PAIN+ CPN

OBJECTIVE: To evaluate the application effects of different manual therapy approaches in the treatment of cervical radiculopathy using a network meta-analysis.

METHODS: Prospective randomized controlled trials on manual therapy for cervical radiculopathy published in PubMed, the Cochrane Library, and Embase databases were retrieved. The neck disability index and visual analogue scale for neck pain were collected and subjected to network meta-analysis.

RESULTS: A total of 8 eligible studies involving 632 participants with a mean age range of 40-47 years were included. The intervention duration ranged from 4 to 6 weeks. Three intervention groups were defined: Group C (exercise and other therapies without manual therapy), Group M (manual therapy without traction), and Group MT (manual therapy with traction). Larger circles indicate more patients, and thicker lines show more studies comparing interventions. Group M had the highest probability (68.1%) of improving the neck disability index, followed by Group MT (29.1%), with Group C the lowest (2.8%). Compared to Group C, neck disability index scores improved by 0.58 (95% CI: -0.17, 1.33) in Group M and by 0.36 (95% CI: -0.39, 1.11) in Group MT. The difference between Group M and Group MT was not significant (0.22, 95% CI: -0.59, 1.03). For neck pain (visual analogue scale score), Group M had the highest probability (59.5%) of improvement, followed by Group MT (39.6%), with Group C the lowest (0.9%). Compared to Group C, the visual analogue scale score improved by 0.74 (95% CI: -0.04, 1.52) in Group M and by 0.61 (95% CI: -0.18, 1.40) in Group MT. The difference between Group M and Group MT was not significant (0.13, 95% CI: -0.72, 0.98). Egger's regression test showed no apparent publication bias.

CONCLUSION: Manual therapy is an effective approach for improving neck pain and neck disability index in patients with cervical radiculopathy, but more evidence-based support is needed regarding the use of cervical traction.

Rehab Clinician (OT/PT) rater

A very interesting and necessary meta-analysis. However, further studies in specific populations and with long-term evaluations are needed. Cost-effectiveness analyses compared with other treatments are also necessary.

Rehab Clinician (OT/PT) rater

As an orthopaedic and sports physiotherapist, the results of this systematic review and network meta-analysis add support to the wide belief among my colleagues that manual therapy is an important and effective therapeutic modality in treating neck disability and pain, and that in carefully selected patients, adding traction may be an effective adjunctive treatment in this population. This helps me in supporting my treatment approach in these patients, and supports education I provide to patients, colleagues, students, and referral sources alike.

Ms. Heather Taylor (5/2/2025 9:36 AM)

The authors clearly state major limitations to the study that include poor quality data and methodological issues with regard to manual therapy with and without traction. As a practising physiotherapist, this seems like an odd factor to include for comparison. Traction is a form of manual therapy.

Prof. Mike Poling (5/1/2025 8:29 AM)

This is smoke and mirrors. First of all, "Exercise" and "other therapies" are all over the board. Nothing consistent and much of it is no more than stretching with no regard for directional preference. Secondly, the margin of difference (20-60% success with manual therapy and 2.8% without) is so large as to make the selection of studies including very suspicious. And, indeed, when one examines the few studies included and then conducts a search and examines how many studies actually exist that were NOT included and actually EXCEED the inclusion criteria of this study, it immediately becomes apparent that this study is extremely biased in scope to favour manual therapy. This is not a worthwhile publication and if it was peer reviewed, the reviewers missed the boat.