Department of Physical Therapy, School of Health Professions, Saint Joseph's University, Philadelphia, PA, USA.
Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA.
J Man Manip Ther. 2024 Feb;32(1):85-95. doi: 10.1080/10669817.2023.2267391. Epub 2024 Jan 16.
Treatment mechanisms involve the steps or processes through which an intervention unfolds and produces change in an outcome variable. Treatment mechanisms can be specific to the intervention provided (i.e. pain modulation) or shared with other treatments (i.e. reduced fear of movement). Whether specific and shared treatment mechanisms are different across interventions and whether they lead to the outcomes seen in trials is largely unknown. The management of individuals with chronic neck pain routinely include manual therapy (MT) and resistance exercise (RE), as both approaches are included in clinical practice guidelines and both yield similar outcomes.
Our study plans to answer two research questions: 1) what are the specific mechanisms associated with MT versus interventions (and are these different), and 2) what are the shared mechanisms associated with these interventions, and do specific or shared mechanisms mediate clinical outcomes?
This study will involve a 2-group parallel (1:1) single-blinded randomized trial to compare the specific and potential shared treatment mechanisms between these two approaches. We will enroll individuals with a history of chronic neck pain and evaluate whether specific or shared mechanisms mediate clinical outcomes.
We hypothesize that MT and RE approaches will both exhibit different specific treatment mechanisms, and that both approaches will exhibit shared treatment mechanisms, which will notably influence outcomes at both discharge and 6-months.
This study is important because it will help identify what specific or shared treatment mechanisms are associated with different interventions and, how different treatment mechanisms influence clinical outcomes.
治疗机制涉及干预措施展开的步骤或过程，以及对结果变量产生的变化。治疗机制可能特定于所提供的干预措施（即疼痛调节），也可能与其他治疗方法共享（即减少对运动的恐惧）。不同干预措施之间是否存在特定和共享的治疗机制，以及它们是否导致试验中观察到的结果，在很大程度上尚不清楚。慢性颈痛患者的管理通常包括手法治疗（MT）和抗阻运动（RE），因为这两种方法都包含在临床实践指南中，并且都能产生相似的结果。
我们的研究计划回答两个研究问题：1）与 MT 相比，干预措施有哪些特定的机制（这些机制是否不同），2）这些干预措施有哪些共同的机制，特定或共同的机制是否会影响临床结果？
本研究将涉及一项 2 组平行（1:1）单盲随机试验，以比较这两种方法之间的特定和潜在的共同治疗机制。我们将招募有慢性颈痛病史的个体，并评估特定或共同的机制是否会影响临床结果。
我们假设 MT 和 RE 方法都将表现出不同的特定治疗机制，并且这两种方法都将表现出共同的治疗机制，这将显著影响出院时和 6 个月时的结果。
这项研究很重要，因为它将有助于确定与不同干预措施相关的特定或共同治疗机制是什么，以及不同的治疗机制如何影响临床结果。
