Table 5 Secondary outcome measures results
Study | Intervention (N) | Comparator (N) | Secondary outcome measures | Key findings |
|---|---|---|---|---|
Bodes-Pardo et al. [51] | Trigger point therapy + stretching (10) | Sham trigger point therapy (10) | Neck pain intensity (VAS), Cervical spine ROM (CROM device), Cervical pressure pain threshold (algometer), Deep Cervical flexors performance (CCFT) | P < 0.001 for neck pain intensity, CCFT, pressure pain thresholds and CROM at 1 week. MCID reached for CROM (MD = 8.2–13.6°) |
Chaibi et al. [52] | Cervical manipulation (4) | Sham manual therapy (4); Control (4) | CGH duration (hrs/day) | P values not calculated due to small sample size |
Dunning et al. [53] | Cervical and thoracic manipulation (58) | Cervical and thoracic mobilization and cranio-cervical flexion exercises (52) | CGH duration (hrs in the last week), Disability (NDI), Global Rating of Change scale (GRC), Drugs intake | P < 0.001 for NDI and GRC at 1, 4 weeks and 3 months. P < 0.05 for headache duration at 1 week and 3 months. P < 0.001 for medication intake at 3 months. MCID proposed by the study for NDI were reached (MD = − 11,6 at 4 weeks) |
Esin et al. [54] | Kinesiotaping (34) | Sham taping (34); Education and autonomous rehabilitation instructions (33) | Pressure pain threshold (cervical, sub-occipital, trapezius muscles) | P < 0.01 for pressure pain threshold at 4 and 8 weeks |
Haas et al. [55] | Cervical and thoracic manipulation—8 sessions (20) | Moist heat and light massage—8 sessions (20) | Disability (MVK), Drugs intake (N in the past 4 weeks), Other headache frequency (episodes in the past month) | Intervention main effect: P < 0.05 for other headache frequency and medication intake at 24 weeks. P < 0.05 for Disability at 12 weeks |
Cervical and thoracic manipulation—16 sessions (20) | Moist heat and light massage—16 sessions (20) | Disability (MVK), Drugs intake (N in the past 4 weeks), Other headache frequency (episodes in the past month) | Intervention main effect: P < 0.05 for other headache frequency and medication intake at 24 weeks. P < 0.05 for Disability at 12 weeks | |
Haas et al. [56] | Cervical and thoracic manipulation—6 sessions (65) | Sham massage (64) | Disability (HIT-6), Perceived change (0-points scale), Quality of life (VAS 0–100), Subjective CGH improvement (20-points scale), satisfaction (7-points Likert scale), neck pain frequency | P < 0.05 for Disability at 6 and 24 weeks |
Cervical and thoracic manipulation—12 sessions (64) | Sham massage (64) | Disability (HIT-6), Perceived change (0-points scale), Quality of life (VAS 0–100), Subjective CGH improvement (20-points scale), satisfaction (7-points Likert scale), neck pain frequency | P < 0.05 for Disability, neck pain frequency and intensity at 6 weeks. P < 0.05 for perceived change at 6 and 24 weeks | |
Cervical and thoracic manipulation—18 sessions (63) | Sham massage (64) | Disability (HIT-6), Perceived change (0-points scale), Quality of life (VAS 0–100), Subjective CGH improvement (20-points scale), satisfaction (7-points Likert scale), neck pain frequency | P < 0.05 for Disability, perceived change and neck pain frequency at 6 and 24 weeks. P < 0.05 for neck pain intensity at 6 weeks | |
Hall et al. [57] | C1-2 SNAG (16) | Sham SNAG (16) | Cervical spine ROM (CROM device during FRT) | P < 0.001 for CROM (FRT), MCID reached (MD = 11–20°) after 1st intervention |
Jafari et al. [58] | Trigger point therapy (9) | No treatment control (10) | Change in elastic modulus in trigger point area (Pa), Trigger point area (cm2), Pressure pain threshold (Algometer, VAS), CGH duration (hrs in the last 2 weeks) | P < 0.05 for headache duration, pressure pain threshold, TrP area at 3 weeks |
Jull et al. [59] | Spinal mobilization and manipulation (51) | No treatment control (48) | Cervical pressure pain threshold (VAS), Deep Cervical flexors performance (CCFT), Pain with neck movement (VAS), Neck pain index (Northwick Park), CGH duration (hrs in the past week), Medication intake | P < 0.05 for neck pain index, headache duration and pain on palpation at 7 weeks and 12 months. P < 0.05 for pain with neck movements at 7 weeks. P < 0.015 for medication intake at 12 months. P > 0.05 for CCFT at 7 weeks and 12 months |
Low load endurance exercises for cervico-scapular muscle (52) | No treatment control (48) | Cervical pressure pain threshold (VAS), Deep Cervical flexors performance (CCFT), Pain with neck movement (VAS), Neck pain index (Northwick Park), CGH duration (hrs in the past week) | P < 0.05 for neck pain index and pain with neck movement at 7 weeks and 12 months. P < 0.05 for pain on palpation at 7 weeks. P < 0.015 for medication intake at 12 months. P < 0.001 for CCFT at 7 weeks and 12 months | |
Combination of the above (49) | No treatment control (48) | Cervical pressure pain threshold (VAS), Deep Cervical flexors performance (CCFT), Pain with neck movement (VAS), Neck pain index (Northwick Park), CGH duration (hrs in the past week) | P < 0.05 for neck pain index, headache duration and pain on palpation at 7 weeks and 12 months. P < 0.05 for pain with neck movements at 7 weeks. P < 0.015 for medication intake at 12 months. P < 0.001 for CCFT at 7 weeks, P < 0.01 at 12 months | |
Malo-Urriès et al. [60] | Upper cervical mobilization (41) | No treatment control (41) | General cervical spine ROM (using CROM device), Upper cervical spine ROM (using CROM device during FRT), Cervical, suboccipital, trapezius pressure pain threshold (Algometer, Kg/cm2) | P > 0.05 for pressure pain thresholds. P < 0.05 for general cervical ROM (flexion, left rotation), P = 0.006 for right FRT and P < 0.001 for left FRT post intervention. MCIDs for FRT were reached (MD + 5.4° to 7.4°) |
Nilsson et al. [61] | Cervical manipulation (28) | G2: Deep friction massage, trigger point therapy to upper back and neck, laser light therapy (26) | Medication intake (N/day) | P = 0.14 at week 5, with P < 0.05 after X2 test for type-2 error. Within-group changes saw P < 0.0001 in the experimental group |
Sedighi et al. [62] | Sub-occipital and trapezius dry needling (15) | Sham sub-occipital and trapezius dry needling (15) | Cervical spine ROM (4-points scale), Sub-occipital and trapezius pressure pain threshold (4-points scale), Function (FRI) | P < 0.01 for FRI at 1 week. Within-group changes only were provided for other outcomes, with P < 0.05 for ROM and P < 0.001 for trigger point tenderness in the MT group at 1 week |
Sharma et al. [63] | Multimodal therapy (spinal mobilization, low load and mobility exercise program for the cervical spine, postural correction intervention) (9) | Postural correction (9) | Deep Cervical flexors performance (CCFT), Disability (NDI), CGH duration (hrs in the past week) | P = 0.001 for all outcome measures at 4 weeks. NDI MCID cannot be assessed due to absence of raw data |
Exercise therapy (low load and mobility exercise program for the cervical spine, postural correction intervention) (9) | Postural correction (9) | Deep Cervical flexors performance (CCFT), Disability (NDI), CGH duration (hrs in the past week) | P = 0.001 for all outcome measures at 4 weeks. NDI MCID cannot be assessed due to absence of raw data | |
von Piekartz et al. [64] | Manual therapy + exercise (TMJ manual therapy, TMJ coordination and ROM exercises) (22) | Usual care (cranio-cervical manual and exercise therapy) (21) | Anamnestic questionnaire (AQ), Graded-chronic pain status (GCPS-NL, scale 1 to 4), Temporo-mandibular pressure pain threshold (Digital algometer, Kgf), Disability (NDI), TMJ noise (presence/absence of click), TMJ-related disability (GCPS), TMJ ROM (cm), Pain with TMJ opening, Mandibular deviation (presence/absence) | Between-group P < 0.05 for all outcomes at 3 months. P < 0.05 for AQ, GCPS, pressure pain thresholds, TMJ noise, pain with TMJ opening at 6 months. MCID proposed by the study reached for NDI (− 6.5 at 3 months), not for mouth opening ROM at both timepoints |
Yang and Shanb [65] | Hot pack and low frequency therapy on trapezius + cranio cervical flexion exercises (10) | Hot pack and low frequency therapy on trapezius (10) | Muscular fatigue (Hz), Muscle tone (N/m) | P < 0.05 for change in muscle fatigue for SCM and UFT muscles at 2 and 4 weeks. P < 0.05 for change in muscle tone at left UT and bilateral SCM at 2 and 4 weeks |
Hot pack and low frequency therapy on trapezius + sub-occipital relaxation (10) | Hot pack and low frequency therapy on trapezius (10) | Muscular fatigue (Hz), Muscle tone (N/m) | P < 0.05 for change in muscle fatigue for SCM and UFT muscles at 2 and 4 weeks. P < 0.05 for change in muscle tone at left UT and bilateral SCM at 2 and 4 weeks | |
Youssef and Shanb [66] | Cervical mobilization and exercise (20) | Massage and exercise (18) | Cervical spine ROM (cm), Disability (NDI), CGH duration (hours/week) | P < 0.05 for all ROM directions and CGH duration at 7 weeks. Between-group P = 0.26 for NDI at 7 weeks, but within-group P < 0.001 and MCID were reached (− 27.2 at 7 weeks) |
Abdel et al. [67] | Exercise Therapy (stretching, isometric contractions, postural correction) + Graston technique (30) | Exercise Therapy (stretching, isometric contractions, postural correction) (30) | Disability (NDI), Cervical spine ROM (CROM device), HD (hours in the past week), Medication intake | Within-group P < 0.05 for flexion, left lateral flexion and right lateral flexion CROM at 2 weeks in the conrol group; P < 0.0001 for all other outcomes at all timepoints in both groups, and for between-groups differences at 4 weeks favouring Graston technique. MCIDs reached for NDI (MD = 11.1 at 4 weeks) |
Dunning et al. [68] | Spinal manipulation and electrical dry needling (74) | Spinal mobilization and scapular and cranio-cervical exercise (68) | HD (hours in the past week), Disability (NDI), Global Rating of Change (GROC), Medication intake | Between-group P < 0.001 for HD at all timepoints, for GRC and Medication intake at 3 months. MCIDs reached for NDI (MD = 14.4 at 4 weeks and 16.9 at 3 months) and between-group P < 0.001 at all timepoints |
Lerner-Lentz et al. [69] | Spinal manipulation, cranio-cervical and scapular exercise (21) | Spinal mobilization and scapular and cranio-cervical exercise (24) | Disability (NDI), Headache Impact Test (HIT-6), Globale Rate of Change (GRC), Patient Acceptable Symptoms Scale (PASS) | MCIDs reached for NDI in both groups (MD = 13.9 for manipulation and MD = 12.8 for mobilization group at 1 month). Within-group P < 0.05 at all timepoionts for all groups for all secondary outcomes. Between-groups P > 0.05 at all time points |
Moustafa et al. [70] | Myofascial release, spinal mobilization, cranio-cervical and scapular exercise, Dennerol cervical extension traction (30) | Myofascial release, spinal mobilization, cranio-cervical and scapular exercise (30) | Disability (HIT-6; HDI), Radiographic cervical alignment variables, Daily Defined Dose (DDD) | Within-group P < 0.001 for HIT-6, HDI, DDD at 10 weeks for the control group, and at all time points for the intervention group. Between group P > 0.05 at 10 weeks for HIT-6, HDI, DDD. Between group P < 0.001 at all timepoints favouring the experimental group for Radiographic variables, and for all other outcome measures at 1 and 2-years follow ups |