400 Section - Effectiveness of manual therapy compared to other types of treatment in chronic neck pain: a systematic review with network meta‑analysis (preliminary results)

To determine which type or combination of manual therapy (MT) techniques is most likely to be effective in reducing neck pain intensity in patients with chronic neck pain (CNP).

Design:

Network meta-analysis (NMA) of randomized controlled trials (RCTs). Studies included adults with CNP who received MT compared to any other type of treatment/no treatment. Searches were conducted in five different databases, without language or publication date restrictions. Risk of bias was assessed by the revised RoB-2 . The Bayesian random-effects NMA models were used, and treatment effects were summarized as standardized mean differences (SMDs) with 95% credible intervals (95%-CrI). The reference node was "no intervention" with an SMD< 0, favoring MT over "no intervention”. We ranked interventions according to the surface under the cumulative ranking curve (SUCRA, 0-100%, higher values indicating a better overall ranking).

Results: Twenty-nine RCTs (n=2187 participants) were included, mostly high RoB (93%). Twenty nodes were identified and the highest-ranked interventions by SUCRA (90.6%, 88.3%, and 86.7%, respectively) were combination of more than three types of MT (SMD:-0.67; 95%-CrI:-1.93,0.59, based on two trials with 60 participants), self-administered MT (SMD:-0.91;95%-CrI:-2.79, 0.96, based on one trial with 30 participants), and other types of treatment not involving MT (SMD:-0.71; 95%-CrI:-2.08,0.65, based on two trials with 51 participants), each with >85.7% probability of being superior to no treatment. The fourth highest-ranked intervention by SUCRA was the control group (no treatment). A high between-trial heterogeneity (τ²=0.35 (95%-CrI:0.11,0.87)) was found, but no evidence of incoherence was present.

Conclusion: There is a high-uncertainty on the effects. Interventions combining MT techniques, as well as self-administered MT and other non-MT treatments, consistently ranked among the most favorable options. Several MT approaches were not more effective than control. Findings suggest potential benefits of multifaceted MT, but the limited precision and small samples highlight the need for robust trials.