Evidence of Physiotherapy Interventions for Patients with Chronic Neck Pain: A Systematic Review of Randomised Controlled Trials

Chronic neck pain (CNP) is common and costly, and the effect of physiotherapeutic interventions on the condition is unclear. We reviewed the literature for evidence of effect of physiotherapy interventions on patients with CNP. Five bibliographic databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, and PEDro) were systematically searched. Randomised, placebo and active-treatment-controlled trials including physiotherapy interventions for adults with CNP were selected. Data were extracted primary outcome was pain. Risk of bias was appraised. Effect of an intervention was assessed, weighted to risk of bias. 42 trials reporting on randomised comparisons of various physiotherapy interventions and control conditions were eligible for inclusion involving 3919 patients with CNP. Out of these, 23 were unclear or at high risk of bias, and their results were considered moderate- or low-quality evidence. Nineteen were at low risk of bias, and here eight trials found effect on pain of a physiotherapy intervention. Only exercise therapy, focusing on strength and endurance training, and multimodal physiotherapy, cognitive-behavioural interventions, massage, manipulations, laser therapy, and to some extent also TNS appear to have an effect on CNP. However, sufficient evidence for application of a specific physiotherapy modality or aiming at a specific patient subgroup is not available. 1. Introduction Musculoskeletal disorders are threatening quality of life by having the potential to restrict daily activities, cause absence from work, and result in a change or discontinuation in employment. These disorders are expensive for society and for patients and are responsible for the highest number of healthy years lost [1–4]. The prevalence of chronic neck pain varies. The 12-month prevalence of pain typically ranges between 30% and 50%; the 12-month prevalence of activity-limiting pain is 1.7% to 11.5% [5]. The annual incidence of neck pain associated with whiplash varies greatly. Although 50% of whiplash victims recover in three to six months, 30% to 40% have persisting mild to moderate pain and 10% to 20% retain more severe pain [6]. It is a multifaceted phenomenon with physical impairment, psychological distress, and social dysfunction, which calls for an evidence-based, cost-effective rehabilitation treatment [7–11]. According to a Dutch study, 44% of patients with chronic neck pain visited their general practitioner (GP) with the condition during a twelve-month period; 51% of these were referred to physiotherapy treatment [12]. Knowledge of the actual effect of