Effectiveness of Multimodal Rehabilitation Interventions for Management of Cervical Radiculopathy in Adults: An Updated Systematic Review from the Ontario Protocol for Traffic Injury Management (Optima) Collaboration
Bibliographic record
Abstract
Objective: To update the systematic review from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration and to evaluate the effectiveness of multimodal rehabilitation interventions for the management of adults with cervical radiculopathy.Study design: Systematic review and best-evidence synthesis.Methods: Eligible studies (from January 2013 to June 2020) were critically appraised using the Scottish Intercollegiate Guidelines Network and Risk of Bias 2.0 criteria. The certainty of the evidence was assessed according to Grading of Recommendations Assessment, Development, and Evaluation.Results: Four RCTs were deemed acceptable and 1 RCT was considered low quality. In adults with recent-onset cervical radiculopathy, multimodal rehabilitation was associated with a trivial and nonclinically important reduction in neck pain compared with mechanical cervical traction; no differences in disability were reported (1 study, 360 participants, low certainty of the evidence). In adults with cervical radiculopathy of any duration, (i) multimodal rehabilitation may be more effective than prescribed physical activity and brief cognitive-behavioural approach; specifically, a small reduction in arm pain and in function was found (1 study, 144 participants, low certainty of the evidence); (ii) no difference in pain reduction was found between multimodal rehabilitation interventions compared with an epidural steroid injection (1 study, 169 participants, low certainty of the evidence); and (iii) compared with surgery combined with neck exercises, multimodal rehabilitation interventions lead to similar arm pain reduction and improvement in function (1 study, 68 participants, low certainty of the evidence).Conclusion: The evidence suggests that some multimodal rehabilitation care may provide small and trivial reduction in neck pain or improvement in function to patients with cervical radiculopathy. LAY ABSTRACTCervical radiculopathy refers to neck and arm pain associated with neurological signs and symptoms. Management of this condition involves clinical rehabilitation as the first line of treatment. A systematic review of the literature was performed to evaluate the effectiveness of multimodal interventions for management of cervical radiculopathy. This review suggests that multimodal interventions that include manual therapy to the cervical spine or neck-specific exercises, education, and a cognitive behavioural approach are associated with trivial benefits to patients with cervical radiculopathy. The review also found that adding medication (gabapentin), education, electrical stimulations, ultrasound, massage, and exercise to epidural steroid injection leads to similar outcomes as an epidural steroid injection alone. Finally, the evidence suggests that multimodal rehabilitation (exercises and education) leads to similar outcomes to surgery combined with neck exercises, pain coping, self-efficacy, and stress management strategies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.039 | 0.118 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.013 | 0.013 |
| Bibliometrics | 0.012 | 0.011 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.003 | 0.004 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".