Effects of Manual Versus Instrumental Spinal Manipulation on Blood Flow of the Vertebral and Internal Carotid Arteries in Participants With Chronic Nonspecific Neck Pain: A Single-Blind, Randomized Study

Burcu Kocabey; Dilber Karagözoğlu Coşkunsu; Koray Güven; Mustafa H. Ağaoğlu; Selvi Yüce

doi:10.1016/j.jcm.2022.05.006

Table 2

Intragroup and Intergroup Comparisons of the ICA Hemodynamic Changes

MSM (n = 15)
ISM (n = 15)
Mean ± SD (95% CI) Median Mean ± SD (95% CI) Median P Value
Ipsilateral ICA PSV
Preintervention 66.8 ± 17.1 (57.32-76.25) 65.8 80.2 ± 18.7 (69.8-90.6) 81.1 .052^a
Postintervention 75.5 ± 17 (66-85) 73.5 72.3 ± 22.3 (60-84.7) 74.8
Pre-/Postdifference 8.7 ± 22.5 (–17.4 to 1.6) 14.3 –7.9 ± 17.2 (–3.6 to 21.2) –8.5 .031^a^,^b
Intragroup difference P value .154^c .097^c
Contralateral ICA PSV
Preintervention 66.5 ± 19.1 (55.9-77) 62.8 67.5 ± 16.9 (58.1-76.9) 62.4 .878^a
Postintervention 65 ± 17.5 (55.3-74.6) 61.1 70.8 ± 26.4 (56.1-85.4) 62.5
Pre-/Postdifference –1.5 ± 18.9 (–9.7 to 16.2) –3.5 3.3 ± 23.4 (–12 to 8.9) 0.5 .543^a
Intragroup difference P value .955^d .650^d
Ipsilateral ICA EDV
Preintervention 21.9 ± 7 (18-25.8) 22 27.4 ± 10.2 (21.7-33) 28.9 .097^a
Postintervention 21.2 ± 8 (16.7-25.6) 21.5 26.8 ± 12.8 (19.7-34) 26.3
Pre-/Postdifference –0.7 ± 10.6 (–6 to 4.9) –0.5 –0.5 ± 9.9 (–6.6 to 5.2) –0.5 .965^a
Intragroup difference P value .802^c .838^c
Contralateral ICA EDV
Preintervention 22.9 ± 8.1 (18.4-27.4) 22.7 27.8 ± 9.2 (22.7-32.9) 29.2 .136^a
Postintervention 21.6 ± 8.3 (17-26.2) 21.2 26.8 ± 13.9 (19.1-34.5) 24
Pre-/Postdifference –1.3 ± 8.7 (–7.7 to 5.7) –1.3 –1 ± 12.1 (–6.2 to 3.5) –2.2 .937^a
Intragroup difference P value .570^c .751^c
Ipsilateral ICA RI
Preintervention 0.67 ± 0.08 (0.6-0.7) 0.67 0.65 ± 0.11 (0.6-0.7) 0.65 .711^e
Postintervention 0.71 ± 0.11 (0.6-0.8) 0.73 0.66 ± 0.10 (0.6-0.7) 0.60
Pre-/Postdifference 0.04 ± 0.14 (–0.06 to 0.10) 0.06 0.01 ± 0.12 (–0.06 to 0.06) 0.03 .534^e
Intragroup difference P value 1^d .854^d
Contralateral ICA RI
Preintervention 0.65 ± 0.09 (0.6-0.7) 0.61 0.60 ± 0.10 (0.5-0.7) 0.60 .098^e
Postintervention 0.66 ± 0.09 (0.6-0.7) 0.65 0.66 ± 0.11 (0.6-0.7) 0.63
Pre-/Postdifference 0.01 ± 0.11 (–0.07 to 0.06) 0.02 0.07 ± 0.15 (–0.02 to 0.13) 0.06 .306^e
Intragroup difference P value .191^d .805^d

CI, confidence interval; EDV, end-diastolic velocity; ICA, internal carotid artery; ISM, instrumental spinal manipulation; MSM, manual spinal manipulation; PSV, peak systolic velocity; RI, resistive index; SD, standard deviation; VF, volume flow.
^at test.
^bIndicates significant P value.
^cPaired samples t test.
^dWilcoxon test.
^eMann-Whitney U test.

	MSM (n = 15)		ISM (n = 15)
	Mean ± SD (95% CI)	Median	Mean ± SD (95% CI)	Median	P Value
Ipsilateral ICA PSV
Preintervention	66.8 ± 17.1 (57.32-76.25)	65.8	80.2 ± 18.7 (69.8-90.6)	81.1	.052^a
Postintervention	75.5 ± 17 (66-85)	73.5	72.3 ± 22.3 (60-84.7)	74.8
Pre-/Postdifference	8.7 ± 22.5 (–17.4 to 1.6)	14.3	–7.9 ± 17.2 (–3.6 to 21.2)	–8.5	.031^a^,^b
Intragroup difference P value	.154^c		.097^c
Contralateral ICA PSV
Preintervention	66.5 ± 19.1 (55.9-77)	62.8	67.5 ± 16.9 (58.1-76.9)	62.4	.878^a
Postintervention	65 ± 17.5 (55.3-74.6)	61.1	70.8 ± 26.4 (56.1-85.4)	62.5
Pre-/Postdifference	–1.5 ± 18.9 (–9.7 to 16.2)	–3.5	3.3 ± 23.4 (–12 to 8.9)	0.5	.543^a
Intragroup difference P value	.955^d		.650^d
Ipsilateral ICA EDV
Preintervention	21.9 ± 7 (18-25.8)	22	27.4 ± 10.2 (21.7-33)	28.9	.097^a
Postintervention	21.2 ± 8 (16.7-25.6)	21.5	26.8 ± 12.8 (19.7-34)	26.3
Pre-/Postdifference	–0.7 ± 10.6 (–6 to 4.9)	–0.5	–0.5 ± 9.9 (–6.6 to 5.2)	–0.5	.965^a
Intragroup difference P value	.802^c		.838^c
Contralateral ICA EDV
Preintervention	22.9 ± 8.1 (18.4-27.4)	22.7	27.8 ± 9.2 (22.7-32.9)	29.2	.136^a
Postintervention	21.6 ± 8.3 (17-26.2)	21.2	26.8 ± 13.9 (19.1-34.5)	24
Pre-/Postdifference	–1.3 ± 8.7 (–7.7 to 5.7)	–1.3	–1 ± 12.1 (–6.2 to 3.5)	–2.2	.937^a
Intragroup difference P value	.570^c		.751^c
Ipsilateral ICA RI
Preintervention	0.67 ± 0.08 (0.6-0.7)	0.67	0.65 ± 0.11 (0.6-0.7)	0.65	.711^e
Postintervention	0.71 ± 0.11 (0.6-0.8)	0.73	0.66 ± 0.10 (0.6-0.7)	0.60
Pre-/Postdifference	0.04 ± 0.14 (–0.06 to 0.10)	0.06	0.01 ± 0.12 (–0.06 to 0.06)	0.03	.534^e
Intragroup difference P value	1^d		.854^d
Contralateral ICA RI
Preintervention	0.65 ± 0.09 (0.6-0.7)	0.61	0.60 ± 0.10 (0.5-0.7)	0.60	.098^e
Postintervention	0.66 ± 0.09 (0.6-0.7)	0.65	0.66 ± 0.11 (0.6-0.7)	0.63
Pre-/Postdifference	0.01 ± 0.11 (–0.07 to 0.06)	0.02	0.07 ± 0.15 (–0.02 to 0.13)	0.06	.306^e
Intragroup difference P value	.191^d		.805^d