Varying naprapathy & manual therapy combinations similarly effective for neck/back pain .
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2016;4(16):20 BMC Musculoskelet Disord. 2016 Apr 23;17(1):1761057 patients with neck and/or back pain were randomized to receive one of the three following treatments: naprapathic manual therapy (NMT), NMT excluding spinal manipulation, or NMT excluding stretching. The purpose of this study was to evaluate the three methods of treatment to determine their comparative efficacy in terms of pain intensity, pain related disability, and perceived recovery after one year. Findings indicated no significant differences in outcomes of NMT, regardless of whether components of the treatment were omitted or not.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
4/4
Randomization
2/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
3/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
Neck and back pain are common musculoskeletal disorders in the general population and can result in a substantial financial burden. To alleviate costs, manual therapists often perform naprapathic manual therapy (NMT), a combination of therapy modalities such as spinal manipulation, spinal mobilization, stretching, and massage. Previous literature regarding manual therapy for treatment of neck and back pain indicate conflicting evidence, and long-term efficacy is still unclear. Naprapathic manual therapy (NMT) is still a relatively new method of treatment therefore, further evidence is required to provide a conclusive result on its efficacy. The present study evaluates different combinations of manual therapies to determine the optimal combination.
Qual era a principal questão de investigação?
In treatment of neck and/or back pain, is there a superior treatment between naprapathy manual therapy (NMT), NMT without spinal manipulation, and NMT without stretching with regards to pain intensity, pain related disabilities, or perceived recovery, as assessed up to 1 year?
- Minimal clinically important improvement (MCI) in pain intensity were similar when NMT was compared to NMT without spinal manipulation and NMT without stretching at 7, 12, 26, and 52 weeks
- MCI in pain related disability were similar when NMT was compared to NMT without spinal manipulation and NMT without stretching at 7, 12, 26, and 52 weeks
- Perceived recovery were similar when NMT was compared to NMT without spinal manipulation and NMT without stretching at 7, 12, 26, and 52 weeks
- The generalized estimating equations (GEE) conducted found no significant differences in effect between the three treatment arms for MCI in pain intensity (p=0.41, Wald test), and pain related disability (p=0.85, Wald test) at one year follow-up
- The GEE framework found no significant differences in perceived recovery effects between the three treatment arms (p=0.98, Wald test)
De que é que me devo lembrar mais?
In treatment of neck and/or back pain, naprapathic manual therapy was reported to be similarly effective in minimal clinically important improvement in pain intensity and pain related disability, as well as perceived recovery, regardless of whether spinal manipulation or stretching were excluded from the therapy treatment.
Como é que isto afectará o tratamento dos meus doentes?
The findings of this study suggest that naprapathic manual therapy (NMT) with spinal manipulation, spinal mobilization, stretching, and massage is similarly effective to NMT without spinal manipulation or NMT without stretching. Future studies should include a control group to determine the overall efficacy of naprapathic manual therapy, and experienced senior therapists and implementation of patient-blinding should be utilized for higher-quality evidence.
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