Author Names
Borrella-Andrés, S., Marqués-García, I., Orosia Lucha-López, M., Fanlo-Mazas, P., Hernández-Secorún, M., Pérez-Bellmunt, A., Miguel Tricás-Moreno, J., and Hidalgo-García, C.

Reviewer Name
Giulia Marsella, SPT at Duke

Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division

 

Paper Abstract
Background. Cervical radiculopathy is defined as a disorder involving dysfunction of the cervical nerve roots characterized by pain radiating and/or loss of motor and sensory function towards the root affected. There is no consensus on a good definition of the term. In addition, the evidence regarding the effectiveness of manual therapy in radiculopathy is contradictory.

Objective. To assess the effectiveness of manual therapy in improving pain, functional capacity,  and range of motion in treating cervical radiculopathy with and without confirmation of altered
nerve conduction. Methods. Systematic review of randomized clinical trials on cervical  radiculopathy and manual therapy, in PubMed, Web of Science, Scopus, PEDro, and Cochrane
Library Plus databases. The PRISMA checklist was followed. Methodological quality was evaluated using the PEDro scale and RoB 2.0. tool. Results. 17 clinical trials published in the past 10 years were selected. Manual therapy was effective in the treatment of symptoms related to cervical radiculopathy in all studies, regardless of the type of technique and dose applied.

Conclusion. This systematic review did not establish which manual therapy techniques are the  most effective for cervical radiculopathy with electrophysiological confirmation of altered nerve
conduction. Without this confirmation, the application of manual therapy, regardless of the  protocol applied and the manual therapy technique selected, appears to be effective in
reducing chronic cervical pain and decreasing the index of cervical disability in cervical  radiculopathy in the short term. However, it would be necessary to agree on a definition and
diagnostic criteria of radiculopathy, as well as the definition and standardization of manual techniques, to analyze the effectiveness of manual therapy in cervical radiculopathy in depth.

 

NIH Risk of Bias Tool
Quality Assessment of Systematic Reviews and Meta-Analyses

    1. Is the review based on a focused question that is adequately formulated and
      described?
      -Yes
    2. Were eligibility criteria for included and excluded studies predefined and specified?
      -Yes
    3. Did the literature search strategy use a comprehensive, systematic approach?
      -Yes
    4. Were titles, abstracts, and full-text articles dually and independently reviewed for
      inclusion and exclusion to minimize bias?
      -Yes
    5. Was the quality of each included study rated independently by two or more reviewers
      using a standard method to appraise its internal validity?
    6. Were the included studies listed along with important characteristics and results of
      each study?
      -Yes
    7. Was publication bias assessed?
      -Yes
    8. Was heterogeneity assessed? (This question applies only to meta-analyses.)
      -Yes

 

Key Finding #1
All studies displayed a statistically significant improvement in pain and cervical disability in the  manual therapy group, irrespective of the protocol and technique, which contributes to the
uncertainty of which manual therapy technique(s) are most effective for treating cervical radiculopathy.

Key Finding #2
Short-term benefits of manual therapy for cervical radiculopathy have been shown to be beneficial, yet its long-term effectiveness has not been established.

Key Finding #3
Cervical and thoracic manipulations appeared to have the most satisfactory results, whereas  manual traction and neural mobilization were the least satisfactory for cervical radiculopathy.

 

Please provide your summary of the paper

This systemic review aims to address the effectiveness of manual therapy in the treatment of  cervical radiculopathy (including or not including the confirmation of altered nerve conduction).
The outcomes observed were pain, functional capacity, and range of motion of the neck. Across all 17 studies included in this systematic review, manual therapy techniques appear beneficial
for reducing chronic cervical pain and disability in the short-term. Of the 17 studies, 9 were deemed high quality, 3 were deemed moderate quality, and 5 were deemed low quality.
Limitations to this study were the lack of blinding and variability of inclusion criteria. All studies lacked blinding, yet 3 of them had assessors blinded to assign participants to groups. The
precise manual therapy techniques varied across studies and the inclusion criteria of this systematic review was heterogeneous, making comparison across studies challenging. Future
studies must employ more precise comparison of interventions and stricter inclusion parameters to analyze results more accurately.

Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.

This study may impact clinical practice in how manual therapy techniques, especially cervical and thoracic manipulations are an appropriate treatment approach for the short-term
improvement of pain and disability related to cervical radiculopathy. It is important to note that the benefits gleaned from these 17 studies were concluded without an EMG and ENG
confirmation. Implementing manual therapy techniques to treat cervical radiculopathy are supported by this literature, yet the lack of technique standardization, methodological
limitations, and lack of follow-up to determine longer-term outcomes should be acknowledged an individual patient bases.