de Oliveira-Souza Ana Izabela Sobral, Barbosa-Silva Jordana, Gross Douglas P, da Costa Bruno R, Ballenberger Nikolaus, Pereira Tiago V, Dennett Liz, Armijo-Olivo Susan
University of Applied Sciences - Hochschule Osnabrück, Osnabrück, Germany.
Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.
Syst Rev. 2025 Jan 31;14(1):30. doi: 10.1186/s13643-024-02737-4.
Neck pain is a prevalent and globally burdensome problem. Clinical practice guidelines have recommended conservative treatments such as education, exercise therapy (ET), manual therapy (MT), and pharmacological therapy (i.e., medication) to manage all types of neck pain based on the chronicity of the disease (acute, subacute, and chronic pain). However, there is scarce evidence to determine which interventions constitute the most effective strategy for this condition. RESEARCH QUESTION: What are the best conservative treatment options (i.e., ET, MT, education, and/or medication) to relieve pain and disability-related outcomes in patients with neck pain? THE OVERALL PURPOSE OF THE STUDY: (1) To identify which type of conservative treatment (education, ET, MT, and/or medication) and their combinations have the greatest probability of being most effective for neck pain using a network meta-analysis (NMA) approach. (2) To rank these conservative treatments in terms of safety (when possible) and effectiveness for managing neck pain. METHODOLOGY: Systematic review (SR) with NMA of randomized controlled trials (RCTs). Studies should include adults (aged > 18) with neck pain who received any of the interventions of interest (education, ET, MT, and medication). The main outcome will be pain intensity. Searches will be conducted in Ovid Medline All®, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Scopus, and Cochrane Library Trials database. No language or publication date restrictions will be applied. The revised Cochrane Risk-of-Bias (RoB) tool for RCTs (RoB-2) will be used to evaluate RoB, and the certainty of evidence will be evaluated by Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). NMAs will be conducted to rank interventions according to their effectiveness and safety (when possible), allowing a comprehensive analysis of all available evidence, with different nodes specified for all conservative interventions of interest, placebo, sham therapy, and non-intervention control. This NMA will help clinicians and the scientific community choose the most effective strategy or combinations of strategies for treating neck pain. The information gathered in this project will inform decision-making and guide personalized care of individual patients in the future.
颈部疼痛是一个普遍存在且给全球带来负担的问题。临床实践指南推荐了保守治疗方法，如教育、运动疗法（ET）、手法治疗（MT）和药物治疗（即用药），以根据疾病的慢性程度（急性、亚急性和慢性疼痛）来管理所有类型的颈部疼痛。然而，几乎没有证据能确定哪些干预措施构成针对这种情况的最有效策略。研究问题：缓解颈部疼痛患者疼痛及与残疾相关结局的最佳保守治疗选择（即ET、MT、教育和/或药物）是什么？研究的总体目的：（1）使用网络荟萃分析（NMA）方法，确定哪种类型的保守治疗（教育、ET、MT和/或药物）及其组合对颈部疼痛最有效的可能性最大。（2）根据安全性（可能的话）和管理颈部疼痛的有效性对这些保守治疗进行排名。方法：对随机对照试验（RCT）进行系统评价（SR）并进行NMA。研究应纳入患有颈部疼痛且接受了任何感兴趣干预措施（教育、ET、MT和药物）的成年人（年龄>18岁）。主要结局将是疼痛强度。检索将在Ovid Medline All®、Embase、CINAHL（护理及相关健康文献累积索引）、Scopus和Cochrane图书馆试验数据库中进行。不设语言或出版日期限制。将使用修订后的Cochrane随机对照试验偏倚风险（RoB）工具（RoB - 2）来评估偏倚风险，并通过推荐分级、评估、制定和评价（GRADE）来评估证据的确定性。将进行NMA，根据干预措施的有效性和安全性（可能的话）对其进行排名，从而对所有可用证据进行全面分析，为所有感兴趣的保守干预措施、安慰剂、假治疗和非干预对照指定不同的节点。这种NMA将帮助临床医生和科学界选择治疗颈部疼痛的最有效策略或策略组合。本项目收集的信息将为未来的决策提供参考，并指导个体患者的个性化护理。
