Author Names
Alshami, A., & Bamhair, D.
Reviewer Name
Beautiful Reed, SPT
Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
BACKGROUND: Research that has examined the effects of cervical spine mobilization on hypoesthesia and hypersensitivity characteristics in patients with cervical radiculopathy is scarce. The aim of this study was to examine the short-term effects of vertebral mobilization on the sensory features in patients with cervical radiculopathy.
METHODS: Twenty-eight participants with chronic cervical radiculopathy were randomly allocated to (1) an experimental group [cervical vertebral mobilization technique and exercise] or (2) a comparison group [minimal superficial circular pressure on the skin and exercise]. Participants received a total of 6 sessions for 3-5 weeks. Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI), pressure pain threshold (PPT), heat/cold pain threshold (HPT/CPT), and active cervical range of motion (ROM) were measured at baseline immediately after the first session and after the sixth session.
RESULTS: The experimental group showed improvements from baseline to session 6 in NPRS [mean difference 2.6; 95% confidence interval: -4.6, -0.7], NDI [14; -23.3, -4.3], and active cervical ROM in extension [14°; 2.3, 25.5], rotation [16°; 8.8, 22.5], and lateral flexion to the affected side [10°; 2.3, 16.8]. Improvements were also found in PPT at the neck [124 kPa; 57, 191.1] and C7 level at the hand [99 kPa; 3.6, 194.9]. There were no changes in the HPT and CPT at any tested area (P>0.050).
CONCLUSIONS: Cervical vertebral mobilization for patients with chronic cervical radiculopathy reduced localized mechanical, but not thermal, pain hypersensitivity.
NIH Risk of Bias Tool
Quality Assessment of Controlled Intervention Studies
- Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT
- Yes
- Was the method of randomization adequate (i.e., use of randomly generated assignment)?
- Yes
- Was the treatment allocation concealed (so that assignments could not be predicted)?
- Yes
- Were study participants and providers blinded to treatment group assignment?
- Yes
- Were the people assessing the outcomes blinded to the participants’ group assignments?
- Yes
- Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
- Yes
- Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
- Yes
- Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
- Yes
- Was there high adherence to the intervention protocols for each treatment group?
- Yes
- Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
- Yes
- Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
- Yes
- Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
- Yes
- Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
- Yes
- Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
- Yes
Key Finding #1
Cervical vertebral mobilization in the manual therapy group found improvements in local mechanical pressure hypersensitivity, self-report measures on pain intensity and neck function, as well as active cervical ROM.
Key Finding #2
There were no improvements noted in the manual therapy group regarding changes in thermal pain thresholds (heat or cold).
Key Finding #3
The mean improvement of pain pressure thresholds (PPT) on the neck in the manual therapy group after session 6 was 124 kPa (kilopascal), which exceeded the minimal detectable change (MDC) of 87 kPa.
Key Finding #4
The findings of the numeric pain rating scale matched with those of pain pressure threshold (PPT) on the neck. Cervical vertebral mobilization resulted in pain reduction of 3.9 points over the study period which is more than the minimal clinically important difference (MCID) of 2.2 points.
Please provide your summary of the paper
This is a randomized-controlled trial that looked at the short-term effects of cervical manual therapy with exercise on the sensory features in patients with chronic cervical radiculopathy. Both self-reported measures of pain intensity and neck function as well as active ROM and mechanical/thermal pain thresholds were gathered through a 6-week treatment bout. Patients were divided into two groups that either received manual therapy (PA glides of the C-spine and upper limb neurodynamic mobilizations with lateral cervical glides) with exercise, or superficial circular pressure on the skin with exercise. The group with manual therapy found improvements in almost all measured outcomes, but not with thermal pain threshold testing.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
This article helps demonstrate that manual therapy can have short-term positive effects on patients with cervical radiculopathy in several aspects including pain intensity, active mobility, self-reported neck function, and pain pressure thresholds. For patients with chronic cervical radiculopathy, physical therapists must be mindful that pain can be a serious limiter in that patients life. This article helps shine light on the importance manual therapy can have on improving not only a patients pain intensity, but their overall pain threshold. By raising the patients PPT, it tells us that a biologic/chemical change in a patients internal system response to pain is occurring with the use of manual therapy techniques. This can be a major game changer for a patient with chronic pain as a first step to improving their overall self-reported neck function.
