EFFECTIVENESS OF NECK-SPECIFIC EXERCISES COMPARED TO OTHER FORMS OF NECK EXERCISES FOR CHRONIC NON-TRAUMATIC NECK PAIN: SYSTEMATIC REVIEW WITH META-ANALYSIS

I. Villanueva Ruiz¹, D. Falla², I. Lascurain Aguirrebeña³

Background: Neck specific exercises (NSE) are advocated for the treatment of chronic non-specific neck pain (CNP), however no systematic review has studied whether they are more effective than alternative exercise interventions (AEI). Furthermore, it has been suggested that SNE aimed at enhancing motor control may have a larger effect when participants have been selected according to predefined criteria of motor-control dysfunction and exercises are tailored to the individual needs of the participant.

Purpose: The aim of this systematic review was twofold. First, to establish if SNE is more effective than AEI to reduce pain intensity and disability in people with CNP. Second, to assess if the effectiveness of SNE is increased when these exercises are provided to participants that fulfil specific criteria of muscle impairment or when exercises are tailored to the individual needs of the participant.

Methods: Medline, Web of Science, Scopus and PEDro databases were searched for relevant studies up until July 2020. Studies were included if participants had CNP, assessed the effectiveness of SNE against any AEI, and outcome measures were pain intensity and/or disability. Meta-analyses were performed if three or more studies investigated the same or comparable outcome measure.  Methodological quality was independently assessed by two assessors using a modified Cochrane Back Review Group tool.

Results: Thirteen studies met the inclusion criteria. All studies reported improvements following both interventions. SNE was found to be more effective than AEI to reduce pain intensity over the short-medium term (4-12 weeks) (p<0.05) although the effect size was small (pooled SMD: -034; 95% CI: -0.66, -0.01).  Compared with AEI, SNE showed a greater reduction in disability over the short-medium term (p<0.05) although the effect size was again small (pooled SMD: -0.37; 95% CI: -0.68, -0.07). Only two studies evaluated long term effects, reporting no difference between interventions. The most commonly used method to assess suitability of participants for SNE or tailored SNE exercises was the cranio-cervical flexion test. The effectiveness of SNE vs AEI was no greater in studies where participants were selected according to a pre-defined criteria of muscle impairment (p = 0.52 for pain; p = 0.81 for disability) or in studies that used some form of exercise tailoring (p = 0.44 for pain; p = 0.15 for disability). Three studies were classified as having a high risk of bias, and two as low risk. The remaining eight studies were classified as moderate risk.

Conclusion(s): SNE is more effective than AIE to reduce pain intensity and disability in CNP however, the effect sizes are small. Current evidence suggests that presently used methods to select participants according to the presence of muscle impairments or to tailor exercises to each individual participant, provides no added value to increase the effectiveness of SNE. Future high quality research is warranted.

Implications: SNE should be preferentially used for the treatment of CNP. However, differences with other interventions are small. Further research is required to assess the usefulness of more comprehensive assessment methods that may be better able to select participants and tailor exercises for more effective outcomes with SNE.

Funding, acknowledgements: Unfunded

Keywords: neck pain, exercise, tailored interventions

Topic: Musculoskeletal: spine

Did this work require ethics approval? No

Institution: University of the Basque Country

Committee: CEISH UPV/EHU BOPV 32 17/02/2015

Reason: As it is a systematic review and meta-analysis, ethics approval was not required