1
|
Cottone KA, Schumacher MR, Young JL, Rhon DI. The majority of clinical trials assessing mobilization and manipulation for neck pain lack a pragmatic approach: a systematic review of 174 trials. J Man Manip Ther 2024:1-17. [PMID: 38525785 DOI: 10.1080/10669817.2024.2327127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/01/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Disorders of the cervical spine are some of the costliest musculoskeletal conditions to manage globally. Joint mobilization and manipulation have been shown to be an effective treatment for neck pain. However, the generalizability and clinical translation depends on the nature of the trial designs that inform its use. The extent to which randomized control trials (RCTs) assessing manual therapy treatments for cervical spine disorders fall on the efficacy (explanatory) -effectiveness (pragmatic) spectrum often informs how the findings are translated into clinical practice. OBJECTIVE The aim of this systematic review was to determine where RCTs of manual therapy for neck disorders fall on the efficacy-effectiveness spectrum. METHODS A search of three electronic databases including PubMed, CINAHL, and CENTRAL were completed for trials published from inception to May 2023. RCTs in which joint mobilization or manipulation were used to treat cervical spine disorders were assessed on the effectiveness-efficacy spectrum using the Rating of Included Trials on the Efficacy-Effectiveness Spectrum (RITES) tool and risk of bias using the Revised Cochrane Risk of Bias tool. RESULTS A total of 174 trials met eligibility. RITES domain two trial setting (71.3% vs 16.1%), domain three flexibility of intervention(s) (62.1% vs 23%), and domain four clinical relevance of experimental and comparison intervention(s) (51.7% vs 29.3%) all favored efficacy over effectiveness. Domain one participant characteristic(s) had a slightly greater emphasis on effectiveness compared to efficacy (36.8% vs 44.8%). Most studies (96%) had at least some risk of bias. CONCLUSION Over half of the RCTs assessing the treatment effect of joint mobilization and manipulation for neck pain favor efficacy (explanatory) over effectiveness (pragmatic) designs. Future RCTs on this topic should consider a greater emphasis on pragmatic trial design components in order to better reflect real-world translation to clinical practice.
Collapse
Affiliation(s)
- Kyle A Cottone
- Doctor of Science in Physical Therapy, Bellin College, Green Bay, WI, USA
- Department of Physical Therapy and Health Science, Bradley University, Peoria, IL, USA
| | - Matthew R Schumacher
- Doctor of Science in Physical Therapy, Bellin College, Green Bay, WI, USA
- Doctor of Physical Therapy Program, University of Mary, Bismarck, ND, USA
| | - Jodi L Young
- Doctor of Science in Physical Therapy, Bellin College, Green Bay, WI, USA
| | - Daniel I Rhon
- Doctor of Science in Physical Therapy, Bellin College, Green Bay, WI, USA
- Department of Rehabilitation Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| |
Collapse
|
2
|
Hwang BK, Park KS, Ku SH, Kim SH, Moon HW, Park MS, Baek HK, Namgoong J, Hwangbo SY, Seo JY, Lee YJ, Lee J, Ha IH. Efficacy and Safety of Korean Herbal Medicine for Patients with Post-Accident Syndrome, Persistent after Acute Phase: A Pragmatic Randomized Controlled Trial. Healthcare (Basel) 2023; 11:healthcare11040534. [PMID: 36833066 PMCID: PMC9957496 DOI: 10.3390/healthcare11040534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/15/2023] Open
Abstract
This is a pragmatic, two-armed, parallel, single-center, randomized controlled clinical trial for comparative evaluation between the effectiveness of integrated Korean medicine (IKM) and herbal medicine treatment with that of IKM monotherapy (control) for post-accident syndrome persistent after the acute phase. Participants were randomized into Herbal Medicine (HM, n = 20) and Control groups (n = 20) to receive the allocated treatment of 1-3 sessions/week for 4 weeks. Intention-to-treat analysis was conducted. The Difference of Numeric Rating Scale (NRS) change of overall post-accident syndromes from baseline to week 5 for the two groups was 1.78 (95% CI: 1.08-2.48; p < 0.001). Regarding secondary outcomes, a significant decrease compared to the baseline values was confirmed for NRS of musculoskeletal, neurological, psychiatric complaints and general symptoms of post-accident syndromes. In a survival analysis based on the recovery criteria of "patients with a reduction in the NRS of overall post-accident syndromes of ≥50%," the HM group showed a shorter time to recovery than the control group during the 17-week study period (p < 0.001 by the log-rank test). IKM combined with herbal medicine treatment significantly improved the quality of life by relieving somatic pain and alleviating the overall post-accident syndrome persistent after the acute phase; this effect was maintained for at least 17 weeks.
Collapse
Affiliation(s)
- Bo-Kyung Hwang
- Bucheon Jaseng Hospital of Korean Medicine, 17, Buil-ro, 191beon-gil, Bucheon-si 14598, Republic of Korea
| | - Kyoung Sun Park
- Jaseng Hospital of Korean Medicine, 536, Gangna-daero, Gangnam-gu, Seoul 06110, Republic of Korea
| | - Seung-Hyeok Ku
- Bucheon Jaseng Hospital of Korean Medicine, 17, Buil-ro, 191beon-gil, Bucheon-si 14598, Republic of Korea
| | - Sung-Hyun Kim
- Bucheon Jaseng Hospital of Korean Medicine, 17, Buil-ro, 191beon-gil, Bucheon-si 14598, Republic of Korea
| | - Hyun-Woo Moon
- Bucheon Jaseng Hospital of Korean Medicine, 17, Buil-ro, 191beon-gil, Bucheon-si 14598, Republic of Korea
| | - Mi-So Park
- Bucheon Jaseng Hospital of Korean Medicine, 17, Buil-ro, 191beon-gil, Bucheon-si 14598, Republic of Korea
| | - Hye-Kyung Baek
- Bucheon Jaseng Hospital of Korean Medicine, 17, Buil-ro, 191beon-gil, Bucheon-si 14598, Republic of Korea
| | - Jin Namgoong
- Bucheon Jaseng Hospital of Korean Medicine, 17, Buil-ro, 191beon-gil, Bucheon-si 14598, Republic of Korea
| | - Seung-Yoon Hwangbo
- Bucheon Jaseng Hospital of Korean Medicine, 17, Buil-ro, 191beon-gil, Bucheon-si 14598, Republic of Korea
| | - Ji-Yeon Seo
- Bucheon Jaseng Hospital of Korean Medicine, 17, Buil-ro, 191beon-gil, Bucheon-si 14598, Republic of Korea
| | - Yoon Jae Lee
- Bucheon Jaseng Hospital of Korean Medicine, 17, Buil-ro, 191beon-gil, Bucheon-si 14598, Republic of Korea
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 2F 540 Gangnam-daero, Gangnam-gu, Seoul 06110, Republic of Korea
| | - Jinho Lee
- Jaseng Hospital of Korean Medicine, 536, Gangna-daero, Gangnam-gu, Seoul 06110, Republic of Korea
| | - In-Hyuk Ha
- Bucheon Jaseng Hospital of Korean Medicine, 17, Buil-ro, 191beon-gil, Bucheon-si 14598, Republic of Korea
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 2F 540 Gangnam-daero, Gangnam-gu, Seoul 06110, Republic of Korea
- Correspondence: ; Tel.: +82-2-2222-2740
| |
Collapse
|