Table 1.
Best evidence summary—systematic reviews and RCTs if conducted after publication of a relevant systematic review.
| Intervention | Target Population | Level of Evidence | Quality of Evidence | Effect Size | Site of Care | Rehabilitation Professions | Key References and/or Treatment Manuals |
|---|---|---|---|---|---|---|---|
| Reassurance, advice, education | |||||||
| Video in ED focussing on activation | WAD (n = 348) |
Level I [9] | Moderate | Small effect compared to no treatment at intermediate follow-up, RR 0.79 (0.59 to 1.06), NNT:23 | ED | All | See systematic review |
| WAD information pamphlet | WAD (n = 102) |
Level I [9] | Low | No effect compared to generic advice | ED | All | See systematic review |
| Booklet or email | NTNP (n = 64) |
Level 1 [10] | Moderate | No effect compared to massage or exercise | Primary | All | See systematic review |
| Booklet/neck school | NTNP (n = 411) |
Level 1 [11] | Very low to low | No effect | Primary and secondary | All | |
| Exercise | |||||||
| Strengthening (upper quarter) | WAD and NTNP (n = 241) |
Level I [12] | Moderate | Moderate to large at short-term follow-up, SMD (pain) −0.71 (−1.33 to −0.10) | Primary and secondary | Exercise professionals | See systematic review |
| Office workers with neck pain (n = 605) |
Level I [13] | Moderate | Moderate effect vs. no intervention, SMD pain = 0.59 (0.29 to 0.89) | Workplace | |||
| Endurance training (upper quarter) | WAD and NTNP (n = 198) |
Level I [12] | Moderate | Small at short-term follow-up | Primary and secondary | Physiotherapists | See systematic review |
| Muscle control (stabilisation) | WAD and NTNP (n = 71) |
Level I [12] | Moderate | Small at intermediate-term follow-up Small to moderate effect on pain in the short to intermediate term (SMD pain −0.59 (95% CI: −0.97 to −0.20)) |
Primary and secondary | Physiotherapists | See systematic review |
| NTNP (n = 174) |
Level 1 [14] | Low to moderate | Small effect on disability (SMD disability −0.44 (95% CI: −0.81 to −0.08)) vs. other treatments | Primary and secondary | Physiotherapists | ||
| Stretching (neck & shoulder) | Workers (n = 96) |
Level II [15] | Pedro (8/10) | Small effect on pain & disability compared to ergonomic advice (−1.4; 95% CI −2.2 to −0.7 for pain; −4.8; 95% CI −9.3 to −0.4 for disability) | Work place | Exercise professionals | Exercise protocol available at [15] |
| Eye-neck co-ordination/proprioception | WAD & NTNP (n = 103) |
Level I [16] | Very low | Small effect on pain MD: −1.6 (−3.6 to 0.3) compared to no exercise Meta-analysis for other outcomes could not be conducted |
Primary and Secondary | Physiotherapists | See systematic review |
| Qigong | WAD and NTNP (n = 191) |
Level I [12] | Moderate | Small at intermediate-term follow-up | Primary and secondary | Exercise professionals | See systematic review |
| Yoga | NTNP (n = 686) |
Level I * (high heterogeneity) [17] | Moderate | Moderate effect on pain and disability vs. various other treatments including exercise, SMD pain = −1.13 (−1.60 to −0.66), SMD disability −0.92 (−1.38 to 0.47) | Primary and secondary | Exercise professionals | See systematic review |
| General exercise | WAD, NTNP, workers (n = 386) |
Level I [13,18] | No effect | Primary and secondary | Exercise professionals | See systematic review | |
| Psychological treatments alone (CBT) | WAD and NTNP (n = 168) |
Level I [19] | Very low to moderate | Small effect on pain and disability when compared to no treatment, SMD pain = −0.58 (−1.01 to −0.16), SMD disability = −0.61 (−1.21 to −0.01) | Primary and secondary | Psychology professionals | See systematic review |
| Combined psychological and physical treatments delivered by physiotherapists | WAD (n = 211) |
Level I * (high heterogeneity) [20] | Moderate quality | No effect on pain and disability | Primary | Physiotherapists | See systematic review |
| Medium effect on fear of avoidance | |||||||
| Acute WAD (n = 108) |
Level II (RCT) [21] | NA Pedro (8/10) |
Medium to large effect on pain related disability compared to exercise only | Physiotherapists | Treatment protocols available at [21] | ||
| Exercise and manual therapy | WAD and NTNP (n = 345) |
Level I [22] | No effect compared to exercise alone | Primary and secondary |
Levels of Evidence were defined as per the Oxford Centre for Evidence Based Medicine [23]. Quality of Evidence as per reported in Systematic reviews or per Pedro scale for RCTs. * Indicates systematic reviews with high heterogeneity indicating caution is required with interpretation of results. WAD: whiplash associated disorders; NTNP: non-traumatic neck pain; ED: emergency department; SMD: standardised mean difference; MD: mean difference; NNT: number needed to treat.