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Meta-Analysis
. 2019 Feb 13;14(2):e0211877.
doi: 10.1371/journal.pone.0211877. eCollection 2019.

Thoracic Spine Manipulation for the Management of Mechanical Neck Pain: A Systematic Review and Meta-Analysis

Affiliations
Free PMC article
Meta-Analysis

Thoracic Spine Manipulation for the Management of Mechanical Neck Pain: A Systematic Review and Meta-Analysis

Michael Masaracchio et al. PLoS One. .
Free PMC article

Abstract

Objective: To investigate the role of thoracic spine manipulation (TSM) on pain and disability in the management of mechanical neck pain (MNP).

Data sources: Electronic databases PubMed, CINAHL, Pedro, Embase, AMED, the Cochrane Library, and clinicaltrials.gov were searched in January 2018.

Study selection: 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.

Study appraisal and synthesis methods: 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).

Results: 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.

Limitations: 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.

Conclusions: 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.

Trial registration: PROSPERO CRD42017068287.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow diagram of search results and studies included.
Fig 2
Fig 2. Meta-analysis of TSM versus placebo TSM for pain at immediate follow-up.
Fig 3
Fig 3. Meta-analysis of TSM versus mobilization for pain without a distinction between immediate and short-term follow-up.
Fig 4
Fig 4. Meta-analysis of TSM versus standard care for pain at short-term follow-up.
Fig 5
Fig 5. Meta-analysis of TSM versus standard care for pain at long-term follow-up.
Fig 6
Fig 6. Meta-analysis of TSM versus cervical manipulation for pain without a distinction between immediate and short-term follow-up.
Fig 7
Fig 7. Meta-analysis for TSM versus mobilization for disability without a distinction between immediate and short-term follow-up.
Fig 8
Fig 8. Meta-analysis for TSM versus standard care for disability at short-term follow-up.
Fig 9
Fig 9. Meta-analysis for TSM versus standard care for disability at long-term follow-up.

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Grant support

The author(s) received no specific funding for this work.
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