Comparative effectiveness of physical exercise interventions for chronic non-specific neck pain: a systematic review with network meta-analysis of 40 randomised controlled trials


Author: Rutger Mj de Zoete1,2, Nigel R Armfield3, James H McAuley4, Kenneth Chen3,5, Michele Sterling3

Affiliation: <sup>1</sup> RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Queensland, Australia rutger.dezoete@adelaide.edu.au.

<sup>2</sup> School of Allied Health Science and Practice, The University of Adelaide, Adelaide, South Australia, Australia.

<sup>3</sup> RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Queensland, Australia.

<sup>4</sup> Neuroscience Research Australia and School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.

<sup>5</sup> Geriatric Education and Research Institute, Singapore.
Conference/Journal: Br J Sports Med
Date published: 2020 Nov 2
Other:
  Special Notes: doi: 10.1136/bjsports-2020-102664.   ,  Word Count: 285  
    Objective:

To compare the effectiveness of different physical exercise interventions for chronic non-specific neck pain.



Design:

Systematic review and network meta-analysis.



Data sources:

Electronic databases: AMED, CINAHL, Cochrane Central Register of Controlled Trials, Embase, MEDLINE, Physiotherapy Evidence Database, PsycINFO, Scopus and SPORTDiscus.



Eligibility criteria:

Randomised controlled trials (RCTs) describing the effects of any physical exercise intervention in adults with chronic non-specific neck pain.



Results:

The search returned 6549 records, 40 studies were included. Two networks of pairwise comparisons were constructed, one for pain intensity (n=38 RCTs, n=3151 participants) and one for disability (n=29 RCTs, n=2336 participants), and direct and indirect evidence was obtained. Compared with no treatment, three exercise interventions were found to be effective for pain and disability: motor control (Hedges' g, pain -1.32, 95% CI: -1.99 to -0.65; disability -0.87, 95% CI: -1.45 o -0.29), yoga/Pilates/Tai Chi/Qigong (pain -1.25, 95% CI: -1.85 to -0.65; disability -1.16, 95% CI: -1.75 to -0.57) and strengthening (pain -1.21, 95% CI: -1.63 to -0.78; disability -0.75, 95% CI: -1.28 to -0.22). Other interventions, including range of motion (pain -0.98 CI: -2.51 to 0.56), balance (pain -0.38, 95% CI: -2.10 to 1.33) and multimodal (three or more exercises types combined) (pain -0.08, 95% CI: -1.70 to 1.53) exercises showed uncertain or negligible effects. The quality of evidence was very low according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria.



Conclusion:

There is not one superior type of physical exercise for people with chronic non-specific neck pain. Rather, there is very low quality evidence that motor control, yoga/Pilates/Tai Chi/Qigong and strengthening exercises are equally effective. These findings may assist clinicians to select exercises for people with chronic non-specific neck pain.



Prospero registration number:

CRD42019126523.



Keywords: chronic; exercise; meta-analysis; neck.



PMID: 33139256 DOI: 10.1136/bjsports-2020-102664