Manual therapy, exercise, and traction for patients with cervical radiculopathy: a randomized clinical trial.
BACKGROUND
To date, optimal strategies for the management of patients with cervical radiculopathy remain elusive. Preliminary evidence suggests that a multimodal treatment program consisting of manual therapy, exercise, and cervical traction may result in positive outcomes for patients with cervical radiculopathy. However, limited evidence exists to support the use of mechanical cervical traction in patients with cervical radiculopathy.


OBJECTIVE
The purpose of this study was to examine the effects of manual therapy and exercise, with or without the addition of cervical traction, on pain, function, and disability in patients with cervical radiculopathy.


METHODS
This study was a multicenter randomized clinical trial.


METHODS
The study was conducted in orthopedic physical therapy clinics.


METHODS
Patients diagnosed with cervical radiculopathy (N=81) were randomly assigned to 1 of 2 groups: a group that received manual therapy, exercise, and intermittent cervical traction (MTEXTraction group) and a group that received manual therapy, exercise, and sham intermittent cervical traction (MTEX group).


METHODS
Patients were treated, on average, 2 times per week for an average of 4.2 weeks.


METHODS
Outcome measurements were collected at baseline and at 2 weeks and 4 weeks using the Numeric Pain Rating Scale (NPRS), the Patient-Specific Functional Scale (PSFS), and the Neck Disability Index (NDI).


RESULTS
There were no significant differences between the groups for any of the primary or secondary outcome measures at 2 weeks or 4 weeks. The effect size between groups for each of the primary outcomes was small (NDI=1.5, 95% confidence interval [CI]=-6.8 to 3.8; PSFS=0.29, 95% CI=-1.8 to 1.2; and NPRS=0.52, 95% CI=-1.8 to 1.2).


CONCLUSIONS
The use of a nonvalidated clinical prediction rule to diagnose cervical radiculopathy and the lack of a control group without treatment were limitations of this study.


CONCLUSIONS
The results suggest that the addition of mechanical cervical traction to a multimodal treatment program of manual therapy and exercise yields no significant additional benefit to pain, function, or disability in patients with cervical radiculopathy.
Young
Ian A
IA
Spine and Sport, Savannah, Georgia, USA. youngian@spinesport.org
Michener
Lori A
LA
Cleland
Joshua A
JA
Aguilera
Arnold J
AJ
Snyder
Alison R
AR
D000328:Adult; D002574:Cervical Vertebrae; D003131:Combined Modality Therapy; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D011843:Radiculopathy / Q000534:rehabilitation*; D016059:Range of Motion, Articular; D016896:Treatment Outcome