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The Effects of Neck-Specific Training Versus Prescribed Physical Activity on Pain and Disability in Patients With Cervical Radiculopathy: A Randomized Controlled Trial

  • Åsa Dedering
    Correspondence
    Corresponding author Åsa Dedering, PhD, Allied Health Professionals Function, Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, 171 76 Stockholm, Sweden.
    Affiliations
    Allied Health Professionals Function, Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden

    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institute, Stockholm, Sweden
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  • Anneli Peolsson
    Affiliations
    Department of Medical and Health Sciences Physiotherapy, Linköping University, Linköping, Sweden
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  • Joshua A. Cleland
    Affiliations
    Franklin Pierce University, Manchester, NH
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  • Marie Halvorsen
    Affiliations
    Allied Health Professionals Function, Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden

    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institute, Stockholm, Sweden
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  • Mikael A. Svensson
    Affiliations
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden

    Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
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  • Marie Kierkegaard
    Affiliations
    Allied Health Professionals Function, Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden

    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institute, Stockholm, Sweden
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      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)
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