Article type
Year
Abstract
Background: Mechanical neck pain is common, can severely limit function at home and work, and is costly to society. Many conservative management techniques are used to treat this condition.
Objective: Our objective was to assess whether conservative treatments - manual therapies, physical medicine methods, drug therapies and patient education/ communication, either alone or in combination - relieve pain or improve function/disability, patient satisfaction, and global perceived effect in adults with mechanical neck disorders.
Methods: Eleven systematic reviews of the literature were performed. Computerized bibliographic databases including MEDLINE, EMBASE, MANTIS, CINAHL, ICL, and CCTR were searched without language restrictions from root up to March 2002 for relevant studies. To qualify, studies had to be randomized or quasi-randomized and investigate the use of conservative treatments for mechanical neck disorders. Two independent reviewers identified citations, selected studies, abstracted data, and assessed the quality of the methodology. Relative risk and standardised mean differences were calculated using a random effects model. The reasonableness of combining studies was assessed on clinical and statistical grounds. In the absence of heterogeneity, we calculated pooled effect measures.
Results: Methodological quality was varied across the 106 studies that met our selection criteria; 55% were of high quality. We noted strong evidence of benefit for maintained pain reduction with pooled SMD -0.85(95%CI:-1.20,-0.50), improvement in function with pooled SMD -0.57(95%CI:-0.94,-0.21) and positive global perceived effect with SMD -2.73(95%CI:-3.30,-2.16) favouring multi-modal care (exercise plus mobilization / manipulation as a core strategy), compared to a no treatment control. We found moderate evidence of long-term benefit for pain reduction favouring therapeutic strengthening. Short-term benefit was found when dizziness exercises, oral muscle relaxants, intra-muscular injection of local anesthetic, cervical water pillow, advice on activation strategies and intermittent traction were used. Heat, TENS, EMS, diadynamic current, micro-current, magnetic necklace, collars, advice to rest, static traction, botulinum-A, and manipulation or mobilization used alone or in combination with various other modalities were unlikely to be beneficial. We found that the evidence was not sufficient or sufficiently clear to evaluate effectiveness for many therapies.
Conclusion: The first priority for future research should be phase II and III trials to delineate potent treatment characteristics, followed by factorial design to detect effective care elements within multi-modal approaches. We recommend standardized reporting of treatment characteristics, dosages and adverse side effects. We noted inadequate power in most negative trials; therefore, their true effects remain unclear. Studies using adequate sample sizes are needed.
Multi-modal care (exercise plus mobilization/manipulation as a core strategy) and strengthening exercises had long-term (1 year) benefits. Other therapies like dizziness exercises, oral muscle relaxants, intra-muscular injection of local anesthetic, cervical water pillow, advice on activation strategies and intermittent traction were of benefit in the short-term. We found numerous treatment approaches that were unlikely to be beneficial or had insufficient evidence to determine effectiveness.
Objective: Our objective was to assess whether conservative treatments - manual therapies, physical medicine methods, drug therapies and patient education/ communication, either alone or in combination - relieve pain or improve function/disability, patient satisfaction, and global perceived effect in adults with mechanical neck disorders.
Methods: Eleven systematic reviews of the literature were performed. Computerized bibliographic databases including MEDLINE, EMBASE, MANTIS, CINAHL, ICL, and CCTR were searched without language restrictions from root up to March 2002 for relevant studies. To qualify, studies had to be randomized or quasi-randomized and investigate the use of conservative treatments for mechanical neck disorders. Two independent reviewers identified citations, selected studies, abstracted data, and assessed the quality of the methodology. Relative risk and standardised mean differences were calculated using a random effects model. The reasonableness of combining studies was assessed on clinical and statistical grounds. In the absence of heterogeneity, we calculated pooled effect measures.
Results: Methodological quality was varied across the 106 studies that met our selection criteria; 55% were of high quality. We noted strong evidence of benefit for maintained pain reduction with pooled SMD -0.85(95%CI:-1.20,-0.50), improvement in function with pooled SMD -0.57(95%CI:-0.94,-0.21) and positive global perceived effect with SMD -2.73(95%CI:-3.30,-2.16) favouring multi-modal care (exercise plus mobilization / manipulation as a core strategy), compared to a no treatment control. We found moderate evidence of long-term benefit for pain reduction favouring therapeutic strengthening. Short-term benefit was found when dizziness exercises, oral muscle relaxants, intra-muscular injection of local anesthetic, cervical water pillow, advice on activation strategies and intermittent traction were used. Heat, TENS, EMS, diadynamic current, micro-current, magnetic necklace, collars, advice to rest, static traction, botulinum-A, and manipulation or mobilization used alone or in combination with various other modalities were unlikely to be beneficial. We found that the evidence was not sufficient or sufficiently clear to evaluate effectiveness for many therapies.
Conclusion: The first priority for future research should be phase II and III trials to delineate potent treatment characteristics, followed by factorial design to detect effective care elements within multi-modal approaches. We recommend standardized reporting of treatment characteristics, dosages and adverse side effects. We noted inadequate power in most negative trials; therefore, their true effects remain unclear. Studies using adequate sample sizes are needed.
Multi-modal care (exercise plus mobilization/manipulation as a core strategy) and strengthening exercises had long-term (1 year) benefits. Other therapies like dizziness exercises, oral muscle relaxants, intra-muscular injection of local anesthetic, cervical water pillow, advice on activation strategies and intermittent traction were of benefit in the short-term. We found numerous treatment approaches that were unlikely to be beneficial or had insufficient evidence to determine effectiveness.