A Cochrane review [Abstract] 1 included 51 studies with a total of 2920 subjects. 18 trials were of manipulation/mobilisation versus control; 34 trials of manipulation/mobilisation versus another treatment, 1 trial had two comparisons.
Cervical manipulation versus inactive control: For subacute and chronic neck pain, a single manipulation (three trials, no meta-analysis, 154 participants) relieved pain at immediate- but not short-term follow-up.
Cervical manipulation versus another active treatment: For acute and chronic neck pain, multiple sessions of cervical manipulation (two trials, 446 participants) produced similar changes in pain, function, quality of life (QoL), global perceived effect (GPE) and patient satisfaction when compared with multiple sessions of cervical mobilisation at immediate-, short- and intermediate-term follow-up. For acute and subacute neck pain, multiple sessions of cervical manipulation were more effective than certain medications in improving pain and function at immediate- (one trial, 182 participants) and long-term follow-up (one trial, 181 participants). These findings are consistent for function at intermediate-term follow-up (one trial, 182 participants). For chronic CGH, multiple sessions of cervical manipulation (two trials, 125 participants) may be more effective than massage in improving pain and function at short/intermediate-term follow-up. Multiple sessions of cervical manipulation (one trial, 65 participants) may be favoured over transcutaneous electrical nerve stimulation (TENS) for pain reduction at short-term follow-up. For acute neck pain, multiple sessions of cervical manipulation (one trial, 20 participants) may be more effective than thoracic manipulation in improving pain and function at short/intermediate-term follow-up.
Thoracic manipulation versus inactive control: Three trials (150 participants) using a single session were assessed at immediate-, short- and intermediate-term follow-up. At short-term follow-up, manipulation improved pain in participants with acute and subacute neck pain (five trials, 346 participants, pooled SMD -1.26, 95% CI -1.86 to -0.66) and improved function (four trials, 258 participants, pooled SMD -1.40, 95% CI -2.24 to -0.55) in participants with acute and chronic neck pain.These findings were consistent at intermediate follow-up for pain/function/quality of life (one trial, 111 participants, low quality).
Thoracic manipulation versus another active treatment: No studies provided sufficient data for statistical analyses. A single session of thoracic manipulation (one trial, 100 participants, moderate quality) was comparable with thoracic mobilisation for pain relief at immediate-term follow-up for chronic neck pain.
Mobilisation versus inactive control: Mobilisation as a stand-alone intervention (two trials, 57 participants) may not reduce pain more than an inactive control.
Mobilisation versus another active treatment: For acute and subacute neck pain, anterior-posterior mobilisation (one trial, 95 participants) may favour pain reduction over rotatory or transverse mobilisations at immediate-term follow-up. For chronic CGH with temporomandibular joint (TMJ) dysfunction, multiple sessions of TMJ manual therapy (one trial, 38 participants) may be more effective than cervical mobilisation in improving pain/function at immediate- and intermediate-term follow-up. For subacute and chronic neck pain, cervical mobilisation alone (four trials, 165 participants) may not be different from ultrasound, TENS, acupuncture and massage in improving pain, function, QoL and participant satisfaction at immediate- and intermediate-term follow-up. Additionally, combining laser with manipulation may be superior to using manipulation or laser alone (one trial, 56 participants).
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment and lack of blinding), by inconsistency (heterogeneity in interventions and outcomes and variability in results across studies), and by imprecise results (limited study size for each comparison).
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