Comparative Effectiveness and Cost-effectiveness of Chuna Manual Therapy for Chronic Neck Pain

Jaseng Medical Foundation108 enrolled

Overview

A multi-center randomized controlled trial assessing the comparative effectiveness and cost-effectiveness of Chuna manual therapy for chronic neck pain

A multi-center randomized controlled, parallel, assessor-blinded trial will be conducted to evaluate the comparative clinical effectiveness and cost-effectiveness of Chuna manual therapy for chronic neck pain patients compared to usual care as assessed using pain, functional disability, health-related quality of life, economic evaluation, and safety measures.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

108

Conditions

Chronic Neck Pain

Interventions

Chuna manual therapyPROCEDURE

Chuna is a Korean manual therapy that has absorbed and incorporated aspects of osteopathic manipulative medicine. Chuna manual therapy utilizes spinal manipulation techniques for joint mobilization including high-velocity, low amplitude thrusts to joints slightly beyond the passive range of motion and gentle force to joints within the passive range of movement, muscle energy, and fascial techniques.

Conventional medicationDRUG

Conventional drugs will be prescribed in an individually-tailored, pragmatic method with reference to most frequently used treatments in patients with a primary diagnosis of cervical sprain/strain group, cervical disc disorder with radiculopathy group, or cervicalgia according to Korean Health Insurance Review and Assessment (HIRA) 2014 statistics.

Physical therapy

Eligibility

Sex: ALLMin age: 19 YearsMax age: 60 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Chronic neck pain patients (with pain duration of 3 months or longer) * Patients with numeric rating scale (NRS) of radicular pain ≤ neck pain in neck pain patients with or without radiculopathy * Patients with NRS of neck pain ≥5 during the 3 days * Patients who have agreed to trial participation and provided written informed consent Exclusion Criteria: * Patients diagnosed with serious pathology(s) which may cause neck pain (e.g. spinal metastasis of tumor(s), acute fracture, spinal dislocation) * Patients with history of neck surgery * Patients with other chronic disease(s) which may interfere with treatment effect, safety, or interpretation of outcomes (e.g. chronic renal failure, vertebral artery complications, rheumatoid arthritis, Down syndrome) * Patients with progressive neurologic deficit or severe neurologic symptoms such as spinal cord injury * Patients with severe mental illness * Patients currently taking steroids, immunosuppressants, medicine for mental illness or other medication(s) that may interfere with study results * Patients who have received Chuna manual therapy or physical therapy, medicine such as nonsteroidal anti-inflammatory drugs (NSAIDs), or treatment(s) that may influence pain within the past week * Pregnant patients or patients with plans of pregnancy * Patients participating in other clinical studies or otherwise deemed unsuitable by the researchers

Locations (5)

Bucheon Jaseng Hospital of Korean Medicine

Bucheon-si, Gyeonggi-do, South Korea

Haeundae Jaseng Hospital of Korean Medicine

Busan, South Korea

Daejeon Jaseng Hospital of Korean Medicine

Daejeon, South Korea

Jaseng Hospital of Korean Medicine

Seoul, South Korea

Outcomes

Primary Outcomes

Difference between visual analogue scale (VAS) of neck pain for the past 3 days at 5 weeks post-baseline and baseline

VAS uses a 10cm line labeled at each end with scale anchors. In pain measurement using VAS, patients are asked to mark a point that represents their pain between the anchors of 'no pain' and 'worst pain possible' (labels may vary by study). Scores are recorded in millimeters with a total range of 0-100 millimeters.

Time frame: Week 5 post-baseline (screening)

Secondary Outcomes

Difference between visual analogue scale (VAS) of radiating arm pain for the past 3 days at each timepoint and baseline, respectively

Time frame: Week 1, 2, 3, 4, 5, 6 post-baseline (screening)

Difference between numeric rating scale (NRS) of neck pain for the past 3 days at each timepoint and baseline, respectively

In pain measurement using NRS, patients are asked to rate their pain by selecting a number from 0 to 10 that best represents their pain severity between the anchors of 0 which indicates 'no pain', and 10 which indicates 'worst pain possible'.

Time frame: Week 1, 2, 3, 4, 5, 6, Month 3, 6, 9, 12 post-baseline (screening)

Difference between numeric rating scale (NRS) of radiating arm pain for the past 3 days at each timepoint and baseline, respectively

Time frame: Week 1, 2, 3, 4, 5, 6, Month 3, 6, 9, 12 post-baseline (screening)

Data from ClinicalTrials.gov

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Physical therapy will be prescribed in an individually-tailored, pragmatic method with reference to most frequently used treatments in patients with a primary diagnosis of cervical sprain/strain group, cervical disc disorder with radiculopathy group, or cervicalgia according to Korean Health Insurance Review and Assessment (HIRA) 2014 statistics.

Kyung Hee University Oriental Medicine Hospital at Gangdong

Seoul, South Korea

Difference between Neck Disability Index (NDI) at each timepoint and baseline, respectively

The NDI evaluates functional impairment and is a 10-item questionnaire developed to assess the level of disability due to neck pain. Each item is graded into 6 levels, each representing a score of 0-5. Higher scores indicate greater limitation relating to neck pain.

Time frame: Week 1, 6, Month 3, 6, 9, 12 post-baseline (screening)

Difference between Northwick Park Neck Pain Questionnaire (NPQ) at each timepoint and baseline, respectively

The NPQ evaluates functional impairment for the past 3 days in this study and is a patient reported outcome of subjective neck pain and pain reduction. The NPQ is a 9-item questionnaire developed to assess the level of disability due to neck pain. Each item is graded into 5 levels, each representing a score of 0-4. Higher scores indicate greater limitation relating to neck pain.

Time frame: Week 1, 6, Month 3, 6, 9, 12 post-baseline (screening)

Patient Global Impression of Change (PGIC)

PGIC grades the level of subjective improvement into 7 levels (1, very much improved; 2, much improved; 3, slightly improved; 4, no change; 5, slightly worse; 6, much worse; and 7, very much worse).

Time frame: Week 6, Month 3, 6, 9, 12 post-baseline (screening)

Physical examination

Pain upon movement in cervical range of motion (ROM) will be assessed.

Time frame: Week 1, 6 post-baseline (screening)

Difference between the 5 level version of EuroQol-5 Dimension (EQ-5D-5L) at each timepoint and baseline, respectively

EQ-5D is a tool developed for health-related quality of life (HRQoL) assessment, and is widely used in the health care sector. Scores range from -1, 'health worse than death' to 1, 'perfect health'. EQ-5D-5L has 5 dimensions covering current health status and functionality: mobility (M), self care (SC), usual activities (UA), pain/discomfort (PD), and anxiety/depression (AD), to be rated out of 5 grades (1, no problem; 2, slight problem; 3, some/moderate problem; 4, severe problem; 5, extreme problem).

Time frame: Week 1, 6, Month 3, 6, 9, 12 post-baseline (screening)

Difference between the EuroQol Visual Analogue Scale (EQ-VAS) at each timepoint and baseline, respectively

EQ-VAS uses a vertical 10cm line labeled at each end with scale anchors. EQ-VAS is used to indicate the patient's health state and patients are asked to mark a point that represents their health state between the anchors of 'worst health state' and 'best health state imaginable'. Scores are recorded in millimeters with a total range of 0-100 millimeters.

Time frame: Week 1, 6 post-baseline (screening)

Difference between the Short Form Health Survey 12 (SF-12) at each timepoint and baseline, respectively

SF-12 is a simplified version of SF-36. SF-12 assesses health-related quality of life (HRQoL) across 8 domains with 1-2 items per domain: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. Higher scores indicate better HRQoL.

Time frame: Week 1, 6, Month 3, 6, 9, 12 post-baseline (screening)

Economic evaluation (medical costs)

Economic evaluation of medical costs will be performed to assess cost-effectiveness of the 2 groups.

Time frame: Week 1, 6, Month 3, 6, 9, 12 post-baseline (screening)

Economic evaluation (time-related costs)

Economic evaluation of time-related costs will be performed to assess cost-effectiveness of the 2 groups.

Time frame: Week 2 post-baseline (screening)

Economic evaluation (lost productivity costs)

Economic evaluation of lost productivity costs will be performed to assess cost-effectiveness of the 2 groups.

Time frame: Week 1, 2, 3, 4, 5, 6, Month 3, 6, 9, 12 post-baseline (screening)

Credibility and Expectancy Questionnaire

The credibility and expectancy questionnaire will be used to assess treatment expectation on a 9-point Likert scale. Participants will be asked to select an answer to the following questions on their first visit of Week 1 (1='not at all'; and 5='somewhat'; to 9='very much'): "How much do you expect that treatment will alleviate your symptoms during the study period?"

Time frame: Week 1 post-baseline (screening)

Drug Consumption

Drug type and dose of prescription for medicine or rescue medicine (acetaminophen), and type and frequency of other treatments (e.g. physical therapy, injections) will be recorded.

Time frame: Week 1, 2, 3, 4, 5, 6, Month 3, 6, 9, 12 post-baseline (screening)

Adverse events

Physicians will monitor and record any unexpected or unintended patient reaction to Chuna or usual care at each visit. Adverse events (AEs) associated with Chuna will include, but not be limited to, AEs anticipated from previous reports of manual therapy, and will stay open to all possibilities taking into consideration other potential, unknown AEs.

Time frame: Week 1, 2, 3, 4, 5, 6, Month 3, 6, 9, 12 post-baseline (screening) (every visit)