Network meta-analysis finds muscle energy technique superior for pain in chronic neck pain.
Photo by Kobe Kian Clata / Unsplash
Key Takeaway
Consider MET for pain relief in chronic neck pain, but note limited evidence quality.
This network meta-analysis included 1,224 patients with chronic nonspecific neck pain, comparing various exercise therapies to conventional exercise therapy. The primary outcomes were neck function measured by the Neck Disability Index (NDI) and pain measured by the Visual Analogue Scale (VAS). For neck function, there was no significant difference among the intervention measures. For pain, muscle energy technique (MET) was significantly superior to conventional exercise therapy, with a p-value < 0.05 implied by the description, though exact effect sizes and absolute numbers were not reported. In SUCRA rankings, biological feedback-assisted training (BBAT) had the highest value of 0.78, indicating it may be the most effective overall, but this result was based on a small sample of single studies, limiting robustness. Safety and tolerability data were not reported, and adverse events, serious adverse events, and discontinuations were not detailed. Key limitations include that 12 studies (70.6%) were of moderate risk and 5 studies (29.4%) were of high risk, and the BBAT finding had limited robustness due to small sample sizes. The analysis provides evidence support for clinical intervention selection, but clinicians should interpret results cautiously given these limitations and the lack of safety information.
View Original Abstract ↓
BackgroundChronic nonspecific neck pain (CNSNP) is a common musculoskeletal disorder that significantly impacts patients’ quality of life and imposes a considerable social and economic burden. Although drug treatment is widely used, it has limitations such as adverse reactions and limited long-term efficacy. Therefore, exercise therapy has gradually become the first-line intervention method. However, there is still a lack of systematic evidence for the efficacy comparison among different exercise therapies.ObjectiveThis study conducted a network meta-analysis to compare the clinical efficacy of different exercise therapies in treating CNSNP, providing evidence support for clinical intervention selection.MethodsSystematic searches were conducted in PubMed, Web of Science, Embase, Cochrane Library, VIP, SinoMed, CNKI, and Wanfang databases up to November 25, 2025, for randomized controlled trials comparing the efficacy of different exercise therapies in patients with CNSNP. Inclusion criteria were studies comparing the efficacy of different exercise therapies in patients with CNSNP. The primary outcome measures were the Neck Disability Index (NDI) and Visual Analogue Scale (VAS). The quality of studies was evaluated using the Cochrane Risk of Bias Assessment Tool 2.0. Network meta-analysis was performed using Stata 16.0 and R 4.5.2, and the intervention measures were ranked using the cumulative ranking area under the curve (SUCRA). The evidence quality was evaluated using the CINeMA tool.ResultsA total of 17 studies were included, involving 1,224 patients and 16 intervention measures. The risk of bias assessment showed that 12 studies (70.6%) were of moderate risk, and 5 studies (29.4%) were of high risk. There was no significant difference in improving neck function (NDI) among the intervention measures. The SUCRA value of BBAT (biological feedback-assisted training) was the highest (0.78), but this result was supported by only a small sample of single studies, and the robustness was limited. In terms of reducing pain (VAS), muscle energy technique (MET) was significantly superior to conventional exercise therapy (p
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