Manual therapy compared with physical therapy in patients with non-specific neck pain: a randomized controlled trial
Groenewang et al. (2017)
Background: Manual therapy according to the School of Manual Therapy Utrecht (MTU) is a specific type of passive
manual joint mobilization. MTU has not yet been systematically compared to other manual therapies and physical
therapy. In this study the effectiveness of MTU is compared to physical therapy, particularly active exercise therapy (PT)
in patients with non-specific neck pain.
Methods: Patients neck pain, aged between 18–70 years, were included in a pragmatic randomized controlled trial
with a one-year follow-up. Primary outcome measures were global perceived effect and functioning (Neck Disability
Index), the secondary outcome was pain intensity (Numeric Rating Scale for Pain). Outcomes were measured at 3, 7, 13,
26 and 52 weeks. Multilevel analyses (intention-to-treat) were the primary analyses for overall between-group
differences.
Additional to the primary and secondary outcomes the number of treatment sessions of the MTU
group and PT group was analyzed. Data were collected from September 2008 to February 2011.
Results: A total of 181 patients were included. Multilevel analyses showed no statistically significant overall differences
at one year between the MTU and PT groups on any of the primary and secondary outcomes.
The MTU group showed
significantly lower treatment sessions compared to the PT group (respectively 3.1 vs. 5.9 after 7 weeks; 6.1 vs.
10.0 after 52 weeks).
Conclusions: Patients with neck pain improved in both groups without statistical significantly or clinically relevant
differences between the MTU and PT groups during one-year follow-up.
Discussion
Although many neck pain sufferers do not consult a health professional [6], the prevalence and costs of neck pain in primary care are high [7, 8].
Furthermore, neck pain has a major effect on participation, activities, work disabilities and is consequently associated with high indirect costs.
In cases of acute neck pain, general practitioners (GP) often take no immediate action [10].If complaints persist for six months or longer, average perceived discomfort appears to remain fairly stable [11]. However, it is both clinically and economically important to ensure
that patients do not enter a chronic phase.
Ramai dalam kalangan anda yang mengalami sakit leher tidak berjumpa doktor. Jika berjumpa doktor sekalipun, doktor tidak mengambil tindakan sewajarnya. Hanya mengambil ubat tahan sakit. Jika sakit melebihi 6 bulan barulah anda bersungguh sungguh mencari rawatan dan pergi berjumpa doktor.
Sebenarnya rawatan manual terapi / urutan / fisioterapi sangat membantu mengurangkan sakit leher anda memandangkan mereka tahu struktur anatomi tulang, otot, sendi dan saraf anda.
Manual therapy is a commonly used treatment for neck pain.
Cochrane Reviews have shown that both manual therapy [12] and exercise therapy [13] are effective in the treatment of patients with neck pain.
Studies in the Netherlands [14–16] in patients with sub-acute and chronic neck pain has shown significant differences in effectiveness and cost-effectiveness in favor of manual therapy compared with exercise therapy or usual GP care, both in short and long-term follow-up.
In general, most manual therapies focus primarily on patient’s symptoms, articularly the main complaint, and on joint function and stability, range of movement, and the severity of symptoms [18].
MTU, in contrast, is guided by an assessment of preferred movement
patterns of the individual patient and is performed by applying passive articular movements to all spinal and pelvic joints and all joints of extremities, with the goal of optimizing individual movement patterns.
Treatment techniques used in MTU are based on arthrokinematic
and osteokinematic principles and are comparable with the mobilization techniques used in other manual therapies.
The main difference between MTU and other manual therapies and physical therapy is the assessment and treatment of the complete chain of joints of the spine, pelvis and extremities, independently of patient’s complaints, based on analysis of the individual movement pattern.
Examples of preferred movement patterns are hand clasping, arm folding, and dominance of arm, leg and eye.
For the group of physical therapy patients, treatments could consist of active exercise therapy, manual traction, muscle stretching and massage [26–28]. Manual mobilization techniques of the neck were not allowed. The aim of active exercises was to improve strength (particularly strengthening of the deep neck muscles and shoulder muscles), mobility of the neck, and movement coordination.
Jadi, mereka membandingkan teknik manual therapy dari Netherlands dengan rawatan fizikal terapi.
Dalam rawatan fizikan terapi, mereka menggabungkan rawatan senaman aktif (stretching dan strengthening), regangan manual (manual traction), dan urutan untuk menghilangkan sakit leher. Kedua- dua kumpulan rawatan mempunyai keberkesanan yang signifikan.
Di My Rehab Spa, kami menggunakan gabungan rawatan ini dengan tambahan bekam sebagai rawatan pilihan untuk memulihkan sakit leher anda alami.
Limitations
Some weaknesses in this study should be considered when interpreting our results.
One issue deals with recruitment of patients, which started well but later slowed down. We therefore added an additional recruitment strategy using local newspapers. This could potentially have influenced the type or the severity of symptoms of patients at baseline
[66, 67].
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