Gross A R, Kay T, Hondras M, Goldsmith C, Haines T, Peloso P, Kennedy C, Hoving J
Hamilton Health Sciences, Hamilton, Ont., Canada.
Man Ther. 2002 Aug;7(3):131-49. doi: 10.1054/math.2002.0465.
Neck disorders are common, disabling and costly. Randomized trials were reviewed using a Cochrane format, to determine if manual therapy improves pain, function and patient satisfaction in adults suffering from neck disorders with and without radicular findings or headache. Sequenced computerized searches ended in December 1997. Two independent reviewers extracted data while three assessed trial quality. Standard mean difference and relative risks were translated to number needed to treat (NNT) and the percent treatment advantage. The 20 selected trials' quality was 2.4 (SD: 1.04) on the 5-point scale described by Jadad. Trials were clinically heterogenous. Manipulation alone, mobilizations alone, manipulation/mobilization and treatments including massage consistently showed similar effects to placebo, wait period or control. Multimodal manual therapy care including exercise were superior to a control, to certain physical medicine methods and to rest for pain and patient satisfaction. The NNT for a clinically important reduction in pain varied from 2 to 11 and treatment advantage from 6% to 41% at the cost of benign transient side-effects. While results remain inconclusive, some clinical themes have emerged. For mechanical neck disorder with or without headache, it appears that to be most beneficial, manual therapies should be done with exercise for improving pain and patient satisfaction. Manipulation and mobilization alone appear to be less effective. Factorial design would help delineate the magnitude of effect for each component of care.
颈部疾病很常见，会导致身体残疾且花费高昂。采用Cochrane格式对随机试验进行综述，以确定手法治疗是否能改善患有颈部疾病且有或无神经根症状或头痛的成年人的疼痛、功能及患者满意度。序列计算机检索截至1997年12月。两名独立评审员提取数据，三名评审员评估试验质量。将标准均数差和相对危险度转换为需治疗人数（NNT）和治疗优势百分比。在Jadad描述的5分制量表上，所选取的20项试验的质量评分为2.4（标准差：1.04）。试验在临床方面存在异质性。单纯手法治疗、单纯松动术、手法治疗/松动术以及包括按摩在内的治疗，始终显示出与安慰剂、等待期或对照组相似的效果。包括运动在内的多模式手法治疗护理在缓解疼痛和提高患者满意度方面优于对照组、某些物理医学方法及休息。临床上疼痛显著减轻的NNT为2至11，治疗优势为6%至41%，代价是出现良性短暂副作用。虽然结果仍无定论，但已出现一些临床规律。对于有或无头痛的机械性颈部疾病，手法治疗若结合运动似乎最为有益，可改善疼痛和患者满意度。单纯手法治疗和松动术似乎效果较差。析因设计将有助于明确护理各组成部分的效应大小。
