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.
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Twitter @DrRdeZoete, @MicheleSterlin7
Contributors RMJdZ conceived the content, wrote the paper and approved the final version. RMJdZ and NRA conducted the analyses. NRA, JM and KC contributed and approved the final version of the paper. MS conceived the design of the study, contributed to writing the paper and approved the final version of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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