continued general practitioner care at relieving symptoms by 7-week follow-up.
“Although differences were not particularly large for all outcome measures, manual therapy seems to be a favorable treatment option for patients with neck pain,” write Jan Lucas Hoving, PT, PhD, from Monash University in Victoria, Australia, and colleagues.
This study followed 183 outpatients, aged 18 to 70 years, who had nonspecific neck pain for at least 2 weeks. Treatment groups consisted of 6 weeks of manual therapy once per week, physical therapy (exercise therapy) twice weekly, or continued care by a general practitioner including analgesics, counseling, and education.
A specially trained physical therapist performed the manual therapy, which involved spinal mobilization with low velocity at the limit of joint range of motion. It did not include spinal manipulation with low amplitude, high velocity thrusts. Patients in all groups were allowed to take analgesics.
After completion of treatment, success rates were 68.3% for manual therapy, 50.8% for physical therapy, and 35.9% for continued care. Reduction in pain intensity and most other outcome measures, such as patient-perceived recovery and functional disability, were significantly better with manual therapy than with the other modalities.
In an accompanying editorial, Joel Posner, MD, and Catherine Glass, MD, from Hahnemann University in Philadelphia, Pennsylvania, note study limitations including lack of blinding and “the infectivity of therapeutic enthusiasm.”
“If the better outcomes seen in this study are indeed due to effects specific to manual therapy, further studies should be done to determine which of the eclectic collection of manual techniques used contributed to a successful outcome,” they write. “Such a determination would be essential to allowing broader evidence-based recommendations.”
Ann Intern Med. 2002;136(10):713-722, 758-759
Reviewed by Gary D. Vogin, MD