FW: [aca-members] manipulation and HA, part 2

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More studies on our treatment of headache.....

Vern Saboe

[aca-members] manipulation and HA, part 2

J Orthop Sports Phys Ther. <javascript:AL_get(this, 'jour', 'J Orthop

Sports Phys Ther.');> 2006 Mar;36(3):160-9. Links

<javascript:PopUpMenu2_Set(Menu16596892);>

Methodological quality of randomized controlled trials of spinal

manipulation and mobilization in tension-type headache,

migraine, and cervicogenic headache.

*Fernández-de-las-Peñas C*

<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed & Cmd=Search & Term=%22Fern%

C3%A1ndez-de-las-Pe%C3%B1as%20C%22%5BAuthor%5D & itool=EntrezSystem2.PEntrez.P

ubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus>,

*Alonso-Blanco C*

<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed & Cmd=Search & Term=%22Alons

o-Blanco%20C%22%5BAuthor%5D & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_Result

sPanel.Pubmed_RVAbstractPlus>,

*San-Roman J*

<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed & Cmd=Search & Term=%22San-R

oman%20J%22%5BAuthor%5D & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPan

el.Pubmed_RVAbstractPlus>,

*Miangolarra-Page JC*

<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed & Cmd=Search & Term=%22Miang

olarra-Page%20JC%22%5BAuthor%5D & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_Re

sultsPanel.Pubmed_RVAbstractPlus>.

Department of Physical Therapy, Occupational Therapy, Physical

Medicine and Rehabilitation, Universidad Rey , Alcorcón,

Madrid, Spain. cesar.fernandez@...

STUDY DESIGN: Literature review of quality of clinical trials.

OBJECTIVE: To determine the methodological quality of published

randomized controlled trials that used spinal manipulation and/or

mobilization to treat patients with tension-type headache (TTH),

cervicogenic headache (CeH), and migraine (M) in the last decade.

BACKGROUND: TTH, CeH, and M are the most prevalent types of

headaches seen in adults. Individuals who have headaches frequently

use physical therapy, manual therapy, or chiropractic care.

Randomized controlled trials are considered an optimal method with

which to assess the efficacy of any intervention. METHODS:

Computerized literature searches were performed in MEDLINE, EMBASE,

COCHRANE, AMED, MANTIS, CINHAL, and PEDro databases. Randomized

controlled trials in which spinal manipulation and/or mobilization

had been used for TTH, CeH, and M published in a peer-reviewed

journal as full text, and with at least 1 clinically relevant

outcome measure (ie, headache intensity, duration, or frequency)

were reviewed. The methodological quality of the studies was

assessed independently by 2 reviewers using a set of predefined

criteria. RESULTS: Only 8 studies met all the inclusion criteria.

One clinical trial evaluated spinal manipulation and mobilization

together, and the remaining 7 assessed spinal manipulative therapy.

No controlled trials analyzing exclusively the effects of spinal

mobilization were found. Methodological scores ranged from 35 to 56

points out of a theoretical maximum of 100 points, indicating an

overall poor methodology of the studies. Only 2 studies obtained a

high-quality score (greater than 50 points). No significant

differences in quality scores were found based on the type of

headache investigated. Methodological quality was not associated

with the year of publication (before 2000, or later) nor with the

results (positive, neutral, negative) reported in the studies. The

most common flaws were a small sample size, the absence of a placebo

control group, lack of blinded patients, and no description of the

manipulative procedure. CONCLUSIONS: There are few published

randomized controlled trials analyzing the effectiveness of spinal

manipulation and/or mobilization for TTH, CeH, and M in the last

decade. In addition, the methodological quality of these papers is

typically low. Clearly, there is a need for high-quality randomized

controlled trials assessing the effectiveness of these interventions

in these headache disorders.

Headache. <javascript:AL_get(this, 'jour', 'Headache.');> 2005

Oct;45(9):1260-3.Click here to read

<http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?PrId=3046 & itool=Abstract

Plus-def & uid=16178960 & db=pubmed & url=http://www.blackwell-synergy.com/openurl

?genre=article & sid=nlm:pubmed & issn=0017-8748 & date=2005 & volume=45 & issue=9 & spa

ge=1260>

Links <javascript:PopUpMenu2_Set(Menu16178960);>

Spinal manipulative therapy in the management of cervicogenic

headache.

*Fernández-de-Las-Peñas C*

<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed & Cmd=Search & Term=%22Fern%

C3%A1ndez-de-Las-Pe%C3%B1as%20C%22%5BAuthor%5D & itool=EntrezSystem2.PEntrez.P

ubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus>,

*Alonso-Blanco C*

<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed & Cmd=Search & Term=%22Alons

o-Blanco%20C%22%5BAuthor%5D & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_Result

sPanel.Pubmed_RVAbstractPlus>,

*Cuadrado ML*

<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed & Cmd=Search & Term=%22Cuadr

ado%20ML%22%5BAuthor%5D & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPan

el.Pubmed_RVAbstractPlus>,

*Pareja JA*

<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed & Cmd=Search & Term=%22Parej

a%20JA%22%5BAuthor%5D & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel

..Pubmed_RVAbstractPlus>.

Department of Physical Therapy, Occupational Therapy, Physical

Medicine and Rehabilitation, Universidad Rey (URJC),

Alcorcón, Madrid, Spain.

Patients suffering from cervicogenic headache (CeH) are commonly

treated with spinal manipulative therapy. We have analyzed the

quality and the outcomes of published, randomized, controlled trials

assessing the effectiveness of spinal manipulation in CeH. Among 121

relevant articles, only two met all the inclusion criteria.

Methodological quality scores were 8/10 and 7/10 points. Only one of

the trials made use of a headache diary. Both the trials reported

positive (+) results on headache intensity, headache duration, and

medication intake, so that spinal manipulative therapy obtained

strong evidence of effectiveness (level 1) with regard to these

outcomes. Conversely, spinal manipulation obtained no more than

limited evidence (level 3) in reducing headache frequency, as it was

analyzed only in one study with positive (+) results. A greater

number of well-designed, randomized, controlled trials are required

to confirm or refute the effectiveness of spinal manipulation in the

management of CeH.

Clin J Pain. <javascript:AL_get(this, 'jour', 'Clin J Pain.');> 2006

Mar-Apr;22(3):278-85.Click here to read

<http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?PrId=3159 & itool=Abstract

Plus-def & uid=16514329 & db=pubmed & url=http://meta.wkhealth.com/pt/pt-core/temp

late-journal/lwwgateway/media/landingpage.htm?an=00002508-200603000-00009>

Links <javascript:PopUpMenu2_Set(Menu16514329);>

Are manual therapies effective in reducing pain from

tension-type headache?: a systematic review.

*Fernández-de-Las-Peñas C*

<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed & Cmd=Search & Term=%22Fern%

C3%A1ndez-de-Las-Pe%C3%B1as%20C%22%5BAuthor%5D & itool=EntrezSystem2.PEntrez.P

ubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus>,

*Alonso-Blanco C*

<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed & Cmd=Search & Term=%22Alons

o-Blanco%20C%22%5BAuthor%5D & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_Result

sPanel.Pubmed_RVAbstractPlus>,

*Cuadrado ML*

<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed & Cmd=Search & Term=%22Cuadr

ado%20ML%22%5BAuthor%5D & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPan

el.Pubmed_RVAbstractPlus>,

*Miangolarra JC*

<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed & Cmd=Search & Term=%22Miang

olarra%20JC%22%5BAuthor%5D & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_Results

Panel.Pubmed_RVAbstractPlus>,

*Barriga FJ*

<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed & Cmd=Search & Term=%22Barri

ga%20FJ%22%5BAuthor%5D & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPane

l.Pubmed_RVAbstractPlus>,

*Pareja JA*

<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed & Cmd=Search & Term=%22Parej

a%20JA%22%5BAuthor%5D & itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel

..Pubmed_RVAbstractPlus>.

Department of Physical Therapy, Occupational Therapy, Physical

Medicine and Rehabilitation, Universidad Rey (URJC),

Alcorcón, Madrid, Spain. cesarfdlp@...

OBJECTIVES: A systematic review was performed to establish whether

manual therapies have specific efficacy in reducing pain from

tension-type headache (TTH). METHODS: Computerized literature

searches were performed in MEDLINE, EMBASE, AMED, MANTIS, CINAHL,

PEDro, and Cochrane databases. Papers were included if they

described clinical (open noncontrolled studies) or randomized

controlled trials in which any form of manual therapy was used for

TTH, and if they were published after 1994 in the English language.

The methodologic quality of the trials was assessed using the PEDro

scale. Levels of scientific evidence, based on the quality and the

outcomes of the studies, were established for each manual therapy:

strong, moderate, limited, and inconclusive evidence. RESULTS: Only

six studies met the inclusion criteria. These trials evaluated

different manual therapy modalities: spinal manipulation (three

trials), classic massage (one trial), connective tissue manipulation

(two trials), soft tissue massage (one trial), Dr. Cyriax's

vertebral mobilization (one trial), manual traction (one trial), and

CV-4 craniosacral technique (one trial). Methodologic PEDro quality

scores ranged from 2 to 8 points out of a theoretical maximum of 10

points (mean=5.8+/-2.1). Analysis of the quality and the outcomes of

all trials did not provide rigorous evidence that manual therapies

have a positive effect in reducing pain from TTH: spinal

manipulative therapy showed inconclusive evidence of effectiveness

(level 4), whereas soft tissue techniques showed limited evidence

(level 3). CONCLUSIONS: The authors found no rigorous evidence that

manual therapies have a positive effect in the evolution of TTH. The

most urgent need for further research is to establish the efficacy

beyond placebo of the different manual therapies currently applied

in patients with TTH.

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