Physiotherapy versus pain medication for managing chronic cervical radiculopathy: protocol for a multi-arm parallel-group randomized clinical trial

Abstract

Background: Cervical radiculopathy (CR) is one of the prevalent causes of neck pain and disability. Physiotherapy and pain medications are the common nonoperative management, and in physiotherapy, there are many concepts of assessment and management. This study aims to determine the comparative effectiveness of three specialized physiotherapy approaches or only pain medications for managing CR cases. Methods: A prospective, assessor, and participant-blind, four-arm randomized control trial (RCT) has been planned to conduct on 160 patients with chronic cervical radiculopathy in 4 specialized centers of Dhaka city recruited between July and December 2022. Four groups (n=40) will be treated through structural diagnosis and management concept (SDM), regional approaches (RA), McKenzie mechanical diagnosis and therapy (MDT) concept prescribed by advanced practice physiotherapist (APP), or pain medications prescribed by the specialist physician for 4 weeks. The outcome will be evaluated in baseline, intermediate test (14 days), and post-treatment (28 days) through Brief Pain Inventory (BPI) for pain, Goniometer reading for cervical range of motion (ROM), and Neck disability index (NDI) as the primary outcome. The secondary outcome will be quality of life measured at baseline and post-treatment by the WHO quality of life questionnaire WHOQOL-BREF. Discussion: The study will compare the efficacy of the three physiotherapy approaches with pain medications when treating chronic cervical radiculopathy. The findings will provide evidence when demining the best conservative management approach for CR. Clinical Trial Registry India: CTRI/2022/03/040922 (08/03/2022)

Efficacy of neck muscle activation versus strengthening for adults with chronic cervical radiculopathy: a study protocol for a randomised clinical trial

“…To qualify for participation, participants must meet at least two or three of the following chronic cervical radiculopathy criteria 8 : (1a) presence of radicular pain on one or both sides of the body and may or may not be accompanied by neck pain, (1b) symptoms like paresthesia, numbness, weakness or altered reflexes in C2-C8 dermatome or myotome and (1c) MRI confirmation of nerve root compression related to clinical findings. Additional inclusion criteria are as follows: (2) age 18–50 with informed consent, 19 20 (3) any gender, 19 21 (4) chronic cervical radiculopathy duration over 3 months, (5) Neck Disability Index (NDI) score <15/50, 14 16 (6) Brief Pain Inventory (BPI) severity score 1–6 on an 11-point scale 20 and (7) poor performance on craniocervical flexion test. Patients cannot elevate the target pressure from 20 mm Hg to 22 mm Hg and hold for 3 s before returning to the initial relaxing position.…”

“…Figure 19 20 (3) any gender, 19 21 (4) chronic cervical radiculopathy duration over 3 months, (5) Neck Disability Index (NDI) score <15/50, 14 16 (6) Brief Pain Inventory (BPI) severity score 1-6 on an 11-point scale 20 and ( 7) poor performance on craniocervical flexion test.…”