Gross Anita, Miller Jordan, D'Sylva Jonathan, Burnie Stephen J, Goldsmith Charles H, Graham Nadine, Haines Ted, Brønfort Gert, Hoving Jan L
School of Rehabilitation Science & Dept Clinical Epidemiology and Biostatistics, McMaster University, 1400 Main Street West, Hamilton, Ontario, Canada, L8S 1C7.
Cochrane Database Syst Rev. 2010 Jan 20(1):CD004249. doi: 10.1002/14651858.CD004249.pub3.
Manipulation and mobilisation are often used, either alone or combined with other treatment approaches, to treat neck pain.
To assess if manipulation or mobilisation improves pain, function/disability, patient satisfaction, quality of life, and global perceived effect in adults with acute/subacute/chronic neck pain with or without cervicogenic headache or radicular findings.
CENTRAL (The Cochrane Library 2009, issue 3) and MEDLINE, EMBASE, Manual Alternative and Natural Therapy, CINAHL, and Index to Chiropractic Literature were updated to July 2009.
Randomised controlled trials on manipulation or mobilisation.
Two review authors independently selected studies, abstracted data, and assessed risk of bias. Pooled relative risk and standardised mean differences (SMD) were calculated.
We included 27 trials (1522 participants).Cervical Manipulation for subacute/chronic neck pain : Moderate quality evidence suggested manipulation and mobilisation produced similar effects on pain, function and patient satisfaction at intermediate-term follow-up. Low quality evidence showed manipulation alone compared to a control may provide short- term relief following one to four sessions (SMD pooled -0.90 (95%CI: -1.78 to -0.02)) and that nine or 12 sessions were superior to three for pain and disability in cervicogenic headache. Optimal technique and dose need to be determined.Thoracic Manipulation for acute/chronic neck pain : Low quality evidence supported thoracic manipulation as an additional therapy for pain reduction (NNT 7; 46.6% treatment advantage) and increased function (NNT 5; 40.6% treatment advantage) in acute pain and favoured a single session of thoracic manipulation for immediate pain reduction compared to placebo for chronic neck pain (NNT 5, 29% treatment advantage).Mobilisation for subacute/chronic neck pain: In addition to the evidence noted above, low quality evidence for subacute and chronic neck pain indicated that 1) a combination of Maitland mobilisation techniques was similar to acupuncture for immediate pain relief and increased function; 2) there was no difference between mobilisation and acupuncture as additional treatments for immediate pain relief and improved function; and 3) neural dynamic mobilisations may produce clinically important reduction of pain immediately post-treatment. Certain mobilisation techniques were superior.
AUTHORS' CONCLUSIONS: Cervical manipulation and mobilisation produced similar changes. Either may provide immediate- or short-term change; no long-term data are available. Thoracic manipulation may improve pain and function. Optimal techniques and dose are unresolved. Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
手法治疗和松动术常常单独使用或与其他治疗方法联合使用，用于治疗颈部疼痛。
评估手法治疗或松动术是否能改善伴有或不伴有颈源性头痛或神经根症状的急性/亚急性/慢性颈部疼痛成人患者的疼痛、功能/残疾状况、患者满意度、生活质量及整体疗效。
CENTRAL（考克兰系统评价数据库2009年第3期）、MEDLINE、EMBASE、手法替代与自然疗法数据库、护理学与健康领域数据库以及脊椎按摩疗法文献索引更新至2009年7月。
关于手法治疗或松动术的随机对照试验。
两名综述作者独立选择研究、提取数据并评估偏倚风险。计算合并相对危险度和标准化均数差（SMD）。
我们纳入了27项试验（1522名参与者）。
针对亚急性/慢性颈部疼痛的颈椎手法治疗：中等质量证据表明，在中期随访时，手法治疗和松动术对疼痛、功能和患者满意度产生相似的效果。低质量证据显示，与对照组相比，手法治疗单独进行1至4次治疗后可能提供短期缓解（合并SMD -0.90（95%CI：-1.78至-0.02）），并且在颈源性头痛中，9次或12次治疗在疼痛和残疾方面优于3次治疗。需要确定最佳技术和剂量。
针对急性/慢性颈部疼痛的胸椎手法治疗：低质量证据支持胸椎手法治疗作为减轻疼痛的辅助疗法（NNT 7；治疗优势46.6%）以及改善急性疼痛功能的辅助疗法（NNT 5；治疗优势40.6%），并且对于慢性颈部疼痛，与安慰剂相比，单次胸椎手法治疗有利于立即减轻疼痛（NNT 5，治疗优势29%）。
针对亚急性/慢性颈部疼痛的松动术：除上述证据外，关于亚急性和慢性颈部疼痛的低质量证据表明：1）梅特兰松动术技术组合在立即缓解疼痛和改善功能方面与针灸相似；2）在立即缓解疼痛和改善功能方面，松动术与针灸作为辅助治疗没有差异；3）神经动态松动术在治疗后即刻可能产生具有临床意义的疼痛减轻。某些松动术技术更具优势。
颈椎手法治疗和松动术产生相似的变化。两者均可提供即刻或短期变化；尚无长期数据。胸椎手法治疗可能改善疼痛和功能。最佳技术和剂量尚未确定。进一步的研究很可能对我们对效应估计的信心产生重要影响，并且可能改变估计结果。
