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Is exercise effective for the management of neck pain and associated disorders or whiplash-associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

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Is exercise effective for the management of neck pain and associated disorders or whiplash-associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

Spine J. 2014 Feb 14;

Authors: Southerst Bsch D, Nordin M, Côté P, Shearer H, Varatharajan S, Yu H, Wong JJ, Sutton D, Randhawa K, van der Velde G, Mior S, Carroll L, Jacobs C, Taylor-Vaisey A

BACKGROUND CONTEXT: In 2008, the Neck Pain Task Force (NPTF) recommended exercise for the management of neck pain and whiplash-associated disorders (WAD). However, no evidence was available on the effectiveness of exercise for grade III neck pain or WAD. Moreover, limited evidence was available to contrast the effectiveness of various types of exercises.
PURPOSE: To update the findings of the NPTF on the effectiveness of exercise for the management of neck pain and WAD grades I to III. Study Design/setting: Systematic review and best evidence synthesis.
SAMPLE: Studies comparing the effectiveness of exercise to other conservative interventions or no intervention.
OUTCOME MEASURES: Outcomes of interest included: 1) self-rated recovery; 2) functional recovery; 3) pain intensity; 4) health-related quality of life; 5) psychological outcomes; and/or 6) adverse events.
METHODS: We searched eight electronic databases from 2000 to 2013. Eligible studies were critically appraised using the SIGN criteria. The results of scientifically admissible studies were synthesized following best evidence synthesis principles. Funding was provided by the Ministry of Finance.
RESULTS: We retrieved 4761 articles and 21 RCTs were critically appraised. Ten RCT’s were scientifically admissible: nine investigated neck pain and one addressed WAD. For the management of recent neck pain grades I/II, unsupervised range of motion exercises, non-steroidal anti-inflammatories (NSAIDs) and acetaminophen, or manual therapy lead to similar outcomes. For recent neck pain grade III, supervised graded strengthening is more effective than advice but leads to similar short-term outcomes as a cervical collar. For persistent neck pain and WAD grades I/II, supervised qigong and combined strengthening, range of motion and flexibility exercises are more effective than wait list. Additionally, supervised Iyengar yoga is more effective than home exercise. Finally supervised high dose strengthening is not superior to home exercises or advice.
CONCLUSIONS: We found evidence that supervised qigong, Iyengar yoga, and combined programs including strengthening, range of motion, and flexibility are effective for the management of persistent neck pain. We did not find evidence that one supervised exercise program is superior to another. Overall, most studies reported small effect sizes suggesting that a small clinical effect can be expected with the use of exercise alone. Systematic Review Registration Number: CRD42013003717.

PMID: 24534390 [PubMed – as supplied by publisher]

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