CONSERVATIVE MANAGEMENT OF MECHANICAL NECK PAIN - SYSTEMATIC OVERVIEWAND METAANALYSIS

Objective-To review the efficacy of conservative management of mechani cal neck disorders. Methods-Published and unpublished reports were ide ntified through computerised and manual searches of bibliographical da tabases, reference lists from primary articles, and letters to authors , agencies, foundations, and content experts. Selection criteria were applied to blinded articles, and selected articles were scored for met hodological quality. Effect sizes were calculated from raw pain scores and combined by using meta-analytic techniques when appropriate. Resu lts-Twenty four randomised clinical trials met the selection criteria and were categorised by type of intervention: nine used manual treatme nts; 12 physical medicine methods; four drug treatment; and three educ ation of patients (four trials investigated more than one form of inte rvention). The intervention strategies were summarised separately. Poo ling of studies was considered only within each category. Five of the nine trials that used manual treatment in combination with other treat ments were combined. One to four weeks after treatment the pooled effe ct size was -0.6 (95% confidence interval -0.9 to -0.4), equivalent to an improvement of 16 (6.9 to 23.1) points on a 100 point scale. Sensi tivity analyses on study quality, chronicity, and data imputation did not alter this estimate. For other interventions, studies could not be combined to arrive at pooled estimates of effect. Conclusions-There i s little information available from clinical trials to support many of the treatments for mechanical neck pain. In general, conservative int erventions have not been studied in enough detail to assess efficacy o r effectiveness adequately.