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

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.