Secondary Logo

Institutional members access full text with Ovid®

Is a Behavioral Graded Activity Program More Effective Than Manual Therapy in Patients With Subacute Neck Pain?: Results of a Randomized Clinical Trial

Pool, Jan J. M., PhD, PT, MT*†; Ostelo, Raymond W. J. G., PhD, PT*‡; Knol, Dirk L., PhD; Vlaeyen, Johan W. S., PhD¶∥; Bouter, Lex M., PhD***; de Vet, Henrica C. W., PhD*

doi: 10.1097/BRS.0b013e3181c212ee
Randomized Trial
Buy

Study Design. A randomized clinical trial.

Objective. To compare the effectiveness of a behavioral graded activity program with manual therapy in patients with subacute (4–12 weeks) nonspecific neck pain.

Summary of Background Data. Neck pain is a common complaint, for which many conservative therapies are available in primary care. There is strong evidence for manual therapy in combination with exercises. Psychosocial factors are also believed to play a role in chronic pain. The evidence of the effectiveness of a program focused on these factors is still unknown.

Methods. A randomized clinical trial was conducted, involving 146 patients with subacute nonspecific neck pain. The BGA program can be described as a time-contingent increase in activities from baseline toward predetermined goals. Manual therapy consists of specific spinal mobilization techniques and exercises. Primary outcomes were global perceived effect, the Numerical Rating Scale for pain and the Neck Disability Index. Secondary outcomes were the Tampa Scale for Kinesiophobia, the 4 Dimensional Symptom Questionnaire, and the Pain Coping and Cognition List. Measurements were carried out at baseline and 6, 13, 26, and 52 weeks after randomization. Data are analyzed according to the intention-to-treat principle, using multilevel analysis.

Results. The success rates at 52 weeks, based on the GPE were 89.4% for the BGA program and 86.5% for MT. This difference was not statistically significant. For pain and disability, a difference was found in favor of the BGA program; mean difference for pain = 0.99 (95% CI 0.15–1.83) and mean difference for NDI = 2.42 (95% CI 0.52–4.32). All other differences between the interventions in the primary and secondary outcomes were not statistically significant.

Conclusion. Based on this trial it can be concluded that there are only marginal, but not clinically relevant, differences between a BGA program and MT.

A randomized clinical trial was conducted, involving 146 patients with subacute nonspecific neck pain, comparing a behavioral graded acitivity program with manual therapy. Based on this trial it can be concluded that there are only marginal, but not clinically relevant, differences between a BGA program and MT.

From the *EMGO Institute for Health and Care research, VU University Medical Center, Amsterdam; †Medical Center Impact, Zoetermeer; ‡Institute for Health Sciences, Faculty of Earth and Life Sciences VU University, Amsterdam; §Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam; ¶Department of Medical, Clinical, and Experimental Psychology, Maastricht University, Maastricht, The Netherlands; ∥Department of Psychology, University of Leuven, Belgium; and **Executive Board of VU University, Amsterdam, The Netherlands.

Acknowledgment date: August 11, 2008. Revision date: July 21, 2009. Acceptance date: July 31, 2009.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Netherlands Organization for Health Research and Development funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Supported by Netherlands Organization for Health Research and Development (ZonMW) grant no-940-31-060.

The Medical Ethics Committee of the VU University Medical Center in Amsterdam approved the study protocol.

The authors declare no conflict of interest including financial interest and affiliations relevant to the manuscript.

Address correspondence and reprint requests to J. J. M. Pool, PhD, EMGO Institute for Health and Care research, VU University Medical Center, Van der Boechorststraat 7,1081 BT Amsterdam, The Netherlands; E-mail: jjm.pool@gmail.com or www.emgo.nl

© 2010 Lippincott Williams & Wilkins, Inc.