Patient education for neck pain with or without radiculopathy

Ted Haines; Anita Gross; Charles H Goldsmith; Lenora Perry

doi:10.1002/14651858.CD005106.pub2

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Analysis 1.1

Comparison 1 ADVICE ‐ focus on activation vs PLACEBO or CONTROL, Outcome 1 pain [intensity].

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Analysis 1.2

Comparison 1 ADVICE ‐ focus on activation vs PLACEBO or CONTROL, Outcome 2 pain [present].

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Study
SCHOOL [exercise, self‐care, relaxation] versus n‐control: acute/subacute/chronic MND at four weeks + 24 weeks follow‐up [afternoon]
Kamwendo 1991: AvC	at either post or follow‐up periods

Analysis 1.3

Comparison 1 ADVICE ‐ focus on activation vs PLACEBO or CONTROL, Outcome 3 headache.

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Study
INVID [written info, instruct: ex] versus o‐control: duration disorder not specified, MND at two weeks
Glossop 1982: 1v2	The authors observed a positive relationship between pain change and compliance

Analysis 1.4

Comparison 1 ADVICE ‐ focus on activation vs PLACEBO or CONTROL, Outcome 4 change in pain.

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Analysis 1.5

Comparison 1 ADVICE ‐ focus on activation vs PLACEBO or CONTROL, Outcome 5 function [self report].

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Analysis 1.6

Comparison 1 ADVICE ‐ focus on activation vs PLACEBO or CONTROL, Outcome 6 sick leave [number of people].

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Study
SCHOOL [instruct: exercise, self‐care, relax] versus n‐control: acute/subacute/chronic MND at four weeks + 24 weeks follow‐up [afternoon]
Kamwendo 1991: AvC	no significant sick occurrences per month

Analysis 1.7

Comparison 1 ADVICE ‐ focus on activation vs PLACEBO or CONTROL, Outcome 7 sick occurrences.

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Study
SCHOOL [instruct: exercise, self‐care, relax] versus n‐controll: acute/subacute/chronic MND at four weeks + 24 weeks follow‐up [afternoon]
Kamwendo 1991: AvC	no significant sick days per month

Analysis 1.8

Comparison 1 ADVICE ‐ focus on activation vs PLACEBO or CONTROL, Outcome 8 sick days.

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Analysis 1.9

Comparison 1 ADVICE ‐ focus on activation vs PLACEBO or CONTROL, Outcome 9 global perceived improvement [felt worse or no change].

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Study
INDIV [written info, instruct: ex] versus o‐control: duration disorder not specified, MND at two weeks
Glossop 1982: 1v2	group 1: mean 6 group 2: mean 4.4 Retention of information is better in the group in which exercises taught are reinforced with the booklet

Analysis 1.10

Comparison 1 ADVICE ‐ focus on activation vs PLACEBO or CONTROL, Outcome 10 knowledge: retention of instruction on exercises.

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Analysis 1.11

Comparison 1 ADVICE ‐ focus on activation vs PLACEBO or CONTROL, Outcome 11 additional health contacts for neck disorder.

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Study
SCHOOL [instruct: exercise, self‐care, relax] versus n‐control: acute/subacute/chronic MND at four weeks + 24 weeks follow‐up [afternoon]
Kamwendo 1991: AvC	post hoc analyses (Turkey HSD) showed that group B had implemented significantly more changes than the other two groups A,C (P < 0.05). There was no significant difference between group A and C. For group B, 37%(19/51) of the implemented changes consisted of pause gymnastics.

Analysis 1.12

Comparison 1 ADVICE ‐ focus on activation vs PLACEBO or CONTROL, Outcome 12 implemented changes.

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Analysis 2.1

Comparison 2 ADVICE ‐ focus on activation vs ANOTHER TREATMENT, Outcome 1 pain [intensity].

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Study
INDIV [act‐as‐usual] versus REST: acute WAD at one session + six weeks follow‐up
Borchgrevink 1998	ANCOVA with repeated meaures and with baseline measurement as covariate showed significant favoring act‐as‐usual group for treatment by time F [1,140] = 4.33, P < 0.05 No significant difference for treatment or time
INDIV [act‐as‐usual] versus REST: acute WAD at one session + 24 weeks follow‐up
Borchgrevink 1998	ANCOVA with repeated meaures and with baseline measurement as covariate showed significant favoring act‐as‐usual group for treatment by time F [1,140] = 4.33, P < 0.05 No significant difference for treatment or time

Analysis 2.2

Comparison 2 ADVICE ‐ focus on activation vs ANOTHER TREATMENT, Outcome 2 pain [intensity].

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Study
INDIV [act‐as‐usual] versus REST: acute WAD at one session + six weeks follow‐up
Borchgrevink 1998	ANCOVA with repeated measures and with the baseline measurement as covariate yielded no significant difference for treatment or time a significant difference was detected for treatment by time for headache F[1,139] = 11.01; P < 0.01
INDIV [act‐as‐usual] versus REST: acute WAD at one session + 24 weeks follow‐up
Borchgrevink 1998	ANCOVA with repeated measures and with the baseline measurement as covariate yielded no significant difference for treatment or time a significant difference was detected for treatment by time for headache F[1,139] = 11.01; P < 0.01

Analysis 2.3

Comparison 2 ADVICE ‐ focus on activation vs ANOTHER TREATMENT, Outcome 3 headache.

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Study
INDIV [written info, instruct: ex] versus BOOKLET: duration disorder not specified, MND at two weeks
Glossop 1982: 1v3	The authors observed a positive relationship between pain change and compliance
INDIV [written info: ex] versus EXERCISE: duration disorder not specified, MND at two weeks
Glossop 1982: 3v2	The authors observed a positive relationship between pain change and compliance

Analysis 2.4

Comparison 2 ADVICE ‐ focus on activation vs ANOTHER TREATMENT, Outcome 4 change in pain.

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Analysis 2.5

Comparison 2 ADVICE ‐ focus on activation vs ANOTHER TREATMENT, Outcome 5 function [self report].

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Study
GROUP [written info, instruct: exercise, disorder] versus HOME EXERCISE: chronic MND at two sessions/two weeks + 12 weeks follow‐up
Taimela2000:cntl v H	No significant discernible differences were noted among the groups in the reduction of physical impairment ANOVA F = 0.27, P = 0.73
GROUP [written info, instruct: exercise, disorder] versus HOME EXERCISE: chronic MND at two sessions/two weeks + 56 weeks follow‐up
Taimela2000:cntl v H	No significant discernible differences were noted among the groups in the reduction of physical impairment ANOVA F = 0.27, P = 0.73
GROUP [written info, instruct: exercise, disorder] versus COGNITIVE BEHAV: chronic MND at two sessions/two weeks + 12 weeks follow‐up
Taimela2000:cntl v A	no significant discernible differences were noted among the groups in the reduction of physical impairment ANOVA F = 0.27, P = 0.73
GROUP [written info, instruct: exercise, disorder] versus COGNITIVE BEHAV: chronic MND at two sessions/two weeks + 56 weeks follow‐up
Taimela2000:cntl v A	no significant discernible differences were noted among the groups in the reduction of physical impairment ANOVA F = 0.27, P = 0.73

Analysis 2.6

Comparison 2 ADVICE ‐ focus on activation vs ANOTHER TREATMENT, Outcome 6 self experienced physical impairment.

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Analysis 2.7

Comparison 2 ADVICE ‐ focus on activation vs ANOTHER TREATMENT, Outcome 7 self experienced physical impairment.

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Study
GROUP [written info, instruct: exercise, disorder] versus HOME EXERCISE: chronic MND at two sessions/two weeks + 12 weeks follow‐up
Taimela2000:cntl v H	an improvement in self‐reported working ability in favour of the Active treatment was seen at three months [P = 0.004]
GROUP [written info, instruct: exercise, disorder] versus HOME EXERCISE: chronic MND at two sessions/two weeks + 56 weeks follow‐up
Taimela2000:cntl v H	an improvement in self‐reported working ability in favour of the Active treatment was seen at three months [P = 0.004]
GROUP [written info, instruct: exercise, disorder] versus COGNITIVE BEHAV: chronic MND at two sessions/two weeks + 12 weeks follow‐up
Taimela2000:cntl v A	an improvement in self‐reported working ability in favour of the Active treatment was seen at three months [P = 0.004]
GROUP [written info, instruct: exercise, disorder] versus COGNITIVE BEHAV: chronic MND at two sessions/two weeks + 56 weeks follow‐up
Taimela2000:cntl v A	an improvement in self‐reported working ability in favour of the Active treatment was seen at three months [P = 0.004]

Analysis 2.8

Comparison 2 ADVICE ‐ focus on activation vs ANOTHER TREATMENT, Outcome 8 working ability.

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Analysis 2.9

Comparison 2 ADVICE ‐ focus on activation vs ANOTHER TREATMENT, Outcome 9 working ability.

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Analysis 2.10

Comparison 2 ADVICE ‐ focus on activation vs ANOTHER TREATMENT, Outcome 10 sick leave [number of people].

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Analysis 2.11

Comparison 2 ADVICE ‐ focus on activation vs ANOTHER TREATMENT, Outcome 11 global perceived improvement [felt worse or no change].

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Study
GROUP [written info, instruct: exercise, disorder] versus HOME EXERCISE: chronic MND at two sessions/two weeks + 12 weeks follow‐up
Taimela2000:cntl v H	mean at three months follow‐up: control = 3.3, home exercise = 3.8 post hoc testing all groups were different from each other @ 12 months, P < 0.03
GROUP [written info, instruct: exercise, disorder] versus HOME EXERCISE: chronic MND at two sessions/two weeks + 56 weeks follow‐up
Taimela2000:cntl v H	mean at 12 months follow‐up: control = 3.4, home exercise = 3.8 post hoc testing all groups were different from each other @ 12 months, P < 0.03
GROUP [written info, instruct: exercise, disorder] versus COGNITIVE BEHAV: chronic MND at two sessions/two weeks + 12 weeks follow‐up
Taimela2000:cntl v A	mean at three months follow‐up: control = 3.3, Active = 4.6 post hoc testing all groups were different from each other @ three months, P < 0.03
GROUP [written info, instruct: exercise, disorder] versus COGNITIVE BEHAV: chronic MND at two sessions/two weeks + 56 weeks follow‐up
Taimela2000:cntl v A	mean at 12 months follow‐up: control = 3.4, Active = 4.2 All groups were different from each other at 12 months follow‐up P < 0.03

Analysis 2.12

Comparison 2 ADVICE ‐ focus on activation vs ANOTHER TREATMENT, Outcome 12 self experienced benefit of treatment.

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Analysis 2.13

Comparison 2 ADVICE ‐ focus on activation vs ANOTHER TREATMENT, Outcome 13 self experienced benefit of treatment.

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Study
INDIV [written info: ex] versus EXERCISE: duration disorder not specified, MND at 2 weeks
Glossop 1982: 3v2	End of study mean: group 3: 5.2, group 2: 4.4
INDIV [written info, instruct: ex] versus BOOKLET: duration disorder not specified, MND at 2 weeks
Glossop 1982: 1v3	group 1: mean 6 group 3: mean 5.2

Analysis 2.14

Comparison 2 ADVICE ‐ focus on activation vs ANOTHER TREATMENT, Outcome 14 knowledge: retention of instruction on exercises.

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Analysis 2.15

Comparison 2 ADVICE ‐ focus on activation vs ANOTHER TREATMENT, Outcome 15 Quality of Life.

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Analysis 3.1

Comparison 3 ADVICE ‐ focus on pain & stress coping skills vs CONTROL, Outcome 1 pain [present].

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Analysis 3.2

Comparison 3 ADVICE ‐ focus on pain & stress coping skills vs CONTROL, Outcome 2 pain [intensity].

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Analysis 3.3

Comparison 3 ADVICE ‐ focus on pain & stress coping skills vs CONTROL, Outcome 3 disability.

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Analysis 4.1

Comparison 4 NECK SCHOOL vs NO TREATMENT, Outcome 1 pain [intensity].

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Study
SCHOOL [exercise, self‐care, relaxation]: acute/subacute/chronic MND at six months follow‐up
Kamwendo 1991: BvC	at either post or follow‐up periods

Analysis 4.2

Comparison 4 NECK SCHOOL vs NO TREATMENT, Outcome 2 headache.

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Study
SCHOOL: acute/subacute/chronic MND at six months follow‐up
Kamwendo 1991: AvB	no significant difference in sick days per month
Kamwendo 1991: AvC	no significant difference in sick days per month
Kamwendo 1991: BvC	no significant difference in sick days per month

Analysis 4.3

Comparison 4 NECK SCHOOL vs NO TREATMENT, Outcome 3 sick days.

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Study
SCHOOL: acute/subacute/chronic MND at six months follow‐up
Kamwendo 1991: AvB	no significant difference in sick occurrences per month
Kamwendo 1991: AvC	no significant difference in sick occurrences per month
Kamwendo 1991: BvC	no significant difference in sick occurrences per month

Analysis 4.4

Comparison 4 NECK SCHOOL vs NO TREATMENT, Outcome 4 sick occurrences.

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Study
Kamwendo 1991	no significance between group differences was found when post‐score values were compared using pre‐score values as the covariate

Analysis 4.5

Comparison 4 NECK SCHOOL vs NO TREATMENT, Outcome 5 ergonomic knowledge.

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Analysis 4.6

Comparison 4 NECK SCHOOL vs NO TREATMENT, Outcome 6 additional health contacts for neck disorder.

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Table 1. Educational Intervention described by six key educational dimensions

Author	Learner Cluster	Medium	Technique	Characteristics	Follow‐up	Theory/Principle
Criteria	independent, one‐on‐one, group,	oral, telephone, written, audiovisual	lecture, discussion, interaction, demonstration, practice, psychological	structure planned, duration, frequency, replication, trained instruction, side effect	reminders, feedback, reinforcement, written action plan, self monitoring	motivation, self‐efficacy, readiness to change, self scan, environmental scan, problem solve
Borchgrevink 1998	one‐on‐one	oral	discussion	structure planned
Brison 2005	independent	audiovisual				motivation
Brodin 1984‐1985		oral	lecture, demonstration	structure planned, replication, trained instruction		self‐efficacy, self scan, environmental scan
Crawford 2004	independent	oral, written
Ferrari 2005	independent	written				self efficacy, readiness to change, self scan
Glossop 1982	independent, one‐on‐one	oral, written	discussion, demonstration, practice	structure planned	self monitoring	self‐efficacy
Horneij 2001	independent, one‐on‐one, group	oral	discussion, interaction psychological	structure planned, duration, frequency, trained instruction	reinforcement	self‐efficacy, self scan environmental scan problem solve
Hoving 2002	one‐on‐one	oral, written	discussion	structure planned, duration, trained instruction
Jensen 1995	group	oral telephone	lecture	structure planned, duration, frequency, trained instruction	reinforcement, write action plan	self‐efficacy, self scan, problem solve
Karlberg 1998	independent			structure planned, duration		self efficacy
Kamwendo 1991	one‐on‐one, group	oral, written, audiovisual	lecture, discussion, interaction, demonstration, practice, psychological	structure planned, duration, frequency	reinforcement, written action plan	self‐efficacy, self scan, environmental scan, problem solve
Klaber Moffet 2005	independent	oral, written		structure planned, frequency, trained instruction		self‐efficacy
Koes 1992	one‐on‐one			duration, frequency
Kogsted 1978	independent, one‐on‐one	oral
Kongsted 2007	independent, one‐on‐one	oral, written	discussion	structure planned, duration, frequency, trained instruction, side effect		motivation, self efficacy
Lundblad 1999	independent, one‐on‐one, group	oral, audiovisual	interaction, demonstration, practice	structure planned, duration, frequency		self‐efficacy, readiness to change, self scan
McKinney 1989	independent, one‐on‐one	oral, written	discussion, demonstration	structure planned, duration		motivation
Mealy 1986	independent	oral
Oliveira 2005	independent	written, audiovisual	demonstration, psychological	structure planned, duration, replication, trained instruction	reinforcement	motivation, self efficacy, self scan
Persson 2001	one‐on‐one			structure planned, duration, frequency		self efficacy
Provinciali 1996				structure planned, duration, frequency		self efficacy
Rosenfeld 2003	independent	oral, written	lecture	structure planned, frequency, side effect		self efficacy, self scan
Sonderlund 2001	independent, one‐on‐one	oral, written	discussion, practice, psychological	structure planned, duration, replication	reinforcement, self monitoring	self‐efficacy, readiness to change, self scan problem solve
Taimela 2000	independent, one‐on‐one, group	oral, written	lecture, discussion, practice, psychological	structure planned, duration, frequency, replication, trained instruction		motivation, self scan

Table 1. Educational Intervention described by six key educational dimensions

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Table 2. Risk of Bias Assessment Results: Jadad Criteria

Author	randomized(1a)	appropriate(1b)	concealed(1c)	double blind(2a)	described(2b)	appropriate(2c)	follow‐up(3)	total
Borchgrevink 1998	1	0	0	0	0	0	1	2/5
Briston 2005	1	1	0	0	0	0	1	3/5
Ferrari 2005	1	0	0	0	0	0	0	1/5
Glossop1982	1	0	0	0	0	0	1	2/5
Horneij 2001	1	0	0	0	0	0	1	2/5
Kamwendo 1996	1	0	0	0	0	0	1	2/5
Klaber‐Moffett 2005 Manca 2006	1	1	0	0	0	0	0	2/5
Kongsted 2007	1	0	1	0	0	0	1	3/5
Soderlund 2001	1	0	0	0	0	0	1	2/5
Taimela 2000	1	0	0	0	0	0	1	2/5

Table 2. Risk of Bias Assessment Results: Jadad Criteria

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Table 3. Criteria for the Risk of Bias Assessment

List	Criteria
Jadad 1996	1a. Was the study described as randomised? (Score 1 if yes) 1b and 1c. Was the method of randomisation described and appropriate to conceal allocation (Score 1 if appropriate and ‐1 if not appropriate); 2a. Was the study described as double‐blinded? (Score 1 if yes) 2b and 2c. Was the method of double blinding described and appropriate to maintain double blinding (Score 1 if appropriate and ‐1 if not appropriate) 3. Was there a description of how withdrawals and dropouts were handled? (Score 1 if yes)
Cochrane Criteria	A. Clearly Adequate: Centralized randomized by telephone; randomization scheme controlled by pharmacy; numbered or coded identical containers administered sequentially; on line computer system accessed only after entering the characteristics of an enrolled participant; sequentially numbered, sealed, opaque envelopes. B. Possibly adequate: Sealed envelopes but not sequentially numbered or opaque; lists of random numbers read by someone entering patient into trial (open list); a trial in which the description suggests concealment, but other features are suspicious (for example, markedly unequal controls and trial groups; stated random, but unable to obtain further details. C. Clearly Inadequate: Any allocation procedure transparent before treatment before assignment (for example: an open list of random numbers, alternation, date of birth, day of week, case record number). D. Not used.
The van Tulder 2003 Criteria (Score: 1 if yes, 0 if no or don't know)	A. Was the method of randomisation adequate? B. Was the treatment allocation concealed? C. Were the groups similar at baseline regarding the most important prognostic indicators? D. Was the patient blinded to the intervention? E. Was the care provider blinded to the intervention? F. [Was the outcome assessor blinded to the intervention? G. Were co‐interventions avoided or similar? H. Was the compliance acceptable in all groups? I. Was the withdrawal/drop‐out rate described and acceptable? J. Was the timing of the outcome assessment in all groups similar?

Table 3. Criteria for the Risk of Bias Assessment

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Table 4. Risk of Bias Assessment Results: van Tulder Scale

Author/ total score	A	B	C	D	E	F	G	H	I	J	K
Borchgrevink 1998	0	0	0	0	0	1	0	0	1	1	0
Brison 2005	1	1	1	0	0	1	0	1	1	1	1
Ferrari 2005	1	0	1	0	1	1	1	1	0	1	0
Glossop1982	1	1	0	0	0	0	0	0	0	1	1
Horneij 2001	0	0	1	1	0	1	0	1	1	1	0
Kamwendo 1996	1	0	1	0	0	0	1	1	1	1	0
Klaber‐Moffett 2005	1	0	0	1	0	1	0	1	1	1	0
Kongsted 2007	1	1	1	0	0	0	0	0	1	1	1
Soderlund 2001	0	0	0	0	0	0	0	0	1	1	0
Taimela 2000	0	0	0	0	0	1	0	0	1	1	1

Table 4. Risk of Bias Assessment Results: van Tulder Scale

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Comparison 1. ADVICE ‐ focus on activation vs PLACEBO or CONTROL

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 pain [intensity] Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

1.1 SCHOOL [instruct: exercise, self‐care, relaxation] versus n‐control: acute/subacute/chronic MND at 4 weeks [afternoon]	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
1.2 SCHOOL [instruct: exercise, self‐care, relaxation] versus n‐control: acute/subacute/chronic MND at four weeks + 24 weeks follow‐up [afternoon]	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
2 pain [present] Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

2.1 INDIV [video: posture, return to daily activities, ROM ex, pain management] versus n‐control: acute WAD at one session + two weeks follow‐up	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
2.2 INDIV [video: posture, return to daily activities, ROM ex, pain management] versus n‐control: acute WAD at one session +24 weeks follow‐up	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
2.3 INDIV [video: posture, return to daily activities, ROM ex, pain management] versus n‐control acute WAD at one session + 52 weeks follow‐up	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
2.4 INDIV [written info: reassure, mobilize, normal activities, explanation] versus pl: acute WAD at one session + 12 weeks follow‐up	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
3 headache Show forest plot			Other data	No numeric data

3.1 SCHOOL [exercise, self‐care, relaxation] versus n‐control: acute/subacute/chronic MND at four weeks + 24 weeks follow‐up [afternoon]			Other data	No numeric data
4 change in pain Show forest plot			Other data	No numeric data

4.1 INVID [written info, instruct: ex] versus o‐control: duration disorder not specified, MND at two weeks			Other data	No numeric data
5 function [self report] Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

5.1 INDIV [written info: reassure, mobilize, normal activities, explanation] versus pl acute WAD at one session + 12 weeks follow‐up	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
6 sick leave [number of people] Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

6.1 INDIV[written info: reasure, mobilize, normal activities, explanation] versus pl: acute WAD at one session + 12 weeks follow‐up	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
7 sick occurrences Show forest plot			Other data	No numeric data

7.1 SCHOOL [instruct: exercise, self‐care, relax] versus n‐control: acute/subacute/chronic MND at four weeks + 24 weeks follow‐up [afternoon]			Other data	No numeric data
8 sick days Show forest plot			Other data	No numeric data

8.1 SCHOOL [instruct: exercise, self‐care, relax] versus n‐controll: acute/subacute/chronic MND at four weeks + 24 weeks follow‐up [afternoon]			Other data	No numeric data
9 global perceived improvement [felt worse or no change] Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

9.1 INDIV[written info: reassure, mobilize, normal activities, explanation] versus pl: acute WAD at one session + 12 weeks follow‐up	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
10 knowledge: retention of instruction on exercises Show forest plot			Other data	No numeric data

10.1 INDIV [written info, instruct: ex] versus o‐control: duration disorder not specified, MND at two weeks			Other data	No numeric data
11 additional health contacts for neck disorder Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

11.1 SCHOOL [instruct: exercise, self‐care, relaxation] versus n‐control: acute/subacute/chronic MND at four weeks [afternoon]	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
12 implemented changes Show forest plot			Other data	No numeric data

12.1 SCHOOL [instruct: exercise, self‐care, relax] versus n‐control: acute/subacute/chronic MND at four weeks + 24 weeks follow‐up [afternoon]			Other data	No numeric data

Comparison 1. ADVICE ‐ focus on activation vs PLACEBO or CONTROL

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Comparison 2. ADVICE ‐ focus on activation vs ANOTHER TREATMENT

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 pain [intensity] Show forest plot	5		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

1.1 INDIV [instruct: act‐as‐usual] versus REST [Collar two weeks]: acute WAD at one session + six weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
1.2 INDIV [instruct: act‐as‐usual] vs REST [Collar two weeks]: acute WAD at one session + 24 weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
1.3 GROUP [written info, instruct: exercise, disorder] versus HOME EXERCISE: chronic MND at two sessions/two weeks + 12 weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
1.4 GROUP [written info, instruct: exercise, disorder] versus HOME EXERCISE: chronic MND at two sessions/two weeks + 56 weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
1.5 GROUP [written info, instruct: exercise, disorder] versus COGNITIVE BEHAV: chronic MND at two sessions/two weeks + 12 weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
1.6 GROUP [written info, instruct: exercise, disorder] versus COGITIVE BEHAV: chronic MND at two sessions/two weeks + 56 weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
1.7 INDIV [instruct: ex, rest/activities, posture, lift/carrying] versus EXERCISE: acute WAD at six weeks/three sessions + 24 weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
1.8 INDIV [Video, written info, discuss: return to normal activities] versus USUAL CARE: subacute/chronic MND at two sessions + 12 weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
1.9 INDIV [Video, written info, discuss: return to normal activities] versus USUAL CARE: subacute/chronic MND at two sessions + 52 weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
2 pain [intensity] Show forest plot			Other data	No numeric data

2.1 INDIV [act‐as‐usual] versus REST: acute WAD at one session + six weeks follow‐up			Other data	No numeric data
2.2 INDIV [act‐as‐usual] versus REST: acute WAD at one session + 24 weeks follow‐up			Other data	No numeric data
3 headache Show forest plot			Other data	No numeric data

3.1 INDIV [act‐as‐usual] versus REST: acute WAD at one session + six weeks follow‐up			Other data	No numeric data
3.2 INDIV [act‐as‐usual] versus REST: acute WAD at one session + 24 weeks follow‐up			Other data	No numeric data
4 change in pain Show forest plot			Other data	No numeric data

4.1 INDIV [written info, instruct: ex] versus BOOKLET: duration disorder not specified, MND at two weeks			Other data	No numeric data
4.2 INDIV [written info: ex] versus EXERCISE: duration disorder not specified, MND at two weeks			Other data	No numeric data
5 function [self report] Show forest plot	2		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

5.1 INDIV [instruct: ex, rest/activities, posture, lift/carrying] versus EXERCISE: acute WAD at six weeks/three sessions + 24 weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
5.2 INDIV [Video, written info, discuss: return to normal activities] versus USUAL CARE: subacute/chronic MND at two sessions + 12 weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
5.3 INDIV [Video, written info, discuss: return to normal activities] versus USUAL CARE: subacute/chronic MND at two sessions + 52 weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
6 self experienced physical impairment Show forest plot			Other data	No numeric data

6.1 GROUP [written info, instruct: exercise, disorder] versus HOME EXERCISE: chronic MND at two sessions/two weeks + 12 weeks follow‐up			Other data	No numeric data
6.2 GROUP [written info, instruct: exercise, disorder] versus HOME EXERCISE: chronic MND at two sessions/two weeks + 56 weeks follow‐up			Other data	No numeric data
6.3 GROUP [written info, instruct: exercise, disorder] versus COGNITIVE BEHAV: chronic MND at two sessions/two weeks + 12 weeks follow‐up			Other data	No numeric data
6.4 GROUP [written info, instruct: exercise, disorder] versus COGNITIVE BEHAV: chronic MND at two sessions/two weeks + 56 weeks follow‐up			Other data	No numeric data
7 self experienced physical impairment Show forest plot	2		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

7.1 GROUP [written info, instruct: exercise, disorder] versus HOME EXERCISE: chronic MND at two sessions/two weeks + 12 weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
7.2 GROUP [written info, instruct: exercise, disorder] versus HOME EXERCISE: chronic MND at two sessions/two weeks + 56 weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
7.3 GROUP [written info, instruct: exercise, disorder] versus COGNITIVE BEHAV: chronic MND at two sessions/two weeks + 12 weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
7.4 GROUP [written info, instruct: exercise, disorder] versus COGNIVITVE BEHAV: chronic MND at two sessions/two weeks + 56 weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
8 working ability Show forest plot			Other data	No numeric data

8.1 GROUP [written info, instruct: exercise, disorder] versus HOME EXERCISE: chronic MND at two sessions/two weeks + 12 weeks follow‐up			Other data	No numeric data
8.2 GROUP [written info, instruct: exercise, disorder] versus HOME EXERCISE: chronic MND at two sessions/two weeks + 56 weeks follow‐up			Other data	No numeric data
8.3 GROUP [written info, instruct: exercise, disorder] versus COGNITIVE BEHAV: chronic MND at two sessions/two weeks + 12 weeks follow‐up			Other data	No numeric data
8.4 GROUP [written info, instruct: exercise, disorder] versus COGNITIVE BEHAV: chronic MND at two sessions/two weeks + 56 weeks follow‐up			Other data	No numeric data
9 working ability Show forest plot	2		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

9.1 GROUP [written info, instruct: exercise, disorder] versus HOME EXERCISE: chronic MND at two sessions/two weeks + 12 weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
9.2 GROUP [written info, instruct: exercise, disorder] versus HOME EXERCISE: chronic MND at two sessions/two weeks + 56 weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
9.3 GROUP [written info, instruct: exercise, disorder] versus COGNITIVE BEHAV: chronic MND at two sessions/two weeks + 12 weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
9.4 GROUP [written info, instruct: exercise, disorder] versus COGNITIVE BEHAV: chronic MND at two sessions/two weeks + 56 weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
10 sick leave [number of people] Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

10.1 INDIV [instruct: act‐as‐usual] versus REST [Collar]: acute WAD at one session + 24 weeks follow‐up	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
11 global perceived improvement [felt worse or no change] Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

11.1 INDIV [instruct: act‐as‐usual] versus REST: acute WAD at one session + 24 weeks follow‐up	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
12 self experienced benefit of treatment Show forest plot			Other data	No numeric data

12.1 GROUP [written info, instruct: exercise, disorder] versus HOME EXERCISE: chronic MND at two sessions/two weeks + 12 weeks follow‐up			Other data	No numeric data
12.2 GROUP [written info, instruct: exercise, disorder] versus HOME EXERCISE: chronic MND at two sessions/two weeks + 56 weeks follow‐up			Other data	No numeric data
12.3 GROUP [written info, instruct: exercise, disorder] versus COGNITIVE BEHAV: chronic MND at two sessions/two weeks + 12 weeks follow‐up			Other data	No numeric data
12.4 GROUP [written info, instruct: exercise, disorder] versus COGNITIVE BEHAV: chronic MND at two sessions/two weeks + 56 weeks follow‐up			Other data	No numeric data
13 self experienced benefit of treatment Show forest plot	2		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

13.1 GROUP [written info, instruct: exercise, disorder] versus HOME EXERCISE: chronic MND at two sessions/two weeks + 12 weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
13.2 GROUP [written info, instruct: exercise, disorder] versus HOME EXERCISE: chronic MND at two sessions/two weeks + 56 weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
13.3 GROUP [written info, instruct: exercise, disorder] versus COGNITIVE BEHAV: chronic MND at two sessions/two weeks + 12 weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
13.4 GROUP [written info, instruct: exercise, disorder] versus COGNITIVE BEHAV: chronic MND at two sessions/two weeks + 56 weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
14 knowledge: retention of instruction on exercises Show forest plot			Other data	No numeric data

14.1 INDIV [written info: ex] versus EXERCISE: duration disorder not specified, MND at 2 weeks			Other data	No numeric data
14.2 INDIV [written info, instruct: ex] versus BOOKLET: duration disorder not specified, MND at 2 weeks			Other data	No numeric data
15 Quality of Life Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

15.1 INDIV [Video, written info, discuss: return to normal activities] versus USUAL CARE: subacute/chronic MND at two sessions + 12 weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
15.2 INDIV [Video, written info, discuss: return to normal activities] versus USUAL CARE: subacute/chronic MND at two sessions + 52 weeks follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 2. ADVICE ‐ focus on activation vs ANOTHER TREATMENT

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Comparison 3. ADVICE ‐ focus on pain & stress coping skills vs CONTROL

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 pain [present] Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

1.1 GROUP [theory, practice, interactive talks, supervisor attend], stress management program versus N‐CONTROL: MND at seven weeks	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
2 pain [intensity] Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

2.1 INDIV [self efficacy and coping skills] versus O‐CONTROL: subacute MND at up to 12 sessions	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
2.2 INDIV: self efficacy and coping skills versus O‐CONTROL: subacute MND at up to 12 sessions + three months follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
3 disability Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

3.1 INDIV [self efficacy and coping skills] versus O‐CONTROL: subacute MND at up to 12 sessions	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
3.2 INDIV [self efficacy and coping skills] versus O‐CONTROL: subacute MND at up to 12 sessions + three months follow‐up	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 3. ADVICE ‐ focus on pain & stress coping skills vs CONTROL

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Comparison 4. NECK SCHOOL vs NO TREATMENT

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 pain [intensity] Show forest plot	2		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

1.1 SCHOOL [exercise, self‐care, relaxation, ergon], work place visit [PT, Psych]: acute/subacute/chronic MND at four weeks Rx	2		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
1.2 SCHOOL[exercise, self‐care, relax, ergo], work place visit [PT, Psych]: acute/subacute/chronic MND at four weeks Rx + six months follow‐up	2		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
2 headache Show forest plot			Other data	No numeric data

2.1 SCHOOL [exercise, self‐care, relaxation]: acute/subacute/chronic MND at six months follow‐up			Other data	No numeric data
3 sick days Show forest plot			Other data	No numeric data

3.1 SCHOOL: acute/subacute/chronic MND at six months follow‐up			Other data	No numeric data
4 sick occurrences Show forest plot			Other data	No numeric data

4.1 SCHOOL: acute/subacute/chronic MND at six months follow‐up			Other data	No numeric data
5 ergonomic knowledge Show forest plot			Other data	No numeric data

6 additional health contacts for neck disorder Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

6.1 SCHOOL [instruct: exercise, self‐care, relaxation]: acute/subacute/chronic MND at four weeks [afternoon]	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 4. NECK SCHOOL vs NO TREATMENT

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