Short-Term Effects of Thrust Versus Nonthrust Mobilization/Manipulation Directed at the Thoracic Spine in Patients With Neck Pain: A Randomized Clinical Trial

Background and Purpose Evidence supports the use of manual physical therapy interventions directed at the thoracic spine in patients with neck pain. The purpose of this study was to compare the effectiveness of thoracic spine thrust mobilization/manipulation with that of nonthrust mobilization/manipulation in patients with a primary complaint of mechanical neck pain. The authors also sought to compare the frequencies, durations, and types of side effects between the groups. Subjects The subjects in this study were 60 patients who were 18 to 60 years of age and had a primary complaint of neck pain. Methods For all subjects, a standardized history and a physical examination were obtained. Self-report outcome measures included the Neck Disability Index (NDI), a pain diagram, the Numeric Pain Rating Scale (NPRS), and the Fear-Avoidance Beliefs Questionnaire. After the baseline evaluation, the subjects were randomly assigned to receive either thoracic spine thrust or nonthrust mobilization/manipulation. The subjects were reexamined 2 to 4 days after the initial examination, and they again completed the NDI and the NPRS, as well as the Global Rating of Change (GROC) Scale. The primary aim was examined with a 2-way repeated-measures analysis of variance (ANOVA), with intervention group (thrust versus nonthrust mobilization/manipulation) as the between-subjects variable and time (baseline and 48 hours) as the within-subject variable. Separate ANOVAs were performed for each dependent variable: disability (NDI) and pain (NPRS). For each ANOVA, the hypothesis of interest was the 2-way group × time interaction. Results Sixty patients with a mean age of 43.3 years (SD=12.7) (55% female) satisfied the eligibility criteria and agreed to participate in the study. Subjects who received thrust mobilization/manipulation experienced greater reductions in disability, with a between-group difference of 10% (95% confidence interval [CI]=5.3–14.7), and in pain, with a between-group difference of 2.0 (95% CI=1.4–2.7). Subjects in the thrust mobilization/manipulation group exhibited significantly higher scores on the GROC Scale at the time of follow-up. No differences in the frequencies, durations, and types of side effects existed between the groups. Discussion and Conclusion The results suggest that thoracic spine thrust mobilization/manipulation results in significantly greater short-term reductions in pain and disability than does thoracic nonthrust mobilization/manipulation in people with neck pain.

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Comparing manual and mechanically assisted manipulations of the thoracic spine in neck pain patients: A pilot study

F1000Research ◽

10.12688/f1000research.13780.1 ◽

2018 ◽

Vol 7 ◽

pp. 156

Author(s):

Anke Langenfeld ◽

B. Kim Humphreys ◽

Rob A. de Bie ◽

Jaap Swanenburg

Keyword(s):

Pilot Study ◽

Neck Pain ◽

Thoracic Spine ◽

Rating Scale ◽

Neck Disability Index ◽

Long Term Effects ◽

Visual Analogue Pain ◽

Quality Of Life Scale ◽

Secondary Outcomes ◽

Neck Disability

Background: Manipulations of the thoracic spine are a common treatment option in patients with neck pain. This approach avoids the risk of cervical arterial dissection. Currently there are different options available which have been evaluated for their efficacy. The aim of this study was to assess short- and long-term effects of two different methods of manipulating the thoracic spine in combination with a standardized exercise program for neck pain. Methods: This pilot study included patients who were over 18 years of age, able to speak and read German or English, had acute or chronic neck pain, and had not previously undergone manual therapy for the thoracic spine. Patients were recruited from private physical therapy practices. Patients were randomly assigned to two treatment groups by using block randomization. The objective was to compare the effects of manually performed manipulations and electromechanical manipulations on the thoracic spine in patients with neck pain. Primary outcome was the visual analogue pain rating scale. Secondary outcomes included Neck Disability Index, European Quality of Life scale, and Patients’ Global Impression of Change Scale. Results: Ten patients were recruited. Five patients received manual manipulations, and five received electromechanical manipulations. Both groups showed an improvement in pain scores (VAS) (X2 (5) = 14.161, p = 0.015) with no difference between the groups. There were no significant changes in the secondary outcomes. The electromechanical (Impulse iQ®) manipulations group showed a clinically relevant reduction in the neck disability index. Conclusion: Both manual and electromechanical manipulations are well tolerated, and show that they can be both successful treatments for neck pain in combination with exercises. Thoracic manipulations seem to be beneficial for the patient’s complaint of neck pain, while electromechanical manipulations seem to be able to reduce neck disability. Trial registration: Current Controlled Trials ISRCTN88585962, registered in January 2013.

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Shi’s Daoyin Therapy for Neck Pain: A Randomized Controlled Trial

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2018/4983891 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10

Author(s):

Huihao Wang ◽

Enyu Jiang ◽

Kuan Wang ◽

Zhen Deng ◽

Hongsheng Zhan ◽

...

Keyword(s):

Neck Pain ◽

Pain Intensity ◽

Rating Scale ◽

Isometric Force ◽

Controlled Trial ◽

Neck Disability Index ◽

Short Term ◽

Significant Difference ◽

Pain Patients

Objective. To compare the immediate and short term effectiveness of Shi’s Daoyin therapy (DT) rather than the Melbourne Protocol (MP) in terms of pain, mobility, and isometric strength of cervical muscles in nonacute nonspecific neck pain patients. Material and Methods. A total of 114 nonacute nonspecific neck pain patients aged 20~50 years were recruited and randomly assigned to be treated by either Shi’s DT or the MP. 56 cases and 54 cases received treatment for 3 weeks and were evaluated before and after intervention and at 3-week follow-up in Shi’s DT group and MP group, respectively. The outcome measures were Chinese version of the Neck Disability Index (NDI), cervical range of motion (ROM), maximal voluntary isometric force (MVIF), and pain intensity (Numeric Pain Rating Scale, NPRS). Results. All outcomes of both groups showed statistically significant improvements after the intervention and at 3-week follow-up (P < 0.05), while no statistically significant difference was found in NDI between groups. When followed up after 3 weeks, the ROM in axial rotation was significantly greater in the Shi’s DT group (P < 0.05), and the NPRS in the Shi’s DT group was significantly lower than the MP group (P < 0.05). At the end of the treatment period, the MVIF in lateral bending in the Shi’s DT group had a lower value (P = 0.044) than in the MP group, but there was no significant difference in flexion and extension between the two groups. Conclusions. Both Shi’s DT and MP groups demonstrated an obvious reduction in pain intensity and improvements in neck mobility after a short term follow-up period. The improvement of Shi’s DT in disability and pain during functional activities is generally similar to that of the MP for the treatment of nonacute nonspecific neck pain.

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Enhancing Case Managers' Skills in the Assessment and Management of Antipsychotic Medication Side-Effects

Australian & New Zealand Journal of Psychiatry ◽

10.1080/j.1440-1614.2000.00821.x ◽

2000 ◽

Vol 34 (5) ◽

pp. 814-821 ◽

Cited By ~ 18

Author(s):

Paul Morrison ◽

Tom Meehan ◽

Deanne Gaskill ◽

Paul Lunney ◽

Paul Collings

Keyword(s):

Side Effects ◽

Training Program ◽

Antipsychotic Medication ◽

Side Effect ◽

Rating Scale ◽

Intervention Group ◽

Case Managers ◽

Short Term ◽

Medication Side Effects ◽

Medication Side

Objective: Our goal was to reduce the prevalence of antipsychotic medication side-effects by providing a short-term training program on the assessment and management of side-effects to case managers. Method: Forty-four patients in receipt of community-based mental health services were allocated to comparison (n = 20) and intervention (n = 24) groups based on the health service district in which they resided. While case managers working with the intervention group attended a short-term training program to improve their assessment and management of neuroleptic side-effects, case managers providing services to the comparison group received no additional training. Side-effects were assessed pre- and postintervention using the Liverpool University Neuroleptic Side-effect Rating Scale (LUNSERS). Results: A reduction in the overall prevalence of side-effects in both groups was observed, however, only those patients in the intervention group reported a statistically significant reduction in mean side-effect scores between the pre- and post-measures (Wilcoxon Matched Pairs Signed-ranks Test, z = −2.8411, two-tailed, p < 0.01). In addition, qualitative data collected during the second survey revealed that patients in the intervention group had acquired some positive management strategies for dealing with unwanted side-effects. The strategies were elicited from eight different patients distributed across six of the 12 case managers who took part in the training program. Conclusions: Training cases managers in the assessment and management of side-effects may help to reduce their impact on the lives of people prescribed neuroleptic medication.

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Psychometric properties of the Numeric Pain Rating Scale and Neck Disability Index in patients with cervicogenic headache

Cephalalgia ◽

10.1177/0333102418772584 ◽

2018 ◽

Vol 39 (1) ◽

pp. 44-51 ◽

Cited By ~ 8

Author(s):

Ian A Young ◽

James Dunning ◽

Raymond Butts ◽

Joshua A Cleland ◽

César Fernández-de-las-Peñas

Keyword(s):

Rating Scale ◽

Neck Disability Index ◽

Self Report ◽

Pain Rating ◽

Short Term ◽

Point Reduction ◽

Cervicogenic Headaches ◽

Numeric Pain Rating Scale ◽

Neck Disability ◽

Pain Rating Scale

Background Self-reported disability and pain intensity are commonly used outcomes in patients with cervicogenic headaches. However, there is a paucity of psychometric evidence to support the use of these self-report outcomes for individuals treated with cervicogenic headaches. Therefore, it is unknown if these measures are reliable, responsive, or result in meaningful clinically important changes in this patient population. Methods A secondary analysis of a randomized clinical trial (n = 110) examining the effects of spinal manipulative therapy with and without exercise in patients with cervicogenic headaches. Reliability, construct validity, responsiveness and thresholds for minimal detectable change and clinically important difference values were calculated for the Neck Disability Index and Numeric Pain Rating Scale. Results The Neck Disability Index exhibited excellent reliability (ICC = 0.92; [95 % CI: 0.46–0.97]), while the Numeric Pain Rating Scale exhibited moderate reliability (ICC = 0.72; [95 % CI: 0.08–0.90]) in the short term. Both instruments also exhibited adequate responsiveness (area under the curve; range = 0.78–0.93) and construct validity ( p < 0.001) in this headache population. Conclusions Both instruments seem well suited as short-term self-report measures for patients with cervicogenic headaches. Clinicians and researchers should expect at least a 2.5-point reduction on the numeric pain rating scale and a 5.5-point reduction on the neck disability index after 4 weeks of intervention to be considered clinically meaningful.

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Efficacy and safety of Shi-style cervical manipulation therapy for treating acute and subacute neck pain: study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-021-05062-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Mingcai Zhang ◽

Guoqing Du ◽

Congying Liu ◽

Wei Li ◽

Jiayu Yang ◽

...

Keyword(s):

Clinical Trial ◽

Neck Pain ◽

Clinical Observation ◽

Rating Scale ◽

Neck Disability Index ◽

Trial Registration ◽

Activity Measurement ◽

Manipulation Therapy ◽

Self Evaluation ◽

Cervical Manipulation

Abstract Background Neck pain is a common clinical disease, which seriously affects people’s mental health and quality of life and results in loss of social productivity. Improving neck pain’s curative effect and reducing its recurrence rate are major medical problems. Shi’s manipulation therapy has unique advantages and technical features that aid in the diagnosis and treatment of neck pain. Compared with first-line non-steroidal anti-inflammatory drug (NSAID) treatment of neck pain, Shi’s cervical manipulation lacks the relevant research basis of therapeutic advantage, safety, and satisfaction for treating acute and subacute neck pain. Herein, we aim to confirm our hypothesis in a clinical trial that the safety and efficacy of Shi’s cervical manipulation will be more effective, safer, and more satisfactory than NSAIDs to treat acute and subacute neck pain. Methods In this multicenter, positive-controlled, randomized clinical trial, traditional analgesic drug (NSAID) is used to evaluate and show that Shi’s manipulation is more effective, safe, and satisfactory for treating acute and subacute neck pain. Overall, 240 subjects are randomly divided into the trial and control groups, with both groups treated by the corresponding main intervention method for up to 12 weeks. Clinical data will be collected before the intervention and immediately after the first treatment; at 3 days and 1, 2, 4, 8, and 12 weeks after the intervention; and at 26 and 52 weeks after treatment follow-up of clinical observation index data collection. The clinical observation indices are as follows: (1) cervical pain is the primary observation index, measured by Numerical Rating Scale. The secondary indices include the following: (2) cervical dysfunction index, measured by patient self-evaluation using cervical Neck Disability Index; (3) cervical activity measurement, measured by the cervical vertebra mobility measurement program of Android mobile phone system; (4) overall improvement, measured by patient self-evaluation with SF-36; and (5) satisfactory treatment, determined by patient self-evaluation. Discussion We will discuss whether Shi’s cervical manipulation has greater advantages in efficacy, safety, and satisfaction of acute and subacute neck pain than traditional NSAIDs, to provide a scientific basis for the dissemination and application of Shi’s cervical manipulation. Trial registration China Registered Clinical Trial Registration Center ChiCTR1900021371. Registered on 17 February 2019

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Clinical Efficacy of Scalene Injection for Thoracic Outlet Syndrome

Archives of Hand and Microsurgery ◽

10.12790/ahm.20.0064 ◽

2021 ◽

Author(s):

Samuel Baek ◽

Seok Kim ◽

Myung Ho Shin ◽

Tae Min Kim ◽

Seoung-Joon Lee ◽

...

Keyword(s):

Side Effects ◽

Clinical Efficacy ◽

Rating Scale ◽

Numerical Rating Scale ◽

Neck Disability Index ◽

Vital Signs ◽

Treatment Technique ◽

The Novel ◽

Numerical Rating ◽

Neck Disability

Purpose: We introduce the novel treatment technique, scalene injection, and study its clinical efficacy for diagnosis, treatment, and pain control for patients with thoracic outlet syndrome.Methods: Between November 2001 and October 2018, 266 patients were studied retrospectively. To evaluate the efficacy and sustainability, we checked the numerical rating scale (NRS) for pain relief and neck disability index (NDI) for functional improvements, prior to and 1, 12 weeks after the injection. The safety was evaluated by examining side effects for at least 24 hours from the point of injection.Results: NRS was improved from 7.12 to 3.11 at 1 week, and to 3.05 at 12 weeks (p<0.05). NDI was improved from 15.87 to 6.15 at 1 week, and to 6.19 at 12 weeks (p<0.05). There were two cases of convulsion immediately after the injection and were treated with prompt oxygen supply and sedatives. Transient side effects included two cases of dyspnea and one case of nausea and were resolved within 1 hour after. All five cases showed symptoms of side effects on the day of injection and were resolved within a day. A total of 242 patients (91.0%) experienced immediate declines in NRS and 161 patients experienced persistent declines for more than 12 weeks. However, 24 patients (9.0%) showed no improvement and 20 patients (7.5%) experienced increases in NRS.Conclusion: Scalene injection is also effective as a therapeutic method. However, this study suggests that it must be done with monitoring of vital signs in an operating room for any possible complications and side effects.

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Effectiveness of Progressive Resisted Exercise along with Conventional Exercise and Conventional Exercise Program alone in Subjects with Text Neck Syndrome

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i59b34412 ◽

2021 ◽

pp. 536-542

Author(s):

Divya Jain ◽

Swapna Jawade ◽

Neha Chitale

Keyword(s):

Neck Pain ◽

Pain Intensity ◽

Conventional Therapy ◽

Rating Scale ◽

Neck Disability Index ◽

Exercise Program ◽

Pain Rating ◽

Numerical Pain Rating Scale ◽

Neck Disability ◽

Pain Rating Scale

Background: "Text neck" is a term coined to describe the posture created by leaning forward for lengthy periods of time, such as when reading and texting on a cellphone which has been linked to stress injuries. Neck pain, upper back discomfort, shoulder pain, frequent headaches, and greater curvature of the spine are all dangerous indications of text neck. According to a survey, 35% of smartphone users suffer from text neck syndrome. People between the ages of 15 and 18 are more likely to have neck pain. This protocol has been created that describes the design of comparative study to evaluate effectiveness of progressive resisted exercise along with conventional exercise and conventional exercise program alone in text neck syndrome. Methods: The participants (n=80) will be recruited in the study suffering from text neck syndrome and meeting the inclusion criteria. Two groups will be formed such that patients in group A will be treated with conventional therapy and group B will be treated with progressive resisted exercise (PRE) along with conventional therapy. The protocol will cover 4 weeks of treatment. In the rehabilitation period, we will evaluate the pain intensity, strength of neck muscles and functional activity. Our outcome measures will be- Numerical pain rating scale (NPRS) and Neck disability index (NDI). Discussion: Efficacy of the intervention will be evaluated by analyzing the pain intensity by using Numerical pain rating scale (NPRS) and level of functional disability by using Neck disability index (NDI). The result of the study will significantly provide affirmation on either using combination therapy of PRE with conventional exercise or conventional exercise alone.

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Reliability and validity of the Mizo-version of neck disability index for non-specific neck pain in the rural North-East Indian population

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20195929 ◽

2019 ◽

Vol 8 (1) ◽

pp. 317

Author(s):

Andrew Lalchhuanawma ◽

Divya Sanghi

Keyword(s):

Neck Pain ◽

Correlation Coefficient ◽

Rating Scale ◽

Neck Disability Index ◽

Reliability And Validity ◽

East Indian ◽

North East ◽

Study Results ◽

Significant Difference ◽

Neck Disability

Background: The Neck Disability Index (NDI) is an important self-assessment tool used extensively worldwide, in clinical practice with implications into scientific research fields. It is used to assess the extent of pain and levels of functional disability associated with neck pain. The NDI consists of 10 items where each item was scored from a scale of 0 to 5 giving the maximum score possible to 50. Though proven to be a reliable instrument in the English-speaking population, the NDI has never been validated and culturally adapted in the Mizo language among the rural north-east Indian region where English is not spoken as means of communication. The aim is to translate and cross culturally adapt the NDI into Mizo tawng (official language of Mizoram) with the objective of establishing reliability and validity of the M-NDI in patients with non-specific neck pain.Methods: A total of 49 subjects participated voluntarily from the rural primary health care, Lunglei district, Mizoram. Subject having chronic non-specific neck pain lasting more than 3 months were included after taking a written formal consent.Results: The internal consistency determined by Cronbach alpha, and the Intraclass Correlation Coefficient (ICC) using the test-retest reliability showed a good and an excellent reliability respectively (α=0.82, ICC=0.97, 95% CI= 0.95-0.98). Construct validity was determined between the variables-Numerical Pain Rating Scale (NPRS) and NDI by Pearson’s correlation coefficient and found to have a good correlation r=0.89 and significant difference at p<0.001.Conclusions: The study results concluded the Mizo version of NDI to be easy to understand, reliable and valid instrument for measuring disability and functional limitations of daily activities in non-specific neck pain in the Mizo speaking population.

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