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An ICON overview on physical modalities for neck pain and associated disorders

Graham, H; Gross, A; Carlesso, L; Santaguida, L; MacDermid, J; Walton, D; Ho, E; Reid, Duncan Arthur
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http://hdl.handle.net/10292/6044
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Abstract
Introduction: 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.

Purpose: 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.
Keywords
Neck pain; Review of reviews; Modalities; Knowledge synthesis
Date
2013
Source
Open Orthopaedics, vol.7(Suppl 4: M2), pp.440 - 460 (20)
Item Type
Journal Article
Publisher
Bentham Open
DOI
10.2174/1874325001307010440
Rights Statement
For authors of Bentham Open there is no restriction to authors for self-archiving of pre-refereeing preprints nor refereed postprints. The same applies for all authors who opt to publish their articles as open access for Bentham Science Publishers journals, in which case the publisher's version/PDF of the published article can be used for self-archiving.

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