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BJSM Online First, published on August 18, 2014 as 10.1136/bjsports-2014-093874 PEDro systematic review update This section features a recent systematic review that is indexed on PEDro, the Physiotherapy Evidence Database (www.pedro.org.au). PEDro is a free, web-based database of evidence relevant to physiotherapy.
Therapeutic exercise for chronic non-specific neck pain ▸ Bertozzi L, Gardenghi I, Turoni F, et al. Effect of therapeutic exercise on pain and disability in the management of chronic non-specific neck pain: systematic review and meta-analysis of randomized trials. Phys Ther 2013;93:1026–36.
BACKGROUND Neck pain is one of the most common musculoskeletal disorders, second only to back pain.1 Its annual prevalence among the general and workforce populations varies from 30% to 50%.2 Researcher interest in evaluating the efficacy of therapeutic interventions used by physiotherapists to manage chronic non-specific neck pain, especially therapeutic exercise, has increased in recent years.3 A key limitation of previous reviews of treatments for chronic nonspecific neck pain has been the inclusion of results pertaining to other conditions such as whiplash associated disorders).
AIM To systematically review randomised controlled trials evaluating the effect of therapeutic exercise on pain and disability among people with chronic non-specific neck pain.
SEARCHES AND INCLUSION CRITERIA Databases searched included MEDLINE, CINAHL, PEDro and CENTRAL; from their inception to August 2012 using the search term ‘neck pain’. Inclusion criteria were randomised controlled trials that evaluated the effect of therapeutic exercise on pain and disability in adults with chronic non-specific neck pain. Trials were excluded if any of the participants received a specific diagnosis, if they investigated mixed populations (with exception of neck and shoulder pain) and/or if any other interventions different from therapeutic exercise were used (eg, education, manual therapy, traction, physical agents and modalities, cognitive–behavioural therapy and multidisciplinary rehabilitation).
INTERVENTIONS Only studies of therapeutic exercise with a control or comparison group were considered in this review.
MAIN OUTCOMES Pain outcomes could be assessed by a visual analogue scale or a numerical pain rating scale. Disability outcomes were eligible if the instrument measured the impact of chronic neck pain on everyday life, work or leisure-time activities.
STATISTICAL METHODS Data were summarised using meta-analysis based on a random-effects model. For continuous data, standardised mean differences with 95% CIs were calculated. Interpretation of magnitude of effect sizes was based on criteria proposed by Cohen for small, medium or large effects.
RESULTS The literature search identified 2574 studies from which 55 full text articles were assessed to verify their eligibility for inclusion. A total of nine trials were included in the review, of which seven
trials were eligible to be pooled in the meta-analysis, involving a total of 265 patients. The trial quality was generally medium with a median PEDro score of 5/10; range from 3/10 to 8/10. On the basis of six trials, the pooled effect of therapeutic exercise at short-term (standardised mean difference with 95% CI) was medium (−0.53, −0.86 to −0.20). In the five trials that assessed pain between 1 and 6 months after the intervention, the pooled effect of therapeutic exercise was small (−0.45, −0.82 to −0.07). For the four trials that assessed disability during the first month after the intervention, the pooled effect of therapeutic exercise was small (−0.39, 0.86 to 0.07). In the three trials that assessed disability between 1 and 6 months after the intervention, the pooled effect was small (−0.46, −1.00 to −0.08).
LIMITATIONS The key limitation of the review is that the trials included in the meta-analysis were generally of medium-to-low quality; so the pooled estimates of treatment effect may be overly optimistic.
CLINICAL IMPLICATIONS There is evidence that therapeutic exercise reduces pain in the short-term (
BJSM Online First, published on August 18, 2014 as 10.1136/bjsports-2014-093874 PEDro systematic review update This section features a recent systematic review that is indexed on PEDro, the Physiotherapy Evidence Database (www.pedro.org.au). PEDro is a free, web-based database of evidence relevant to physiotherapy.
Therapeutic exercise for chronic non-specific neck pain ▸ Bertozzi L, Gardenghi I, Turoni F, et al. Effect of therapeutic exercise on pain and disability in the management of chronic non-specific neck pain: systematic review and meta-analysis of randomized trials. Phys Ther 2013;93:1026–36.
BACKGROUND Neck pain is one of the most common musculoskeletal disorders, second only to back pain.1 Its annual prevalence among the general and workforce populations varies from 30% to 50%.2 Researcher interest in evaluating the efficacy of therapeutic interventions used by physiotherapists to manage chronic non-specific neck pain, especially therapeutic exercise, has increased in recent years.3 A key limitation of previous reviews of treatments for chronic nonspecific neck pain has been the inclusion of results pertaining to other conditions such as whiplash associated disorders).
AIM To systematically review randomised controlled trials evaluating the effect of therapeutic exercise on pain and disability among people with chronic non-specific neck pain.
SEARCHES AND INCLUSION CRITERIA Databases searched included MEDLINE, CINAHL, PEDro and CENTRAL; from their inception to August 2012 using the search term ‘neck pain’. Inclusion criteria were randomised controlled trials that evaluated the effect of therapeutic exercise on pain and disability in adults with chronic non-specific neck pain. Trials were excluded if any of the participants received a specific diagnosis, if they investigated mixed populations (with exception of neck and shoulder pain) and/or if any other interventions different from therapeutic exercise were used (eg, education, manual therapy, traction, physical agents and modalities, cognitive–behavioural therapy and multidisciplinary rehabilitation).
INTERVENTIONS Only studies of therapeutic exercise with a control or comparison group were considered in this review.
MAIN OUTCOMES Pain outcomes could be assessed by a visual analogue scale or a numerical pain rating scale. Disability outcomes were eligible if the instrument measured the impact of chronic neck pain on everyday life, work or leisure-time activities.
STATISTICAL METHODS Data were summarised using meta-analysis based on a random-effects model. For continuous data, standardised mean differences with 95% CIs were calculated. Interpretation of magnitude of effect sizes was based on criteria proposed by Cohen for small, medium or large effects.
RESULTS The literature search identified 2574 studies from which 55 full text articles were assessed to verify their eligibility for inclusion. A total of nine trials were included in the review, of which seven
trials were eligible to be pooled in the meta-analysis, involving a total of 265 patients. The trial quality was generally medium with a median PEDro score of 5/10; range from 3/10 to 8/10. On the basis of six trials, the pooled effect of therapeutic exercise at short-term (standardised mean difference with 95% CI) was medium (−0.53, −0.86 to −0.20). In the five trials that assessed pain between 1 and 6 months after the intervention, the pooled effect of therapeutic exercise was small (−0.45, −0.82 to −0.07). For the four trials that assessed disability during the first month after the intervention, the pooled effect of therapeutic exercise was small (−0.39, 0.86 to 0.07). In the three trials that assessed disability between 1 and 6 months after the intervention, the pooled effect was small (−0.46, −1.00 to −0.08).
LIMITATIONS The key limitation of the review is that the trials included in the meta-analysis were generally of medium-to-low quality; so the pooled estimates of treatment effect may be overly optimistic.
CLINICAL IMPLICATIONS There is evidence that therapeutic exercise reduces pain in the short-term (
