Abstract
Objective
To compare the effects of a neck-specific training program to prescribed physical
activity with both groups receiving a cognitive behavioral approach, on pain and disability
in patients with cervical radiculopathy (CR).
Design
Parallel-group randomized clinical trial with follow-up at 3, 6, 12, and 24 months.
Setting
Recruitment and assessments of participants were performed at a university hospital.
Interventions were performed in primary care setting at outpatient physiotherapy clinics.
Participants
Patients (N=144) with CR were recruited to participate in this clinical trial.
Interventions
Patients were randomly assigned to 3 months of either of a neck-specific training
program or prescribed physical activity.
Main Outcome Measures
Primary outcomes included self-rated neck and arm pain as collected by the visual
analog scale (VAS). Secondary outcomes were self-rated headache measured with the
VAS, the Neck Disability Index, the EuroQol 5D, the Fear Avoidance Beliefs Questionnaire,
and the Hospital Anxiety and Depression Scale. Assessments were performed at baseline
and at 3-, 6-, 12-, and 24-month follow-up periods.
Results
Intention-to-treat and per-protocol analyses showed no significant interaction (group
× time) or group effects. There were, however, significant time effects indicating
improvement over time for both groups for all outcomes except for levels of depression.
Conclusions
The study revealed that neck-specific training as well as prescribed physical activity
both including additional cognitive behavioral approach decreased the pain in patients
with CR, that is, participants improved regardless of the intervention received. There
is a lack of consensus of how to best manage individuals with CR. However, our findings
suggest that CR has a natural favorable long-term outcome when patients are prescribed
neck-specific training and exercise in combination with a behavioral approach.
Keywords
List of abbreviations:
95% CI (95% confidence interval), CR (cervical radiculopathy), EQ-5D (EuroQol 5D), FABQ (Fear Avoidance Beliefs Questionnaire), HADS (Hospital Anxiety and Depression Scale), ITT (intention to treat), NDI (Neck Disability Index), VAS (visual analog scale), WAD (whiplash associated disorder)To read this article in full you will need to make a payment
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References
- Headache in patients with cervical radiculopathy: a prospective study with selective nerve root blocks in 275 patients.Eur Spine J. 2007; 16: 953-959
- Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990.Brain. 1994; 117: 325-335
- Cervical radiculopathy: pathophysiology, presentation, and clinical evaluation.Neurosurgery. 2007; 60: S28-S34
- Treatment of neck pain: injections and surgical interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.Spine. 2008; 33: S153-S169
- Research priorities and methodological implications: the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.Spine. 2008; 33: S214-S220
- A systematic literature review on the effectiveness of non-invasive therapy for cervicobrachial pain.Man Ther. 2011; 16: 53-65
- The effectiveness of conservative treatment for patients with cervical radiculopathy: a systematic review.Clin J Pain. 2013; 29: 1073-1086
- Can the results 6 months after anterior cervical decompression and fusion identify patients who will have remaining deficit at long-term?.Disabil Rehabil. 2006; 28: 117-124
- Neck-related physical function, self-efficacy, and coping strategies in patients with cervical radiculopathy: a randomized clinical trial of postoperative physiotherapy.J Manipulative Physiol Ther. 2017; 40: 330-339
- Physical function outcome in cervical radiculopathy patients after physiotherapy alone compared with anterior surgery followed by physiotherapy: a prospective randomized study with a 2-year follow-up.Spine (Phila Pa 1976). 2013; 38: 300-307
- Surgery versus nonsurgical treatment of cervical radiculopathy: a prospective, randomized study comparing surgery plus physiotherapy with physiotherapy alone with a 2-year follow-up.Spine (Phila Pa 1976). 2013; 38: 1715-1722
- Neck Pain: revision 2017.J Orthop Sports Phys Ther. 2017; 47: A1-A83
- Exercises for mechanical neck disorders.Cochrane Database Syst Rev. 2015; 1: CD004250
- Psychological approaches to chronic pain management: evidence and challenges.Br J Anaesth. 2013; 111: 59-63
- Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews.Cochrane Database Syst Rev. 2017; 4: CD011279
- Factors associated with pain and disability reduction following exercise interventions in chronic whiplash.Eur J Pain. 2016; 20: 307-315
- One- and two-year follow-up of a randomized trial of neck-specific exercise with or without a behavioural approach compared with prescription of physical activity in chronic whiplash disorder.J Rehabil Med. 2016; 48: 56-64
- Neck-specific training with a cognitive behavioural approach compared with prescribed physical activity in patients with cervical radiculopathy: a protocol of a prospective randomised clinical trial.BMC Musculoskelet Disord. 2014; 15: 274
- The Spurling test and cervical radiculopathy.Spine (Phila Pa 1976). 2002; 27: 156-159
- Dimensions underlying measures of disability, personal factors, and health status in cervical radiculopathy: a cross-sectional study.Medicine. 2015; 94: e999
- FaR: individanpassad skriftlig ordination av fysisk aktivitet.Östersund, Stockholm, Sweden2011
- Physical activity and muscle training in the elderly.Acta Med Scand Suppl. 1986; 711: 233-237
- Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale.Pain. 1983; 16: 87-101
- The validity of using an electrocutaneous device for pain assessment in patients with cervical radiculopathy.Physiother Theory Pract. 2014; 30: 500-506
- Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP).Arthritis Care Res (Hoboken). 2011; 63: S240-S252
- The Neck Disability Index: a study of reliability and validity.J Manipulative Physiol Ther. 1991; 14: 409-415
- Validity and reliability of a modified version of the neck disability index.J Rehabil Med. 2002; 34: 284-287
- The reliability and construct validity of the Neck Disability Index and patient specific functional scale in patients with cervical radiculopathy.Spine. 2006; 31: 598-602
- Reliability, construct validity, and responsiveness of the neck disability index, patient-specific functional scale, and numeric pain rating scale in patients with cervical radiculopathy.Am J Phys Med Rehabil. 2010; 89: 831-839
- EuroQol: the current state of play.Health Policy. 1996; 37: 53-72
- Modeling valuations for EuroQol health states.Med Care. 1997; 35: 1095-1108
- Assessing fear-avoidance beliefs in patients with cervical radiculopathy.Physiother Res Int. 2013; 18: 193-202
- A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability.Pain. 1993; 52: 157-168
- The hospital anxiety and depression scale.Acta Psychiatr Scand. 1983; 67: 361-370
- [Validity of the hospital anxiety and depression scale in patients with chronic pain].Rev Bras Anestesiol. 2006; 56 ([Portuguese]): 470-477
- What is meant by intention to treat analysis? Survey of published randomised controlled trials.BMJ. 1999; 319: 670-674
- National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy.Eur Spine J. 2017; 26: 2242-2257
- Short- and long-term effects of exercise on neck muscle function in cervical radiculopathy: a randomized clinical trial.J Rehabil Med. 2016; 48: 696-704
- Exercise training for non-operative and post-operative patient with cervical radiculopathy: a literature review.J Phys Ther Sci. 2015; 27: 3011-3018
- The effect of neck-specific exercise with, or without a behavioral approach, on pain, disability, and self-efficacy in chronic whiplash-associated disorders: a randomized clinical trial.Clin J Pain. 2015; 31: 294-303
- Clinic-based training in comparison to home-based training after first-time lumbar disc surgery: a randomised controlled trial.Eur Spine J. 2009; 18: 398-409
- Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults.Cochrane Database Syst Rev. 2010; 20: CD005956
Article info
Publication history
Published online: July 03, 2018
Footnotes
Supported by the Swedish Government through the Karolinska Institute, in the Swedish National School of Research Education in Health Care Sciences, and the Strategic Research Programme in Care Sciences, as well as from the Stockholm County Council Funding ALF Medicine (grant no 20110071).
Clinical Trial Registration No.: NCT01831271.
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
