Comparative efficacy of exercise versus passive physical therapy in improving nonspecific neck pain: a multilevel...

Nonspecific neck pain causes chronic pain, functional impairment, and adversely affects quality of life. It remains unclear whether exercise or other nonphysical therapies are more effective in improving nonspecific neck pain (NSNP), and the optimal dosage of exercise for alleviating NSNP has yet to be determined.

The comparative efficacy of exercise and passive physical therapies in alleviating NSNP was evaluated, and the optimal exercise dosage was determined.

Multilevel network meta-analysis study (ML-NMA) included adult patients (≥18 years old) with NSNP.

Four electronic databases were searched from the inception of each database to November 2024. Two independent reviewers extracted the data and evaluated the risk of bias. A ML-NMA integrated with a dose-response meta-analysis was performed for comprehensive comparisons.

Resistance combined with coordination training demonstrated the highest efficacy (Hedges' g=-0.76, 95% credibility interval (CrI): -0.99 to -0.52; surface under the cumulative ranking curve (SUCRA=0.87; k=2), followed by aerobic combine with resistance training (g=-0.92, 95% CrI: -1.16 to -0.68; SUCRA=0.71; k=3). Passive therapies, including laser therapy (g=-0.58, 95% CrI: -0.79 to -0.37; SUCRA=0.61; k=11) and manual therapy (g=-0.64, 95% CrI: -0.79 to -0.49; SUCRA=0.55; k=43), showed moderate yet significant benefits. The analysis revealed a nonlinear inverse dose-response relationship between exercise intervention and NSNP reduction, with a significant negative correlation. The optimal weekly dosage for NSNP relief was 420 metabolic equivalent of tasks min/week (METs-min/week), whereas 210 METs-min/week achieved minimal clinically important differences.

This research suggests that resistance combined with coordination training and aerobic combined with resistance training, may be effective exercise-based interventions for NSNP. For patients with exercise intolerance, passive physical therapies, particularly laser and manual therapies, could serve as alternatives. To potentially optimize treatment effects, the findings indicate that clinicians might consider an exercise dose around 420 METs-min/week as a potential reference.