Psychological Care, Patient Education, Orthotics, Ergonomics and Prevention Strategies for Neck Pain: An Systematic Overview Update as Part of the ICON§ Project

Anita R. Gross*, 1, Faith Kaplan1, Stacey Huang1, Mahweesh Khan1, P. Lina Santaguida2, Lisa C. Carlesso3, Joy C. MacDermid4, David M. Walton5, Justin Kenardy6, Anne Söderlund7, Arianne Verhagen8, Jan Hartvigsen9
1 McMaster University, Hamilton, ON, Canada;
2 McMaster University Evidence-Based Practice Centre, Department of Clinical Epidemiology and Biostatistics, Hamilton, ON, Canada;
3 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada;
4 School of Rehabilitation Sciences McMaster University, Hamilton, Ontario and Clinical Research Lab, Hand and Upper Limb Centre, St. Joseph’s Health Centre, London, ON, Canada;
5 School of Physical Therapy, University of Western Ontario, London, ON, Canada;
6 Centre of National Research on Disability and Rehabilitation Medicine, The University of Queensland, Royal Brisbane and Women’s Hospital, QLD, Australia;
7 School of Health, Care and Social Welfare Malardalens University, Vasteras, Sweden;
8 Erasmus Medical Centre, Utrecht, The Netherlands;
9 Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark

Article Metrics

CrossRef Citations:
Total Statistics:

Full-Text HTML Views: 1265
Abstract HTML Views: 314
PDF Downloads: 291
Total Views/Downloads: 1870
Unique Statistics:

Full-Text HTML Views: 743
Abstract HTML Views: 211
PDF Downloads: 213
Total Views/Downloads: 1167

Creative Commons License
© Gross 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 McMaster University, School of Rehabilitation Science, IAHS, 1400 Main Street West, 4th floor, Hamilton, ON, L8S 1C7, Canada; Tel: 905-577-0098; Fax: 905-577-0603; E-mail:
§ ICON (International Collaboration on Neck), Canada Expert Panel: Gert Bronfort DC, PhD, Northwestern Health Sciences University, USA; Norm Buckley, MD - Anesthesia, Department of Anesthesia Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; Linda Carroll, Psychologist, PhD, School of Public Health, University of Alberta, Edmonton, AB, Canada; Ted Haines, MD, MSc, Occupational Health & Safety, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Ron Kaplan, PhD, C.Psych, Kaplan Psychologists, Hamilton, ON, Canada; Jan Poole, PT, PhD, Hogeschool Utrecht, University of Applied Science, Utrecht, The Netherlands; Duncan Reid PT, PhD, School Rehabilitation and Occupation Studies AUT University, NZ; Grace P.Y. Szeto PT, PhD, Department of Rehabilitation Sciences Hong Kong Polytechnic University, Hong Kong; Marc White MD, PhD, Executive Director, Canadian Institute for the Relief of Pain and Disability, Department of Family Practice, University of British Columbia, BC, Canada.



To conduct an overview on psychological interventions, orthoses, patient education, ergonomics, and 1⁰/2⁰ neck pain prevention for adults with acute-chronic neck pain.

Search Strategy:

Computerized databases and grey literature were searched (2006-2012).

Selection Criteria:

Systematic reviews of randomized controlled trials (RCTs) on pain, function/disability, global perceived effect, quality-of-life and patient satisfaction were retrieved.

Data Collection & Analysis:

Two independent authors selected articles, assessed risk of bias using AMSTAR tool and extracted data. The GRADE tool was used to evaluate the body of evidence and an external panel to provide critical review.

Main Results:

We retrieved 30 reviews (5-9 AMSTAR score) reporting on 75 RCTs with the following moderate GRADE evidence. For acute whiplash associated disorder (WAD), an education video in emergency rooms (1RCT, 405participants] favoured pain reduction at long-term follow-up thus helping 1 in 23 people [Standard Mean Difference: -0.44(95%CI: -0.66 to -0.23)). Use of a soft collar (2RCTs, 1278participants) was not beneficial in the long-term. For chronic neck pain, a mind-body intervention (2RCTs, 1 meta-analysis, 191participants) improved short-term pain/function in 1 of 4 or 6 participants. In workers, 2-minutes of daily scapula-thoracic endurance training (1RCT, 127participants) over 10 weeks was beneficial in 1 of 4 participants. A number of psychosocial interventions, workplace interventions, collar use and self-management educational strategies were not beneficial.

Reviewers' Conclusions:

Moderate evidence exists for quantifying beneficial and non-beneficial effects of a limited number of interventions for acute WAD and chronic neck pain. Larger trials with more rigorous controls need to target promising interventions

Keywords: overview, psychological, education, orthotics, ergonomics, prevention, neck pain.