Are baseline clinical tests associated with the relative effectiveness of manual therapy and neck-specific exercise for people with chronic non-specific neck pain? Secondary analysis of a randomized controlled trial

Abstract

Objective

To evaluate whether baseline clinical tests are associated with the relative effectiveness of manual therapy versus neck-specific exercise for people with chronic non-specific neck pain (NSNP).

Design

Pre-planned secondary analysis of a single-blind, parallel, randomized clinical trial with two treatment arms, adhering to CONSORT guidelines.

Methods

65 participants with NSNP were randomly allocated with a 1:1 allocation ratio to a programme of either manual therapy or neck-specific exercise. A battery of clinical tests was performed pre-treatment. The manual therapy group had four 30-min sessions, while the exercise group followed a four-week program with physiotherapist-led sessions and daily home exercises. Outcomes measured at baseline, two weeks, four weeks, and 12 weeks post-treatment included pain intensity, disability, patient-perceived improvement, quality of life, and kinesiophobia. Patients were categorized into either responders or non-responders according to pain intensity, disability and patient-perceived improvement.

Results

Patients with NSNP that reported bilateral pain, no blocking sensation and greater pain at end of range, showed side flexion or rotation range of movement asymmetry, and whose symptoms could be reproduced during the specific neck movements, were more likely to be classified as responders if they received manual therapy when compared to neck-specific exercise. Adjusted odds ratios (Prob >0.95) varied considerably (range 7.01xe-14 to 0.32) depending on clinical tests and the follow up time point.

Conclusion

A battery of clinical tests showed significant associations with the relative effectiveness of manual therapy versus neck-specific exercise in patients with NSNP.