Cervical Radiculopathy: Who will respond to physical therapy?

A recent article in the Journal of Physical Therapy attempts to answer this question through a prospective cohort study. The purpose of the study was to determine if factors discovered during either the examination or course of treatment were able to predict clinical outcomes for patients with cervical radiculopathy.

This study took 96 consecutive patients with a diagnosis of cervical radiculopathy. The patients underwent a clinical exam and completed standardized outcome tools such as the Neck Disability Index (NDI), Patient Specific Functional Scale (PSFS), and Numeric Pain Rating Scale (NPRS). Treatments were not standardized and left to the discretion of the physical therapist. Short term-success was defined as surpassing the minimal clinically important change for ALL outcome measures at discharge or last reexamination.

The study revealed eight predictor variables identifying individuals likely to show short-term success from physical therapy intervention. Three were based on historical data, one from clinical examination, and four from intervention selection. Based on likelihood ratios the authors cited the following cluster of variables as most significant:

• Age of less than 54 years
• Dominant arm not affected
• Looking down does not worsen symptoms
• Multimodal treatment (manual therapy, cervical traction, deep neck flexor strengthening for at least 50% of visits)

Having three of the four variables present led to an 85% posttest probability the patient would experience short-term success. Having all four variables present were associated with a 90% post-test probability.

While the authors acknowledge some key limitations in their study, their findings do suggest a possible set of clinical variables useful to the practicing therapist treating cervical radiculopathy. Studies such as this are likely to begin to discriminate between patients likely to benefit from physical therapy and those needing referral to other health care providers.

Cleland, J.A., Fritz, J.M., Whitman, J.M., Heath, R. (2007). Predictors of Short-Term Outcome in People With a Clinical Diagnosis of Cervical Radiculopathy. Journal of Physical Therapy, 87(12), 1619-1632.