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. 2015 May 26;2015(5):CD010664. doi: 10.1002/14651858.CD010664.pub2

Summary of findings 2. Cognitive‐behavioural treatment compared to other types of treatment for subacute neck pain at short‐term follow‐up.

Cognitive‐behavioural treatment compared to other types of treatment for subacute neck pain at short‐term follow‐up
Patient or population: subacute neck pain
Settings: primary and secondary health care centres
Intervention: cognitive‐behavioural treatment
Comparison: other types of treatment
Outcomes Illustrative comparative risks (95% CI) No of Participants
(studies) Quality of the evidence
(GRADE) Comments
Assumed risk Corresponding risk
Other types of treatment Cognitive‐behavioural treatment
Pain
Numerical Rating Scale, from 0 (no pain) to 10 (maximum pain) *The short‐term follow‐up for the most representative study (Pool 2010) was 2.15 (SD 2.57). The estimated mean pain in the CBT group was 0.62 lower (1.23 lower to 0.00). 265 (2 study) ⊕⊕⊝⊝
low1,2 The effect was not clinically relevant. A clinically important treatment effect on 0‐10 pain scale is about 2.5 points.
Disability
Neck Disability Index,
from 0 (no disability) to 50 (maximal disability)
*The short‐term follow‐up for the most representative study (Pool 2010) was 6.28 (SD 5.79). The estimated mean disability in the CBT group was 0.69 lower (2.08 lower to 0.69 higher). 265 (2 study) ⊕⊕⊝⊝
low1,2 No effect was found.
Kinesiophobia
various scales
*The short‐term follow‐up for the most representative study (Pool 2010) was not reported. The other study (Robinson 2013) reported a short‐term follow‐up of 105.7 (139.2). Outcome measure: Fear of Specific Neck Movements (PFActS‐C), from 0 (no fear) to 720 (maximal fear). No difference was found individually by the two studies. A meta‐analysis was not conducted since one study (Pool 2010) did not report individual data. 265 (2 study) ⊕⊕⊝⊝
low1,2 No effect was found.
*Of the included trials for this outcome, we chose the study with low risk of bias (Pool 2010). The reported data represent the intermediate follow‐up mean in the control group of this study.
CI: Confidence interval; CBT: cognitive‐behavioural therapy.
GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Serious imprecision (i.e. total number of participants < 300 for each outcome; an optimal information size of 300 was computed considering a α of 0.05, a β of 0.2, and an effect size of 0.3 standard deviations).

2 Serious limitation in the design and implementation since the estimates of the treatment effects were derived from two studies, one with high (Robinson 2013) and one with low risk of bias (Pool 2010). The study of Robinson 2013 was considered as high risk of bias since it satisfied less than six criteria, as outlined in the Methods section.