OBJECTIVE: To compare the effectiveness of different physical exercise interventions for chronic non-specific neck pain. DESIGN: Systematic review and network meta-analysis. DATA SOURCES: Electronic databases: AMED, CINAHL, Cochrane Central Register of Controlled Trials, Embase, Medline, Physiotherapy Evidence Database, PsycINFO, Scopus and SPORTDiscus. ELIGIBILITY CRITERIA: Randomised controlled trials (RCTs) describing the effects of any physical exercise intervention in adults with chronic non-specific neck pain. RESULTS: The search returned 6549 records, 40 studies were included. Two networks of pairwise comparisons were constructed, one for pain intensity (n = 38 RCTs, n = 3,151 participants) and one for disability (n = 29 RCTs, n = 2,336 participants), and direct and indirect evidence was obtained. Compared with no treatment, three exercise interventions were found to be effective for pain and disability: motor control (Hedges' g, pain -1.32, 95% CI -1.99 to -0.65; disability -0.87, 95% CI -1.45 o -0.29), yoga/Pilates/Tai Chi/Qigong (pain -1.25, 95% CI -1.85 to -0.65; disability -1.16, 95% CI -1.75 to -0.57) and strengthening (pain -1.21, 95% CI -1.63 to -0.78; disability -0.75, 95% CI -1.28 to -0.22). Other interventions, including range of motion (pain -0.98 CI -2.51 to 0.56), balance (pain -0.38, 95% CI -2.10 to 1.33) and multimodal (three or more exercises types combined) (pain -0.08, 95% CI -1.70 to 1.53) exercises showed uncertain or negligible effects. The quality of evidence was very low according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. CONCLUSION: There is not one superior type of physical exercise for people with chronic non-specific neck pain. Rather, there is very low quality evidence that motor control, yoga/Pilates/Tai Chi/Qigong and strengthening exercises are equally effective. These findings may assist clinicians to select exercises for people with chronic non-specific neck pain. PROSPERO REGISTRATION NUMBER: CRD42019126523.
Reproduced with permission from the BMJ Publishing Group.

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