Specific and shared mechanisms associated with treatment for chronic neck pain: study protocol for the SS-MECH trial

ABSTRACT

Background

Treatment mechanisms involve the steps or processes through which an intervention unfolds and produces change in an outcome variable. Treatment mechanisms can be specific to the intervention provided (i.e. pain modulation) or shared with other treatments (i.e. reduced fear of movement). Whether specific and shared treatment mechanisms are different across interventions and whether they lead to the outcomes seen in trials is largely unknown. The management of individuals with chronic neck pain routinely include manual therapy (MT) and resistance exercise (RE), as both approaches are included in clinical practice guidelines and both yield similar outcomes.

Objectives

Our study plans to answer two research questions: 1) what are the specific mechanisms associated with MT versus interventions (and are these different), and 2) what are the shared mechanisms associated with these interventions, and do specific or shared mechanisms mediate clinical outcomes?

Methods

This study will involve a 2-group parallel (1:1) single-blinded randomized trial to compare the specific and potential shared treatment mechanisms between these two approaches. We will enroll individuals with a history of chronic neck pain and evaluate whether specific or shared mechanisms mediate clinical outcomes.

Results

We hypothesize that MT and RE approaches will both exhibit different specific treatment mechanisms, and that both approaches will exhibit shared treatment mechanisms, which will notably influence outcomes at both discharge and 6-months.

Conclusions

This study is important because it will help identify what specific or shared treatment mechanisms are associated with different interventions and, how different treatment mechanisms influence clinical outcomes.

KEYWORDS:

• Manual therapy
• Physical therapy
• Neck pain
• Mechanisms

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10669817.2023.2267391.

Additional information

Funding

The study is funded by the Foundation for Physical Therapy, Paris/Patla Grant.

Notes on contributors

Chad E. Cook

Chad E. Cook PT, PhD, FAPTA is a Professor in the Department of Orthopaedic Surgery in Duke University. He also has appointments in Population Health Sciences and the DUke Clinical Research Instutute. Dr Cook is an NIH and DoD funded researcher and is the Director of the Duke Center for Excellence in Manual and Manipulative Therapy.

Bryan O’Halloran

Bryan O’Halloran PT, DPT, DSc has been a clinician practice owner and clinician researcher prior to joining the Doctor of Physical Therapy program at St Joseph’s University in Philadelpia as an Asistant Professor. He completed his initial degree in Physiotherapy at Latrobe University in Melbourne, his DPT from MGH-IHP in Boston and his DSc from Andrews University in Michigan. He is a board certified orthopaedic and sports specialist and a Fellow of the American Academy of Orthopaedic Manual Physical Therapists.

Amy McDevitt

Amy McDevitt PT, DPT, PhD is an Associate Professor in the Doctor of Physical Therapy program at the University of Colorado School of Medicine. She completed her Bachelor of Science in Biology from Fairfield University, her Doctor of Physical Therapy from the University of St Augustine in Florida, and her Doctor of Philosophy in Physiotherapy from the University of Newcastle in Callahan, Australia. She is a board-certified orthopaedic physical therapist and Fellow of the American Academy of Orthopaedic Manual Physical Therapists with over 20 years of clinical experience in the managment of acute and chronic musculoskeletal conditions.

Francis J. Keefe

Francis J. Keefe is a Professor in the Department of Psychiatry and Behavioural Sciences at Duke University. He also holds appointments in Psychology and Neuroscience, Anesthesiology, Medicine and is a Member of the Duke Cancer Institute. He is an NIH funded researcher and has published over 500 peer reviewed papers.