Neck-specific strengthening exercises and cognitive therapy for chronic neck pain: a systematic review

Abstract

Background: Neck pain has been estimated to affect one in two people. Cognitive therapy and neck-specific strengthening exercises are two interventions that target different factors related to chronic neck pain in order to decrease pain and disability.

Objectives: To critically appraise the effect of a combination of neck-specific strengthening exercises and cognitive therapy compared to the individual therapies on pain and disability in patients with non-specific chronic neck pain.

Methods: A systematic search of the five following online databases was undertaken from inception up to April 2017: Ovid MEDLINE, PsycINFO, EMBASE + EMBASE Classic, CINAHL, and PEDro. Key inclusion criteria were as follows: randomized control trials published in English, participants with chronic neck pain (greater than three months), an intervention of cognitive therapy and neck-specific strengthening exercise, and an outcome measure of pain and/or disability.

Results: Seven randomized control trials met inclusion criteria, and five were included in meta-analysis. The studies were of a low-to-moderate methodological quality. Evidence was found for the effectiveness of neck-specific strengthening exercises (SMD 0.30, 95%CI 0.09 to 0.52, p = .005) and a combination of cognitive therapy and neck-specific strengthening exercise (SMD 0.50, 95%CI 0.29 to 0.71, p < .0001) in reducing pain and disability compared to a control of prescribed physical activity. The combination of cognitive therapy and neck-specific strengthening exercises was not found to be more effective at reducing pain and disability than neck-specific strengthening exercises alone (SMD 0.22, 95%CI −0.01 to 0.45, p = .06) or cognitive therapy alone (SMD 0.26, 95%CI −0.33 to 0.86, p = .39).

Conclusions: The effects of both neck-specific exercises and cognitive therapy observed in this review are statistically significant; however, it is questionable whether they are clinically significant based on the measures used.

Keywords:

• Chronic pain
• neck pain
• cognitive therapy
• strengthening exercises
• systematic review

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

This review was conducted in the Physiotherapy Department of Monash University and was conducted with no external funding support.

Table 1. Included study details.

Additional information

Notes on contributors

Laura G. Cox

Laura G. Cox is a Bachelor of Physiotherapy – Advanced Research (Honors) student at Monash University.

Dawson J. Kidgell

Dr Dawson J. Kidgell’s research interests are in the area of neurophysiology of exercise and he specializes in the technique of Transcranial Magnetic Stimulation (TMS) which is a non-invasive method of measuring the functional properties (neuroplasticity) of the human brain, in particular the primary motor cortex.

Ross A. Iles

Ross A. Iles is a Senior Research Fellow in the Insurance Work and Health Group at Monash University. He has a Physiotherapy degree and PhD from La Trobe University, and a postgraduate diploma in Work Disability Prevention studies from the University of Sherbrooke, Canada.