Effects of matched vs. unmatched physical therapy interventions on pain or disability in patients with neck pain - a systematic review and meta-analysis.

BACKGROUND: The interventions performed in most randomized controlled trials (RCTs) on neck pain patients are standardized, irrespective of the high heterogeneity of patients. However, clinicians tend to choose an intervention based on the patients' clinical characteristics, and thus match the treatment to the patient. OBJECTIVES: To investigate the effectiveness of interventions matched to the clinical characteristics of patients with neck pain versus the same, but unmatched treatment for improving pain or disability. DESIGN: A systematic review and meta-analysis conducted following Cochrane guidelines. METHODS: Databases searches were performed from inception to September 2023. RCTs were included if the patients in the experimental group received a treatment matched to clinical presentation or to clinicians' assessment, if the patients in the control group received a similar but unmatched treatment, and if pain or disability were reported as outcome measures. RESULTS: The literature search produced 9516 records of which 27 met the inclusion criteria. Matched exercise therapy was superior to unmatched exercise for pain (SMD -0.57; 95% CI -0.95, -0.18) and for disability (SMD -0.69; 95% CI -1.14, -0.23) at short term, but not at intermediate-term follow-up. Matched manual treatment was not superior to unmatched manual therapy for pain or for disability at short or intermediate-term follow-up. CONCLUSIONS: Results suggest that matching exercise to movement limitation, trapezius myalgia, or forward head position may lead to better outcomes in the short term, but not in the intermediate-term. Matched manual therapy was not superior to unmatched treatment either short or intermediate-term. Further research is warranted to verify if those criteria are potentially useful matching criteria.

First rib dysfunction in patients with neck and shoulder pain: a Delphi investigation.

BACKGROUND: First rib dysfunction is a possible cause of symptoms in patients with neck and/or shoulder pain. OBJECTIVES: To explore therapists' perceptions of useful diagnostic criteria to identify first rib dysfunction. METHODS: A Delphi survey over four rounds involving international manual therapy experts who were asked to agree on which items were most useful in identifying first rib dysfunction. RESULTS: Consensus (>70% agreement) was reached on key aspects of first rib dysfunction being first rib mobility restriction, upper limb symptom distribution, and a subclassification into two subgroups was suggested. The main clinical findings suggested were: painful and restricted neck movements and shoulder girdle loading activities; positive Upper Limb Neural Test 1; direct palpation of first rib, neural structures, and scalene muscles; pain and hypomobility of first rib accessory movements with improvement after mobilization. The cervical rotation lateral-flexion test was considered a useful, although not widely used test among the experts. Its diagnostic accuracy and interpretation in isolation was questioned. CONCLUSIONS: This Delphi study produced a cluster of clinical tests aimed to identify first rib dysfunction in patients with neck and/or shoulder conditions. However, these need to be tested out in further research to establish reliability and validity.