title: 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.
abstract: 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.
  
  
  
  To update the findings of the NPTF on the effectiveness of exercise for the management of neck pain and WAD grades I to III.
  
  
  
  Systematic review and best evidence synthesis.
  
  
  
  Studies comparing the effectiveness of exercise to other conservative interventions or no intervention.
  
  
  
  Outcomes of interest included self-rated recovery, functional recovery, pain intensity, health-related quality of life, psychological outcomes, and/or adverse events.
  
  
  
  We searched eight electronic databases from 2000 to 2013. Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. The results of scientifically admissible studies were synthesized following best-evidence synthesis principles.
  
  
  
  We retrieved 4,761 articles, and 21 randomized controlled trials (RCTs) were critically appraised. Ten RCTs were scientifically admissible: nine investigated neck pain and one addressed WAD. For the management of recent neck pain Grade I/II, unsupervised range-of-motion exercises, nonsteroidal anti-inflammatory drugs 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 Grade 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.
  
  
  
  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.
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, Canada, M2H 3J1. Electronic address: danielle.southerst@uoit.ca.
authors.forename: Danielle
authors.initials: D
authors.lastname: Southerst
authors.affiliation: Department of Orthopedic Surgery, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York University, 63 Downing Street, New York, New York, USA, 10014.
authors.forename: Margareta C
authors.initials: MC
authors.lastname: Nordin
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, Canada, M2H 3J1; Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Science building, Room 3000, Oshawa, Ontario, Canada, L1H 7K4.
authors.forename: Pierre
authors.initials: P
authors.lastname: Côté
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, Canada, M2H 3J1.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Shearer
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, Canada, M2H 3J1.
authors.forename: Sharanya
authors.initials: S
authors.lastname: Varatharajan
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, Canada, M2H 3J1.
authors.forename: Hainan
authors.initials: H
authors.lastname: Yu
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, Canada, M2H 3J1.
authors.forename: Jessica J
authors.initials: JJ
authors.lastname: Wong
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, Canada, M2H 3J1.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Sutton
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, Canada, M2H 3J1.
authors.forename: Kristi A
authors.initials: KA
authors.lastname: Randhawa
authors.affiliation: Toronto Health Economics and Technology Assessment (THETA) Collaborative, Leslie Dan Pharmacy Building, University of Toronto, 6th Floor, Room 658, 144 College Street, Toronto, Ontario, Canada, M5S 3M2; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario, Canada, M5S 3M2; Institute for Work and Health, 481 University Ave, Toronto, Ontario, Canada, M5G 2E9.
authors.forename: Gabrielle M
authors.initials: GM
authors.lastname: van der Velde
authors.affiliation: Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Science building, Room 3000, Oshawa, Ontario, Canada, L1H 7K4; Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, Canada, M2H 3J1.
authors.forename: Silvano A
authors.initials: SA
authors.lastname: Mior
authors.affiliation: Department of Public Health Sciences and Alberta Centre for Injury Prevention and Research, School of Public Health, University of Alberta, 4075 RTF, 8308-114 Street, Edmonton, Alberta, Canada, T6G 2E1.
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Carroll
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, Canada, M2H 3J1; Division of Clinical Education, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, Canada, M2H 3J1.
authors.forename: Craig L
authors.initials: CL
authors.lastname: Jacobs
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, Canada, M2H 3J1.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Taylor-Vaisey
mesh_terms: D005081:Exercise Therapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D019547:Neck Pain / Q000209:etiology / Q000534:rehabilitation* / Q000628:therapy; D011788:Quality of Life; D020127:Recovery of Function; D000078202:Systematic Reviews as Topic; D014911:Whiplash Injuries / Q000150:complications / Q000534:rehabilitation* / Q000628:therapy
keywords: Exercise; Neck pain; Rehabilitation; Systematic review; Treatment; Whiplash-associated disorders