Evidence of Impaired Proprioception in Chronic, Idiopathic Neck Pain: Systematic Review and Meta-Analysis

Abstract

Background: Despite common use of proprioceptive retraining interventions in people with chronic, idiopathic neck pain, evidence that proprioceptive dysfunction exists in this population is lacking. Determining whether proprioceptive dysfunction exists in people with chronic neck pain has clear implications for treatment prescription.

Purpose: The aim of this study was to synthesize and critically appraise all evidence evaluating proprioceptive dysfunction in people with chronic, idiopathic neck pain by completing a systematic review and meta-analysis.

Data sources: MEDLINE, CINAHL, PubMed, Allied and Complementary Medicine, EMBASE, Academic Search Premier, Scopus, Physiotherapy Evidence Database (PEDro), and Cochrane Collaboration databases were searched.

Study selection: All published studies that compared neck proprioception (joint position sense) between a chronic, idiopathic neck pain sample and asymptomatic controls were included.

Data extraction: Two independent reviewers extracted relevant population and proprioception data and assessed methodological quality using a modified Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.

Data synthesis: Thirteen studies were included in the present review. Meta-analysis on 10 studies demonstrated that people with chronic neck pain perform significantly worse on head-to-neutral repositioning tests, with a moderate standardized mean difference of 0.44 (95% confidence interval=0.25, 0.63). Two studies evaluated head repositioning using trunk movement (no active head movement thus hypothesized to remove vestibular input) and showed conflicting results. Three studies evaluated complex or postural repositioning tests; postural repositioning was no different between groups, and complex movement tests were impaired only in participants with chronic neck pain if error was continuously evaluated throughout the movement.

Limitations: A paucity of studies evaluating complex or postural repositioning tests does not permit any solid conclusions about them.

Conclusions: People with chronic, idiopathic neck pain are worse than asymptomatic controls at head-to-neutral repositioning tests.

Figure 1.

The PRISMA flow diagram describing the screening and review process.

Figure 2.

Meta-analysis of head-to-neutral proprioceptive repositioning tests. All sample sizes have been reduced to reflect the number of times each study appears in the forest plot. IV=inverse variance, CI=confidence interval.

Appendix 1.

MEDLINE Search Strategy^{a a} MH=MeSH heading, TX=text word.

Appendix 2.

Risk of Bias Assessment Questions (Informed by Strengthening the Reporting of Observational Studies in Epidemiology [STROBE] Statement Reporting Recommendations)