Journal of Physiotherapy

Journal of Physiotherapy

Volume 68, Issue 4, October 2022, Pages 244-254
Journal of Physiotherapy

Research
Some conservative interventions are more effective than others for people with chronic non-specific neck pain: a systematic review and network meta-analysis

https://doi.org/10.1016/j.jphys.2022.09.007Get rights and content
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Abstract

Question

Which is the most effective conservative intervention for patients with non-specific chronic neck pain (CNSNP)?

Design

A systematic review and network meta-analysis of randomised clinical trials.

Participants

Adults with CNSNP of at least 3 months duration.

Interventions

All available pharmacological and non-pharmacological interventions.

Outcome measures

The primary outcomes were pain intensity and disability. The secondary outcome was adverse events.

Results

Overall, 119 RCTs (12,496 patients; 32 interventions) were included. Risk of bias was low in 50.4% of trials, unclear in 22.7% and high in 26.9%. Compared with inert treatment, a combination of active and/or passive multimodal non-pharmacological inventions (eg, exercise and manual therapy) were effective for pain on a 0-to-10 scale at 1 month (MD range 0.84 to 3.74) and at 3 to 6 months (MD range 1.06 to 1.49), and effective on disability on a 0-to-100 scale at 1 month (MD range 10.26 to 14.09) and 3 to 6 months (MD range 5.60 to 16.46). These effects ranged from possible to definite clinical relevance. Compared with inert treatment, anti-inflammatory drugs alone or in combination with another non-pharmacological treatment did not reduce pain at 1 month or 3 to 6 months. At 12 months, no superiority was found over inert treatment on both outcomes. Most mild adverse events were experienced following acupuncture/dry needling intervention. On average, the evidence varied from low to very low certainty.

Conclusions

While multimodal non-pharmacological interventions may reduce pain and disability for up to 3 to 6 months of follow-up when compared with inert treatment, the evidence was very uncertain about their effects. Better quality and larger trials are needed to improve the certainty of evidence.

Registration

PROSPERO CRD42019124501

keywords

Chronic neck pain
Conservative interventions
Pharmacological interventions
Pain
Disability

Cited by (0)

aEndNote, Version EndNote X9, Clarivate, Philadelphia, USA.

bStata Statistical Software, v 15. StataCorp LLC, College Station, USA.

eAddenda: Appendices 1 to 21 can be found online at https://doi.org/10.1016/j.jphys.2022.09.007

Ethics approval: Nil.

Competing interests: Nil.

Source(s) of support: The work was supported by the Italian Ministry of Health “Efficacia degli interventi riabilitativi nel back pain: una network meta-analisi” (L3026). The funding sources had no controlling role in the study design, data collection, analysis, interpretation, or report writing.

1

Co-first authors.

2

Co-last authors.