Original research
The Effects of Neck-Specific Training Versus Prescribed Physical Activity on Pain and Disability in Patients With Cervical Radiculopathy: A Randomized Controlled Trial

https://doi.org/10.1016/j.apmr.2018.06.008Get rights and content

Abstract

Objective

To compare the effects of a neck-specific training program to prescribed physical activity with both groups receiving a cognitive behavioral approach, on pain and disability in patients with cervical radiculopathy (CR).

Design

Parallel-group randomized clinical trial with follow-up at 3, 6, 12, and 24 months.

Setting

Recruitment and assessments of participants were performed at a university hospital. Interventions were performed in primary care setting at outpatient physiotherapy clinics.

Participants

Patients (N=144) with CR were recruited to participate in this clinical trial.

Interventions

Patients were randomly assigned to 3 months of either of a neck-specific training program or prescribed physical activity.

Main Outcome Measures

Primary outcomes included self-rated neck and arm pain as collected by the visual analog scale (VAS). Secondary outcomes were self-rated headache measured with the VAS, the Neck Disability Index, the EuroQol 5D, the Fear Avoidance Beliefs Questionnaire, and the Hospital Anxiety and Depression Scale. Assessments were performed at baseline and at 3-, 6-, 12-, and 24-month follow-up periods.

Results

Intention-to-treat and per-protocol analyses showed no significant interaction (group × time) or group effects. There were, however, significant time effects indicating improvement over time for both groups for all outcomes except for levels of depression.

Conclusions

The study revealed that neck-specific training as well as prescribed physical activity both including additional cognitive behavioral approach decreased the pain in patients with CR, that is, participants improved regardless of the intervention received. There is a lack of consensus of how to best manage individuals with CR. However, our findings suggest that CR has a natural favorable long-term outcome when patients are prescribed neck-specific training and exercise in combination with a behavioral approach.

Section snippets

Trial design

This was a parallel-group randomized clinical trial with follow-up assessments at 3, 6, 12, and 24 months.18 The trial was registered before participant recruitment began (ClinicalTrials.gov NCT01831271).

Participants

Patients with CR were recruited from a neurosurgical department from October 2010 to November 2012. Criteria for eligibility were as follows: (1) magnetic resonance imaging verified cervical disc disease showing cervical nerve root compression; and (2) neck and/or arm pain, verified with a neck

Results

Figure 1 provides a flow diagram of patient recruitment and retention. Recruitment of patients were performed between October 2010 and November 2012, and follow-ups were performed between January 2011 and November 2014. At the 3-month follow-up, 21 patients in the neck-specific training and 28 in the prescribed physical activity group had discontinued their participation and did not complete the follow-up assessments. At the 6-month follow-up, another 6 patients in the neck-specific training

Discussion

The results of the current study demonstrated that both training groups improved regardless of the intervention received. No interaction existed for either the primary or secondary outcomes indicating that 1 treatment was not superior to the other. However, there appeared to be slightly faster (although not significant) improvement for the neck-specific training group compared to the prescribed physical activity group. Because both groups experienced a significant reduction in pain, both

Conclusions

The study revealed that neck-specific training as well as prescribed physical activity, both including additional cognitive behavioral approach, decreased the pain in patients with CR, that is, participants improved regardless of the intervention received. There is a lack of consensus of how to best manage individuals with CR. However, our findings suggest that CR has a natural favorable long-term outcome when patients are prescribed neck-specific training and exercise in combination with a

Supplier

  • a.

    IBM SPSS Statistics, version 20; IBM Corporation.

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  • Supported by the Swedish Government through the Karolinska Institute, in the Swedish National School of Research Education in Health Care Sciences, and the Strategic Research Programme in Care Sciences, as well as from the Stockholm County Council Funding ALF Medicine (grant no 20110071).

    Clinical Trial Registration No.: NCT01831271.

    Disclosures: none.

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