Kay Theresa M, Gross Anita, Goldsmith Charles H, Rutherford Sherrill, Voth Sandra, Hoving Jan L, Brønfort Gert, Santaguida Pasqualina L
Women's College Hospital, Toronto, Canada.
Cochrane Database Syst Rev. 2012 Aug 15(8):CD004250. doi: 10.1002/14651858.CD004250.pub4.
Neck disorders are common, disabling and costly. The effectiveness of exercise as a physiotherapy intervention remains unclear.
To improve pain, disability, function, patient satisfaction, quality of life and global perceived effect in adults with neck pain.
Computerized searches were conducted up to February 2012.
We included single therapeutic exercise randomized controlled trials for adults with neck pain with or without cervicogenic headache or radiculopathy.
Two review authors independently conducted selection, data extraction, 'Risk of bias' assessment, and clinical relevance. The quality of the body of evidence was assessed using GRADE. Relative risk and standardized mean differences (SMD) were calculated. After judging clinical and statistical heterogeneity, we performed meta-analyses.
Six of the 21 selected trials had low risk of bias. Moderate quality evidence shows that combined cervical, scapulothoracic stretching and strengthening are beneficial for pain relief post treatment (pooled SMD -0.35, 95% confidence interval (CI): -0.60, -0.10) and at intermediate follow-up (pooled SMD -0.31, 95% CI: -0.57, -0.06), and improved function short term and intermediate term (pooled SMD -0.45, 95% CI: -0.72, -0.18) for chronic neck pain. Moderate quality evidence demonstrates patients are very satisfied with their care when treated with therapeutic exercise. Low quality evidence shows exercise is of benefit for pain in the short term and for function up to long-term follow-up for chronic neck pain. Low to moderate quality evidence shows that chronic neck pain does not respond to upper extremity stretching and strengthening or a general exercise program.Low to moderate quality evidence supports self-mobilization, craniocervical endurance and low load cervical-scapular endurance exercises in reducing pain, improving function and global perceived effect in the long term for subacute/chronic cervicogenic headache. Low quality evidence supports neck strengthening exercise in acute cervical radiculopathy for pain relief in the short term.
AUTHORS' CONCLUSIONS: Low to moderate quality evidence supports the use of specific cervical and scapular stretching and strengthening exercise for chronic neck pain immediately post treatment and intermediate term, and cervicogenic headaches in the long term. Low to moderate evidence suggests no benefit for some upper extremity stretching and strengthening exercises or a general exercise program. Future trials should consider using an exercise classification system to establish similarity between protocols and adequate sample sizes. Factorial trials would help determine the active treatment agent within a treatment regimen where a standardized representation of dosage is essential. Standardized reporting of adverse events is needed for balancing the likelihood of treatment benefits over potential harms.
颈部疾病常见、致残且代价高昂。运动作为一种物理治疗干预措施的有效性仍不明确。
改善颈部疼痛成人的疼痛、功能障碍、功能、患者满意度、生活质量和整体感知效果。
截至2012年2月进行了计算机检索。
我们纳入了针对有或无颈源性头痛或神经根病的颈部疼痛成人的单项治疗性运动随机对照试验。
两位综述作者独立进行选择、数据提取、“偏倚风险”评估和临床相关性评估。使用GRADE评估证据体的质量。计算相对风险和标准化均数差（SMD）。在判断临床和统计异质性后，我们进行了荟萃分析。
21项入选试验中有6项偏倚风险较低。中等质量证据表明，颈部和肩胛胸廓联合拉伸与强化对治疗后疼痛缓解有益（合并SMD -0.35，95%置信区间（CI）：-0.60，-0.10）以及中期随访时有益（合并SMD -0.31，95%CI：-0.57，-0.06），并且对慢性颈部疼痛的短期和中期功能有改善（合并SMD -0.45，95%CI：-0.72，-0.18）。中等质量证据表明，患者接受治疗性运动时对其护理非常满意。低质量证据表明，运动对慢性颈部疼痛的短期疼痛和长期随访的功能有益。低至中等质量证据表明，慢性颈部疼痛对上肢拉伸与强化或一般运动计划无反应。低至中等质量证据支持自我松动、颅颈耐力和低负荷颈肩胛耐力运动在亚急性/慢性颈源性头痛长期缓解疼痛、改善功能和整体感知效果方面的作用。低质量证据支持颈部强化运动对急性颈椎神经根病短期疼痛缓解的作用。
低至中等质量证据支持在治疗后即刻和中期对慢性颈部疼痛以及长期对颈源性头痛使用特定的颈部和肩胛拉伸与强化运动。低至中等质量证据表明某些上肢拉伸与强化运动或一般运动计划无益处。未来试验应考虑使用运动分类系统来确定方案之间的相似性和足够的样本量。析因试验将有助于确定治疗方案中的有效治疗因素，其中剂量的标准化表示至关重要。需要对不良事件进行标准化报告，以平衡治疗益处与潜在危害的可能性。
