Effectiveness of Manual Joint Mobilization Techniques in the Treatment of Non-specific Neck Pain. Systematic Review With Meta-Analysis of Randomized Controlled Trials

Benetton, Alessia; Battista, Simone; Bertoni, Gianluca; Rossettini, Giacomo; Maistrello, Luca Falsiroli

Abstract

OBJECTIVE: To investigate the effects of cervical joint mobilization techniques (JMTs) on pain and disability in adults with non-specific neck pain (NSNP). DESIGN: Intervention systematic review with meta-analysis and meta-regression of randomized controlled trials (RCTs). LITERATURE SEARCH: We searched MEDLINE, Cochrane CENTRAL, EMBASE, CINAHL, PEDro and Web of Science databases, including references from other reviews or clinical practice guidelines up to October 16, 2024. STUDY SELECTION CRITERIA: Eligible RCTs evaluated JMTs compared to routine physiotherapy, minimally active interventions or no treatment. The primary outcome was pain; secondary outcomes were disability, Global Perceived Effect (GPE), quality of life, psychosocial status and adverse events. DATA SYNTHESIS: Meta-analyses and meta-regression were conducted for pain, disability and GPE. The risk of bias was assessed with Cochrane RoB 2.0 Tool; the certainty of the evidence was assessed with the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. We used The Template for the Intervention Description and Replication (TIDieR) checklist to evaluate the quality of reporting of interventions delivered. RESULTS: Results from 16 RCTs were pooled (n = 1157 participants), reporting non-clinically positive results on pain reduction (Mean Difference (MD): -0.86 (95% CI: [-1.35; -0.36]), disability (MD: -2.45 [-4.32; -0.59]) and GPE (Standardized Mean Difference: 0.11 ([-0.15; 0.37]) and high heterogeneity. The meta-regressions did not identify any covariates associated with the treatment effects. Minor side effects (increased neck pain and headache) were reported. CONCLUSION: There was very low certainty evidence supporting the efficacy of JTMs for reducing pain and improving disability in people with NSNP.

• Journal Article Type: Article
• Acceptance Date: Feb 6, 2025
• Online Publication Date: Feb 12, 2025
• Deposit Date: Mar 7, 2025
• Publicly Available Date: Mar 11, 2025
• Journal: Journal of Orthopaedic & Sports Physical Therapy
• Print ISSN: 0190-6011
• Electronic ISSN: 1938-1344
• Peer Reviewed: Peer Reviewed
• Pages: 1-45
• DOI: https://doi.org/10.2519/jospt.2025.12836