A nonsurgical approach to the management of patients with cervical radiculopathy: a prospective observational cohort study.
OBJECTIVE
The objective of this study was to describe the clinical outcomes of patients with cervical radiculopathy (CR) treated nonsurgically after a diagnosis-based decision rule.


METHODS
A prospective observational cohort study on consecutive patients with CR was performed. Data on 35 consecutive patients were collected at baseline, at the end of the active treatment, and at a minimum of 3 months after cessation of treatment. Disability was measured using the Bournemouth Disability Questionnaire. Pain intensity was measured using the Numerical Pain Rating Scale. Patients were also asked to self-rate their improvement.


RESULTS
Complete outcome data were available for 31 of the 35 patients. Twenty-seven patients were reached for long-term follow-up. The mean number of months from last treatment to follow-up was 8.2 months. Seventeen patients (49%) reported their improvement as "excellent" and another 14 (40%) did so as "good." The mean patient-rated improvement was 88.2%. The mean percentage of improvement in the Bournemouth Disability Questionnaire score was 78%. The mean percentage of improvement in the Numerical Pain Rating Scale score was 72%. Twenty-four of 31 (77.4%) patients had a clinically significant improvement from baseline to the end of treatment, and 25 of 27 (92.6%) had a clinically significant improvement from baseline to long-term follow-up.


CONCLUSIONS
The management strategy that we studied yielded favorable outcomes in this patient sample and appears to be a safe option for patients with CR. However, the absence of randomization and a control group limits interpretation with regard to clinical effectiveness. Randomized clinical trials are necessary to distinguish treatment effects from the natural history of CR.
Murphy
Donald R
DR
Department of Community Health, Brown University Medical School, Providence RI, USA. rispine@aol.com
Hurwitz
Eric L
EL
Gregory
Amy
A
Clary
Ronald
R
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal; D008875:Middle Aged; D011446:Prospective Studies; D011843:Radiculopathy / Q000628:therapy*