Evaluation of microkinesitherapy effectiveness in post-traumatic cervicalgia: a new approach applied to previous data
Background. Cervicalgia from traumatic events such as road traffic accidents and falls can lead to musculoskeletal and soft tissue injuries with the development of pain and headache. Microkinesitherapy is a manual therapy technique that normalizes soft tissue tensions and articular range of motion throughout micropalpation. Objective. This study is a secondary analysis with a clinical significance approach to data collected in a previously published study. These data were obtained during a randomized double-blind clinical trial to evaluate the effectiveness of microkinesitherapy treatment in cervical trauma. Methods. The authors performed a secondary analysis of a previous randomized, double-blind clinical trial, using the Minimal Clinically Important Difference (MCID). This study was conducted at the Faculty of medicine of the Université Grenoble Alpes (Grenoble, FRA), and analyzed 29 patients with cervical trauma less than three months of trauma. This is a secondary analysis of data collected in a previously published randomized double-blind clinical trial where the treated group received a microkinesitherapy treatment (n= 15, 8 females) and the other group received a sham treatment (n=14, 7 females). To look at the clinical significance of those results, it was used the MCID of the instantaneous pain and cervical articular mobility, before and after the treatment or sham treatment. The clinical significance of the treatment was obtained through an inter-group comparison (Pearson’s chi-squared test) based on MCID. Results. With both threshold values, the Pearson’s chi-squared test provide a significant difference in the treatment result compared to sham group. Conclusion. The use of the MCID concept and its value is drawn from recent studies on neck pain allowed us to demonstrate, on an intergroup analysis basis, that there is a clinically significant difference in the effect of a microkinesitherapy treatment on post-traumatic neck pain as compared to a sham treatment.
1. Cohen PS. Epidemiology, Diagnosis, and Treatment of Neck Pain. Mayo Clin Proc. 2015; 90: 284-299.
2. Baconnier P, Vial B, Vaudaux G, Vaudaux, G, Maindet-Dominici C; Poquin D et al. Evaluation of the clinical effectiveness of microkinesitherapy in post-traumatic cervicalgia. A randomized, double-blinded clinical trial. MTP & Rehab Journal. 2016; 14: 385-9.
3. Pinsault N, Dolgopoloff M, Guillaud A. Letter to the Editor.MTP & Rehab Journal; 2017; 15: 497
4. Kyte DG, Clavert M, Van der Wees PJ, ten Hover R, Tolan S, Hill JC. An introduction to patient-reported outcome measures (PROMs) in physiotherapy. Physiotherapy. 2015; 101: 119-25.
5. Horn ME, Brennan GP, George SZ, Harman JS, Bishop MD. A value proposition for early physical therapist management of neck pain: a retrospective cohort analysis. BMC Health Services Research. 2016; 16: 253-61.
6. Wu X, Liu J, Tanadini LG, Wu X, Liu J, Lammertse DP et al. Challenges for defining minimal clinically important difference (MCID) after spinal cord injury. Spinal Cord. 2015; 53(2): 84-91.
7. Jeschke R, Singer J, Guyatt GH. Measurement of health statusascertaining the minimal clinically important difference. Control Clin Trials.1989;10:407-15.
8. Tubach F, Ravaud P. Minimal clinically important difference and patient acceptable symptomatic state, two concepts to help interpretation of clinical trial results. La lettre du Rhumatologue. 2006; 321: 3-4.
9. Crosby RD, Kolotkin RL, Williams R. Defining clinically meaningful change in health-related quality of life. J Clin Epidemiol. 2003; 56:395-407.
10. Tubach F, Ravaud P, Martin-Mola E, Awada H, Bellamy N, Bombardier C, et al. Minimum clinically important improvement and patient acceptable symptom state in pain and function in Rheumatoid Arthritis, ankylosing spondylitis, Chronic Back Pain, Hand Osteoarthritis, and Hip and Knee Osteoarthritis: Results from a Prospective Multinational Study. Arthr Care & Res. 2012; 11(64): 1699-707.
11. Katz P, Paillard C, Ekman E. Determining the clinical importance of treatment benefits for interventions for painful orthopedic conditions. J Orthop Surg Res. 2015; 10: 24-34.
12. Carreon LY, Glassman SD, Campbell MJ, Anderson PA. Neck Disability Index, short form-36 physical component summary, and pain scales for neck and arm pain: the minimum clinically important difference and substantial clinical benefit after cervical spine fusion. Spine. 2010; 10(6): 469-74.
13. Juul T, Søgaard K, Davis AM, Roos EM. Psychometric properties of the Neck Outcome Score, Neck Disability Index and Short Form-36 were evaluated in patients with neck pain. J Clin Epidemiol. 2016; 79: 31-40.
14. Myles PS, Myles DB, Galagher W, Boyd D, Mastigação C, MacDonald N, et al. Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state. Br J Anaesth. 2017;118(3): 424-9.
15. Pool JJM, Ostelo RWJG, Hoving JL, Bouter LM, Vet HCW. Minimal clinically important change of the Neck Disability Index and the Numerical Rating Scale for patients with neck pain. Spine. 2007; 32(26): 3047-51.
16. Cleland JA, Childs JD, Whitman JM. Psychometric properties of the Neck Disability Index and numeric pain rating scale in patients with mechanical neck pain. Arch Phys Med Rehabil. 2008 ;89:69-74.
17. Jørgensen R, Ris I, Falla D, Juul-Kristensen B. Reliability, construct and discriminative validity of clinical testing in subjects with and without chronic neck pain. BMC Musculoskeletal Disorders. 2014; 15: 408-22.
18. Jørgensen R, Ris I, Juhl C, Falla D, Juul-Kristensen B. Responsiveness of clinical tests for people with neck pain. BMC Musculoskeletal Disorders. 2017; 18: 548-55.
19. Bodian CA, Freedman G, Hossain S, Eisenkra JB, Beilin Y. The visual analog scale for pain: clinical significance in postoperative patients. Anesthesiology. 2001; 95(6): 1356-61.
20. Wiangkham T, Duda J, Haque S, Madi M, Rushton A. The effectiveness of conservative management for acute whiplash-associated disorder (WAD) II: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2015; 10(7): e0133415.
21. Grosjean D, Salgado A, Parreira R, et al. A new approach to manual therapy for the immune system: an experimental study. Int J Sci Res Methodol. 2017; 8(1): 137-48.