1. Title: “Does the number of visits of mobilizations influence the MCID* on pain improvement in patients with chronic idiopathic neck pain- A cross-sectional study?”
*MCID= Minimum clinically important difference
2. The specific aim of this cross-sectional study is to reduce cost and improve pain outcome in patients with chronic idiopathic neck pain (CINP). To do this, the study will examine whether the number of visits of mobilization (hypothesis) affect the MCID on pain reduction for patients to begin exercising. In addition, the study will also identify which patients are likely to respond or not to mobilization based on their conditioned pain modulation (CPM) profile? (research questions). These findings could potentially cut costs
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- Providing 1 session of joint mobilization has been shown to immediately improve the impaired CPM in those with knee osteoarthritis (Courtney et al., 2016) compared to placebo.
- Some patients with chronic pain related to knee osteoarthritis have impaired CPM while others do not (Courtney et al 2016)
- However, because Courtney et al did not apply joint mobilization to those whose CPM is not impaired, it is unclear if joint mobilization is or is not effective in changing pain in those with normal functioning CPM
- More importantly, it is not clear whether the positive results Courtney et al 2016 achieved in chronic pain related to knee osteoarthritis carries over to patients with CINP.
4. Scope of the problem
- The high cost of CINP may be related to the fact that these patients typically seek on average 5 providers over 21 visits every year and receive largely ineffective treatments (Carlesso et al., 2014).
- Heat, NSAID, exercise, cold and spinal manipulation/mobilization are the most common treatments received (Goode et al., 2010).
- Only exercise and spinal manipulation/mobilization, however, have good evidence for effectiveness based on multiple systematic reviews and meta-analyses.
- In fact, current practice guidelines suggest combining exercise and spinal mobilization for better pain and functional outcomes than mobilization or exercise alone.
- To prevent long term disability
• Doing strength and range-of-motion exercises (physical therapy) as told by your health care provider.
Murray J. McAllister created this website because he had concerns for how chronic pain was being understood and managed in the current healthcare system. There is no uniform or consistency in how chronic pain is being treated among healthcare providers. Many providers also correlate chronic pain to a previous orthopedic injury and not from a nervous system related condition. This poses many concerns
We are grateful for the “Manual Therapy” reviewers thoughtful review and suggestions to improve our manuscript. Our author team has reviewed, considered, and responded to all comments and suggestions the reviewers proposed in accordance with “Manual Therapy” guidelines. Thus, we are submitting a revised manuscript “The Immediate Cardiovascular Response to Joint Mobilization of the Neck- A Randomized, Placebo-Controlled Trial in Pain-Free Adults” for follow-up consideration for publication in “Manual Therapy”. We are hopeful that our work will be deemed as valuable and disseminated for other manual therapists to consider.
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Chronic neck pain is the 3rd most common pain condition in the US with about 30-50% of adults being affected each year. On average, spin care costs about 9% of total health care cost each year ranging from about $3,000 to $8,000 per patient. This high cost of treatment for idiopathic neck pain raises an issue because treatment seems to be ineffective. Current research is analyzing the effectiveness of treatment consisting of joint mobilization combined with exercise. Research shows that a combination of the two techniques prove to be more effective than each alone for improving patient function. However, the sequence of the therapy as well of the number of visits is still unclear.
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