Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain: A randomized, controlled trial

Jan Lucas Hoving*, Bart W. Koes, Henrica C.W. De Vet, Danielle A.W.M. Van der Windt, Willem J.J. Assendelft, Henk Van Mameren, Walter L.J.M. Devillé, Jan J.M. Pool, Rob J.P.M. Scholten, Lex M. Bouter

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Neck pain is a common problem, but the effectiveness of frequently applied conservative therapies has never been directly compared. Objective: To determine the effectiveness of manual therapy, physical therapy, and continued care by a general practitioner. Design: Randomized, controlled trial. Setting: Outpatient care setting in the Netherlands. Patients: 183 patients, 18 to 70 years of age, who had nonspecific neck pain for at least 2 weeks. Intervention: 6 weeks of manual therapy (specific mobilization techniques) once per week, physical therapy (exercise therapy) twice per week, or continued care by a general practitioner (analgesics, counseling, and education). Measurements: Treatment was considered successful if the patient reported being "completely recovered" or "much improved" on an ordinal six-point scale. Physical dysfunction, pain intensity, and disability were also measured. Results: At 7 weeks, the success rates were 68.3% for manual therapy, 50.8% for physical therapy, and 35.9% for continued care. Statistically significant differences in pain intensity with manual therapy compared with continued care or physical therapy ranged from 0.9 to 1.5 on a scale of 0 to 10. Disability scores also favored manual therapy, but the differences among groups were small. Manual therapy scored consistently better than the other two interventions on most outcome measures. Physical therapy scored better than continued care on some outcome measures, but the differences were not statistically significant. Conclusion: In daily practice, manual therapy is a favorable treatment option for patients with neck pain compared with physical therapy or continued care by a general practitioner.

Original languageEnglish
Pages (from-to)713-722
Number of pages10
JournalAnnals of Internal Medicine
Issue number10
Publication statusPublished - 21 May 2002

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