Author Names
Boyes, R; Toy, P; Mellon Jr., J; Hayes, M; Hammer, B
Reviewer Name
Andres Carro
Reviewer Affiliation(s)
Duke University School of Medicine: Doctor of Physical Therapy
Paper Abstract
Abstract Study design Systematic review of randomized clinical trials. Objective Review of current literature regarding the effectiveness of manual therapy in the treatment of cervical radiculopathy. Background Cervical radiculopathy (CR) is a clinical condition frequently encountered in the physical therapy clinic. Cervical radiculopathy is a result of space occupying lesions in the cervical spine: either cervical disc herniations, spondylosis, or osteophytosis. These affect the pain generators of bony and ligamentous tissues, producing radicular symptoms (i.e. pain, numbness, weakness, paresthesia) observed in the upper extremity of patients with cervical nerve root pathology. Cervical radiculopathy has a reported annual incidence of 83·2 per 100 000 and an increased prevalence in the fifth decade of life among the general population. Results Medline and CINAHL via EBSCO, Cochrane Library, and Google Scholar were used to retrieve the randomized clinical trial studies for this review between the years of 1995 and February of 2011. Four studies met inclusion criteria and were considered to be high quality (PEDro scores of ⩾5). Manual therapy techniques included muscle energy techniques, non-thrust/thrust manipulation/mobilization of the cervical and/or thoracic spine, soft-tissue mobilization, and neural mobilization. In each study, manual therapy was either a stand-alone intervention or part of a multimodal approach which included therapeutic exercise and often some form of cervical traction. Although no clear cause and effect relationship can be established between improvement in radicular symptoms and manual therapy, results are generally promising. Conclusion Although a definitive treatment progression for treating CR has not been developed a general consensus exists within the literature that using manual therapy techniques in conjunction with therapeutic exercise is effective in regard to increasing function, as well as AROM, while decreasing levels of pain and disability. High quality RCTs featuring control groups are necessary to establish clear and effective protocols in the treatment of CR. Keywords: Cervical radiculopathy, Conservative treatment, Manual therapy, Manipulation, Mobilization, Non-operative, Physiotherapy, Physical therapy
NIH Risk of Bias Tool
- Is the review based on a focused question that is adequately formulated and described?
- Yes
- Were eligibility criteria for included and excluded studies predefined and specified?
- Yes
- Did the literature search strategy use a comprehensive, systematic approach?
- Yes
- Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?
- Yes
- Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?
- Were the included studies listed along with important characteristics and results of each study?
- Yes
- Was publication bias assessed?
- Cannot Determine, Not Reported, Not Applicable
- Was heterogeneity assessed? (This question applies only to meta-analyses.)
- Cannot Determine, Not Reported, Not Applicable
Key Finding #1
Rangonese found that those with cervical radiculopathy who received a combination of manual therapy and exercise interventions showed a significant improvement measures of pain when compared to only manual therapy and only therapeutic exercise groups, yet all three groups demonstrated statistically significant improvements.
Key Finding #2
Cleland et al. found that 66.7% of the patients within the study that were treated with thoracic spine thrust mobilization as part of their treatment had a successful outcome that met the minimally clinically important change (MCIC) for the NDI, PSFS, NPRS, and GROC at re-examination
Key Finding #3
In the Cleland et al’s article, 57% of patients who received non-thrust manipulation to the cervical spine as part of their treatment protocol for CR had successful outcomes
Key Finding #4
In the Rangonese article, 56.5% of patients who received neural dynamic techniques or neural mobilizations had a successful outcome.
Please provide your summary of the paper
This systematic review of the literature on the effectiveness of manual therapy as a treatment for cervical radiculopathy (CR) found that the general consensus within the literature is that manual therapy can be used as an effective adjunct to exercise therapy in the treatment of cervical radiculopathy. Four articles were used in this systematic based on the authors’ inclusion criteria. All four articles found a reduction in pain with some form of manual therapy treatment. Rangonese found that pain improved more with manual therapy and exercise combination groups than each treatment group alone. While three of the four articles did not specify exactly what manual therapy techniques were performed the articles in review reach a general consensus that thrust mobilizations, non-thrust mobilizations, neural dynamic techniques, and muscle energy techniques all have some evidence as successful forms of treatment for CR meeting the minimal clinically important changes (MCIC) in multiple pain and function outcome measures.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
This paper summarizes the literature that was available from 1995-2011 for manual therapy’s effectiveness as a treatment for cervical radiculopathy (CR), and really shows the potential that manual therapy has as a treatment for these patients but also demonstrates the dearth of quality RCTs that have been conducted to find a cause and effect relationship. The largest issue with the majority of the articles utilized is that they do not specify the manual therapy techniques utilized for many of these patients and only specify the category of manual therapy (i.e. muscle energy, non-thrust mobilization, etc.) used as part of a treatment protocol for patients with CR. The Rangonese article takes a step in the right direction by separating out treatment groups and specifying the type of manual therapy performed on the patients involved in the study. Clinically, these results can be used in a limited manner, but do at least show the therapist that there are no harms in utilizing manual therapy and that the literature is trending towards showing that manual therapy is an effective treatment as an adjunct to exercise for patients with CR.
