The 130th Annual Meeting of APHA

Abstract #39323

Eric L. Hurwitz, DC, PhD, Department of Epidemiology, UCLA School of Public Health, Box 951772, Los Angeles, CA 90095-1772, 310-206-4074, ehurwitz@ucla.edu, Hal Morgenstern, PhD, Department of Epidemiology, University of California, Los Angeles, School of Public Health, Box 951772, Los Angeles, CA 90095-1772, Philip Harber, MD, MPH, Department of Family Medicine, UCLA School of Medicine, 10940 Wilshire Boulevard, Suite 1220, Los Angeles, CA 90024, Gerald F. Kominski, PhD, Department of Health Services, UCLA School of Public Health, Box 951772, Los Angeles, CA 90095-1772, Fei Yu, PhD, Department of Epidemiology, UCLA, School of Public Health, 10833 Le Conte Ave., Los Angeles, CA 90095, and Alan H. Adams, DC, Los Angeles College of Chiropractic, Southern California University of Health Sciences, 16200 East Amber Valley Drive, Whittier, CA 90609-1166.

Despite the burden that neck pain places on patients, providers, and society, the relative effectiveness of common conservative treatment strategies is largely unknown. The purpose of this study is to estimate the effects of manipulation versus mobilization for neck pain and disability among neck-pain patients followed up for 6 months in a randomized clinical trial conducted among chiropractic patients. Three-hundred-thirty-six (336) neck-pain patients presenting to a large managed-care facility from February 9, 1998 through June 30, 2000 were randomized to each of 8 treatment groups in a balanced 2x2x2 factorial design: spinal manipulation with and without heat and with and without electrical muscle stimulation (EMS); and spinal mobilization with and without heat and with and without EMS. The primary outcome variables are average and most severe neck-pain intensity in the past week, assessed with 0-10 numerical rating scales, and neck pain-related disability, assessed with the Neck Disability Index. Linear regression models were used to estimate differences in mean change on each outcome variable from baseline to each follow-up assessment. Of 961 eligible patients, 336 were enrolled; 269 (80%) were followed through 6 months. The mean changes in neck-pain intensity and disability of participants in the manipulation and mobilization groups were similar at each follow-up assessment (adjusted mean differences at 6 months for most severe pain: 0.02, 95% confidence interval -0.69 to 0.65; average pain: 0.01, -0.52 to 0.54; and disability: 0.46, -0.89 to 1.82). After 6 months of follow-up, manipulation and mobilization for neck pain were comparable in their effectiveness.

Learning Objectives:

• Participants will acquire knowledge about the research design and methods of the UCLA Neck Pain Study, including the source population, interventions, and measures used to assess clinical outcomes, as well as the statistical models used to estimate treatment effects. Participants will be able to describe the study design and population, discuss pertinent results, identify the study's strengths and limitations, and place the study in the context of existing literature on conservative treatment for neck pain.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.