(Cost‐)effectiveness of personalised multimodal physiotherapy compared to surgery in patients with cervical radiculopathy: A systematic review

• Published in: Journal of evaluation in clinical practice Vol. 30; no. 7; pp. 1227 - 1238
• Main Authors: Klein Heerenbrink, Sebastiaan, Coenen, Pieter, Coppieters, Michel W., Dongen, Johanna M., Vleggeert‐Lankamp, Carmen L. A., Rooker, Servan, Meulen, Bastiaan C., Bosboom, Johannes L. W., Bouma, Gerrit J., Lutke Schipholt, Ivo J., Sleijser‐Koehorst, Marije L. S., Vries, Ralph, Ostelo, Raymond W. J. G., Scholten‐Peeters, Gwendolyne G. M.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-10-2024
• Subjects: ACDF; anterior cervical discectomy and fusion; cervical disc herniation; literature review; Neck pain; Physical therapy; Quality of life; rehabilitation; Surgery; surgical procedures; surgical procedures; anterior cervical discectomy and fusion; rehabilitation; ACDF; cervical disc herniation; literature review
• ISSN: 1356-1294; 1365-2753; 1365-2753
• DOI: 10.1111/jep.14036

Rationale
Cervical radiculopathy is initially typically managed conservatively. Surgery is indicated when conservative management fails or with severe/progressive neurological signs. Personalised multimodal physiotherapy could be a promising conservative strategy. However, aggregated evidence on the (cost‐)effectiveness of personalised multimodal physiotherapy compared to surgery with/without post‐operative physiotherapy is lacking.
Aim/Objectives
To systematically summarise the literature on the (cost‐)effectiveness of personalised multimodal physiotherapy compared to surgery with or without post‐operative physiotherapy in patients with cervical radiculopathy.
Methods
PubMed, Embase, CINAHL, PsycINFO and Web of Science were searched from inception to 1st of March 2023. Primary outcomes were effectiveness regarding costs, arm pain intensity and disability. Neck pain intensity, perceived recovery, quality of life, neurological symptoms, range‐of‐motion, return‐to‐work, medication use, (re)surgeries and adverse events were considered secondary outcomes. Randomised clinical trials comparing personalised multimodal physiotherapy versus surgical approaches with/without post‐operative physiotherapy were included. Two independent reviewers performed study selection, data‐extraction, and risk of bias assessment using the Cochrane RoB 2 and Consolidated Health Economic Evaluation Reporting Standards statement. Certainty of the evidence was determined using Grading of Recommendations, Assessment, Development and Evaluations.
Results
From 2109 records, eight papers from two original trials, with 117 participants in total were included. Low certainty evidence showed there were no significant differences on arm pain intensity and disability, except for the subscale ‘heavy work’ related disability (12 months) and disability at 5–8 years. Cost‐effectiveness was not assessed. There was low certainty evidence that physiotherapy improved significantly less on neck pain intensity, sensory loss and perceived recovery compared to surgery with/without physiotherapy. Low certainty evidence showed there were no significant differences on numbness, range of motion, medication use, and quality of life. No adverse events were reported.
Conclusion
Considering the clinical importance of accurate management recommendations and the current low level of certainty, high‐quality cost‐effectiveness studies are needed.