A pilot randomized clinical trial on the relative effect of instrumental (MFMA) versus manual (HVLA) manipulation in the treatment of cervical spine dysfunction

Objective: To determine the relative effect of instrument-delivered thrust cervical manipulations in comparison with traditional manual-delivered thru st cervical manipulations in the treatment of cervical spine dysfunction. Design: Prospective, randomized, comparative clinical trial. Setting: Outpatient chiropractic clinic, Technikon Natal, South Africa. Pat ients: Thirty patients diagnosed with neck pain and restricted cervical spi ne range of motion without complicating pathosis for at least I month were included in the study. Interventions: The patients were randomized into 2 groups. Those in one gro up received mechanical force, manually assisted (MFMA) manipulation to the cervical spine, delivered by means of a hand-held instrument (Activator II Adjusting Instrument). Those in the other group received specific contact h igh-velocity, low-amplitude (HVLA) manipulation consisting of standard Dive rsified rotary/lateral break techniques to the cervical spine. Each group r eceived only the specific therapeutic intervention, no other treatment moda lities or interventions (including medication) being used, until asymptomat ic status was achieved or a maximum of 8 treatments had been received. Main Outcome Measures: Both treatment groups were assessed through use of s ubjective (Numerical Pain Rating Scale 101, McGill Short-Form Pain Question naire, and Neck Disability Index) and objective (goniometer cervical range of motion) measurement parameters at specific intervals during the treatmen t period and at 1-month follow-up. The data were assessed through use of 2- tailed nonparametric paired and unpaired analysis, descriptive statistics, and power analysis of the data. Results: The results indicate that both treatment methods had a positive ef fect on the subjective and objective clinical outcome measures, no signific ant difference being observed between the 2 groups (P < .025). The subjecti ve data from all 3 questionnaires showed statistically significant changes from initial to final consultations as well as from initial consultation to 1-month follow-up (P < .025). The objective range of motion measures showe d statistically significant changes in the MFMA group for left and right ro tation and left and right lateral flexion from initial consultation to fina l consultations and for right rotation and right lateral flexion from initi al consultation to 1-month follow-up. The HVLA group showed only the change in left rotation from initial to final consultations and from initial cons ultation to 1-month follow-up to be statistically significant. Conclusions: The results of this clinical trial indicate that both instrume ntal (MFMA) manipulation and manual (HVLA) manipulation have beneficial eff ects associated with reducing pain and disability and improving cervical ra nge of motion in this patient population. A randomized, controlled clinical trial in a similar patient base with a larger sample size is necessary to verify the clinical relevance of these findings.