Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration.
Study Goal
The researchers aimed to update evidence on the effectiveness of passive physical modalities, including Low-Level Laser Therapy (LLLT), for managing whiplash-associated disorders (WAD) and neck pain and associated disorders (NAD).
Results Summary
The study found that LLLT did not offer benefits for persistent NAD grades I-II or recent NAD grades III, suggesting it is ineffective for managing neck pain in these populations.
Population
Patients with persistent NAD grades I-II and recent NAD grades III.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
thoracic manipulation | increase | NAD grades I-II | recent but not persistent NAD grades I-II | - | offers short-term benefits | #1 |
technical parameters of cervical mobilization | no change | NAD grades I-II | persistent NAD grades I-II | - | do not impact outcomes | #2 |
one session of cervical manipulation | no change | outcomes | persistent NAD grades I-II | - | is similar to | #3 |
strain-counterstrain treatment | no change | NAD grades I-II | NAD grades I-II | - | is no better than placebo | #4 |
cervical and thoracic manipulation | no change | NAD grades I-II | recent NAD grades I-II | - | provides no additional benefit to high-dose supervised exercises | #5 |
Swedish or clinical massage | increase | NAD grades I-II | recent NAD grades I-II | - | adds benefit to self-care advice | #6 |
home-based cupping massage | no change | NAD grades I-II | persistent NAD grades I-II | - | has similar outcomes to home-based muscle relaxation | #7 |
low-level laser therapy (LLLT) | no change | NAD grades I-II | persistent NAD grades I-II | - | does not offer benefits | #8 |
Western acupuncture | no change | NAD grades I-II | persistent NAD grades I-II | - | provides similar outcomes to non-penetrating placebo electroacupuncture | #9 |
needle acupuncture | no change | NAD grades I-II | persistent NAD grades I-II | - | provides similar outcomes to sham-penetrating acupuncture | #10 |
needle electroacupuncture | no change | WAD grades I-II | WAD grades I-II | - | offers similar outcomes as simulated electroacupuncture | #11 |
a semi-rigid cervical collar with rest and graded strengthening exercises | no change | NAD grades III | recent NAD grades III | - | lead to similar outcomes | #12 |
LLLT | no change | NAD grades III | recent NAD grades III | - | does not offer benefits | #13 |
mobilization, manipulation, and clinical massage | decrease | neck pain | - | - | are effective interventions for the management of neck pain | #14 |
electroacupuncture, strain-counterstrain, relaxation massage, and some passive physical modalities (heat, cold, diathermy, hydrotherapy, and ultrasound) | no change | neck pain | - | - | are not effective and should not be used to manage neck pain | #15 |
BACKGROUND CONTEXT: In 2008, the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders (Neck Pain Task Force) found limited evidence on the effectiveness of manual therapies, passive physical modalities, or acupuncture for the management of whiplash-associated disorders (WAD) or neck pain and associated disorders (NAD). PURPOSE: This review aimed to update the findings of the Neck Pain Task Force, which examined the effectiveness of manual therapies, passive physical modalities, and acupuncture for the management of WAD or NAD. STUDY DESIGN/SETTING: This is a systematic review and best evidence synthesis. SAMPLE: The sample includes randomized controlled trials, cohort studies, and case-control studies comparing manual therapies, passive physical modalities, or acupuncture with other interventions, placebo or sham, or no intervention. OUTCOME MEASURES: The outcome measures were self-rated or functional recovery, pain intensity, health-related quality of life, psychological outcomes, or adverse events. METHODS: We systematically searched five databases from 2000 to 2014. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with a low risk of bias were stratified by the intervention's stage of development (exploratory vs. evaluation) and synthesized following best evidence synthesis principles. Funding was provided by the Ministry of Finance. RESULTS: We screened 8,551 citations, and 38 studies were relevant and 22 had a low risk of bias. Evidence from seven exploratory studies suggests that (1) for recent but not persistent NAD grades I-II, thoracic manipulation offers short-term benefits; (2) for persistent NAD grades I-II, technical parameters of cervical mobilization (eg, direction or site of manual contact) do not impact outcomes, whereas one session of cervical manipulation is similar to Kinesio Taping; and (3) for NAD grades I-II, strain-counterstrain treatment is no better than placebo. Evidence from 15 evaluation studies suggests that (1) for recent NAD grades I-II, cervical and thoracic manipulation provides no additional benefit to high-dose supervised exercises, and Swedish or clinical massage adds benefit to self-care advice; (2) for persistent NAD grades I-II, home-based cupping massage has similar outcomes to home-based muscle relaxation, low-level laser therapy (LLLT) does not offer benefits, Western acupuncture provides similar outcomes to non-penetrating placebo electroacupuncture, and needle acupuncture provides similar outcomes to sham-penetrating acupuncture; (3) for WAD grades I-II, needle electroacupuncture offers similar outcomes as simulated electroacupuncture; and (4) for recent NAD grades III, a semi-rigid cervical collar with rest and graded strengthening exercises lead to similar outcomes, and LLLT does not offer benefits. CONCLUSIONS: Our review adds new evidence to the Neck Pain Task Force and suggests that mobilization, manipulation, and clinical massage are effective interventions for the management of neck pain. It also suggests that electroacupuncture, strain-counterstrain, relaxation massage, and some passive physical modalities (heat, cold, diathermy, hydrotherapy, and ultrasound) are not effective and should not be used to manage neck pain.