1 Gross, et al: Management of neck disorders Conservative Management of Mechanical Neck Disorders: A Systematic Review ANITA R. GROSS, CHARLIE GOLDSMITH, JAN L. HOVING, TED HAINES, PAUL PELOSO, PETER AKER, PASQUALINA SANTAGUIDA, CYNTHIA MYERS, and the Cervical Overview Group ABSTRACT. Objective. To determine if conservative treatments (manual therapies, physical medicine methods, med- ication, and patient education) relieved pain or improved function/disability, patient satisfaction, and global perceived effect in adults with acute, subacute, and chronic mechanical neck disorders (MND) by updating 11 systematic reviews of randomized controlled trials (RCT). Methods. Two independent authors selected studies, abstracted data, and assessed methodological qual- ity from computerized databases. We calculated relative risks and standardized mean differences (SMD) when possible. In the absence of heterogeneity, we calculated pooled effect sizes. Results. We studied 88 unique RCT. The mean methodological quality scores were acceptable in 59% of the trials. We noted strong evidence of benefit for maintained pain reduction [pooled SMD –0.85 (95% CI –1.20, –0.50)], improvement in function, and positive global perceived effect favoring exer- cise plus mobilization/manipulation versus control for subacute/chronic MND. We found moderate evi- dence of longterm benefit for improved function favoring direct neck strengthening and stretching for chronic MND, and for high global perceived effect favoring vertigo exercises. We noted moderate evi- dence of no benefit for botulinium-A injection [pooled SMD –0.39 (95% CI –01.25, 0.47)]. We found many treatments demonstrating short-term effects. Conclusion. Exercise combined with mobilization/manipulation, exercise alone, and intramuscular lidocaine for chronic MND; intravenous glucocorticoid for acute whiplash associated disorders; and low-level laser therapy demonstrated either intermediate or longterm benefits. Optimal dosage of effec- tive techniques and prognostic indicators for responders to care should be explored in future research. (J Rheumatol First Release Jan 15 2007) Key Indexing Terms: NECK WHIPLASH DEGENERATIVE RADICULAR TREATMENTS SYSTEMATIC REVIEW From the School of Rehabilitation Sciences, Clinical Epidemiology and Biostatistics, and Occupational Health and Environmental Medicine, McMaster University, Hamilton, Ontario, Canada; Coronel Institute of Occupational Health, Academic Medical Center, Universiteit van Amsterdam, Amsterdam, The Netherlands; and the Integrative Medicine Program, H. Lee Moffitt Cancer Center, Tampa, Florida, USA. Supported by a Problem-based Research Grant from Sunnybrook and Women’s Health Sciences Centre, Toronto, Canada. A.R. Gross, MSc, Associate Clinical Professor; C. Goldsmith, PhD, Professor; T. Haines, MSc, Associate Professor; P. Santaguida, PhD, Associate Professor, School of Rehabilitation Sciences, Clinical Epidemiology and Biostatistics, and Occupational Health and Environmental Medicine, McMaster University; J.L. Hoving, PhD, Senior Research Fellow, Coronel Institute of Occupational Health, Academic Medical Center, Universiteit van Amsterdam, and Department of Epidemiology and Preventive Medicine, Monash University, Australia; P. Peloso, MD, Director, Product Benefit Risk Assessment and Management, Amgen Inc.; P. Aker, MSc, Private Practice, Belleville, ON, Canada; C. Myers, PhD, Director, Integrative Medicine Program, H. Lee Moffitt Cancer Center. The Cervical Overview Group: T. Kay, P. Kroeling, N. Graham, B. Haraldsson, A.M. Eady, K. Trinh, J. Ezzo, G. Bronfort, A. Morien, E. Wang, I. Cameron. Address reprint requests to A.R. Gross, School of Rehabilitation Sciences, McMaster University, 1400 Main Street West, Hamilton, Ontario L8N 3Z5, Canada. E-mail: grossa@mcmaster.ca Accepted for publication October 13, 2006. Neck pain is still a major contributor to disability worldwide 1-4 , with about 70% of the population experiencing an episode of neck pain at some point in their lives 1,5 and 15% experiencing chronic neck pain 6 . Chronic pain accounts for $150 to $215 billion US each year in economic loss (i.e., lost workdays, therapy, disability) 7,8 , yet very little is known about the effec- tiveness of many of the available treatments. In this report, we update our previous systematic reviews from the Cervical Overview Group on conservative management for mechanical neck disorders 9-19 . MATERIALS AND METHODS The medical and alternative-medicine literature was searched from 1997 to September 2004 with no language restrictions using a sensitive search strate- gy 20 . It included computerized bibliographic databases: Cochrane Register of Controlled Trials (Central), Medline, Embase, Manual Alternative and Natural Therapy, Cumulative Index to Nursing and Allied Health Literature, Index to Chiropractic Literature, an acupuncture database in China (root to September 2005). Medical Subject Headings key words included terms relat- ed to anatomic, disorder/syndrome, treatment, and methodology. Figure 1 depicts the review retrieval flow from selection to metaanalyses. Two inde- pendent reviewers conducted study selection using pilot-tested forms (qw kappa 0.82, SD 0.05) 21 .