Clinical Sciences/Health Conditions
Ana Izabela Oliveira Souza, PhD
PhD
Hochschule Osnabruck - University of Applied Sciences
Osnabrueck, Niedersachsen, Germany
Jordana Barbosa-Silva, PhD
PhD
Hochschule Osnabrück - University of Applied Sciences
Osnabrück, Niedersachsen, Germany
Tiago da Veiga pereira, n/a
Prof. Dr.
University of Oxford
Oxford, England, United Kingdom
Javier Muñoz Laguna, n/a
PhD
Epidemiology, Biostatistics and Prevention Institute, University of Zurich
Zürich, Zurich, Switzerland
Liz Dennett, MLIS
Faculty Engagement Librarian
University of Alberta
Edmonton, Alberta, Canada
Nathalie M. Schweyckart, n/a
Master
Epidemiology, Biostatistics and Prevention Institute, University of Zurich
Zürich, Zurich, Switzerland
Dorothea Charlotte Zimmerman, n/a
Master candidate
ZHAW- Zürcher Hochschule für Angewandte Wissenschaften
Winterthur, Zurich, Switzerland
Henry Dan Kiyomoto, n/a
PhD
Instituto de Pesquisa e Ensino em Avaliação de Tecnologia em Saúde
Porto Alegre, Rio Grande do Sul, Brazil
Clara Gieseke Lopes, n/a
Master candidate
Epidemiology, Biostatistics and Prevention Institute, University of Zurich
Zürich, Zurich, Switzerland
Haliton de Oliveira Junior, n/a
Dr
Health Technology Assessment unit. A Beneficência Portuguesa de São Paulo.
São Paulo, Sao Paulo, Brazil
Cesar A Hincapié, n/a
Prof. Dr.
Epidemiology, Biostatistics and Prevention Institute, University of Zurich
Zürich, Zurich, Switzerland
Nikolaus Ballenberger, n/a
Prof. Dr.
University of Applied Sciences Osnabrück
Osnabrück, Niedersachsen, Germany
Bruno R. Da Costa, n/a
Prof. Dr.
University of Oxford
Oxford, England, United Kingdom
Douglas P Gross, n/a
Prof. Dr.
University of Alberta / Department of Physical Therapy
Edmonton, Alberta, Canada
Susan Armijo-Olivo, PhD
Prof. Dr.
Hochschule Osnabrück - University of Applied Sciences/University of Alberta
Osnabrück, Niedersachsen, Germany
NMA of randomized controlled trials (RCTs). We included RCTs with adults with chronic neck pain receiving any intervention of interest (MT, pharmacological treatment, ET, and/or education). Primary outcome was pain intensity (post-treatment). Bayesian random-effects NMA models estimated standardized mean differences (SMDs) with 95% credible intervals (95%-CrI). “No intervention” was the reference node (SMD< 0 favoring the intervention). Interventions were ranked using SUCRA (0–100%). Study quality was assessed using the RoB-2 tool.
Results:
One hundred RCTs (7681 analyzed participants) examining 49 interventions were included. Most trials had a high RoB (97.5%). The five highest-ranked interventions from the network by SUCRA (95.5%, 91.9%, 90.1%, 88.1%, and 82.0%, respectively) were exercise plus acupuncture (SMD: -2.30; 95%-CrI: -3.53, -1.07, based on one trial with 64 participants), exercise plus kinesiotape (SMD: -1.97; 95%CrI: -3.20, -0.74, based on two trials with 43 participants), exercise plus other type of treatment (SMD: -1.69; 95%-CrI: -2.44, -0.95, based on two trials with 48 participants), kinesiotape (SMD: -1.95; 95%-CrI: -3.66, -0.24, based on one trial with 21 participants), and topical agents (SMD: -1.57; 95%-CrI: -3.10, -0.03, based on two trials with 52 participants), each with >97.7% probability of being superior to no treatment. High between-trial heterogeneity (τ² = 0.25, 95%-CrI, 0.17, 0.38) was found, but no evidence of incoherence was present.
Conclusion:
The NMA suggests that multimodal interventions combining exercise with acupuncture, kinesiotape, or other therapeutic modalities, as well as kinesiotape and topical agents, may offer the greatest short-term symptom reduction compared with no treatment. However, these estimates come from small, heterogeneous trials, suggesting limited certainty. Larger, high-quality studies are needed to confirm these findings.
