Resistance, Motor Control, and Mindfulness-Based Exercises Are Effective for Treating Chronic Nonspecific Neck Pain: A Systematic Review With Meta-Analysis and Dose-Response Meta-Regression

OBJECTIVE: We aimed to analyze the effects and dose-response relationship of the most effective exercises for improving pain and disability in people with chronic nonspecific neck pain. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: We searched the PubMed, PEDro, and CENTRAL databases from their inception to September 30, 2022. STUDY SELECTION CRITERIA: We included randomized controlled trials that involved people with chronic neck pain adopting a longitudinal exercise intervention and assessed one pain and/or disability outcome. DATA SYNTHESIS: Restricted maximum-likelihood random-effects meta-analyses were modeled separately for resistance, mindfulness-based, and motor control exercises; standardized mean differences (Hedge's g, standardized mean difference [SMD]) were effect estimators. Meta-regressions (dependent variable: effect sizes of the interventions; independent variables: training dose and control group effects) were conducted to explore the dose-response relationship for therapy success of any exercise type. RESULTS: We included 68 trials. Compared to true control, effects on pain and disability were significantly larger for resistance exercise (pain: SMD, −1.27; 95% confidence interval [CI]: −2.26, −0.28; | 2 = 96%; disability: SMD, −1.76; 95% CI: −3.16, −0.37; | 2 = 98%), motor control exercise (pain: SMD, −2.29; 95% CI: −3.82, −0.75; | 2 = 98%; disability: SMD, −2.42; 95% CI: −3.38, −1.47; | 2 = 94%), and Yoga/Pilates/Tai Chi/Qui Gong exercise (pain: SMD, 1.91; 95% CI:−3.28, −0.55; | 2 = 96%; disability: SMD, −0.62; 95% CI: −0.85, −0.38; | 2 = 0%). Yoga/Pilates/Tai Chi/Qui Gong exercise was more effective than other exercises (SMD, −0.84; 95% CI: −1.553, −0.13; | 2 = 86%) for reducing pain. For disability, motor control exercise was superior to other exercises (SMD, −0.70; 95% CI: −1.23, −0.17; | 2 = 98%). There was no dose-response relationship for resistance exercise ( R 2 = 0.32). Higher frequencies (estimate = −0.10) and longer durations (estimate = −0.11) of motor control exercise had larger effects on pain ( R 2 = 0.72). Longer sessions (estimate = −0.13) of motor control exercise had larger effects on disability ( R 2 = 0.61). CONCLUSION: Resistance, mindfulness-based, and motor control exercises were effective for reducing neck pain (very low– to moderate-certainty evidence). Higher frequencies and longer duration of sessions had a significant effect on pain for motor control exercise. J Orthop Sports Phys Ther 2023;53(8):420–459. Epub: 20 June 2023. doi:10.2519/jospt.2023.11820