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Is manipulative therapy clinically necessary for relief of neck pain? A systematic review and meta-analysis

  • Evidence-Based Integrative Medicine
  • Published:
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Abstract

Objective

To summarize and critically assess the effificacy of Eastern and Western manipulative therapies for the treatment of neck pain in adults.

Methods

A search of PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, EMBASE, etc. from their inception date to January 2014 with Chinese, Japanese, and Korean databases. Two reviewers independently selected randomized controlled trials (RCTs) with negative control or blank control, extracted data and assessed methodological quality. Meta-analysis and levels of evidence were performed by Revman5.1 and Grades of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results

Nineteen clinical trials with adequate randomization were included in this review, 11 of them had a low risk of bias. The primary outcome for short-term pain had no significant differences, however, the secondary outcome, only the Numerical Pain Rating Scale (NPRS) score of intermediate-term [n=916, pooled mean differences (MD) =–0.29, P=0.02], the Neck Disability Index (NDI) score of short-term (n=1,145, pooled MD=–2.10, P<0.01), and intermediate-term (n=987, pooled MD=–1.45, P=0.01) were signifificantly reduced with moderate quality evidence. However, it supported the minimally clinically important difference (MCID) of the Visual Analogue Scale and NPRS pain score to be 13 mm, while NDI was 3.5 points. The meta-analysis only suggested a trend in favor of manipulative therapy rather than clinical signifificance.

Conclusions

The results do not support the existing evidences for the clinical value of Eastern or Western manipulative therapy for neck pain of short-term follow-up according to MCIDs. The limitations of our review related to blinding, allocation concealment and small sample size.

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Acknowledgements

We appreciate Dr. Jun Xia from University of Nottingham assistance in the consultation for systematic review solutions. Additionally we gratefully acknowledge the assistance of Michael R. Berger from Nanjing University of Traditional Chinese Medicine in revision of the manuscript.

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Authors and Affiliations

  1. Institute of Spine Disease, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China

    Min Yao, Yue-li Sun, Jin-long Li, Yong-jun Wang & Xue-jun Cui

  2. Yueyang College of Clinical Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200403, China

    Rong-liang Dun

  3. Shuguang College of Clinical Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200025, China

    Tian-ying Lan & Noriko Haraguchi

  4. Longhua College of Clinical Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China

    Hyo Jin Lee

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  1. Min Yao
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Correspondence to Xue-jun Cui.

Additional information

Supported by the National Natural Science Foundation of China (No. 81373666), Municipal Hospitals Cutting-Edge Technologies Emerging Joint Project (No. SHDC12013113), Municipal Science and Technology Commission of Shanghai Chinese Medicine Key Project (No.14401970400), National Research Projects of the State Administration of Traditional Chinese Medicine (No. 201407001-2), Traditional Chinese Medicine Research Foundation (No. 2012L032A), and Special Project of Scientific Research Base by State Administration of Traditional Chinese Medicine (No. JDZX2012118), China

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Yao, M., Sun, Yl., Dun, Rl. et al. Is manipulative therapy clinically necessary for relief of neck pain? A systematic review and meta-analysis. Chin. J. Integr. Med. 23, 543–554 (2017). https://doi.org/10.1007/s11655-016-2506-1

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