Department of Environmental Medicine, Division of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Nobels väg 13, 171 77, Stockholm, Sweden.
Centre for Musculoskeletal Research (CBF), Department of Occupational Health Sciences and Psychology, University of Gävle, Gävle, Sweden.
Chiropr Man Therap. 2021 Nov 29;29(1):48. doi: 10.1186/s12998-021-00406-0.
Persistent or recurrent neck pain is, together with other chronic conditions, suggested to be associated with disturbances of the Autonomic Nervous System. Acute effects on the Autonomic Nervous System, commonly measured using Heart Rate Variability, have been observed with manual therapy. This study aimed to investigate the effect on Heart Rate Variability in (1) a combination of home stretching exercises and spinal manipulative therapy versus (2) home stretching exercises alone over 2 weeks in participants with persistent or recurrent neck pain.
A randomized controlled clinical trial was carried out in five multidisciplinary primary care clinics in Stockholm from January 2019 to April 2020. The study sample consisted of 131 participants with a history of persistent or recurrent neck. All participants performed home stretching exercises daily for 2 weeks and were scheduled for four treatments during this period, with the intervention group receiving spinal manipulative therapy in addition to the home exercises. Heart Rate Variability at rest was measured at baseline, after 1 week, and after 2 weeks, with RMSSD (Root mean square of successive RR interval differences) as the primary outcome. Both groups were blinded to the other group intervention. Thus, they were aware of the purpose of the trial but not the details of the "other" intervention. The researchers collecting data were blinded to treatment allocation, as was the statistician performing data analyses. The clinicians provided treatment for participants in both groups and could not be blinded. A linear mixed-effects model with continuous variables and person-specific random intercept was used to investigate the group-time interaction using an intention to treat analysis.
Sixty-six participants were randomized to the intervention group and sixty-five to the control group. For RMSSD, a B coefficient of 0.4 (p value: 0.9) was found, indicating a non-significant difference in the regression slope for each time point with the control group as reference. No statistically significant differences were found between groups for any of the Heart Rate Variability indices.
Adding four treatments of spinal manipulation therapy to a 2-week program of daily stretching exercises gave no significant change in Heart Rate Variability.
The trial was registered 03/07/2018 at ClinicalTrials.gov, registration number: NCT03576846. ( https://pubmed.ncbi.nlm.nih.gov/31606042/ ).
持续性或复发性颈部疼痛，以及其他慢性疾病，被认为与自主神经系统紊乱有关。使用心率变异性（HRV）已经观察到手法治疗对自主神经系统的急性影响。本研究旨在调查在 2 周内（1）家庭伸展运动和脊柱手法治疗的组合与（2）仅家庭伸展运动对持续性或复发性颈部疼痛患者的 HRV 的影响。
2019 年 1 月至 2020 年 4 月，在斯德哥尔摩的五家多学科初级保健诊所进行了一项随机对照临床试验。研究样本包括 131 名有持续性或复发性颈部疼痛病史的参与者。所有参与者均在 2 周内每天进行家庭伸展运动，在此期间安排了 4 次治疗，干预组除家庭运动外还接受脊柱手法治疗。在基线、第 1 周和第 2 周测量静息时的 HRV，以 RMSSD（连续 RR 间期差异的均方根）为主要结局。两组均对另一组的干预措施不知情。因此，他们知道试验的目的，但不知道“另一种”干预的细节。收集数据的研究人员对治疗分配不知情，进行数据分析的统计学家也不知情。临床医生为两组的参与者提供治疗，不能被蒙蔽。使用具有连续变量和个体特定随机截距的线性混合效应模型，使用意向治疗分析来研究组间时间交互作用。
66 名参与者被随机分配到干预组，65 名参与者被随机分配到对照组。对于 RMSSD，发现 B 系数为 0.4（p 值：0.9），这表明以对照组为参考，每个时间点的回归斜率没有显著差异。在任何 HRV 指数方面，两组之间均未发现统计学上的显著差异。
在为期 2 周的每日伸展运动方案中增加 4 次脊柱手法治疗并没有显著改变 HRV。
该试验于 2018 年 3 月 7 日在 ClinicalTrials.gov 注册，注册号为 NCT03576846。（https://pubmed.ncbi.nlm.nih.gov/31606042/）。
