title: An ICON Overview on Physical Modalities for Neck Pain and Associated Disorders.
abstract: BACKGROUND
  Neck pain is common, can be disabling and is costly to society. Physical modalities are often included in neck rehabilitation programs. Interventions may include thermal, electrotherapy, ultrasound, mechanical traction, laser and acupuncture. Definitive knowledge regarding optimal modalities and dosage for neck pain management is limited.
  
  
  OBJECTIVE
  To systematically review existing literature to establish the evidence-base for recommendations on physical modalities for acute to chronic neck pain.
  
  
  METHODS
  A comprehensive computerized and manual search strategy from January 2000 to July 2012, systematic review methodological quality assessment using AMSTAR, qualitative assessment using a GRADE approach and recommendation presentation was included. Systematic or meta-analyses of studies evaluating physical modalities were eligible. Independent assessment by at least two review team members was conducted. Data extraction was performed by one reviewer and checked by a second. Disagreements were resolved by consensus.
  
  
  RESULTS
  Of 103 reviews eligible, 20 were included and 83 were excluded. Short term pain relief - Moderate evidence of benefit: acupuncture, intermittent traction and laser were shown to be better than placebo for chronic neck pain. Moderate evidence of no benefit: pulsed ultrasound, infrared light or continuous traction was no better than placebo for acute whiplash associated disorder, chronic myofascial neck pain or subacute to chronic neck pain. There was no added benefit when hot packs were combined with mobilization, manipulation or electrical muscle stimulation for chronic neck pain, function or patient satisfaction at six month follow-up.
  
  
  CONCLUSIONS
  The current state of the evidence favours acupuncture, laser and intermittent traction for chronic neck pain. Some electrotherapies show little benefit for chronic neck pain. Consistent dosage, improved design and long term follow-up continue to be the recommendations for future research.
authors.affiliation: School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Nadine
authors.initials: N
authors.lastname: Graham
authors.forename: Anita R
authors.initials: AR
authors.lastname: Gross
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Carlesso
authors.forename: P Lina
authors.initials: PL
authors.lastname: Santaguida
authors.forename: Joy C
authors.initials: JC
authors.lastname: Macdermid
authors.forename: Dave
authors.initials: D
authors.lastname: Walton
authors.forename: Enoch
authors.initials: E
authors.lastname: Ho
keywords: Neck pain; knowledge synthesis.; modalities; review of reviews