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Conservative management of mechanical neck pain: systematic overview and meta-analysis

^a Division of Graduate Studies and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada, ^b Chedoke-McMaster Hospitals and School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada, ^c Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, ^d Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

Correspondence to: Dr C H Goldsmith, Centre for Evaluation of Medicines, St Joseph's Hospital, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada.

Abstract

Objective: To review the efficacy of conservative management of mechanical neck disorders.
Methods: Published and unpublished reports were identified through computerised and manual searches of bibliographical databases, reference lists from primary articles, and letters to authors, agencies, foundations, and content experts. Selection criteria were applied to blinded articles, and selected articles were scored for methodological quality. Effect sizes were calculated from raw pain scores and combined by using meta-analytic techniques when appropriate.
Results: Twenty four randomised clinical trials met the selection criteria and were categorised by type of intervention: nine used manual treatments; 12 physical medicine methods; four drug treatment; and three education of patients (four trials investigated more than one form of intervention). The intervention strategies were summarised separately. Pooling of studies was considered only within each category. Five of the nine trials that used manual treatment in combination with other treatments were combined. One to four weeks after treatment the pooled effect size was -0.6 (95% confidence interval -0.9 to -0.4), equivalent to an improvement of 16 (6.9 to 23.1) points on a 100 point scale. Sensitivity analyses on study quality, chronicity, and data imputation did not alter this estimate. For other interventions, studies could not be combined to arrive at pooled estimates of effect.
Conclusions: There is little information available from clinical trials to support many of the treatments for mechanical neck pain. In general, conservative interventions have not been studied in enough detail to assess efficacy or effectiveness adequately.

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