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Manual Therapy, Physical Therapy, or Continued Care by the General Practitioner for Patients With Neck Pain: Long-Term Results From a Pragmatic Randomized Clinical Trial

Hoving, Jan L. PhD* †; de Vet, Henrica C. W. PhD*; Koes, Bart W. PhD; Mameren, Henk van MD, PhD§; Devillé, Walter L. J. M. MD, PhD; van der Windt, Daniëlle A. W. M. PhD*; Assendelft, Willem J. J. MD, PhD; Pool, Jan J. M. PT*; Scholten, Rob J. P. M. MD, PhD**; Korthals–de Bos, Ingeborg B. C. PhD*; Bouter, Lex M. PhD*

The Clinical Journal of Pain: May 2006 - Volume 22 - Issue 4 - p 370-377
doi: 10.1097/01.ajp.0000180185.79382.3f
Original Articles
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Objectives The authors' goals were to compare the effectiveness of manual therapy (MT; mainly spinal mobilization), physical therapy (PT; mainly exercise therapy), and continued care by the general practitioner (GP; analgesics, counseling and education) over a period of 1 year.

Methods One hundred eighty-three patients suffering for at least 2 weeks from nonspecific neck pain were randomized to receive a 6-week treatment strategy of MT once a week, PT twice a week, or GP care once every 2 weeks. The primary outcome measures were perceived recovery, severity of physical dysfunctioning, pain intensity, and functional disability.

Results The differences between groups considered over 1 year were statistically significant (repeated measurements analyses P<0.001 to P=0.02) for all outcomes but borderline for the Neck Disability Index (P=0.06). Higher improvement scores were observed for MT for all outcomes, followed by PT and GP care. The success rate, based on perceived recovery after 13 weeks, was 72% for MT, which was significantly higher than the success rate for continued GP care (42%, P=0.001) but not significantly higher compared with PT treatment (59%, P=0.16). The difference between PT and GP approached statistical significance (P=0.06). After 1 year the success rates were 75%, 63%, and 56%, respectively, and no longer significantly different.

Conclusions Short-term results (at 7 weeks) have shown that MT speeded recovery compared with GP care and, to a lesser extent, also compared with PT. In the long-term, GP treatment and PT caught up with MT, and differences between the three treatment groups decreased and lost statistical significance at the 13-week and 52-week follow-up.

*Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands

Department of Clinical Epidemiology, Cabrini Hospital, and Monash University, Department of Epidemiology and Preventive Medicine, Malvern, Victoria, Australia

Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

§Department of Anatomy and Embryology, Faculty of Medicine, Maastricht University, Maastricht, The Netherlands

NIVEL Netherlands Institute for Health Services Research, Utrecht, The Netherlands

Department of General Practice and Nursing Homes Sciences, Leiden University Medical Center, Leiden, The Netherlands

**Dutch Cochrane Centre, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Supported by grants from the Netherlands Organization for Scientific Research (NWO grant 904-66-068) and from the Fund for Investigative Medicine of the Health Insurance Council (grant OG 95-008).

Reprints: Prof Dr Henrica C. W. de Vet, Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands (e-mail: hcw.devet@vumc.nl).

Received for publication January 30, 2005; revised July 3, 2005; accepted July 23, 2005

© 2006 Lippincott Williams & Wilkins, Inc.