1
|
Agarwal S, Patel VD, Prabhakar AJ, Eapen C. Use of cervical traction for managing neck pain: A cross-sectional survey of physiotherapists in India. J Bodyw Mov Ther 2024; 39:476-482. [PMID: 38876671 DOI: 10.1016/j.jbmt.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 12/08/2023] [Accepted: 03/03/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Neck pain remains the fourth leading cause of disability and work loss, and a multimodal treatment approach is effective in reducing neck pain and disability. PURPOSE The purpose of this study is to examine the use of cervical traction for managing neck pain by Physiotherapists in India, including how and when the traction is used, the modes and parameters of traction, any additional interventions given with traction, and the influence of professional demographic characteristics in decision making in traction usage. STUDY DESIGN A cross-sectional survey. METHODOLOGY A random sample of approximately 2500 musculoskeletal physiotherapists was surveyed, and the data was presented in a descriptive form. Chi-square analyses were used to identify the association between responders' qualifications and traction usage. RESULTS From the total physiotherapist approached 18.52% (n = 463) responses were obtained, and 62% (n = 287) respondents reported that they would use traction in their clinical practice. Out of 92.3% of responders indicated using traction for radiculopathy, 78.7% of respondents used traction for patients with neck pain without radiculopathy. It is used as a combination therapy by 58.8% for radiculopathy and 52.2% for stiffness. There was no association between the responder's qualification and traction usage (χ2 = 0.707, p = 0.40). Traction is used in combination with other physiotherapeutic techniques. CONCLUSION Traction use was consistent with the proposed criteria identifying patients likely to benefit. However, disregarding current guidelines, physiotherapists also use traction for non-radicular neck pain. Various traction delivery modes and parameters were used within a comprehensive plan of care incorporating multiple interventions.
Collapse
Affiliation(s)
- Shilpa Agarwal
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Vivek Dineshbhai Patel
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Ashish John Prabhakar
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Charu Eapen
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| |
Collapse
|
2
|
López-Pardo MJ, Calvache-Mateo A, Martín-Núñez J, Heredia-Ciuró A, López-López L, Valenza MC, Cabrera-Martos I. Routine Physical Therapy with and without Neural Mobilization in Chronic Musculoskeletal Neck Disorders with Nerve-Related Symptoms: Systematic Review and Meta-Analysis. Healthcare (Basel) 2024; 12:1225. [PMID: 38921339 PMCID: PMC11203317 DOI: 10.3390/healthcare12121225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/18/2024] [Accepted: 06/18/2024] [Indexed: 06/27/2024] Open
Abstract
No previous study has evaluated the effectiveness of routine physical therapy with and without neural mobilization for patients with chronic musculoskeletal neck disorders and cervical radiculopathy. The objective is to evaluate the effectiveness of routine physical therapy with and without neural mobilization on pain and mobility in patients with chronic musculoskeletal neck disorders and cervical radiculopathy. A systematic review with meta-analysis of randomized clinical trials involving the use of neural mobilization techniques for the treatment of chronic musculoskeletal neck disorders and cervical radiculopathy was conducted. Methodological quality was assessed by the Cochrane Risk of Bias Tool and PEDro scale. Data were pooled and a meta-analysis was performed using a random effects model with Review Manager 5 software. Seven articles were included in our review. Significant differences were found in mobility but not in pain in favor of using routine physical therapy with neural mobilization for the treatment of chronic musculoskeletal neck disorders and cervical radiculopathy. Our results show that routine physical therapy accompanied by neural mobilization is superior for improving mobility in comparison with routine physical therapy alone in patients with musculoskeletal neck disorders and cervical radiculopathy.
Collapse
Affiliation(s)
| | | | | | | | - Laura López-López
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 60 Av. De la Ilustración, 18016 Granada, Spain; (M.J.L.-P.); (A.C.-M.); (J.M.-N.); (A.H.-C.); (M.C.V.); (I.C.-M.)
| | | | | |
Collapse
|
3
|
Lascurain-Aguirrebeña I, Dominguez L, Villanueva-Ruiz I, Ballesteros J, Rueda-Etxeberria M, Rueda JR, Casado-Zumeta X, Araolaza-Arrieta M, Arbillaga-Etxarri A, Tampin B. Effectiveness of neural mobilisation for the treatment of nerve-related cervicobrachial pain: a systematic review with subgroup meta-analysis. Pain 2024; 165:537-549. [PMID: 37870223 DOI: 10.1097/j.pain.0000000000003071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/13/2023] [Indexed: 10/24/2023]
Abstract
ABSTRACT Neural mobilisations (NM) have been advocated for the treatment of nerve-related cervicobrachial pain; however, it is unclear what types of patients with nerve-related cervicobrachial pain (if any) may benefit. Medline, Web of Science, Scopus, PeDro, Cinahl, and Cochrane databases were searched from inception until December 2022. Randomised controlled trials were included if they assessed the effectiveness of NM in nerve-related cervicobrachial pain, and outcome measures were pain intensity and/or disability. Studies were classified according to their inclusion/exclusion criteria as radiculopathy , Wainner cluster , Hall , and Elvey cluster or other . Meta-analyses with subgroup analyses were performed. Risk of bias was assessed using Cochrane Rob2 tool. Twenty-seven studies were included. For pain and disability reduction, NM was found to be more effective than no treatment (pooled pain mean difference [MD] = -2.81, 95% confidence interval [CI] = -3.81 to -1.81; pooled disability standardized mean difference = -1.55, 95% CI = -2.72 to -0.37), increased the effectiveness of standard physiotherapy as an adjuvant when compared with standard physiotherapy alone (pooled pain MD = -1.44, 95% CI = -1.98 to -0.89; pooled disability MD = -11.07, 95% CI = -16.38 to -5.75) but was no more effective than cervical traction (pooled pain MD = -0.33, 95% CI = -1.35 to 0.68; pooled disability MD = -10.09, 95% CI = -21.89 to 1.81). For disability reduction, NM was found to be more effective than exercise (pooled MD = -18.27, 95% CI = -20.29 to -17.44). In most comparisons, there were significant differences in the effectiveness of NM between the subgroups. Neural mobilisations was consistently more effective than all alternative interventions (no treatment, traction, exercise, and standard physiotherapy alone) in 13 studies classified as Wainner cluster . PROSPERO registration: CRD42022376087.
Collapse
Affiliation(s)
- Ion Lascurain-Aguirrebeña
- Department of Physiology, Physiotherapy Area, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
- Biodonostia Health Research Institute, Bioengineering Area, Innovación Group, San Sebastián, Spain
| | - Laura Dominguez
- Department of Preventive Medicine and Public Health, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Iker Villanueva-Ruiz
- Department of Preventive Medicine and Public Health, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
- Deusto Physical TherapIker Group, Physical Therapy Department, Faculty of Health Sciences, University of Deusto, Donostia-San Sebastián, Spain
| | - Javier Ballesteros
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Department of Neurosciences, University of the Basque Country UPV/EHU, Leioa, Spain
- Ciber Mental Health (CIBERSAM), Madrid, Spain
| | | | - Jose-Ramón Rueda
- Department of Preventive Medicine and Public Health, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Xabat Casado-Zumeta
- Deusto Physical TherapIker Group, Physical Therapy Department, Faculty of Health Sciences, University of Deusto, Donostia-San Sebastián, Spain
| | - Maialen Araolaza-Arrieta
- Deusto Physical TherapIker Group, Physical Therapy Department, Faculty of Health Sciences, University of Deusto, Donostia-San Sebastián, Spain
| | - Ane Arbillaga-Etxarri
- Deusto Physical TherapIker Group, Physical Therapy Department, Faculty of Health Sciences, University of Deusto, Donostia-San Sebastián, Spain
| | - Brigitte Tampin
- Department of Physiotherapy, Sir Charles Gairdner Hospital, Perth, Australia
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Faculty of Business and Social Sciences, Hochschule Osnabrueck, University of Applied Sciences, Osnabrueck, Germany
| |
Collapse
|
4
|
Salniccia F, de Vidania S, Martinez-Caro L. Peripheral and central changes induced by neural mobilization in animal models of neuropathic pain: a systematic review. Front Neurol 2024; 14:1289361. [PMID: 38249743 PMCID: PMC10797109 DOI: 10.3389/fneur.2023.1289361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Neural mobilization (NM) is a physiotherapy technique involving the passive mobilization of limb nerve structures with the aim to attempt to restore normal movement and structural properties. In recent years, human studies have shown pain relief in various neuropathic diseases and other pathologies as a result of this technique. Improvement in the range of motion (ROM), muscle strength and endurance, limb function, and postural control were considered beneficial effects of NM. To determine which systems generate these effects, it is necessary to conduct studies using animal models. The objective of this study was to gather information on the physiological effects of NM on the peripheral and central nervous systems (PNS and CNS) in animal models. Methods The search was performed in Medline, Pubmed and Web of Science and included 8 studies according to the inclusion criteria. Results The physiological effects found in the nervous system included the analgesic, particularly the endogenous opioid pathway, the inflammatory, by modulation of cytokines, and the immune system. Conclusion On the basis of these results, we can conclude that NM physiologically modifies the peripheral and central nervous systems in animal models.
Collapse
Affiliation(s)
- Federico Salniccia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | - Silvia de Vidania
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | - Leticia Martinez-Caro
- Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, Logroño, Spain
- Facultad de Ciencias Sociales Aplicadas y de la Comunicación, UNIE Universidad y Empresa, Madrid, Spain
| |
Collapse
|
5
|
Plener J, da Silva-Oolup S, To D, Csiernik B, Hofkirchner C, Cox J, Chow N, Hogg-Johnson S, Ammendolia C. Eligibility Criteria of Participants in Randomized Controlled Trials Assessing Conservative Management of Cervical Radiculopathy: A Systematic Review. Spine (Phila Pa 1976) 2023; 48:E132-E157. [PMID: 36730764 DOI: 10.1097/brs.0000000000004537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/13/2022] [Indexed: 02/04/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE The aim of this study was to evaluate the inclusion and exclusion criteria for participants in randomized control trials (RCTs) assessing conservative management for cervical radiculopathy (CR), to determine if any consensus exists within the literature. SUMMARY OF BACKGROUND DATA A 2012 systematic review identified a lack of uniformity for the eligibility criteria of participants in RCTs evaluating conservative interventions for CR. Since then, a large number of RCTs have been published, signaling the need for an updated evaluation of this topic. MATERIALS AND METHODS We electronically searched MEDLINE, CENTRAL, CINAHL, Embase, and PsycINFO from inception to June 15, 2022, to identify RCTs assessing conservative management of CR. Information extracted was analyzed to determine the level of homogeneity and/or heterogeneity of the inclusion and exclusion criteria across studies. RESULTS Seventy-six RCTs met our inclusion criteria with 68 distinct trials identified. The inclusion of arm pain with or without another symptom ( i.e. numbness, paresthesia, or weakness) was required in 69.12% of trials, 50% of trials required participants to exhibit neck symptoms, and 73.53% of studies required some form of clinical examination findings, but inconsistencies existed for the number and type of tests used. Furthermore, 41.18% of trials included imaging, with 33.82% of trials requiring magnetic resonance imaging findings. The most common exclusion criteria included were the presence of red flags and cervical myelopathy in 66.18% and 58.82% of trials, respectively. CONCLUSIONS Overall, there is still a lack of uniformity for the inclusion/exclusion criteria of trials assessing the conservative management of CR, with some improvements noted compared with the 2012 review. Based on the current literature assessing the diagnostic utility of clinical symptoms and confirmatory tests, we proposed inclusion criteria for trials assessing conservative interventions. Future research should aim to develop standardized classification criteria to improve consistency among studies.
Collapse
Affiliation(s)
- Joshua Plener
- Division of Graduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sophia da Silva-Oolup
- Division of Graduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Daphne To
- Department of Clinical Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Ben Csiernik
- Department of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | | | - Jocelyn Cox
- Department of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Ngai Chow
- Private Practice, Toronto, ON, Canada
| | - Sheilah Hogg-Johnson
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Institute for Disability and Rehabilitation Research, Oshawa, ON, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | - Carlo Ammendolia
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
6
|
Plener J, Csiernik B, To D, da Silva-Oolup S, Hofkirchner C, Cox J, Cancelliere C, Chow N, Hogg-Johnson S, Ammendolia C. Conservative Management of Cervical Radiculopathy: A Systematic Review. Clin J Pain 2023; 39:138-146. [PMID: 36599029 DOI: 10.1097/ajp.0000000000001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/13/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The purpose of this systematic review was to assess the effectiveness and safety of conservative interventions compared with other interventions, placebo/sham interventions, or no intervention on disability, pain, function, quality of life, and psychological impact in adults with cervical radiculopathy (CR). METHODS We searched MEDLINE, CENTRAL, CINAHL, Embase, and PsycINFO from inception to June 15, 2022 to identify studies that were randomized controlled trials, had at least one conservative treatment arm, and diagnosed participants with CR through confirmatory clinical examination and/or diagnostic tests. Studies were appraised using the Cochrane Risk of Bias 2 tool and the quality of the evidence was rated using the Grades of Recommendations, Assessment, Development, and Evaluation approach. RESULTS Of the 2561 records identified, 59 trials met our inclusion criteria (n = 4108 participants). Due to clinical and statistical heterogeneity, the findings were synthesized narratively. There is very-low certainty evidence supporting the use of acupuncture, prednisolone, cervical manipulation, and low-level laser therapy for pain and disability in the immediate to short-term, and thoracic manipulation and low-level laser therapy for improvements in cervical range of motion in the immediate term. There is low to very-low certainty evidence for multimodal interventions, providing inconclusive evidence for pain, disability, and range of motion. There is inconclusive evidence for pain reduction after conservative management compared with surgery, rated as very-low certainty. DISCUSSION There is a lack of high-quality evidence, limiting our ability to make any meaningful conclusions. As the number of people with CR is expected to increase, there is an urgent need for future research to help address these gaps.
Collapse
Affiliation(s)
- Joshua Plener
- Division of Graduate Education
- Institute of Health Policy, Management and Evaluation
| | | | | | | | | | | | - Carol Cancelliere
- Institute for Disability and Rehabilitation Research
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | | | - Sheilah Hogg-Johnson
- Department of Research and Innovation, Canadian Memorial Chiropractic College
- Institute of Health Policy, Management and Evaluation
- Dalla Lana School of Public Health
- Institute for Disability and Rehabilitation Research
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Carlo Ammendolia
- Institute of Health Policy, Management and Evaluation
- Department of Surgery, University of Toronto
- Department of Medicine, Mount Sinai Hospital, Toronto
| |
Collapse
|
7
|
The Effectiveness of Neuromobilization in Patients With Cervical Radiculopathy: A Systematic Review With Meta-Analysis. J Sport Rehabil 2023; 32:325-334. [PMID: 36395760 DOI: 10.1123/jsr.2022-0259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022]
Abstract
CONTEXT Neuromobilization exercises (NE) could be a useful therapeutic tool to induce analgesia and increase function and range of motion (ROM) in patients with musculoskeletal pathologies with neuropathic components; however, the effectiveness of this intervention in patients with cervical radiculopathy (CR) is unknown. OBJECTIVE To determine the effectiveness of NE in CR on pain, function, and ROM. DESIGN Systematic review and meta-analysis. EVIDENCE ACQUISITION An electronic search was performed in the MEDLINE, Scopus, PEDro, and EBSCO databases from inception until June 2022. The authors included randomized clinical trials that evaluated the effectiveness of NE against control groups or other interventions that aimed to treat patients with CR. EVIDENCE SYNTHESIS Seven clinical trials met the eligibility criteria, and for the quantitative synthesis, 5 studies were included. For the studies that compared NE with a control group, the standardized mean difference for pain was -1.33/10 (95% confidence interval [CI], -1.80 to -0.86; P < .01; I2 = 0%), for function with the Neck Disability Index was -1.21/50 (95% CI, -1.67 to -0.75; P < .01; I2 = 0%), and for neck flexion and extensions was 0.66 (95% CI, 0.23 to 1.10; P < .01; I2 = 0%) and 0.47 (95% CI, 0.04 to 0.90; P < .01; I2 = 0%), respectively, with evidence of clinical effectiveness. These findings were based on moderate-quality evidence according to the Grading of Recommendation, Assessment, Development, and Evaluation rating. In studies that compared NE with other interventions, the meta-analysis failed to demonstrate the statistical or clinical superiority of NE. CONCLUSIONS Moderate quality of evidence suggests that NE may be superior to no treatment for pain, function, and ROM in patients with CR. In contrast, NE are not superior to other interventions in the same outcomes, based on low- to very low-quality evidence. More high-quality research is needed to assess the consistency of these results.
Collapse
|
8
|
Comparison of neural mobilization and conservative treatment on pain, range of motion, and disability in cervical radiculopathy: A randomized controlled trial. PLoS One 2022; 17:e0278177. [PMID: 36472990 PMCID: PMC9725158 DOI: 10.1371/journal.pone.0278177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/12/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The objective of the study was to compare the effectiveness of neural mobilization technique with conservative treatment on pain intensity, cervical range of motion, and disability. METHODS It was a randomized clinical trial; data was collected from Mayo Hospital, Lahore. Eighty-eight patients fulfilling the sample selection criteria were randomly assigned into group 1 (neural mobilization) and group 2 (conventional treatment). Pain intensity was measured on a numeric pain rating scale, range of motion with an inclinometer, and functional status with neck disability index (NDI). Data were analyzed using SPSS, repeated measure ANOVA for cervical ranges and the Friedman test for NPRS and NDI were used for within-group analysis. Independent samples t-test for cervical ranges and Mann-Whitney U test for NPRS and NDI were used for between-group comparisons. RESULTS There was a significant improvement in pain, disability, and cervical range of motion after the treatment in both groups compared to the pre-treatment status (p < 0.001), and when both groups were compared neural mobilization was more effective than conventional treatment in reducing pain and neck disability (p < 0.001), but there was no significant difference present in the mean score of cervical range of motion between both groups. (p>0.05). CONCLUSIONS The present study concluded that both neural mobilization and conservative treatment were effective as an exercise program for patients with cervical radiculopathy, however, neural mobilization was more effective in reducing pain and neck disability in cervical radiculopathy. TRIAL REGISTRATION RCT20190325043109N1.
Collapse
|
9
|
Çelenlioğlu AE, Şencan S, Saçaklıdır R, Can Öztürk E, Gündüz OH. Cervical Radiculopathy Impact Scale: Translation, cross-cultural adaptation, reliability and validity of the Turkish version. Arch Rheumatol 2022; 37:574-583. [PMID: 36879564 PMCID: PMC9985382 DOI: 10.46497/archrheumatol.2022.9639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/12/2022] [Indexed: 03/08/2023] Open
Abstract
Objectives The aim of this study was to translate and cross-culturally adapt the English version of the Cervical Radiculopathy Impact Scale (CRIS) and to investigate the validity and reliability of the Turkish version of the CRIS. Patients and methods Between October 2021 and February 2022, a total of 105 patients (48 males, 57 females; mean age: 45.4±11.8 years; range, 36.5 to 55.5 years) who were diagnosed with cervical radiculopathy due to disc herniation were included. Disability and quality of life were evaluated with the Neck Disability Index (NDI), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Short Form-12 (SF-12). Pain severity was evaluated using the Numerical Rating Scale (NRS) in three subscales (neck pain, pain radiating to the arm, and numbness in the finger, hand, or arm). The internal consistency for CRIS was assessed using the Cronbach alpha and test-retest reliability by intraclass correlation coefficients (ICCs). Explanatory factor analyses were performed for construct validity. To examine the content validity, the correlations among the three subgroup scores of CRIS and the other scale scores were analyzed. Results The internal consistency of CRIS was found to be high (α=0.937). A high reliability was obtained for test-retest reliability for the three subscales of CRIS (Symptoms, Energy and postures, Actions and activities) (ICC: 0.950, 0.941, 0.962, respectively; p<0.001). All three subscale scores of CRIS were correlated with the NDI, QuickDASH, SF-12 (physical and mental) and NRS scores (r=0.358-0.713, p<0.001). Factor analysis showed that the scale had five factors. Conclusion The CRIS is a valid and reliable instrument for Turkish patients with cervical radiculopathy due to disc herniation.
Collapse
Affiliation(s)
- Alp Eren Çelenlioğlu
- Department of Pain Medicine, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Savaş Şencan
- Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Marmara University Faculty of Medicine, Istanbul, Türkiye
| | - Rekib Saçaklıdır
- Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Marmara University Faculty of Medicine, Istanbul, Türkiye
| | - Ekim Can Öztürk
- Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Marmara University Faculty of Medicine, Istanbul, Türkiye
| | - Osman Hakan Gündüz
- Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Marmara University Faculty of Medicine, Istanbul, Türkiye
| |
Collapse
|
10
|
Muacevic A, Adler JR. Addition of McKenzie Exercises to a Multimodal Physical Therapy Approach for Cervical Radiculopathy: A Case Report. Cureus 2022; 14:e32992. [PMID: 36712723 PMCID: PMC9879586 DOI: 10.7759/cureus.32992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 12/29/2022] Open
Abstract
Cervical radiculopathy is a common subset of neck pain involving cervical nerve root irritation potentially resulting in numbness, radicular pain, and/or upper extremity weakness. The Neck Pain Clinical Practice Guidelines published by the American Physical Therapy Association does not support McKenzie exercises in isolation when treating cervical radiculopathy, but endorses a multimodal physical therapy approach for the management of cervical radiculopathy. The purpose of this case report is to exemplify the treatment of a patient with cervical radiculopathy utilizing McKenzie centralization exercises within a multimodal physical therapy approach for improved patient outcomes. The patient was a 49-year-old female with a past medical history of type 1 diabetes mellitus with a history of subacute cervical pain with left upper extremity radicular symptoms for four months consistent with cervical radiculopathy. Interventions included a multimodal physical therapy approach consisting of McKenzie cervical retraction exercises, thoracic manipulation, rib mobilizations, manual cervical traction, peripheral nerve mobilization, and scapular retraction with postural exercises. The patient received four visits over a five-week period with an emphasis on patient education and independence. Although McKenzie centralization exercises are not supported by the Neck Pain Clinical Practice Guideline (CPG) in isolation, adding these exercises to the supported recommendation of a multimodal physical therapy approach for cervical radiculopathy has promise.
Collapse
|
11
|
Effects of Neurodynamic Mobilization on Health-Related Quality of Life and Cervical Deep Flexors Endurance in Patients of Cervical Radiculopathy: A Randomized Trial. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9385459. [PMID: 36246968 PMCID: PMC9556173 DOI: 10.1155/2022/9385459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022]
Abstract
Purpose Cervical radiculopathy is disorder of cervical spinal nerve root affecting large number of population. Previously many studies are conducted to design suitable protocol for management of this disorder, but they lack in quality. The purpose of this study was to compare the effects of neural mobilization and cervical isometrics on health-related quality of life and deep flexors endurance in cervical radiculopathy. Methods A double-blinded randomized clinical trial was conducted at Mayo Hospital, Lahore, Pakistan. Eighty-eight patients within the age range of 35-50 years were included in the study after taking their consent. In the experimental group (n = 44), median nerve mobilization was applied along with cervical isometric exercises. The control group (n = 44) performed cervical isometric exercises alone. Muscle endurance was measured by craniocervical flexion test and quality of life on 36 items short form health survey SF-36 scale. Measurements were taken at baseline, at 2nd week, and at 4th week. For missing data, intention-to-treat analysis was used. Results Within-group comparison with Friedman test showed a significant difference between pre, mid, and posttreatment scores on craniocervical flexion test and in all domains of SF 36 in both groups. While between-group comparison with Mann–Whitney U test showed all variables were similar at baseline but after 4 weeks there was a statistically significant improvement in craniocervical flexion test scores and all domains of SF 36 in the experimental group. But domain of pain showed mean rank of 49.43 after 4 weeks in the experimental group and 39.57 in the control group with p = 0.065 and d = 0.579, while for all the other 7 domains values were p < .05 and d > 0.25. Conclusion Neural mobilization combined with cervical isometrics shows significant effects in improving quality of life and deep flexors endurance in patients with cervical radiculopathy than cervical isometrics alone.
Collapse
|
12
|
Alharmoodi BY, Arumugam A, Ahbouch A, Moustafa IM. Comparative Effects of Tensioning and Sliding Neural Mobilization on Peripheral and Autonomic Nervous System Function: A Randomized Controlled Trial. Hong Kong Physiother J 2022; 42:41-53. [PMID: 35782695 PMCID: PMC9244596 DOI: 10.1142/s1013702522500056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 12/24/2021] [Accepted: 01/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Although different types of neural mobilization (NM) exercises induce different amounts of longitudinal nerve excursion and strain, the question whether the increased longitudinal stress and nerve excursion from sliding or tensioning intervention may subtly affect the neural functions has not been answered yet. Objective: To compare the effects of tensioning NM versus sliding NM of the median nerve on peripheral and autonomic nervous system function. Methods: In this randomized controlled trial, 90 participants were randomly assigned to tensioning NM, sliding NM, or sham NM. The neurophysiological outcome measures included peak-to-peak amplitude of the dermatomal somatosensory evoked potential (DSSEP) for dermatomes C6, C7, C8, and T1. Secondary outcome measures included amplitude and latency of skin sympathetic response. All outcome measures were assessed pretreatment, immediately after the two weeks of treatment and one week after the last session of the treatment. Results: A 2-way repeated measures ANOVA revealed significant differences between the three groups. The post hoc analysis indicated that tensioning NM significantly decreased the dermatomal amplitude for C6, C7, C8, and T1 (p<0.005). Sympathetic skin responses in the gliding NM group showed lower amplitudes and prolonged latencies post-treatment when compared to tensioning NM group (p<0.05). In contrast, no significant changes were observed in the DSSEPs and skin sympathetic responses for participants in the sham treatment group (p>0.05). Conclusions: A tensioning NM on the median nerve had a possible adverse effect on the neurophysiology variables of the nerves involved in the neural mobilization. Thus, tensioning NM with the current parameters that place increased stress and strain on the peripheral nervous system should be avoided.
Collapse
Affiliation(s)
| | - Ashokan Arumugam
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Amal Ahbouch
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Ibrahim M. Moustafa
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, UAE
- Basic Science Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| |
Collapse
|
13
|
Martin-Vera D, Fernández-Carnero J, Rodríguez-Sanz D, Calvo-Lobo C, López-de-Uralde-Villanueva I, Arribas-Romano A, Martínez-Lozano P, Pecos-Martín D. Median Nerve Neural Mobilization Adds No Additional Benefit When Combined with Cervical Lateral Glide in the Treatment of Neck Pain: A Randomized Clinical Trial. J Clin Med 2021; 10:jcm10215178. [PMID: 34768696 PMCID: PMC8584397 DOI: 10.3390/jcm10215178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 01/02/2023] Open
Abstract
Background: This study aimed to compare the effectiveness of cervical lateral glide (CLG) added to median nerve neural mobilization (MNNM) in patients with neck pain (NP). Methods: A single-blinded randomized controlled clinical trial was carried out in a Pain Management Unit from a Hospital. A total sample of 72 patients with NP was recruited from a hospital. Patients were randomized to receive isolated CLG (n = 36) or CLG + MNNM (n = 36). Bilateral elbow extension range of motion (ROM) on upper limb neurodynamic test 1 (ULNT1), bilateral pressure pain thresholds (PPT) on the median nerve at elbow joint, C6 zygapophyseal joint and tibialis anterior, Visual analogue scale (VAS), body chart distribution of pain, active cervical ROM (CROM), Neck Disability Index (NDI), and Tampa Scale of Kinesiophobia (TSK-11) were measured at baseline as well as immediately, 15 days, and 1 month after treatment. Results: There were no statistically significant interactions (p > 0.05) between treatment and time for median nerve mechanosensitivity outcomes, pain intensity, symptom distribution, and PPT of the widespread pain assessment, as well as cervical function, and kinesiophobia. Conclusions: MNNM gave no additional benefit to CLG in patients with NP regarding pain intensity, symptom distribution, mechanosensitivity, functionality, and kinesiophobia. Only two treatment sessions and the short follow-up are important issues, therefore, justifying further studies to answer the research question with better methodology.
Collapse
Affiliation(s)
- Daniel Martin-Vera
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28005 Madrid, Spain; (D.M.-V.); (P.M.-L.)
| | - Josué Fernández-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28922 Madrid, Spain;
- La Paz Hospital Institute for Health Research, IdiPAZ, 261, 28046 Madrid, Spain
- Grupo Multidisciplinar de Investigación y Tratamiento del Dolor, Grupo de Excelencia Investigadora, URJC-Banco de Santander, 28922 Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonóma de Madrid, 28049 Madrid, Spain
- Grupo de Investigación de Dolor musculoesqueletico y Control Motor, Universidad Europea de Madrid, 28005 Madrid, Spain
- Correspondence: ; Tel.: +34-914888949
| | - David Rodríguez-Sanz
- School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28606 Madrid, Spain; (D.R.-S.); (C.C.-L.)
| | - Cesar Calvo-Lobo
- School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28606 Madrid, Spain; (D.R.-S.); (C.C.-L.)
| | | | - Alberto Arribas-Romano
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28922 Madrid, Spain;
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933 Alcorcón, Spain
| | - Pedro Martínez-Lozano
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28005 Madrid, Spain; (D.M.-V.); (P.M.-L.)
| | - Daniel Pecos-Martín
- Physiotherapy and Pain Research Center, General Foundation of the University of Alcalá, 28805 Madrid, Spain;
- Department of Physical Therapy, Alcalá University, 28805 Alcalá de Henares, Spain
| |
Collapse
|
14
|
Varangot-Reille C, Cuenca-Martínez F, Arribas-Romano A, Bertoletti-Rodríguez R, Gutiérrez-Martín Á, Mateo-Perrino F, Suso-Martí L, Blanco-Díaz M, Calatayud J, Casaña J. Effectiveness of Neural Mobilisation Techniques in the Management of Musculoskeletal Neck Disorders with Nerve-Related Symptoms: A Systematic Review and Meta-Analysis with a Mapping Report. PAIN MEDICINE 2021; 23:707-732. [PMID: 34633462 DOI: 10.1093/pm/pnab300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/17/2021] [Accepted: 10/08/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objective was to assess the effectiveness of neural mobilisation (NM) techniques in the management of musculoskeletal neck disorders with nerve-related symptoms (MND-NRS). METHODS We conducted a systematic review with meta-analysis, using pain intensity, disability, perceived function, cervical range of motion and mechanosensitivity as the main outcome measures. RESULTS The systematic review included 22 studies (n = 978). More favourable outcomes were observed for NM on pain intensity compared with control interventions (standardised mean differences (SMDs) -0.92; 95% CI - 1.66--0.18), but not compared with other treatments (OTs) (SMD 1.06; 95% CI - 0.02-2.15). Regarding neck pain intensity, no significant differences were found in favour of NM compared with OTs (SMD 0.37; 95% CI - 0.35-1.1). However, between-treatment differences were found in favour of OT on arm-pain intensity (SMD 0.57; 95% CI 0.08-1.05). In addition, the grouped MA did not show statistically significant differences between NM and OT outcomes on the cervical range of motion (SMD 0.16; 95% CI - 0.06-0.38). However, compared with no intervention, NM was associated with significantly improved outcomes in cervical rotation (SMD 0.91; 95% CI 0.61-1.22). Similar results were found regarding disability (SMD -0.08; 95% CI - 0.36--0.20, and SMD -1.44; 95% CI - 2.28--0.6, respectively). Finally, NM was associated with more favourable outcomes on mechanosensitivity compared with OT (SMD 0.79; 95% CI 0.15-1.42) and greater improvements in function compared with no intervention (SMD 0.89; 95% CI 0.16-1.62). CONCLUSIONS NM appeared to be effective to improve overall pain intensity when embedded in a physiotherapy treatment in the management of MND-NRS. When compared with no intervention, it was effective to improve neck rotation, disability, and function. However, it was not superior to other types of treatments in improving overall pain intensity, neck pain intensity, arm pain intensity, cervical range of motion and disability, except for mechanosensitivity.
Collapse
Affiliation(s)
- Clovis Varangot-Reille
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain
| | - Ferran Cuenca-Martínez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alberto Arribas-Romano
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Rodrigo Bertoletti-Rodríguez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain
| | - Álvaro Gutiérrez-Martín
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain
| | - Fernando Mateo-Perrino
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain
| | - Luis Suso-Martí
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Department of Physiotherapy, Universidad CEU Cardenal Herrera, CEU Universities, Valencia, Spain
| | - María Blanco-Díaz
- Surgery and Medical Surgical Specialities Department, Faculty of Medicine and Health Sciences, University of Oviedo, Oviedo, Asturias, Spain
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - José Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| |
Collapse
|
15
|
Kuligowski T, Skrzek A, Cieślik B. Manual Therapy in Cervical and Lumbar Radiculopathy: A Systematic Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116176. [PMID: 34200510 PMCID: PMC8201115 DOI: 10.3390/ijerph18116176] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/07/2021] [Accepted: 06/07/2021] [Indexed: 01/22/2023]
Abstract
The aim of this study was to describe and update current knowledge of manual therapy accuracy in treating cervical and lumbar radiculopathy, to identify the limitations in current studies, and to suggest areas for future research. The study was conducted according to PRISMA guidelines for systematic reviews. A comprehensive literature review was conducted using PubMed and Web of Science databases up to April 2020. The following inclusion criteria were used: (1) presence of radiculopathy; (2) treatment defined as manual therapy (i.e., traction, manipulation, mobilization); and (3) publication defined as a Randomized Controlled Trial. The electronic literature search resulted in 473 potentially relevant articles. Finally, 27 articles were accepted: 21 on cervical (CR) and 6 in lumbar radiculopathy (LR). The mean PEDro score for CR was 6.6 (SD 1.3), and for LR 6.7 (SD 1.6). Traction-oriented techniques are the most frequently chosen treatment form for CR and are efficient in reducing pain and improving functional outcomes. In LR, each of the included publications used a different form of manual therapy, which makes it challenging to summarize knowledge in this group. Of included publications, 93% were either of moderate or low quality, which indicates that quality improvement is necessary for this type of research.
Collapse
Affiliation(s)
- Tomasz Kuligowski
- Faculty of Physiotherapy, University School of Physical Education in Wroclaw, 51-612 Wroclaw, Poland; (T.K.); (A.S.)
| | - Anna Skrzek
- Faculty of Physiotherapy, University School of Physical Education in Wroclaw, 51-612 Wroclaw, Poland; (T.K.); (A.S.)
| | - Błażej Cieślik
- Faculty of Health Sciences, Jan Dlugosz University in Czestochowa, 42-200 Czestochowa, Poland
- Correspondence:
| |
Collapse
|
16
|
Borrella-Andrés S, Marqués-García I, Lucha-López MO, Fanlo-Mazas P, Hernández-Secorún M, Pérez-Bellmunt A, Tricás-Moreno JM, Hidalgo-García C. Manual Therapy as a Management of Cervical Radiculopathy: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9936981. [PMID: 34189141 PMCID: PMC8195637 DOI: 10.1155/2021/9936981] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/03/2021] [Accepted: 05/27/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cervical radiculopathy is defined as a disorder involving dysfunction of the cervical nerve roots characterised by pain radiating and/or loss of motor and sensory function towards the root affected. There is no consensus on a good definition of the term. In addition, the evidence regarding the effectiveness of manual therapy in radiculopathy is contradictory. OBJECTIVE To assess the effectiveness of manual therapy in improving pain, functional capacity, and range of motion in treating cervical radiculopathy with and without confirmation of altered nerve conduction. METHODS Systematic review of randomised clinical trials on cervical radiculopathy and manual therapy, in PubMed, Web of Science, Scopus, PEDro, and Cochrane Library Plus databases. The PRISMA checklist was followed. Methodological quality was evaluated using the PEDro scale and RoB 2.0. tool. RESULTS 17 clinical trials published in the past 10 years were selected. Manual therapy was effective in the treatment of symptoms related to cervical radiculopathy in all studies, regardless of the type of technique and dose applied. CONCLUSIONS This systematic review did not establish which manual therapy techniques are the most effective for cervical radiculopathy with electrophysiological confirmation of altered nerve conduction. Without this confirmation, the application of manual therapy, regardless of the protocol applied and the manual therapy technique selected, appears to be effective in reducing chronic cervical pain and decreasing the index of cervical disability in cervical radiculopathy in the short term. However, it would be necessary to agree on a definition and diagnostic criteria of radiculopathy, as well as the definition and standardisation of manual techniques, to analyse the effectiveness of manual therapy in cervical radiculopathy in depth.
Collapse
Affiliation(s)
- Sergio Borrella-Andrés
- Health Sciences Faculty, University of Zaragoza, Zaragoza 50009, Spain
- Physiotherapy Research Unit, University of Zaragoza, Zaragoza 50009, Spain
| | - Isabel Marqués-García
- Health Sciences Faculty, University of Zaragoza, Zaragoza 50009, Spain
- Physiotherapy Research Unit, University of Zaragoza, Zaragoza 50009, Spain
| | - María Orosia Lucha-López
- Health Sciences Faculty, University of Zaragoza, Zaragoza 50009, Spain
- Physiotherapy Research Unit, University of Zaragoza, Zaragoza 50009, Spain
| | - Pablo Fanlo-Mazas
- Health Sciences Faculty, University of Zaragoza, Zaragoza 50009, Spain
- Physiotherapy Research Unit, University of Zaragoza, Zaragoza 50009, Spain
| | - Mar Hernández-Secorún
- Health Sciences Faculty, University of Zaragoza, Zaragoza 50009, Spain
- Physiotherapy Research Unit, University of Zaragoza, Zaragoza 50009, Spain
| | - Albert Pérez-Bellmunt
- Department of Basic Sciences, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés 08195, Spain
- ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, Sant Cugat del Vallés 08195, Spain
| | - José Miguel Tricás-Moreno
- Health Sciences Faculty, University of Zaragoza, Zaragoza 50009, Spain
- Physiotherapy Research Unit, University of Zaragoza, Zaragoza 50009, Spain
| | - César Hidalgo-García
- Health Sciences Faculty, University of Zaragoza, Zaragoza 50009, Spain
- Physiotherapy Research Unit, University of Zaragoza, Zaragoza 50009, Spain
| |
Collapse
|
17
|
Savva C, Korakakis V, Efstathiou M, Karagiannis C. Cervical traction combined with neural mobilization for patients with cervical radiculopathy: A randomized controlled trial. J Bodyw Mov Ther 2020; 26:279-289. [PMID: 33992259 DOI: 10.1016/j.jbmt.2020.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 07/24/2020] [Accepted: 08/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although both neural mobilization (NM) and cervical traction (CT) are widely used interventions in cervical radiculopathy (CR), there is limited clinical data to support their use. OBJECTIVE To evaluate the effects of CT, with or without the addition of NM, on pain, function, and disability in patients with CR. DESIGN A randomized, double-blinded, placebo-controlled clinical trial. METHODS 66 patients with CR were randomly allocated to: a group (n = 22) received CT combined with NM (CT + NM), a group (n = 22) received CT combined with sham NM (CT + shamNM) and a wait-list control (WLC) group (n = 22). The Neck Disability Index (NDI), the Patient-Specific Functional Scale, the Numeric Pain Rating Scale (NPRS), grip strength and cervical spine mobility were used as outcome measures. A two-way analysis of variance was used to evaluate differences between the three groups at baseline and at 4-week follow-up. RESULTS Statistically and clinically significant between-group differences at 4-week follow-up were found between CT + NM and WLC groups in favor of CT + NM group in NDI scores (d = 1.30), NRPS (d = 1.94), and active cervical rotation towards the opposite arm (d = 1.18) and between CT + NM and CT + shamNM groups in favor of CT + NM group in NRPS (d = 1.21). No significant differences were observed between CT + shamNM and WLC groups in all outcome measures. Clinically significant within-group improvements were found only for the CT + NM group. CONCLUSION At 4-week follow-up, CT in combination with NM resulted in improved outcomes in pain, function and disability in patients with CR.
Collapse
Affiliation(s)
- Christos Savva
- Department of Health Science, European University, Diogenous 6, Engomi, Nicosia, Cyprus.
| | | | - Michalis Efstathiou
- Department of Life and Health Sciences, University of Nicosia, 46 Makedonitissas Avenue, Nicosia, Cyprus
| | - Christos Karagiannis
- Department of Health Science, European University, Diogenous 6, Engomi, Nicosia, Cyprus
| |
Collapse
|
18
|
Jesson T, Runge N, Schmid AB. Physiotherapy for people with painful peripheral neuropathies: a narrative review of its efficacy and safety. Pain Rep 2020; 5:e834. [PMID: 33490836 PMCID: PMC7808681 DOI: 10.1097/pr9.0000000000000834] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/28/2020] [Accepted: 06/04/2020] [Indexed: 01/12/2023] Open
Abstract
Pharmacological treatment for peripheral neuropathic pain has only modest effects and is often limited by serious adverse responses. Alternative treatment approaches including physiotherapy management have thus gained interest in the management of people with peripheral neuropathies. This narrative review summarises the current literature on the efficacy and safety of physiotherapy to reduce pain and disability in people with radicular pain and chemotherapy-induced peripheral neuropathy, 2 common peripheral neuropathies. For chemotherapy-induced peripheral neuropathy, the current evidence based on 8 randomised controlled trials suggests that exercise may reduce symptoms in patients with established neuropathy, but there is a lack of evidence for its preventative effect in patients who do not yet have symptoms. For radicular pain, most of the 21 trials investigated interventions targeted at improving motor control or reducing neural mechanosensitivity. The results were equivocal, with some indication that neural tissue management may show some benefits in reducing pain. Adverse events to physiotherapy seemed rare; however, these were not consistently reported across all studies. Although it is encouraging to see that the evidence base for physiotherapy in the treatment of peripheral neuropathic pain is growing steadily, the mixed quality of available studies currently prevents firm treatment recommendations. Based on promising preliminary data, suggestions are made on potential directions to move the field forward.
Collapse
Affiliation(s)
- Tom Jesson
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Nils Runge
- Connect Health, Benton Lane, Newcastle upon Tyne, Tyne and Wear, United Kingdom
| | - Annina B. Schmid
- Nuffield Department for Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
19
|
Liang L, Wei X, Feng M, Zhu L, Yu J, Yang G, Yin X, Zhou S, Li K, Yang M, Wang X. Huangqi Guizhi Wuwu Decoction for treating cervical radiculopathy: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e19137. [PMID: 32049834 PMCID: PMC7035008 DOI: 10.1097/md.0000000000019137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Huangqi Guizhi Wuwu Decoction (HGWD) is a common prescription for the treatment of cervical radiculopathy (CR). And the effectiveness and safety of HGWD for CR were assessed in this study. METHODS Seven databases were searched. Randomized controlled trials involving HGWD alone or HGWD combined with conventional treatment were enrolled. The authors in pairs independently assessed the risk of bias and extracted the data. RESULTS Eight studies involving 783 participants with CR were included. Meta-analysis revealed that the efficacy of HGWD for CR was significantly superior compared with control treatment (risk ratio = 1.12, 95% confidence interval [CI]:1.06-1.19, Z = 3.71; P = .0002). Compare with control group, there is an increase in visual analog scale (mean difference [MD] = 0.99; 95% CI: 0.83-1.14; Z = 12.57; P < .00001). There was also an improvement of neck disability index (MD = 9.2; 95% CI: 8.28-10.11; Z = 19.75; P < .00001). Adverse events were not mentioned in the 8 trials. CONCLUSION HGWD alone or HGWD plus other treatment may be helpful to patients with CR. However, the methodological quality of the randomized controlled trials was generally low. Larger and better-designed randomized controlled trials are recommended.
Collapse
Affiliation(s)
- Long Liang
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences, Chaoyang District
| | - Xu Wei
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences, Chaoyang District
| | - Minshan Feng
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences, Chaoyang District
| | - Liguo Zhu
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences, Chaoyang District
| | - Jie Yu
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences, Chaoyang District
| | - Gongbo Yang
- Department of Traumatology and Orthopedics, Xiyuan Hospital of Chinese Academy of Chinese Medical Sciences, Haidian District, Beijing
| | - Xunlu Yin
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences, Chaoyang District
| | - Shuaiqi Zhou
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences, Chaoyang District
| | - Kaiming Li
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences, Chaoyang District
| | - Mao Yang
- First Affiliated Hospital of Anhui University of Chinese Medicine, Shushan District, Anhui, China
| | - Xingyu Wang
- First Affiliated Hospital of Anhui University of Chinese Medicine, Shushan District, Anhui, China
| |
Collapse
|
20
|
Liang L, Feng M, Cui X, Zhou S, Yin X, Wang X, Yang M, Liu C, Xie R, Zhu L, Yu J, Wei X. The effect of exercise on cervical radiculopathy: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e17733. [PMID: 31702624 PMCID: PMC6855577 DOI: 10.1097/md.0000000000017733] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Cervical radiculopathy (CR), which is most often stems from degenerative disease in the cervical spine, has increasingly become a common and frequently occurring disease in clinic due to the popularity of electronic products, such as computes and cell phones. Some studies have shown that exercise or exercise combined with other treatments can effectively decrease pain and improve functional status. The objective was to analyze the effects of exercise for treating patients with CR. METHODS Seven databases were searched from inception to December 2018. Randomized controlled trials involving exercise alone or exercise combined with conventional treatment were enrolled. Data were pooled after trials quality assessment for meta-analysis. Outcomes were pain (visual analog scale [VAS]), quality of life (12-short form health survey, 36-short form health survey), and physical function accessed by neck disability index (NDI). RESULTS Ten studies involving 871 participants with CR were included. Meta-analysis revealed that compared with control group, there was a reduction in VAS (standardized mean difference = -0.89; 95% confidence interval [CI]: -1.34 to -0.44; Z = 3.89; P < .001). There was also an improvement of NDI (mean difference = -3.60; 95% CI: -6.27 to -0.94; Z = 2.65; P = .008)]. Additionally, although the results of subgroup analyses were changed due to the paucity of the quantity and quality of the included studies. The pooled results were verified to be stable by sensitivity analyses. Besides, the grading of recommendations assessment, development, and evaluation level of evidence is low for each outcome. CONCLUSION Exercise alone or exercise plus other treatment may be helpful to patients with CR. However, exercise option should be carefully considered for each patient with CR in accordance with their different situations. Large-scale studies using proper methodology are recommended.
Collapse
Affiliation(s)
- Long Liang
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Chaoyang District
- Beijing Key Laboratory of Orthopedics of Traditional Chinese Medicine, Beijing
| | - Minshan Feng
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Chaoyang District
- Beijing Key Laboratory of Orthopedics of Traditional Chinese Medicine, Beijing
| | - Xin Cui
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Chaoyang District
| | - Shuaiqi Zhou
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Chaoyang District
- Beijing Key Laboratory of Orthopedics of Traditional Chinese Medicine, Beijing
| | - Xunlu Yin
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Chaoyang District
- Beijing Key Laboratory of Orthopedics of Traditional Chinese Medicine, Beijing
| | - Xingyu Wang
- First Affiliated Hospital of Anhui University of Chinese Medicine
| | - Mao Yang
- First Affiliated Hospital of Anhui University of Chinese Medicine
| | - Cunhuan Liu
- Jinzhai County Chinese Medicine Hospital, Anhui, China
| | - Rong Xie
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Chaoyang District
| | - Liguo Zhu
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Chaoyang District
- Beijing Key Laboratory of Orthopedics of Traditional Chinese Medicine, Beijing
| | - Jie Yu
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Chaoyang District
- Beijing Key Laboratory of Orthopedics of Traditional Chinese Medicine, Beijing
| | - Xu Wei
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Chaoyang District
- Beijing Key Laboratory of Orthopedics of Traditional Chinese Medicine, Beijing
| |
Collapse
|