Effect Sizes for Changes in Health and Well-Being Following Treatment With the One-To-Zero Technique in Individuals With Occipito-Atlantal Joint Dysfunction: A Repeated Measures Study

Objectives: The purpose of this study was to determine effect sizes (ES) for changes in self-reported measures of musculoskeletal pain and dysfunction resulting from the one-to-zero method using a repeated measures study design.

Methods: Twenty participants presenting with articular dysfunction of the occipito-atlantal (C0-C1) complex were treated using the one-to-zero method, a high-velocity low-amplitude thrust administered between the C0-C1 complex before treating other restrictive segments in a cephalocaudal direction. The participants completed online questionnaires using Google Forms that assessed aspects of the biopsychosocial model of pain at baseline and within a week after treatment. The questionnaires included the following: (1) Demographic and Health Behavior Survey; (2) Neck Bournemouth Questionnaire (NBQ) or Neck Disability Index (NDI); (3) Beck Anxiety Index (BAI); (4) Insomnia Severity Index (ISI); and (5) 36-Item Short Form Health Survey (SF-36). Paired t test or Wilcoxon signed ranks test was performed, dependent on normality. Cohen's d values were calculated for each questionnaire score (0.20 indicative of small; ≥0.50 medium; and ≥0.80 large ES).

Results: The NDI, NBQ, BAI, and ISI had a large ES (all d ≥ 0.80). In the SF-36, 4 subscales had a small to near-medium ES, 1 subscale had a medium to near-large ES, and the remaining 2 had a large ES (d ≥ 0.80). The physical and mental component summary had a large (d = 0.88) and small ES (d = 0.35), respectively.

Conclusion: The effect sizes suggest the one-to-zero treatment induces change in various aspects of the biopsychosocial model.