NSNP is defined as pain or discomfort in and around the neck and shoulder girdle, with or without pain or sensory changes into the arms, 6 with or without the loss of cervical range of movement (ROM) 7 in the absence of infection, inflammatory or structural pathology (eg, fracture). 5 Given the prevalence of neck pain, it is likely that most adults will experience neck pain at some point in their life. 3 Neck pain is the fourth greatest cause of global disability 4 and affects between 30% and 50% of adults in any given year. 2 The global incidence of non-specific neck pain (NSNP) in the adult population is 4.9%, with the highest incidence in North America (mean 6.5%) followed by Western Europe (mean 6.3%). Neck pain is one of the biggest contributors to musculoskeletal disability, with a prevalence ranging between 16% and 75% worldwide, 1 impacting on the physical, social and psychological well-being of an individual, as well as imparting domestic and socioeconomic implications on society and business. Where not possible, data will be presented descriptively. Meta-analysis will be performed where individual studies measure comparable outcomes including performance-based outcome measures such as range of movement or patient reported outcome measures such as Neck Disability Index and where interventions are comparable in their delivery such as number of oscillations and Maitland grading. Two independent reviewers will conduct the searches independently, extract data, assess risk of bias (Cochrane Risk of Bias Tool 2) and assess overall strength of evidence (Grading of Recommendations, Assessment, Development and Evaluation). Studies will be screened by title and abstract and full text. Grey literature and unpublished studies will also be searched. Key journals will be searched using predefined keywords determined from preliminary scoping searches for randomised controlled trials of manipulation and mobilisation modalities for adults with NSNP in the absence of radiculopathy or whiplash, published in English. A targeted search strategy will enable searching of key databases from inception to 31 March 2020: CINAHL, PEDro, AMED, EMBASE, OVID, MEDLINE, Web of Science, PubMed and Google Scholar. A systematic review protocol has been designed and is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols.
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