Southerst Danielle, Nordin Margareta C, Côté Pierre, Shearer Heather M, Varatharajan Sharanya, Yu Hainan, Wong Jessica J, Sutton Deborah A, Randhawa Kristi A, van der Velde Gabrielle M, Mior Silvano A, Carroll Linda J, Jacobs Craig L, Taylor-Vaisey Anne L
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario, Canada, M2H 3J1.
Department of Orthopedic Surgery, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York University, 63 Downing Street, New York, New York, USA, 10014.
Spine J. 2016 Dec;16(12):1503-1523. doi: 10.1016/j.spinee.2014.02.014. Epub 2014 Feb 15.
In 2008, the Neck Pain Task Force (NPTF) recommended exercise for the management of neck pain and whiplash-associated disorders (WAD). However, no evidence was available on the effectiveness of exercise for Grade III neck pain or WAD. Moreover, limited evidence was available to contrast the effectiveness of various types of exercises.
To update the findings of the NPTF on the effectiveness of exercise for the management of neck pain and WAD grades I to III.
STUDY DESIGN/SETTING: Systematic review and best evidence synthesis.
Studies comparing the effectiveness of exercise to other conservative interventions or no intervention.
Outcomes of interest included self-rated recovery, functional recovery, pain intensity, health-related quality of life, psychological outcomes, and/or adverse events.
We searched eight electronic databases from 2000 to 2013. Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. The results of scientifically admissible studies were synthesized following best-evidence synthesis principles.
We retrieved 4,761 articles, and 21 randomized controlled trials (RCTs) were critically appraised. Ten RCTs were scientifically admissible: nine investigated neck pain and one addressed WAD. For the management of recent neck pain Grade I/II, unsupervised range-of-motion exercises, nonsteroidal anti-inflammatory drugs and acetaminophen, or manual therapy lead to similar outcomes. For recent neck pain Grade III, supervised graded strengthening is more effective than advice but leads to similar short-term outcomes as a cervical collar. For persistent neck pain and WAD Grade I/II, supervised qigong and combined strengthening, range-of-motion, and flexibility exercises are more effective than wait list. Additionally, supervised Iyengar yoga is more effective than home exercise. Finally, supervised high-dose strengthening is not superior to home exercises or advice.
We found evidence that supervised qigong, Iyengar yoga, and combined programs including strengthening, range of motion, and flexibility are effective for the management of persistent neck pain. We did not find evidence that one supervised exercise program is superior to another. Overall, most studies reported small effect sizes suggesting that a small clinical effect can be expected with the use of exercise alone.
2008年，颈部疼痛特别工作组（NPTF）建议通过运动来管理颈部疼痛和挥鞭样损伤相关疾病（WAD）。然而，尚无关于运动对III级颈部疼痛或WAD有效性的证据。此外，对比各类运动有效性的证据有限。
更新NPTF关于运动对颈部疼痛和I至III级WAD管理有效性的研究结果。
研究设计/设置：系统评价和最佳证据综合分析。
比较运动与其他保守干预措施或不干预措施有效性的研究。
感兴趣的结果包括自我评定的恢复情况、功能恢复、疼痛强度、健康相关生活质量、心理结果和/或不良事件。
我们检索了2000年至2013年期间的八个电子数据库。使用苏格兰校际指南网络标准对符合条件的研究进行严格评估。按照最佳证据综合分析原则对科学上可接受的研究结果进行综合分析。
我们检索到4761篇文章，并对21项随机对照试验（RCT）进行了严格评估。其中10项RCT在科学上是可接受的：9项研究颈部疼痛，1项研究WAD。对于近期I/II级颈部疼痛的管理，无监督的活动范围练习、非甾体抗炎药和对乙酰氨基酚，或手法治疗产生相似的结果。对于近期III级颈部疼痛，有监督的分级强化训练比建议更有效，但与颈托相比短期结果相似。对于持续性颈部疼痛和I/II级WAD，有监督的气功以及强化训练、活动范围练习和灵活性练习相结合比等待观察更有效。此外，有监督的艾扬格瑜伽比家庭锻炼更有效。最后，有监督的高剂量强化训练并不优于家庭锻炼或建议。
我们发现有证据表明，有监督的气功、艾扬格瑜伽以及包括强化训练、活动范围和灵活性练习的综合方案对持续性颈部疼痛的管理有效。我们没有发现证据表明一种有监督的运动方案优于另一种。总体而言，大多数研究报告的效应量较小，表明单独使用运动预计临床效果较小。
