None listed
Conditions
Brief summary
Neck pain is highly prevalent and a leading cause of disability worldwide. Manual therapies are commonly used to treat neck pain, and there is some evidence of the effectiveness of mobilisation and manipulation for neck pain. When compared with each other, mobilisation and manipulation have been shown to have similar effects. In light of the potential serious adverse events associated with manipulation, the Cochrane Back and Neck Group have highlighted further investigation of mobilisation as a research priority. Additionally, with little information available about which are the most effective techniques and approaches to mobilisation, the Cochrane Group has recommended future research also focus on addressing this question. There are currently two distinctly different approaches to cervical spine mobilisation for people with neck pain. A pragmatic approach is based on the assumption that individualised treatments, with key dosage parameters determined by careful assessment of pain and movement are important determinants of outcome. A prescriptive approach is based on the assumption that standardised techniques and dose are effective, and that patient selection is the main determinant of outcome. This pilot study will investigate the feasibility of a trial to determine whether a pragmatic or a prescriptive approach to cervical spine mobilisation more effective in relieving pain and restoring function in people with recent onset neck pain
Interventions
Pragmatic neck mobilisation: Cervical Spine Mobilisation in which the selected technique, target spinal segment, and dose will be determined by the treating practitioner on the basis of their assessment findings. The clinical assessment of the treating physiotherapist is not standardised. The techniques which the treating practitioner may choose will be restricted to therapist-applied or -assisted movements that are applied directly or indirectly to the spine with the purpose of moving the joint
Pragmatic neck mobilisation: Cervical Spine Mobilisation in which the selected technique, target spinal segment, and dose will be determined by the treating practitioner on the basis of their assessment findings. The clinical assessment of the treating physiotherapist is not standardised. The techniques which the treating practitioner may choose will be restricted to therapist-applied or -assisted movements that are applied directly or indirectly to the spine with the purpose of moving the joints of the cervical spine. The treating practitioner may choose the side of the spine targeted or direction of movement. The treating practitioner may choose individual dosage parameters including the grade of movement (according to the grading of passive movements described by Maitland 1986), the duration (seconds) and the number of times the mobilisation is applied up to a maximum of three separate sets. All participants will receive a single treatment session of up to 10 minutes duration. The treating practitioner will record details of the techniques and dosage chosen using standardised forms The treating practitioners will be physiotherapists with post-graduate qualification in manual therapy, be recognised as titled musculoskeletal physiotherapists or specialist musculoskeletal physiotherapists by the Australian Physiotherapy Association and have at least 10 years of clinical experience. The treating practitioners will receive specific training in implementation of the trial protocol, work-health and safety induction and training in emergency procedures. Treatments will take place in the university clinical laboratory.
Sponsors
The University of Sydney
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
Adults of both sexes aged 18-60 years - Primary complaint of neck pain in region described by Merskey (1994) - Neck pain that is aggravated by particular movements or positions, and fully or partially relieved by rest. - Of less than 6 weeks duration, - Pain score at least 2/10 NRS - Disability score (NDI) greater than 10%. - Score of less than 105 on the Orebro Musculoskeletal Pain Questionnaire - Able to complete written questionnaires in English.
Exclusion criteria
- History of whiplash or significant neck trauma - History of cervical spine fracture or spinal surgery - History of serious illness e.g TB, HIV, cancer or inflammatory arthritis - Presence of ‘red flag’ symptoms: fever, chills night sweats, recent unexplained weight loss, recent infection - Neck pain that is unrelieved by rest - Neck mobility that is restricted in all directions. - Signs of widespread sensitisation - Signs of radiculopathy or myelopathy - Deemed unsuitable for manipulation by the treating practitioner
Outcome results
None listed