A CRITICAL ANALYSIS OF RANDOMISED CLINICAL TRIALS ON NECK PAIN AND TREATMENT EFFICACY. A REVIEW OF THE LITERATURE
Görel V. Kjellman, Elisabeth I. Skargren and Birgitta E. Öberg
The efficacy of physiotherapy or chiro- practic treatment for patients with neck pain was analysed by reviewing 27 randomised clinical trials published 1966–1995. Three different methods were employed: systematic analyses of; methodological quality; comparison of effect size; analysis of inclu- sion criteria, intervention and outcome according to The Disablement Process model. The quality of most of the studies was low; only one-third scored 50 or more of a possible 100 points. Positive outcomes were noted for 18 of the investigations, and the methodological quality was high in studies using electromagnetic therapy, manipulation, or active physiotherapy. High methodological quality was also noted in studies with traction and acupuncture, however, the interventions had either no effect or a negative effect on outcome. Pooling data and calculation of effect size showed that treatments used in the studies were effective for pain, range of motion, and activities of daily living. Inclusion criteria, intervention, and outcome were based on impairment in most of the analysed investigations. Broader outcome assessments probably would have revealed relationships between treatment effect and impairment, functional limitation and disability
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