Association between cervical spine clinical active range of motion and pain or disability in people with neuromusculoskeletal neck pain: A systematic review and meta-analysis

Objectives: To quantify the association between clinical cervical active range of motion and patient-reported outcomes of pain and disability in people with neuromusculoskeletal neck pain. Design: Systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, registered with PROSPERO (CRD42023417317). Methods: A comprehensive search of six databases and grey literature up to December 2024 identified observational studies reporting cross-sectional correlations between active range of motion and patient-reported outcomes in adults with neck pain. Risk of bias was assessed using an adapted National Institutes of Health quality assessment tool. Eight meta-analyses were conducted using random-effects models. Heterogeneity, subgroup analyses (acute versus chronic neck pain, whiplash-related versus non-traumatic), and meta-regressions (age, sex, publication year, risk of bias) were performed. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Results: 45 studies (total N = 3,494) were included. Meta-analyses showed statistically significant small to moderate negative correlations (r = −0.21 to −0.34) between active range of motion and patient-reported outcomes in all planes of motion, with stronger associations in acute and whiplash-related neck pain. Substantial heterogeneity (I2 = 67–91%) was partly explained by symptom duration and mechanism of onset. Certainty of evidence was very low due to risk of bias, inconsistency, and imprecision. Conclusions: Cervical active range of motion is modestly associated with pain and disability, especially in acute and traumatic neck pain. Findings should be interpreted with caution. Standardized measurement protocols and higher-quality studies are needed to inform practice.