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Conservative Management of Mechanical Neck Disorders: A Systematic Review
ANITA R. GROSS, CHARLIE GOLDSMITH, JAN L. HOVING, TED HAINES, PAUL PELOSO, PETER AKER, PASQUALINA SANTAGUIDA, CYNTHIA MYERS, and the Cervical Overview Group
ABSTRACT. Methods. Two independent authors selected studies, abstracted data, and assessed methodological quality from computerized databases. We calculated relative risks and standardized mean differences (SMD) when possible. In the absence of heterogeneity, we calculated pooled effect sizes. Results. We studied 88 unique RCT. The mean methodological quality scores were acceptable in 59% of the trials. We noted strong evidence of benefit for maintained pain reduction [pooled SMD –0.85 (95% CI –1.20, –0.50)], improvement in function, and positive global perceived effect favoring exercise plus mobilization/manipulation versus control for subacute/chronic MND. We found moderate evidence of longterm benefit for improved function favoring direct neck strengthening and stretching for chronic MND, and for high global perceived effect favoring vertigo exercises. We noted moderate evidence of no benefit for botulinium-A injection [pooled SMD –0.39 (95% CI –01.25, 0.47)]. We found many treatments demonstrating short-term effects. Conclusion. Exercise combined with mobilization/manipulation, exercise alone, and intramuscular lidocaine for chronic MND; intravenous glucocorticoid for acute whiplash associated disorders; and low-level laser therapy demonstrated either intermediate or longterm benefits. Optimal dosage of effective techniques and prognostic indicators for responders to care should be explored in future research. (First Release Jan 15 2007; J Rheumatol 2007;34:1083-102) Key Indexing Terms:
NECK
From the School of Rehabilitation Sciences, Clinical Epidemiology and Biostatistics, and Occupational Health and Environmental Medicine, McMaster University, Hamilton, Ontario, Canada; Coronel Institute of Occupational Health, Academic Medical Center, Universiteit van Amsterdam, Amsterdam, The Netherlands; and the Integrative Medicine Program, H. Lee Moffitt Cancer Center, Tampa, Florida, USA. Supported by a Problem-based Research Grant from Sunnybrook and Women's Health Sciences Centre, Toronto, Canada. A.R. Gross, MSc, Associate Clinical Professor; C. Goldsmith, PhD, Professor; T. Haines, MSc, Associate Professor; P. Santaguida, PhD, Associate Professor, School of Rehabilitation Sciences, Clinical Epidemiology and Biostatistics, and Occupational Health and Environmental Medicine, McMaster University; J.L. Hoving, PhD, Senior Research Fellow, Coronel Institute of Occupational Health, Academic Medical Center, Universiteit van Amsterdam, and Department of Epidemiology and Preventive Medicine, Monash University, Australia; P. Peloso, MD, Director, Product Benefit Risk Assessment and Management, Amgen Inc.; P. Aker, MSc, Private Practice, Belleville, ON, Canada; C. Myers, PhD, Director, Integrative Medicine Program, H. Lee Moffitt Cancer Center. The Cervical Overview Group: T. Kay, P. Kroeling, N. Graham, B. Haraldsson, A.M. Eady, K. Trinh, J. Ezzo, G. Bronfort, A. Morien, E. Wang, I. Cameron.
Address reprint requests to A.R. Gross, School of Rehabilitation Sciences, McMaster University, 1400 Main Street West, Hamilton, Ontario Accepted for publication October 13, 2006.
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