Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: randomised trial

doi:10.1136/bmj.b3883

Published 7 October 2009, doi:10.1136/bmj.b3883
Cite this as: BMJ 2009;339:b3883

Research

Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: randomised trial

Barbara Kuijper, neurologist¹^,2, Jos Th J Tans, retired neurologist ¹, Anita Beelen, chair of research group³, Frans Nollet, professor of rehabilitation medicine and chair of department³, Marianne de Visser, professor of neurology⁴

¹ Department of Neurology, Medical Centre Haaglanden, The Hague, Netherlands, ² Department of Neurology, Maasstad Hospital, Rotterdam, Netherlands, ³ Department of Rehabilitation, Academic Medical Centre, Amsterdam, Netherlands, ⁴ Department of Neurology, Academic Medical Centre, Amsterdam

Correspondence to: B Kuijper, Maasstad Hospital, Department of Neurology, P O Box 9119, 3078 AC, Rotterdam, Netherlands kuijperb{at}maasstadziekenhuis.nl

Objective To evaluate the effectiveness of treatment with collaror physiotherapy compared with a wait and see policy in recentonset cervical radiculopathy.

Design Randomised controlled trial.

Setting Neurology outpatient clinics in three Dutch hospitals.

Participants 205 patients with symptoms and signs of cervicalradiculopathy of less than one month’s duration

Interventions Treatment with a semi-hard collar and taking restfor three to six weeks; 12 twice weekly sessions of physiotherapyand home exercises for six weeks; or continuation of daily activitiesas much as possible without specific treatment (control group).

Main outcome measures Time course of changes in pain scoresfor arm and neck pain on a 100 mm visual analogue scale andin the neck disability index during the first six weeks.

Results In the wait and see group, arm pain diminished by 3mm/week on the visual analogue scale (β=–3.1 mm,95% confidence interval –4.0 to –2.2 mm) and by19 mm in total over six weeks. Patients who were treated withcervical collar or physiotherapy achieved additional pain reduction(collar: β=–1.9 mm, –3.3 to –0.5 mm;physiotherapy: β=–1.9, –3.3 to –0.8),resulting in an extra pain reduction compared with the controlgroup of 12 mm after six weeks. In the wait and see group, neckpain did not decrease significantly in the first six weeks (β=–0.9mm, –2.0 to 0.3). Treatment with the collar resulted ina weekly reduction on the visual analogue scale of 2.8 mm (–4.2to –1.3), amounting to 17 mm in six weeks, whereas physiotherapygave a weekly reduction of 2.4 mm (–3.9 to –0.8)resulting in a decrease of 14 mm after six weeks. Compared witha wait and see policy, the neck disability index showed a significantchange with the use of the collar and rest (β=–0.9mm, –1.6 to –0.1) and a non-significant effect withphysiotherapy and home exercises.

Conclusion A semi-hard cervical collar and rest for three tosix weeks or physiotherapy accompanied by home exercises forsix weeks reduced neck and arm pain substantially compared witha wait and see policy in the early phase of cervical radiculopathy.

Trial registration Clinical trials NCT00129714 [ClinicalTrials.gov] .

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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