Walker Michael J, Boyles Robert E, Young Brian A, Strunce Joseph B, Garber Matthew B, Whitman Julie M, Deyle Gail, Wainner Robert S
Doctoral Program in Physical Therapy, US Army-Baylor University, Fort Sam Houston, TX, USA.
Spine (Phila Pa 1976). 2008 Oct 15;33(22):2371-8. doi: 10.1097/BRS.0b013e318183391e.
Randomized clinical trial.
To assess the effectiveness of manual physical therapy and exercise (MTE) for mechanical neck pain with or without unilateral upper extremity (UE) symptoms, as compared to a minimal intervention (MIN) approach.
Mounting evidence supports the use of manual therapy and exercise for mechanical neck pain, but no studies have directly assessed its effectiveness for UE symptoms.
A total of 94 patients referred to 3 physical therapy clinics with a primary complaint of mechanical neck pain, with or without unilateral UE symptoms, were randomized to receive MTE or a MIN approach of advice, motion exercise, and subtherapeutic ultrasound. Primary outcomes were the neck disability index, cervical and UE pain visual analog scales (VAS), and patient-perceived global rating of change assessed at 3-, 6-, and 52-weeks. Secondary measures included treatment success rates and post-treatment healthcare utilization.
The MTE group demonstrated significantly larger reductions in short- and long-term neck disability index scores (mean 1-year difference -5.1, 95% confidence intervals (CI) -8.1 to -2.1; P = 0.001) and short-term cervical VAS scores (mean 6-week difference -14.2, 95% CI -22.7 to -5.6; P = 0.001) as compared to the MIN group. The MTE group also demonstrated significant within group reductions in short- and long-term UE VAS scores at all time periods (mean 1-year difference -16.3, 95% CI -23.1 to -9.5; P = 0.000). At 1-year, patient perceived treatment success was reported by 62% (29 of 47) of the MTE group and 32% (15 of 47) of the MIN group (P = 0.004).
An impairment-based MTE program resulted in clinically and statistically significant short- and long-term improvements in pain, disability, and patient-perceived recovery in patients with mechanical neck pain when compared to a program comprising advice, a mobility exercise, and subtherapeutic ultrasound.
随机临床试验。
评估手法物理治疗与运动疗法（MTE）对伴有或不伴有单侧上肢（UE）症状的机械性颈部疼痛的有效性，并与最小干预（MIN）方法进行比较。
越来越多的证据支持将手法治疗和运动疗法用于治疗机械性颈部疼痛，但尚无研究直接评估其对UE症状的有效性。
共有94名因主要主诉为机械性颈部疼痛（伴有或不伴有单侧UE症状）而转诊至3家物理治疗诊所的患者被随机分配接受MTE或包含建议、运动锻炼及亚治疗剂量超声的MIN方法。主要结局指标为颈部功能障碍指数、颈部及UE疼痛视觉模拟量表（VAS），以及在3周、6周和52周时评估的患者自我感知的总体变化评分。次要指标包括治疗成功率和治疗后的医疗资源利用情况。
与MIN组相比，MTE组在短期和长期颈部功能障碍指数评分（平均1年差值-5.1，95%置信区间（CI）-8.1至-2.1；P = 0.001）以及短期颈部VAS评分（平均6周差值-14.2，95% CI -22.7至-5.6；P = 0.001）方面的降低幅度显著更大。MTE组在所有时间段的短期和长期UE VAS评分方面也显示出组内显著降低（平均1年差值-16.3，95% CI -23.1至-9.5；P = 0.000）。在1年时，MTE组62%（47例中的29例）的患者报告治疗成功，而MIN组为32%（47例中的15例）（P = 0.004）。
与包含建议、运动锻炼和亚治疗剂量超声的方案相比，基于损伤的MTE方案在临床上和统计学上均能使机械性颈部疼痛患者在短期和长期的疼痛、功能障碍及患者自我感知的恢复方面得到显著改善。
