Thoracic spine manipulation for the management of mechanical neck pain: A systematic review and meta-analysis

• Published in: PloS one Vol. 14; no. 2; p. e0211877
• Main Authors: Masaracchio, Michael, Kirker, Kaitlin, States, Rebecca, Hanney, William J, Liu, Xinliang, Kolber, Morey
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 13.02.2019; Public Library of Science (PLoS)
• Subjects: Adult; Analysis; Back pain; Biology and Life Sciences; Care and treatment; Clinical medicine; Clinical trials; Collaboration; Confidence intervals; Disabled Persons; Female; Handbooks; Heterogeneity; Humans; Intervention; Low Back Pain - physiopathology; Low Back Pain - therapy; Male; Manipulation, Spinal - methods; Manipulative therapy; Medical ethics; Medicine and Health Sciences; Meta-analysis; Middle Aged; Neck; Neck - physiopathology; Neck pain; Neck Pain - physiopathology; Neck Pain - therapy; Pain; Pain management; Physical Sciences; Physical therapists; Physical therapy; Research and Analysis Methods; Science Policy; Spinal adjustment; Spine; Spine (cervical); Spine (thoracic); Spine - physiopathology; Stress, Mechanical; Systematic review; Treatment outcome; New York; Long Island New York; Florida; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0211877

To investigate the role of thoracic spine manipulation (TSM) on pain and disability in the management of mechanical neck pain (MNP). Electronic databases PubMed, CINAHL, Pedro, Embase, AMED, the Cochrane Library, and clinicaltrials.gov were searched in January 2018. Eligible studies were completed RCTs, written in English, had at least 2 groups with one group receiving TSM, had at least one measure of pain or disability, and included patients with MNP of any duration. The search identified 1717 potential articles, with 14 studies meeting inclusion criteria. Methodological quality was evaluated independently by two authors using the guidelines published by the Cochrane Collaboration. Pooled analyses were analyzed using a random-effects model with inverse variance methods to calculate mean differences (MD) and 95% confidence intervals for pain (VAS 0-100mm, NPRS 0-10pts; 0 = no pain) and disability (NDI and NPQ 0-100%; 0 = no disability). Across the included studies, there was increased risk of bias for inadequate provider and participant blinding. The GRADE approach demonstrated an overall level of evidence ranging from very low to moderate. Meta-analysis that compared TSM to thoracic or cervical mobilization revealed a significant effect favoring the TSM group for pain (MD -13.63; 95% CI: -21.79, -5.46) and disability (MD -9.93; 95% CI: -14.38, -5.48). Meta-analysis that compared TSM to standard care revealed a significant effect favoring the TSM group for pain (MD -13.21; 95% CI: -21.87, -4.55) and disability (MD -11.36; 95% CI: -18.93, -3.78) at short-term follow-up, and a significant effect for disability (MD -4.75; 95% CI: -6.54, -2.95) at long-term follow-up. Meta-analysis that compared TSM to cervical spine manipulation revealed a non-significant effect (MD 3.43; 95% CI: -7.26, 14.11) for pain without a distinction between immediate and short-term follow-up. The greatest limitation in this systematic review was the heterogeneity among the studies making it difficult to assess the true clinical benefit, as well as the overall level of quality of evidence. TSM has been shown to be more beneficial than thoracic mobilization, cervical mobilization, and standard care in the short-term, but no better than cervical manipulation or placebo thoracic spine manipulation to improve pain and disability. PROSPERO CRD42017068287.