Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: randomised trial.
OBJECTIVE
To evaluate the effectiveness of treatment with collar or physiotherapy compared with a wait and see policy in recent onset cervical radiculopathy.


METHODS
Randomised controlled trial.


METHODS
Neurology outpatient clinics in three Dutch hospitals.


METHODS
205 patients with symptoms and signs of cervical radiculopathy of less than one month's duration


METHODS
Treatment with a semi-hard collar and taking rest for three to six weeks; 12 twice weekly sessions of physiotherapy and home exercises for six weeks; or continuation of daily activities as much as possible without specific treatment (control group).


METHODS
Time course of changes in pain scores for arm and neck pain on a 100 mm visual analogue scale and in the neck disability index during the first six weeks.


RESULTS
In the wait and see group, arm pain diminished by 3 mm/week on the visual analogue scale (beta=-3.1 mm, 95% confidence interval -4.0 to -2.2 mm) and by 19 mm in total over six weeks. Patients who were treated with cervical collar or physiotherapy achieved additional pain reduction (collar: beta=-1.9 mm, -3.3 to -0.5 mm; physiotherapy: beta=-1.9, -3.3 to -0.8), resulting in an extra pain reduction compared with the control group of 12 mm after six weeks. In the wait and see group, neck pain did not decrease significantly in the first six weeks (beta=-0.9 mm, -2.0 to 0.3). Treatment with the collar resulted in a weekly reduction on the visual analogue scale of 2.8 mm (-4.2 to -1.3), amounting to 17 mm in six weeks, whereas physiotherapy gave a weekly reduction of 2.4 mm (-3.9 to -0.8) resulting in a decrease of 14 mm after six weeks. Compared with a wait and see policy, the neck disability index showed a significant change with the use of the collar and rest (beta=-0.9 mm, -1.6 to -0.1) and a non-significant effect with physiotherapy and home exercises.


CONCLUSIONS
A semi-hard cervical collar and rest for three to six weeks or physiotherapy accompanied by home exercises for six weeks reduced neck and arm pain substantially compared with a wait and see policy in the early phase of cervical radiculopathy. Trial registration Clinical trials NCT00129714.
Kuijper
Barbara
B
Department of Neurology, Medical Centre Haaglanden, The Hague, Netherlands. kuijperb@maasstadziekenhuis.nl
Tans
Jos Th J
JT
Beelen
Anita
A
Nollet
Frans
F
de Visser
Marianne
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D001132:Arm; D006233:Persons with Disabilities; D005081:Exercise Therapy; D006699:Home Care Services; D006801:Humans; D007103:Immobilization / Q000295:instrumentation*; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology / Q000517:prevention & control; D009989:Orthotic Devices; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D011843:Radiculopathy / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult