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A randomized trial comparing manual physical therapy to therapeutic exercises, to a combination of therapies, for the treatment of cervical radiculopathy
Ragonese J
Orthopaedic Physical Therapy Practice 2009;21(3):71-76
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

STUDY DESIGN: Randomized clinical trial. OBJECTIVES: To determine which treatment method will produce superior outcomes for patients with cervical radiculopathy: manual physical therapy, therapeutic exercises, or a combination of manual physical therapy and therapeutic exercises. BACKGROUND: There are many different interventions that are commonly used to treat patients with cervical radiculopathy. Many of these interventions include cervical traction, mobilization and manipulation techniques to the cervical and thoracic spine, strengthening exercises directed at the cervical and thoracic musculature, and pain modalities. There have been few randomized and blind studies that have examined the effectiveness of any of these interventions for use with patient's suffering from cervical radiculopathy. METHODS AND MEASURES: Thirty patients with cervical radiculopathy were randomized into 3 treatment groups, one group received only manual physical therapy interventions, a second received only therapeutic exercises, and the third received both manual physical therapy techniques and therapeutic exercises. Each patient was seen 3 sessions per week for 3 weeks. The patients were then re-evaluated by a therapist who was blinded as to which treatment group each patient received. Self report measures of pain and function using a numeric pain rating scale (NPRS) and the Neck Disability Index (NDI), along with goniometric measurements of active cervical rotation were used as outcome measures. Results were analyzed using independent groups ANOVA. RESULTS: Significant differences in treatment effects were observed for the reduction of pain and an increase in score on the NDI, with the group receiving the combination of manual techniques and exercises demonstrating the greatest improvements. All three groups demonstrated equal improvements in active cervical rotation. CONCLUSION: When treating patients with a diagnosis of cervical radiculopathy, an approach that combines manual therapy and therapeutic exercise appears to be superior to treatment when compared to either intervention alone.

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