Evidence map›Paper›PMID 31142519›Full record

Trial reportBMJ open2019

Effect of cervical manipulation on vertebral artery and cerebral haemodynamics in patients with chronic neck pain: a crossover randomised controlled trial.

Nicholas Moser, Silvano Mior, Michael Noseworthy, Pierre Côté, Greg Wells, Michael Behr, John Triano

2 registry-linked trialsOpen access · goldAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 16 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed, 1 pooled it
1.4field-weighted citation impact, top 19% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02667821 nacompletednot on this map

Changes in Vertebral Artery and Cerebral Hemodynamics Following Various Head Positions & Cervical Manipulation in Patients With Chronic/Recurrent Neck Pain

TypeinterventionalSponsorCanadian Memorial Chiropractic CollegeRan2016 to 2017Enrolled20ConditionsVertebral Artery Dissection, Cerebrovascular Accident, StrokeArmsHead positions and spinal manipulation
NCT04398160 naunknown statusnot on this mapstarted 2024, after this paper: background citation

Influence of Bilateral Cervical Manipulation (C3/C4) on Thoracoabdominal Kinematics on Healthy Young Adults: Randomized Controlled Trial (RCT)

TypeinterventionalSponsorEscola Superior de Tecnologia da Saúde do PortoRan2024 to 2024Enrolled90ConditionsHealthyArmsHVLA C3/C4 manipulation, Sham technique
3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 1 synthesis or guideline pooled it, 28 citations in OpenAlex.

  1. Pooled it
  2. Effects of traction therapy on atlantoaxial joint dislocation-induced cervical vertigo.Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologica · 2022
    Trial
  3. Article
  4. Review
  5. Article
  6. Article
  7. Article
  8. Article
  9. Article
  10. Review
  11. Article
  12. Article
  13. Review
  14. Article
  15. Review
  16. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 4 institutions in 1 country.

Nicholas MoserGraduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
Silvano MiorGraduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
Michael NoseworthyRadiology, McMaster University Faculty of Engineering, Hamilton, Ontario, Canada.
Pierre CôtéFaculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada.
Greg WellsFaculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada.
Michael BehrDepartment of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada.
John TrianoGraduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
Canadian Memorial Chiropractic College · CAUniversity of Ontario Institute of Technology · CAUniversity of Toronto · CAMcMaster University · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveIt is hypothesised that cervical manipulation may increase the risk of cerebrovascular accidents. We aimed to determine whether cervical spine manipulation is associated with changes in vertebral artery and cerebrovascular haemodynamics measured with MRI compared with neutral neck position and maximum neck rotation in patients with chronic neck pain.

settingThe Imaging Research Centre at St. Joseph's Hospital in Hamilton, Ontario, Canada.

participantsTwenty patients were included. The mean age was 32 years (SD ±12.5), mean neck pain duration was 5.3 years (SD ±5.7) and mean neck disability index score was 13/50 (SD ±6.4).

interventionsFollowing baseline measurement of cerebrovascular haemodynamics, we randomised participants to: (1) maximal neck rotation followed by cervical manipulation or (2) cervical manipulation followed by maximal neck rotation. The primary outcome, vertebral arteries and cerebral haemodynamics, was measured after each intervention and was obtained by measuring three-dimensional T1-weighted high-resolution anatomical images, arterial spin labelling and phase-contrast flow encoded MRI. Our secondary outcome was functional connectivity within the default mode network measured with resting state functional MRI.

resultsCompared with neutral neck position, we found a significant change in contralateral blood flow following maximal neck rotation. There was also a significant change in contralateral vertebral artery blood velocity following maximal neck rotation and cervical manipulation. We found no significant changes within the cerebral haemodynamics following cervical manipulation or maximal neck rotation. However, we observed significant increases in functional connectivity in the posterior cerebrum and cerebellum (resting state MRI) after manipulation and maximum rotation.

conclusionOur results are in accordance with previous work, which has shown a decrease in blood flow and velocity in the contralateral vertebral artery with head rotation. This may explain why we also observed a decrease in blood velocity with manipulation because it involves neck rotation. Our work is the first to show that cervical manipulation does not result in brain perfusion changes compared with a neutral neck position or maximal neck rotation. The changes observed were found to not be clinically meaningful and suggests that cervical manipulation may not increase the risk of cerebrovascular events through a haemodynamic mechanism. TRIAL REGISTRATION NUMBER: NCT02667821.

Indexed as

AdultArterial Occlusive DiseasesChronic PainCross-Over StudiesFemaleHumansMaleManipulation, SpinalNeck PainOntarioRange of Motion, ArticularRegional Blood FlowRisk AssessmentVertebrobasilar InsufficiencyBOLD fMRIchronic neck painfMRIneck painspinal manipulationstrokevertebral arteryvertebral artery dissection

Identifiers

PMID31142519
PMCPMC6549698
OpenAlexW2947852943

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.