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
Cristian Justribo-Manion, n/a
PhD candidate
Universidad Abat Oliba – CEU, CEU Universities
Barcelona, Madrid, Spain
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
To determine which form of exercise therapy, either alone or in combination, is most likely to be effective in reducing neck pain intensity for individuals with chronic neck pain using a network meta-analysis (NMA) approach.
Design:
Systematic review with NMA of randomized controlled trials (RCTs) including adults with chronic neck pain receiving any exercise versus other treatments or no treatment. Primary outcome: pain intensity. Searches were conducted in Ovid Medline All®, Embase, CINAHL, Scopus, and Cochrane Library Trials without language or date restrictions. Risk of bias was assessed using RoB-2. Bayesian random-effects NMA summarized effects as standardized mean differences (SMDs) with 95% credible intervals (95%-CrI), using ‘no intervention’ as the reference (SMD< 0 favoring intervention). Interventions were ranked using SUCRA (0-100%).
Results:
Total of 74 RCTs (n = 5751 participants analyzed) were included. Most trials had a high RoB (98%). Among 34 nodes identified, the fourth highest-ranked interventions by SUCRA (95.1%, 91.8%, 89.4, and 78.5%, respectively) were exercise plus acupuncture (SMD: -2.32; 95%CrI: -3.55, -1.08, based on one trial with 64 participants), exercise plus kinesiotape (SMD: -2.03; 95%-CrI: -3.28, -0.79, based on two trials with 43 participants), exercise plus other type of treatment (SMD: -1.72; 95%-CrI: -2.48, -0.97, based on two trials with 48 participants), and the combination of more than three types of exercise plus kinesiotape (SMD: -1.44; 95%-CrI: -2.60, -0.23, based on one trial with 29 participants), each with >98.9% probability of being superior to no treatment. A high between-trial heterogeneity (τ² of 0.25 (95%-CrI, 0.16, 0.40)) was found, but no evidence of incoherence was present.
Conclusion:
NMA indicates that the most effective interventions were multimodal approaches combining exercise with acupuncture, kinesiotape, or other therapies, as well as multi-exercise programs with kinesiotape. However, these findings rely on small samples and considerable heterogeneity, limiting certainty. Larger, rigorously designed trials are warranted.
