Resistance, motor control and mindfulness-based exercises are effective for treating chronic non-specific neck pain: A systematic review with meta-analysis and dose-response meta-regression

OBJECTIVE: To analyse effects and dose-response-relationship of the most effective exercises for improving pain and disability in people with chronic non-specific neck pain. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: We searched the PubMed, PEDro, and CENTRAL databases to 30.09.2022 STUDY SELECTION CRITERIA: Randomized controlled trials that involved people with chronic neck pain adopting a longitudinal exercise intervention and assessed one pain and/or disability outcome were included. DATA SYNTHESIS: Restricted maximum-likelihood random-effects meta-analyses were modelled separately for resistance, mindfulness-based and motor control exercise; standardized mean differences (Hedge's g, SMD) were effect estimators. Meta-regressions (dependent variable: effect sizes of the interventions; independent variables: training dose and control group effects) were conducted to explore the dose-response-relationship for therapy success of any exercise type. RESULTS: We included 68 trials. Compared to true control, effects on pain and disability were significantly larger for resistance exercise (pain: SMD= -1.27 [95% CI= -2.26 to -0.28], I2=96%; disability: -1.76 [-3.16 to -0.37], I2=98%), motor control exercise (pain: -2.29 [-3.82 to -0.75], I2=98%; disability: -2.42 [-3.38 to -1.47], I2=94%), and Yoga/Pilates/TaiChi/QuiGong (pain: 1.91 [-3.28 to -0.55], I2=96%; disability: -0.62 [-0.85 to -0.38], I2=0%). Yoga/Pilates/TaiChi/QuiGong was more effective than other exercises (-0.84 [-1.553 to -0.13], I2=86%) for reducing pain. For disability, motor control exercise was superior to other exercises (-0.70 [-1.23 to -0.17], I2=98%). There was no dose-response-relationship for resistance exercise (R2=0.32). Higher frequencies (estimate=-0.10) and longer durations (estimate=-0.11) of motor control exercise had larger effects on pain (R2=0.72). Longer sessions (estimate=-0.13) of motor control exercise had larger effects on disability (R2=0.61). CONCLUSION: Resistance, mindfulness-based and motor control exercise were effective for reducing neck pain (very low to moderate certainty evidence). Higher frequencies and longer duration of sessions had a significant effect on pain for motor control exercise.

Keywords: CNP; NP; dose-response; motor control exercise; sensorimotor.

PMID: 37339388 DOI: 10.2519/jospt.2023.11820