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Abstract
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BACKGROUND CONTEXT: In 2013, the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration identified one high-quality Randomized Controlled Trial (RCT) investigating multimodal rehabilitation of recent-onset cervical radiculopathy. No high quality RCTs were identified to inform the management of persistent cervical radiculopathy. Therefore, updating this systematic review is warranted.
PURPOSE: To update the systematic review from the OPTIMa Collaboration and to evaluate the effectiveness and safety of multimodal rehabilitation interventions compared to other interventions, placebo/sham interventions, or no intervention for the management of adults with cervical radiculopathy. STUDY DESIGN/SETTING: Systematic review and best evidence synthesis. PARTICIPANTS: We searched for RCTs, cohort studies, and case-control studies targeting adults with cervical radiculopathy (neck pain with symptoms in the arm and hand). OUTCOME MEASURES: 1) self-rated recovery; 2) functional recovery (e.g., return to activities, work or school); 3) disability; 4) clinical outcomes (e.g., pain, health-related quality of life); 5) psychological outcomes (e.g., depression, anxiety, stress); 6) administrative data (e.g., time on benefits); or 7) adverse events.
METHODS: We searched nine databases from January 1, 2013 to June 22, 2020. Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network (SIGN) and Risk of Bias (RoB) 2.0 criteria. We conducted a sensitivity analysis to examine whether our results were impacted by the method used to critically appraise the RCTs. We conducted a qualitative synthesis of the evidence according to the Synthesis Without Meta-analysis (SWIM) guidelines, and included acceptable studies in our synthesis. The certainty of the evidence was assessed according to Grading of Recommendations Assessment, Development, and Evaluation (GRADE).
RESULTS: We retrieved 3306 articles and five articles were eligible for critical appraisal. Four RCTs were deemed acceptable and one RCT was considered low quality. In adults with recent-onset cervical radiculopathy, multimodal rehabilitation that includes Shi-style cervical manipulations (soothing tendon step, osteopathic step, and dredging collateral step) was associated with a trivial and non-clinically important reduction in neck pain at 6 months compared to mechanical cervical traction (mean difference (MD) 3.66/100, 95% CI 1.8 to 5.5; 1 study, 360 participants, low certainty of the evidence) and no differences in disability were reported (MD 1.37/50, 95% CI 0.6 to 2.1; 1 study, 360 participants, low certainty of the evidence). In adults with cervical radiculopathy of any duration, the evidence suggests that: 1) multimodal rehabilitation that combines neck-specific exercises, education, and a cognitive-behavioural program may be more effective than prescribed physical activity and brief cognitive-behavioural approach; specifically, a small reduction in arm pain was found (MD 12/100, 95% CI 5.9 to 18.1; 1 study, 144 participants, low certainty of the evidence) and function at 6 months (MD 5/100, 95% CI 0.1 to 9.9; 1 study, 144 participants, low certainty of the evidence); 2) no difference in pain reduction was found at 6 months between a program that combined gabapentin and/or nortriptyline, education, electrical stimulations, ultrasound, massage and exercise and epidural steroid injection to an epidural steroid injection alone (MD -0.56/100, 95% CI -1.1 to 0.0; 1 study, 169 participants, low certainty of the evidence); and 3) compared to surgery combined with neck exercises, exercises combined with education, pain coping, self-efficacy and stress management strategies lead to similar arm pain reduction (MD 5.1/100, 95% CI -15 to 25.2; 1 study, 68 participants, low certainty of the evidence) and similar improvement in function at 6 months (MD 4.4/100, 95% CI -4.4 to 13.2; 1 study, 68 participants, low certainty of the evidence). Conclusion: The evidence suggests that some multimodal rehabilitation care may provide small and trivial reduction in neck pain or improvement in function to patients with cervical radiculopathy. However, the effectiveness of these interventions has not been demonstrated and more research is needed to determine the effectiveness of multimodal rehabilitation interventions for the management of adults with cervical radiculopathy.
Language: en |