STUDY:

JOURNAL: BMJ. 2003;326:911-914

AUTHORS: Ingeborg Korthals-de Bos

ABSTRACT: Manual therapy is more effective than traditional physiotherapy or general medical care for the treatment of neck pain.

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COMMENTARY: "Our findings showed manual therapy to be more cost effective than physiotherapy and continued care provided by a general practitioner in the treatment of nonspecific neck pain," write Ingeborg Korthals-de Bos, from VU University Medical Centre in Amsterdam, the Netherlands, and colleagues.

A total of 183 patients with neck pain for at least two weeks were recruited by 42 general practitioners in the Netherlands. Age range was 18 to 70 years. Of the 183 subjects, 60 were randomized to manual therapy consisting of spinal mobilization, 59 to physiotherapy consisting mainly of exercise, and 64 to standard care from a general practitioner, including counseling, education, and medications. "Spinal mobilization was defined as low velocity passive movements within or at the limit of joint range of motion. Spinal manipulation (low amplitude, high velocity techniques) was not provided," according to the authors.

After 26 weeks, patients in the manual therapy group recovered more quickly than did patients in the other two groups. By 52 weeks, there were no significant differences between groups. The total average costs of manual therapy were $402, about one third of the costs in the other two groups (P < .01).

"Manual therapy had significantly lower costs and slightly better effects in treating neck pain at 52 weeks compared with physiotherapy and general practitioner care," the authors write. "The clinical outcome measures showed that manual therapy resulted in faster recovery."