Exercise modalities associated with reduced functional disability in nonspecific neck pain: a network meta-analysis...

Nonspecific neck pain (NSNP) is a common musculoskeletal condition that often leads to substantial functional disability and reduced quality of life. Exercise therapy is central to its management. However, the comparative effectiveness of specific modalities and dose-related patterns remains unclear.

We conducted a systematic review and network meta-analysis (NMA) including 51 randomized controlled trials with 4,140 participants. Functional disability, measured using validated instruments, was the primary outcome. A Bayesian random-effects NMA was performed to compare exercise modalities, and a dose-response analysis examined the association between exercise parameters and outcomes. Effects were summarized as standardized mean differences (SMDs) with 95% credible intervals (CrIs).

Mind-body exercise was associated with a greater reduction in NSNP-related functional disability than control (SMD -0.363; 95% CrI [-0.516 to -0.151]). Resistance training (SMD -0.359; 95% CrI [-0.611 to -0.102]), flexibility training (SMD -0.352; 95% CrI [-0.623 to -0.078]), and coordination training (SMD -0.328; 95% CrI [-0.579 to -0.076]) were also associated with reductions in NSNP-related functional disability relative to control. Exploratory dose-response analysis suggested a possible non-linear association between per-session exercise dose, expressed pragmatically as MET-min, and NSNP-related functional disability. Estimated reductions were observed from around 100 MET-min per session, with larger study-level effects around 300-400 MET-min per session.

Mind-body exercise, resistance training, flexibility training, and coordination training appear to be relatively favorable modalities for reducing NSNP-related functional disability. The dose-response findings should be interpreted cautiously, given the heterogeneity of the interventions and the limitations of the available study-level data.