Gross A R, Kay T M, Kennedy C, Gasner D, Hurley L, Yardley K, Hendry L, McLaughlin L
McMaster University, Hamilton, Ontario, Canada.
Man Ther. 2002 Nov;7(4):193-205. doi: 10.1054/math.2002.0477.
An evidence-based clinical practice guideline was developed to ascertain the risks and benefits for manipulation or mobilization in treating mechanical neck disorders with or without radicular findings or cerviogenic headache. Pain, function, patient satisfaction and adverse events were appraised.
The practice guideline development cycle/model and Cochrane reviewing process, critiquing past reviews, randomized trials and surveys were used.
Manipulation and mobilization alone showed similar effects as placebo, wait period, or control group, and appeared similar in benefit for pain relief. While high-technology exercises were superior to manipulation alone for improving long-term pain scores, manipulation plus low-technology exercise had the same effect. Patient satisfaction scores favoured manipulation plus low-technology exercise over manipulation alone, and high-technology exercise alone. Multi-modal care including some combination of manipulation or mobilizations and exercise was superior to control, other physical medicine methods, and rest. Based on weak evidence, estimates for serious complication for manipulation ranged from one in 20,000 to five in 10,000,000.
Stronger evidence suggests a multi-modal management strategy using mobilization or manipulation plus exercise is beneficial for relief of mechanical neck pain. Weaker evidence suggest less benefit to either manipulation/mobilization done alone than when used with exercise. The risk rate is uncertain.
制定一项基于证据的临床实践指南，以确定手法治疗或松动术治疗伴有或不伴有神经根症状或颈源性头痛的机械性颈部疾病的风险和益处。对疼痛、功能、患者满意度和不良事件进行评估。
采用实践指南制定周期/模型和Cochrane综述流程，对既往综述、随机试验和调查进行评判。
单纯手法治疗和松动术与安慰剂、等待期或对照组显示出相似的效果，在缓解疼痛方面的益处似乎相似。虽然高科技运动在改善长期疼痛评分方面优于单纯手法治疗，但手法治疗加低科技运动具有相同的效果。患者满意度评分显示，手法治疗加低科技运动优于单纯手法治疗和单纯高科技运动。包括手法治疗或松动术与运动的某种组合的多模式护理优于对照组、其他物理医学方法和休息。基于薄弱证据，手法治疗严重并发症的估计发生率为20000分之一至10000000分之五。
更强有力的证据表明，采用松动术或手法治疗加运动的多模式管理策略有利于缓解机械性颈部疼痛。较弱的证据表明，单独进行手法治疗/松动术比与运动联合使用的益处要少。风险率尚不确定。
