Curator: Gert Bronfort DC PhD
Papers
Showing 1-10 of 10
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| Reviews | |
Effectiveness of manual therapies: the UK evidence report. |
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| Bronfort, Gert; Haas, Mitch; Evans, Roni; Leininger, Brent & Triano, Jay | |
| Chiropractic \& osteopathy | |
| 2010 | |
| The purpose of this report is to provide a succinct but comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal conditions. | |
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| Reviews | |
Evidence-based guidelines for the chiropractic treatment of adults with neck pain. |
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| Bryans, Roland; Decina, Philip; Descarreaux, Martin; Duranleau, Mireille; Marcoux, Henri; Potter, Brock; Ruegg, Richard P; Shaw, Lynn; Watkin, Robert & White, Eleanor | |
| Journal of manipulative and physiological therapeutics | |
| 2014 | |
| OBJECTIVE: The purpose of this study was to develop evidence-based treatment recommendations for the treatment of nonspecific (mechanical) neck pain in adults. METHODS: Systematic literature searches of controlled clinical trials published through December 2011 relevant to chiropractic practice were conducted using the databases MEDLINE, EMBASE, EMCARE, Index to Chiropractic Literature, and the Cochrane Library. The number, quality, and consistency of findings were considered to assign an overall strength of evidence (strong, moderate, weak, or conflicting) and to formulate treatment recommendations. RESULTS: Forty-one randomized controlled trials meeting the inclusion criteria and scoring a low risk of bias were used to develop 11 treatment recommendations. Strong recommendations were made for the treatment of chronic neck pain with manipulation, manual therapy, and exercise in combination with other modalities. Strong recommendations were also made for the treatment of chronic neck pain with stretching, strengthening, and endurance exercises alone. Moderate recommendations were made for the treatment of acute neck pain with manipulation and mobilization in combination with other modalities. Moderate recommendations were made for the treatment of chronic neck pain with mobilization as well as massage in combination with other therapies. A weak recommendation was made for the treatment of acute neck pain with exercise alone and the treatment of chronic neck pain with manipulation alone. Thoracic manipulation and trigger point therapy could not be recommended for the treatment of acute neck pain. Transcutaneous nerve stimulation, thoracic manipulation, laser, and traction could not be recommended for the treatment of chronic neck pain. CONCLUSIONS: Interventions commonly used in chiropractic care improve outcomes for the treatment of acute and chronic neck pain. Increased benefit has been shown in several instances where a multimodal approach to neck pain has been used. | |
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| Reviews | |
Manual therapies for cervicogenic headache: a systematic review. |
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| Chaibi, Aleksander & Russell, Michael Bjørn | |
| The journal of headache and pain | |
| 2012 | |
| This paper systematically reviewed randomized clinical trials (RCT) assessing the efficacy of manual therapies for cervicogenic headache (CEH). A total of seven RCTs were identified, i.e. one study applied physiotherapy ± temporomadibular mobilization techniques and six studies applied cervical spinal manipulative therapy (SMT). The RCTs suggest that physiotherapy and SMT might be an effective treatment in the management of CEH, but the results are difficult to evaluate, since only one study included a control group that did not receive treatment. Furthermore, the RCTs mostly included participant with infrequent CEH. Future challenges regarding CEH are substantial both from a diagnostic and management point of view. | |
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| Reviews | |
Manual therapies for migraine: a systematic review. |
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| Chaibi, Aleksander; Tuchin, Peter J & Russell, Michael Bjørn | |
| The journal of headache and pain | |
| 2011 | |
| Migraine occurs in about 15\% of the general population. Migraine is usually managed by medication, but some patients do not tolerate migraine medication due to side effects or prefer to avoid medication for other reasons. Non-pharmacological management is an alternative treatment option. We systematically reviewed randomized clinical trials (RCTs) on manual therapies for migraine. The RCTs suggest that massage therapy, physiotherapy, relaxation and chiropractic spinal manipulative therapy might be equally effective as propranolol and topiramate in the prophylactic management of migraine. However, the evaluated RCTs had many methodological shortcomings. Therefore, any firm conclusion will require future, well-conducted RCTs on manual therapies for migraine. | |
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| Tension-Type Headache | |
Effectiveness of manual therapy for chronic tension-type headache: a pragmatic, randomised, clinical trial. |
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| Castien René F, van der Windt Daniëlle A, W M Grooten Anneke, Dekker Joost |
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| Cephalalgia : an international journal of headache | |
| 0 | |
| Get the paper here | |
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| Tension-Type Headache | |
Spinal manipulation in the treatment of episodic tension-type headache: a randomized controlled trial. |
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| Bove, G & Nilsson, N | |
| JAMA | |
| 1998 | |
| CONTEXT: Episodic tension-type headache is common and is often treated using manual therapies. Few data exist for the efficacy of these interventions. OBJECTIVE: To determine the effects of spinal manipulation therapy on adults with episodic tension-type headache. DESIGN: Randomized controlled trial lasting 19 weeks. SETTING: Outpatient facility of a National Health Service-funded chiropractic research institution in Denmark. PARTICIPANTS: Volunteer sample of 26 men and 49 women aged 20 to 59 years who met the diagnostic criteria for episodic tension-type headache as defined by the International Headache Society. INTERVENTION: Participants were randomized into 2 groups, 1 receiving soft tissue therapy and spinal manipulation (the manipulation group), and the other receiving soft tissue therapy and a placebo laser treatment (the control group). All participants received 8 treatments over 4 weeks; all treatments were performed by the same chiropractor. MAIN OUTCOME MEASURES: Daily hours of headache, pain intensity per episode, and daily analgesic use, as recorded in diaries. RESULTS: Based on intent-to-treat analysis, no significant differences between the manipulation and control groups were observed in any of the 3 outcome measures. However, by week 7, each group experienced significant reductions in mean daily headache hours (manipulation group, reduction from 2.8 to 1.5 hours; control group, reduction from 3.4 to 1.9 hours) and mean number of analgesics per day (manipulation group, reduction from 0.66 to 0.38; control group, reduction from 0.82 to 0.59). These changes were maintained through the observation period. Headache pain intensity was unchanged for the duration of the trial. CONCLUSION: As an isolated intervention, spinal manipulation does not seem to have a positive effect on episodic tension-type headache. | |
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| Tension-Type Headache | |
Efficacy of physiotherapy including a craniocervical training programme for tension-type headache; a randomized clinical trial. |
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| van Ettekoven, H & Lucas, C | |
| Cephalalgia : an international journal of headache | |
| 2006 | |
| We conducted a multicentre, randomized controlled trial with blinded outcome assessment. The treatment period was 6 weeks with follow-up assessment immediately thereafter and after 6 months. The objective was to determine the effectiveness of a craniocervical training programme combined with physiotherapy for tension-type headache. Eighty-one participants meeting the diagnostic criteria for tension-type headache were randomly assigned to an exercise group (physiotherapy and an additional craniocervical training programme) and a control group (physiotherapy alone). The primary outcome measure was headache frequency. Secondary outcomes included headache intensity and duration, Quality of Life (SF-36) and the Multidimensional Headache Locus of Control scale (MHLC). At 6 months’ follow-up, the craniocervical training group showed significantly reduced headache frequency, intensity and duration (P < 0.001 for all). Effect sizes were large and clinically relevant. Loss to follow-up amounted to 3.7\%. Physiotherapy including craniocervical training reduces symptoms of tension-type headache significantly over a prolonged time frame. | |
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| Cervicogenic Headache | |
Efficacy of a C1-C2 self-sustained natural apophyseal glide (SNAG) in the management of cervicogenic headache. |
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| Hall, Toby; Chan, Ho Tak; Christensen, Lene; Odenthal, Britta; Wells, Cherie & Robinson, Kim | |
| The Journal of orthopaedic and sports physical therapy | |
| 2007 | |
| STUDY DESIGN: Randomized, double-blind, placebo controlled trial. OBJECTIVES: To determine the effect of a C1-C2 self-sustained natural apophyseal glide (SNAG) on cervicogenic headache. BACKGROUND: Cervicogenic headache is a common condition causing significant disability. Recent studies have shown a high incidence of C1-C2 dysfunction, evaluated by the flexion-rotation test (FRT), in subjects with cervicogenic headache. To manage this dysfunction, Mulligan has described a C1-C2 self-SNAG, though no studies have investigated the efficacy of this intervention approach. METHODS: A sample of 32 subjects (mean \_ SD age, 36 +/- 3 years) with cervicogenic headache and FRT limitation were randomized into a C1-C2 self-SNAG or placebo group. After an initial instruction and practice visit in the clinic, interventions consisted of exercises applied independently by the subject twice daily at home on a continual basis. FRT range was measured twice, before and immediately after the instruction and practice visit. Headache symptoms were determined by a headache index over time, assessed by questionnaire preintervention, at 4 weeks postintervention, and at 12 months postintervention. RESULTS: No differences were found in baseline measures between groups. Immediately after the initial instruction and practice visit performed with the supervision of the therapist, FRT range increased by 15 degrees (SD, 9) for the C1-C2 self-SNAG group (P < .001), which was significantly more than 5 degrees (SD, 5) for the placebo intervention (P < .001). There was also a significant interaction for the variable headache index between group and time (P < .001), indicating that group difference was dependent on time. There was no difference in headache index scores at baseline between groups. Headache index scores were substantially less in the C1-C2 self-SNAG group (mean +/- SD points at 4 weeks, 31 +/- 9; mean +/- SD points at 12 months, 24 +/- 9) compared to the placebo group (mean +/- SD points at 4 weeks, 51 +/- 15; mean +/- SD points at 12 months, 44 +/- 13) at 4 weeks (P < .001) and 12 months (P < .001), with an overall (+/-SD) reduction of 54\% (+/-17\%) for the individuals in the C1-C2 self-SNAG group. CONCLUSIONS: These results provide evidence for the efficacy of the C1-C2 self-SNAG technique in the management of individuals with cervicogenic headache. | |
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| Cervicogenic Headache | |
A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. |
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| Jull, Gwendolen; Trott, Patricia; Potter, Helen; Zito, Guy; Niere, Ken; Shirley, Debra; Emberson, Jonathan; Marschner, Ian & Richardson, Carolyn | |
| Spine | |
| 2002 | |
| STUDY DESIGN: A multicenter, randomized controlled trial with unblinded treatment and blinded outcome assessment was conducted. The treatment period was 6 weeks with follow-up assessment after treatment, then at 3, 6, and 12 months. OBJECTIVES: To determine the effectiveness of manipulative therapy and a low-load exercise program for cervicogenic headache when used alone and in combination, as compared with a control group. SUMMARY OF BACKGROUND DATA: Headaches arising from cervical musculoskeletal disorders are common. Conservative therapies are recommended as the first treatment of choice. Evidence for the effectiveness of manipulative therapy is inconclusive and available only for the short term. There is no evidence for exercise, and no study has investigated the effect of combined therapies for cervicogenic headache. METHODS: In this study, 200 participants who met the diagnostic criteria for cervicogenic headache were randomized into four groups: manipulative therapy group, exercise therapy group, combined therapy group, and a control group. The primary outcome was a change in headache frequency. Other outcomes included changes in headache intensity and duration, the Northwick Park Neck Pain Index, medication intake, and patient satisfaction. Physical outcomes included pain on neck movement, upper cervical joint tenderness, a craniocervical flexion muscle test, and a photographic measure of posture. RESULTS: There were no differences in headache-related and demographic characteristics between the groups at baseline. The loss to follow-up evaluation was 3.5\%. At the 12-month follow-up assessment, both manipulative therapy and specific exercise had significantly reduced headache frequency and intensity, and the neck pain and effects were maintained (P < 0.05 for all). The combined therapies was not significantly superior to either therapy alone, but 10\% more patients gained relief with the combination. Effect sizes were at least moderate and clinically relevant. CONCLUSION: Manipulative therapy and exercise can reduce the symptoms of cervicogenic headache, and the effects are maintained. | |
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| Migraine Headache | |
The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. |
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| Nelson, C F; Bronfort, G; Evans, R; Boline, P; Goldsmith, C & Anderson, A V | |
| Journal of manipulative and physiological therapeutics | |
| 1998 | |
| BACKGROUND: Migraine headache affects approximately 11 million adults in the United States. Spinal manipulation is a common alternative therapy for headaches, but its efficacy compared with standard medical therapies is unknown. OBJECTIVE: To measure the relative efficacy of amitriptyline, spinal manipulation and the combination of both therapies for the prophylaxis of migraine headache. DESIGN: A prospective, randomized, parallel-group comparison. After a 4-wk baseline period, patients were randomly assigned to 8 wk of treatment, after which there was a 4-wk follow-up period. SETTING: Chiropractic college outpatient clinic. PARTICIPANTS: A total of 218 patients with the diagnosis of migraine headache. INTERVENTIONS: An 8-wk course of therapy with spinal manipulation, amitriptyline or a combination of the two treatments. MAIN OUTCOME MEASURES: A headache index score derived from a daily headache pain diary during the last 4 wk of treatment and during the 4-wk follow-up period. RESULTS: Clinically important improvement was observed in both primary and secondary outcomes in all three study groups over time. The reduction in headache index scores during treatment compared with baseline was 49\% for amitriptyline, 40\% for spinal manipulation and 41\% for the combined group; p = .66. During the posttreatment follow-up period the reduction from baseline was 24\% for amitriptyline, 42\% for spinal manipulation and 25\% for the combined group; p = .05. CONCLUSION: There was no advantage to combining amitriptyline and spinal manipulation for the treatment of migraine headache. Spinal manipulation seemed to be as effective as a well-established and efficacious treatment (amitriptyline), and on the basis of a benign side effects profile, it should be considered a treatment option for patients with frequent migraine headaches. |