摘要：Objectives. This study compared the relative effectiveness of cervical spine manipulation and mobilization for neck pain. Methods. Neck-pain patients were randomized to the following conditions: manipulation with or without heat, manipulation with or without electrical muscle stimulation, mobilization with or without heat, and mobilization with or without electrical muscle stimulation. Results. Of 960 eligible patients, 336 enrolled in the study. Mean reductions in pain and disability were similar in the manipulation and mobilization groups through 6 months. Conclusions. Cervical spine manipulation and mobilization yield comparable clinical outcomes. Neck pain is one of the most prevalent and costly health problems in the United States. 1– 3 Among US residents, 50% to 70% will experience neck pain at least once in their lives, 4– 6 as many as one third are affected each year, 4 and about 10% suffer from neck pain at any given point in time. 4, 7 Neck pain is the second most prevalent chief complaint reported by patients seeking chiropractic care, and it follows only low back pain as the most common reason for provision of manipulative therapy. 8, 9 An estimated 31% of all alternative health care visits occurring in the United States in 1997 were visits to chiropractors. 9 There is little information available from randomized clinical trials to support manipulation, mobilization, or other approaches for treating neck pain. 10, 11 A 1996 systematic review of randomized clinical trials involving cervical spine manipulation and mobilization revealed that manipulation or mobilization may be more effective than muscle relaxants or usual medical care in producing short-term pain relief among some patients; however, manipulation was found to be associated with rare but serious complications. 10 The Quebec Task Force on Whiplash-Associated Disorders concluded that the value of manipulation has not been established for patients with postwhiplash head and neck symptoms 12 and that mobilization may be effective for some patients in the short term, but long-term effectiveness is unknown. 12 Although 2 previous randomized clinical trials compared the immediate effects of manipulation and mobilization on neck pain, 13, 14 no published studies, to our knowledge, have assessed the long-term effectiveness of manipulation vs mobilization for patients with neck pain. Despite being the 2 most common physical therapeutic modalities that chiropractors use as adjuncts to spinal manipulation, 8 heat and electrical muscle stimulation (EMS) have not been tested in a randomized design. The purpose of the present study was to assess the relative effectiveness of neck-pain treatment approaches commonly used by chiropractors.
