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Clinical effectiveness of manipulation and mobilisation interventions for the treatment of non-specific neck pain: protocol for a systematic review and meta-analysis
  1. Elizabeth Bailey1,
  2. Nicola R Heneghan2,
  3. Natasha J Cassidy3,
  4. Deborah Falla2,
  5. Alison B Rushton2,4
  1. 1Physiotherapy, University Hospitals Plymouth NHS Trust, Plymouth, UK
  2. 2Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
  3. 3Physiotherapy, The Royal Orthopaedic Hospital, Birmingham, UK
  4. 4School of Physical Therapy, Western University, London, Ontario, Canada
  1. Correspondence to Professor Alison B Rushton; arushto3{at}


Introduction Non-specific neck pain (NSNP) is a common musculoskeletal condition resulting in pain, physical limitations and associated functional disability. Current guidelines recommend manipulation and/or mobilisation as part of the multimodal management of NSNP. This study focuses on intervention at the articular level and aims to identify whether joint mobilisation or joint manipulation has a greater effect on function, range of movement or pain outcomes in the management of NSNP.

Methods and analysis A systematic review protocol has been designed and is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. A targeted search strategy will enable searching of key databases from inception to 31 March 2020: CINAHL, PEDro, AMED, EMBASE, OVID, MEDLINE, Web of Science, PubMed and Google Scholar. Key journals will be searched using predefined keywords determined from preliminary scoping searches for randomised controlled trials of manipulation and mobilisation modalities for adults with NSNP in the absence of radiculopathy or whiplash, published in English. Grey literature and unpublished studies will also be searched. Studies will be screened by title and abstract and full text. Two independent reviewers will conduct the searches independently, extract data, assess risk of bias (Cochrane Risk of Bias Tool 2) and assess overall strength of evidence (Grading of Recommendations, Assessment, Development and Evaluation). Meta-analysis will be performed where individual studies measure comparable outcomes including performance-based outcome measures such as range of movement or patient reported outcome measures such as Neck Disability Index; and where interventions are comparable in their delivery such as number of oscillations and Maitland grading. Where not possible, data will be presented descriptively.

Ethics and dissemination This study does not require ethical approval. Findings will be submitted for publication to relevant peer-reviewed journals and will be presented at profession-specific conferences.

PROSPERO registration number CRD42020164457.

  • rehabilitation medicine
  • clinical trials
  • musculoskeletal disorders
  • spine

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  • Contributors All authors contributed towards the submitted final manuscript. EB is an MRes student at the University of Birmingham and a practising physiotherapist. ABR is the lead supervisor, third reviewer and corresponding author. NRH and DF are co-supervisors. EB drafted the initial manuscript and received guidance on content, methodology and analysis from all supervisors. NJC was the second reviewer and is a physiotherapist. All authors have read and agreed the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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