Manipulação e mobilização cervical são eficazes para reduzir a dor e incapacidade em adultos com dor cervical crônica inespecífica? Uma revisão sistemática com metanálise

Abstract

The isolated efficacy of mobilization or manipulation for chronic non-specific neck pain is still uncertain. This systematic review investigated whether neck manipulation and mobilization are effective in reducing pain and disability in patients with chronic nonspecific neck pain. A comprehensive search was carried out in the Pubmed, Embase, PeDro, CINAHL and Cochrane Library databases using terms such as "Pain, Neck, "Manipulations, Musculoskeletal" and "Clinical Trial" to filter out clinical trials, without language restriction, published up to March 2023. Only randomized clinical trials with adults over the age of 18, of both sexes, diagnosed with chronic, non-specific neck pain, treated with neck manipulations and mobilizations and compared with a control group (inactive or no intervention) were included in this review. The primary outcomes were pain intensity, pressure pain threshold and neck disability. Secondary outcomes were range of motion and the presence of adverse events mentioned in the included studies. All outcomes were analyzed immediately after the interventions and in the short, medium and long term. The PEDro scale was used to assess the risk of bias of the included clinical trials, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess the quality of the evidence. A total of 6,511 studies were identified in the databases. Of these, seven studies (n = 367) were included in the review, and of these three studies (n = 155) that used only neck manipulation were included for quantitative analysis. In terms of pressure pain threshold, there were no differences between neck manipulation or simulated manipulation immediately after the intervention (MD = 27.04, 95% CI = -31.01 to 85.09; I² = 70%, p = 0.003). For pain intensity, neck manipulation was superior to sham manipulation immediately after the intervention (MD = -1.30, 95% CI = -1.52 to -1.08; I² = 3%, p = 0.092) and in the short term (MD = -0.84, 95% CI = -0.99 to -0.68; I² = 0%, p = 0.037). Furthermore, neck manipulation was superior to simulated manipulation for improving disability in the short term (MD = -11.55, 95% CI = -12.79 to -10.32; I² = 0% p = 0.86). Only one study monitored adverse events - the presence of transient mild pain. Based on the evidence that ranged from "very low to low" quality in this review, there are no recommendations to support the use of neck manipulation to reduce the pressure pain threshold immediately after the intervention in patients with chronic non-specific neck pain. However, neck manipulation reduced pain intensity immediately after intervention and in the short term, as well as improving short-term disability in this population.