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Meta-Analysis
. 2024;32(S1):385-402.
doi: 10.3233/THC-248034.

Effectiveness and safety of thoracic manipulation in the treatment of neck pain: An updated systematic review and meta-analysis

Jiao Yang  1   2 , Sha Zhao  3 , Rui Zhang  1 , Cheng Huang  1   2   4 , Ke-Yao Huang  1 , Ying Cheng  5 , Cheng-Qi He  1   2   4 , Ling-Xin Li  1   2   4
Affiliations
Meta-Analysis

Effectiveness and safety of thoracic manipulation in the treatment of neck pain: An updated systematic review and meta-analysis

Jiao Yang et al. Technol Health Care. 2024.

Abstract

Background: The purpose of this meta-analysis was to evaluate the effectiveness and safety of thoracic manipulation (TM) in patients with neck pain (NP).

Objective: The purpose of this meta-analysis was to evaluate the effectiveness and safety of thoracic manipulation (TM) in patients with neck pain (NP).

Methods: Seven electronic databases were searched from their inception through October 2023 by two authors. The methodological quality assessments were performed with the Physiotherapy Evidence Database (PEDro) scale. Pain, cervical range of motion (ROM), disability, and quality of life (QOL) were estimated for TM treatment in patients with NP.

Results: Eighteen randomized controlled trials (RCTs) with 914 patients were included with a PEDro score of 6.923 ± 3.120. Pooled effect sizes of pain (SMD =-0.481, 95% CI -0.653 to -0.309, P= 0.000), disability (SMD =-1.435, 95% CI -2.480 to -0.390, P= 0.007), QOL-physical component score (PCS) (SMD = 0.658, 95% CI 0.290 to 1.025, P= 0.000), ROM of flexion (SMD = 0.921, 95% CI 0.287 to 1.555, P= 0.000), ROM of extension (SMD = 0.572, 95% CI 0.321 to 0.822, P= 0.000), ROM of left lateral flexion (SMD = 0.593, 95% CI 0.075 to 1.112, P= 0.025) and ROM of left rotation (SMD = 0.230, 95% CI 0.010 to 0.450, P= 0.04) were favored by the TM group.

Conclusions: TM provides short-term effect on relieving neck pain, increasing cervical ROM, and disability in patients with NP without serious side effects. Continuous therapy and distraction therapy are recommended as optimal choice on reducing pain and improving cervical ROM, especially in patients with chronic NP (> 3 months). The TM-induced improvements in the QOL of patients with NP should be verified by more further high-quality RCTs.

Keywords: Thoracic manipulation (TM); cervical range of motion (ROM); chronic neck pain; disability; neck pain; thoracic spine manipulation.

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Conflict of interest statement

None to report.

Figures

Figure 1.
Figure 1.
Search flowchart of the meta-analysis. Flow diagram illustrating search strategy.
Figure 2.
Figure 2.
Forest plots of pain and disability. Efficacy of TM vs placebo. Forest plot was built considering p< 0.05 as statistically significant effect.
Figure 3.
Figure 3.
Funnel plots of pain and disability.
Figure 4.
Figure 4.
Forest plots of ROM in all planes.
Figure 4.
Figure 4.
continued.
Figure 4.
Figure 4.
continued.
Figure 5.
Figure 5.
Funnel plots of ROM in all planes.
See this image and copyright information in PMC

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