Tsegay Gebrerufael Solomon, Gebregergs Gebremedhin Berhe, Weleslassie Gidey Gomera, Hailemariam Teklehaimanot Tekle
Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Tigray, Ethiopia.
Department of Epidemiology, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia.
J Pain Res. 2023 Feb 27;16:597-609. doi: 10.2147/JPR.S368910. eCollection 2023.
There are contradicting findings regarding the effect of thoracic spine manipulation in decreasing pain and disability in patients with chronic mechanical neck pain. Hence, the purpose of this review was to evaluate the current evidence on the effectiveness of thoracic spine thrust manipulation in decreasing pain intensity, and neck disability among subjects with chronic mechanical neck pain. We made a comprehensive search of literature published between 2010 and 2020 from the electronic databases of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Physiotherapy Evidence Database (PEDro). We adhered to Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA). The methodological quality was assessed by the PEDro scale, and the level of evidence rated by Grading of Recommendations Assessment, Development, and Evaluation (GRADE) software. Finally, a meta-analysis was done using RevMan 5.3 with a random-effects model to calculate the mean difference (MD) and 95% confidence intervals for pain and disability. Eight eligible randomized controlled trials were identified with a total of 457 participants. The quality assessment of the included studies was found to be fair in quality (mean PEDro score of 6.63/10). The overall GRADE of the review showed low to moderate level of evidence. Effect size estimates of the studies showed modest differences in pain reduction, as it revealed a significant effect in Visual Analog Scale ((VAS) 0-100mm) (MD -12.46; 95% CI: -17.29, -7.64), and Pain Numeric Rating Scale ((PNRS) 0-10 pts) (MD -0.8; 95% CI: -1.60, -0.10). The thoracic manipulation also resulted in a significant effect in decreasing neck disability, in which the mean difference in Neck disability index (NDI) showed (MD -6.46; 95% CI: -10.43 -2.50). This review suggested that thoracic spine manipulation was effective in reducing pain and neck disability in all adults with chronic mechanical neck pain compared to other interventions.
关于胸椎整复手法对慢性机械性颈部疼痛患者减轻疼痛及功能障碍的效果，存在相互矛盾的研究结果。因此，本综述的目的是评估目前有关胸椎推按整复手法在减轻慢性机械性颈部疼痛受试者疼痛强度及颈部功能障碍方面有效性的证据。我们全面检索了2010年至2020年间发表于PubMed、护理及相关健康文献累积索引数据库（CINAHL）、考科蓝图书馆及物理治疗证据数据库（PEDro）等电子数据库的文献。我们遵循系统评价与Meta分析的首选报告项目（PRISMA）。采用PEDro量表评估方法学质量，使用推荐分级的评估、制定与评价（GRADE）软件评定证据等级。最后，使用RevMan 5.3软件并采用随机效应模型进行Meta分析，以计算疼痛及功能障碍的平均差（MD）和95%置信区间。共纳入8项符合条件的随机对照试验，总计457名参与者。纳入研究的质量评估结果显示质量为中等（平均PEDro评分为6.63/10）。本综述的总体GRADE证据等级显示为低到中等水平。各研究的效应量估计显示在疼痛减轻方面存在适度差异，在视觉模拟量表（VAS，0 - 100mm）上显示出显著效果（MD -12.46；95% CI：-17.29，-7.64），在疼痛数字评定量表（PNRS，0 - 10分）上也显示出显著效果（MD -0.8；95% CI：-1.60，-0.10）。胸椎整复手法在减轻颈部功能障碍方面也产生了显著效果，颈部功能障碍指数（NDI）的平均差显示为（MD -6.46；95% CI：-10.43，-2.50）。本综述表明，与其他干预措施相比，胸椎整复手法对所有患有慢性机械性颈部疼痛的成年人减轻疼痛及颈部功能障碍是有效的。
