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Manual Therapy, Physical Therapy, or Continued Care by a General Practitioner for Patients with Neck Pain: A Randomized, Controlled Trial

Jan Lucas Hoving, PT, PhD; Bart W. Koes, PhD; Henrica C.W. de Vet, PhD; Danielle A.W.M. van der Windt, PhD; Willem J.J. Assendelft, MD, PhD; Henk van Mameren, MD, PhD; Walter L.J.M. Devillé, MD, PhD; Jan J.M. Pool, PT; Rob J.P.M Scholten, MD, PhD; and Lex M. Bouter, PhD
[+] Article and Author Information

From Institute for Research in Extramural Medicine, Vrije Universiteit Medical Centre, Amsterdam, the Netherlands; Cabrini Medical Centre, Malvern, and Monash University, Melbourne, Victoria, Australia; Erasmus University Rotterdam, Rotterdam, the Netherlands; University of Maastricht, Maastricht, the Netherlands; and Dutch College of General Practitioners and Nivel Netherlands Institute for Health Services Research, Utrecht, the Netherlands.


Acknowledgments: The authors thank Anita Gross for critical review of the manuscript; Eva Stokx, Luite van Assen, Vera Veldman, and Ingeborg Korthals-de Bos for data collection and data entry; Frans Krapels for advice on usual care; and Brigitte Kapteijn and Raymond Swinkels for advice on physical and manual therapy. They also thank the participating physical therapists, manual therapists, general practitioners, and patients.

Grant Support: By Netherlands Organization for Scientific Research (904-66-068) and the Fund for Investigative Medicine of the Health Insurance Council (OG95-008).

Requests for Single Reprints: Jan Lucas Hoving, PhD, Department of Clinical Epidemiology, Cabrini Hospital, and Monash University Department of Epidemiology and Preventive Medicine, Cabrini Medical Centre, Suite 41, 183 Wattletree Road, Malvern, 3144 Victoria, Australia; e-mail, Jan.Hoving@med.monash.edu.au.

Current Author Addresses: Dr. Hoving: Department of Clinical Epidemiology, Cabrini Hospital, and Monash University Department of Epidemiology and Preventive Medicine, Cabrini Medical Centre, Suite 41, 183 Wattletree Road, Malvern, 3144 Victoria, Australia.

Dr. Koes: Department of General Practice, Faculty of Medicine, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, the Netherlands.

Drs. de Vet, van der Windt, and Bouter and Mr. Pool: Institute for Research in Extramural Medicine, Vrije Universiteit Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.

Dr. Assendelft: Dutch College of General Practitioners, Department of Guidelines and Research Policy, PO Box 3231, 3502 GE Utrecht, the Netherlands.

Dr. van Mameren: Department of Anatomy/Embryology, Faculty of Medicine, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands.

Dr. Devillé: Nivel Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands.

Dr. Scholten: Dutch Cochrane Centre, Academic Medical Center, University of Amsterdam, J2-229, PO Box 22700, 1100 DE Amsterdam, the Netherlands.

Author Contributions: Conception and design: J.L. Hoving, B.W. Koes, D.A.W.M. van der Windt, W.J.J. Assendelft, H. van Mameren, J.J.M. Pool, R.J.P.M. Scholten, L.M. Bouter.

Analysis and interpretation of the data: J.L. Hoving, B.W. Koes, H.C.W. de Vet, D.A.W.M. van der Windt, W.L.J.M. Devillé, J.J.M. Pool, R.J.P.M. Scholten, L.M. Bouter.

Drafting of the article: J.L. Hoving, B.W. Koes, H.C.W. de Vet, D.A.W.M. van der Windt, W.J.J. Assendelft, H. van Mameren, R.J.P.M. Scholten, L.M. Bouter.

Critical revision of the article for important intellectual content: J.L. Hoving, B.W. Koes, H.C.W. de Vet, D.A.W.M. van der Windt, W.J.J. Assendelft, H. van Mameren, W.L.J.M. Devillé, R.J.P.M. Scholten, L.M. Bouter.

Final approval of the article: J.L. Hoving, B.W. Koes, H.C.W. de Vet, D.A.W.M. van der Windt, W.J.J. Assendelft, H. van Mameren, W.L.J.M. Devillé, J.J.M. Pool, R.J.P.M. Scholten, L.M. Bouter.

Provision of study materials or patients: J.L. Hoving, J.J.M. Pool.

Statistical expertise: J.L. Hoving, W.L.J.M. Devillé, R.J.P.M. Scholten.

Obtaining of funding: B.W. Koes, W.J.J. Assendelft, L.M. Bouter.

Administrative, technical, or logistic support: J.L. Hoving, H.C.W. de Vet, J.J.M. Pool.

Collection and assembly of data: J.L. Hoving, J.J.M. Pool.


Ann Intern Med. 2002;136(10):713-722. doi:10.7326/0003-4819-136-10-200205210-00006
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We compared the effectiveness of frequently used treatments for nonspecific neck pain in general practice. We found that manual therapy was more effective than continued care, and our results consistently favored manual therapy on almost all outcome measures. Although physical therapy scored slightly better than continued care, most of the differences were not statistically significant. In addition, although manual therapy seemed to be more effective than physical therapy, differences were small for all outcome measures except perceived recovery and were not always statistically significant. The magnitude of the differences between manual therapy and physical therapy, but also between manual therapy and continued care, were most pronounced for perceived recovery. Because perceived recovery combines other outcomes, such as pain, disability, and patient satisfaction, it may be the most responsive outcome measure. For pain intensity, statistically significant differences among the treatment groups ranged from 0.9 to 1.5 on a scale of 0 to 10. Although smaller differences could have been detected with larger sample sizes, they would not have been clinically relevant.

Topics

neck pain ; pain

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Figures

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Figure 1.
Flow chart describing the progress of patients through the trial.
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Figure 2.
Results of primary care outcome measures during the 7-week follow-up.
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Summary for Patients

Manual Therapy, Physical Therapy, or Care by Primary Care Doctors for Patients with Neck Pain

The summary below is from the full report titled “Manual Therapy, Physical Therapy, or Continued Care by a General Practitioner for Patients with Neck Pain. A Randomized, Controlled Trial.” It is in the 21 May 2002 issue of Annals of Internal Medicine (volume 136, pages 713-722). The authors are JL Hoving, BW Koes, HCW de Vet, DAWM van der Windt, WJJ Assendelft, H van Mameren, WLJM Devillé, JJM Pool, RJPM Scholten, and LM Bouter.

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