Wibault Johanna, Öberg Birgitta, Dedering Åsa, Löfgren Håkan, Zsigmond Peter, Peolsson Anneli
1Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University.
2Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.
J Neurosurg Spine. 2018 Jan;28(1):1-9. doi: 10.3171/2017.5.SPINE16736. Epub 2017 Nov 3.
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. Clinical trial registration no.: NCT01547611 (clinicaltrials.gov).
结构化物理治疗已被建议作为颈椎神经根病（CR）患者手术前后的治疗方法，以改善临床疗效，但缺乏为CR患者术后治疗提供循证临床指南的随机临床试验。本研究的目的是比较结构化术后物理治疗（结合颈部特定锻炼和行为方法）与标准术后治疗方法在因CR行颈椎间盘疾病手术患者术后6个月时的效果。方法：计划接受手术的颈椎间盘疾病和持续性CR患者在术前被随机分为结构化术后物理治疗组（n = 101）或标准术后治疗组（n = 100）。后者包括按照瑞典常规术后护理进行的实用物理治疗。结局指标包括用颈部残疾指数（NDI）测量的患者报告的颈部残疾情况、颈部和手臂疼痛的强度和频率、治疗的总体结局、期望达成情况以及赋能情况。结果：与接受标准术后治疗方法的患者相比，接受结构化术后物理治疗的患者报告的期望达成情况更好（p = 0.01），参加至少50%治疗课程的患者报告的颈部疼痛频率更低（p = 0.05）、期望达成情况更好（p = 0.001）以及赋能情况更好（p = 0.04）。未发现治疗组之间的其他差异（p > 0.15）。两组在术后6个月时NDI以及颈部和手臂疼痛强度均有所改善（p < 0.001）。接受标准术后治疗方法的患者中有61%报告额外使用了术后物理治疗。结论：这项术后物理治疗的首次随机临床试验结果显示，与标准术后治疗方法相比，结构化术后物理治疗在因CR行颈椎间盘疾病手术患者术后6个月时仅显示出轻微的额外益处。接受结构化术后物理治疗的患者报告的期望达成情况更高，并且标准术后治疗组中的许多患者认为术后需要额外治疗，这表明CR患者需要进一步的术后支持。结果证实CR患者术后能够耐受颈部特定锻炼，但需要更多关于术后物理治疗的研究来为该患者群体的临床指南提供依据。临床试验注册号：NCT01547611（clinicaltrials.gov）。
