J Orthop Sports Phys Ther. 2019 May;49(5):299-309. doi: 10.2519/jospt.2019.8150. Epub 2019 Apr 25.
Thoracic spine thrust manipulation has been shown to improve patient-rated outcomes for individuals with neck pain. However, there is limited evidence of its effectiveness in patients with cervical radiculopathy.
To compare the immediate and short-term effects of thoracic manipulation to those of a sham thoracic manipulation in patients with cervical radiculopathy.
In this multicenter randomized controlled trial, participants with cervical radiculopathy were randomized to receive either manipulation (n = 22) or sham manipulation (n = 21) of the thoracic spine. Outcomes were measured at baseline, immediately after treatment, and at a follow-up 48 to 72 hours after manipulation. A repeated-measures analysis of variance was used to analyze neck and upper extremity pain (numeric pain-rating scale), disability (Neck Disability Index), cervical range of motion (ROM), and endurance (deep neck flexor endurance test). The chi-square test was used to analyze changes in neck and upper extremity pain, centralization of symptoms, and beliefs about receiving the active manipulation treatment using a global rating of change scale.
Neck and upper extremity pain, cervical ROM, disability, and deep neck flexor endurance all showed significant interactions between group and time (<.01). Immediately after treatment and at the 48-to-72-hour follow-up, the manipulation group had lower neck pain (<.01), better cervical ROM (<.01), lower disability (<.01), and better deep neck flexor endurance ( = .02) compared to the sham manipulation group. The manipulation group had moderate to large effect-size changes over time. No between-group differences for upper extremity pain were found immediately following the intervention ( = .34) and at 48 to 72 hours after the intervention ( = .18). At 48 to 72 hours after treatment, a greater proportion of participants in the manipulation group reported improvement (global rating of change scale score of 4 or greater) in neck and upper extremity symptoms (<.01), centralization of symptoms (<.01), and beliefs about receiving an active manipulation ( = .01) compared to the sham manipulation group.
One session of thoracic manipulation resulted in improvements in pain, disability, cervical ROM, and deep neck flexor endurance in patients with cervical radiculopathy. Patients treated with manipulation were more likely to report at least moderate change in their neck and upper extremity symptoms up to 48 to 72 hours following treatment.
Therapy, level 2. .
胸椎推扳手法已被证明可改善颈痛患者的患者自评结果。然而，其在神经根型颈椎病患者中的有效性证据有限。
比较胸椎推拿与假胸椎推拿对神经根型颈椎病患者的即刻和短期效果。
在这项多中心随机对照试验中，将神经根型颈椎病患者随机分为推拿组（n=22）和假推拿组（n=21）。在基线、治疗后即刻和推拿后 48 至 72 小时测量结局。采用重复测量方差分析比较颈痛和上肢痛（数字疼痛评分量表）、残疾（颈椎功能障碍指数）、颈椎活动度（ROM）和耐力（颈深屈肌耐力试验）。采用卡方检验分析颈痛和上肢痛、症状集中化以及基于整体变化评分的对接受主动推拿治疗的信念的变化。
颈痛和上肢痛、颈椎 ROM、残疾和颈深屈肌耐力均显示出组间和时间之间的显著交互作用（<0.01）。治疗后即刻和 48 至 72 小时随访时，推拿组的颈痛明显低于假推拿组（<0.01），颈椎 ROM 更好（<0.01），残疾程度更低（<0.01），颈深屈肌耐力更好（=0.02）。推拿组随时间变化的效应大小为中到大。干预后即刻（=0.34）和干预后 48 至 72 小时（=0.18），两组上肢痛无差异。治疗后 48 至 72 小时，推拿组报告颈痛和上肢痛症状改善（整体变化评分≥4 分）、症状集中化（<0.01）和接受主动推拿治疗的信念（=0.01）的比例明显高于假推拿组。
单次胸椎推拿可改善神经根型颈椎病患者的疼痛、残疾、颈椎 ROM 和颈深屈肌耐力。推拿组患者在治疗后 48 至 72 小时内，颈痛和上肢痛症状至少有中度改善的可能性更高。
治疗，2 级。
