OBJECTIVE: The purpose of this review was to evaluate the effects of sling exercise on pain intensity, disability, and health-related quality of life in adults with neck pain. METHODS: We searched the Cochrane Central Register of Controlled Trials, Embase, Physiotherapy Evidence Database (PEDro), and 6 other databases from inception to July 2020. We also screened the reference lists of relevant articles to identify additional trials. Randomized controlled trials were included if they investigated the effects of sling suspension therapy in patients with neck pain including mechanical neck disorders, cervicogenic headache, and neck disorders with radicular findings. Studies were required to be published in English or Chinese. The methodological quality and levels of evidence of studies were assessed using the PEDro scale and the GRADE approach, respectively. The random-effects model was used to perform meta-analyses. RESULTS: Eleven randomized controlled trials were included (n = 595). The mean total PEDro score was 4.64 (SD 1.21) of 10, which indicated a fair methodological quality. The intervention groups showed significant improvements in pain intensity (SMD -1.23; 95% CI -1.88 to -0.58) immediately postintervention compared to the control groups. No significant effects were found for disability, cervical range of motion, and health-related quality of life. However, sensitivity analyses revealed significant short-term improvements in pain intensity, disability, and cervical range of motion, and sustained effects on disability at intermediate-term follow-up. CONCLUSION: Sling exercise appears to be beneficial for improvements in pain intensity (moderate- to low-level evidence) among patients with neck pain. However, no definitive conclusion could be made regarding the effect of sling exercise for neck pain due to methodological limitations and high heterogeneity in the included studies. IMPACT: This review provides overall moderate- to very low-level evidence for health care professionals who may consider including sling exercise in the intervention program for patients with neck pain.

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