title: Conservative management of mechanical neck disorders: a systematic review.
abstract: OBJECTIVE
  To determine if conservative treatments (manual therapies, physical medicine methods, medication, and patient education) relieved pain or improved function/disability, patient satisfaction, and global perceived effect in adults with acute, subacute, and chronic mechanical neck disorders (MND) by updating 11 systematic reviews of randomized controlled trials (RCT).
  
  
  METHODS
  Two independent authors selected studies, abstracted data, and assessed methodological quality from computerized databases. We calculated relative risks and standardized mean differences (SMD) when possible. In the absence of heterogeneity, we calculated pooled effect sizes.
  
  
  RESULTS
  We studied 88 unique RCT. The mean methodological quality scores were acceptable in 59% of the trials. We noted strong evidence of benefit for maintained pain reduction [pooled SMD -0.85 (95% CI -1.20, -0.50)], improvement in function, and positive global perceived effect favoring exercise plus mobilization/manipulation versus control for subacute/chronic MND. We found moderate evidence of longterm benefit for improved function favoring direct neck strengthening and stretching for chronic MND, and for high global perceived effect favoring vertigo exercises. We noted moderate evidence of no benefit for botulinium-A injection [pooled SMD -0.39 (95% CI -01.25, 0.47)]. We found many treatments demonstrating short-term effects.
  
  
  CONCLUSIONS
  Exercise combined with mobilization/manipulation, exercise alone, and intramuscular lidocaine for chronic MND; intravenous glucocorticoid for acute whiplash associated disorders; and low-level laser therapy demonstrated either intermediate or longterm benefits. Optimal dosage of effective techniques and prognostic indicators for responders to care should be explored in future research.
authors.affiliation: School of Rehabilitation Sciences, Clinical Epidemiology and Biostatistics, and Occupational Health and Environmental Medicine, McMaster University, Hamilton, Ontario, Canada. grossa@mcmaster.ca
authors.forename: Anita R
authors.initials: AR
authors.lastname: Gross
authors.forename: Charlie
authors.initials: C
authors.lastname: Goldsmith
authors.forename: Jan L
authors.initials: JL
authors.lastname: Hoving
authors.forename: Ted
authors.initials: T
authors.lastname: Haines
authors.forename: Paul
authors.initials: P
authors.lastname: Peloso
authors.forename: Peter
authors.initials: P
authors.lastname: Aker
authors.forename: Pasqualina
authors.initials: P
authors.lastname: Santaguida
authors.forename: Cynthia
authors.initials: C
authors.lastname: Myers
mesh_terms: D000208:Acute Disease; D002908:Chronic Disease; D016206:Databases, Bibliographic; D006801:Humans; D015201:Meta-Analysis as Topic; D019547:Neck Pain / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D016896:Treatment Outcome; D014911:Whiplash Injuries / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation