In the fourth edition of Manual Therapy Research Review IFOMPT reviews a paper on exercise and spinal manual therapy for the management of chronic neck pain, a study comparing surgery plus physiotherapy with physiotherapy alone for the management of cervical radiculopathy, and a study investigating the utilisation of physiotherapy for LBP in the primary care setting.
Read the full Review here or read the summary below.
Evans R, Bronfort G, Schulz C, Maiers M, Bracha Y, Svendsen K, Grimm R, Garvey T and Transfeldt E (2012). Supervised Exercise With and Without Spinal Manipulation Performs Similarly and Better Than Home Exercise for Chronic Neck Pain. Spine 37 (11) 903-914
The management of chronic neck pain is an on-going problem for manual therapists. This well-designed study compares a good combination of multi-modal approaches. The exercise regimes in this study are well described with progression relevant to good strength parameters. The manipulation is delivered in chiropractic model with high velocity small amplitude techniques delivered to the cervical and thoracic joints with 20 sessions over 12 weeks. The results indicate the two exercise groups (with and without spi- nal manual therapy) are more effective than the home exercise programme in reducing pain. However, one of the nice features of this study was the qualitative analysis undertaken with the patients. These data indicate that pain relief is an important outcome (55% of patients expressed this view) but even more patients (62%) felt that for overall satisfaction the interaction with the staff who delivered the SMT and the exercise programme was very important. As many of us know, personal human factors are very strong in determining a good outcome.
Engquist M, Löfgren H,Öberg B, Holtz A, Peolsson A, Söderlund A, Vavruch L and
Lind B (2012). Surgery Versus Nonsurgical Treatment of Cervical Radiculopathy: A Pro- spective, Randomized Study Comparing Surgery Plus Physiotherapy With Physiotherapy. Spine 38 (20) 1715-22.
The management of patients with neck and radiating arm pain has always been a clinical challenge. The ability for well-constructed research to offer guidance in this area has also been lacking as often studies into the management of patients with neck pain exclude those with radiating arm pain. This study has now provided a good comparison between surgery with follow up physiotherapy and physiotherapy alone. The follow-up period for the study is also important (2 years) as this accounts for the natural history of the condition. The results are positive for physiotherapy both post-surgery and in isolation. The detail of the physiotherapy programme is not given in the paper which is a shame. There is a brief mention of the neck exercises and procedures utilised to relieve pain but no specifics of the actual techniques are provided. It is also unknown if there was a manual therapy component in the pain relieving procedures. Whilst always having to fit within word limits for paper publication, for research to transfer into practice details of the interventions are most helpful for clinicians. Still, this is a positive study for physiotherapy in this patient group.
Fritz J, Childs J, Wainner R and Flynn T (2012). Primary Care Referral of Patients With Low Back Pain to Physical Therapy. Spine 37 (25) 2114 -2121
These types of papers are critical for physiotherapy to continue to justify its place in the health care system of any country. As a profession we have devoted a significant amount of time and energy to prove that physiotherapy is effective from a clinical perspective. Studies that demonstrate that we are cost effective are even more powerful. When the many guidelines into the management of low back pain were introduced around the world, the delay to getting early interventions was of great concern to therapists. The guidelines all had a similar message that given the natural history of acute LBP, people did not need to seek care (other than to get this initial assessment and rule out red and yellow flags) and that advice to stay active would be sufficient. Many therapists were not happy with this approach as a consultation with a therapist could provide so much more than this basic advice. This study demonstrates that delaying physical therapy interventions increases the cost of the on-going health care, particularly in the use of strong medication, injections and further imaging. Using data from studies like these that demonstrate cost effectiveness of physiotherapy should also be factored into future guidelines.
Thank you to Annelies Pool for providing the papers reviewed in this edition. Thank you also to Jillian Caldwell who is the co-editor of the review. If you’re interested in contributing to future issues of the Manual Therapy Research Review please contact Dr Duncan Reid on [email protected]