Johanna Wibault

Using the cervical range of motion (CROM) device to assess head repositioning accuracy in individuals with cervical radiculopathy in comparison to neck- healthy individuals

This study had two purposes: to compare head repositioning accuracy (HRA) using the cervical range of motion (CROM) device between individuals with cervical radiculopathy caused by disc disease (CDD; n = 71) and neck- healthy individuals (n = 173); and to evaluate the test-retest reliability of the CROM device in individuals with CDD, and criterion validity between the CROM device and a laser in neck-healthy individuals, with quantification of measurement errors. Parameters of reliability and validity were expressed with intra- class- correlation coefficients (ICCs), and measurement errors with standard error of measurement (SEM) and Bland Altman limits of agreement. HRA (Mdn, IQR) differed significantly between individuals with CDD and neck- healthy individuals after rotation right 2.7° (6.0), 1.7° (2.7); and rotation left 2.7° (3.3), 1.3° (2.7) (p < = 0.021); 31% of individuals with CDD were classified as having impairment in HRA. The test-retest reliability of the CROM device in individuals with CDD showed ICCs of 0.79- 0.85, and SEMs of 1.4°- 2°. The criterion validity between the CROM device and the laser in neck-healthy individuals showed ICCs of 0.43- 0.91 and SEMs of 0.8°- 1.3°. The results support the use of the CROM device for quantifying HRA impairment in individuals with CDD in clinical practice; however, criterion validity between the CROM device and a laser in neck-healthy individuals was questionable. HRA impairment in individuals with CDD may be important to consider during rehabilitation and evaluated with the criterion established with the CROM device in neck-healthy individuals.

Structured postoperative physiotherapy in patients with cervical radiculopathy: 6-month outcomes of a randomized clinical trial

OBJECTIVE Structured physiotherapy has been suggested as treatment before as well as after surgery to improve clinical outcomes in patients with cervical radiculopathy (CR), but randomized clinical trials to inform evidence-based clinical guidelines for the treatment of patients with CR after surgery are lacking. The aim of this study was to compare the results of structured postoperative physiotherapy combining neck-specific exercises with a behavioral approach to a standard postoperative approach in patients who had undergone surgery for cervical disc disease with CR at 6 months after surgery. METHODS Patients with cervical disc disease and persistent CR who were scheduled for surgery were randomized preoperatively to structured postoperative physiotherapy (n = 101) or a standard postoperative approach (n = 100). The latter included pragmatic physiotherapy in accordance with the usual Swedish postoperative care. Outcome measures included patient-reported neck disability as measured with the Neck Disability Index (NDI), intensity and frequency of neck and arm pain, global outcome of treatment, and expectation fulfillment, as well as enablement. RESULTS Patients who received structured postoperative physiotherapy reported greater expectation fulfillment (p = 0.01), and those who attended at least 50% of the treatment sessions reported less neck pain frequency (p = 0.05), greater expectation fulfillment (p = 0.001), and greater enablement (p = 0.04) compared with patients who received the standard postoperative approach. No other difference between treatment groups was found (p > 0.15). The NDI and neck and arm pain intensity were improved in both groups at 6 months after surgery (p < 0.001). Additional use of postoperative physiotherapy was reported by 61% of the patients who received the standard postoperative approach. CONCLUSIONS The results from this first randomized clinical trial of postoperative physiotherapy showed only minor additional benefit of structured postoperative physiotherapy compared with standard postoperative approach 6 months postoperatively in patients who underwent surgery for cervical disc disease with CR. Patients who received structured postoperative physiotherapy reported higher expectation fulfillment, and many patients in the standard postoperative approach group perceived a need for additional treatments after surgery, suggesting that patients with CR are in need of further postoperative support. The results confirm that neck-specific exercises are tolerated postoperatively by patients with CR, but more studies of postoperative physiotherapy are needed to inform clinical guidelines for this patient group. Clinical trial registration no.: NCT01547611 (clinicaltrials.gov).

Outcome of physiotherapy after surgery for cervical disc disease: a prospective randomised multi-centre trial

BackgroundMany patients with cervical disc disease require leave from work, due to long-lasting, complex symptoms, including chronic pain and reduced levels of physical and psychological function. Surgery on a few segmental levels might be expected to resolve disc-specific pain and reduce neurological deficits, but not the non-specific neck pain and the frequent illness. No study has investigated whether post-surgery physiotherapy might improve the outcome of surgery. The main purpose of this study was to evaluate whether a well-structured rehabilitation programme might add benefit to the customary post-surgical treatment for cervical disc disease, with respect to function, disability, work capability, and cost effectiveness.Methods/DesignThis study was designed as a prospective, randomised, controlled, multi-centre study. An independent, blinded investigator will compare two alternatives of rehabilitation. We will include 200 patients of working age, with cervical disc disease confirmed by clinical findings and symptoms of cervical nerve root compression. After providing informed consent, study participants will be randomised to one of two alternative physiotherapy regimes; (A) customary treatment (information and advice on a specialist clinic); or (B) customary treatment plus active physiotherapy. Physiotherapy will follow a standardised, structured programme of neck-specific exercises combined with a behavioural approach. All patients will be evaluated both clinically and subjectively (with questionnaires) before surgery and at 6 weeks, 3 months, 6 months, 12 months, and 24 months after surgery. The main outcome variable will be neck-specific disability. Cost-effectiveness will also be calculated.DiscussionWe anticipate that the results of this study will provide evidence to support physiotherapeutic rehabilitation applied after surgery for cervical radiculopathy due to cervical disc disease.Trial registrationClinicalTrials.gov identifier: NCT01547611

Neck-related physical function, self-efficacy and coping strategies in patients with cervical radiculopathy : a randomized clinical trial of postoperative physiotherapy

Objective The purpose of this study was to compare postoperative rehabilitation with structured physiotherapy to the standard approach in patients with cervical radiculopathy (CR) in a prospective randomized study at 6 months follow‐up based on measures of neck‐related physical function, self‐efficacy, and coping strategies. Methods Patients with persistent CR and scheduled for surgery (N = 202) were randomly assigned to structured postoperative physiotherapy or a standard postoperative approach. Structured postoperative physiotherapy combined neck‐specific exercises with a behavioral approach. Baseline, 3‐month, and 6‐month evaluations included questionnaires and clinical examinations. Neck muscle endurance, active cervical range of motion, self‐efficacy, pain catastrophizing (CSQ‐CAT), perceived control over pain, and ability to decrease pain were analyzed for between‐group differences using complete case and per‐protocol approaches. Results No between‐group difference was reported at the 6‐month follow‐up (P = .05‐.99), but all outcomes had improved from baseline (P < .001). Patients undergoing structured postoperative physiotherapy with ≥50% attendance at treatment sessions had larger improvements in CSQ‐CAT (P = .04) during the rehabilitation period from 3 to 6 months after surgery compared with the patients who received standard postoperative approach. Conclusions No between‐group difference was found at 6 months after surgery based on measures of neck‐related physical function, self‐efficacy, and coping strategies. However, the results confirm that neck‐specific exercises are tolerated by patients with CR after surgery and may suggest a benefit from combining surgery with structured postoperative physiotherapy for patients with CR.