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International Journal of Environmental... Jun 2021The aim of this study was to describe and update current knowledge of manual therapy accuracy in treating cervical and lumbar radiculopathy, to identify the limitations...
The aim of this study was to describe and update current knowledge of manual therapy accuracy in treating cervical and lumbar radiculopathy, to identify the limitations in current studies, and to suggest areas for future research. The study was conducted according to PRISMA guidelines for systematic reviews. A comprehensive literature review was conducted using PubMed and Web of Science databases up to April 2020. The following inclusion criteria were used: (1) presence of radiculopathy; (2) treatment defined as manual therapy (i.e., traction, manipulation, mobilization); and (3) publication defined as a Randomized Controlled Trial. The electronic literature search resulted in 473 potentially relevant articles. Finally, 27 articles were accepted: 21 on cervical (CR) and 6 in lumbar radiculopathy (LR). The mean PEDro score for CR was 6.6 (SD 1.3), and for LR 6.7 (SD 1.6). Traction-oriented techniques are the most frequently chosen treatment form for CR and are efficient in reducing pain and improving functional outcomes. In LR, each of the included publications used a different form of manual therapy, which makes it challenging to summarize knowledge in this group. Of included publications, 93% were either of moderate or low quality, which indicates that quality improvement is necessary for this type of research.
Topics: Humans; Musculoskeletal Manipulations; Neck; Neck Pain; Radiculopathy; Randomized Controlled Trials as Topic; Traction
PubMed: 34200510
DOI: 10.3390/ijerph18116176 -
Archives of Physical Medicine and... Nov 2023To Identify evidence-based rehabilitation interventions for persons with non-specific low back pain (LBP) with and without radiculopathy and to develop recommendations... (Review)
Review
A Systematic Review of Clinical Practice Guidelines for Persons With Non-specific Low Back Pain With and Without Radiculopathy: Identification of Best Evidence for Rehabilitation to Develop the WHO's Package of Interventions for Rehabilitation.
OBJECTIVE
To Identify evidence-based rehabilitation interventions for persons with non-specific low back pain (LBP) with and without radiculopathy and to develop recommendations from high-quality clinical practice guidelines (CPGs) to inform the World Health Organization's (WHO) Package of Interventions for Rehabilitation (PIR).
DATA SOURCE
We searched MEDLINE, EMBASE, CINAHL, PsycINFO, National Health Services Economic Evaluation Database, Health Technology Assessment Database, PEDro, the Trip Database, the Index to Chiropractic Literature and the gray literature.
STUDY SELECTION
Eligible guidelines were (1) published between 2009 and 2019 in English, French, Italian, or Swedish; (2) included adults or children with non-specific LBP with or without radiculopathy; and (3) assessed the benefits of rehabilitation interventions on functioning. Pairs of independent reviewers assessed the quality of the CPGs using AGREE II.
DATA SYNTHESIS
We identified 4 high-quality CPGs. Recommended interventions included (1) education about recovery expectations, self-management strategies, and maintenance of usual activities; (2) multimodal approaches incorporating education, exercise, and spinal manipulation; (3) nonsteroidal anti-inflammatory drugs combined with education in the acute stage; and (4) intensive interdisciplinary rehabilitation that includes exercise and cognitive/behavioral interventions for persistent pain. We did not identify high-quality CPGs for people younger than 16 years of age.
CONCLUSION
We developed evidence-based recommendations from high-quality CPGs to inform the WHO PIR for people with LBP with and without radiculopathy. These recommendations emphasize the potential benefits of education, exercise, manual therapy, and cognitive/behavioral interventions.
Topics: Adult; Child; Humans; Radiculopathy; Low Back Pain; Musculoskeletal Manipulations; World Health Organization
PubMed: 36963709
DOI: 10.1016/j.apmr.2023.02.022 -
Frontiers in Medicine 2021Neuropathic pain (NP), a severe and disruptive symptom following many diseases, normally restricts patients' physical functions and leads to anxiety and depression. As...
Neuropathic pain (NP), a severe and disruptive symptom following many diseases, normally restricts patients' physical functions and leads to anxiety and depression. As an economical and effective therapy, exercise may be helpful in NP management. However, few guidelines and reviews focused on exercise therapy for NP associated with specific diseases. The study aimed to summarize the effectiveness and efficacy of exercise for various diseases with NP supported by evidence, describe expert recommendations for NP from different causes, and inform policymakers of the guidelines. A systematic review and expert consensus. A systematic search was conducted in PubMed. We included systematic review and meta-analysis, randomized controlled trials (RCTs), which assessed patients with NP. Studies involved exercise intervention and outcome included pain intensity at least. Physiotherapy Evidence Database and the Assessment of Multiple Systematic reviews tool were used to grade the quality assessment of the included RCTs and systematic reviews, respectively. The final grades of recommendation were based on strength of evidence and a consensus discussion of results of Delphi rounds by the Delphi consensus panel including 21 experts from the Chinese Association of Rehabilitation Medicine. Eight systematic reviews and 21 RCTs fulfilled all of the inclusion criteria and were included, which were used to create the 10 evidence-based consensus statements. The 10 expert recommendations regarding exercise for NP symptoms were relevant to the following 10 different diseases: spinal cord injury, stroke, multiple sclerosis, Parkinson's disease, cervical radiculopathy, sciatica, diabetic neuropathy, chemotherapy-induced peripheral neuropathy, HIV/AIDS, and surgery, respectively. The exercise recommended in the expert consensus involved but was not limited to muscle stretching, strengthening/resistance exercise, aerobic exercise, motor control/stabilization training and mind-body exercise (Tai Chi and yoga). Based on the available evidence, exercise is helpful to alleviate NP intensity. Therefore, these expert consensuses recommend that proper exercise programs can be considered as an effective alternative treatment or complementary therapy for most patients with NP. The expert consensus provided medical staff and policymakers with applicable recommendations for the formulation of exercise prescription for NP. This consensus statement will require regular updates after five-ten years.
PubMed: 34901069
DOI: 10.3389/fmed.2021.756940 -
BioMed Research International 2021Cervical radiculopathy is defined as a disorder involving dysfunction of the cervical nerve roots characterised by pain radiating and/or loss of motor and sensory...
BACKGROUND
Cervical radiculopathy is defined as a disorder involving dysfunction of the cervical nerve roots characterised 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 randomised 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.
CONCLUSIONS
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 standardisation of manual techniques, to analyse the effectiveness of manual therapy in cervical radiculopathy in depth.
Topics: Cervical Vertebrae; Clinical Trials as Topic; Electromyography; Humans; Musculoskeletal Manipulations; Neck Pain; Radiculopathy; Range of Motion, Articular
PubMed: 34189141
DOI: 10.1155/2021/9936981 -
Overlapping, Masquerading, and Causative Cervical Spine and Shoulder Pathology: A Systematic Review.Global Spine Journal Apr 2020Systematic review. (Review)
Review
STUDY DESIGN
Systematic review.
OBJECTIVE
To assess the current literature regarding the relationship between the shoulder and the spine with regard to (1) overlapping pain pathways; (2) differentiating history, exam findings, and diagnostic findings; (3) concomitant pathology and optimal treatments; and (4) cervical spine-based etiology for shoulder problems.
METHODS
A systematic literature search was performed according to the guidelines set forth by the Cochrane Collaboration. Studies were included if they examined the clinical, anatomical, or physiological overlap between the shoulder and cervical spine. Two reviewers screened and selected full texts for inclusion according to the objectives of the study. Quality of evidence was graded using OCEBM (Oxford Center for Evidence Based Medicine) and MINORS (Methodological Index for Nonrandomized Studies) scores.
RESULTS
Out of 477 references screened, 76 articles were included for review and grouped into 4 main sections (overlapping pain pathways, differentiating exam findings, concomitant/masquerading pathology, and cervical spine-based etiology of shoulder pathology). There is evidence to suggest cervical spine pathology may cause shoulder pain and that shoulder pathology may cause neck pain. Specific examination tests used to differentiate shoulder and spine pathology are critical as imaging studies may be misleading. Diagnostic injections can be useful to confirm sources of pain as well as predicting the success of surgery in both the shoulder and the spine. There is limited evidence to suggest alterations in the relationship between the spine and the scapula may predispose to shoulder impingement or rotator cuff tears. Moreover, cervical neurological lesions may predispose patients to developing rotator cuff tears. The decision to proceed with shoulder or spine surgery first should be delineated with careful examination and the use of shoulder and spine diagnostic injections.
CONCLUSION
Shoulder and spine pathology commonly overlap. Knowledge of anatomy, pain referral patterns, shoulder kinematics, and examination techniques are invaluable to the clinician in making an appropriate diagnosis and guiding treatment. In this review, we present an algorithm for the identification and treatment of shoulder and cervical spine pathology.
PubMed: 32206519
DOI: 10.1177/2192568218822536 -
European Spine Journal : Official... Feb 2023Physiotherapy interventions are prescribed as first-line treatment for people with sciatica; however, their effectiveness remains controversial. The purpose of this... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Physiotherapy interventions are prescribed as first-line treatment for people with sciatica; however, their effectiveness remains controversial. The purpose of this systematic review was to establish the short-, medium- and long-term effectiveness of physiotherapy interventions compared to control interventions for people with clinically diagnosed sciatica.
METHODS
This systematic review was registered on PROSPERO CRD42018103900. Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (EBSCO), Embase, PEDro, PubMed, Scopus and grey literature were searched from inception to January 2021 without language restrictions. Inclusion criteria were randomised controlled trials evaluating physiotherapy interventions compared to a control intervention in people with clinical or imaging diagnosis of sciatica. Primary outcome measures were pain and disability. Study selection and data extraction were performed by two independent reviewers with consensus reached by discussion or third-party arbitration if required. Risk of bias was assessed independently by two reviewers using the Cochrane Risk of Bias tool with third-party consensus if required. Meta-analyses and sensitivity analyses were performed with random effects models using Revman v5.4. Subgroup analyses were undertaken to examine the effectiveness of physiotherapy interventions compared to minimal (e.g. advice only) or substantial control interventions (e.g. surgery).
RESULTS
Three thousand nine hundred and fifty eight records were identified, of which 18 trials were included, with a total number of 2699 participants. All trials had a high or unclear risk of bias. Meta-analysis of trials for the outcome of pain showed no difference in the short (SMD - 0.34 [95%CI - 1.05, 0.37] p = 0.34, I = 98%), medium (SMD 0.15 [95%CI - 0.09, 0.38], p = 0.22, I= 80%) or long term (SMD 0.09 [95%CI - 0.18, 0.36], p = 0.51, I= 82%). For disability there was no difference in the short (SMD - 0.00 [95%CI - 0.36, 0.35], p = 0.98, I = 92%, medium (SMD 0.25 [95%CI - 0.04, 0.55] p = 0.09, I = 87%), or long term (SMD 0.26 [95%CI - 0.16, 0.68] p = 0.22, I = 92%) between physiotherapy and control interventions. Subgroup analysis of studies comparing physiotherapy with minimal intervention favoured physiotherapy for pain at the long-term time points. Large confidence intervals and high heterogeneity indicate substantial uncertainly surrounding these estimates. Many trials evaluating physiotherapy intervention compared to substantial intervention did not use contemporary physiotherapy interventions.
CONCLUSION
Based on currently available, mostly high risk of bias and highly heterogeneous data, there is inadequate evidence to make clinical recommendations on the effectiveness of physiotherapy interventions for people with clinically diagnosed sciatica. Future studies should aim to reduce clinical heterogeneity and to use contemporary physiotherapy interventions.
Topics: Humans; Sciatica; Physical Therapy Modalities
PubMed: 36580149
DOI: 10.1007/s00586-022-07356-y -
Global Spine Journal Oct 2022(1) To evaluate the effects of surgery and conservative treatments for cervical spondylotic radiculopathy and (2) provide reference for choosing the time and method of... (Review)
Review
OBJECTIVE
(1) To evaluate the effects of surgery and conservative treatments for cervical spondylotic radiculopathy and (2) provide reference for choosing the time and method of treatment.
METHODS
A literature search was performed using PubMed, EMbase, The Cochrane Library, Web of Science, and ClinicalTrials from inception to September 2021. Randomized controlled trials (RCTs) on the use of surgery or conservative Treatments in Cervical Spondylotic Radiculopathy (CSR) were selected. The primary outcomes were the neck and arm visual analog scale (VAS) and Neck Disability Index (NDI). Secondary outcomes included active range of cervical motion (ROM) and Mental Health. Two reviewers proceeded study selection and quality assessment.
RESULTS
A total of 6 studies, which comprised a total of 464 participants were included in the final meta-analysis. Compared with conservative treatment, surgical treatment was more effective in lowering Neck-VAS (<3 m: MD = -29.44, 95% CI = (-41.62,-17.27), P < .00001; 3-6 M: MD = -20.97, 95% CI = (-26.36,-15.57), P < .00001; 6 M: MD = -13.40, 95% CI = (-19.39, -7.41), P<.0001; 12 M: MD=-15.53, 95% CI=(-28.38, -2.68), P=.02), Arm-VAS(<3 m: MD = -33.52, 95% CI = (-39.89, -27.16), P < .00001; 3-6 M: MD = -20.97, 95% CI = (-26.36, -15.57), P < .00001; 6 M: MD = -17.52, 95% CI=(-23.94, -11.11), P < .0001; 12 M: MD = -21.91, 95% CI=(-27.09, -16.72), P < .00001) and NDI (<3 m: MD = -8.89, 95% CI = (-11.17, -6.61), P < .00001; 6 M: MD = -5.14, 95% CI = (-7.60, -2.69), P < .0001). No significant difference was observed in NDI at 12-month time point (MD = -5.17, 95% CI = (-12.33, 2.00), P = .16), ROM(MD = 2.91, 95% CI = (-4.51, 10.33), P = .77) and Mental Health (MD = .05, 95% CI=(-.24, .33), P = .74).
CONCLUSION
The 6 included studies that had low risk of bias, providing high-quality evidence for the surgical efficacy of CSR. The evidence indicates that surgical treatment is better than conservative treatment in terms of VAS score and NDI score, and superior to conservative treatment in less than one year. There was no evidence of a difference between surgical and conservative care in ROM and mental health. A small sample study with a follow-up of 5 to 8 years showed that surgical treatment was still better than conservative treatment, but the sample size was small and the results should be carefully interpreted.Compared with conservative treatment, surgical treatment had a faster onset of response, especially in pain relief, but did not have a significant advantage in range of motion or NDI. This seems to mean that for patients with severe or even unbearable pain, the benefits of surgery as soon as possible will be significant. Although it is not clear whether the short-term risks of surgery are outweighed by the long-term benefits, rapid pain relief is necessary. Conservative treatment (including medical exercise therapy, mechanical cervical tractions, transcutaneous electrical nerve stimulation, pain management education, and cervical collar) once or twice a week for 3 months is beneficial in the long term and avoids the risks of surgery. In consideration of the good natural history of CSR and the relatively good outcome of conservative treatment (although symptom relief is slow), we think that surgery is not necessary for patients who do not need rapid pain relief.
PubMed: 35324370
DOI: 10.1177/21925682221075290 -
Medicine Nov 2019Cervical radiculopathy (CR), which is most often stems from degenerative disease in the cervical spine, has increasingly become a common and frequently occurring disease... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cervical radiculopathy (CR), which is most often stems from degenerative disease in the cervical spine, has increasingly become a common and frequently occurring disease in clinic due to the popularity of electronic products, such as computes and cell phones. Some studies have shown that exercise or exercise combined with other treatments can effectively decrease pain and improve functional status. The objective was to analyze the effects of exercise for treating patients with CR.
METHODS
Seven databases were searched from inception to December 2018. Randomized controlled trials involving exercise alone or exercise combined with conventional treatment were enrolled. Data were pooled after trials quality assessment for meta-analysis. Outcomes were pain (visual analog scale [VAS]), quality of life (12-short form health survey, 36-short form health survey), and physical function accessed by neck disability index (NDI).
RESULTS
Ten studies involving 871 participants with CR were included. Meta-analysis revealed that compared with control group, there was a reduction in VAS (standardized mean difference = -0.89; 95% confidence interval [CI]: -1.34 to -0.44; Z = 3.89; P < .001). There was also an improvement of NDI (mean difference = -3.60; 95% CI: -6.27 to -0.94; Z = 2.65; P = .008)]. Additionally, although the results of subgroup analyses were changed due to the paucity of the quantity and quality of the included studies. The pooled results were verified to be stable by sensitivity analyses. Besides, the grading of recommendations assessment, development, and evaluation level of evidence is low for each outcome.
CONCLUSION
Exercise alone or exercise plus other treatment may be helpful to patients with CR. However, exercise option should be carefully considered for each patient with CR in accordance with their different situations. Large-scale studies using proper methodology are recommended.
Topics: Exercise Therapy; Humans; Pain Measurement; Quality of Life; Radiculopathy; Treatment Outcome; Visual Analog Scale
PubMed: 31702624
DOI: 10.1097/MD.0000000000017733 -
Medicine Nov 2019Cervical spondylosis radiculopathy (CSR) is often described as neck pain accompanied with radiating pain and neurologic symptoms, such as numbness, muscle weakness, and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cervical spondylosis radiculopathy (CSR) is often described as neck pain accompanied with radiating pain and neurologic symptoms, such as numbness, muscle weakness, and diminished reflexes, in 1 or both upper extremities. As people's lifestyle changes and the population ages, the incidence of CSR continues to increase. Many clinical trials have proven that acupuncture and chiropractic has a significant effect in the treatment of CSR. In this systematic review, we aim to evaluate the effectiveness and safety of acupuncture and chiropractic for CSR.
METHODS
We will search PubMed, Cochrane Library, AMED, EMbase, WorldSciNet; Nature, Science online and China Journal Full-text Database, China Biomedical Literature CD-ROM Database, and related randomized controlled trials included in the ChinaResources Database. The time is limited from the construction of the library to February, 2019. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of CSR.
TRIAL REGISTRATION NUMBER
CRD42019119941.
Topics: Acupuncture Therapy; Humans; Manipulation, Chiropractic; Radiculopathy; Spondylosis; Treatment Outcome
PubMed: 31770206
DOI: 10.1097/MD.0000000000017974