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 3

Intragroup and Intergroup Comparisons of the VA Hemodynamic Changes

MSM (n = 15)
ISM (n = 15)
Mean ± SD (95% CI) Median Mean ± SD (95% CI) Median P
Ipsilateral VA PSV
Preintervention 48.5 ± 12.5 (41.6-55.4) 48 48.2 ± 18 (38.2-58.2) 47.3 .960^a
Postintervention 50.5 ± 18.2 (40.4-60.5) 48 46.3 ± 18.7 (36-56.6) 43.5
Pre-/Postdifference 2 ± 13.5 (–13.1 to 9.3) –2 –1.9 ± 20.3 (–5.5 to 9.5) –1.6 .541^a
Intragroup difference P value .582^b .719^b
Contralateral VA PSV
Preintervention 43.3 ± 15.8 (34.5-52) 41.5 48.9 ± 15 (40.6-57.2) 48.9 .324^a
Postintervention 48.6 ± 19.3 (37.9-59.2) 48.7 48.8 ± 15.6 (40.1-57.4) 44.8
Pre-/Postdifference 5.3 ± 16.4 (–8.1 to 7.7) 0 –0.2 ± 14.2 (–3.8 to 14.3) 1.3 .338^a
Intragroup difference P value .760^b .597^b
Ipsilateral VA EDV
Preintervention 16.7 ± 5.8 (13.5-19.9) 15.8 15.5 ± 6.2 (12.1-19) 15.8 .607^a
Postintervention 17.2 ± 7.4 (13.1-21.6) 17.1 14 ± 6.9 (10.1-17.8) 12.5
Pre-/Postdifference 0.5 ± 5.8 (–4.6 to 1.4) –0.7 –1.6 ± 5.4 (–2.7 to 3.7) –0.5 .310^a
Intragroup difference P value .720^b .281^b
Contralateral VA EDV
Preintervention 14.7 ± 4.4 (12.3-17.1) 13.2 15.8 ± 4.6 (13.3-18.3) 16.1 .455^c
Postintervention 15.4 ± 4.6 (12.9-17.9) 14.1 15.8 ± 7.1 (11.9-19.7) 15.2
Pre-/Postdifference 0.7 ± 3.5 (–3.2 to 3.1) 0 0 ± 5.7 (–1.7 to 2.6) –0.3 .648^c
Intragroup difference P value .950^d .551^d
Ipsilateral VA RI
Preintervention 0.66 ± 0.13 (0.59-0.74) 0.70 0.67 ± 0.07 (0.63-0.71) 0.7 .911^c
Postintervention 0.7 ± 0.11 (0.59-0.7) 0.7 0.7 ± 0.1 (0.63-0.76) 0.7
Pre-/Postdifference 0.02 ± 0.11 (–0.04 to 0.1) 0.00 0.01 ± 0.12 (–0.04 to 0.01) 0.03 .405^c
Intragroup difference P value .317^d .417^d
Contralateral VA RI
Preintervention 0.64 ± 0.09 (0.58-0.67) 0.61 0.67 ± 0.06 (0.64-0.71) 0.66 .603^c
Postintervention 0.73 ± 0.24 (0.61-0.87) 0.69 0.67 ± 0.07 (0.62-0.71) 0.68
Pre-/Postdifference 0.10 ± 0.31 (–0.04 to 0.03) 0.01 0.01 ± 0.06 (–0.05 to 0.2) 0.02 .371^c
Intragroup difference P value .126^d .705^d
Ipsilateral VA VF
Preintervention 98.5 ± 61.5 (64.4-132.5) 92.0 104.1 ± 69.3 (65.7-142.5) 110.1 .885^c
Postintervention 108.1 ± 88.1 (59.2-156.9) 95.5 91.3 ± 57.5 (59.5-123.1) 65.2
Pre-/Postdifference 9.6 ± 34.9 (–31.3 to 5.8) –2.0 -12.8 ± 33.5 (–9.7 to 28.9) 0.7 .419^c
Intragroup difference P value .570^d .427^d
Contralateral VA VF
Preintervention 88.3 ± 62.7 (53.6-123) 75.2 103.1 ± 41.4 (80.1-126) 118.9 .178^c
Postintervention 93.6 ± 54.1 (63.7-123.6) 84.2 99.9 ± 57.5 (68-131.7) 93.0
Pre-/Postdifference 5.3 ± 53.6 (–31.5 to 25) –1.0 –3.2 ± 51.0 (–24.4 to 35) –2.1 .820^c
Intragroup difference P value .733^d .975^d

CI, confidence interval; EDV, end-diastolic velocity; ISM, instrumental spinal manipulation; MSM, manual spinal manipulation; PSV, peak systolic velocity; RI, resistive index; SD, standard deviation; VA, vertebral artery; VF, volume flow.
^at test.
^bPaired samples t test.
^cMann-Whitney U test.
^dWilcoxon test.

	MSM (n = 15)		ISM (n = 15)
	Mean ± SD (95% CI)	Median	Mean ± SD (95% CI)	Median	P
Ipsilateral VA PSV
Preintervention	48.5 ± 12.5 (41.6-55.4)	48	48.2 ± 18 (38.2-58.2)	47.3	.960^a
Postintervention	50.5 ± 18.2 (40.4-60.5)	48	46.3 ± 18.7 (36-56.6)	43.5
Pre-/Postdifference	2 ± 13.5 (–13.1 to 9.3)	–2	–1.9 ± 20.3 (–5.5 to 9.5)	–1.6	.541^a
Intragroup difference P value	.582^b		.719^b
Contralateral VA PSV
Preintervention	43.3 ± 15.8 (34.5-52)	41.5	48.9 ± 15 (40.6-57.2)	48.9	.324^a
Postintervention	48.6 ± 19.3 (37.9-59.2)	48.7	48.8 ± 15.6 (40.1-57.4)	44.8
Pre-/Postdifference	5.3 ± 16.4 (–8.1 to 7.7)	0	–0.2 ± 14.2 (–3.8 to 14.3)	1.3	.338^a
Intragroup difference P value	.760^b		.597^b
Ipsilateral VA EDV
Preintervention	16.7 ± 5.8 (13.5-19.9)	15.8	15.5 ± 6.2 (12.1-19)	15.8	.607^a
Postintervention	17.2 ± 7.4 (13.1-21.6)	17.1	14 ± 6.9 (10.1-17.8)	12.5
Pre-/Postdifference	0.5 ± 5.8 (–4.6 to 1.4)	–0.7	–1.6 ± 5.4 (–2.7 to 3.7)	–0.5	.310^a
Intragroup difference P value	.720^b		.281^b
Contralateral VA EDV
Preintervention	14.7 ± 4.4 (12.3-17.1)	13.2	15.8 ± 4.6 (13.3-18.3)	16.1	.455^c
Postintervention	15.4 ± 4.6 (12.9-17.9)	14.1	15.8 ± 7.1 (11.9-19.7)	15.2
Pre-/Postdifference	0.7 ± 3.5 (–3.2 to 3.1)	0	0 ± 5.7 (–1.7 to 2.6)	–0.3	.648^c
Intragroup difference P value	.950^d		.551^d
Ipsilateral VA RI
Preintervention	0.66 ± 0.13 (0.59-0.74)	0.70	0.67 ± 0.07 (0.63-0.71)	0.7	.911^c
Postintervention	0.7 ± 0.11 (0.59-0.7)	0.7	0.7 ± 0.1 (0.63-0.76)	0.7
Pre-/Postdifference	0.02 ± 0.11 (–0.04 to 0.1)	0.00	0.01 ± 0.12 (–0.04 to 0.01)	0.03	.405^c
Intragroup difference P value	.317^d		.417^d
Contralateral VA RI
Preintervention	0.64 ± 0.09 (0.58-0.67)	0.61	0.67 ± 0.06 (0.64-0.71)	0.66	.603^c
Postintervention	0.73 ± 0.24 (0.61-0.87)	0.69	0.67 ± 0.07 (0.62-0.71)	0.68
Pre-/Postdifference	0.10 ± 0.31 (–0.04 to 0.03)	0.01	0.01 ± 0.06 (–0.05 to 0.2)	0.02	.371^c
Intragroup difference P value	.126^d		.705^d
Ipsilateral VA VF
Preintervention	98.5 ± 61.5 (64.4-132.5)	92.0	104.1 ± 69.3 (65.7-142.5)	110.1	.885^c
Postintervention	108.1 ± 88.1 (59.2-156.9)	95.5	91.3 ± 57.5 (59.5-123.1)	65.2
Pre-/Postdifference	9.6 ± 34.9 (–31.3 to 5.8)	–2.0	-12.8 ± 33.5 (–9.7 to 28.9)	0.7	.419^c
Intragroup difference P value	.570^d		.427^d
Contralateral VA VF
Preintervention	88.3 ± 62.7 (53.6-123)	75.2	103.1 ± 41.4 (80.1-126)	118.9	.178^c
Postintervention	93.6 ± 54.1 (63.7-123.6)	84.2	99.9 ± 57.5 (68-131.7)	93.0
Pre-/Postdifference	5.3 ± 53.6 (–31.5 to 25)	–1.0	–3.2 ± 51.0 (–24.4 to 35)	–2.1	.820^c
Intragroup difference P value	.733^d		.975^d