Immediate Changes in Widespread Pressure Pain Sensitivity, Neck Pain, and Cervical Range of Motion After Cervical or Thoracic Thrust Manipulation in Patients With Bilateral Chronic Mechanical Neck Pain: A Randomized Clinical Trial
Immediate Changes in Widespread Pressure Pain Sensitivity, Neck Pain, and Cervical Range of Motion After Cervical or Thoracic Thrust Manipulation in Patients With Bilateral Chronic Mechanical Neck Pain: A Randomized Clinical Trial
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DOI：
10.2519/jospt.2012.4151
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发表时间：
2012-09-01
影响因子：
6.1
通讯作者：
Fernandez-De-Las-Penas, Cesar
中科院分区：
文献类型：
--
作者：
Martinez-Segura, Raquel;Isabel De-La-Llave-Rincon, Ana;Fernandez-De-Las-Penas, Cesar
研究设计：随机临床试验。目的：比较颈部和胸部推拿手法对双侧慢性机械性颈痛患者压痛敏感性、颈部疼痛和颈椎活动范围(CROM)的影响。背景：有证据表明，脊柱干预可以刺激下行抑制性疼痛通路。方法：90例患者(51%为女性)随机分为3组：右侧颈椎推拿、左侧颈椎推拿或胸部推拿。在基线和干预10min后，由盲法对患者的治疗分配进行评估，收集C5-6关节突关节、外上髁和胫前肌的压力痛阈值(PPTs)、颈痛(11分数字疼痛评定量表)和颈椎活动度(CROM)。采用混合模型协方差分析来检验治疗对每个结果变量的影响，其中组为受试者间变量，时间和侧边为受试者内变量，性别为协变量。结果：PPT水平(C5-6，P>；.210；外上髁，P>；.186；胫骨前肌，P>；.268)、颈部疼痛强度(P=.923)或CROM(屈曲，P=.700；伸展，P=.387；侧屈，P>；.672；旋转，P>；.192)作为因变量的混合模型协方差分析没有发现显著的交互作用。所有组的PPT、颈部疼痛和CROM的变化相似(ALL，第10页)。结论：当前随机临床试验的结果表明，颈椎和胸部推拿在双侧慢性机械性颈痛患者的PPT、颈部疼痛强度和CROM方面的变化相似。然而，PPT和CROM的变化很小，没有超过它们各自的最小可检测变化值。此外，由于我们没有纳入对照组，我们不能排除推力干预对结果的安慰剂效应。证据水平：治疗，水平1b。《矫形外科体育杂志》2012；42(9)：806-814，Epub，2012年6月18日。Doi：10.2519/jospt.2012.4151
STUDY DESIGN: Randomized clinical trial.OBJECTIVES: To compare the effects of cervical versus thoracic thrust manipulation in patients with bilateral chronic mechanical neck pain on pressure pain sensitivity, neck pain, and cervical range of motion (CROM).BACKGROUND: Evidence suggests that spinal interventions can stimulate descending inhibitory pain pathways. To our knowledge, no study has investigated the neurophysiological effects of thoracic thrust manipulation in individuals with bilateral chronic mechanical neck pain, including widespread changes on pressure sensitivity.METHODS: Ninety patients (51% female) were randomly assigned to 1 of 3 groups: cervical thrust manipulation on the right, cervical thrust manipulation on the left, or thoracic thrust manipulation. Pressure pain thresholds (PPTs) over the C5-6 zygapophyseal joint, lateral epicondyle, and tibialis anterior muscle, neck pain (11-point numeric pain rating scale), and cervical spine range of motion (CROM) were collected at baseline and 10 minutes after the intervention by an assessor blinded to the treatment allocation of the patients. Mixed-model analyses of covariance were used to examine the effects of the treatment on each outcome variable, with group as the between-subjects variable, time and side as the within-subject variables, and gender as the covariate. The primary analysis was the group-by-time interaction.RESULTS: No significant interactions were found with the mixed-model analyses of covariance for PPT level (C5-6, P>.210; lateral epicondyle, P>.186; tibialis anterior muscle, P>.268), neck pain intensity (P=.923), or CROM (flexion, P=.700; extension, P=.387; lateral flexion, P>.672; rotation, P>.192) as dependent variables. All groups exhibited similar changes in PPT, neck pain, and CROM (all, P.10).CONCLUSION: The results of the current randomized clinical trial suggest that cervical and thoracic thrust manipulation induce similar changes in PPT, neck pain intensity, and CROM in individuals with bilateral chronic mechanical neck pain. However, changes in PPT and CROM were small and did not surpass their respective minimal detectable change values. Further, because we did not include a control group, we cannot rule out a placebo effect of the thrust interventions on the outcomes.LEVEL OF EVIDENCE: Therapy, level 1b. J Orthop Sports Phys Ther 2012;42(9):806-814, Epub 18 June 2012. doi:10.2519/jospt.2012.4151