Can baseline features predict a reduction in pain and disability following neck-specific exercise in people with chronic non-specific neck pain? A systematic review

BACKGROUND: Neck-specific exercises are effective for chronic non-specific neck pain, though responses vary considerably.

OBJECTIVES: Identify baseline features that predict a reduction in neck disability, pain and better global change following neck-specific exercise interventions.

DESIGN: Systematic review of prospective cohort studies and secondary analyses of randomised controlled trials.

METHODS: Six databases were searched until June 2025. Studies investigating baseline demographic and clinical characteristics, as well as physical and psychological features, with the outcome of pain and disability, or global changes were included. Methodological quality was assessed with the Quality in Prognosis Studies tool, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool was used to assess the certainty of evidence.

RESULTS: Four studies (318 participants) were included. Older age (OR = 5.52) and being male (OR = 5.52) predicted pain reduction. Catastrophising predicted higher levels of disability (OR = 2.91) post exercise. Higher cervical movement velocity (OR = 3.68) and lower accuracy (OR = 5.99) at baseline both predicted less disability and pain. Shorter pain duration (LR+:3.21; LR-:0.36) and lower baseline disability (LR+:2.29; LR-:0.52) predicted a successful global response. The certainty of evidence for these findings is very low.

CONCLUSIONS: Baseline characteristics such as older age, male sex, lower movement accuracy, higher movement velocity, shorter pain duration, and lower baseline disability may predict favourable outcomes following neck-specific exercises, while catastrophising may predict poorer disability outcomes. However, given the very low certainty of evidence, these results should be interpreted cautiously.

TRIAL REGISTRATION: PROSPERO (Registration number CRD42023408332).