Lopez-Lopez A, Alonso Perez J L, González Gutierez J L, La Touche R, Lerma Lara S, Izquierdo H, Fernández-Carnero J
Department of Psychology, Universidad Rey Juan Carlos Alcorcón, Madrid, Spain -
Eur J Phys Rehabil Med. 2015 Apr;51(2):121-32. Epub 2014 Oct 9.
Three different types of manual therapy techniques for patients with neck pain and relationship with psychological factors has not been evaluated.
To compare the effectiveness high velocity and low amplitude (HVLA) manipulation vs. posteroanterior mobilization (PA mob) vs. sustain appophyseal natural glide (SNAG) in the management of patients with neck pain and to evaluate the interaction with psychological factors.
Randomized clinical trial.
Primary Health Care Center.
Patients with history of chronic neck pain over the last 3 months were recruited.
Patients were randomly assigned to receive treatment with HVLA (N.=15), with PA mob (N.=16) or with SNAG (N.=17). One session was applied. Pain intensity of neck pain, pressure pain threshold over processus spinosus of C2 (PPT_C2) and cervical range of motion (CROM) were measured pre- and post-intervention. Pain catastrophizing, depression, anxiety and kinesiophobia were assessed in baseline. ANOVAs were performed, with main effects, two-way (treatment x time) and three-way interactions (treatment x psychological variable x time) were examined.
Fourthy-eight patients (mean±SD age, 36.5±8.7 years; 87.5% female). A significant interaction treatment x time was observed for VAS-rest in HVLA and AP mob groups (P<0.05). With more pain relief to HVLA and AP mob groups than SNAG groups but all groups improve the same in CROM. Also, a significant three-way treatment x anxiety x time interaction for VAS in Flexion/Extension was identified (P<0.01), and a trend toward significance was observed for the three way treatment x anxiety x time interaction, with respect to CROM in Lateral-Flexion movement (P<0.05).
The results suggest that an HVLA and PA mob groups relieved pain at rest more than SNAG in patients with Neck pain. Among psychological factors, only trait anxiety seems interact with Manual therapy, mainly high anxiety conditions interact with the Mobilization and SNAG effects but under low anxiety conditions interact with the HVLA effects. Significant mean differences can be observed both in VAS in Flexion/Extension and in CROM in lateral-flexion movement when using mobilization under high anxiety conditions
The findings provide preliminary evidence to support that three different techniques have similar immediate effects over neck pain and while under high anxiety levels a better outcome is expected after mobilization intervention, under low anxiety levels a better prognosis is expected after manipulation and SNAG intervention.
针对颈部疼痛患者的三种不同类型的手法治疗技术及其与心理因素的关系尚未得到评估。
比较高速低幅（HVLA）整复术、后前松动术（PA mob）和持续骨骺自然滑动术（SNAG）在治疗颈部疼痛患者中的有效性，并评估其与心理因素的相互作用。
随机临床试验。
初级卫生保健中心。
招募过去3个月有慢性颈部疼痛病史的患者。
患者被随机分配接受HVLA治疗（n = 15）、PA mob治疗（n = 16）或SNAG治疗（n = 17）。各进行一次治疗。在干预前后测量颈部疼痛的疼痛强度、C2棘突的压痛阈值（PPT_C2）和颈椎活动范围（CROM）。在基线时评估疼痛灾难化、抑郁、焦虑和运动恐惧。进行方差分析，检验主效应、双向（治疗×时间）和三向交互作用（治疗×心理变量×时间）。
48例患者（平均±标准差年龄，36.5±8.7岁；87.5%为女性）。在HVLA组和AP mob组中观察到治疗×时间的显著交互作用对静息视觉模拟评分（VAS-rest）有影响（P<0.05）。与SNAG组相比，HVLA组和AP mob组疼痛缓解更明显，但所有组在CROM方面改善程度相同。此外，还发现了屈伸时VAS的治疗×焦虑×时间的显著三向交互作用（P<0.01），并且在侧屈运动的CROM方面观察到治疗×焦虑×时间的三向交互作用有显著趋势（P<0.05）。
结果表明，在颈部疼痛患者中，HVLA组和PA mob组在静息时缓解疼痛的效果优于SNAG组。在心理因素中，只有特质焦虑似乎与手法治疗相互作用，主要是高焦虑状态与松动术和SNAG的效果相互作用，而在低焦虑状态下与HVLA的效果相互作用。在高焦虑状态下使用松动术时，屈伸时的VAS和侧屈运动的CROM均能观察到显著的平均差异。
研究结果提供了初步证据，支持三种不同技术对颈部疼痛有相似的即时效果，并且在高焦虑水平下，松动术干预后预期效果更好，在低焦虑水平下，整复术和SNAG干预后预期预后更好。
