• A R Gross, J P Paquin, G Dupont, S Blanchette, P Lalonde, T Cristie, N Graham, T M Kay, S J Burnie, G Gelley, C H Goldsmith, M Forget, P L Santaguida, A J Yee, G G Radisic, J L Hoving, G Bronfort, and Cervical Overview Group.
• Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; School of Rehabilitation Science, McMaster University, Hamilton, Canada. Electronic address: grossa@mcmaster.ca.
• Man Ther. 2016 Aug 1; 24: 25-45.

BackgroundNeck pain (NP) is disabling and costly.ObjectivesTo assess the effectiveness of exercise on pain, disability, function, patient satisfaction, quality of life (QoL) and global perceived effect (GPE) in adults with NP.MethodsWe searched computerised databases up to May 2014 for randomized controlled trials (RCTs) comparing exercise to a control in adults with NP with/without cervicogenic headache (CGH) or radiculopathy. Two reviewers independently conducted selection, data abstraction and assessed risk of bias. Meta-analyses were performed to establish pooled standardised mean differences (SMDp). The Grade of Recommendation, Assessment, Development and Evaluation (GRADE) was used to summarise the body of evidence.Main ResultsThe following exercises (27 trials) were supported by 'Moderate GRADE' evidence: For chronic NP, 1) cervico-scapulothoracic and upper extremity (UE) strengthening for moderate to large pain reduction immediately post treatment (IP) and at short-term (ST) follow-up; 2) scapulothoracic and UE endurance training for a small pain reduction (IP/ST); 3) cervical, shoulder and scapulothoracic strengthening and stretching exercise for a small to large pain reduction in the long-term (LT) (SMDp -0.45 [95%CI: -0.72 to -0.18]) and function improvement; 4) cervico-scapulothoracic strengthening/stabilisation exercises for pain and function at intermediate-term (IT) (SMDp -14.90 [95%CI: -22.40 to -7.39]). 5) mindfulness exercises (Qigong) for minor improved function but not GPE (ST). For chronic CGH, cervico-scapulothoracic strengthening and endurance exercises including pressure biofeedback for small/moderate improvement of pain, function and GPE (IP/LT).Authors' ConclusionsSpecific strengthening exercises of the neck, scapulothoracic and shoulder for chronic NP and chronic CGH are beneficial. Future research should explore optimal dosage.Copyright © 2016 Elsevier Ltd. All rights reserved.

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