Effectiveness of Physiotherapy interventions plus Extrinsic Feedback for neck disorders: A systematic review with meta-analysis

Abstract Purpose To systematically review the effectiveness of Physiotherapy interventions combined with extrinsic feedback (EF) compared to Physiotherapy interventions alone or control for the management of neck pain and disability. Methods Randomized clinical trials were searched and retrieved from six databases, from inception through August 2016. Risk of bias of included studies was assessed using the PEDro scale. When possible data were pooled and Meta-analyses were conducted. The quality and strength of evidence for each outcome was assessed using the GRADE approach. Results Eight studies (n = 677) were included in the review. The pooled estimates suggested Physiotherapy intervention + EF was not superior to Physiotherapy intervention alone for disability (MD = −0.38; 95%CI = −0.91 to 0.18; I 2  = 82%), but was superior for pain (MD = −0.37; 95%CI = −0.73 to −0.01; I 2  = 68%). Physiotherapy intervention + EF was not superior than control for disability scores (SMD = −3.94; 95%CI = −12.06 to 4.18; I 2  = 92%). Physiotherapy intervention + EF intervention was more effective than control for pain scores at short-term (SMD = −1.44; 95%CI = −2.25 to-0.63; I 2  = 50%). Most studies did not specify nor use the ideal characteristics of EF. Conclusion There is very low quality of evidence that Physiotherapy intervention + EF is more effective than Physiotherapy intervention alone or control for short-term pain, but not for disability. Physiotherapy intervention plus EF was more effective than Physiotherapy alone for acute neck pain, but not for chronic pain or disability. There was high risk of bias within included studies. Future studies are likely to change the estimates of the effects of Physiotherapy intervention plus EF on neck rehabilitation.