Abstract:
Background
Non-specific neck pain (NS-NP) is a common phenomenon resulting in physical and social dysfunction, high utilisation of healthcare and economic burden. In South Africa the incidence of one or more episodes of neck pain in working people between the ages of 25 and 29 years of age is reported to range between 25% and 30% while approximations of the incidence of neck pain for people aged 45 years and above rise to 50%. The hypothesised point prevalence of acute NS-NP in the adult population is 10%.
Mechanical traction and joint mobilisation are treatment modalities used for acute NS-NP. The value of mechanical traction for neck pain has been questioned because studies pertaining to the effectiveness thereof are limited, with small sample sizes and are of poor quality.
Aim:
To assess whether mechanical traction or joint mobilisation of the cervical spine was more effective in the treatment of acute NS-NP in adult patients, when combined with secondary treatment categories [electrotherapy (E.T.), exercise and soft tissue joint mobilisation (STM)].
Methodology:
A descriptive retrospective analysis was conducted on the clinical records of patients suffering from acute non-specific neck pain who were treated at the Physiotherapy Outpatient Department of the Steve Biko Hospital from 2000-2011 . Non-probability purposive sampling was done. The inclusion criteria were as follows: age 18-50 years, acute NS-NP with or without referred pain, pain rated on the Visual Analogue Scale at first treatment and discharge, treated with joint mobilisation or mechanical traction and more than one treatment in a two week period. The exclusion criteria were as follows: cervical pathology, fractures, malignancy, surgery, whiplash-associated disorders and involvement in litigation or compensation claims. A total of 109 records were included. The outcomes of this study was calculated by the change in reported pain intensity as measured with a Visual Analogue Scale (VAS)
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in the patient records and by assessing clinical improvement. Regression analysis was employed for data analysis.
Results:
The treatment groups differed marginally (p=0.08) with respect to a positive change in VAS with joint mobilisation indicating a greater change in VAS scores with a mean change in VAS of 3.94mm, while the secondary treatment categories differed significantly (p=0.03) with respect to a positive change in VAS with exercise and STM with a mean change in VAS of 4.20mm seeming more effective in reducing acute NS-NP. Traction had an increased risk of poor clinical outcome in terms of pain reduction (OR:-3.26; 95% CI; 1.16-9.15). Compared to the joint mobilisation group, the traction group’s risk for poor clinical outcome was increased by 3.26. Relative to E.T., exercise and STM prevented a poor clinical outcome (OR=0.39; 95% CI; p=0.04).
Conclusion:
Joint mobilisation combined with exercise and STM had a clinically significant, positive outcome in the treatment of acute non-specific neck pain, as opposed to mechanical traction combined with exercise and STM.
