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Klein Heerenbrink S, Coenen P, Coppieters MW, van Dongen JM, Vleggeert-Lankamp CLA, Rooker S, Ter Meulen BC, Bosboom JLW, Bouma GJ, Lutke Schipholt IJ, Sleijser-Koehorst MLS, de Vries R, Ostelo RWJG, Scholten-Peeters GGM. (Cost-)effectiveness of personalised multimodal physiotherapy compared to surgery in patients with cervical radiculopathy: A systematic review. J Eval Clin Pract 2024. [PMID: 38825757 DOI: 10.1111/jep.14036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/10/2024] [Accepted: 05/19/2024] [Indexed: 06/04/2024]
Abstract
RATIONALE Cervical radiculopathy is initially typically managed conservatively. Surgery is indicated when conservative management fails or with severe/progressive neurological signs. Personalised multimodal physiotherapy could be a promising conservative strategy. However, aggregated evidence on the (cost-)effectiveness of personalised multimodal physiotherapy compared to surgery with/without post-operative physiotherapy is lacking. AIM/OBJECTIVES To systematically summarise the literature on the (cost-)effectiveness of personalised multimodal physiotherapy compared to surgery with or without post-operative physiotherapy in patients with cervical radiculopathy. METHODS PubMed, Embase, CINAHL, PsycINFO and Web of Science were searched from inception to 1st of March 2023. Primary outcomes were effectiveness regarding costs, arm pain intensity and disability. Neck pain intensity, perceived recovery, quality of life, neurological symptoms, range-of-motion, return-to-work, medication use, (re)surgeries and adverse events were considered secondary outcomes. Randomised clinical trials comparing personalised multimodal physiotherapy versus surgical approaches with/without post-operative physiotherapy were included. Two independent reviewers performed study selection, data-extraction, and risk of bias assessment using the Cochrane RoB 2 and Consolidated Health Economic Evaluation Reporting Standards statement. Certainty of the evidence was determined using Grading of Recommendations, Assessment, Development and Evaluations. RESULTS From 2109 records, eight papers from two original trials, with 117 participants in total were included. Low certainty evidence showed there were no significant differences on arm pain intensity and disability, except for the subscale 'heavy work' related disability (12 months) and disability at 5-8 years. Cost-effectiveness was not assessed. There was low certainty evidence that physiotherapy improved significantly less on neck pain intensity, sensory loss and perceived recovery compared to surgery with/without physiotherapy. Low certainty evidence showed there were no significant differences on numbness, range of motion, medication use, and quality of life. No adverse events were reported. CONCLUSION Considering the clinical importance of accurate management recommendations and the current low level of certainty, high-quality cost-effectiveness studies are needed.
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Affiliation(s)
- Sebastiaan Klein Heerenbrink
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pieter Coenen
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
| | - Michel W Coppieters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Physiotherapy, School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, Australia
| | - Johanna M van Dongen
- Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Carmen L A Vleggeert-Lankamp
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurosurgery, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Servan Rooker
- Department of Neurosurgery, Kliniek ViaSana, Mill, The Netherlands
- Department of Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
| | - Bastiaan C Ter Meulen
- Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, OLVG Teaching Hospital Amsterdam, Amsterdam, The Netherlands
| | - Johannes L W Bosboom
- Department of Neurology, OLVG Teaching Hospital Amsterdam, Amsterdam, The Netherlands
| | - Gerrit J Bouma
- Department of Neurosurgery, OLVG Teaching Hospital Amsterdam, Amsterdam, The Netherlands
| | - Ivo J Lutke Schipholt
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marije L S Sleijser-Koehorst
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Raymond W J G Ostelo
- Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gwendolyne G M Scholten-Peeters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Gao QY, Wei FL, Zhu KL, Zhou CP, Zhang H, Cui WX, Li T, Qian JX, Hao DJ. Clinical Efficacy and Safety of Surgical Treatments in Patients With Pure Cervical Radiculopathy. Front Public Health 2022; 10:892042. [PMID: 35910906 PMCID: PMC9330161 DOI: 10.3389/fpubh.2022.892042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Traditionally paired meta-analysis revealed inconsistencies in the safety and effectiveness of surgical interventions. We conducted a network meta-analysis to assess various treatments' clinical efficacy and safety for pure cervical radiculopathy. Methods The Embase, PubMed, and Cochrane Library databases were searched for randomized controlled trials (RCTs) comparing different treatment options for patients with pure cervical radiculopathy from inception until October 23, 2021. The primary outcomes were postoperative success rates, postoperative complication rates, and postoperative reoperation rates. The pooled data were subjected to a random-effects consistency model. The protocol was published in PROSPERO (CRD42021284819). Results This study included 23 RCTs (n = 1,844) that evaluated various treatments for patients with pure cervical radiculopathy. There were no statistical differences between treatments in the consistency model in terms of major clinical effectiveness and safety outcomes. Postoperative success rates were higher for anterior cervical foraminotomy (ACF: probability 38%), posterior cervical foraminotomy (PCF: 24%), and anterior cervical discectomy with fusion and additional plating (ACDFP: 21%). Postoperative complication rates ranked from high to low as follows: cervical disc replacement (CDR: probability 32%), physiotherapy (25%), ACF (25%). Autologous bone graft (ABG) had better relief from arm pain (probability 71%) and neck disability (71%). Among the seven surgical interventions with a statistical difference, anterior cervical discectomy with allograft bone graft plus plating (ABGP) had the shortest surgery time. Conclusions According to current results, all surgical interventions can achieve satisfactory results, and there are no statistically significant differences. As a result, based on their strengths and patient-related factors, surgeons can exercise discretion in determining the appropriate surgical intervention for pure cervical radiculopathy. Systematic Review Registration: CRD42021284819.
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Affiliation(s)
- Quan-You Gao
- Health Science Center of Xi'an Jiaotong University, Xi'an, China
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiao Tong University, Xi'an, China
| | - Fei-Long Wei
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Kai-Long Zhu
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Cheng-Pei Zhou
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Hu Zhang
- School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Wen-Xing Cui
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, Xi'an, China
- *Correspondence: Ding-Jun Hao
| | - Ji-Xian Qian
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
- Ji-Xian Qian
| | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiao Tong University, Xi'an, China
- Tian Li
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