Yoshida Ryota, Ichikawa Kazuna, Nagahori Hiraku, Tazawa Tomohiro, Kuruma Hironobu
Department of Physical Therapy Tokyo Metropolitan University: 7-2-10 Higashiogu Arakawa-ku Tokyo Japan.
Yomiuri Clinic: 1-7-1 Otemachi, Chiyoda-ku Tokyo Japan.
Health Sci Rep. 2024 Aug 30;7(9):e70031. doi: 10.1002/hsr2.70031. eCollection 2024 Sep.
Thoracic spine manipulation (TSM) increases the thoracic spine's range of motion (ROM), effectively reducing pain intensity and disability in patients with mechanical neck pain. We aimed to determine the effect of TSM on neck pain intensity and functional impairment in patients classified under the "mobility" category in Childs' classification.
In this randomized controlled trial, patients with mechanical neck pain who met the inclusion criteria were randomly assigned to either the TSM ( = 21) or sham manipulation ( = 20) group. The primary outcomes were pain during neck rotation and subjective improvement assessed using the Numerical Pain Rating Scale (NPRS) and Global Rating of Change (GROC), respectively. The secondary outcomes were NPRS at rest, disability (assessed using the Neck Disability Index [NDI]), and ROM of the cervical and thoracic spine rotation. Outcome measurements were performed at baseline, immediately after treatment, 1 week after treatment, and at the 4-week follow-up. Linear mixed models were used to analyze the NPRS, NDI, and ROM. The GROC was analyzed using a chi-square test for the percentage recording ≥+4; the means of each group were compared using an unpaired t-test.
The NPRS with neck rotation, neck and thoracic ROM, and NDI showed significant interactions between the groups. The NPRS with neck rotation was significantly lower in the TSM group than in the sham group at all time points after the treatment ( < 0.001). There was no difference between the groups in the proportion showing moderate (≥+4) improvement according to the GROC; however, there was a significant difference in the mean values ( = 0.013).
Incorporating TSM into treatment protocols may improve clinical outcomes in patients with neck pain, potentially leading to better pain management and functional recovery. Therefore, physiotherapists should consider TSM as a viable and effective intervention to improve patient outcomes in neck pain rehabilitation.
胸椎整复术（TSM）可增加胸椎活动度（ROM），有效减轻机械性颈部疼痛患者的疼痛强度和功能障碍。我们旨在确定TSM对Childs分类中“活动度”类别患者颈部疼痛强度和功能损害的影响。
在这项随机对照试验中，符合纳入标准的机械性颈部疼痛患者被随机分配到TSM组（n = 21）或假整复组（n = 20）。主要结局分别是颈部旋转时的疼痛以及使用数字疼痛评分量表（NPRS）和总体变化评分（GROC）评估的主观改善情况。次要结局包括静息时的NPRS、功能障碍（使用颈部功能障碍指数[NDI]评估）以及颈椎和胸椎旋转的ROM。在基线、治疗后即刻、治疗后1周和4周随访时进行结局测量。使用线性混合模型分析NPRS、NDI和ROM。使用卡方检验分析记录≥ +4百分比的GROC；使用不成对t检验比较每组的均值。
颈部旋转时的NPRS、颈部和胸椎ROM以及NDI在两组之间显示出显著的交互作用。治疗后的所有时间点，TSM组颈部旋转时的NPRS均显著低于假整复组（P < 0.001）。根据GROC显示中度（≥ +4）改善的比例在两组之间没有差异；然而，均值存在显著差异（P = 0.013）。
将TSM纳入治疗方案可能改善颈部疼痛患者的临床结局，有可能实现更好的疼痛管理和功能恢复。因此，物理治疗师应将TSM视为改善颈部疼痛康复患者结局的一种可行且有效的干预措施。
