To investigate the immediate and long term effects of thoracic manipulation (TM) in patients with chronic mechanical neck pain : a randomized controlled trial

Abstract

The first part of this thesis focuses on the development and validation of an apparatus (the Electronic Head Posture Instrument [EHPI]) for measuring head and neck posture - the cranio-vertebral angle (CV angle) - particularly in patients with chronic mechanical neck pain and disorders. The Intra-class Correlation Coefficients, intra-and inter-rater reliabilities of the EHPI in both groups of EHPI were high. The criterion validity of the EHPI investigated by comparing the CV angles of chronic mechanical neck pain patients with lateral radiographs of the cervical spine (anterior head translation [AHT]) revealed a good reverse correlation (r = -0.71). The second part of this thesis involved a randomized controlled clinical trial undertaken to investigate the effects of thoracic manipulation (TM) on patients with chronic mechanical neck pain by comparing a TM group and control group. Outcome measures included level of pain (measured with the Numeric Pain Rating Scale [NPRS]), neck disability (based on the Northwick Park Neck Disability Questionnaire (Chinese version) [NPQ]), cervical range of motion (ROM), CV angle, and Health-related Quality of Life (HRQoL) status (based on the Medical Outcomes Study 36-item Short-form Health Survey [SF36] score - Mental Component Score [MCS] and Physical Component Score [PCS]). Assessments were conducted at baseline, immediately after completion of the eight treatment sessions, and six months after completion of treatments. TM group demonstrated significant less pain intensity (p = 0.043), larger CV angle (p = 0.049), smaller NPQ scores (p = 0.018), better cervical ROM [flexion (p < 0.001); left side flexion (p = 0.043); right side flexion (p=0.038)] and better PCS score (p = 0.002) at the immediate post-intervention follow-up. These positive results were continued at 6-month follow-up assessment. It is concluded that the EHPI is a valid and reliable apparatus for measuring the CV angle of patients with chronic mechanical neck pain. TM is effective in reducing neck pain and improving dysfunction, neck posture, and neck ROM with positive effects last up to six months. Hence, TM could be an effective method in treating chronic mechanical neck pain.