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Effectiveness and cost-effectiveness of Chuna manual therapy for temporomandibular disorder: A randomized clinical trial
The effectiveness and cost-effectiveness of Chuna manual therapy (CMT) for temporomandibular joint disorders (TMD) remain unclear. Here, we compared the effectiveness of CMT and usual care for treating myofascial TMD. A 26-week randomized controlled trial was conducted from 2018 to 2019 with 80 patients across five hospitals in Korea who were diagnosed with myofascial TMD and had temporomandibular joint (TMJ) pain lasting more than three months. Patients were randomly assigned in a 1:1 ratio to either the CMT group, which underwent eight sessions of CMT over four weeks, or the usual care (UC) group, which received physical therapy for the same period. Treatment effectiveness was evaluated in terms of pain, function, and quality of life over 26 weeks. For determining cost-effectiveness, quality-adjusted life years (QALY) were analyzed, and the incremental cost-effectiveness ratios from the societal and healthcare system perspectives were calculated. At week 5, the visual analog scale (VAS) scores decreased more in the CMT group than in the control group, although the difference was statistically insignificant. The CMT group showed significant improvement in specific functional and quality of life measures, particularly in the EuroQoL-VAS (-13.21 (95% confidence interval [CI] -20.03 to -6.38) and the Jaw Functional Limitation Scale-Global score of 0.59 (95% CI 0.13 to 1.05), through improvements were not consistent across all indices. The CMT group showed a slightly higher QALY, and the 26-week incremental cost in the CMT group was$338 lower than that of the usual care group. The cost of CMT was $ 150 higher than that of usual care, and the incremental cost-effectiveness ratio per utility ranged from$4,011 to $ 17,851. When a “willingness to pay for treatment ($26,375)” threshold was applied, the probability of CMT being cost-effective was 68.1%–98.3%. Despite no significant differences in pain reduction at week 5, CMT was found to be a cost-effective treatment for TMD, particularly for improving function and quality of life. These findings may serve as a basis for considering the expansion of national health insurance coverage for Chuna therapy in Korea. Trial Registration: Clinical Research Information Service KCT0003192
Journal Article
The effect of manual therapy and stabilizing exercises on forward head and rounded shoulder postures: a six-week intervention with a one-month follow-up study
Background
The purpose of this study is to evaluate the effect of a six-week combined manual therapy (MT) and stabilizing exercises (SEs), with a one-month follow-up on neck pain and improving function and posture in patients with forward head and rounded shoulder postures (FHRSP).
Methods
Sixty women with neck pain and FHRSP were randomized into three groups: Group 1 performed SE and received MT (
n
= 20), Group 2 performed SE (n = 20) and Group 3 performed home exercises (n = 20) for six weeks. The follow-up time was one month after the post test. The pain, function, and head and shoulder angles were measured before and after the six-week interventions, and during a one-month follow-up.
Results
There were significant within-group improvements in pain, function, and head and shoulder posture in groups 1 and 2. There were significant between-group differences in groups 1 and 2 in head posture, pain, and function favoring group 1 with effect size 0.432(
p
= 0.041), 0.533 (
P
= 0.038), and 0.565(
P
= 0.018) respectively. There were significant between-group differences in both intervention groups versus the control group favoring the intervention groups.
Conclusion
These findings suggest that both interventions were significantly effective in reducing neck pain and improving function and posture in patients. However, the improvement in function and pain were more effective in Group 1 as compared to Group 2, suggesting that MT can be used as a supplementary method to the stabilizing intervention in the treatment of neck pain. More researches are needed to confirm the result of this study.
Trial registration
UMIN000030141
modified on 2018.03.08.
This study is a randomized control trial registered at UMIN-CTR website, the trial was retrospectively registered and the unique trial number is
UMIN000030141
.
Journal Article
Connective tissue massage : Bindegewebsmassage according to Dicke
\"In 1929 Germany, physiotherapist Elisabeth Dicke suffered from poor circulation in her right leg, acute back pain, and a host of other ailments. With no medical options offered beyond amputation of the leg, she turned to her own training for help. She began to massage the skin and subcutaneous fascia of the sacral bone and pelvic crest with pulling strokes. After several applications, she experienced less back pain, increased circulation to the leg, and within three months, disappearance of all symptoms. This was the beginning of Dickes systematic, scientifically based treatment method of connective tissue massage (or Bindegewebsmassage), now in wide use throughout the world. In this book, practitioners will get the first detailed, how-to description of connective tissue massage (CTM) {in the English language} including the principles, knowledge, and skills to implement it. Special Features: Begins with the origin and practical benefits of CTM, including its neuroanatomical and neurophysiological basis, Explores the relationship between the sensory, motor, and autonomic nervous systems and the complex reflex mechanisms that are activated by CTM therapy, Describes and illustrates specific stroking techniques that trigger the appropriate neural reflexes in every body segment, Shows how to make a diagnostic assessment based on skin, connective tissue, and muscle zones, Covers the full range of orthopedic, neurological, internal medicine, and gynecologic disorders that can be effectively treated with CTM. Complete with treatment plans, indications and contraindications, and modern medical guidelines, this book is essential for all physical and massage therapists and osteopaths who want to successfully integrate CTM into their practices. It is also a fascinating reference for physicians and other medical professionals who are interested in learning more about this important manual technique.\" --Provided by publisher.
Book
Chuna Manual Therapy vs Usual Care for Patients With Nonspecific Chronic Neck Pain
The incidence rate of neck pain is increasing worldwide, and the disease is associated with a high social burden. Manual therapy has been widely applied in the treatment of neck pain, but a high-quality, pragmatic randomized clinical trial for this treatment has not been conducted to date.
This study aimed to compare the effectiveness of Chuna manual therapy with that of usual care for patients with chronic neck pain.
A multicenter, assessor-blinded, pragmatic, randomized clinical trial was conducted between October 18, 2017, and June 28, 2019. This intention-to-treat analysis included 108 patients with chronic neck pain persisting for at least 3 months; patients were recruited from 5 hospitals in Korea.
Ten sessions (2 sessions per week for 5 weeks) of Chuna manual therapy or usual care (electrotherapy and oral medication) were conducted.
The main outcome was the difference in visual analog scale (VAS) score for chronic neck pain between baseline and 5 weeks after randomization.
This randomized clinical trial recruited 108 patients (mean [SD] age, 38.4 [9.3] years; 73 women [67.6%]). Fifty-four patients were allocated to the Chuna therapy group, and 54 received usual care. At 5 weeks after randomization, manual therapy showed statistically superior results compared with usual care in terms of pain (difference in chronic neck pain VAS, 16.8 mm; 95% CI, 10.1-23.5 mm), function (difference in Neck Disability Index, 8.6%; 95% CI, 4.2%-13.1%), and quality of life (difference in the European Quality of Life-5 Dimension 5 Levels (EQ-5D-5L) scores, -0.07 points; 95% CI, -0.11 to -0.02 points). Regarding the 1-year cumulative values measured using area under the curve analyses, superior outcomes were attained in the manual therapy group in terms of the numerical rating scale for chronic neck pain (1.3 points; 95% CI, 0.5-2.0 points), Neck Disability Index (6.7%; 95% CI, 2.5%-10.9%), Neck Pain Questionnaire (7.4%; 95% CI, 2.3%-12.6%), and EQ-5D-5L scores (-0.03 points; -0.07 to 0.00 points).
In this randomized clinical trial, for patients with chronic neck pain, Chuna manual therapy was more effective than usual care in terms of pain and functional recovery at 5 weeks and 1 year after randomization. These results support the need to consider recommending manual therapies as primary care treatments for chronic neck pain.
ClinicalTrials.gov identifier: NCT03294785.
Journal Article
Cost-effectiveness of manual therapy versus physiotherapy in patients with sub-acute and chronic neck pain: a randomised controlled trial
Purpose
To evaluate the cost-effectiveness of manual therapy according to the Utrecht School (MTU) in comparison with physiotherapy (PT) in sub-acute and chronic non-specific neck pain patients from a societal perspective.
Methods
An economic evaluation was conducted alongside a 52-week randomized controlled trial, in which 90 patients were randomized to the MTU group and 91 to the PT group. Clinical outcomes included perceived recovery (yes/no), functional status (continuous and yes/no), and quality-adjusted life-years (QALYs). Costs were measured from a societal perspective using self-reported questionnaires. Missing data were imputed using multiple imputation. To estimate statistical uncertainty, bootstrapping techniques were used.
Results
After 52 weeks, there were no significant between-group differences in clinical outcomes. During follow-up, intervention costs (β:€−32; 95 %CI: −54 to −10) and healthcare costs (β:€−126; 95 %CI: −235 to −32) were significantly lower in the MTU group than in the PT group, whereas unpaid productivity costs were significantly higher (β:€186; 95 %CI:19–557). Societal costs did not significantly differ between groups (β:€−96; 95 %CI:−1975–2022). For QALYs and functional status (yes/no), the maximum probability of MTU being cost-effective in comparison with PT was low (≤0.54). For perceived recovery (yes/no) and functional status (continuous), a large amount of money must be paid per additional unit of effect to reach a reasonable probability of cost-effectiveness.
Conclusions
From a societal perspective, MTU was not cost-effective in comparison with PT in patients with sub-acute and chronic non-specific neck pain for perceived recovery, functional status, and QALYs. As no clear total societal cost and effect differences were found between MTU and PT, the decision about what intervention to administer, reimburse, and/or implement can be based on the preferences of the patient and the decision-maker at hand.
Trial registration
ClinicalTrials.gov Identifier: NCT00713843
Journal Article
Does the Addition of Manual Therapy Approach to a Cervical Exercise Program Improve Clinical Outcomes for Patients with Chronic Neck Pain in Short- and Mid-Term? A Randomized Controlled Trial
Chronic neck pain is one of today’s most prevalent pathologies. The International Classification of Diseases categorizes four subgroups based on patients’ associated symptoms. However, this classification does not encompass upper cervical spine dysfunction. The aim is to compare the short- and mid-term effectiveness of adding a manual therapy approach to a cervical exercise protocol in patients with chronic neck pain and upper cervical spine dysfunction. Fifty-eight subjects with chronic neck pain and upper cervical spine dysfunction were recruited (29 = Manual therapy + Exercise; 29 = Exercise). Each group received four 20-min sessions, one per week during four consecutive weeks, and a home exercise regime. Upper flexion and flexion-rotation test range of motion, neck disability index, craniocervical flexion test, visual analogue scale, pressure pain threshold, global rating of change scale, and adherence to self-treatment were assessed at the beginning, end of the intervention and at 3- and 6-month follow-ups. The Manual therapy + Exercise group statistically improved short- and medium-term in all variables compared to the Exercise group. Four 20-min sessions of Manual therapy + Exercise along with a home-exercise program is more effective in the short- to mid-term than an exercise protocol and a home-exercise program for patients with chronic neck pain and upper cervical dysfunction.
Journal Article