Table 2
Author, date and countryPatient groupStudy type (level of evidence)OutcomesKey resultsStudy weaknesses
Koes BW et al, Netherlands, 19915 RCTs all comparing cervical manipulation to a controlReviewRecovery3 studies concluded manipulation better than collar and analgesics.Studies rated poor-moderate on methodology scoring
Total number of patients combined 1112 studies showed no significant difference between manipulation and diazepam, a collar and transcutaneous nerve stimulation
Cassidy JD et al, Canada, 1992100 patients with mechanical neck pain,RCTMean improvement in pain as measured by visual analogue scale17.3 (SD19.5) v 10.5 (SD14.8)Only one treatment with pain score repeated immediately afterwards
One manipulation v mobilizationNo long term follow up
Manipulation was not carried out by an osteopath or chiropractor
Koes BW et al, Netherlands, 199329 patient with neck painRCTSubjective pain measurement and physical function over 12 monthsBoth groups improved without any statistical difference between groupsPatients were also assigned to receive treatment by their GP and placebo. These results were not reported Small numbers
physiotherapy (n=17) v manual therapy n=12 (manipulation and mobilisation)
Skargren EI et al, Sweden, 199670 patients with neck painRCTSubjective pain; Function, general healthSignificant improvement in pain, function and general health in both groupsNo breakdown of results between back and neck pain patients given for the last 2 outcomes
physiotherapy (n=29) v chiropractic (n=41)Sick leaveNo difference
Fulfillment of patient expectation.41% of chiropractic group v 24% physiotherapy group
All measured until 6 months
Verhoef MJ et al, Canada, 1997106 patients with neck pain and 88 with neck and back pain.Prospective cohortDisability (Neck Disability Index)Baseline mean score 23.5, mean score at 6 weeks 13.3 p<0.001No control group
All had chiropractic manipulation
Woodward MN et al, UK, 199628 patients with chronic “whiplash” syndrome.Retrospective cohortDisability at baseline and following treatment26/28 patients had reduction in disabilityFollow-up time period not specified
All had chiropractic manipulationDisability classified by either a chiropractor or by an orthopaedic doctor over the phone
No control group
Jordan A et al, Denmark, 1998119 patients with neck pain for more than 3 monthsRCTSelf reported pain and disabilityAll treatment modality groups had improved pain levels and disability scoresAll groups underwent intervention.
intensive training physiotherapy v chiropractic treatmentMedication useAll groups progressively reduced analgesic intakeNo comparison with natural progression of injury
All of above measured until 12 months.
Giles LGF and Muller R, Australia, 199933 patients with neck pain for at least 13 weeks,RCTDisability (Neck Disability Index) Measured at 4 weeksManipulation group median index score reduced by 10 points p=0.001Very small numbers particularly in acupuncture and medication groups
chiropractor manipulation (n=18), acupuncture (n=7) or medication (n=7)No statistically significant reduction in acupuncture or medication groupNumbers within table referring to number of patient with neck pain do not add up
Pain as measured by visual analogue scaleManipulation group median pain score reduced by 1.5 points p=0.002
No statistically significant reduction in acupuncture or medication groups
McMorland G and Suter E, Canada, 199961 patients presenting to chiropractic with neck pain. All received chiropractic manipulationRetrospective cohortNeck Disability Index scoreReduction in score after 4 weeks of treatmentNo statistics displayed
244 patients who did not complete therapy because they got better or worse were excluded!
No control group