A Nonsurgical Approach to the Management of Patients With Cervical Radiculopathy: A Prospective Observational Cohort Study
Received 15 July 2005; received in revised form 15 November 2005
Abstract
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.
aClinical Assistant Professor, Department of Community Health, Brown University Medical School, Providence RI; Adjunct Associate Professor, Department of Research, New York Chiropractic College, Seneca Falls, NY
bDepartment of Public Health Sciences and Epidemiology, John A. Burns School of Medicine, University of Hawaii, Manoa, Hawaii
ABSTRACT