Structured postoperative physiotherapy in patients with cervical radiculopathy: 6-month outcomes of a randomized clinical trial
Structured postoperative physiotherapy in patients with cervical radiculopathy: 6-month outcomes of a randomized clinical trial
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DOI：
10.3171/2017.5.spine16736
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发表时间：
2018-01-01
影响因子：
2.8
通讯作者：
Peolsson, Anneli
中科院分区：
文献类型：
--
作者：
Wibault, Johanna;Oberg, Birgitta;Peolsson, Anneli
结构化物理疗法已被建议作为术前和术后治疗，以改善颈椎神经根病（CR）患者的临床结局，但缺乏随机临床试验，以告知手术后CR患者治疗的循证临床指南。本研究的目的是比较结构化的术后物理治疗结合颈部特定的锻炼与行为方法的结果，标准的术后方法在术后6个月接受手术治疗颈椎间盘疾病并出现CR的患者中的结果。101例）或标准术后入路（n = 100）。后者包括根据瑞典通常的术后护理进行的实用物理治疗。结果指标包括患者报告的颈部残疾，用颈部残疾指数（NDI）、颈部和手臂疼痛的强度和频率、治疗的总体结果、期望实现以及实现。结果接受结构化术后物理治疗的患者报告了更高的期望实现（p = 0.01），并且那些参加至少50%的治疗课程的人报告颈部疼痛频率较低（p = 0.05），更大的期望实现（p = 0.001），更大的实现（p = 0.04）与接受标准术后方法的患者相比。治疗组间无其他差异（p > 0.15）。术后6个月，两组NDI和颈臂疼痛强度均有所改善（p < 0.001）。额外使用的术后物理治疗的61%的患者谁收到了标准的postoperative approach.CONCLUSIONS从这第一次随机临床试验的结果术后物理治疗显示，只有轻微的额外好处结构化术后物理治疗相比，标准的术后方法6个月后，在接受手术的颈椎间盘疾病与CR。接受结构化术后物理治疗的患者报告了更高的期望实现，标准术后方法组中的许多患者认为需要在术后进行额外治疗，这表明CR患者需要进一步的术后支持。结果证实，颈部特定的运动是耐受术后CR患者，但需要更多的研究，术后物理治疗，为这一患者群体的临床指南。
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.