A Description of the Methodology Used in an Overview of Reviews to Evaluate Evidence on the Treatment, Harms, Diagnosis/Classification, Prognosis and Outcomes Used in the Management of Neck Pain

P. Lina Santaguida*, 1, Homa Keshavarz 2, Lisa C Carlesso3, Margaret Lomotan3, Anita Gross2, Joy C MacDermid4, David M Walton5, ICON Working Group
1 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
2 Department of Onclology, McMaster University, Hamilton, Ontario, Canada
3 School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
4 School of Rehabilitation Sciences, McMaster University, Hamilton Ontario Canada and Co-Director, Clinical Research Lab, Hand and Upper Limb Centre, St. Joseph's Health Centre, London, Ontario, Canada
5 School of Physical Therapy, Western University, London, Ontario, Canada

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Creative Commons License
© Santaguida et al.; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License ( which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

* Address correspondence to this author at the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Tel: 905-525-9140; Fax: 905-522-7681; E-mail:
§ ICON is a multi-disciplinary collaborative group that includes scientist-authors (listed below) and support staff (Margaret Lomotan) that conduct knowledge synthesis and translation aimed at reducing the burden of neck pain.



Neck Pain (NP) is a common musculoskeletal disorder and the literature provides conflicting evidence about its management.


To describe the methodology used to conduct an overview of reviews (OvR) and to characterize the distribution and risk of bias profiles across the evidence for all areas of NP management.


Standard systematic review (SR) methodology was employed. MEDLINE, CINAHL, EMBASE, ILC, Cochrane CENTRAL, and LILACS were searched from 2000 to March 2012; Narrative and SR and clinical practice guidelines (CPG) evaluating the efficacy of treatment (benefits and harms), diagnosis/classification, prognosis, and outcomes were eligible. For treatment, articles were limited to SRs from 2005 forward. Risk of bias of SR was assessed with the AMSTAR; the AGREE II was used to critically appraise the CPGs.


From 2476 articles, 508 were eligible for full text screening. A total of 341 articles were included. Treatment (n=117) had the greatest yield. Other clinical areas had less literature (diagnosis=54, prognosis=16, outcomes=27, harms=16). There were no SR for classification and narrative reviews were problematic for this topic. There was great overlap across different databases within each clinical area except for those for outcome measures. Risk of bias assessment using the AMSTAR of eligible SRs showed a similar trend across different clinical areas.


A summary of methods used to review the literature in five clinical areas of NP management have been described. The challenges of selecting and synthesizing eligible articles in an OvR required customized solutions across different areas of clinical focus.

Keywords: Evidence syntheses, overview of reviews, neck pain.