Oliver Kwan, PhD (Psy); Jon Friel, PhD (Psy)
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Kwan O, Friel J. Effects of Three Therapies for Neck Pain. Ann Intern Med. 2003;138:685. doi: 10.7326/0003-4819-138-8-200304150-00021
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Published: Ann Intern Med. 2003;138(8):685.
TO THE EDITOR:
In their study of manual therapy, physical therapy, and general practitioner care for patients with neck pain, Hoving and colleagues concluded, “In daily practice, manual therapy is a favorable treatment option for patients with neck pain compared with physical therapy or continued care by a general practitioner” (1). We consider this an overstatement of the significance of their results. We note that although the manual therapy outcomes showed “higher scores,” scores were later referred to as “not statistically different.” We also see terms like trend, a way of saying that the results did not impress the statistician but at least are pointing in the right direction. Strictly speaking, such trends could simply be the result of some unknown or random error. Hoving and colleagues stated, “The success rates for manual therapy were statistically significantly higher than those for physical therapy.” However, they then stated, “Manual therapy scored better than physical therapy on all outcome measures, although not all differences were significant.” It seems that to appreciate the “favorable” effect of manual therapy, one has to be very careful about which outcomes are selected, since some will not show differences but arbitrarily defined “success rates” will. Hoving and colleagues noted that patients receiving manual therapy had fewer work absences, but then they stated that this was not significant. Again, such an observation might be attributable to random or some unknown error.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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