Manual Therapy and Quality of Life in People with Headache: Systematic Review and Meta-analysis of Randomized Controlled Trials

Luca Falsiroli Maistrello, Marco Rafanelli, Andrea Turolla

Research output: Contribution to journalReview article

Abstract

Purpose of Review: People with headache usually experienced significantly lower health-related quality of life (HRQoL) than the healthy subjects. The goal of this systematic review was to evaluate the effectiveness of manual therapy on HRQoL in patients with tension-type headache (TTH), migraine (MH) or cervicogenic headache (CGH). Recent Findings: We searched randomized controlled trials (RCTs) on MEDLINE, COCHRANE and PEDro databases. Treatment was manual therapy compared to usual care or placebo. The outcome was the HRQoL that could be measured by Headache Impact Test (HIT-6), Headache Disability Inventory (HDI), Migraine Disability Assessment Questionnaire (MIDAS) and Short Form Health Survey 12/36 (SF-12/36). For the RCT internal validity, we used the Cochrane risk of bias (RoB) tool. For the level of evidence, we used the Grading of Recommendations, Assessment, Development and Evaluation approach (GRADE). We identified a total of 10 RCTs, 7 of which were included into the meta-analysis. For HIT-6 scale, meta-analysis showed statistically significant differences in favour to manual therapy both after treatment (mean difference (MD) − 3.67; 95% CI from − 5.71 to − 1.63) and at follow-up (MD − 2.47; 95% CI from − 3.27 to − 1.68). For HDI scale, meta-analysis showed statistically significant differences in favour to manual therapy both after treatment (MD − 4.01; 95% CI from − 5.82 to − 2.20) and at follow-up (MD − 5.62; 95% CI from − 10.69 to − 0.54). Other scales provided inconclusive results. Summary: Manual therapy should be considered as an effective approach in improving the quality of life in patients with TTH and MH, while in patients with CGH, the results were inconsistent. Those positive results should be considered with caution due to the very low level of evidence. Researchers should in future design primary studies using valid and reliable disease-specific outcome measures.

Original languageEnglish
Article number78
JournalCurrent Pain and Headache Reports
Volume23
Issue number10
DOIs
Publication statusPublished - Oct 1 2019

Fingerprint

Musculoskeletal Manipulations
Headache
Meta-Analysis
Randomized Controlled Trials
Quality of Life
Post-Traumatic Headache
Tension-Type Headache
Migraine Disorders
Equipment and Supplies
Health Surveys
MEDLINE
Healthy Volunteers
Therapeutics
Placebos
Research Personnel
Outcome Assessment (Health Care)
Databases

Keywords

  • Cervicogenic headache
  • HRQoL
  • Manual treatment
  • Migraine
  • Physical therapy
  • Tension-type

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Manual Therapy and Quality of Life in People with Headache : Systematic Review and Meta-analysis of Randomized Controlled Trials. / Falsiroli Maistrello, Luca; Rafanelli, Marco; Turolla, Andrea.

In: Current Pain and Headache Reports, Vol. 23, No. 10, 78, 01.10.2019.

Research output: Contribution to journalReview article

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abstract = "Purpose of Review: People with headache usually experienced significantly lower health-related quality of life (HRQoL) than the healthy subjects. The goal of this systematic review was to evaluate the effectiveness of manual therapy on HRQoL in patients with tension-type headache (TTH), migraine (MH) or cervicogenic headache (CGH). Recent Findings: We searched randomized controlled trials (RCTs) on MEDLINE, COCHRANE and PEDro databases. Treatment was manual therapy compared to usual care or placebo. The outcome was the HRQoL that could be measured by Headache Impact Test (HIT-6), Headache Disability Inventory (HDI), Migraine Disability Assessment Questionnaire (MIDAS) and Short Form Health Survey 12/36 (SF-12/36). For the RCT internal validity, we used the Cochrane risk of bias (RoB) tool. For the level of evidence, we used the Grading of Recommendations, Assessment, Development and Evaluation approach (GRADE). We identified a total of 10 RCTs, 7 of which were included into the meta-analysis. For HIT-6 scale, meta-analysis showed statistically significant differences in favour to manual therapy both after treatment (mean difference (MD) − 3.67; 95{\%} CI from − 5.71 to − 1.63) and at follow-up (MD − 2.47; 95{\%} CI from − 3.27 to − 1.68). For HDI scale, meta-analysis showed statistically significant differences in favour to manual therapy both after treatment (MD − 4.01; 95{\%} CI from − 5.82 to − 2.20) and at follow-up (MD − 5.62; 95{\%} CI from − 10.69 to − 0.54). Other scales provided inconclusive results. Summary: Manual therapy should be considered as an effective approach in improving the quality of life in patients with TTH and MH, while in patients with CGH, the results were inconsistent. Those positive results should be considered with caution due to the very low level of evidence. Researchers should in future design primary studies using valid and reliable disease-specific outcome measures.",
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