Resistance, Motor Control, and Mindfulness-Based Exercises Are Effective for Treating Chronic Nonspecific Neck Pain: A Systematic Review With Meta-Analysis and Dose-Response Meta-Regression.

Abstract

<b>OBJECTIVE:</b> We aimed to analyze the effects and dose-response relationship of the most effective exercises for improving pain and disability in people with chronic nonspecific neck pain. <b>DESIGN:</b> Intervention systematic review with meta-analysis. <b>LITERATURE SEARCH:</b> We searched the PubMed, PEDro, and CENTRAL databases from their inception to September 30, 2022. <b>STUDY SELECTION CRITERIA:</b> We included randomized controlled trials that involved people with chronic neck pain adopting a longitudinal exercise intervention and assessed one pain and/or disability outcome. <b>DATA SYNTHESIS:</b> Restricted maximum-likelihood random-effects meta-analyses were modeled separately for resistance, mindfulness-based, and motor control exercises; standardized mean differences (Hedge's <i>g</i>, standardized mean difference [SMD]) were effect estimators. Meta-regressions (dependent variable: effect sizes of the interventions; independent variables: training dose and control group effects) were conducted to explore the dose-response relationship for therapy success of any exercise type. <b>RESULTS:</b> We included 68 trials. Compared to true control, effects on pain and disability were significantly larger for resistance exercise (pain: SMD, -1.27; 95% confidence interval [CI]: -2.26, -0.28; |² = 96%; disability: SMD, -1.76; 95% CI: -3.16, -0.37; |² = 98%), motor control exercise (pain: SMD, -2.29; 95% CI: -3.82, -0.75; |² = 98%; disability: SMD, -2.42; 95% CI: -3.38, -1.47; |² = 94%), and Yoga/Pilates/Tai Chi/Qui Gong exercise (pain: SMD, 1.91; 95% CI:-3.28, -0.55; |² = 96%; disability: SMD, -0.62; 95% CI: -0.85, -0.38; |² = 0%). Yoga/Pilates/Tai Chi/Qui Gong exercise was more effective than other exercises (SMD, -0.84; 95% CI: -1.553, -0.13; |² = 86%) for reducing pain. For disability, motor control exercise was superior to other exercises (SMD, -0.70; 95% CI: -1.23, -0.17; |² = 98%). There was no dose-response relationship for resistance exercise (<i>R</i>² = 0.32). Higher frequencies (estimate = -0.10) and longer durations (estimate = -0.11) of motor control exercise had larger effects on pain (<i>R</i>² = 0.72). Longer sessions (estimate = -0.13) of motor control exercise had larger effects on disability (<i>R</i>² = 0.61). <b>CONCLUSION:</b> Resistance, mindfulness-based, and motor control exercises were effective for reducing neck pain (very low- to moderate-certainty evidence). Higher frequencies and longer duration of sessions had a significant effect on pain for motor control exercise. <i>J Orthop Sports Phys Ther 2023;53(8):1-41. Epub: 20 June 2023. doi:10.2519/jospt.2023.11820</i>.