Professional Documents
Culture Documents
Gross A, Kay TM, Paquin JP, Blanchette S, Lalonde P, Christie T, Dupont G, Graham N, Burnie SJ,
Gelley G, Goldsmith CH, Forget M, Hoving JL, Brønfort G, Santaguida PL, Cervical Overview Group
Gross A, Kay TM, Paquin JP, Blanchette S, Lalonde P, Christie T, Dupont G, Graham N, Burnie SJ, Gelley G, Goldsmith CH, Forget M, Hoving
JL, Brønfort G, Santaguida PL, Cervical Overview Group.
Exercises for mechanical neck disorders.
Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD004250.
DOI: 10.1002/14651858.CD004250.pub5.
www.cochranelibrary.com
HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . . . . . . . . . . . . . . . . . . . 4
BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Figure 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Figure 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Figure 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Figure 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Figure 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Figure 6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Figure 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Figure 8. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Figure 9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
ADDITIONAL SUMMARY OF FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . 23
DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
AUTHORS’ CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
CHARACTERISTICS OF STUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
DATA AND ANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Analysis 1.1. Comparison 1 Chronic MND: Breathing Patterns vs CONTROL, Outcome 1 Pain Intensity (Borg 0 to 10):
10 weeks of treatment vs Control. . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Analysis 1.2. Comparison 1 Chronic MND: Breathing Patterns vs CONTROL, Outcome 2 Function (NDI 0 to 100): 10
weeks of treatment vs Control. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Analysis 1.3. Comparison 1 Chronic MND: Breathing Patterns vs CONTROL, Outcome 3 SF-36 (physical function): 10
weeks of treatment vs Control. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Analysis 2.1. Comparison 2 Acute to Chronic MND: General Fitness Training vs CONTROL, Outcome 1 Pain Intensity
(VAS): 10 weeks of treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Analysis 2.2. Comparison 2 Acute to Chronic MND: General Fitness Training vs CONTROL, Outcome 2 Pain Intensity
(VAS): 10 weeks of treatment + 10 weeks follow-up. . . . . . . . . . . . . . . . . . . . . 146
Analysis 4.1. Comparison 4 Chronic MND: Cervical Stretch/ROM Exercises + Dynamic Cervical Stabilization vs SHAM,
Outcome 1 Pain Intensity (VAS): 8 weeks of treatment. . . . . . . . . . . . . . . . . . . . 148
Analysis 4.2. Comparison 4 Chronic MND: Cervical Stretch/ROM Exercises + Dynamic Cervical Stabilization vs SHAM,
Outcome 2 Pain Intensity (VAS): 8 weeks of treatment + 6 month follow-up. . . . . . . . . . . . . 148
Analysis 4.3. Comparison 4 Chronic MND: Cervical Stretch/ROM Exercises + Dynamic Cervical Stabilization vs SHAM,
Outcome 3 Pain Intensity (VAS): 8 weeks of treatment + 12 months follow-up. . . . . . . . . . . . 149
Analysis 4.4. Comparison 4 Chronic MND: Cervical Stretch/ROM Exercises + Dynamic Cervical Stabilization vs SHAM,
Outcome 4 Function (NDI): 8 weeks of treatment. . . . . . . . . . . . . . . . . . . . . . 149
Analysis 4.5. Comparison 4 Chronic MND: Cervical Stretch/ROM Exercises + Dynamic Cervical Stabilization vs SHAM,
Outcome 5 Function (NDI): 8 weeks of treatment + 6 month follow-up. . . . . . . . . . . . . . 150
Analysis 4.6. Comparison 4 Chronic MND: Cervical Stretch/ROM Exercises + Dynamic Cervical Stabilization vs SHAM,
Outcome 6 Function (NDI): 8 weeks of treatment + 12 month follow-up. . . . . . . . . . . . . . 150
Analysis 5.1. Comparison 5 Chronic MND: Static Cervical Strengthening + Static Stabilization vs NO INTERVENTION
OR WAIT LIST, Outcome 1 Pain Intensity (VAS): 6 weeks of treatment. . . . . . . . . . . . . . 151
Analysis 5.2. Comparison 5 Chronic MND: Static Cervical Strengthening + Static Stabilization vs NO INTERVENTION
OR WAIT LIST, Outcome 2 Pain Intensity (VAS): 6 weeks of treatment + 6 weeks follow-up. . . . . . . 151
Exercises for mechanical neck disorders (Review) i
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 5.3. Comparison 5 Chronic MND: Static Cervical Strengthening + Static Stabilization vs NO INTERVENTION
OR WAIT LIST, Outcome 3 Function (NPQ): 6 weeks of treatment. . . . . . . . . . . . . . . 152
Analysis 5.4. Comparison 5 Chronic MND: Static Cervical Strengthening + Static Stabilization vs NO INTERVENTION
OR WAIT LIST, Outcome 4 Function (NPQ): 6 weeks of treatment + 6 weeks follow-up. . . . . . . . 152
Analysis 5.6. Comparison 5 Chronic MND: Static Cervical Strengthening + Static Stabilization vs NO INTERVENTION
OR WAIT LIST, Outcome 6 Quality of Life (SF-36): 6 weeks of treatment + 6 w follow-up. . . . . . . 153
Analysis 6.1. Comparison 6 Chronic MND: Pattern synchronization (sitting posture) vs CONTROL, Outcome 1 Pain
intensity (VAS) 2 weeks of treatment. . . . . . . . . . . . . . . . . . . . . . . . . . 153
Analysis 6.2. Comparison 6 Chronic MND: Pattern synchronization (sitting posture) vs CONTROL, Outcome 2 Function
(NDI): 2 weeks of treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Analysis 7.1. Comparison 7 Acute to Chronic MND: Scapulothoracic + UE Strengthening vs CONTROL, Outcome 1
Pain Intensity (NPS): 4 weeks of treatment. . . . . . . . . . . . . . . . . . . . . . . . 154
Analysis 7.2. Comparison 7 Acute to Chronic MND: Scapulothoracic + UE Strengthening vs CONTROL, Outcome 2
Pain Intensity: 10 to 20 weeks of treatment. . . . . . . . . . . . . . . . . . . . . . . . 155
Analysis 7.3. Comparison 7 Acute to Chronic MND: Scapulothoracic + UE Strengthening vs CONTROL, Outcome 3
Pain Intensity: 20 weeks of treatment. . . . . . . . . . . . . . . . . . . . . . . . . . 156
Analysis 7.4. Comparison 7 Acute to Chronic MND: Scapulothoracic + UE Strengthening vs CONTROL, Outcome 4
Pain Intensity (VAS): 10 weeks of treatment + 10 weeks follow-up. . . . . . . . . . . . . . . . 156
Analysis 7.5. Comparison 7 Acute to Chronic MND: Scapulothoracic + UE Strengthening vs CONTROL, Outcome 5
Function: 4 weeks of treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Analysis 7.6. Comparison 7 Acute to Chronic MND: Scapulothoracic + UE Strengthening vs CONTROL, Outcome 6
Function: 20 weeks of treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Analysis 7.7. Comparison 7 Acute to Chronic MND: Scapulothoracic + UE Strengthening vs CONTROL, Outcome 7
Function: 12 to 20 weeks of treatment/follow-up. . . . . . . . . . . . . . . . . . . . . . 158
Analysis 8.1. Comparison 8 Chronic MND: Cervical/UE Stretch/ROM Exercise + Cervical/UE Strengthening + Dynamic
Cervical Stabilization vs PLACEBO or SHAM, Outcome 1 Pain Intensity (VAS): 8 weeks of treatment. . . . 158
Analysis 8.2. Comparison 8 Chronic MND: Cervical/UE Stretch/ROM Exercise + Cervical/UE Strengthening + Dynamic
Cervical Stabilization vs PLACEBO or SHAM, Outcome 2 Pain Intensity (VAS): 8 weeks of treatment + 6 month
follow-up. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Analysis 8.3. Comparison 8 Chronic MND: Cervical/UE Stretch/ROM Exercise + Cervical/UE Strengthening + Dynamic
Cervical Stabilization vs PLACEBO or SHAM, Outcome 3 Pain Intensity (VAS): 8 weeks of treatment + 12 month
follow-up. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Analysis 8.4. Comparison 8 Chronic MND: Cervical/UE Stretch/ROM Exercise + Cervical/UE Strengthening + Dynamic
Cervical Stabilization vs PLACEBO or SHAM, Outcome 4 Function (NDI): 8 weeks of treatment. . . . . 160
Analysis 8.5. Comparison 8 Chronic MND: Cervical/UE Stretch/ROM Exercise + Cervical/UE Strengthening + Dynamic
Cervical Stabilization vs PLACEBO or SHAM, Outcome 5 Function (NDI): 8 weeks of treatment + 6 month follow-
up. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Analysis 8.6. Comparison 8 Chronic MND: Cervical/UE Stretch/ROM Exercise + Cervical/UE Strengthening + Dynamic
Cervical Stabilization vs PLACEBO or SHAM, Outcome 6 Function (NDI): 8 weeks treatment + 12 month follow-
up. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Analysis 9.1. Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/-UE
Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME
INTERVENTION, Outcome 1 Pain Intensity: Immediate Post Treatment (<11w of treatment). . . . . . 161
Analysis 9.2. Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/-UE
Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME
INTERVENTION, Outcome 2 Pain Intensity: 11 w of treatment + 3 month follow-up. . . . . . . . . 162
Analysis 9.3. Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/-UE
Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME
INTERVENTION, Outcome 3 Pain Intensity: Treatment + IT follow-up (11 weeks of treatment + 6 month follow-
up. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Analysis 9.4. Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/-UE
Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME
INTERVENTION, Outcome 4 Pain Intensity: Treatment + LT follow-up. . . . . . . . . . . . . 164
Exercises for mechanical neck disorders (Review) ii
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 9.5. Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/-UE
Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME
INTERVENTION, Outcome 5 Function: Immediate Post treatment. . . . . . . . . . . . . . . 164
Analysis 9.6. Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/-UE
Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME
INTERVENTION, Outcome 6 Function: Treatment + ST follow-up. . . . . . . . . . . . . . . 165
Analysis 9.7. Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/-UE
Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME
INTERVENTION, Outcome 7 Function: Treatment + IT follow-up. . . . . . . . . . . . . . . 166
Analysis 9.8. Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/-UE
Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME
INTERVENTION, Outcome 8 Function: Treatment + LT follow-up. . . . . . . . . . . . . . . 166
Analysis 9.9. Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/-UE
Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME
INTERVENTION, Outcome 9 Quality of Life: Immediate Post Treatment. . . . . . . . . . . . . 167
Analysis 9.10. Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/-
UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME
INTERVENTION, Outcome 10 Quality of Life: Treatment + ST follow-up. . . . . . . . . . . . . 168
Analysis 9.11. Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/-
UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME
INTERVENTION, Outcome 11 Quality of Life: Treatment + IT follow-up. . . . . . . . . . . . . 168
Analysis 9.12. Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/-
UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME
INTERVENTION, Outcome 12 Quality of Life: Treatment + LT follow-up. . . . . . . . . . . . . 169
Analysis 9.13. Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/-
UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME
INTERVENTION, Outcome 13 Patient Satisfaction: Immediate Post Treatment. . . . . . . . . . . 169
Analysis 9.14. Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/-
UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME
INTERVENTION, Outcome 14 Patient Satisfaction: Treatment + ST follow-up. . . . . . . . . . . 170
Analysis 9.15. Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/-
UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME
INTERVENTION, Outcome 15 Patient Satisfaction: Treatment + IT follow-up. . . . . . . . . . . 170
Analysis 9.16. Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/-
UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME
INTERVENTION, Outcome 16 Patient Satisfaction: Treatment + LT follow-up. . . . . . . . . . . 171
Analysis 9.17. Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/-
UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME
INTERVENTION, Outcome 17 Global Perceived Effect: Immediate Post Treatment. . . . . . . . . . 171
Analysis 9.18. Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/-
UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME
INTERVENTION, Outcome 18 Global Perceived Effect: Treatment + ST follow-up. . . . . . . . . . 172
Analysis 9.19. Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/-
UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME
INTERVENTION, Outcome 19 Global Perceived Effect: Treatment + IT follow-up. . . . . . . . . . 172
Analysis 9.20. Comparison 9 Chronic MND: Cervical/UE Stretch/ROM Exercises + Cervical/Scapulothoracic+/-
UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER INTERVENTION vs THAT SAME
INTERVENTION, Outcome 20 Global Perceived Effect: Treatment + LT follow-up. . . . . . . . . . 173
Analysis 10.1. Comparison 10 Chronic MND: Cervical Stretch/ROM Exercises + Cervical/Scapulothoracic Strengthening
+ Static/Dynamic Cervical/Shoulder Stabilization vs WAIT LIST, Outcome 1 Pain Intensity (VAS): 12 weeks of
treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Anita Gross1 , Theresa M Kay2,3 , Jean-Philippe Paquin4 , Samuel Blanchette5 , Patrick Lalonde6 , Trevor Christie6 , Genevieve Dupont
6,Nadine Graham7 , Stephen J Burnie8 , Geoff Gelley9 , Charles H Goldsmith10 , Mario Forget11 , Jan L Hoving12 , Gert Brønfort13 ,
Pasqualina L Santaguida14 , Cervical Overview Group15
1 School of Rehabilitation Science & Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
2 Women’s College Hospital, Toronto, Canada. 3 Department of Physical Therapy, University of Toronto, Toronto, Canada. 4 Physio St-
Maurice, Trois-Rivières, Canada. 5 Laval University, Québec, Canada. 6 University of Western Ontario, London, Canada. 7 School of Re-
habilitation Science, McMaster University, Hamilton, Canada. 8 Department of Clinical Education, Canadian Memorial Chiropractic
College, Toronto, Canada. 9 Applied Health Sciences, University of Manitoba, Winnipeg, Canada. 10 Faculty of Health Sciences, Simon
Fraser University, Burnaby, Canada. 11 Canadian Forces Health Services Group | Groupe de services de santé des Forces Canadiennes,
National Defence | Défense Nationale, Government of Canada | Gouvernement du Canada, Kingston, Canada. 12 Coronel Institute of
Occupational Health and Research Center for Insurance Medicine, Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands. 13 Integrative Health & Wellbeing Research Program, Center for Spirituality & Healing, University of Minnesota, Min-
neapolis, MN, USA. 14 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada. 15 Hamilton,
Canada
Contact address: Theresa M Kay, Women’s College Hospital, Toronto, ON, Canada. theresa.m.kay@gmail.com.
Citation: Gross A, Kay TM, Paquin JP, Blanchette S, Lalonde P, Christie T, Dupont G, Graham N, Burnie SJ, Gelley G, Goldsmith
CH, Forget M, Hoving JL, Brønfort G, Santaguida PL, Cervical Overview Group. Exercises for mechanical neck disorders. Cochrane
Database of Systematic Reviews 2015, Issue 1. Art. No.: CD004250. DOI: 10.1002/14651858.CD004250.pub5.
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
ABSTRACT
Background
Neck pain is common, disabling and costly. Exercise is one treatment approach.
Objectives
To assess the effectiveness of exercises to improve pain, disability, function, patient satisfaction, quality of life and global perceived effect
in adults with neck pain.
Search methods
We searched MEDLINE, MANTIS, ClinicalTrials.gov and three other computerized databases up to between January and May 2014
plus additional sources (reference checking, citation searching, contact with authors).
Selection criteria
We included randomized controlled trials (RCTs) comparing single therapeutic exercise with a control for adults suffering from neck
pain with or without cervicogenic headache or radiculopathy.
Data collection and analysis
Two review authors independently conducted trial selection, data extraction, ’Risk of bias’ assessment and clinical relevance. The quality
of the evidence was assessed using GRADE. Meta-analyses were performed for relative risk and standardized mean differences (SMD)
with 95% confidence intervals (CIs) after judging clinical and statistical heterogeneity.
Exercises for mechanical neck disorders (Review) 1
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Main results
Twenty-seven trials (2485 analyzed /3005 randomized participants) met our inclusion criteria.
For acute neck pain only, no evidence was found.
For chronic neck pain, moderate quality evidence supports 1) cervico-scapulothoracic and upper extremity strength training to improve
pain of a moderate to large amount immediately post treatment [pooled SMD (SMDp) -0.71 (95% CI: -1.33 to -0.10)] and at
short-term follow-up; 2) scapulothoracic and upper extremity endurance training for slight beneficial effect on pain at immediate post
treatment and short-term follow-up; 3) combined cervical, shoulder and scapulothoracic strengthening and stretching exercises varied
from a small to large magnitude of beneficial effect on pain at immediate post treatment [SMDp -0.33 (95% CI: -0.55 to -0.10)] and
up to long-term follow-up and a medium magnitude of effect improving function at both immediate post treatment and at short-term
follow-up [SMDp -0.45 (95%CI: -0.72 to -0.18)]; 4) cervico-scapulothoracic strengthening/stabilization exercises to improve pain
and function at intermediate term [SMDp -14.90 (95% CI:-22.40 to -7.39)]; 5) Mindfulness exercises (Qigong) minimally improved
function but not global perceived effect at short term. Low evidence suggests 1) breathing exercises; 2) general fitness training; 3)
stretching alone; and 4) feedback exercises combined with pattern synchronization may not change pain or function at immediate post
treatment to short-term follow-up. Very low evidence suggests neuromuscular eye-neck co-ordination/proprioceptive exercises may
improve pain and function at short-term follow-up.
For chronic cervicogenic headache, moderate quality evidence supports static-dynamic cervico-scapulothoracic strengthening/endurance
exercises including pressure biofeedback immediate post treatment and probably improves pain, function and global perceived effect
at long-term follow-up. Low grade evidence supports sustained natural apophyseal glides (SNAG) exercises.
For acute radiculopathy, low quality evidence suggests a small benefit for pain reduction at immediate post treatment with cervical
stretch/strengthening/stabilization exercises.
Authors’ conclusions
No high quality evidence was found, indicating that there is still uncertainty about the effectiveness of exercise for neck pain. Using
specific strengthening exercises as a part of routine practice for chronic neck pain, cervicogenic headache and radiculopathy may be
beneficial. Research showed the use of strengthening and endurance exercises for the cervico-scapulothoracic and shoulder may be
beneficial in reducing pain and improving function. However, when only stretching exercises were used no beneficial effects may be
expected. Future research should explore optimal dosage.
Cervical/ UE Stretch/ ROM Exercises + Cervical/ Scapulothoracic+/ - UE Strengthening + Dynamic/ Static Cervical Stabilization + ANOTHER INTERVENTION compared to THAT
SAM E INTERVENTION for chronic mechanical neck disorders
Pain Intensity: VAS 0 no pain to 10 worst Three trials showed a sm all reduction in 241 ⊕⊕⊕
pain pain. (3 studies: Bronf ort 2011, Chiu 2005, moderate 1
(f ollow-up: 6 m onths) Pooled scores estim ated using a m ean Franca 2008)
dif f erence of -0.67 (-1.32 to -0.02)
Function: NDI 0 no disability to 50 m axi- Three trials showed a sm all to m oderate 241 ⊕⊕⊕
m um disability (f ollow-up: 6 m onths) im provem ent in f unction (3 studies: Bronf ort 2011, Chiu 2005, moderate 1
Pooled scores estim ated using a m ean Franca 2008)
dif f erence of -2.80 (-6.36 to 0.76)
Quality of Life: SF-36 (physical com po- Two trials showed no signif icant dif f erence 165 ⊕⊕
nent) 0 worse to 100 better, SF-12. Pooled scores estim ated using a standard (2 studies: Bronf ort 2001, M artel 2011) low1
(f ollow-up: Im m ediate post treatm ent) m ean dif f erence of -0.18 (-0.48 to 0.13)
Patient Satisfaction: 1 to 7; com pletely One trial showed m oderate im provem ent 101 ⊕⊕⊕
satisf ied to com pletely dissatisf ied in satisf action (1 study: Bronf ort 2001) moderate
(f ollow-up: 24 m onths) Scores estim ated using a standard m ean
dif f erence of -0.93 (-1.35 to -0.52)
Global Perceived Effect: Patient- Rated One trial showed a sm all to m oderate im - 101 ⊕⊕⊕
Im provem ent 1 m ore im provem ent to 9 provem ent in global perceived ef f ect (1 study: Bronf ort 2001) moderate
less im provem ent Scores estim ated using a standard m ean
(f ollow-up: 24 m onths) dif f erence of -0.42 (-0.81 to -0.03)
4
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Exercises for mechanical neck disorders (Review)
Adverse Effects One study reported increased neck or headache pain: Intervention group (n = 8), com parison group (n = 6); increased radicular
pain intervention group (n = 1); severe thoracic pain com parison group (n = 1); all cases self -lim iting and no perm anent injuries
(Bronf ort 2001). 3 trials reported no com plications or serious adverse events (Chiu 2005, Franca 2008, M artel 2011)
M oderate quality evidence: (4 trials, 341 participants, Bronf ort 2001; Chiu 2005; Franca 2008; M artel 2011) shows m oderate pain relief and im proved f unction up to long-term
f ollow-up f or com bined cervical, scapulothoracic stretching and strengthening f or chronic neck pain. A clinician m ay need to treat 6 to18 people to achieve this type of pain
relief and 4 to 13 to achieve this f unctional benef it. M oderate quality evidence (one trial, 101 participants; Bronf ort 2001) dem onstrates patients are very satisf ied with their
care. Changes in quality of lif e are suggestive of benef it but not conclusive. Changes in global perceived ef f ect m easures indicate a dif f erence im m ediately post treatm ent
and at long-term f ollow-up
We used the Cochrane GRADE approach and considered a num- Results of the search
ber of additional factors (adverse events, costs, temporality, plau- Considering all sources, we identified 5614 records through
sibility, dose response, strength of association, and clinical appli- database searches and we found 44 records from other sources
cability) to place the results into a larger context. The number searched from start up to November 2013. Following screening
needed to treat to benefit (NNTB) and treatment advantages were of 201 full text articles, 192 were assessed for eligibility, (agree-
calculated to communicate the magnitude of effect for main find- ment on selection showed weighted kappa 0.94, SE 0.02). After
ings (Gross 2002). further application of the eligibility criteria, we found 27 trials
that used exercise treatment for non-specific subacute and chronic
neck pain, and selected them for this review; Figure 1 describes the
Subgroup analysis and investigation of heterogeneity flow of included, excluded, and ongoing, as well as those awaiting
Not conducted due to lack of data. classification.
• Function outcomes
b) Cardiovascular/Aerobic Training
No difference in function between groups immediately post treat-
ment.
• Quality of Life outcomes
General Fitness Training versus Control
No difference in quality of life between groups immediately post One trial with two publications (Andersen 2008) compared a gen-
treatment. eral exercise program with a no treatment control (general health
Conclusion: There is low quality evidence (one trial, 24 partici- information) intervention.
pants, Hallman 2011) that diaphragmatic breathing may have no • Pain Intensity Outcomes
effect on pain, function and quality of life when compared to a no
treatment control for chronic mechanical neck pain immediately No difference in pain between both (see above: general exercise
post treatment (50 sessions over 10 weeks). versus control) groups immediately post treatment (Figure 5).
Figure 5. Forest plot of comparison: 2 Acute to Chronic MND: General Fitness Training vs CONTROL,
outcome: 2.2 Pain Intensity (VAS): 10 weeks of treatment + 10 weeks follow-up.
Conclusion: There is low quality evidence (one trial with two publi-
cations, 24 participants, Andersen 2008) that general fitness train- One trial (Allan 2003) evaluated neck stretching either before or
ing exercises may have no difference in pain when compared with after manipulation compared with manipulation alone.
a reference intervention for (sub)acute/chronic neck pain imme- • Pain Intensity Outcomes
diately post treatment.
No difference in pain between all groups immediately post treat-
ment.
2. Base Element • Function Outcomes
Figure 6. Forest plot of comparison: 4 Chronic MND: Cervical Stretch/ROM Exercises + Dynamic Cervical
Stabilization vs SHAM, outcome: 4.3 Pain Intensity (VAS): 8 weeks of treatment + 12 months follow-up.
• Function Outcomes
fit (exercise + an intervention versus that same intervention) on
There was no evidence of benefit on function immediately post
function immediately post treatment and at short-term follow-up.
treatment, at intermediate-term or long-term follow-up.
(Helewa 2007).
Conclusion: Low quality evidence (one trial, 50 participants,
• Function Outcomes
Kjellman 2002) shows no difference for pain relief and function
immediately post intervention, at six- and 12-month follow-up Of the two comparisons, one showed no evidence of benefit (ex-
using Cervical Stretch/ROM Exercise + Dynamic Cervical Stabi- ercise versus control) while the other showed evidence of bene-
lization for chronic MND. fit (exercise + an intervention versus that same intervention) on
function immediately post treatment and at short-term follow-up.
b) Strengthening (Helewa 2007).
• Quality of Life
Static Cervical Strengthening + Static Stabilization versus No In two comparisons (exercise versus control, exercise + an inter-
Intervention or Wait List vention versus that same intervention), there was no evidence of
benefit immediately post treatment and at short-term follow-up
One trials (two comparisons) studying chronic neck pain com-
on quality of life (Helewa 2007), albeit there may be a clinically
pared either manually (1) resisted isometric neck exercise plus pos-
important effect favouring exercise + pillow versus pillow alone.
tural training with mirror feedback to a control, or (2) these same
Conclusion : Evidence exists from two trials (three comparisons)
isometric neck exercises and the use of an orthopaedic pillow were
where data are not combinable. Low quality evidence from one
compared with the use of an orthopaedic pillow (Helewa 2007).
trial (two independent comparisons, 50 participants, Helewa
• Pain Intensity Outcomes
2007) gives varying results. Evidence of benefit showed people
Of the two comparisons, one showed no evidence of benefit (ex- may improve slightly when exercise was added to a pillow versus a
ercise versus control) while the other showed evidence of bene- pillow alone (NNTB = 9). However, this was not observed when
Exercises for mechanical neck disorders (Review) 16
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
isometric exercise alone was evaluated for function and quality of on pain and function when compared to control for chronic me-
life, from immediately post treatment to short-term follow-up. chanical neck pain immediately post treatment (two-week inter-
vention).
Figure 8. Forest plot of comparison for Chronic MND: Cervical Stretch/ROM Exercises +
Cervical/Scapulothoracic Strengthening + Static/Dynamic Cervical/Shoulder Stabilization vs WAIT LIST,
outcome: Pain Intensity (VAS): 24 weeks of treatment.
• Function Outcomes
When the two trials were pooled, no significant difference in qual-
One trial (Rendant 2011), showed evidence of benefit for function ity of life was found at any time point. [Heterogeneity: Tau² =
post treatment. One trial (von Trott 2009) showed no significant 0.00; Chi² = 0.95, df = 1 (P = 0.33); I² = 0% MD pooled at
difference immediately post treatment and at short-term follow- 12 weeks -2.22 (CI 95% -5.17 to 0.72) (Analysis 10.7), at short-
up. When the two studies were pooled, there was a significantly term follow-up pooled MD 0.01 (CI 95% -0.47 to 0.49) (Analysis
different, clinically important, moderate change in function. [Het- 10.8)].
erogeneity: Tau² = 0.09; Chi² = 2.63, df = 1 (P = 0.10); I² = 62% Conclusion : Moderate quality evidence (two trials, 147 partic-
SMD pooled:-0.50 (CI 95% -1.04 to 0.03), NNTB = 5 (Analysis ipants, Rendant 2011; von Trott 2009) shows cervical stretch/
10.3)]. At short-term follow-up (24 weeks of treatment), pooled ROM exercises + cervical/scapulothoracic strengthening + static/
SMD: -0.40 (CI 95% -0.74 to -0.06) (Analysis 10.4). dynamic cervical/shoulder stabilization probably has moderate
• Global Perceived Effect benefit for pain and function, but not global perceived effect and
quality of life immediately post treatment and at short-term fol-
No significant difference in global perceived effect was found at low-up. A clinician may need to treat four people to achieve a
any time points. moderate degree of pain relief and five to achieve moderate func-
• Quality of Life tional benefit in one patient.
Figure 9. Forest plot of comparison for chronic MND: Cervical/UE Stretch/ROM Exercises +
Cervical/Scapulothoracic+/-UE Strengthening + Dynamic/Static Cervical Stabilization + ANOTHER
INTERVENTION vs THAT SAME INTERVENTION in the outcome Function at intermediate term follow-up.
Stretch/ROM + Strength and Endurance Training (trunk and 2. Base and Modular Element
limb) + Pattern/Synchronization: Balance Co-ordination +
Cardiovascular/Aerobic + Cognitive (Coaching +
Motivational) versus that Same Intervention Cervical/Scapulothoracic Strengthening with Endurance
One trial (Stewart 2007) compared an individualized, progressive Training + Craniocervical Pressure Biofeedback + Dynamic
submaximal program, which included aerobic training, trunk and Cervical Stabilization versus No Intervention
limb exercises and advice compared with advice alone. One trial (Jull 2002) studied chronic cervicogenic headache and
• Pain Intensity compared endurance exercises including pressure biofeedback for
the cervicoscapular region with no treatment.
There was evidence of small benefit on pain post treatment but
• Pain Intensity
not at long-term follow-up.
• Function When compared with no treatment, there was evidence of a large
benefit post treatment and a moderate size benefit at long-term
There was evidence of small benefit on function post treatment follow-up (Analysis 21.2) for pain relief. The number needed to
and at long-term follow-up. treat for one patient to benefit is six.
• Global Perceived Effect • Function
There was evidence of small benefit on global perceived effect post When compared with no treatment, there was evidence of a mod-
treatment but not at long-term follow-up. erate degree of benefit at post treatment and at long-term follow-
• Quality of Life up (Analysis 21.4) on function. The number needed to treat for
There was evidence of small benefit on quality of life post treatment one patient to benefit is six.
but not at long-term follow-up. • Global Perceived Effect
Conclusion: Low quality evidence (one trial, 132 participants, When compared with no treatment, there was evidence of a large
Stewart 2007) shows small benefits for pain relief, function,global benefit post treatment and at long-term follow-up (Analysis 21.6)
perceived effect and quality of life immediately post treatment and on global perceived effect.
small benefit at 12-month follow-up for function using Trunk/Ex- Conclusion : Moderate quality evidence (one trial, 97 partici-
tremity Stretch/ROM + Trunk/Extremity Strengthening + Trunk/ pants, Jull 2002) shows cervicoscapular strengthening and en-
Extremity Endurance Training + Pattern/Synchronization: Co-or- durance exercises including pressure biofeedback probably im-
dination + Cardiovascular/Aerobic + Cognitive (CBT) + another prove pain, function and global perceived effect for chronic cer-
treatment for Subacute/chronic WAD. vicogenic headaches at long-term follow-up when compared to
no treatment. A clinician may need to treat six people to achieve
this type (medium to large amount) of pain relief and functional
Cervicogenic Headache benefit in one patient.
Acute Radiculopathy
Adverse Events
Fifteen of the 27 trials did not report on adverse events (Andersen
1. Base Element 2008; Andersen Ch 2012; Ang 2009; Beer 2012; Dellve 2011; Hall
2007; Hallman 2011; Hansson 2013; Humphreys 2002; Kjellman
2002; Kuijper 2009; Lundblad 1999; Revel 1994; Takala 1994;
a) Stretching and Strengthening Viljanen 2003); six trials found patients did not report any adverse
events (Allan 2003; Chiu 2005; Franca 2008; Helewa 2007; Lange
2013; Martel 2011; six studies reported self-limiting side effects
Cervical Stretch/ROM + Cervical/Scapulothoracic/UE such as headache, neck, shoulder or thoracic pain or worsening of
Strengthening + Static/Dynamic Cervical Stabilization versus symptoms (Andersen 2011; Bronfort 2001; Jull 2002; Rendant
Wait List 2011; Stewart 2007; von Trott 2009).
Cervical Stretch/ ROM Exercises + Cervical/ Scapulothoracic Strengthening + Static/ Dynamic Cervical/ Shoulder Stabilization compared to WAIT LIST for mechanical neck
disorders
Pain Intensity: VAS 0 no pain to 100 Two trials showed a m edium reduction in 147 ⊕⊕⊕
worst pain; (f ollow-up: im m ediate post pain. (2 studies: Rendant 2011, von Trott 2009) moderate 1,2
treatm ent) a. Pooled m ean dif f erence -14.90 (-22.40
a. 12 weeks of treatm ent to -7.39)
b. 24 weeks of treatm ent or 12 weeks of b. Pooled m ean dif f erence -10.94 (-18.81
treatm ent+ 12 weeks f ollow-up to -3.08)
Function: NPDI or NDI 0 no disability to 100 Two trials showed a m edium im provem ent 147 ⊕⊕⊕
m axim um disability; (f ollow-up: im m ediate in f unction. (2 studies: Rendant 2011, von Trott 2009) moderate 1,2
post treatm ent) a. Pooled SM D -0.50 (-1.04 to 0.03)
a. 12 weeks of treatm ent b. Pooled SM D -0.40 (-0.74 to -0.06)
b. 24 weeks of treatm ent or 12 weeks
treatm ent + 12 weeks f ollow-up
Quality of Life: SF-36 (physical com po- Two trials showed no signif icant dif f erence 143 ⊕⊕⊕
nent) 0 worse to 100 better; (f ollow-up: in quality of lif e scores (2 studies: Rendant 2011, von Trott 2009) moderate 1,2
im m ediate post treatm ent) a. Pooled m ean dif f erence -2.22 (-5.17 to
a. 12 weeks of treatm ent 0.72)
b. 24 weeks of treatm ent or 12 weeks b. Pooled m ean dif f erence 0.06 (-4.06 to
treatm ent + 12 weeks f ollow-up 4.17)
24
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Exercises for mechanical neck disorders (Review)
Global Perceived Effect: General Health One trial showed no signif icant dif f erence 70 ⊕⊕⊕
Perception 0 worse to 100 better (f ollow- in GPE. (1 study: von Trott 2009) moderate 2
up: im m ediate post treatm ent)
a. 12 weeks of treatm ent
b. 24 weeks of treatm ent
M oderate quality evidence (two trials, 147 participants, von Trott 2009; Rendant 2011) shows cervical stretch/ ROM exercises + cervical/ scapulothoracic strengthening +
static/ dynam ic cervical/ shoulder stabilization probably has m oderate benef it f or pain and f unction, but not GPE and QoL at im m ediate post treatm ent and short-term f ollow-
up. A clinician m ay need to treat f our people to achieve m oderate degree of pain relief and f ive to achieve m oderate f unctional benef it in one patient
Stretch/ ROM + Endurance Training + Dynamic Stabilization + Cognitive (mindfulness & emotional balance) compared to WAIT LIST for mechanical neck disorders
Pain Intensity: VAS 0 no pain to 100 worst Two trials showed a m oderate reduction in 148 ⊕⊕⊕
pain (f ollow-up: im m ediate post treatm ent) pain (2 studies: Rendant 2011, von Trott 2009) moderate 1
a. 12 weeks of treatm ent Pooled scores estim ated using a
b. 24 weeks of treatm ent or 12 treatm ents a. M ean dif f erence of -13.28 (-20.98 to -5.
+ 12 weeks f ollow-up 58)
b. M ean dif f erence of -7.82 (-14.57 to -1.
07)
Function: NPDI 0 no disability to 100 m axi- Two trials showed a sm all im provem ent in 148 ⊕⊕⊕
m um disability (f ollow-up: im m ediate post f unction (2 studies: Rendant 2011, von Trott 2009) moderate 1
treatm ent) Pooled scores estim ated using a
a. 12 weeks of treatm ent a. Standard m ean dif f erence of -0.36 (-0.
b. 24 weeks of treatm ent or 12 weeks 68 to -0.03)
treatm ent + 12 weeks f ollow-up b. Standard m ean dif f erence of -0.28 (-0.
68 to 0.11)
Quality of Life: SF-36 (physical com po- Two trials showed little to no dif f erence in 148 ⊕⊕⊕
1
nent) 0 worse to 100 better (f ollow-up: im - quality of lif e (2 studies: Rendant 2011, von Trott 2009) moderate
m ediate post treatm ent) Pooled scores estim ated using a
a. 12 weeks of treatm ent a. M ean dif f erence of -2.72 (-5.42 to -0.01)
b. 24 weeks of treatm ent or 12 weeks b. M ean dif f erence of -1.88 (-5.80 to 2.04)
treatm ent + 12 weeks f ollow-up
26
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Exercises for mechanical neck disorders (Review)
Global Perceived Effect: General Health One trial showed no signif icant dif f erence 70 ⊕⊕⊕
Perception 0 worse to 100 better (f ollow- in GPE. (1 study: von Trott 2009) moderate 1,2
up im m ediate post treatm ent and short-
term )
M oderate quality evidence: (2 trials, 148 participants, Rendant 2011; von Trott 2009) shows Qigong exercises (Dantian Qigong) m ay im prove pain and f unction slightly when
com pared with a wait list control at im m ediate and short-term f ollow-up. It m ay have little or no benef it at im m ediate and short-term f ollow-up on quality of lif e and global
perceived ef f ect. A clinician m ay need to treat f our to six people to achieve this type of pain relief , f ive to eight people to achieve this f unctional benef it, and seven to 10
people f or this im provem ent in quality of lif e
Cervical Stretch/ ROM + Cervical/ Scapulothoracic/ UE Strengthening + Static/ Dynamic Cervical Stabilization compared with wait list for acute radiculopathy
Pain Intensity: VAS 0 no pain to 10 worst One trial showed a sm all reduction in pain 133 participants ⊕⊕
1,2
pain im m ediately post treatm ent and no benef it (1 study: Kuijper 2009) low
(f ollow-up: im m ediate post treatm ent) at 6 m onths f ollow-up
a. 6 weeks of treatm ent a. Standard m ean dif f erence are -0.47 (-0.
(f ollow-up period af ter treatm ent) 81 to -0.12) post intervention
b. 6 m onths b. Standard m ean dif f erence are 0.16 (-0.
19 to 0.51) at 6 m onths f ollow-up
Function: NDI 0 no disability to 50 m axi- One trial showed a sm all reduction in f unc- 133 participants ⊕⊕
1,2
m um disability (f ollow-up: im m ediate post tional disability im m ediately post treat- (1 study: Kuijper 2009) low
treatm ent) m ent and no benef it at 6 m onths f ollow-up
a. 6 weeks of treatm ent a. Standard m ean dif f erence are -0.11 (-0.
(f ollow-up period af ter treatm ent) 45 to 0.23) post intervention
b. 6 m onths b. Standard m ean dif f erence are 0.06 (-0.
29 to 0.40) at 6 m onth f ollow-up
Patient Satisfaction: 5-point scale, 1 to 5; a. One trial showed no dif f erence in patient 129 participants ⊕⊕
1,2
very satisf ied to unsatisf ied satisf action im m ediately post treatm ent. (1 study: Kuijper 2009) low
(f ollow-up: im m ediate post treatm ent) relative risk ratio are 0.92 (0.62 to 1.37)
a. 6 weeks of treatm ent post intervention
Low quality evidence: (one trial, 133 participants, Kuijper 2009) Cervical Stretch/ ROM + Cervical/ Scapulothoracic/ UE Strengthening + Static/ Dynam ic Cervical Stabilization
m ay im prove pain slightly, but m ay m ake no dif f erence in f unction and patient satisf action when com pared im m ediately post treatm ent with a control f or acute cervical
radiculopathy. However, there m ay be no dif f erence in pain and f unctional im provem ent at interm ediate-term f ollow-up
28
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Exercises for mechanical neck disorders (Review)
Cervical stretch/ ROM vs SHAM compared with SHAM intervention for subAcute CGH
Pain Intensity: VAS 0 no pain to 100 worst One trial showed a sm all reduction in pain 32 ⊕⊕
pain a. Standard m ean dif f erence are -1.58 (-2. (1 study: Hall 2007) low1,2
(f ollow-up: im m ediate post treatm ent ) 38 to -0.77) at 4 weeks
a. 4 weeks of treatm ent b. Standard m ean dif f erence are -1.74 (-2.
(f ollow-up period af ter treatm ent) 57 to -0.91) at 12 m onths
b. 12 m onths
Low quality evidence: (one trial, 32 participants, Hall 2007 ) shows Cervical stretch/ ROM m ay im prove a large am ount f or pain reduction at short- and long-term f ollow-up with
the use of C1 to C2 self -SNAG exercises when com pared with a sham f or (sub)acute cervicogenic headache. A clinician m ay need to treat three people to achieve this type of
long-term pain relief
Cervical/ Scapulothoracic Strengthening with Endurance Training + Craniocervical Pressure Biofeedback + Dynamic Cervical Stabilization compared with NO INTERVENTION
for Chronic CGH
Pain Intensity: VAS 0 no pain to 10 worst One trial showed a large reduction in pain 97 ⊕⊕⊕
pain at 6 weeks and 12 m onths f ollow up (1 study: Jull 2002) moderate 1
(f ollow-up: im m ediate post treatm ent) a. Standard m ean dif f erence are -0.75 (-1.
a. 6 weeks 16 to -0.34) at 6 weeks
(f ollow-up period af ter treatm ent) b. Standard m ean dif f erence are -0.59 (-1.
b. 12 m onths 00 to -0.18) at 12 m onths f ollow-up
Function: NPNPQ 0% no disability to 100% One trial showed a m oderate reduction in 97 ⊕⊕⊕
m axim um disability f unctional disability (1 study: Jull 2002) moderate 1
(f ollow-up: im m ediate post treatm ent) a. Standard m ean dif f erence are -0.56 (-0.
a. 6 weeks 96 to -0.15) at 6 weeks
(f ollow-up period af ter treatm ent) b. Standard m ean dif f erence are -0.70 (-1.
b. 12 m onths 11 to 0.29) at 12 m onths f ollow-up
Global Perceived Effect: VAS 0 to 100 One trial showed a large benef it in global 97 ⊕⊕⊕
(f ollow-up: im m ediate post treatm ent) perceived ef f ect (1 study: Jull 2002) moderate 1
a. 6 weeks a. Standard m ean dif f erence are -2.96 (-3.
(f ollow-up period af ter treatm ent) 55 to -2.38) at 6 weeks
b. 12 m onths b. Standard m ean dif f erence are -2.51 (-3.
05 to -1.97) at 12 m onths f ollow-up
Adverse effects M inor and tem porary adverse ef f ects were noted: 6.7% of headaches were provoked by treatm ent
31
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Exercises for mechanical neck disorders (Review)
M oderate quality evidence: (one trial, 97 participants, Jull 2002) shows cervicoscapular strengthening and endurance exercises including pressure biof eedback probably
im proves pain, f unction and global perceived ef f ect f or chronic cervicogenic headaches at long term f ollow-up when com pared to no treatm ent. A clinician m ay need to treat
six people to achieve this type of pain relief and f unctional benef it in one patient
Cervical/ Scapulothoracic Strengthening with Endurance Training + Craniocervical Pressure Biofeedback + Dynamic Cervical Stabilization + M anual Therapy compared with
M anual Therapy for Chronic CGH
Pain Intensity: 6 weeks treatm ent VAS 0 One trial showed a sm all reduction in pain 96 ⊕⊕⊕
no pain to 10 worst pain a. Standard m ean dif f erence are -0.11 (-0. (1 study: Jull 2002) moderate 1
(f ollow-up: im m ediate post treatm ent) 50 to 0.29) at 6 weeks
a. 6 weeks b. Standard m ean dif f erence are -0.17 (-0.
(f ollow-up period af ter treatm ent) 57 to 0.23) at 12 m onths f ollow-up
b. 12 m onths
Function: NPNPQ 0% no disability to 100% One trial showed a sm all reduction in f unc- 96 ⊕⊕⊕
m axim um disability tional disability (1 study: Jull 2002) moderate 1
(f ollow-up: im m ediate post treatm ent) a. Standard m ean dif f erence are -0.11 (-0.
a. 6 weeks of treatm ent 51 to 0.28) at 6 weeks
(f ollow-up period af ter treatm ent) b. Standard m ean dif f erence are -0.23 (-0.
b. 12 m onths 63 to 0.17) at 12 m onths f ollow-up
Global Perceived Effect: VAS 0 to 100 One trial showed a sm all benef it in global 96 ⊕⊕⊕
(f ollow-up: im m ediate post treatm ent) perceived ef f ect (1 study: Jull 2002) moderate 1
a. 6 weeks of treatm ent a. Standard m ean dif f erence are -0.29 (-0.
(f ollow-up period af ter treatm ent) 68 to 0.11) at 6 weeks
b. 12 m onths b. Standard m ean dif f erence -0.30 (-0.70
to 0.10) at 12 m onths f ollow-up
Adverse effects M inor and tem porary adverse ef f ects were noted: 6.7% of headaches were provoked by treatm ent
M oderate quality evidence (one trial, 96 participants, Jull 2002) shows when exercise com bined with m anual therapy contrasted with m anual therapy alone there is probably
no dif f erence in pain, f unction and global perceived ef f ect f or chronic cervicogenic headaches at long-term f ollow-up
33
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Exercises for mechanical neck disorders (Review)
Cervical/ UE Stretch/ ROM Exercise + Cervical/ UE Strengthening + Dynamic Cervical Stabilization compared with PLACEBO or SHAM for Chronic M ND
Pain Intensity: VAS 0 no pain to 100 worst One trial showed no dif f erence in pain 77 ⊕⊕
pain im m ediately post intervention and at 6 and (1 study: Kjellm an 2002) low1,2
(f ollow-up: im m ediate post treatm ent) 12 m onths f ollow-up
a. 2 m onths of treatm ent a. Standard m ean dif f erence 0.26 (-0.33 to
(f ollow-up period af ter treatm ent) 0.85) im m ediately 2 m onths post interven-
b. 6 m onths tion
c. 12 m onths b. Standard m ean dif f erence -0.16 (-0.75
to 0.43) at 6 m onths f ollow-up
c. Standard m ean dif f erence -0.19 (-0.40
to 0.78) at 12 m onths f ollow-up
Function: 2 m onths treatm ent NDI 0 no One trial showed no dif f erence in f unction 77 ⊕⊕
disability to 50 m axim um disability im m ediately post intervention and at 6 and (1 study: Kjellm an 2002) low1,2
(f ollow-up: im m ediate post treatm ent) 12 m onths f ollow-up
a. 2 m onths of treatm ent a. Standard m ean dif f erence are 0.14 (-
(f ollow-up period af ter treatm ent ) 0.45 to 0.73) im m ediately post 2 m onths
b. 6 m onths intervention
c. 12 m onths b. Standard m ean dif f erence -0.06 (-0.66
to 0.53) at 6 m onths f ollow-up
c. Standard m ean dif f erence 0.12 (-0.47 to
0.72) at 12 m onths f ollow-up
Low quality evidence: (One trial, 77 participants, Kjellm an 2002) No dif f erence f or pain relief and f unction im m ediately post intervention, at 6 and 12 m onths f ollow-up using
Cervical/ UE Stretch/ ROM Exercise + Cervical/ UE Strengthening + Dynam ic Cervical Stabilization f or chronic M ND
35
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Exercises for mechanical neck disorders (Review)
Cervical Stretch/ ROM Exercise + Dynamic Cervical Stabilization compared with SHAM for Chronic M ND
Pain Intensity: VAS 0 no pain to 100 worst One trial showed no dif f erence in pain 50 ⊕⊕
pain (f ollow-up: im m ediate post treatm ent) im m ediately post intervention and at 6 and (1 study: Kjellm an 2002) low1,2
a. 2 m onths of treatm ent 12 m onths f ollow-up
(f ollow-up period af ter treatm ent) a. Standard m ean dif f erence are -0.10 (-
b. 6 m onths 0.66 to 0.45) im m ediately post 2 m onths
c. 12 m onths intervention
b. Standard m ean dif f erence -0.29 (-0.85
to 0.27) at 6 m onths f ollow-up
c. Standard m ean dif f erence 0.04 (-0.51 to
0.60) at 12 m onths f ollow-up
Function: NDI 0 no disability to 50 m axi- One trial showed no dif f erence in f unction 50 ⊕⊕
m um disability (f ollow-up: im m ediate post im m ediately post intervention and at 6 and (1 study: Kjellm an 2002) low1,2
treatm ent) 12 m onths f ollow-up
a. 2 m onths of treatm ent a. Standard m ean dif f erence are -0.24 (-
(f ollow-up period af ter treatm ent ) 0.79 to 0.32) im m ediately post 2 m onth
b. 6 m onths intervention
c. 12 m onths b. Standard m ean dif f erence -0.22 (-0.79
to 0.36) at 6 m onths f ollow-up
c. Standard m ean dif f erence 0.14 (-0.44 to
0.71) at 12 m onths f ollow-up
Low quality evidence: (One trial, 50 participants, Kjellm an 2002) No dif f erence f or pain relief and f unction im m ediately post intervention, at 6 and 12 m onth f ollow-up using
Cervical Stretch/ ROM Exercise + Dynam ic Cervical Stabilization f or chronic M ND
37
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Exercises for mechanical neck disorders (Review)
Chronic M ND: Cervical/ Scapulothoracic/ UE Stretch + UE Endurance Training compared with NO INTERVENTION or WAIT LIST for chronic M ND
Pain Intensity: VAS 0 no pain to 100 worst One trial showed no dif f erence in pain 393 ⊕⊕⊕
pain im m ediately post intervention and at 3 (1 study: Viljanen 2003) moderate 1
(f ollow-up: im m ediate post treatm ent) and 9 m onths f ollow-up
a. 12 weeks of treatm ent a. Standard m ean dif f erence are 0.08 (-
(f ollow-up period af ter treatm ent) 0.16 to 0.32) im m ediately post 12 weeks
b. 3 m onths intervention
c. 9 m onths b. Standard m ean dif f erence 0.00 (-0.24
to 0.24) at 3 m onths f ollow-up
c. Standard m ean dif f erence -0.04 (-0.28
to 0.20) at 9 m onths f ollow-up
Function: NDI 0 no disability to 50 m axi- One trial showed no dif f erence in f unction 393 ⊕⊕⊕
m um disability im m ediately post intervention and at 3 (1 study: Viljanen 2003) moderate 1
(f ollow-up: im m ediate post treatm ent) and 9 m onths f ollow up
a. 12 weeks of treatm ent a. Standard m ean dif f erence 0.07 (-0.17
(f ollow-up period af ter treatm ent) to 0.31) im m ediately post 12 weeks inter-
b. 3 m onths vention
c. 9 m onths b. Standard m ean dif f erence 0.07 (-0.17
to 0.31) at 3 m onths f ollow-up
c. Standard m ean dif f erence 0.14 (-0.11
to 0.38) at 9 m onths f ollow-up
M oderate quality evidence: (one trial, 393 participants, Viljanen 2003) Little to no dif f erence f or pain relief and f unction im m ediately post intervention, at 3 and 9 m onths
f ollow-up using Cervical/ Scapulothoracic/ UE Stretch + UE Endurance Training f or chronic M ND
39
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Exercises for mechanical neck disorders (Review)
Pain Intensity: VAS 0 no pain to 10 worst One trial showed m oderate pain relief im - 198 ⊕⊕⊕
pain (f ollow-up: im m ediate post 10 weeks m ediately post intervention (1 study: Andersen 2011) moderate 1
treatm ent) a. Standard m ean dif f erence f or the 2
a. 2-m inute training group m inute training group -0.66 (-1.02 to -0.30)
b. 12-m inute training group b. Standard m ean dif f erence f or the 12
m inute training group -0.59 (-0.94 to -0.23)
Adverse effects Reported worsening of neck m uscle tension during and/ or in the days af ter training (2-m inute n = 1, 12-m inute n = 4), shoulder
joint pain during training (2-m inute n = 1, 12-m inute n = 4), pain in the upper arm during training (2-m inute n = 1, 12-m inute n = 1),
pain of the f orearm / wrist during training (12-m inute n = 2), worsening of headache af ter training (2-m inute n = 1, 12-m inute n = 1).
No long-lasting or m ajor com plications resulted f rom the training program
M oderate quality evidence: (one trial, 198 participants, Andersen 2011) M oderate benef it f or pain relief im m ediately post intervention using Scapulothoracic/ UE Endurance
Training f or (sub)Acute/ Chronic M ND. A clinician m ay need to treat f our people to achieve this type of pain relief
Trunk/ Extremity Stretch/ ROM + Trunk/ Extremity Strengthening + Trunk/ Extremity Endurance Training + Pattern/ Synchronization: Coordination + Cardiovascular/ Aerobic +
Cognitive (CBT) + ANOTHER TREATM ENT compared with THAT SAM E OTHER TREATM ENT for Subacute/ chronic WAD
Pain Intensity: VAS 0 no pain to 10 worst One trial showed sm all pain relief im m e- 132 ⊕⊕
pain diately post intervention and no dif f erence (1 study: Stewart 2007) low1,2
(f ollow-up: im m ediate post treatm ent) at 12 m onths f ollow-up
a. 6 weeks of treatm ent a. Standard m ean dif f erence -0.46 (-0.81
(f ollow-up period af ter treatm ent) to -0.12) im m ediately post 6 weeks inter-
b. 12 m onths vention
b. Standard m ean dif f erence -0.12 (-0.47
to 0.23) at 12 m onths f ollow-up
Function: NDI 0 no disability to 50 m axi- One trial showed sm all benef it in f unction 132 ⊕⊕
m um disability im m ediately post intervention and at 12 (1 study: Stewart 2007) low1,2
(f ollow-up: im m ediate post treatm ent) m onths f ollow-up
a. 6 weeks of treatm ent a. Standard m ean dif f erence -0.50 (-0.85
(f ollow-up period af ter treatm ent) to -0.15) im m ediately post 6 weeks inter-
b. 12 m onths vention
b. Standard m ean dif f erence -0.39 (-0.74
to -0.03) at 12 m onths f ollow-up
Global perceived effect: -5 to 5 scale; One trial showed sm all benef it in global 132 ⊕⊕
vastly worse to com pletely recovered perceived ef f ect im m ediately post inter- (1 study: Stewart 2007) low1,2
(f ollow-up: im m ediate post treatm ent) vention and no dif f erence at 12 m onths
a. 6 weeks of treatm ent f ollow-up
(f ollow-up af ter treatm ent) a. Standard m ean dif f erence -0.46 (-0.80
b. 12 m onths to -0.11) im m ediately post 6 weeks inter-
vention
42
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Exercises for mechanical neck disorders (Review)
Quality of Life: SF-36 0 high disability One trial showed sm all benef it in global 132 ⊕⊕
to 100 no disability (f ollow-up: im m ediate perceived ef f ect im m ediately post inter- (1 study: Stewart 2007) low1,2
post treatm ent) vention and no dif f erence at 12 m onth f ol-
a. 6 weeks of treatm ent low-up
(f ollow-up af ter treatm ent) a. Standard m ean dif f erence -0.35 (-0.69
b. 12 m onths to -0.01) im m ediately post 6 weeks inter-
vention
b. Standard m ean dif f erence -0.15 (-0.50
to 0.20) at 12 m onth f ollow-up
Adverse effects Reported; The m ain com plaint in this group was m uscle pain with exercise (3) f ollowed
by knee pain (2) and lum bar spine pain (2).
Low quality evidence: (one trial, 132 participants, Stewart 2007) Sm all benef it f or pain relief , f unction, global perceived ef f ect and quality of lif e im m ediately post treatm ent
and sm all benef it at 12 m onth f ollow up f or f unction using Trunk/ Extrem ity Stretch/ ROM + Trunk/ Extrem ity Strengthening + Trunk/ Extrem ity Endurance Training + Pattern/
Synchronization: Coordination + Cardiovascular/ Aerobic + Cognitive (CBT) + ANOTHER TREATM ENT f or Subacute/ chronic WAD
Pain Intensity: VAS 0 no pain to 100 worst Three trials showed a m oderate reduction 157 ⊕⊕⊕
pain (f ollow-up: im m ediate post 10 to 20 in pain. Pooled scores estim ated using a (3 studies: Andesen 2008, Andersen CH moderate
weeks of treatm ent) standard m ean dif f erence -0.71 (-1.33 to - 2012, Dellve 2011)
0.10)
Pain Intensity: VAS 0 no pain to 100 worst One trial (two com parisons) showed no 163
pain (f ollow-up: im m ediate post 20 weeks dif f erence in pain relief im m ediately post (1 study: three groups, Andersen CH 2012) very low1
of treatm ent) intervention
a. 1 weekly session a. One weekly session of 60 m inutes,
b. 9 weekly sessions scores using a standard m ean dif f erence -
0.20 (-0.63 to 0.22)
b. Nine weekly sessions of seven m inutes,
scores using a standard m ean dif f erence -
0.13 (-0.61 to 0.34)
Pain Intensity: VAS 0 no pain to 100 worst One trial showed m oderate reduction in 26 ⊕⊕
pain (f ollow-up: im m ediate post 10 weeks pain 10 weeks post intervention. Scores (1 study: Andersen 2008) low
of treatm ent) using a standard m ean dif f erence -0.89 (-
1.76 to -0.01) at 10 week f ollow-up
Function: DASH 20% no dif f iculty to 100% One trial showed no dif f erence in f unction 163
f ully unable (f ollow-up: im m ediate post 20 im m ediately post intervention (1 study: Andersen CH 2012) very low1
weeks of treatm ent) a. Standard m ean dif f erence -0.17 (-0.58
a. 1 weekly session to 0.24) im m ediately post intervention f or
b. 9 weekly sessions one weekly session of 60 m inutes
b. Standard m ean dif f erence -0.06 (-0.53
44
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Exercises for mechanical neck disorders (Review)
Work ability index: 7 poor ability to 49 One trial showed a sm all im provem ent in 88 ⊕⊕
excellent ability treatm ent (f ollow-up: im - work ability im m ediately post intervention. (1 study: Dellve 2011) low
m ediate post 20 weeks treatm ent) Standard m ean dif f erence -0.23 (-0.66 to
0.19) im m ediately post 20 weeks interven-
tion
M oderate quality evidence: (3 trials, 157 participants, Andersen 2008, Andersen Ch 2012, Dellve 2011) that scapulothoracic and upper extrem ity strength training probably
im proves pain. It probably f unctional outcom es when com pared to control f or chronic m echanical neck pain im m ediately post treatm ent (10 or 20 week interventions).
However low quality evidence suggests that scapulothoracic and upper extrem ity strength training m ay im prove pain slightly
Limiting the eligible trials to those with single interventions that • Low quality evidence suggest that there is a slight beneficial
compared exercise with a control or comparative group maximized effect on pain with acute cervical radiculopathy when combining
the opportunity to evaluate the treatment effect of exercise inter- the use of static and dynamic cervical, scapulothoracic and upper
ventions. Moreover, having selected a priori an exercise classifi- extremity stretching and strengthening immediately post
cation system allowed us to use a clinical rationale for selecting treatment but not at intermediate-term follow-up. There was
studies with similar interventions for interpretation and inclusion little to no difference in function.
within meta-analyses, particularly for the outcomes of pain and
function. Although there were only 28 studies eligible for this sys- • Low grade evidence suggests there is little to no difference
tematic review, these two new strategies provided greater clarity in chronic mechanical neck pain and function with respect to the
in our conclusions about the effectiveness of exercise therapy. In use of breathing exercises or general fitness training
summary, for moderate quality evidence there is still uncertainty
• Low grade evidence suggests there is little to no difference
about the effectiveness of exercise for neck pain. Further research
in chronic mechanical neck pain and function with respect to the
is likely to have an important impact on the effect estimate. Fur-
use of cervical spine stretches and range of motion exercises.
thermore, for low quality evidence further research is very likely
to have an important impact on the effect estimate. The reader • Moderate grade evidence suggests there is little to no
should take these limitations into account when interpreting the difference in chronic neck pain and function with the use of
following evidence statements. cervical, scapulothoracic and upper extremity stretching and
• Moderate to low quality evidence suggests there can be endurance training both immediately post treatment as well as
small to large beneficial effects on chronic mechanical neck pain short- and long-term follow-up.
when combining the use of cervical, shoulder/scapulothoracic
strengthening and stretching exercises immediately post • Low quality evidence suggests that there is little to no
treatment and at short- and long-term follow-up. There may also difference in chronic mechanical neck pain when combining the
be a small to moderate beneficial effect on function when use of trunk and upper extremity stretching, balance exercises
combining the use of cervical, shoulder/scapulothoracic and aerobic training immediately post treatment.
strengthening and stretching exercises immediately post
• Low quality evidence suggests that there is little to no
treatment and at short- to long-term follow-up.
difference in chronic mechanical neck pain when combining the
• Moderate grade evidence suggests there may be a slight use of endurance, general stretching, body mechanics and
beneficial effect on chronic mechanical neck pain with the use of lumbar stabilization exercises at short-term follow-up.
scapulothoracic and upper extremity endurance training
immediately post treatment. Knowledge of key multimodal approaches like exercise and manual
therapy is still needed as this model of combined care is commonly
• Moderate quality evidence suggests there may be a slight used in clinical practice.
improvement in chronic mechanical neck pain and function
with the use of Qigong (stretch, endurance, dynamic
stabilization exercises combined with cognitive exercises
emphasizing mindfulness and emotion) immediately post
Overall completeness and applicability of
treatment and at short-term follow-up. There may be little to no
evidence
difference in quality of life and general perceived effect measures Our group looked at the clinical applicability of 28 trials associ-
with the use of qigong exercises. ated with neck disorders versus control: 25 studies were interested
in neck pain, two in cervicogenic headache and one in cervical
• Low quality evidence suggests there may be a large
radiculopathy. The level of evidence ranged from low to moderate.
beneficial effect in cervicogenic headaches with the use of
Most studies adequately described the study population. Three
craniovertebral stretch and range of motion exercises (C1-C2
studies did not specify the duration of neck pain. Radicular signs
Self-SNAG) both at short- and long-term follow-up.
and symptoms were present in 14% of the studies, absent in 29%
• Moderate quality evidence suggests there is a large beneficial and not specified in 57%. Of the 28 studies in this update, 36%
effect on pain in cervicogenic headaches when combining the use provided sufficient details for the treatment protocol to be repli-
of static and dynamic cervical, scapulothoracic strengthening and cated and 18 studies omitted important details about the treat-
endurance exercises including pressure biofeedback immediately ment administration or included insufficient description of the
post treatment and probably improves pain moderately in qualifications of the treatment provider.
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Exercises for mechanical neck disorders (Review) 52
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tailored to the individual needs of patients with whiplash- pacientes con cervicalgia mecanica en atencion primaria:
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Outcomes PAIN
NRS, 0 to 100
Baseline Mean: Manip 30, Stretch before 58, Stretch After 63
Reported Results: no significant difference between groups
FUNCTION
NDI, 0 to 50
Baseline Mean: Manip 5, Stretch before 16, Stretch After 11
Reported Results: no significant difference between groups
REASON FOR DROP-OUTS: N/A
Notes
Risk of bias
Blinding (performance bias and detection High risk Not possible due to design
bias)
All outcomes - patients?
Blinding (performance bias and detection High risk Not possible due to design
bias)
All outcomes - providers?
Blinding (performance bias and detection High risk Not possible due to design
bias)
All outcomes - outcome assessors?
Notes
Risk of bias
Blinding (performance bias and detection High risk Not possible due to intervention
bias)
All outcomes - patients?
Blinding (performance bias and detection High risk Not possible due to intervention
bias)
All outcomes - providers?
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - outcome assessors?
Incomplete outcome data (attrition bias) Unclear risk 9% drop-out acceptable, but reason for
All outcomes - drop-outs? drop-outs not described. Furthermore, it
is unclear which groups’ data were missing
(see Sogaard 2012)
Incomplete outcome data (attrition bias) Unclear risk p 90 - 6 drop-outs in the REF group - not
All outcomes - ITT analysis? analyzed
Selective reporting (reporting bias) Low risk Trial registration adequate. International
Standard Randomized Controlled Trial
Number Register: ISRCTN87055459.
(see Sogaard 2012)
Timing outcome assessments similar? Low risk P175, right column, 2nd paragraph (So-
gaard 2012)
Andersen 2011
Outcomes PAIN
VAS, 0 to 10
Baseline Mean: 2 minutes 3.5, 12 minutes 3.9, Control 3.5
Reported Results: ANOVA showed a strong group-by-time effect for neck/shoulder
pain intensity (P < 0.0001). Compared with the control group, pain intensity decreased
in both training groups. This change was not significantly different between the 2 training
groups.
SMD (2 min): -0.66 (95% CI: -1.02 to -0.30)
SMD (12 min): -0.59 (95% CI: -0.94 to -0.23)
REASON FOR DROP-OUTS: 3 in 2 minutes group, 1 in 12 minutes group, 2 in
Control group, reasons reported
SIDE EFFECTS: Reported worsening of neck muscle tension during and/or in the days
after training (2-minute n = 1, 12-minute n = 4), shoulder joint pain during training
(2-minute n = 1, 12-minute n = 4), pain in the upper arm during training (2-minute
Notes
Risk of bias
Random sequence generation (selection Low risk pg 444 second column/ pg 442 first column
bias)
Blinding (performance bias and detection High risk Not possible due to intervention
bias)
All outcomes - patients?
Blinding (performance bias and detection High risk Not possible due to intervention
bias)
All outcomes - providers?
Blinding (performance bias and detection High risk Not possible self- assessment evaluation
bias) NPRS
All outcomes - outcome assessors?
Incomplete outcome data (attrition bias) Low risk p 443 second column
All outcomes - drop-outs?
Incomplete outcome data (attrition bias) High risk Figure 1 p 441 - not all participants ran-
All outcomes - ITT analysis? domized were analyzed
Co-interventions avoided or similar? Low risk Co-interventions similar p 443 section 2.5
Timing outcome assessments similar? Low risk p 443 top of 1st/p 441 under methods
Outcomes PAIN
Modified Nordic Questionnaire (MNQ), 0 to 9
Baseline Mean: 1WS (4.83), 3WS (4.96), 9WS (4.71), REF (4.83)
Reported Results: no significant difference between groups
SMD (1WS vs control): -0.44 (95% CI: -1.31 to 0.43); SMD (3WS vs control): -0.67
(95% CI: -1.59 to 0.25); SMD (9WS vs control): -0.30 (95% CI: -1.36 to 0.76)
FUNCTION
Disability of the arm, shoulder and hand (DASH), 0 to100
Baseline Mean: 1WS (16), 3WS (18), 9WS (15), REF (16)
Reported Results: no significant difference between groups
SMD (1WS vs control): -0.17 (95% CI: -0.58 to 0.24); SMD (3WS vs control): -0.23
(95% CI: -0.66 to 0.19); SMD (9WS vs control): -0.06 (95% CI: -0.53 to 0.41)
REASON FOR DROP-OUTS: NR
SIDE EFFECTS: NR
COST OF CARE: NR
Notes
Risk of bias
Random sequence generation (selection Unclear risk Not described in this paper, but Anderson
bias) 2010 is referenced to have details
Allocation concealment (selection bias) Unclear risk Not described in this paper, but Anderson
2010 is referenced to have details
Blinding (performance bias and detection High risk Perceptible difference between groups
bias)
All outcomes - patients?
Blinding (performance bias and detection High risk Perceptible difference between groups
bias)
All outcomes - providers?
Blinding (performance bias and detection High risk Patient is the assessor
bias)
All outcomes - outcome assessors?
Incomplete outcome data (attrition bias) High risk 38% drop-out rate
All outcomes - drop-outs?
Incomplete outcome data (attrition bias) Unclear risk Minimum supervision group not described
All outcomes - ITT analysis? (Figure 1); P1007Lp
Similarity of baseline characteristics? Low risk Table 2 - gave yes, but some hesitation be-
cause of higher proportion of males in 3WS
group
Compliance acceptable? High risk P1007Lp1; 56% did more than 20 min-
utes exercise per week - 60min/week was
planned
Ang 2009
Participants Chronic MND (Mechanical Neck Pain & Myofascial Pain Syndrome)
Radicular signs/symptoms: Absent
Setting: 2 air force helicopter bases
Country: Sweden
Outcomes PAIN
Prevelance during previous week
Baseline Mean (SD): Exercise 13 (38), Control 11 (32)
Reported Results: In the exercise group, the prevalence of cases for the previous week
and the previous 3 months decreased from 38% to 15% and 76% to 44% respectively,
whereas in controls it was unchanged
RR (exercise group vs control): 0.45 (95% CI: 0.18 to 1.14). Between-group regression
analyses revealed that the members of the exercising group had a 3.2 times greater chance
(odds ratio) than the control group of having been pain-free during the previous 7 days
and a 1.9 times great chance (odds ratio) of having been pain-free during the previous 3
months, P = 0.01
REASON FOR DROP-OUTS: 6 in Exercise Group, 6 in Control Group, reasons
reported
SIDE EFFECTS: NR
COST OF CARE: NR
Notes
Risk of bias
Random sequence generation (selection Unclear risk Randomization technique not adequately
bias) described
Beer 2012
Country: Australia
Outcomes PAIN
VAS, 0 to 10
Baseline mean: treatment 3.0 control 2.6
Reported results: no significant
SMD (exercise vs control): 0.13 (95% CI: -0.74 to 1.01)
FUNCTION
NDI, 0 to100
Baseline mean: treatment 18.1 control 20.6
Reported results: no significant
SMD (exercise vs control): -0.32 (95% CI: -1.21 to 0.56)
REASONS FOR DROP-OUTS: NR
SIDE EFFECTS: NR
COST OF CARE: NR
Notes
Risk of bias
Random sequence generation (selection Unclear risk Randomization technique not adequately
bias) described (p.221- left column)
Blinding (performance bias and detection High risk Not possible. Required active patient par-
bias) ticipation (exercise/posture)
All outcomes - patients?
Blinding (performance bias and detection High risk Not possible. Required active provider
bias) participation (exercise prescription/posture
All outcomes - providers? education)
Blinding (performance bias and detection High risk Patient is the outcome assessor.
bias)
All outcomes - outcome assessors?
Bronfort 2001
table with wearing head gear with variable weights from 1.25 lb to 10 lbs guided by a
simple pulley system attached to the table
Treatment Schedule: 20 sessions over 3 months
COMPARISON TREATMENT
Arm 3- Spinal Manipulative (SMT): Chiropractic manipulation, 20 sessions over 3
months
Treatment Schedule: 11 weeks, 20 session
Duration of Follow-up: 12 months
CO-INTERVENTION: NR
Notes Final data since there was small difference in reporting data between Bronfort 2001 and
Evans 2002, we elected to abstract Evans 2002 data for the data and analyses table.
Risk of bias
Random sequence generation (selection Low risk Sequentially numbered, opaque envelopes,
bias) prepared using a computer-generated list
prior to start of study p2384
Allocation concealment (selection bias) Low risk Study staff, investigators, clinicians, and
patients were masked to upcoming treat-
ment assignments p2384
Blinding (performance bias and detection High risk Not possible due to self-report measures
bias)
All outcomes - patients?
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - providers?
Blinding (performance bias and detection High risk Not possible due to study design.
bias)
All outcomes - outcome assessors?
Incomplete outcome data (attrition bias) High risk 93% at 11 weeks, 76% overall, but not de-
All outcomes - drop-outs? scribed.
Incomplete outcome data (attrition bias) High risk Only 145 out of 178 participants were an-
All outcomes - ITT analysis? alyzed according to Table 2
Similarity of baseline characteristics? Low risk Comparable on measured clinical and de-
mographic characteristics, see Table 1
Outcomes PAIN
VAS, 0 to 10
Baseline Mean: CCF 4.61, TENS 4.69, IR 4.26
Reported Results: NS
SMD (CCF vs IR): -0.34 (95% CI: -0.72 to 0.04); NNTB 6, treatment advantage 24%
FUNCTION
Northwick Park Questionnaire (NPQ) - Chinese version, 0 to 4
Baseline Mean: CCF 1.39, TENS 1.55, IR 1.36
Reported Results: CCF vs IR was significant (P = 0.02)
SMD (CCF vs IR): -0.33 (95% CI: -0.71 to 0.05); NNTB 6, treatment advantage 16%
REASON FOR DROP-OUTS: Reported
SIDE EFFECTS: No complications occurred.
COST OF CARE: NR
Notes
Risk of bias
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - patients?
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - providers?
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - outcome assessors?
Dellve 2011
Outcomes PAIN
Numeric Pain Scale, 0 to 10
Baseline Mean: MT (6.0), IMST (6.3), Control (6.2)
Reported Results: no significant difference between groups
SMD (IMST vs control) at immediate post-treatment: -0.30 (95% CI: -0.92 to 0.33);
SMD (IMST vs control) at 2 months follow-up: -0.63 (95% CI: -1.27 to 0.00)
FUNCTION
Work Ability Index, 7 to 49
Baseline Mean: MT (19.3), IMST (19.0), Control (19.0)
Reported Results: no significant difference between groups
SMD (IMST vs control) at immediate post-treatment: -0.18 (95% CI: -0.80 to 0.44);
SMD (IMST vs control) at 2 months follow-up: 0.38 (95% CI: -0.25 to 1.01)
REASON FOR DROP-OUTS: 5 in MT Group, 7 in IMST Group, 1 in Control Group,
reasons reported
SIDE EFFECTS: NR
COST OF CARE: NR
Notes
Risk of bias
Blinding (performance bias and detection High risk Not possible due to design
bias)
All outcomes - patients?
Blinding (performance bias and detection High risk Not possible due to design
bias)
All outcomes - providers?
Exercises for mechanical neck disorders (Review) 80
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Dellve 2011 (Continued)
Blinding (performance bias and detection High risk Not possible due to design
bias)
All outcomes - outcome assessors?
Incomplete outcome data (attrition bias) Unclear risk High drop-out rate in second group; rea-
All outcomes - drop-outs? sons for drop-outs not described
Incomplete outcome data (attrition bias) High risk Figure 1 - only 20 analyzed per group
All outcomes - ITT analysis?
Franca 2008
Outcomes PAIN
VAS, 0 to 100
Baseline Mean: PT+Acup 85.0, Acup 80.0, PT 70.0
Reported Results: According to KWT (Kruskal-Wallis test), the statistical analysis of
the inter-groups demonstrated significant (P < 0.05) differences among the groups. The
DMCT (Dunn’s Multiple Comparison test) showed that G1 was superior to G3 in pain
improvement (P < 0.05)
SMD (PT+ Acup vs Acup) at immediate post treatment: -0.73 (95% CI: -1.46 to -0.
00), treatment advantage 11%
FUNCTION
NDI - Brazilian/Portuguese version
Baseline Mean: PT+Acup 24.0, Acup 30.0, PT 28.0
Reported Results: The DMCT (Dunn’s Multiple Comparison test) showed that G1
was superior to G3 in reducing functional disability (P < 0.0001)
SMD (PT + Acup vs Acup) at IT follow-up: -0.95 (95% CI: -1.70 to -0.20), NNTB13,
treatment advantage 13%
REASONS FOR DROP-OUTS: Reported (3 drop-outs, 1 in each group)
SIDE EFFECTS: Reported; no record of serious complication of acupuncture or phys-
iotherapy occurred during treatments or during the follow-up period after any of the
treatments that could harm the patients during the assessment all stages of the trial
COST OF CARE: NR
Notes
Risk of bias
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - patients?
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - providers?
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - outcome assessors?
Similarity of baseline characteristics? High risk VAS scores were significantly different be-
tween groups
Hall 2007
Outcomes PAIN
Headache intensity change score (VAS), 0 to 100
Baseline Mean: SSng 52 Mock 51
Reported Results: group difference in patient-rated pain favours the SSng exercise group
SMD(SSng vs Mock) at ST follow-up: -1.58 (95% CI: -2.38 to -0.77); power 100%,
NNTB 2, Treatment advantage 40%
SMD(SSng vs Mock) at LT follow-up: -1.74 (95% CI:-2.57 to -0.91);power 100%,
NNTB 3, treatment advantage 40%
REASONS FOR DROP-OUTS: N/A
SIDE EFFECTS: NR
COST OF CARE: NR
Notes
Risk of bias
Random sequence generation (selection High risk Participans were allocated to treatment
bias) group using lottery ticket randomization
chosen from a concealed container
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - providers?
Timing outcome assessments similar? Low risk 4 weeks postintervention and 12 months
postintervention
Hallman 2011
Outcomes PAIN
Borg Scale, 0 to 10
Baseline Mean : Treatment 2.6, Control 2.5
Reported Results: no significant difference between groups
SMD (treatment vs control): -0.19 (95% CI: -1.01 to 0.63)
FUNCTION
NDI, 0 to 100
Baseline Mean: Treatment 21.3, Control 25.6
Reported Results: no significant difference between groups
SMD (treatment vs control): -0.52 (95% CI: -1.35 to 0.32)
QUALITY OF LIFE
SF-36 (physical function subscale)
Baseline mean: Treatment 89.6, Control 77.5
Reported Results: no significant difference between groups
SMD (treatment vs control): 0.65 (95% CI: -0.19 to 1.49)
REASONS FOR DROP-OUTS: NR
SIDE EFFECTS: NR
COST OF CARE: NR
Risk of bias
Blinding (performance bias and detection High risk Not possible due to design
bias)
All outcomes - patients?
Blinding (performance bias and detection High risk Not possible due to design
bias)
All outcomes - providers?
Blinding (performance bias and detection High risk Patient is outcome assessor
bias)
All outcomes - outcome assessors?
Incomplete outcome data (attrition bias) Low risk P.74, right column
All outcomes - drop-outs?
Incomplete outcome data (attrition bias) High risk 1 drop-out not included in analysis - Table
All outcomes - ITT analysis? 1
Similarity of baseline characteristics? Unclear risk See Table 2 - differences in physical func-
tion, vitality, social function, depression
Hansson 2013
Participants WAD
Radicular signs/symptoms: Not specified
Setting: Physiotherapy centre
Country: Sweden
Outcomes PAIN
VAS, 0 to 100
Baseline Median : Intervention 60, Control 60
Reported Results: no significant difference between groups, SMD (6 weeks vs control)
6 weeks 0.07 (95% CI: -0.68 to 0.82); SMD (3 months vs control) -0.60 (95% CI: -1.
35 to 0.15)
REASONS FOR DROP-OUTS: reported
SIDE EFFECTS: NR
COST OF CARE: NR
Notes We utilized median values (SD) rather than mean scores (SMD) to calculate SMD
Risk of bias
Random sequence generation (selection Low risk p.907 L bottom column: Random number
bias) table
Allocation concealment (selection bias) High risk p. 907 L bottom column: The same inde-
pendent person also carried out the inter-
vention
Blinding (performance bias and detection High risk Not possible due to design
bias)
All outcomes - patients?
Blinding (performance bias and detection High risk Not possible due to design
bias)
All outcomes - providers?
Blinding (performance bias and detection High risk Not possible since pt is outcome assessor
bias) for VAS.
All outcomes - outcome assessors?
Incomplete outcome data (attrition bias) High risk Drop- out rate too high: 17/29 dropped
All outcomes - drop-outs? out (figure 1)
Incomplete outcome data (attrition bias) High risk Table 3- 6 weeks control (N = 12)
All outcomes - ITT analysis?
Selective reporting (reporting bias) Unclear risk Unable to find registration online (reg.
number lu 702-01)
Co-interventions avoided or similar? High risk P907 Lp1 - 5 patients underwent other
types of physio during the study
Timing outcome assessments similar? Low risk p.907 bottom right column: the control
group was tested at the same intervals as the
intervention group
Helewa 2007
Arm 3- Neck Support and Exercise (Exercise + Pillow): Orthopaedic Pillow(s) + Exercise
+ Active Control Treatment: Orthopaedic pillows were used and were of two types: Shape
of Sleep pillow (Manutex Products, Mississauga, ON, Canada) or the SIssel Design AB
pillow (Sissel Design AB, Svedala, Sweden). The two types of pillows were randomly
assigned equally in each arm. The pillows did not differ in shape but in the firmness of
the foam. Pillow use, plus Exercise plus Active control treatment (massage and thermal
modality) were administered in this group
Arm 4- Massage Therapy and thermal modality (Control): Standard (regular) Pillow +
Active Control Group: The Standard (regular) pillow is assumed to be used by this group.
Active Control treatment that included massage and thermal modality,
Efflurage type massage for 10 sessions in 10 weeks. Visits were 2 sessions/week for 3
weeks, then 1 visit/week for 3 weeks, then 1 visit in 10th week.
Arm 5- Thermal modality: 20 minutes of moist heat or ice.
Treatment Schedule: 6 weeks (assume that the use of the pillow was constrained to these
6 weeks)
Duration of Follow-up: 6 weeks
CO-INTERVENTION: avoided in trial design
Outcomes PAIN
VAS, 0 to 10
Baseline Mean: Exercise 2.9, Pillow 3.6, Exercise + Pillow 2.3, Control 2.5
Reported Results: Not significant at all points
SMD (Exercise v Control): SMD -0.00 (95% CI: -0.52 to 0.52) SMD (Exercise + Pillow
v Pillow): SMD -0.59 (95% CI: -1.09 to -0.09); power 50.69%
FUNCTION
Northwick Park Neck Pain Questionnaire (NPQ), 0 to 100
Baseline Mean: Exercise 32.3, Pillow 35.01, Exercise + Pillow 29.9, Control 27.4
Reported Results: Interaction of pillow and exercises are statistically significant and
clinically important
SMD (Exercise vs Control): 0.00 (-0.52 to 0.52); power 100% SMD (Exercise + Pillow
vs Pillow): -0.61 (-1.11 to -0.12); power 100%
QUALITY OF LIFE
SF 36, 0 to 100
Baseline Mean: Exercise 42.8, Pillow 41.1, Exercise + Pillow 43.7, Control 43.8
Reported Results: no significant difference between groups
SMD (Exercise vs Control): 0.15 (95% CI: -0.34 to 0.65); power 100% SMD (Exercise
+ Pillow vs Pillow): -0.46 (95% CI: -0.95, to 0.04); power 100%
REASON FOR DROP-OUTS: Reported
SIDE EFFECTS: None present
COST OF CARE: NR
Notes
Risk of bias
Random sequence generation (selection Low risk 2x2 balanced factorial design, balanced
bias) treatment-group allocation was done us-
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - patients?
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - providers?
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - outcome assessors?
Timing outcome assessments similar? Low risk Post treatment, 6 weeks treatment + 6
weeks follow-up, 6 weeks treatment + 18
weeks follow-up, 6 weeks treatment + 46
weeks follow-up
Humphreys 2002
Outcomes PAIN
VAS, 0 to 100
Baseline Mean: SEG 55, SNEG 49
Reported Results: no significant difference between groups SMD (SEG vs SNEG): 0.
00 (95% CI: -0.74 to 0.74)
REASON FOR DROP-OUTS: NR
SIDE EFFECTS: NR
COST OF CARE: NR
Notes
Risk of bias
Blinding (performance bias and detection High risk Patient is the assessor
bias)
All outcomes - outcome assessors?
Incomplete outcome data (attrition bias) Low risk p.105, Results: 56/63
All outcomes - drop-outs?
Timing outcome assessments similar? Low risk Baseline, 2 weeks & 4 weeks
Jull 2002
Outcomes PAIN
Headache intensity change score (VAS), 0 to 10
Baseline Mean: SMT 4.8, CCF 5.4, MT/ET 5.1, NT 5.3
Reported Results: significant favouring SMT and CCF
SMD (CCF v NT) at LT follow-up:-0.59 (95% CI:-1.00 to -0.18), NNTB 6, treatment
advantage 28%
FUNCTION
Northwick Park Neck Pain Questionnaire (NPQ) change score, 0 to 36
Baseline Mean: SMT 27.5, CCF 29.6, MT/ET 29.7, NT 30.7
Reported Results: significant favouring MT or MT/ET over control; no significant
difference between MT, ET and MT/ET comparisons
SMD (CCF vs NT) at LT follow-up:-0.59 (95% CI:-1.00 to -0.18), NNTB 6, treatment
advantage 32%
GLOBAL PERCEIVED EFFECT
Participant perceived effect (VAS 0 to 100)
Reported Results: significant favouring SMT and MT/ET over NT, not significant for
SMT or MT/ET when compared to CCF
SMD (CCF vs NT):-2.51 (95% CI:-3.05 to -1.97)
REASONS FOR DROP-OUTS: reported
SIDE EFFECT: minor and temporary, 6.7% of headaches were provoked by treatment
COST OF CARE: NR
Notes
Risk of bias
Random sequence generation (selection Low risk 2x2 factorial design, randomized permuted
bias) block design was used with stratification
for length of headache history and city of
residence
Allocation concealment (selection bias) Low risk An independent body implemented ran-
domization by telephone contact with each
trial centre
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - patients?
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - providers?
Incomplete outcome data (attrition bias) Low risk ITT analysis performed
All outcomes - ITT analysis?
Similarity of baseline characteristics? Low risk Baseline characteristics across the four
treatment groups were similar (See Table 1)
. The only exception was the distribution
of females across treatment groups, subse-
quently included as a covariate in the anal-
ysis
Timing outcome assessments similar? Low risk 6 weeks treatment + 1 week, 3 months, 6
months and 12 months follow-up
Kjellman 2002
Outcomes PAIN
VAS, 0 to 100
Baseline Mean: ET 27.0, McK 19, SUS 21
Reported Results: no significant difference between groups
SMD (ET vs SUS) at LT follow-up: -0.19 (95% CI: -0.41 to 0.80)
SMD (McK vs SUS) at LT follow-up: 0.04 (95% CI: -0.51 to 0.60)
FUNCTION
NDI, 0 to 50
Baseline Mean: ET 27.0, McK 19, US 21
Reported Results: no significant difference between groups
SMD (ET vs SUS) at LT follow-up: -0.19 (95% CI: -0.41 to 0.80)
SMD (McK vs SUS) at LT follow-up: 0.04 (95% CI: -0.51 to 0.60)
REASONS FOR DROP-OUTS: reported
SIDE EFFECTS: NR
COST OF CARE: NR
Notes
Risk of bias
Random sequence generation (selection Low risk Randomization by drawing sealed en-
bias) velopes out of a box
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - patients?
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - providers?
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - outcome assessors?
Co-interventions avoided or similar? High risk Table 5, higher use by control group
Timing outcome assessments similar? Low risk Post treatment, 8 weeks treatment + 6
months, 8 weeks treatment + 52 weeks fol-
low-up
Kuijper 2009
Outcomes PAIN
VAS, 0 to100
Baseline Mean: Cervical Collar 57.4, Physiotherapy 61.7, WLG 55.6
Reported Results: At 6 weeks there was a significant decrease in neck pain in the collar
group 2.8 mm/week (17 mm in 6 weeks) and 2.4 mm/week in the physiotherapy group
(14 mm in 6 weeks), while the control group showed only 0.9 mm reduction in pain
over the 6 weeks. After 6 months the pain scores in the two treatment groups did not
differ from those of the control patients.
SMD (PT vs WLG) at Immediate post treatment: -0.47 (95% CI: -0.81 to -0.12);
NNTB 4, treatment advantage 33%
FUNCTION
NDI, 0 to 100
Baseline Mean: Cervical Collar 41.0, Physiotherapy 45.1, WLG 39.8
Reported Results: The collar group showed a significant difference in rate of improve-
ment compared with the control group, the weekly change in the physiotherapy group
was not significantly different from that of the control patients.
SMD (PT vs WLC) at immediate post treatment: -0.11 (95% CI: -0.45 to 0.23)
PATIENT SATISFACTION
scale 0 to 5
Reported Results: NR
RR (PT vs WLC) at immediate post treatment: 0.92 (95% CI: 0.62 to 1.37)
REASONS FOR DROP-OUTS: NR
SIDE EFFECT: NR
COST OF CARE: NR
Notes
Risk of bias
Allocation concealment (selection bias) Low risk Sealed envelopes prepared by an employee
who had no other involvement with the
study. The investigator assigned patients to
specific groups
Blinding (performance bias and detection High risk Stated within text page 2
bias)
All outcomes - patients?
Blinding (performance bias and detection High risk Stated within text page 2
bias)
All outcomes - providers?
Blinding (performance bias and detection High risk Patient self-report so not blinded
bias)
All outcomes - outcome assessors?
Incomplete outcome data (attrition bias) High risk There were 5 participants who were not
All outcomes - drop-outs? available for follow-up at 6 weeks;similarly
there were 13 participants lost to follow-up
at 6 months. Figure one details this
Incomplete outcome data (attrition bias) High risk Not all those randomized were included in
All outcomes - ITT analysis? the analysis ( those without follow-up data
were excluded). However this was a very
small number and unlikely to affect the es-
timates. They undertook a LOCF analysis
but did not state an ITT analysis within the
report
Similarity of baseline characteristics? High risk Greater arm pain in the collar group. Also
the control group had the smallest evidence
for root compression based on MRI
Co-interventions avoided or similar? Unclear risk All groups were allowed to take anal-
gesics and anitinflammatories.All patients
received the same information about the
natural course of the disease
Compliance acceptable? Low risk Compliance was monitored for both collar
use and physiotherapy. A total of 6 patients
(almost 10%) did not wear the collar at all
during the first 3 weeks
Timing outcome assessments similar? Low risk 6 weeks of treatment + 6 months and 12
months follow-up
Lange 2013
Outcomes PAIN
VAS, 0 to 10
Baseline Mean:Training group 1 and control 1.2
Reported Results: no significant difference between groups
SMD (training vs control): -0.58 (95% CI: -1.12 to -0.04)
REASON FOR DROP-OUTS: Reported
SIDE EFFECTS: Reported
COST OF CARE: NR
Notes
Risk of bias
Random sequence generation (selection Unclear risk P.51, right column, 1st paragraph: method
bias) of randomization very unconventional
Blinding (performance bias and detection High risk Not possible due to design.
bias)
All outcomes - patients?
Blinding (performance bias and detection High risk Not possible due to design
bias)
All outcomes - providers?
Blinding (performance bias and detection High risk Not possible due to design
bias)
All outcomes - outcome assessors?
Incomplete outcome data (attrition bias) Low risk P53, left column: 1 drop-out per group
All outcomes - drop-outs?
Incomplete outcome data (attrition bias) Low risk P53, left column, paragraph 6
All outcomes - ITT analysis?
Compliance acceptable? High risk P54, right column, Figure 3: 58% compli-
ance
Lundblad 1999
Outcomes PAIN
VAS, 0 to 10
Baseline Mean: VAS - usually MmPT 1.2, F 1.5, NT 2.0, VAS - worst MmPT 4.1, F
4.4, NT 5.5
Reported Results: no significant differences
SMD (PT vs no treatment) at LT follow-up: -0.14 (95% CI: -0.80 to 0.51)
DISABILITY
Work and leisure, 0 to 4; Sick leave, days and %
Baseline Mean:
Disability - work MmPT 1.3, F 1.2, NT 1.3,
Disability - leisure MmPT 0.6, F 0.9, NT 0.6
Sick leave (days) MmPT 12.7, F 12.0, NT 11.5,
Sick leave (%) MmPT 6.5, F 5.8, NT 5.9
Reported Results: no significant differences
REASON FOR DROP-OUTS: Reported
SIDE EFFECTS: NR
COST OF CARE: NR
Notes
Risk of bias
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - patients?
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - providers?
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - outcome assessors?
Timing outcome assessments similar? Low risk 16 weeks of treatment + 6 weeks follow-up
Martel 2011
Participants Chronic MND with or without referral/radiation to the head, trunk or limbs
Radicular signs/symptoms: Present
Setting: Chiropractic Clinic and Human Research Laboratory of the Department of
Chiropractice at the Universite du Quebec
Country: Canada
Outcomes PAIN
VAS, 0 to 10
Baseline Mean: SMT 3.1, SMT + Ex 3.8
Reported Results: no significant differences
FUNCTION
NDI, 0 to 50
Baseline Mean: SMT 21.4, SMT + Ex 22.2
Reported Results: no significant differences
HEALTH-RELATED QUALITY OF LIFE
SF-12, 0 to 100
Baseline Mean Physical Scale: SMT 48.7, SMT + Ex 50.0, Mental Scale: SMT 45.3,
SMT + Ex 44.8
Reported Results: no significant differences
REASON FOR DROP-OUTS: Reported
SIDE EFFECTS: Reported: No serious adverse events were reported during RCT
COST OF CARE: NR
Notes
Risk of bias
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - patients?
Exercises for mechanical neck disorders (Review) 104
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Martel 2011 (Continued)
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - providers?
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - outcome assessors?
Rendant 2011
Outcomes PAIN
VAS, 0 to 100
Baseline Mean: Qigong 57.7, E 57.5, NT 53.4
Reported Results: significant differences Qigong vs no treatment;
MD (Qigong vs no treatment) at 12 weeks treatment: -15.60 (-24.72 to -6.48)
MD (Qigong vs no treatment) at 24 weeks treatment: -8.10 (-15.72 to -0.48)
MD (Exercise vs no treatment) at 12 weeks treatment:-17.30 (95%CI: -26.60 to -8.00)
MD (Exercise vs no treatment) at 24 weeks treatment:-10.30 (95%CI: -19.97 to -0.63)
No significant difference Qigong vs exercise
FUNCTION
NPDI, 0 to 100
Baseline Mean: Qigong 44.0, E 39.5, NT 43.2
Reported Results: significant differences Qigong vs no treatment;
SMD (Qigong vs no treatment) at 12 weeks treatment: -0.48 (95%CI: -0.92 to -0.04)
SMD (Qigong vs no treatment) at 24 weeks treatment: -0.47 (95%CI: -0.92 to -0.02)
SMD (Exercise vs no treatment) at 12 weeks treatment: -0.78 (95%CI: -1.24 to -0.31)
SMD (Exercise vs no treatment) at 24 weeks treatment: -0.50 (95%CI: -0.97 to -0.04)
No difference Qigong vs exercise
QUALITY of LIFE
SF 36, physical component
Baseline Mean: Qigong 43.1, E 43.7, NT 43.3
Reported Results: significant differences qigong vs no treatment;
MD (Qigong vs no treatment) at 12 weeks treatment: -3.40 (95% CI: -6.97 to 0.17)
MD (Qigong vs no treatment) at 24 weeks treatment: -3.90 (95%CI: -8.07 to 0.27)
MD (Exercise vs no treatment) at 12 weeks treatment:-2.70 (95%CI: -6.76 to 1.36)
MD (Exercise vs no treatment) at 24 weeks treatment:-2.00 (95%CI: -5.83 to 1.83)
No difference qigong vs exercise
REASON FOR DROP-OUTS: detailed
SIDE EFFECTS: Reported by 19 patients in qigong group including: muscle soreness
(n = 15), myogelosis (n = 12), vertigo (n = 10), other pain (n = 4), headache (n = 3)
, thirst (n = 1), engorged hands (n = 1), twinge in the neck (n = 1), urinary urgency
(n = 1), bursitis of left shoulder (n = 1). Reported by 16 patients muscle soreness (n =
14), myogelosis (n = 11), headaches (n = 5), vertigo (n = 2), change in mood (n = 1),
worsening of neck pain (n = 1), worsening of tinnitus (n = 1)
COST OF CARE: NR
Risk of bias
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - patients?
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - providers?
Blinding (performance bias and detection High risk The outcome assessor was the patient (i.e.
bias) VAS) therefore not blind to previous an-
All outcomes - outcome assessors? swer
Incomplete outcome data (attrition bias) Low risk Quigong 39/42 - acceptable; exercise 35/
All outcomes - drop-outs? 39 acceptable ; Wait list 39/41
Incomplete outcome data (attrition bias) Low risk ITT was stated
All outcomes - ITT analysis?
Similarity of baseline characteristics? Low risk Table 1, Overall no difference noted be-
tween most variables albeit perceived effec-
tiveness has some differences
Timing outcome assessments similar? Low risk Baseline, 3 months and 6 months
Revel 1994
Outcomes PAIN
VAS, 0 to 100
Baseline Mean: RG 50.5, CG 45.9
Reported Results: significant favouring RG
SMD at ST follow-up: -0.77 (95% CI: -1.29 to -0.24), NNTB 4, treatment advantage
34%
DAILY INTAKE OF NSAID / ANALGESICS
Baseline Mean: RG 2.0/1.8, CG 2.3/1.6
Reported Results: not significant
FUNCTIONAL IMPROVEMENT SELF-ASSESSED
scale 0 to 5
Reported Results: significant favouring RG
SMD at ST follow-up: 0.55 (95% CI: 0.33 to 0.89), NNTB 3, treatment advantage NA
REASON FOR DROP-OUTS: NR
SIDE EFFECTS: NR
COST OF CARE: NR
Notes
Risk of bias
Blinding (performance bias and detection High risk Not possible due to intervention
bias)
All outcomes - providers?
Blinding (performance bias and detection High risk Patient self-report so not blinded
bias)
All outcomes - outcome assessors?
Timing outcome assessments similar? Low risk 8 weeks of treatment + 10 weeks follow-up
Stewart 2007
sessions
COMPARISON TREATMENT
Arm 2- Advice Alone: Standardised education, reassurance and encouragement to re-
sume light activity alone. One consultation and 2 follow-up phone contacts. Favorable
prognosis of whiplash, addressed common inaccurate beliefs about whiplash, exploration
of fear-avoidance beliefs. Participants given a written report of main points of advice
session. Standardized advice reinforced at 2 weeks and 4 weeks
Treatment Schedule: 6 weeks, 12 sessions
Duration of Follow-up: 42 weeks
CO-INTERVENTION: avoided in trial design
Outcomes PAIN
VAS, 0 to 10
Baseline Mean: Exercise + Advice 5.2, Advice Alone 5.3
Reported Results: Groups were similar at baseline.
SMD post: -0.46 (95% CI: -0.81 to -0.12) SMD 12 month: -0.12 (95% CI: -0.47 to
0.23)
FUNCTION
NDI, 0 to 50
Baseline Mean: Exercise + Advice 18.2, Advice Alone 19.7
Reported Results: Groups were similar at baseline.
SMD post: -0.50 (95% CI: -0.85 to -0.15) SMD 12 month: -0.39 (95% CI: -0.74 to -
0.03)
GLOBAL PERCEIVED EFFECT
scale -5 to 5
Baseline Mean: Exercise + Advice 0.6, Advice Alone 0.3
Reported Results: Groups were similar at baseline.
SMD post: -0.46 (95% CI: -0.80 to -0.11), SMD 12 month: -0.18 (95% CI: -0.54 to
0.17)
QUALITY OF LIFE
SF-36 Physical, 0 to 100
Baseline Mean: Exercise + Advice 36.4, Advice Alone 36.8
Reported Results: Groups were similar at baseline
SMD post: -0.35 (95% CI: -0.69 to -0.01), SMD 12 month: -0.15 (95% CI: -0.50 to
0.20)
REASON FOR DROP-OUTS: Reported but not specified
SIDE EFFECTS: Reported; The main complaint in this group was muscle pain with
exercise (3) followed
by knee pain (2) and lumbar spine pain (2).
COST OF CARE: NR
Notes
Risk of bias
Random sequence generation (selection High risk Randomized method is not described
bias)
Blinding (performance bias and detection High risk pg 61, self-report scales therefore patient is
bias) assessor even though author reports scales
All outcomes - outcome assessors? being administered and scored by staff
blind to group assignment
Incomplete outcome data (attrition bias) Low risk Although descriptions of drop-outs were
All outcomes - drop-outs? not given, due to the low number of drop-
outs we feel this is acceptable
Takala 1994
Outcomes PAIN
VAS, 0 to 100
Baseline Median: ET 40, NT 50
Reported Results: no significant difference
PRESSURE PAIN SENSITIVITY
Algometer (pressure pain threshold (PPT) on upper trapezius, levator scapulae, rhom-
boid, infraspinatus) mean score of 8 measures
Baseline Mean: ET 45.2, NT 44.8
Reported Results: no significant difference
SMD at immediate post treatment: -0.06 (95% CI: -0.65 to 0.53)
REASON FOR DROP-OUTS: NR
SIDE EFFECTS: NR
COST OF CARE: NR
Notes
Risk of bias
Random sequence generation (selection High risk Matching then random allocation not de-
bias) scribed
Allocation concealment (selection bias) Low risk The rater was blinded with respect to the
group status (treatment or control) of the
participant
Blinding (performance bias and detection High risk Patient self-report so not blinded
bias)
Incomplete outcome data (attrition bias) High risk ITT not performed
All outcomes - ITT analysis?
Viljanen 2003
Outcomes PAIN
VAS, 0 to 10
Baseline Mean: Exercise 4.8, Relax 4.8, Cntl 4.1
Reported Results: no group difference
Notes
Risk of bias
Allocation concealment (selection bias) Low risk Treatment allocation was concealed in a
numbered opaque envelope, which was
opened by the physician after baseline mea-
surements had been taken
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - patients?
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - providers?
Blinding (performance bias and detection High risk Not possible due to study design
bias)
All outcomes - outcome assessors?
Incomplete outcome data (attrition bias) High risk Reasons for drop-outs not described
All outcomes - drop-outs?
Timing outcome assessments similar? Low risk 12 weeks of treatment + 3 and 9 month
follow-up
Outcomes PAIN
VAS, 0 to100
Baseline Mean : Qigong 56.4, Exercise 47.1, Wait List Control 49.9
Reported Results: After 3 months there was not significant difference for the average
neck pain between the Qigong and the wait list group -11.0 mm (95% CI: -24.0 to 2.1;
P = 0.99, ANCOVA), and no significant difference between the Qigong and the exercise
therapy group the group difference being -2.5 mm (95% CI: -15.4 to 10.3, P = 0.68)
MD (Qigong vs control) at 12 weeks treatment: -7.50 (95% CI: -21.88 to 6.88)
MD (Qigong vs control) at 12 weeks treatment + 12 weeks follow-up: -6.80 (95% CI:
-21.34 to 7.74)
MD (Exercise vs control) at 12 weeks treatment: -10.40 (95%CI: -23.11 to 2.31)
MD (Exercise vs control) at 12 weeks treatment + 12 weeks follow-up: -12.20 (95%CI:
-25.73 to 1.33)
FUNCTION
NDI, 0 to100
Baseline Mean: Qigong 38.5, Exercise 41.8, Wait List Control 36.1
Reported Results: No significant difference was found between the groups after 3 and
6 months
SMD (Qigong vs control) at 12 weeks treatment: -0.21 (95% CI: -0.69 to 0.28)
SMD (Qigong vs control) at 12 weeks treatment + 12 weeks follow-up: -0.06 (95% CI:
-0.57 to 0.45)
SMD (Exercise vs control) at 12 weeks treatment: -0.23 (95%CI: -0.70 to 0.24)
SMD (Exercise vs control) at 12 weeks treatment + 12 weeks follow-up: -0.29 (95%CI:
-0.77 to 0.20)
GLOBAL PERCEIVED EFFECT
SMD (Qigong vs control) at 12 weeks treatment: -0.01 (95% CI: -0.49 to 0.47)
SMD (Qigong vs control) at 12 weeks treatment + 12 weeks follow-up: -0.09 (95% CI:
-0.60 to 0.42)
SMD (Exercise vs control) at 12 weeks treatment: 0.09 (95%CI: -0.38 to 0.56)
SMD (Exercise vs control) at 12 weeks treatment + 12 weeks follow-up: -0.21 (95% CI:
-0.69 to 0.28)
QUALITY OF LIFE
SF-36 physical component, 0 to 100
Baseline Mean: Qigong 30.4, Exercise 28.7, Wait List Control 30.6
Reported Results: No significant difference was found between the groups after 3 and
6 months
MD (Qigong vs control) at 12 weeks treatment: -1.80 (95% CI: -5.94 to 2.34)
MD (Qigong vs control) at 12 weeks treatment + 12 weeks follow-up: 0.10 (95% CI: -
3.99 to 4.19)
MD (Exercise vs control) at 12 weeks treatment: -1.70 (95%CI: -5.96 to 2.56)
MD (Exercise vs control) at 12 weeks treatment + 12 weeks follow-up: 2.20 (95%CI: -
1.81 to 6.21)
REASON FOR DROP-OUTS: Reported
SIDE EFFECTS: Reported; 5 side-effects were reported by 4 patients in the Qigong
group (2 nausea, 2 aching muscles, 1 muscle tension) and 4 side effects by 2 patients in
the exercise therapy group (2 muscle tensions, 1 acing muscles, 1 nausea)
COST OF CARE: NR
Notes
Risk of bias
Blinding (performance bias and detection High risk Perceptibly different interventions between
bias) groups
All outcomes - patients?
Blinding (performance bias and detection High risk Not possible due to intervention
bias)
All outcomes - providers?
Co-interventions avoided or similar? Unclear risk Unclear about the wait list group
Allison 2002 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Andersen 2008a Comparison: Comparison group received equal attention by forming groups which should improve
workplace ergonomics, stress management, etc
Andersen 2010 Comparison: Comparison group received equal attention by forming groups which should improve
workplace ergonomics, stress management, etc
Bernaards 2007 Intervention: Multimodal including exercise and cognitive behavioral training (companion paper to
Bernaards 2008 and Bernaards 2012.
Bernaards 2008 Intervention: Multimodal including cognitive behavioral training (companion paper to Bernaards
2007 and Bernaards 2012).
Bernaards 2012 Intervention: Multimodal including exercise and cognitive behavioral training (companion to
Bernaards 2007 and Bernaards 2008).
Bissett 1985 Intervention: EMG biofeedback mediated muscle relaxation not active exercise
Blangsted 2008 Comparison: Comparison group received equal attention by forming groups which should improve
workplace etc (companion paper to Andersen 2008).
Bonk 2000 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Bosmans 2011 Intervention: Multimodal approach with intervention groups without ability to differentiate each
treatment techniques contribution
Brewerton 1966 Intervention: Instruction on posture is not considered an exercise. There was no exercise group outside
“instruction on posture”
Brodin 1985 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Burketorp 2006 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Carlsson 1990 Population: Chronic tension headache (either occipital, temporal and/or frontal)
Cleland 2010 Intervention: Both treatment and control received same exercise intervention
Escortell-Mayor 2008 Intervention: Both treatment and control received same exercise intervention
Escortell-Mayor 2011 Intevention: Both treatment and control received same exercise intervention
Falla 2006 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Fitz-Ritson 1995 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Friedrich 1996 Intervention: Education comparison, exercise is the same in all 3 groups
Gam 1998 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Giebel 1997 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Gustavsson 2006 Intervention: The control treatment was individualized care (acupuncture, massage, mobs, hot pack,
TENS, US, exercise) and we were not able to elucidate the exact treatment mix for the treat as usual
group
Guzel 2006 Intervention: Both groups received the same exercise intervention
Hagberg 2000 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Hanten 1997 Outcome Measures: Did not use any of the identified outcome measures (only pain pressure threshold
as a proxy for pain)
Hanten 2000 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Henning 1997 Population: Preventional trial, although participants rated neck and shoulder discomfort this subpop-
ulation was never identified, nor was discomfort ratings in neck and shoulders reported
Hoving 2002 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Hoving 2006 Intervention: manual therapy versus exercise versus continued care (medication and education)
Hudson 2010 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Jensen 2001 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Jensen 2005 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Jordan 1998 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Jull 2007 Pain Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Karlberg 1996 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Koes 1991 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Kogstad 1978 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Lansinger 2007 Intevention: Both treatment and control received same exercise intervention
Lee 2013 Intervention: Exercise within a multimodal care approach specifically MT + Ex + PT vs that same PT
Levoska 1993 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Linton 2001a Intervention: Unable to separate exercise group within treatment as usual comparison group
Madson 2010 Intevention: Both treatment and control received same exercise intervention
Manca 2006 Intervention: Exercise prescription was not a significant component of the study (less than 10%)
Marangoni 2010 Population: less than 80% of the population have neck pain (72%)
McKinney 1989 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Mealy 1986 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Moffet 2006 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Murphy 2010 Intervention: Both treatment and control received same exercise intervention
O’Leary 2007 Outcome Measures: The reported outcomes are not outcomes of interest to this review
O’Leary 2007 JoPain Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Pato 2010 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Pennie 1990 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Persson 1994 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Pool 2006 Intervention: Protocol only, multimodal approach within intervention groups without ability to dif-
ferentiate each treatment techniques contribution (Ex+graded activity+MT)
Provinciali 1996 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Randlov 1998 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Rosenfeld 2000 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Rundcrantz 1991 Design: This was a quasi-RCT, treatment was individualized and unable to specify exercise
Salmon 2013 Population: participants did not have neck pain prior to start of trial
Schnabel 2004 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Scholten-Peeters 2006 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Skargren 1997 Intervention: Unable to separate data for exercise group (unclear if McKenzie treatment mobilization
or exercise)
Skillgate 2007 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Soderlund 2000 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Soderlund 2001 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Song 2012 Abstract Outcome/Publication: Insufficient information. Further data were sought but not found. No full
publication could be source
Taimela 2000 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Telci 2012 Intervention: Multimodal treatment with exercise VS multimodal treatment VS medicines
Tsauo 2004 Population: Prevention trial, between than 14.3 -58.5 % of participants had neck pain at baseline
van den Heuvel 2003 Population: Prevention trial, greater proportion of participants non-symptomatic in past week at
baseline
Exercises for mechanical neck disorders (Review) 124
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
(Continued)
van Ettekoven 2006 Population: The primary diagnosis was tension type headaches
Vasseljen 1995 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Vikne 2007 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Voerman 2007 Intervention: Relaxation therapy using myofeedback versus ergonomic intervention, no active com-
ponent
von Piekartz 2011 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Waling 2002 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Wei 2007 Outcome Measure: not our primary outcomes of interest in this review
Ylinen 2006b Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Ylinen 2007b Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Ylinen 2010 Intervention: Both treatment and control received same exercise intervention
Zaproudina 2007 Intervention: Multimodal approach within intervention groups without ability to differentiate each
treatment techniques contribution
Zebis 2011 Population: Is for the greater part a prevention trial (2/3 of N without neck pain)
EMG: electromyography
Ex: exercise therapy
MT: manual therapy
PT: physiotherapy
Falla 2013
Methods RCT
EMG: electromyographic
NDI: neck disability index
RCT: randomized controlled trial
Trial name or title Protocol for work place adjusted intelligent physical exercise reducing musculoskeletal pain in shoulder and
neck (VIMS): a cluster randomized controlled trial
Methods
Participants
Outcomes Pain
Starting date
Contact information National Research Centre for the Working Environment, Copenhagen O, Denmark
Notes
Trial name or title Protocol for shoulder function training reducing musculoskeletal pain in shoulder and neck: A randomized
controlled trial
Methods
Starting date
Contact information National Research Centre for the Working Environment, Copenhagen O, Denmark
Notes Protocol
Guerriero 1997
Trial name or title Comparative effects of manipulation and physical therapy on motion in the cervical spine
Methods
Starting date
Contact information Palmer Institute of Graduate Studies and Research, Davenport, Iowa
Notes
Gurumoorthy 2000
Trial name or title A prospective study of acute whiplash injury and its clinical management
Methods
Outcomes Pain, cervical ROM, neck muscle strength, time to return to normal duties
Starting date
Notes
Trial name or title Neck exercises, physical and cognitive behavioral-graded activity as a treatment for adult whiplash patients
with chronic neck pain: Design of a randomized controlled trial
Methods
Starting date
Contact information Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical
Biomechanics, University of Southern Denmark, Odense M, Denmark
Notes
Trial name or title A randomized clinical trial of a comprehensive exercise program for chronic whiplash: trial protocol
Methods
Outcomes Pain intensity, disability, health-related quality of life and health service utilization
Starting date
Contact information The George Institute for International Health, The University of Sydney, George Street, Sydney, 2000,
Australia
Notes
Reginiussen 2000
Trial name or title Efficiency of manual therapy on patients with cervicogenic headache. A randomized single-blinded controlled
trial
Methods
Interventions Manual therapy (soft tissue methods, stretching/massage, mobilizing and thrust techniques)
vs standardized physiotherapy treatment consisting of SWD, exercises and stretching
Starting date
Notes
Stokke 1995
Trial name or title A randomized comparison of chiropractic and physiotherapy treatment for neck pain of functional (mechan-
ical) origins. A controlled clinical trial
Methods
Participants Neck pain, neck and head pain, neck and shoulder pain
Starting date
Contact information Institute of Community Medicine, School of Medicine, Uniersity of Tramso, 9037 Tromso, Norway
Notes
Trial name or title Development and delivery of a physiotherapy intervention for the early management of whiplash injuries:
The Managing Injuries of Neck Trial (MINT) Intervention
Methods
Interventions Manual therapy, exercise, and psychological strategies and self-management advice
Outcomes
Starting date
Contact information Clinical Trials Unit, Medical School Building, Gibbet Hill Campus, University of Warwick, Coventry CV4
7AL, UK
Notes
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Pain Intensity (Borg 0 to 10): 10 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
weeks of treatment vs Control
1.1 Practice paced breathing 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
vs Control
2 Function (NDI 0 to 100): 10 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
weeks of treatment vs Control
2.1 Practice paced breathing 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
vs Control
3 SF-36 (physical function): 10 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
weeks of treatment vs Control
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Pain Intensity (VAS): 10 weeks 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
of treatment
1.1 General Fitness Training v 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
Reference Intervention
2 Pain Intensity (VAS): 10 weeks 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
of treatment + 10 weeks
follow-up
2.1 General Fitness Training v 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
Reference Intervention
Comparison 3. Chronic MND: Cervical Stretch/ROM Exercises + ANOTHER INTERVENTION vs THAT SAME
INTERVENTION
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
Comparison 4. Chronic MND: Cervical Stretch/ROM Exercises + Dynamic Cervical Stabilization vs SHAM
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Pain Intensity (VAS): 8 weeks of 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
treatment
1.1 McKenzie Treatment v 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
Control
2 Pain Intensity (VAS): 8 weeks of 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
treatment + 6 month follow-up
2.1 McKenzie Treatment v 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
Control
3 Pain Intensity (VAS): 8 weeks 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
of treatment + 12 months
follow-up
3.1 McKenzie Treatment v 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
Control
4 Function (NDI): 8 weeks of 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
treatment
4.1 McKenzie Treatment v 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
Control
5 Function (NDI): 8 weeks of 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
treatment + 6 month follow-up
5.1 McKenzie Treatment v 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
Control
6 Function (NDI): 8 weeks 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
of treatment + 12 month
follow-up
6.1 McKenzie Treatment v 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
Control
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Pain Intensity (VAS): 6 weeks of 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
treatment
1.1 Isometric neck exercises +/ 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
- pillow vs control or pillow
2 Pain Intensity (VAS): 6 weeks of 1 Mean Difference (IV, Random, 95% CI) Totals not selected
treatment + 6 weeks follow-up
2.1 Isometric neck exercises +/ 1 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
- pillow vs pillow or placebo
3 Function (NPQ): 6 weeks of 1 Mean Difference (IV, Random, 95% CI) Totals not selected
treatment
3.1 Isometric neck exercises +/ 1 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
- pillow vs pillow or placebo
4 Function (NPQ): 6 weeks of 1 Mean Difference (IV, Random, 95% CI) Totals not selected
treatment + 6 weeks follow-up
4.1 Isometric neck exercises +/ 1 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
- pillow vs pillow or placebo
5 Global Perceived Effect 0 Risk Ratio (M-H, Random, 95% CI) Totals not selected
Treatment (patients assessment)
: 3 weeks of treatment
5.1 Isometric exercises vs no 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
intervention
6 Quality of Life (SF-36): 6 weeks 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
of treatment + 6 w follow-up
6.1 Isometric neck exercises +/ 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
- pillow vs pillow or placebo
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Pain intensity (VAS) 2 weeks of 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
treatment
1.1 Postural Exercise vs 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
Control
2 Function (NDI): 2 weeks of 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
treatment
2.1 Postural Exercise vs 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
Control
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Pain Intensity (NPS): 4 weeks of 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
treatment
1.1 Muscle strength training 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
vs CONTROL
2 Pain Intensity: 10 to 20 weeks of 3 Std. Mean Difference (IV, Random, 95% CI) Subtotals only
treatment
2.1 Strength Specific Training 3 157 Std. Mean Difference (IV, Random, 95% CI) -0.71 [-1.33, -0.10]
vs Reference Group
3 Pain Intensity: 20 weeks of 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
treatment
3.1 Strength Specific Training 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
vs Reference Group
4 Pain Intensity (VAS): 10 weeks 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
of treatment + 10 weeks
follow-up
4.1 Strength Specific Training 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
vs Reference Group
5 Function: 4 weeks of treatment 1 Mean Difference (IV, Random, 95% CI) Totals not selected
5.1 Intensive muscular 1 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
strength training vs
CONTROL
6 Function: 20 weeks of treatment 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
6.1 Specific strength training 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
vs Control
7 Function: 12 to 20 weeks of 2 Std. Mean Difference (IV, Random, 95% CI) Subtotals only
treatment/follow-up
7.1 Muscle strength training 2 128 Std. Mean Difference (IV, Random, 95% CI) -0.28 [-0.63, 0.07]
vs CONTROL
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Pain Intensity (VAS): 8 weeks of 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
treatment
1.1 General Exercise vs Sham 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
US
2 Pain Intensity (VAS): 8 weeks of 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
treatment + 6 month follow-up
2.1 General Exercise vs Sham 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
US
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3 Pain Intensity (VAS): 8 weeks 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
of treatment + 12 month
follow-up
3.1 General Exercise vs Sham 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
US
4 Function (NDI): 8 weeks of 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
treatment
4.1 General Exercise vs Sham 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
US
5 Function (NDI): 8 weeks of 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
treatment + 6 month follow-up
5.1 General Exercise vs Sham 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
US
6 Function (NDI): 8 weeks 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
treatment + 12 month
follow-up
6.1 General Exercise vs Sham 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
US
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Pain Intensity: Immediate Post 4 Mean Difference (IV, Random, 95% CI) Subtotals only
Treatment (<11w of treatment)
1.1 Exercise +/- Infrared 4 317 Mean Difference (IV, Random, 95% CI) -0.66 [-1.28, -0.03]
+/- SMT +/- Acupuncture
vs Infrared or SMT or
Acupuncture
2 Pain Intensity: 11 w of treatment 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
+ 3 month follow-up
2.1 SMT + Rehab Exercises vs 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
SMT
3 Pain Intensity: Treatment + 3 Mean Difference (IV, Random, 95% CI) Subtotals only
IT follow-up (11 weeks of
treatment + 6 month follow-up
3.1 <11w of treatment + 6 3 241 Mean Difference (IV, Random, 95% CI) -0.67 [-1.32, -0.02]
month follow-up
4 Pain Intensity: Treatment + LT 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
follow-up
4.1 <11w of treatment + 24 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
month follow-up
5 Function: Immediate Post 4 Mean Difference (IV, Random, 95% CI) Subtotals only
treatment
5.1 <11w of treatment 4 317 Mean Difference (IV, Random, 95% CI) -1.91 [-4.65, 0.83]
6 Function: Treatment + ST 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
follow-up
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6.1 <11w of treatment + 3 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
month follow-up
7 Function: Treatment + IT 3 Std. Mean Difference (IV, Random, 95% CI) Subtotals only
follow-up
7.1 <11w of treatment + 6 3 241 Std. Mean Difference (IV, Random, 95% CI) -0.45 [-0.72, -0.18]
month follow-up
8 Function: Treatment + LT 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
follow-up
8.1 <11w of treatment + 24 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
month follow-up
9 Quality of Life: Immediate Post 2 Std. Mean Difference (IV, Random, 95% CI) Subtotals only
Treatment
9.1 <11w of treatment 2 165 Std. Mean Difference (IV, Random, 95% CI) -0.18 [-0.48, 0.13]
10 Quality of Life: Treatment + 1 Mean Difference (IV, Random, 95% CI) Totals not selected
ST follow-up
10.1 11w of treatment + 3 1 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
month follow-up
11 Quality of Life: Treatment + IT 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
follow-up
11.1 11w of treatment + 6 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
month follow-up
12 Quality of Life: Treatment + 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
LT follow-up
12.1 11w of treatment + 24 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
month follow-up
13 Patient Satisfaction: Immediate 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
Post Treatment
13.1 11>w of treatment 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
14 Patient Satisfaction: Treatment 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
+ ST follow-up
14.1 11w of treatment + 3 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
month follow-up
15 Patient Satisfaction: Treatment 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
+ IT follow-up
15.1 11w of treatment + 6 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
month follow-up
16 Patient Satisfaction: Treatment 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
+ LT follow-up
16.1 11w of treatment + 24 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
month follow-up
17 Global Perceived Effect: 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
Immediate Post Treatment
17.1 11w of treatment 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
18 Global Perceived Effect: 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
Treatment + ST follow-up
18.1 11w of treatment + 3 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
month follow-up
19 Global Perceived Effect: 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
Treatment + IT follow-up
19.1 11w of treatment + 6 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
month follow-up
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20 Global Perceived Effect: 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
Treatment + LT follow-up
20.1 11w of treatment + 24 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
month follow-up
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Pain Intensity (VAS): 12 weeks 2 Mean Difference (IV, Random, 95% CI) Subtotals only
of treatment
1.1 Exercise Therapy vs No 2 147 Mean Difference (IV, Random, 95% CI) -14.90 [-22.40, -7.
Treatment 39]
2 Pain Intensity (VAS): 24 weeks 2 Mean Difference (IV, Random, 95% CI) Subtotals only
of treatment
2.1 Exercise Therapy vs No 2 140 Mean Difference (IV, Random, 95% CI) -10.94 [-18.81, -3.
Treatment 08]
3 Function: 12 weeks of treatment 2 Std. Mean Difference (IV, Random, 95% CI) Subtotals only
3.1 Exercise Therapy vs No 2 147 Std. Mean Difference (IV, Random, 95% CI) -0.50 [-1.04, 0.03]
Treatment
4 Function: 24 weeks of treatment 2 Std. Mean Difference (IV, Random, 95% CI) Subtotals only
4.1 Exercise Therapy vs No 2 140 Std. Mean Difference (IV, Random, 95% CI) -0.40 [-0.74, -0.06]
Treatment
5 Global Perceived Effect (General 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
Health Perception): 12 weeks
of treatment
5.1 Exercise Therapy vs No 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
Treatment
6 Global Perceived Effect (General 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
Health Perception): 12 weeks
of treatment + 12 weeks
follow-up
6.1 Exercise Therapy vs No 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
Treatment
7 Quality of Life (SF-36): 12 2 Mean Difference (IV, Random, 95% CI) Subtotals only
weeks of treatment
7.1 Exercise Therapy vs No 2 143 Mean Difference (IV, Random, 95% CI) -2.22 [-5.17, 0.72]
Treatment
8 Quality of Life (SF-36): 24 2 Mean Difference (IV, Random, 95% CI) Subtotals only
weeks of treatment
8.1 Exercise Therapy vs No 2 144 Mean Difference (IV, Random, 95% CI) 0.06 [-4.06, 4.17]
Treatment
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Pain Intensity (VAS): 12 weeks 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
of treatment
1.1 Dynamic muscle training 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
vs control
2 Pain Intensity (VAS): 12 weeks 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
of treatment + 3 month
follow-up
2.1 Dynamic muscle training 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
vs control
3 Pain Intensity (VAS): 12 weeks 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
of treatment + 9 month
follow-up
3.1 Dynamic muscle training 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
vs control
4 Function (Neck Disability 0-80): 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
12 weeks of treatment
4.1 Dynamic muscle training 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
vs control
5 Function (Neck Disability 0-80): 1 Std. Mean Difference (IV, Fixed, 95% CI) Totals not selected
12 weeks of treatment + 3
month follow-up
5.1 Dynamic muscle training 1 Std. Mean Difference (IV, Fixed, 95% CI) 0.0 [0.0, 0.0]
vs control
6 Function (Neck Disability 0-80): 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
12 weeks of treatment + 9
month follow-up
6.1 Dynamic muscle training 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
vs control
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Pain Intensity (VAS 0 to 10): 24 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
weeks of treatment
1.1 Training group vs control 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Pain Prevelance during previous 1 Risk Ratio (M-H, Random, 95% CI) Totals not selected
week: 6 weeks of treatment +
46 weeks follow-up
1.1 Exercise Regimen vs 1 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
control group
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Pain Intensity (VAS): 10 weeks 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
treatment
1.1 2 minute training group 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
vs Control
1.2 12 minute training group 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
vs Control
Comparison 15. Chronic MND: Neuromuscular Education (eye neck coordination/proprioception) + ANOTHER
INTERVENTION VS THAT SAME INTERVENTION
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Pain Intensity (VAS): 8 weeks 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
treatment + 10 weeks follow-up
1.1 Rehabilitation Group vs 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
Control Group
2 Function (pt’s assessment of 1 Risk Ratio (M-H, Random, 95% CI) Totals not selected
functional improvement): 8
weeks treatment + 10 weeks
follow-up
2.1 Rehabilitation Group vs 1 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
Control Group
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Pain Intensity (VAS): 10 weeks 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
of treatment
1.1 Group Gymnastics vs 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
Control
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Pain Intensity (VAS): 16 weeks 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
treatment + 6 weeks follow-up
1.1 Physiotherapy Group vs 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
Control Group
Comparison 18. Chronic MND: Stretch/ROM + Endurance Training + Dynamic Stabilization + Cognitive
(mindfulness & emotional balance) vs WAIT LIST
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Pain Intensity (VAS): 12 weeks 2 Mean Difference (IV, Random, 95% CI) Subtotals only
of treatment
1.1 Qigong vs No Treatment 2 148 Mean Difference (IV, Random, 95% CI) -13.28 [-20.98, -5.
58]
2 Pain Intensity (VAS): 24 weeks 2 Mean Difference (IV, Random, 95% CI) Subtotals only
of treatment
2.1 Qigong vs No Treatment 2 137 Mean Difference (IV, Random, 95% CI) -7.82 [-14.57, -1.07]
3 Function: 12 weeks of treatment 2 Std. Mean Difference (IV, Random, 95% CI) Subtotals only
3.1 Qigong vs No Treatment 2 148 Std. Mean Difference (IV, Random, 95% CI) -0.36 [-0.68, -0.03]
4 Function: 24 weeks of treatment 2 Std. Mean Difference (IV, Random, 95% CI) Subtotals only
4.1 Qigong vs No Treatment 2 137 Std. Mean Difference (IV, Random, 95% CI) -0.28 [-0.68, 0.11]
5 Global Perceived Effect (General 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
Health Perception): 12 weeks
of treatment
5.1 Qigong vs No Treatment 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
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6 Global Perceived Effect (General 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
Health Perception): 12 weeks
of treatment + 12 weeks
Follow-up
6.1 Qigong vs No Treatment 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
7 Quality of Life (SF-36 physical 2 Mean Difference (IV, Random, 95% CI) Subtotals only
component): 12 weeks of
treatment
7.1 Qigong vs No Treatment 2 148 Mean Difference (IV, Random, 95% CI) -2.72 [-5.42, -0.01]
8 Quality of Life: 24 weeks of 2 Mean Difference (IV, Random, 95% CI) Subtotals only
treatment
8.1 Qigong vs No Treatment 2 137 Mean Difference (IV, Random, 95% CI) -1.88 [-5.80, 2.04]
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Pain Intensity: (0-10 box scale): 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
6 weeks of treatment
1.1 Exercise + Advice vs 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
Advice
2 Pain Intensity (0-10 box scale): 6 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
weeks treatment + 12 month
follow-up
2.1 Exercise + Advice vs 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
Advice
3 Function (NDI): 6 weeks of 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
treatment
3.1 Exercise + Advice vs 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
Advice
4 Function (NDI): 6 weeks 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
of treatment + 12 month
follow-up
4.1 Exercise + Advice vs 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
Advice
5 Global Perceived Effect (-5 to 5 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
scale): 6 weeks of treatment
5.1 Exercise + Advice vs 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
Advice
6 Global Perceived Effect (-5 to 5 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
scale): 6 weeks of treatment +
12 month follow-up
6.1 Exercise + Advice vs 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
Advice
7 Quality of Life (SF-36): 6 weeks 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
of treatment
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7.1 Exercise + Advice vs 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
Advice
8 Quality of Life (SF-36): 6 weeks 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
of treatment + 12 month
follow-up
8.1 Exercise + Advice vs 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
Advice
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Pain Intensity (Headache 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
Questionnaire): Treatment + 4
weeks follow-up
1.1 C1-C2 Self Snag vs 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
Placebo Group
2 Pain Intensity (Headache 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
Questionnaire): Treatment +
12 month follow-up
2.1 C1-C2 Self Snag vs 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
Placebo Group
Comparison 21. Chronic CGH: Cervical/Scapulothoracic Strengthening with Endurance Training + Craniocer-
vical Pressure Biofeedback + Dynamic Cervical Stabilization vs NO INTERVENTION or WAIT LIST
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Headache Intensity (VAS 0-10): 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
6 weeks of treatment
1.1 Therapeutic Exercise +/ 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
- Manip vs Control Group or
Manip
2 Headache Intensity (VAS 0-10): 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
6 weeks treatment + 12 month
follow-up
2.1 Therapeutic Exercise +/ 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
- Manip vs Control Group or
Manip
3 Function (NPNPQ 0-36): 6 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
weeks treatment
3.1 Therapeutic Exercise +/ 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
- Manip vs Control Group or
Manip
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4 Function (NPNPQ 0-36): 6 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
weeks treatment + 12 month
follow-up
4.1 Therapeutic Exercise +/ 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
- Manip vs Control Group or
Manip
5 Global Perceived Effect (VAS): 6 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
weeks treatment
5.1 Therapeutic Exercise +/ 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
- Manip vs Control Group or
Manip
6 Global Perceived Effect (VAS): 6 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
weeks treatment + 12 month
follow-up
6.1 Therapeutic Exercise +/ 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
- Manip vs Control Group or
Manip
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Pain Intensity (VAS): 6 weeks 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
treatment
1.1 Physiotherapy vs Control 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
2 Pain Intensity (VAS): 6 weeks 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
treatment + 6 month follow-up
2.1 Physiotherapy vs Control 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
3 Function (NDI): 6 weeks 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
treatment
3.1 Physiotherapy vs Control 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
4 Function (NDI): 6 weeks 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
treatment + 6 month follow-up
4.1 Physiotherapy vs Control 1 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
5 Satisfaction (5 point scale): 6 1 Risk Ratio (M-H, Random, 95% CI) Totals not selected
weeks treatment
5.1 Physiotherapy vs Control 1 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Pain Intensity (VAS) 6 weeks vs 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
Control
2 Pain Intensity (VAS) 3 months 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
vs control
Comparison 24. Chronic MND: Patterns synchronization + Feedforward/feedback: exercises for coordinating the
neck, eyes and upper limbs vs NO INTERVENTION
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Pain intensity (VAS) 4 weeks vs 1 Std. Mean Difference (IV, Random, 95% CI) Totals not selected
Control
Analysis 1.1. Comparison 1 Chronic MND: Breathing Patterns vs CONTROL, Outcome 1 Pain Intensity
(Borg 0 to 10): 10 weeks of treatment vs Control.
Std. Std.
Mean Mean
Study or subgroup Experimental Control Difference Difference
N Mean(SD)[0 to 10] N Mean(SD)[0 to 10] IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours treatment Favours control
Std. Std.
Mean Mean
Study or subgroup Experimental Control Difference Difference
N Mean(SD)[0 to 10] N Mean(SD)[0 to 10] IV,Random,95% CI IV,Random,95% CI
-10 -5 0 5 10
Favours treatment Favours control
Analysis 1.3. Comparison 1 Chronic MND: Breathing Patterns vs CONTROL, Outcome 3 SF-36 (physical
function): 10 weeks of treatment vs Control.
Std. Std.
Mean Mean
Study or subgroup Experimental Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours treatment Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
Mean(SD)[VAS Mean(SD)[VAS
N 0-100] N 0-100] IV,Random,95% CI IV,Random,95% CI
Analysis 2.2. Comparison 2 Acute to Chronic MND: General Fitness Training vs CONTROL, Outcome 2
Pain Intensity (VAS): 10 weeks of treatment + 10 weeks follow-up.
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours treatment Favours control
Study
Allan 2003 Although the stretch before manipulation group had 30% (n = 2) greater decrease in intra-group pain by the end of the
study than those who received maniplation alone, inter-group analysis using the Kruskal-Wallis test found no statistical
signifance between the groups (X2 = 2.447, d.f. = 2, P = 0.294)
There was no statistically significant difference in pain between the stretch before manipulation group and the control
group of manipulation alone
There was no statistically significant difference between the stretch before manipulation vs stretch after manipulation
Allan 2003 Although the manipulation then stretch group had 26% (n = 2) greater decrease in intra-group pain by the end of the
study than those who received maniplation alone, inter-group analysis using the Kruskal-Wallis test found no statistical
signifance between the groups (X2 = 2.447, d.f. = 2, P = 0.294)
There was no statistically significant difference in pain between the stretch after manipulation group from the control
group of manipulation alone
There was no statistically significant difference between the stretch before manipulation vs stretch after manipulation
Analysis 3.2. Comparison 3 Chronic MND: Cervical Stretch/ROM Exercises + ANOTHER INTERVENTION
vs THAT SAME INTERVENTION, Outcome 2 Function (NDI): 4 weeks of treatment.
Function (NDI): 4 weeks of treatment
Study
Allan 2003 There was no statistically significant difference in function between the stretch before manipulation and the control
group of manipulation alone
There was no statistically significant difference in function between stretch before manipulation vs stretch after manip-
ulation
Allan 2003 no statistically significant difference in function between stretch after manipulation groups from control group of
manipulation alone
no statistically significant difference in function between stretch before manipulation vs stretch after manipulation
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours treatment Favours control
Analysis 4.2. Comparison 4 Chronic MND: Cervical Stretch/ROM Exercises + Dynamic Cervical
Stabilization vs SHAM, Outcome 2 Pain Intensity (VAS): 8 weeks of treatment + 6 month follow-up.
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours treatment Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours treatment Favours control
Analysis 4.4. Comparison 4 Chronic MND: Cervical Stretch/ROM Exercises + Dynamic Cervical
Stabilization vs SHAM, Outcome 4 Function (NDI): 8 weeks of treatment.
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours experimental Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours experimental Favours control
Analysis 4.6. Comparison 4 Chronic MND: Cervical Stretch/ROM Exercises + Dynamic Cervical
Stabilization vs SHAM, Outcome 6 Function (NDI): 8 weeks of treatment + 12 month follow-up.
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours experimental Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
Helewa 2007 (2) 28 1.9 (1.8) 33 1.7 (1.7) 0.11 [ -0.39, 0.62 ]
-4 -2 0 2 4
Favours treatment Favours control
Analysis 5.2. Comparison 5 Chronic MND: Static Cervical Strengthening + Static Stabilization vs NO
INTERVENTION OR WAIT LIST, Outcome 2 Pain Intensity (VAS): 6 weeks of treatment + 6 weeks follow-up.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
Helewa 2007 (2) 31 17.7 (11.6) 31 26.1 (13.5) -8.40 [ -14.67, -2.13 ]
Analysis 5.4. Comparison 5 Chronic MND: Static Cervical Strengthening + Static Stabilization vs NO
INTERVENTION OR WAIT LIST, Outcome 4 Function (NPQ): 6 weeks of treatment + 6 weeks follow-up.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
Helewa 2007 (2) 29 20.1 (11.6) 34 18.6 (10) 1.50 [ -3.90, 6.90 ]
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
Helewa 2007 (2) 33 -52.1 (6.5) 32 -48.5 (8.9) -0.46 [ -0.95, 0.04 ]
-4 -2 0 2 4
Favours experimental Favours control
Analysis 6.1. Comparison 6 Chronic MND: Pattern synchronization (sitting posture) vs CONTROL,
Outcome 1 Pain intensity (VAS) 2 weeks of treatment.
Std. Std.
Mean Mean
Study or subgroup Experimental Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-10 -5 0 5 10
Favours treatment Favours control
Std. Std.
Mean Mean
Study or subgroup Experimental Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-10 -5 0 5 10
Favours treatment Favours control
Std. Std.
Mean Mean
Study or subgroup Experimental Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-10 -5 0 5 10
Favours experimental Favours control
(1) Delve 2001: Intensive muscular strength training vs Control: Duration: 4 weeks of treatment: follow-up: Instrument: NPS 0 to 10.
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Weight Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
Andersen Ch 2012 (2) 43 3.19 (2.18) 48 3.86 (2.2) 42.9 % -0.30 [ -0.72, 0.11 ]
Dellve 2011 (3) 20 -0.3 (1.8) 20 1.1 (2.2) 33.7 % -0.68 [ -1.32, -0.04 ]
-4 -2 0 2 4
Favours treatment Favours control
(1) Andersen 2008: Specific strength training vs Health councelling group: Duration: 10 weeks of treatment: follow-up: none: Instrument: VAS 0 to 100
(2) Andersen Ch 2012: Training group (3 weekly sessions of 20 minutes) vs Reference group: Duration: 20 weeks of treatment: follow-up: none: Instrument: modified
nordic questionnaire 0 to 9.
(3) Delve 2011: Intensive muscular strength training vs Control: Duration: 4 weeks of treatment: follow-up: 2 months: Instrument: NPS 0 to 10.
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
Andersen Ch 2012 (2) 27 3.56 (2.26) 48 3.86 (2.2) -0.13 [ -0.61, 0.34 ]
-4 -2 0 2 4
Favours treatment Favours control
(1) Andersen Ch 2012: Training group (1 weekly sessions of 60 minutes) vs Reference group: Duration: 20 weeks of treatment: follow-up: none: Instrument: modified
nordic questionnaire 0 to 9.
(2) Andersen Ch 2012: Training group (9 weekly sessions of 7 minutes) vs Reference group: Duration: 20 weeks of treatment: follow-up: none: Instrument: modified
nordic questionnaire 0 to 9.
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours treatment Favours control
(1) Andersen 2008: Specific strength training vs Health counselling group: Duration: 10 weeks of treatment: follow-up: 10 weeks: Instrument: VAS 0 to 100
Mean Mean
Study or subgroup Experimental Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-10 -5 0 5 10
Favours treatment Favours control
(1) Delve 2011: Intensive muscular strength training vs Control: Duration: 4 weeks of treatment: follow-up: none: Instrument: Work Ability Index.
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours treatment Favours control
(1) Andersen Ch 2012: Training group (1 weekly sessions of 60 minutes) vs Reference group: Duration: 20 weeks of treatment: follow-up: none: Instrument: DASH.
(2) Andersen Ch 2012: Training group (9 weekly sessions of 7 minutes) vs Reference group: Duration: 20 weeks of treatment: follow-up: none: Instrument: DASH.
Std. Std.
Mean Mean
Study or subgroup Experimental Control Difference Weight Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours experimental Favours control
(1) Delve 2011: Intensive muscular strength training vs Control: Duration: 4 weeks of treatment: follow-up: 2 months (with home program): Instrument: Work ability
index.
(2) Andersen Ch 2012: Training group (3 weekly sessions of 20 minutes) vs Reference group: Duration: 20 weeks of treatment: follow-up: none: Instrument: DASH.
Analysis 8.1. Comparison 8 Chronic MND: Cervical/UE Stretch/ROM Exercise + Cervical/UE Strengthening
+ Dynamic Cervical Stabilization vs PLACEBO or SHAM, Outcome 1 Pain Intensity (VAS): 8 weeks of
treatment.
Review: Exercises for mechanical neck disorders
Comparison: 8 Chronic MND: Cervical/UE Stretch/ROM Exercise + Cervical/UE Strengthening + Dynamic Cervical Stabilization vs PLACEBO or SHAM
Outcome: 1 Pain Intensity (VAS): 8 weeks of treatment
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours treatment Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours treatment Favours control
Analysis 8.3. Comparison 8 Chronic MND: Cervical/UE Stretch/ROM Exercise + Cervical/UE Strengthening
+ Dynamic Cervical Stabilization vs PLACEBO or SHAM, Outcome 3 Pain Intensity (VAS): 8 weeks of
treatment + 12 month follow-up.
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours treatment Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours treatment Favours control
Analysis 8.5. Comparison 8 Chronic MND: Cervical/UE Stretch/ROM Exercise + Cervical/UE Strengthening
+ Dynamic Cervical Stabilization vs PLACEBO or SHAM, Outcome 5 Function (NDI): 8 weeks of treatment +
6 month follow-up.
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours treatment Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours treatment Favours control
Mean Mean
Study or subgroup Treatment Control Difference Weight Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 Exercise +/- Infrared +/- SMT +/- Acupuncture vs Infrared or SMT or Acupuncture
Bronfort 2001 (1) 51 2.4 (1.8) 50 2.9 (2.1) 39.7 % -0.50 [ -1.26, 0.26 ]
Franca 2008 16 6.8 (9.4) 15 15.3 (13) 0.6 % -8.50 [ -16.53, -0.47 ]
Martel 2011 32 1.6 (2.3) 32 2.1 (2.3) 23.3 % -0.50 [ -1.63, 0.63 ]
-4 -2 0 2 4
Favours treatment Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
Mean Mean
Study or subgroup Treatment Control Difference Weight Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
Chiu 2005 48 3.1 (2.4) 61 3.9 (2.4) 49.5 % -0.80 [ -1.71, 0.11 ]
Franca 2008 16 10.06 (12.3) 15 19.3 (21.5) 0.3 % -9.24 [ -21.68, 3.20 ]
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
Mean Mean
Study or subgroup Treatment Control Difference Weight Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 <11w of treatment
Bronfort 2001 (1) 51 13.8 (8.6) 50 15.4 (11.7) 23.0 % -1.60 [ -5.61, 2.41 ]
Martel 2011 32 11.3 (11.8) 32 13.7 (12.1) 14.7 % -2.40 [ -8.26, 3.46 ]
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Weight Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
Bronfort 2001 (1) 51 14.3 (10.2) 50 17.5 (2.1) 42.2 % -0.43 [ -0.82, -0.03 ]
-4 -2 0 2 4
Favours treatment Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Weight Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 <11w of treatment
Bronfort 2001 (1) 51 -81.7 (12) 50 -78.8 (16.1) 61.1 % -0.20 [ -0.59, 0.19 ]
Martel 2011 32 -54.1 (7.2) 32 -53.1 (6.9) 38.9 % -0.14 [ -0.63, 0.35 ]
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 11>w of treatment
Bronfort 2001 (1) 51 76.9 (41.8) 50 95.2 (48.6) -0.40 [ -0.80, -0.01 ]
-1 -0.5 0 0.5 1
Favours experimental Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-2 -1 0 1 2
Favours experimental Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours experimental Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-2 -1 0 1 2
Favours experimental Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 11w of treatment
Bronfort 2001 (1) 51 76.6 (43.3) 50 95.6 (46.8) -0.42 [ -0.81, -0.02 ]
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-2 -1 0 1 2
Favours experimental Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-1 -0.5 0 0.5 1
Favours experimental Favours control
Mean Mean
Study or subgroup Treatment Control Difference Weight Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
von Trott 2009 (2) 35 44.5 (25.7) 35 54.9 (28.5) 34.8 % -10.40 [ -23.11, 2.31 ]
Mean Mean
Study or subgroup Treatment Control Difference Weight Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
von Trott 2009 (2) 34 47.7 (30.5) 32 59.9 (25.5) 33.8 % -12.20 [ -25.73, 1.33 ]
-50 -25 0 25 50
Favours treatment Favours control
(1) Rendant 2011: Exercise therapy vs Wait list control; duration: 18 sessions over 6 months; follow-up: none; instrument: VAS:
(2) von Trott 2009: Exercise therapy vs Wait list control; duration: 24 sessions over 3 months; follow-up: 3 months with home program; instrument: VAS:
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Weight Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
von Trott 2009 (2) 35 33.6 (25.5) 35 39.1 (21.7) 49.8 % -0.23 [ -0.70, 0.24 ]
-4 -2 0 2 4
Favours experimental Favours control
(1) Rendant 2011: Exercise therapy vs Wait list control; duration: 3 months; follow-up: none; instrument: NPDI 0 - 100
(2) von Trott 2009 Exercise therapy vs Wait list control; duration: 24 sessions over 3 months; follow-up: 3 months with home program; instrument: NDI 0 - 100
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Weight Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
von Trott 2009 (2) 34 34.3 (24.8) 32 41.3 (23.4) 47.7 % -0.29 [ -0.77, 0.20 ]
-4 -2 0 2 4
Favours treatment Favours control
(1) Rendant 2011: Exercise therapy vs Wait list control; duration: 18 sessions over 6 months; follow-up: none; instrument: NPDI 0 - 100
(2) von Trott 2009: Exercise therapy vs Wait list control; duration: 24 sessions over 3 months; follow-up: 3 months with home program; instrument: NDI 0 -100:
Std. Std.
Mean Mean
Study or subgroup Experimental Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours experimental Favours control
Std. Std.
Mean Mean
Study or subgroup Experimental Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours experimental Favours control
(1) von Trott 2009: Exercise therapy vs Wait list control; duration: 24 sessions over 3 months; follow-up: 3 months with home program; instrument: GPE:
Mean Mean
Study or subgroup Experimental Control Difference Weight Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
von Trott 2009 (2) 34 -30.3 (7.8) 32 -28.6 (9.7) 47.6 % -1.70 [ -5.96, 2.56 ]
(1) Rendant 2011: Exercise therapy vs Wait list control; duration: 3 months; follow-up: none; instrument: SF-36:
(2) von Trott 2009: Exercise therapy vs Wait list control; duration: 24 sessions over 3 months; follow-up: 3 months with home program; instrument: SF-36:
Mean Mean
Study or subgroup Treatement Control Difference Weight Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
von Trott 2009 (2) 35 -29.3 (8.8) 35 -31.5 (8.3) 49.0 % 2.20 [ -1.81, 6.21 ]
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours treatment Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours treatment Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-10 -5 0 5 10
Favours treatment Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours experimental Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Fixed,95% CI IV,Fixed,95% CI
-4 -2 0 2 4
Favours experimental Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours experimental Favours control
Std. Std.
Mean Mean
Study or subgroup Experimental Control Difference Difference
N Mean(SD)[0 to 10] N Mean(SD)[0 to 10] IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours treatment Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours treatment Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-10 -5 0 5 10
Favours treatment Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-10 -5 0 5 10
Favours treatment Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-10 -5 0 5 10
Favours treatment Favours control
(1) PT vs no treatment
Mean Mean
Study or subgroup Treatment Control Difference Weight Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 Qigong vs No Treatment
Rendant 2011 (1) 41 29.9 (22.6) 41 45.5 (19.4) 71.3 % -15.60 [ -24.72, -6.48 ]
von Trott 2009 (2) 31 47.4 (30.8) 35 54.9 (28.5) 28.7 % -7.50 [ -21.88, 6.88 ]
(1) Rendant 2011: Qigong vs Wait list control; duration: 3 months; follow-up: none; instrument: VAS:
(2) von Trott 2009: Qigong vs Wait list control; duration: 24 sessions over 3 months; follow-up: 3 months with home program; instrument: VAS:
Mean Mean
Study or subgroup Experimental Control Difference Weight Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 Qigong vs No Treatment
Rendant 2011 (1) 39 30.8 (16.2) 39 38.9 (18.1) 78.4 % -8.10 [ -15.72, -0.48 ]
von Trott 2009 (2) 27 53.1 (30.6) 32 59.9 (25.5) 21.6 % -6.80 [ -21.34, 7.74 ]
-50 -25 0 25 50
Favours experimental Favours control
(1) Rendant 2011: Qigong vs Wait list control; duration: 18 sessions over 6 months; follow-up: none; instrument: VAS:
(2) von Trott 2009: Qigong vs Wait list control; duration: 24 sessions over 3 months; follow-up: 3 months with home program; instrument: VAS:
Std. Std.
Mean Mean
Study or subgroup Experimental Control Difference Weight Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 Qigong vs No Treatment
Rendant 2011 (1) 41 34.2 (16.9) 41 42 (15.2) 54.9 % -0.48 [ -0.92, -0.04 ]
von Trott 2009 (2) 31 34.3 (23.6) 35 39.1 (21.7) 45.1 % -0.21 [ -0.69, 0.28 ]
-4 -2 0 2 4
Favours experimental Favours control
(1) Rendant 2011: Qigong vs Wait list control; duration: 3 months; follow-up: none; instrument: NPDI :
(2) von Trott 2009: Qigong vs Wait list control; duration: 24 sessions over 3 months; follow-up: 3 months with home program; instrument: NDI:
Std. Std.
Mean Mean
Study or subgroup Experimental Control Difference Weight Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 Qigong vs No Treatment
Rendant 2011 (1) 39 30.8 (16.2) 39 38.9 (18.1) 54.7 % -0.47 [ -0.92, -0.02 ]
von Trott 2009 (2) 27 39.8 (25.8) 32 41.3 (23.4) 45.3 % -0.06 [ -0.57, 0.45 ]
-4 -2 0 2 4
Favours experimental Favours control
(1) Rendant 2011: Qigong vs Wait list control; duration: 18 sessions over 6 months; follow-up: none; instrument: NPDI:
(2) von Trott 2009: Qigong vs Wait list control; duration: 24 sessions over 3 months; follow-up: 3 months with home program; instrument: NDI 0-100:
Analysis 18.5. Comparison 18 Chronic MND: Stretch/ROM + Endurance Training + Dynamic Stabilization +
Cognitive (mindfulness & emotional balance) vs WAIT LIST, Outcome 5 Global Perceived Effect (General
Health Perception): 12 weeks of treatment.
Std. Std.
Mean Mean
Study or subgroup Experimental Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 Qigong vs No Treatment
von Trott 2009 (1) 31 36.3 (9.1) 35 36.4 (9.8) -0.01 [ -0.49, 0.47 ]
-4 -2 0 2 4
Favours experimental Favours control
(1) von Trott 2009: Qigong vs Wait list control; duration: 24 sessions over 3 months; follow-up: 3 months with home program; instrument: general health perception:
Std. Std.
Mean Mean
Study or subgroup Experimental Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 Qigong vs No Treatment
von Trott 2009 (1) 27 36.1 (8.4) 32 36.9 (9.2) -0.09 [ -0.60, 0.42 ]
-4 -2 0 2 4
Favours experimental Favours control
(1) von Trott 2009: Qigong vs Wait list control; duration: 24 sessions over 3 months; follow-up: 3 months with home program; instrument: general health perception:
Analysis 18.7. Comparison 18 Chronic MND: Stretch/ROM + Endurance Training + Dynamic Stabilization +
Cognitive (mindfulness & emotional balance) vs WAIT LIST, Outcome 7 Quality of Life (SF-36 physical
component): 12 weeks of treatment.
Mean Mean
Study or subgroup Experimental Control Difference Weight Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 Qigong vs No Treatment
Rendant 2011 (1) 41 -46.6 (8.3) 41 -43.2 (8.2) 57.3 % -3.40 [ -6.97, 0.17 ]
von Trott 2009 (2) 31 -30.4 (7.4) 35 -28.6 (9.7) 42.7 % -1.80 [ -5.94, 2.34 ]
Analysis 18.8. Comparison 18 Chronic MND: Stretch/ROM + Endurance Training + Dynamic Stabilization +
Cognitive (mindfulness & emotional balance) vs WAIT LIST, Outcome 8 Quality of Life: 24 weeks of treatment.
Mean Mean
Study or subgroup Experimental Control Difference Weight Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 Qigong vs No Treatment
Rendant 2011 (1) 39 -47 (10.2) 39 -43.1 (8.5) 49.5 % -3.90 [ -8.07, 0.27 ]
von Trott 2009 (2) 27 -31.4 (7.7) 32 -31.5 (8.3) 50.5 % 0.10 [ -3.99, 4.19 ]
-20 -10 0 10 20
Favours experimental Favours control
(1) Rendant 2011: Qigong vs Wait list control; duration: 18 sessions over 6 months; follow-up: none; instrument: SF-36:
(2) von Trott 2009: Qigong vs Wait list control; duration: 24 sessions over 3 months; follow-up: 3 months with home program; instrument: SF-36:
Std. Std.
Mean Mean
Study or subgroup Experimental Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-2 -1 0 1 2
Favours experimental Favours control
Std. Std.
Mean Mean
Study or subgroup Experimental Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours experimental Favours control
Std. Std.
Mean Mean
Study or subgroup Experimental Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours experimental Favours control
Std. Std.
Mean Mean
Study or subgroup Experimental Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours experimental Favours control
Std. Std.
Mean Mean
Study or subgroup Experimental Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours experimental Favours control
Std. Std.
Mean Mean
Study or subgroup Experimental Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours experimental Favours control
Std. Std.
Mean Mean
Study or subgroup Experimental Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours experimental Favours control
Std. Std.
Mean Mean
Study or subgroup Experimental Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours experimental Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours experimental Favours control
Analysis 20.2. Comparison 20 Acute to Subacute CGH: Cervical Stretch/ROM vs SHAM, Outcome 2 Pain
Intensity (Headache Questionnaire): Treatment + 12 month follow-up.
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours treatment Favours control
Std. Std.
Mean Mean
Study or subgroup Favours treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
Jull 2002 (2) 51 -3.26 (2.71) 46 -1.43 (2.04) -0.75 [ -1.16, -0.34 ]
-4 -2 0 2 4
Favours treatment Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
Jull 2002 (2) 48 -2.69 (2.22) 48 -2.27 (2.63) -0.17 [ -0.57, 0.23 ]
-4 -2 0 2 4
Favours treatment Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
Jull 2002 (2) 51 -11.03 (15.43) 46 -3.72 (9.77) -0.56 [ -0.96, -0.15 ]
-2 -1 0 1 2
Favours experimental Favours control
(1) Exercise + MT vs MT
(2) Exercise vs Control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
Jull 2002 (2) 48 -14.21 (12.61) 48 -11.21 (13.03) -0.23 [ -0.63, 0.17 ]
-4 -2 0 2 4
Favours experimental Favours control
(1) Ex vs Control
(2) Exercise + Manip vs Manip
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
Jull 2002 (2) 49 -7.72 (1.96) 49 -7.09 (2.38) -0.29 [ -0.68, 0.11 ]
-4 -2 0 2 4
Favours experimental Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
Jull 2002 (2) 51 -6.92 (3.21) 46 -0.43 (1.56) -2.51 [ -3.05, -1.97 ]
-4 -2 0 2 4
Favours experimental Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 Physiotherapy vs Control
Kuijper 2009 (1) 68 36.2 (31) 65 51.1 (32.7) -0.47 [ -0.81, -0.12 ]
-4 -2 0 2 4
Favours treatment Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 Physiotherapy vs Control
Kuijper 2009 68 20 (58.4) 61 10 (66.7) 0.16 [ -0.19, 0.51 ]
-2 -1 0 1 2
Favours treatment Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 Physiotherapy vs Control
Kuijper 2009 (1) 68 27.8 (17.7) 65 29.9 (20) -0.11 [ -0.45, 0.23 ]
-4 -2 0 2 4
Favours experimental Favours control
Std. Std.
Mean Mean
Study or subgroup Treatment Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 Physiotherapy vs Control
Kuijper 2009 68 10 (36.3) 61 8 (34.6) 0.06 [ -0.29, 0.40 ]
1 Physiotherapy vs Control
Kuijper 2009 (1) 27/66 28/63 0.92 [ 0.62, 1.37 ]
Std. Std.
Mean Mean
Study or subgroup Experimental Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours treatment Favours control
Std. Std.
Mean Mean
Study or subgroup Experimental Control Difference Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours treatment Favours control
Std. Std.
Mean Mean
Study or subgroup Experimental Control Difference Difference
N Mean(SD)[mm] N Mean(SD)[mm] IV,Random,95% CI IV,Random,95% CI
-4 -2 0 2 4
Favours treatment Favours control
MEDLINE- OVID
1. Neck Pain/
2. exp Brachial Plexus Neuropathies/
3. exp neck injuries/ or exp whiplash injuries/
4. cervical pain.mp.
5. neckache.mp.
6. whiplash.mp.
7. cervicodynia.mp.
8. cervicalgia.mp.
9. brachialgia.mp.
10. brachial neuritis.mp.
11. brachial neuralgia.mp.
12. neck pain.mp.
13. neck injur*.mp.
14. brachial plexus neuropath*.mp.
15. brachial plexus neuritis.mp.
16. thoracic outlet syndrome/ or cervical rib syndrome/
17. Torticollis/
18. exp brachial plexus neuropathies/ or exp brachial plexus neuritis/
19. cervico brachial neuralgia.ti,ab.
20. cervicobrachial neuralgia.ti,ab.
21. (monoradicul* or monoradicl*).tw.
22. or/1-21
23. exp headache/ and cervic*.tw.
24. exp genital diseases, female/
25. genital disease*.mp.
26. or/24-25
27. 23 not 26
28. 22 or 27
29. neck/
30. neck muscles/
31. exp cervical plexus/
32. exp cervical vertebrae/
33. atlanto-axial joint/
34. atlanto-occipital joint/
35. Cervical Atlas/
36. spinal nerve roots/
37. exp brachial plexus/
38. (odontoid* or cervical or occip* or atlant*).tw.
39. axis/ or odontoid process/
40. Thoracic Vertebrae/
41. cervical vertebrae.mp.
42. cervical plexus.mp.
43. cervical spine.mp.
44. (neck adj3 muscles).mp.
45. (brachial adj3 plexus).mp.
46. (thoracic adj3 vertebrae).mp.
Exercises for mechanical neck disorders (Review) 205
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47. neck.mp.
48. (thoracic adj3 spine).mp.
49. (thoracic adj3 outlet).mp.
50. trapezius.mp.
51. cervical.mp.
52. cervico*.mp.
53. 51 or 52
54. exp genital diseases, female/
55. genital disease*.mp.
56. exp *Uterus/
57. 54 or 55 or 56
58. 53 not 57
59. 29 or 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 38 or 39 or 40 or 41 or 42 or 43 or 44 or 45 or 46 or 47 or 48 or 49 or 50
or 58
60. exp pain/
61. exp injuries/
62. pain.mp.
63. ache.mp.
64. sore.mp.
65. stiff.mp.
66. discomfort.mp.
67. injur*.mp.
68. neuropath*.mp.
69. or/60-68
70. 59 and 69
71. Radiculopathy/
72. exp temporomandibular joint disorders/ or exp temporomandibular joint dysfunction syndrome/
73. myofascial pain syndromes/
74. exp “Sprains and Strains”/
75. exp Spinal Osteophytosis/
76. exp Neuritis/
77. Polyradiculopathy/
78. exp Arthritis/
79. Fibromyalgia/
80. spondylitis/ or discitis/
81. spondylosis/ or spondylolysis/ or spondylolisthesis/
82. radiculopathy.mp.
83. radiculitis.mp.
84. temporomandibular.mp.
85. myofascial pain syndrome*.mp.
86. thoracic outlet syndrome*.mp.
87. spinal osteophytosis.mp.
88. neuritis.mp.
89. spondylosis.mp.
90. spondylitis.mp.
91. spondylolisthesis.mp.
92. or/71-91
93. 59 and 92
94. exp neck/
95. exp cervical vertebrae/
96. Thoracic Vertebrae/
97. neck.mp.
98. (thoracic adj3 vertebrae).mp.
Exercises for mechanical neck disorders (Review) 206
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99. cervical.mp.
100. cervico*.mp.
101. 99 or 100
102. exp genital diseases, female/
103. genital disease*.mp.
104. exp *Uterus/
105. or/102-104
106. 101 not 105
107. (thoracic adj3 spine).mp.
108. cervical spine.mp.
109. 94 or 95 or 96 or 97 or 98 or 106 or 107 or 108
110. Intervertebral Disk/
111. (disc or discs).mp.
112. (disk or disks).mp.
113. 110 or 111 or 112
114. 109 and 113
115. herniat*.mp.
116. slipped.mp.
117. prolapse*.mp.
118. displace*.mp.
119. degenerat*.mp.
120. (bulge or bulged or bulging).mp.
121. 115 or 116 or 117 or 118 or 119 or 120
122. 114 and 121
123. intervertebral disk degeneration/ or intervertebral disk displacement/
124. intervertebral disk displacement.mp.
125. intervertebral disc displacement.mp.
126. intervertebral disk degeneration.mp.
127. intervertebral disc degeneration.mp.
128. 123 or 124 or 125 or 126 or 127
129. 109 and 128
130. 28 or 70 or 93 or 122 or 129
131. animals/ not (animals/ and humans/)
132. 130 not 131
133. exp *neoplasms/
134. exp *wounds, penetrating/
135. 133 or 134
136. 132 not 135
137. Neck Pain/rh [Rehabilitation]
138. exp Brachial Plexus Neuropathies/rh
139. exp neck injuries/rh or exp whiplash injuries/rh
140. thoracic outlet syndrome/rh or cervical rib syndrome/rh
141. Torticollis/rh
142. exp brachial plexus neuropathies/rh or exp brachial plexus neuritis/rh
143. 137 or 138 or 139 or 140 or 141 or 142
144. Radiculopathy/rh
145. exp temporomandibular joint disorders/rh or exp temporomandibular joint dysfunction syndrome/rh
146. myofascial pain syndromes/rh
147. exp “Sprains and Strains”/rh
148. exp Spinal Osteophytosis/rh
149. exp Neuritis/rh
150. Polyradiculopathy/rh
151. exp Arthritis/rh
Exercises for mechanical neck disorders (Review) 207
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152. Fibromyalgia/rh
153. spondylitis/rh or discitis/rh
154. spondylosis/rh or spondylolysis/rh or spondylolisthesis/rh
155. or/144-154
156. 59 and 155
157. exp Combined Modality Therapy/
158. Exercise/
159. Physical Exertion/
160. exp Exercise Therapy/
161. exp Electric Stimulation Therapy/
162. exp Rehabilitation/
163. exp Physical Therapy Modalities/
164. Hydrotherapy/
165. postur* correction.mp.
166. Feldenkrais.mp.
167. (alexander adj (technique or method)).tw.
168. Relaxation Therapy/
169. Biofeedback, Psychology/
170. or/157-169
171. 136 and 170
172. 143 or 156 or 171
173. animals/ not (animals/ and humans/)
174. 172 not 173
175. exp randomised controlled trials as topic/
176. randomised controlled trial.pt.
177. controlled clinical trial.pt.
178. (random* or sham or placebo*).tw.
179. placebos/
180. random allocation/
181. single blind method/
182. double blind method/
183. ((singl* or doubl* or trebl* or tripl*) adj25 (blind* or dumm* or mask*)).ti,ab.
184. (rct or rcts).tw.
185. (control* adj2 (study or studies or trial*)).tw.
186. or/175-185
187. 174 and 186
188. limit 187 to yr=“2006 -Current”
189. limit 187 to yr=“1902 - 2005”
190. guidelines as topic/
191. practice guidelines as topic/
192. guideline.pt.
193. practice guideline.pt.
194. (guideline? or guidance or recommendations).ti.
195. consensus.ti.
196. or/190-195
197. 174 and 196
198. 136 and 196
199. 197 or 198
200. limit 199 to yr=“2006 -Current”
201. limit 199 to yr=“1902 - 2005”
202. meta-analysis/
203. exp meta-analysis as topic/
204. (meta analy* or metaanaly* or met analy* or metanaly*).tw.
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205. review literature as topic/
206. (collaborative research or collaborative review* or collaborative overview*).tw.
207. (integrative research or integrative review* or intergrative overview*).tw.
208. (quantitative adj3 (research or review* or overview*)).tw.
209. (research integration or research overview*).tw.
210. (systematic* adj3 (review* or overview*)).tw.
211. (methodologic* adj3 (review* or overview*)).tw.
212. exp technology assessment biomedical/
213. (hta or thas or technology assessment*).tw.
214. ((hand adj2 search*) or (manual* adj search*)).tw.
215. ((electronic adj database*) or (bibliographic* adj database*)).tw.
216. ((data adj2 abstract*) or (data adj2 extract*)).tw.
217. (analys* adj3 (pool or pooled or pooling)).tw.
218. mantel haenszel.tw.
219. (cohrane or pubmed or pub med or medline or embase or psycinfo or psyclit or psychinfo or psychlit or cinahl or science citation
index).ab.
220. or/202-219
221. 174 and 220
222. limit 221 to yr=“2006 -Current”
223. limit 221 to yr=“1902 - 2005”
224. (ae or to or po or co).fs.
225. (safe or safety or unsafe).tw.
226. (side effect* or side event*).tw.
227. ((adverse or undesirable or harm* or injurious or serious or toxic) adj3 (effect* or event* or reaction* or incident* or outcome*)).tw.
228. (abnormalit* or toxicit* or complication* or consequence* or noxious or tolerabilit*).tw.
229. or/224-228
230. 174 and 229
231. limit 230 to yr=“2006 -Current”
232. limit 230 to yr=“1902 - 2005”
233. limit 187 to ed=20100701-20120313
234. limit 199 to ed=20100701-20120313
235. limit 221 to ed=20100701-20120313
236. limit 230 to ed=20100701-20120313
237. limit 189 to ed=20120313-20131108
Embase-OVID
1. neck pain/
2. brachial plexus neuropathy/
3. neck injury/ or whiplash injury/
4. cervical pain.mp.
5. neckache.mp.
6. whiplash.mp.
7. cervicodynia.mp.
8. cervicalgia.mp.
9. brachialgia/
10. brachialgia.mp.
11. brachial neuritis.mp.
12. brachial neuralgia.mp.
13. neck pain.mp.
14. neck injur*.mp.
15. brachial plexus neuropath*.mp.
16. brachial plexus neuritis.mp.
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17. thorax outlet syndrome/
18. torticollis/
19. cervico brachial neuralgia.ti,ab.
20. cervicobrachial neuralgia.ti,ab.
21. (monoradicul* or monoradicl*).tw.
22. or/1-21
23. exp headache/ and cervic*.tw.
24. exp gynecologic disease/
25. genital disease*.mp.
26. exp *uterine cervix/
27. or/24-26
28. 23 not 27
29. 22 or 28
30. neck/ or neck muscle/
31. cervical plexus/
32. cervical spine/
33. atlantoaxial joint/
34. atlantooccipital joint/
35. atlas/
36. “spinal root”/
37. brachial plexus/
38. (odontoid* or cervical or occip* or atlant*).tw.
39. odontoid process/
40. cervical vertebra.mp.
41. cervical vertebrae.mp.
42. cervical plexus.mp.
43. cervical spine.mp.
44. (neck adj3 muscles).mp.
45. (brachial adj3 plexus).mp.
46. (thoracic adj3 vertebra?).mp.
47. neck.mp.
48. (thoracic adj3 spine).mp.
49. (thoracic adj3 outlet).mp.
50. trapezius.mp.
51. cervical.mp.
52. cervico*.mp.
53. 51 or 52
54. exp gynecologic disease/
55. genital disease*.mp.
56. exp *uterine cervix/
57. 54 or 55 or 56
58. 53 not 57
59. 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 38 or 39 or 40 or 41 or 42 or 43 or 44 or 45 or 46 or 47 or 48 or 49 or 50 or 58
60. exp pain/
61. exp injury/
62. pain.mp.
63. ache.mp.
64. sore.mp.
65. stiff.mp.
66. discomfort.mp.
67. injur*.mp.
68. neuropath*.mp.
69. or/60-68
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70. radiculopathy/
71. temporomandibular joint disorder/
72. myofascial pain/
73. spondylosis/ or cervical spondylosis/
74. neuritis/
75. exp arthritis/
76. fibromyalgia/
77. exp spondylitis/
78. diskitis/
79. spondylolisthesis/
80. radiculopathy.mp.
81. radiculitis.mp.
82. temporomandibular.mp.
83. myofascial pain syndrome*.mp.
84. spinal osteophytosis.mp.
85. neuritis.mp.
86. spondylosis.mp.
87. spondylitis.mp.
88. spondylolisthesis.mp.
89. or/70-88
90. 59 and 89
91. neck/
92. cervical spine/
93. neck.mp.
94. (thoracic adj3 vertebra?).mp.
95. cervical.mp.
96. cervico*.mp.
97. exp gynecologic disease/
98. genital disease*.mp.
99. exp *uterine cervix/
100. or/97-99
101. 95 or 96
102. 101 not 100
103. (thoracic adj3 spine).mp.
104. cervical spine.mp.
105. 91 or 92 or 93 or 94 or 102 or 103 or 104
106. intervertebral disk/
107. (disc or discs).mp.
108. (disk or disks).mp.
109. 106 or 107 or 108
110. 105 and 109
111. herniat*.mp.
112. slipped.mp.
113. prolapse*.mp.
114. displace*.mp.
115. degenerat*.mp.
116. (bulge or bulged or bulging).mp.
117. 110 or 111 or 112 or 113 or 114 or 115 or 116
118. 110 and 117
119. intervertebral disk hernia/
120. intervertebral disk degeneration/
121. intervertebral disc degeneration.mp.
122. intervertebral disk degeneration.mp.
Exercises for mechanical neck disorders (Review) 211
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123. intervertebral disc displacement.mp.
124. intervertebral disk displacement.mp.
125. 119 or 120 or 121 or 122 or 123 or 124
126. 105 and 125
127. 59 and 69
128. 29 or 90 or 118 or 126 or 127
129. exp *neoplasm/
130. exp *penetrating trauma/
131. 129 or 130
132. 128 not 131
133. neck pain/rh [Rehabilitation]
134. brachial plexus neuropathy/rh
135. neck injury/rh or whiplash injury/rh
136. brachialgia/rh
137. thorax outlet syndrome/rh
138. Torticollis/rh
139. 133 or 134 or 135 or 136 or 137 or 138
140. radiculopathy/rh
141. temporomandibular joint disorder/rh
142. myofascial pain/rh
143. spondylosis/rh or cervical spondylosis/rh
144. neuritis/rh
145. exp arthritis/rh
146. fibromyalgia/rh
147. exp spondylitis/rh
148. diskitis/rh
149. spondylolisthesis/rh
150. or/140-149
151. 59 and 150
152. exp exercise/
153. exp kinesiotherapy/
154. physical medicine/
155. feedback system/
156. biofeedback.tw.
157. relaxation training/
158. bodywork/ or alexander technique/ or feldenkrais method/
159. postur* correction.mp.
160. or/152-159
161. 132 and 160
162. 139 or 151 or 161
163. human/
164. nonhuman/
165. animal/
166. animal experiment/
167. or/164-166
168. 167 not (163 and 167)
169. 162 not 169
170. randomized controlled trial/
171. controlled clinical trial/
172. (random* or sham or placebo*).tw.
173. placebo/
174. randomization/
175. single blind procedure/
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176. double blind procedure/
177. ((singl* or doubl* or trebl* or tripl*) adj5 (blind* or dumm*or mask*)).ti,ab.
178. (rct or rcts).tw.
179. (control* adj2 (study or studies or tiral*)).tw.
180. or/170-179
181. human/
182. nonhuman/
183. animal/
184. animal experiment/
185. or/182-184
186. 185 not (185 and 181)
187. 180 not 186
188. 169 and 187
189. limit 219 to yr=“2006 -Current”
190. limit 219 to yr=“1928 - 2005”
191. guidelines as topic/
192. practice guidelines as topic/
193. (guideline? or guidance or recommendations).ti.
194. consensus.ti.
195. or/191-194
196. 169 and 195
197. limit 196 to yr=“2006 -Current”
198. limit 196 to yr=“1928 - 2005”
199. meta analysis/
200. systematic review/
201. (meta analy* or metaanaly* or met analy* or metanaly*).tw.
202. (collaborative research or collaborative review* or collaborative overview*).tw.
203. (integrative research or integrative review* or intergrative overview*).tw.
204. (quantitative adj3 (research or review* or overview*)).tw.
205. (research integration or research overview*).tw.
206. (systematic* adj3 (review* or overview*)).tw.
207. (methodologic* adj3 (review* or overview*)).tw.
208. biomedical technology assessment/
209. (hta or thas or technology assessment*).tw.
210. ((hand adj2 search*) or (manual* adj search*)).tw.
211. ((electronic adj database*) or (bibliographic* adj database*)).tw.
212. ((data adj2 abstract*) or (data adj2 extract*)).tw.
213. (data adj3 (pooled or pool or pooling)).tw.
214. (analys* adj3 (pool or pooled or pooling)).tw.
215. mantel haenszel.tw.
216. (cochrane or Pubmed or pub med or medline or embase or psycinfo or psyclit or psychinfo or psychlit or cinahl or science citation
index).ab.
217. or/199-216
218. 169 and 217
219. limit 218 to yr=“2006 -Current”
220. limit 218 to yr=“1928 - 2005”
221. (ae or co or si or to).fs.
222. (safe or safety or unsafe).tw.
223. (side effect* or side event*).tw.
224. ((adverse or undesirable or harm* or injurious or serious or toxic) adj3 (effect* or event* or reaction* or incident* or outcome*)).tw.
225. (abnormalit* or toxicit* or complication* or consequence* or noxious or tolerabilit*).tw.
226. or/221-225
227. 169 and 226
Exercises for mechanical neck disorders (Review) 213
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228. limit 227 to yr=“2006 -Current”
229. limit 227 to yr=“1928 - 2005”
230. limit 188 to em=201027-201210
231. limit 196 to em=201027-201210
232. limit 218 to em=201027-201210
233. limit 227 to em=201027-201210
CENTRAL-OVID
1. Neck Pain/
2. exp Brachial Plexus Neuropathies/
3. exp neck injuries/ or exp whiplash injuries/
4. cervical pain.mp.
5. neckache.mp.
6. whiplash.mp.
7. cervicodynia.mp.
8. cervicalgia.mp.
9. brachialgia.mp.
10. brachial neuritis.mp.
11. brachial neuralgia.mp.
12. neck pain.mp.
13. neck injur*.mp.
14. brachial plexus neuropath*.mp.
15. brachial plexus neuritis.mp.
16. thoracic outlet syndrome/ or cervical rib syndrome/
17. Torticollis/
18. exp brachial plexus neuropathies/ or exp brachial plexus neuritis/
19. cervico brachial neuralgia.ti,ab.
20. cervicobrachial neuralgia.ti,ab.
21. (monoradicul* or monoradicl*).tw.
22. or/1-21
23. exp headache/ and cervic*.tw.
24. exp genital diseases, female/
25. genital disease*.mp.
26. or/24-25
27. 23 not 26
28. 22 or 27
29. neck/
30. neck muscles/
31. exp cervical plexus/
32. exp cervical vertebrae/
33. atlanto-axial joint/
34. atlanto-occipital joint/
35. Cervical Atlas/
36. spinal nerve roots/
37. exp brachial plexus/
38. (odontoid* or cervical or occip* or atlant*).tw.
39. axis/ or odontoid process/
40. Thoracic Vertebrae/
41. cervical vertebrae.mp.
42. cervical plexus.mp.
43. cervical spine.mp.
44. (neck adj3 muscles).mp.
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45. (brachial adj3 plexus).mp.
46. (thoracic adj3 vertebrae).mp.
47. neck.mp.
48. (thoracic adj3 spine).mp.
49. (thoracic adj3 outlet).mp.
50. trapezius.mp.
51. cervical.mp.
52. cervico*.mp.
53. 51 or 52
54. exp genital diseases, female/
55. genital disease*.mp.
56. exp *Uterus/
57. 54 or 55 or 56
58. 53 not 57
59. 29 or 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 38 or 39 or 40 or 41 or 42 or 43 or 44 or 45 or 46 or 47 or 48 or 49 or 50
or 58
60. exp pain/
61. exp injuries/
62. pain.mp.
63. ache.mp.
64. sore.mp.
65. stiff.mp.
66. discomfort.mp.
67. injur*.mp.
68. neuropath*.mp.
69. or/60-68
70. 59 and 69
71. Radiculopathy/
72. exp temporomandibular joint disorders/ or exp temporomandibular joint dysfunction syndrome/
73. myofascial pain syndromes/
74. exp “Sprains and Strains”/
75. exp Spinal Osteophytosis/
76. exp Neuritis/
77. Polyradiculopathy/
78. exp Arthritis/
79. Fibromyalgia/
80. spondylitis/ or discitis/
81. spondylosis/ or spondylolysis/ or spondylolisthesis/
82. radiculopathy.mp.
83. radiculitis.mp.
84. temporomandibular.mp.
85. myofascial pain syndrome*.mp.
86. thoracic outlet syndrome*.mp.
87. spinal osteophytosis.mp.
88. neuritis.mp.
89. spondylosis.mp.
90. spondylitis.mp.
91. spondylolisthesis.mp.
92. or/71-91
93. 59 and 92
94. exp neck/
95. exp cervical vertebrae/
96. Thoracic Vertebrae/
Exercises for mechanical neck disorders (Review) 215
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97. neck.mp.
98. (thoracic adj3 vertebrae).mp.
99. cervical.mp.
100. cervico*.mp.
101. 99 or 100
102. exp genital diseases, female/
103. genital disease*.mp.
104. exp *Uterus/
105. or/102-104
106. 101 not 105
107. (thoracic adj3 spine).mp.
108. cervical spine.mp.
109. 94 or 95 or 96 or 97 or 98 or 106 or 107 or 108
110. Intervertebral Disk/
111. (disc or discs).mp.
112. (disk or disks).mp.
113. 110 or 111 or 112
114. 109 and 113
115. herniat*.mp.
116. slipped.mp.
117. prolapse*.mp.
118. displace*.mp.
119. degenerat*.mp.
120. (bulge or bulged or bulging).mp.
121. 115 or 116 or 117 or 118 or 119 or 120
122. 114 and 121
123. intervertebral disk degeneration/ or intervertebral disk displacement/
124. intervertebral disk displacement.mp.
125. intervertebral disc displacement.mp.
126. intervertebral disk degeneration.mp.
127. intervertebral disc degeneration.mp.
128. 123 or 124 or 125 or 126 or 127
129. 109 and 128
130. 28 or 70 or 93 or 122 or 129
131. animals/ not (animals/ and humans/)
132. 130 not 131
133. exp *neoplasms/
134. exp *wounds, penetrating/
135. 133 or 134
136. 132 not 135
137. Neck Pain/rh [Rehabilitation]
138. exp Brachial Plexus Neuropathies/rh
139. exp neck injuries/rh or exp whiplash injuries/rh
140. thoracic outlet syndrome/rh or cervical rib syndrome/rh
141. Torticollis/rh
142. exp brachial plexus neuropathies/rh or exp brachial plexus neuritis/rh
143. 137 or 138 or 139 or 140 or 141 or 142
144. Radiculopathy/rh
145. exp temporomandibular joint disorders/rh or exp temporomandibular joint dysfunction syndrome/rh
146. myofascial pain syndromes/rh
147. exp “Sprains and Strains”/rh
148. exp Spinal Osteophytosis/rh
149. exp Neuritis/rh
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150. Polyradiculopathy/rh
151. exp Arthritis/rh
152. Fibromyalgia/rh
153. spondylitis/rh or discitis/rh
154. spondylosis/rh or spondylolysis/rh or spondylolisthesis/rh
155. or/144-154
156. 59 and 155
157. exp Combined Modality Therapy/
158. Exercise/
159. Physical Exertion/
160. exp Exercise Therapy/
161. exp Rehabilitation/
162. exp Physical Therapy Modalities/
162. Hydrotherapy/
163. postur* correction.mp.
164. Feldenkrais.mp.
165. (alexander adj (technique or method)).tw.
166. Relaxation Therapy/
167. Biofeedback, Psychology/
168. or/157-167
169. 136 and 168
170. 143 or 156 or 169
171. limit 170 to yr=“2006 -Current”
172. limit 170 to yr=“1888 - 2005”
173. limit 170 to yr=“2010 -Current”
ICL Search
S1 Subject:“Neck Pain” OR Subject:“Brachial Plexus Neuritis” OR All Fields:“brachial plexus neuropathies”
S2 All Fields:brachial plexus neuropathy
S4 Subject:“Neck Injuries” OR Subject:“Whiplash Injuries” OR Subject:“Cervical Vertebrae / abnormalities
S5 All Fields:”cervical pain“ OR All Fields:neckache OR All Fields:whiplash
S6 All Fields:cervicodynia OR All Fields:cervicalgia OR All Fields:brachialgia
S7 All Fields:”brachial neuritis“ OR All Fields:”brachial neuralgia“ OR All Fields:”neck pain“
S8 Subject:”Thoracic Outlet Syndrome“ OR Subject:”Torticollis“ OR All Fields:cervical rib syndrom*
S11 All Fields:cerv* AND All Fields:headache*
S12 All Fields:monoradicul* OR All Fields:monoradicl*
S13 S1 OR S2 OR S4 OR S5 OR S6 OR S7 OR S8 OR S11 OR S12
S14 Subject:”Neck“ OR Subject:”Neck Muscles“ OR Subject:”Cervical Vertebrae“
S16 Subject:”Cervical Atlas“ OR Subject:”Atlanto-Axial Joint“ OR Subject:”Atlanto-Occipital Joint“ S17 Subject:”Atlas“ OR Subject:
”Spinal Nerve Roots“ OR All Fields:”brachial plexus“
S18 All Fields:ondontoid* OR All Fields:occip* OR All Fields:atlant*
S20 Subject:”Odontoid Process“ OR Subject:”Thoracic Vertebrae“ OR All Fields:”cervical vertebrae“
S21 All Fields:”cervical spine“ OR All Fields:trapezius OR All Fields:cervico*
S22 S14 OR S16 OR S17 OR S18 OR S20 OR S21
S23 Subject:”Pain“ OR All Fields:sore OR All Fields:stiff
S24 All Fields:ache OR All Fields:pain OR All Fields:discomfort
S25 All Fields:injur* OR All Fields:neuropath*
S26 S23 OR S24 OR S25
S27 S22 AND S26
S28 Subject:”Radiculopathy“ OR Subject:”Temporomandibular Joint Disorders“ OR Subject:”Temporomandibular Joint Dysfunction
Syndrome“
S30 Subject:”Myofascial Pain Syndromes“ OR Subject:”Sprains and Strains“ OR Subject:”Spinal Osteophytosis“
S31 Subject:”Neuritis“ OR Subject:”Polyradiculoneuritis“ OR Subject:”Arthritis“
Exercises for mechanical neck disorders (Review) 220
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S32 Subject:”Fibromyalgia“ OR Subject:”Discitis“ OR Subject:”Spondylitis“
S33 Subject:”Spondylolisthesis“ OR Subject:”Spondylolysis“ OR Subject:”Spondylosis“
S34 S28 OR S30 OR S31 OR S32 OR S33
S35 S22 AND S34
S36 Subject:”Neck“ OR Subject:”Cervical Vertebrae“ OR Subject:”Thoracic Vertebrae“
S37 All Fields:”thoracic spine“ OR All Fields:”cervical spine“ OR All Fields:cervico*
S38 S36 OR S37
S39 All Fields:herniat* OR All Fields:slipped OR All Fields:prolapse*
S40 All Fields:displace* OR All Fields:degenerat*
S41 All Fields:bulge OR All Fields:bulged OR All Fields:bulging
S42 S39 OR S40 OR S41
S43 S38 AND S42
S44 Subject:”Intervertebral Disk Displacement“ OR All Fields:”intervertebral disk degeneration“ OR All Fields:”intervertebral disc
degeneration“
S45 All Fields:”Intervertebral Disk Displacement“ OR All Fields:”intervertebral disc displacement“
S46 S44 OR S45
S47 S38 AND S46
S48 S13 OR S27 OR S35 OR S43 OR S47
S49 Subject:”Exercise“ OR Subject:”Exercise Therapy“ OR Subject:”Electric Stimulation therapy“
S50 Subject:”Physical Medicine“ OR Subject:”Physical Therapy“ OR Subject:”Physical Stimulation“
S51 Subject:”Physical Therapy Techniques“ OR Subject:”Cryotherapy“ OR Subject:”Hydrotherapy“
S52 Subject:”Hyperthermia, Induced“ OR Subject:”Ice“ OR Subject:”Biofeedback (Psychology)“
S53 Subject:”Relaxation Techniques“ OR Subject:”Postural Balance“ OR All Fields:feldenkrais
S54 S49 OR S50 OR S51 OR S52 OR S53
S55 S48 AND S54
S56 Subject:”Randomized Controlled Trials as Topic“ OR Subject:”Controlled Clinical Trials“ OR Subject:”Placebos“
S57 All Fields:random* OR All Fields:sham OR All Fields:placebo*
S58 All Fields:clinical trial* OR All Fields:”controlled study“ OR All Fields:”controlled studies“
S59 All Fields:RCT OR All Fields:RCTs
S60 S56 OR S57 OR S58 OR S59
S61 S55 AND S60
S62 Year: from 2006 to 2014
S63 S61 AND S62
MANTIS-OVID
1 neck pain.mp. [mp=title, abstract, descriptors] (2538)
2 brachial plexus neuropathies.mp. [mp=title, abstract, descriptors]
(58)
3 neck injuries.mp. [mp=title, abstract, descriptors] (201)
4 cervical pain.mp. [mp=title, abstract, descriptors] (196)
5 neckache.mp. [mp=title, abstract, descriptors] (3)
6 whiplash.mp. [mp=title, abstract, descriptors] (1165)
7 cervicodynia.mp. [mp=title, abstract, descriptors] (1)
8 cervicalgia.mp. [mp=title, abstract, descriptors] (20)
9 brachialgia.mp. [mp=title, abstract, descriptors] (25)
10 brachial neuritis.mp. [mp=title, abstract, descriptors] (15)
11 brachial neuralgia.mp. [mp=title, abstract, descriptors] (64)
12 brachial plexus neuropath*.mp. [mp=title, abstract, descriptors]
(70)
13 brachial plexus neuritis.mp. [mp=title, abstract, descriptors]
(65)
14 (thoracic outlet syndrome or cervical rib syndrome).mp.
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[mp=title,
abstract, descriptors] (245)
15 torticollis.mp. [mp=title, abstract, descriptors] (227)
16 cervico brachial neuralgia.mp. [mp=title, abstract, descriptors]
(64)
17 (monoradicul* or monoradicl*).tw. (26)
18 or/1-17 (4232)
19 headache.mp. and cervic*.tw. [mp=title, abstract, descriptors]
(796)
20 genital diseases, female.mp. [mp=title, abstract, descriptors]
(9)
21 genital disease*.mp. [mp=title, abstract, descriptors] (12)
22 or/20-21 (12)
23 19 not 22 (796)
24 18 or 23 (4759)
25 neck.mp. [mp=title, abstract, descriptors] (8069)
26 neck muscles.mp. [mp=title, abstract, descriptors] (260)
27 cervical plexus.mp. [mp=title, abstract, descriptors] (15)
28 cervical vertebrae.mp. [mp=title, abstract, descriptors] (3569)
29 atlanto-axial joint.mp. [mp=title, abstract, descriptors] (217)
30 atlanto-occipital joint.mp. [mp=title, abstract, descriptors]
(132)
31 cervical atlas.mp. [mp=title, abstract, descriptors] (2)
32 spinal nerve roots.mp. [mp=title, abstract, descriptors] (754)
33 brachial plexus.mp. [mp=title, abstract, descriptors] (744)
34 (odontoid* or cervical or occip* or atlant*).tw. (11621)
35 (axis or odontoid process).mp. [mp=title, abstract, descriptors]
(3007)
36 thoracic vertebrae.mp. [mp=title, abstract, descriptors] (920)
37 cervical vertebrae.mp. [mp=title, abstract, descriptors] (3569)
38 cervical plexus.mp. [mp=title, abstract, descriptors] (15)
39 cervical spine.mp. [mp=title, abstract, descriptors] (4032)
40 (neck adj3 muscles).mp. [mp=title, abstract, descriptors] (590)
41 (brachial adj3 plexus).mp. [mp=title, abstract, descriptors]
(749)
42 (thoracic adj3 vertebrae).mp. [mp=title, abstract, descriptors]
(974)
43 (thoracic adj3 spine).mp. [mp=title, abstract, descriptors]
(1422)
44 (thoracic adj3 outlet).mp. [mp=title, abstract, descriptors]
(266)
45 trapezius.mp. [mp=title, abstract, descriptors] (696)
46 cervical.mp. [mp=title, abstract, descriptors] (11164)
47 cervico*.mp. [mp=title, abstract, descriptors] (915)
48 46 or 47 (11552)
49 genital diseases, female.mp. [mp=title, abstract, descriptors]
(9)
50 genital disease*.mp. [mp=title, abstract, descriptors] (12)
51 uterus.mp. [mp=title, abstract, descriptors] (484)
52 49 or 50 or 51 (495)
53 48 not 52 (11533)
54 25 or 26 or 27 or 28 or 29 or 30 or 31 or 32 or 33 or 34 or 35 or
36
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or 37 or 38 or 39 or 40 or 41 or 42 or 43 or 44 or 45 or 53 (23259)
55 pain.mp. [mp=title, abstract, descriptors] (52530)
56 injuries.mp. [mp=title, abstract, descriptors] (29006)
57 ache.mp. [mp=title, abstract, descriptors] (303)
58 sore.mp. [mp=title, abstract, descriptors] (239)
59 stiff.mp. [mp=title, abstract, descriptors] (480)
60 discomfort.mp. [mp=title, abstract, descriptors] (1911)
61 injur*.mp. [mp=title, abstract, descriptors] (39409)
62 neuropath*.mp. [mp=title, abstract, descriptors] (5362)
63 or/55-62 (88035)
64 54 and 63 (10588)
65 radiculopathy.mp. [mp=title, abstract, descriptors] (1323)
66 (temporomandibular joint disorders or temporomandibular joint
dysfunction syndrome).mp. [mp=title, abstract, descriptors] (409)
67 myofascial pain syndromes.mp. [mp=title, abstract, descriptors]
(692)
68 ”sprains and strains“.mp. [mp=title, abstract, descriptors]
(3593)
69 spinal osteophytosis.mp. [mp=title, abstract, descriptors] (492)
70 neuritis.mp. [mp=title, abstract, descriptors] (273)
71 polyradiculopathy.mp. [mp=title, abstract, descriptors] (76)
72 arthritis.mp. [mp=title, abstract, descriptors] (8230)
73 fibromyalgia.mp. [mp=title, abstract, descriptors] (1439)
74 (spondylitis or discitis).mp. [mp=title, abstract, descriptors]
(1048)
75 (spondylosis or spondylolysis or spondylolisthesis).mp.
[mp=title,
abstract, descriptors] (1674)
76 radiculitis.mp. [mp=title, abstract, descriptors] (246)
77 tempomandibular.mp. [mp=title, abstract, descriptors] (2)
78 myofascial pain syndrome*.mp. [mp=title, abstract, descriptors]
(755)
79 thoracic outlet syndrome*.mp. [mp=title, abstract, descriptors]
(247)
80 spinal osteophytosis.mp. [mp=title, abstract, descriptors] (492)
81 neuritis.mp. [mp=title, abstract, descriptors] (273)
82 spondylosis.mp. [mp=title, abstract, descriptors] (472)
83 spondylitis.mp. [mp=title, abstract, descriptors] (881)
84 spondylolisthesis.mp. [mp=title, abstract, descriptors] (1068)
85 or/65-84 (18580)
86 54 and 85 (2910)
87 neck.mp. [mp=title, abstract, descriptors] (8069)
88 cervical vertebrae.mp. [mp=title, abstract, descriptors] (3569)
89 thoracic vertebrae.mp. [mp=title, abstract, descriptors] (920)
90 (thoracic adj3 vertebrae).mp. [mp=title, abstract, descriptors]
(974)
91 cervical.mp. [mp=title, abstract, descriptors] (11164)
92 cervico*.mp. [mp=title, abstract, descriptors] (915)
93 91 or 92 (11552)
94 genital diseases, female.mp. [mp=title, abstract, descriptors]
(9)
95 genital disease*.mp. [mp=title, abstract, descriptors] (12)
96 uterus.mp. [mp=title, abstract, descriptors] (484)
Exercises for mechanical neck disorders (Review) 223
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97 or/94-96 (495)
98 93 not 97 (11533)
99 (thoracic adj3 spine).mp. [mp=title, abstract, descriptors]
(1422)
100 cervical spine.mp. [mp=title, abstract, descriptors] (4032)
101 87 or 88 or 89 or 90 or 98 or 99 or 100 (18115)
102 intervertebral disk.mp. [mp=title, abstract, descriptors] (2894)
103 (disc or discs).mp. [mp=title, abstract, descriptors] (6484)
104 (disk or disks).mp. [mp=title, abstract, descriptors] (3754)
105 102 or 103 or 104 (8015)
106 101 and 105 (1423)
107 herniat*.mp. [mp=title, abstract, descriptors] (2358)
108 slipped.mp. [mp=title, abstract, descriptors] (205)
109 prolapse*.mp. [mp=title, abstract, descriptors] (434)
110 displace*.mp. [mp=title, abstract, descriptors] (6285)
111 degenerat*.mp. [mp=title, abstract, descriptors] (6917)
112 (bulge or bulged or bulging).mp. [mp=title, abstract,
descriptors]
(323)
113 107 or 108 or 109 or 110 or 111 or 112 (14641)
114 106 and 113 (881)
115 intervertebral disk displacement.mp. [mp=title, abstract,
descriptors] (1455)
116 intervertebral disc displacement.mp. [mp=title, abstract,
descriptors] (9)
117 intervertebral disk degeneration.mp. [mp=title, abstract,
descriptors] (12)
118 intervertebral disc degeneration.mp. [mp=title, abstract,
descriptors] (179)
119 115 or 116 or 117 or 118 (1632)
120 101 and 119 (279)
121 24 or 64 or 86 or 106 or 114 or 120 (13027)
122 (animals not (animals and humans)).mp. [mp=title, abstract,
descriptors] (8422)
123 121 not 122 (12814)
124 neoplasms.mp. [mp=title, abstract, descriptors] (12262)
125 wounds, penetrating.mp. [mp=title, abstract, descriptors] (12)
126 124 or 125 (12274)
127 123 not 126 (12532)
128 rehabilitation.mp. [mp=title, abstract, descriptors] (14485)
129 therapy.mp. [mp=title, abstract, descriptors] (44097)
130 128 or 129 (55359)
131 (neck pain or brachial plexus neuropathies or neck injuries or
whiplash or thoracic outlet syndrome or cervical rib syndrome or torticollis or brachial plexus neuritis).mp. [mp=title, abstract,
descriptors]
(4034)
132 (temporomandibular joint disorder or temporomandibular joint
dysfunction syndrome).mp. [mp=title, abstract, descriptors] (181)
133 (myofascial pain syndromes or ”sprains and strains“).mp.
[mp=title,
abstract, descriptors] (4274)
134 (radiculopathy or osteophytosis or neuritis or polyradiculopathy
or
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arthritis or fibromyalgia or spondylitis or spondylosis or spondylolysis or spondylolisthesis).mp. [mp=title, abstract, descriptors] (13607)
135 131 or 132 or 133 or 134 (21290)
136 130 and 135 (4916)
137 54 and 136 (1655)
138 (acupuncture or chiropractic).mp. [mp=title, abstract,
descriptors]
(29544)
139 musculoskeletal manipulation*.mp. [mp=title, abstract,
descriptors]
(179)
140 massage.mp. [mp=title, abstract, descriptors] (1649)
141 mobili?ation.mp. [mp=title, abstract, descriptors] (1966)
142 acupuncture therapy.mp. [mp=title, abstract, descriptors] (936)
143 (acupuncture or acu-puncture or needling or acupressure or
mox?bustion).mp. [mp=title, abstract, descriptors] (8413)
144 ((neck or spine or spinal or cervical or chiropractic* or
musculoskeletal*) adj3 (adjust* or manipulat* or mobiliz* or mobilis*)).mp.
[mp=title, abstract, descriptors] (6218)
145 (manual adj therap*).mp. [mp=title, abstract, descriptors] (824)
146 (manipulati* adj (therap* or medicine)).mp. [mp=title, abstract,
descriptors] (998)
147 (massag* or reflexolog* or rolfing or zone therap*).mp.
[mp=title,
abstract, descriptors] (1720)
148 Nimmo.mp. [mp=title, abstract, descriptors] (14)
149 vibration therapy.mp. [mp=title, abstract, descriptors] (11)
150 (vibration adj5 (therap* or treatment*)).mp. [mp=title,
abstract,
descriptors] (61)
151 (ChihYa or Shiatsu or Shiatzu or ZhiYa).mp. [mp=title, abstract,
descriptors] (65)
152 (flexion adj2 distraction*).mp. [mp=title, abstract,
descriptors]
(157)
153 (myofascial adj3 (release or therap*)).mp. [mp=title, abstract,
descriptors] (221)
154 muscle energy technique*.mp. [mp=title, abstract, descriptors]
(59)
155 trigger point.mp. [mp=title, abstract, descriptors] (359)
156 proprioceptive neuromuscular facilitation*.mp. [mp=title,
abstract,
descriptors] (94)
157 cyriax friction.mp. [mp=title, abstract, descriptors] (0)
158 (lomilomi or lomi-lomi or trager).mp. [mp=title, abstract,
descriptors] (13)
159 aston patterning.mp. [mp=title, abstract, descriptors] (1)
160 (strain adj counterstrain).mp. [mp=title, abstract, descriptors]
(22)
161 (craniosacraltherap* or cranio-sacral therap* or craniosacral
therap*).mp. [mp=title, abstract, descriptors] (45)
162 (amma or ammo or effleuurage or effleurage or petrissage or
hacking
or tapotment).mp. [mp=title, abstract, descriptors] (30)
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163 complementary therapies.mp. [mp=title, abstract, descriptors]
(4070)
164 ((complement* or alternat* or osteopathic*) adj (therap* or
medicine)).mp. [mp=title, abstract, descriptors] (13440)
165 (Tui Na or Tuina).mp. [mp=title, abstract, descriptors] (56)
166 or/138-165 (45999)
167 127 and 166 (3028)
168 136 or 137 or 167 (6966)
169 (animals not (animals and humans)).mp. [mp=title, abstract,
descriptors] (8422)
170 168 not 169 (6925)
171 randomized controlled trial*.mp. [mp=title, abstract,
descriptors]
(4411)
172 controlled clinical trial*.mp. [mp=title, abstract, descriptors]
(1187)
173 (random* or sham or placebo*).mp. [mp=title, abstract,
descriptors]
(31492)
174 placebos.mp. [mp=title, abstract, descriptors] (447)
175 random allocation.mp. [mp=title, abstract, descriptors] (103)
176 single blind method.mp. [mp=title, abstract, descriptors] (30)
177 double blind method.mp. [mp=title, abstract, descriptors] (339)
178 ((singl* or doubl* or trebl* or tripl*) adj25 (blind* or dumm*
or
mask*)).mp. [mp=title, abstract, descriptors] (5989)
179 (rct or rcts).mp. [mp=title, abstract, descriptors] (844)
180 (control* adj2 (study or studies or trial*)).mp. [mp=title,
abstract, descriptors] (14625)
181 or/171-180 (37245)
182 170 and 181 (1292)
183 (guideline* or practice guideline*).mp. [mp=title, abstract,
descriptors] (7859)
184 (guideline* or guidance* or recommendation*).ti. (2163)
185 consensus.ti. (308)
186 183 or 184 or 185 (8394)
187 170 and 186 (196)
188 meta-analysis.mp. [mp=title, abstract, descriptors] (1159)
189 (metaanaly* or meta analy* or met analy* or metanaly*).mp.
[mp=title, abstract, descriptors] (1479)
190 (collaborative research or collaborative review* or
collaborative
overview*).mp. [mp=title, abstract, descriptors] (61)
191 (integrative research or integrative review* or integrative
overview*).mp. [mp=title, abstract, descriptors] (42)
192 (quantitative adj3 (research or review* or overview*)).mp.
[mp=title, abstract, descriptors] (280)
193 (research integration or research overview*).mp. [mp=title,
abstract, descriptors] (18)
194 (systematic* adj3 (review* or overview*)).mp. [mp=title,
abstract,
descriptors] (2712)
195 (methodologic* adj3 (review* or overview*)).mp. [mp=title,
Exercises for mechanical neck disorders (Review) 226
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
abstract,
descriptors] (234)
196 technology assessment biomedical.mp. [mp=title, abstract,
descriptors] (33)
197 (hta or thas or technology assessment*).mp. [mp=title, abstract,
descriptors] (212)
198 ((hand adj2 search*) or (manual* adj search*)).mp. [mp=title,
abstract, descriptors] (312)
199 ((electronic adj database*) or (bibliographic* adj
database*)).mp.
[mp=title, abstract, descriptors] (450)
200 ((data adj2 abstract*) or (data adj2 extract*)).mp. [mp=title,
abstract, descriptors] (1077)
201 (analys* adj3 (pool or pooled or pooling)).mp. [mp=title,
abstract,
descriptors] (199)
202 mantel haenszel.mp. [mp=title, abstract, descriptors] (62)
203 (cochrane or pubmed or pub med or medline or embase or psycinfo
or
psyclit or psychinfo or psychlit or cinahl or science citation index).ab.
(2730)
204 or/188-203 (6435)
205 170 and 204 (273)
206 182 or 187 or 205 (1529)
207 limit 206 to yr=”2009 -Current“ (190)
Selection bias (biased allocation to interventions) due to inadequate generation of a randomized sequence
There is a low risk of selection bias if the investigators describe a random component in the sequence generation process such as: referring
to a random number table, using a computer random number generator, coin tossing, shuffling cards or envelopes, throwing dice,
drawing of lots, minimization (minimization may be implemented without a random element, and this is considered to be equivalent
to being random).
There is a high risk of selection bias if the investigators describe a non-random component in the sequence generation process, such
as: sequence generated by odd or even date of birth, date (or day) of admission, hospital or clinic record number; or allocation by
judgement of the clinician, preference of the participant, results of a laboratory test or a series of tests, or availability of the intervention.
Selection bias (biased allocation to interventions) due to inadequate concealment of allocations prior to assignment
There is a low risk of selection bias if the participants and investigators enrolling participants could not foresee assignment because
one of the following, or an equivalent method, was used to conceal allocation: central allocation (including telephone, web-based
and pharmacy-controlled randomization); sequentially numbered drug containers of identical appearance; or sequentially numbered,
opaque, sealed envelopes.
There is a high risk of bias if participants or investigators enrolling participants could possibly foresee assignments and thus introduce
selection bias, such as allocation based on: using an open random allocation schedule (e.g. a list of random numbers); assignment
Exercises for mechanical neck disorders (Review) 227
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
envelopes were used without appropriate safeguards (e.g. if envelopes were unsealed or non-opaque or not sequentially numbered);
alternation or rotation; date of birth; case record number; or other explicitly unconcealed procedures.
Blinding of participants
Performance bias due to knowledge of the allocated interventions by participants during the study
There is a low risk of performance bias if blinding of participants was ensured and it was unlikely that the blinding could have been
broken; or if there was no blinding or incomplete blinding, but the review authors judge that the outcome is not likely to be influenced
by lack of blinding.
Performance bias due to knowledge of the allocated interventions by personnel/care providers during the study
There is a low risk of performance bias if blinding of personnel was ensured and it was unlikely that the blinding could have been
broken; or if there was no blinding or incomplete blinding, but the review authors judge that the outcome is not likely to be influenced
by lack of blinding.
Intention-to-treat-analysis
There is low risk of bias if all randomized patients were reported/analyzed in the group to which they were allocated by randomization.
Bias because important outcomes were not measured at the same time across groups
There is low risk of bias if all important outcome assessments for all intervention groups were measured at the same time (Van Tulder
2003).
Other bias
27 June 2014 New citation required and conclusions have changed Based on 28 trials, five subclasses of exercise were identified
to show moderate quality evidence of be beneficial versus
two in our 2012 update. Four subclasses of exercise were
identified showing low quality evidence of no benefit in this
update compared to three in our 2012 update
22 May 2014 New search has been performed Eligible trials were added that compared exercise with a con-
trol group. Twenty-eight trials have been incorporated re-
sulting in a report of 25 evidence-based findings
HISTORY
Protocol first published: Issue 2, 2003
Review first published: Issue 3, 2005
8 November 2013 New citation required but conclusions have not Eligible trials were limited to those with single inter-
changed ventions that compared exercise with a control or com-
parative group. Conclusions similar
8 November 2013 New search has been performed Updated literature search November 08 2013
4 May 2008 New citation required and conclusions have changed Substantive amendment
1 June 2005 Amended June 2005 -- we reduced the length of the abstract;
made some edits to the text for clarification; corrected
the format in some of the references
DECLARATIONS OF INTEREST
Dr. Gert Bronfort is the first author of one of the trials included in this systematic review. He was not involved in the selection of
studies, quality assessment, or data extraction for the study for which he was author.
SOURCES OF SUPPORT
Internal sources
• Centric and LifeMark Health, Canada.
• McMaster University, Department of Clinical Epidemiology and Biostatistics, School of Rehabilitation Science, Occupational
Health Program, Canada.
• University of Toronto, Department of Rehabilitation Medicine, Canada.
External sources
• CIHR Knowledge Synthesis Grant 2010, Canada.
• National Institutes of Health, Consortial Center for Chiropractic Research, Bethesda, MD (2002), USA.
• Hamilton Hospital Assessment Centre (2002), Canada.
• Hamilton District Research Grant (2000), Canada.
• Hamilton Health Sciences Corporation, Chedoke-McMaster Foundation (1997), Canada.
• University of Saskatchewan, Clinical Teaching and Research Award (1997), Canada.
[∗ methods]; Neck; Neck Pain [etiology; ∗ therapy]; Pain Management [methods]; Radiculopathy [∗ therapy]; Randomized Controlled
Trials as Topic