Pragmatic application of manipulation versus mobilization to the upper segments of the cervical spine plus exercise for treatment of cervicogenic headache: a randomized clinical trial

ABSTRACT

Background

The effectiveness of manipulation versus mobilization for the management of spinal conditions, including cervicogenic headache, is conflicting. However, a pragmatic approach comparing manipulation to mobilization has not been examined in a patient population with cervicogenic headache.

Objectives

To evaluate the effectiveness of manipulation compared to mobilization applied in a pragmatic fashion for patients with cervicogenic headache.

Methods

Forty-five (26 females) patients with cervicogenic headache (mean age 47.8 ± SD 16.9 years) were randomly assigned to receive either pragmatically selected manipulation or mobilization. Outcomes were measured at baseline, the second visit, discharge, and 1-month follow-up and included the Neck Disability Index (NDI), Numeric Pain Rating Scale (NPRS), the Headache Impact Test (HIT-6), the Global Rating of Change (GRC), the Patient Acceptable Symptoms Scale (PASS). The primary aim (effects of treatment on disability and pain were examined with a mixed-model analysis of variance (ANOVA), with treatment group (manipulation versus mobilization) as the between subjects variable and time (baseline, 48 hours, discharge and follow-up) as the within subjects variable.

Results

The interaction for the mixed model ANOVA was not statistically significant for NDI (p = 0.91), NPRS (p = 0.81), or HIT (p = 0.89). There was no significant difference between groups for the GRC or PASS.

Discussion and Conclusion

The results suggest that manipulation has similar effects on disability, pain, GRC, and cervical range of motion as mobilization when applied in a pragmatic fashion for patients with cervicogenic headaches.

Clinicaltrials.gov

NCT03919630

KEYWORDS:

• Cervicogenic headache
• manipulation
• mobilization
• pragmatic

Acknowledgments

We would like to thank Alex Ivashenko and Dhaval Talati for their participation in recruitment and treatment of patients in this clinical trial. We would also like to thank all the participants who agreed to participate in this study.

Supplemental Material

Supplemental data for this article can be accessed here

Disclosure statement

Josh Cleland teaches manual therapy courses which often include techniques used in this clinical trial.

Data availability statement

The data set resides with the authors of the manuscript.

Geolocation information

Data for this study were collected from Physical Therapy Clinics Located in Pennsylvania and New Jersey.

Additional information

Funding

No funding was provided for this project.