Musculoskeletal science & practice · 2026
Personalizing rehabilitation approaches: Moderator analyses of manual therapy and exercise effectiveness in individuals with chronic neck pain: Secondary analysis of the SS-MECH trial.
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Cook Chad E, McDevitt Amy, Clewley Derek, O'Halloran Bryan, Learman Ken, Keter Damian, Rossettini Giacomo, Keefe Francis
Аннотация
BACKGROUND: Treatment-effect moderator analyses (third-order questions) help identify baseline characteristics that predict who benefits most from specific interventions. Limited evidence exists regarding which characteristics influence outcomes following manual therapy (MT) or exercise (EX).
OBJECTIVE: To evaluate whether baseline participant characteristics moderated differential improvement with MT versus EX at 4 weeks and 6 months in 124 patients with chronic neck pain.
METHODS: This study used a linear regression-based product-term interaction models and the Johnson-Newman technique to test 18 potential baseline moderators against 4-week and 6-month outcomes for pain interference, pain intensity, and physical function.
RESULTS: At 4 weeks, EX produced greater physical function improvements in participants with prior neck treatment, whereas MT was more effective for those with lesser ROM. For 4-week pain interference, distinct predictor profiles emerged: participants with greater ROM, lower fear, and higher baseline physical function improved more with EX, while those with higher fear, lower physical function, and limited ROM benefited more from MT. At 6 months, greater baseline ROM asymmetry predicted superior pain interference outcomes following EX.
CONCLUSION: Only a few baseline characteristics moderated treatment response to MT or EX and observed effects were small. Although promising, these findings also suggest that MT and EX may influence outcomes similarly, potentially due to comparable specific effects, shared mechanisms, or limitations related to outcome selection and moderator-modeling approaches.
OBJECTIVE: To evaluate whether baseline participant characteristics moderated differential improvement with MT versus EX at 4 weeks and 6 months in 124 patients with chronic neck pain.
METHODS: This study used a linear regression-based product-term interaction models and the Johnson-Newman technique to test 18 potential baseline moderators against 4-week and 6-month outcomes for pain interference, pain intensity, and physical function.
RESULTS: At 4 weeks, EX produced greater physical function improvements in participants with prior neck treatment, whereas MT was more effective for those with lesser ROM. For 4-week pain interference, distinct predictor profiles emerged: participants with greater ROM, lower fear, and higher baseline physical function improved more with EX, while those with higher fear, lower physical function, and limited ROM benefited more from MT. At 6 months, greater baseline ROM asymmetry predicted superior pain interference outcomes following EX.
CONCLUSION: Only a few baseline characteristics moderated treatment response to MT or EX and observed effects were small. Although promising, these findings also suggest that MT and EX may influence outcomes similarly, potentially due to comparable specific effects, shared mechanisms, or limitations related to outcome selection and moderator-modeling approaches.