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Dose Optimization for Spinal Treatment Effectiveness: A Randomized Controlled Trial Investigating the Effects of High and Low Mobilization Forces in Patients With Neck Pain.
- Source :
- Journal of Orthopaedic & Sports Physical Therapy; Mar2014, Vol. 44 Issue 3, p141-152, 12p
- Publication Year :
- 2014
-
Abstract
- STUDY DESIGN: Randomized controlled trial. OBJECTIVE: To determine if force magnitude during posterior-to-anterior mobilization affects immediate and short-term outcomes in patients with chronic, nonspecific neck pain. BACKGROUND: The optimal dose of mobilization to effectively treat patients with neck pain is not known. METHODS: Patients with neck pain of at least 3 months in duration (n = 64) were randomized to receive a single treatment of posterior-to-anterior mobilization applied with 30 N or 90 N of mean peak force (3 sets of 30 seconds) or a placebo (detuned laser) on the spinous process at the painful spinal level. Pressure pain threshold, pain measured with a visual analog scale (range, 0-100 mm), cervical range of motion, and spinal stiffness at the painful spinal level (measured with a custom device and normalized as a percentage of C7 stiffness) were assessed before, immediately after, and at a mean ±SD follow-up of 4.0 ± 1.8 days following treatment. Repeated-measures analysis of covariance and Bonferroni-adjusted post hoc tests determined group differences for each outcome measure after treatment and at follow-up. RESULTS: At follow-up, the 90-N group had less pain than the 30-N group (mean difference, 11.3 mm; 95% confidence interval: 0.1, 22.6 mm; P = .048) and lower stiffness than the placebo group (mean difference, 17.5%; 95% confidence interval: 4.2%, 30.9%; P = .006). These differences were not present immediately after treatment. There were no significant between-group differences in pressure pain threshold or range of motion after treatment or at follow-up. CONCLUSION: A specific dose of mobilization, in terms of applied force, appears necessary for reducing stiffness and potentially pain in patients with chronic neck pain. Changes were not observed immediately after mobilization, suggesting that its effects are not directly mechanical. Trial registration: Australian and New Zealand Clinical Trials Registry (http://www.anzctr.org.au/): ACTRN12611000374965. [ABSTRACT FROM AUTHOR]
- Subjects :
- RANGE of motion of joints
CHRONIC pain treatment
NECK pain treatment
SPINE physiology
PHYSICAL therapy
ANALYSIS of covariance
ANALYSIS of variance
CLINICAL trials
CONFIDENCE intervals
DOSE-response relationship in biochemistry
HUMAN comfort
MANIPULATION therapy
HEALTH outcome assessment
PHYSICAL therapists
PLACEBOS
RESEARCH funding
STATISTICAL sampling
SCALE analysis (Psychology)
STATISTICS
STATISTICAL power analysis
DATA analysis
PAIN measurement
PAIN tolerance
RANDOMIZED controlled trials
VISUAL analog scale
TREATMENT effectiveness
PRE-tests & post-tests
CONTINUING education units
REPEATED measures design
ALGOMETRY
MEDICAL equipment reliability
DATA analysis software
DESCRIPTIVE statistics
Subjects
Details
- Language :
- English
- ISSN :
- 01906011
- Volume :
- 44
- Issue :
- 3
- Database :
- Complementary Index
- Journal :
- Journal of Orthopaedic & Sports Physical Therapy
- Publication Type :
- Academic Journal
- Accession number :
- 94797064
- Full Text :
- https://doi.org/10.2519/jospt.2014.4778