Mechanisms of recovery after neck-specific or general exercises in patients with cervical radiculopathy

A functional intervention within a cognitive approach to chronic cervical radiculopathy : Description of the non-surgical treatment arm in a randomised controlled trial evaluating the effectiveness of surgery

BACKGROUND

Most patients with cervical radiculopathy improve within the first months without treatment or with non-surgical treatment. A systematic review concluded that these patients improve, regardless of their intervention. Still, many patients are offered surgery, despite limited evidence regarding the indications for surgical treatments. The aim of this article is to describe the intervention that is going to be followed in the non-surgical treatment arm of a randomised controlled trial (RCT) comparing the effectiveness of surgical and non-surgical treatment for patients with cervical radiculopathy.

METHODS

The non-surgical intervention is a functional intervention within a cognitive approach founded on previous experiences, and current recommendations for best practice care of musculoskeletal pain and cervical radiculopathy. It is based on the biopsychosocial rather than a biomedical perspective, comprises an interdisciplinary approach (physicians, physiotherapy specialists), and includes brief intervention and graded activities. The intervention consists of 6 sessions over 12 weeks. The primary goals are first, to validate the patients´ symptoms and build a therapeutic alliance, second, to explore the understanding and promote alternatives, and third, to explore problems and opportunities based on patients´ symptoms and function. Motivational factors toward self-management are challenging. We will attempt shared decision-making in planning progress for the individual patient and emphasise learning of practical self-help strategies and encouragement to stay active (reinforcing the positive natural course). General physical activities such as walking will be promoted along with simple functional exercises for the neck- and shoulder region. We will also explore social activity, comorbidities, pain location, sleep, and work-related factors. The health providers will set individualised goals together with each patient.

DISCUSSION

The aim of the intervention is to describe a functional intervention within a cognitive approach for patients with chronic cervical radiculopathy. The effectiveness of the present program will be compared to surgery in a randomised controlled trial.

Video-oculographic measures of eye movement control in the smooth pursuit neck torsion test can classify idiopathic neck pain patients from healthy individuals: A datamining based diagnostic accuracy study

BACKGROUND

Idiopathic neck pain patients frequently experience oculomotor disfunctions with deficits in eye movement control between neutral and neck torsion position (SPNT test) being commonly investigated in clinical and research settings.

OBJECTIVES

The aim of the study was to determine accuracy of SPNT test in classifying idiopathic neck pain patients.

DESIGN

a datamining based diagnostic accuracy study.

METHODS

The study was conducted on a referred sample of 38 chronic neck pain patients from orthopaedic outpatient clinic and 40 healthy controls. Video-oculography was used to study gain and SPNT_diff during SPNT test under three target movement velocities and amplitudes and two different angles of neck torsion. A Naïve Bayesian predictive model was used to classify neck pain patients based on gain or SPNT_diff.

RESULTS

Gain during two target movement profiles at velocities of 30°s^-1 and amplitudes of 30° and 40° under 45° of neck torsion presented with highest area under the curve (0.837), specificity (92%), sensitivity (94%), highest true positive and lowest false negative predicted value. Highest area under the curve (0.760), specificity (50%), sensitivity (71%), highest true positive and lowest false negative values were observed for SPNT_diff at velocities of 30°s^-1 and amplitude of 30° applying 45° of neck torsion.

CONCLUSION

SPNT test provides useful diagnostic tool for classifying neck pain patients when using single or combination of two target movement profiles. Neck torsion of 45° as opposed to 30° should be used during SPNT test when investigating patients with neck pain disorders.

Classification criteria for cervical radiculopathy: An international e-Delphi study

BACKGROUND

Establishing a set of uniform classification criteria (CC) for cervical radiculopathy (CR) is required to aid future recruitment of homogenous populations to clinical trials.

OBJECTIVES

To establish expert informed consensus on CC for CR.

DESIGN

A pre-defined four round e-Delphi study in accordance with the guidance on Conducting and Reporting Delphi Studies.

METHODS

Individuals with a background in physiotherapy who had authored two or more peer-reviewed publications on CR were invited to participate. The initial round asked opinions on CC for CR. Content analysis was performed on round one output and a list of discrete items were generated forming the round two survey. In rounds two to four, participants were asked to rate the level of importance of each item on a six-point Likert scale. Data were analysed descriptively using median, interquartile range and percentage agreement. Items reaching pre-defined consensus criteria were carried forward to the next round. Items remaining after the fourth round constituted expert consensus on CC for CR.

RESULTS

Twelve participants participated with one drop out. The final round identified one inclusion CC and 12 exclusion CC. The inclusion CC that remained achieved 82% agreement and was a cluster criterion consisting of radicular pain with arm pain worse than neck pain; paraesthesia or numbness and/or weakness and/or altered reflex; MRI confirmed nerve root compression compatible with clinical findings.

CONCLUSIONS

The CC identified can be used to inform eligibility criteria for future CR trials although caution should be practiced as consensus on measurement tools requires further investigation.