![]() ![]() It also is not possible to easily transfer the results of pragmatic trials into the clinic as there is often little detail provided about the treatments that were performed. One disadvantage of this approach is that the treatment being tested is not standardized. This approach is consistent with traditional manual therapy practice in which techniques are individualized and determined by careful assessment of spinal pain and movement dysfunction and targeted accordingly. In many mobilization trials the approach has been pragmatic, and decisions related to the choice of technique and dosages were left to the judgment of the therapists in the trial. In clinical trials of mobilization to date there have been two distinctly different approaches to the way that mobilization has been applied. This type of trial is important because it is not known whether certain approaches to manual therapy are more effective than others. There is considerable diversity between and even within these disciplines and to date there have been few head-to-head clinical trials that have directly compared different mobilization techniques or approaches. Cervical spine mobilization is practiced by a range of different disciplines including physiotherapists, chiropractors, osteopaths and some medical practitioners. One of the barriers to better understanding the efficacy of cervical spine mobilization is the diversity of techniques and approaches employed. Further investigation of mobilization has been highlighted as a research priority by the Cochrane Back and Neck Group, as potentially serious adverse events are associated with manipulation. There is some evidence that cervical spine mobilization provides small improvements in neck pain at short term follow-up but limited evidence of clinically significant outcomes in the longer term. It is distinguished from cervical manipulation in that it does not involve application of a rapid thrust or production of an audible ‘crack’ that is associated with spinal manipulation. Mobilization is a manual therapy technique that involves application of low-velocity, passive inter-vertebral movements that are within the patient’s range of motion and their control. Ĭervical spine mobilization is widely used in the management of mechanical neck pain. Trial registration: Australian New Zealand Clinical Trials Registry (ACTRN12616000446460). Our results provide supporting evidence for the feasibility of a future larger scale randomized clinical trial. There was sufficient variety in the range of pragmatic treatments selected and the data collection process imposed minimal burden on participants. Recruitment rates were approximately 2.5 participants per week and 100% of eligible participants were deemed suitable for treatment with cervical mobilization. The primary clinical outcome of interest was disability level measured at 48-h follow-up after randomization. Feasibility outcomes were recruitment rates, randomization audit and completion of treatment and follow-up per protocol. The prescriptive group received a single treatment of standardized mobilization with techniques similar to a previous mobilization clinical trial. The pragmatic group received a single treatment of cervical mobilization with the technique, target segment, and grade selected by their treating therapist. Twenty adults with a new episode of mechanical neck pain were randomly allocated to either pragmatic or prescriptive mobilization intervention groups. The objective of this pilot study was to assess feasibility aspects for a future randomized clinical trial by exploring short-term pain and disability outcomes after a single treatment with pragmatic versus prescriptive approaches to cervical mobilization for people with recent-onset neck pain at 48-h follow-up after randomization. Two distinct approaches to the practice of mobilization have emerged in recent years, based on different reasoning models for selection of mobilization techniques. ![]() Backgroundīetter understanding of the relative effectiveness of different approaches to cervical spine mobilization has been identified as a research priority in manual therapy practice. ![]()
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