Timing of evidence-based nonsurgical interventions as part of multimodal treatment guidelines for the management of cervical radiculopathy: a Delphi study

OBJECTIVE: Conservative management of cervical radiculopathy (CR) is a first treatment option as the risk-benefit ratio for surgery is less favorable. Systematic reviews and clinical practice guidelines reporting on the effectiveness of nonsurgical management have not considered the timing of management. The aim of this study was to establish consensus on effective nonsurgical treatment modalities at different stages (ie, acute, subacute or chronic) of CR, using the Delphi method approach.

METHODS: Through an iterative multistage process, experts within the field rated their agreement with a list of proposed treatment modalities according to the stage of CR and could suggest missing treatment modalities. Agreement was measured using a 5-point Likert scale. Descriptive statistics were used to measure agreement (median, interquartile ranges and percentage of agreement). Consensus criteria were defined a priori for each round. Consensus for Round 3 was based on ≥2 of the following: a median Likert scale value of ≥4, IQR value of ≤1 and/or a percentage of agreement ≥70%.

RESULTS: Data analysis produced a consensus list of effective treatment modalities in different stages of recovery.

CONCLUSION: According to experts, in the acute stage the focus of multimodal management should consist of patient education and spinal manipulative therapy, specific (foraminal opening) exercises and sustained pain-relieving positions. In the subacute stage, increasing individualized physical activity including supervised motor control, specific exercises and/or neurodynamic mobilization could be added. In the chronic stage, focus should shift to include general aerobic exercise as well as focused strength training. Postural education and vocational ergonomic assessment should also be considered.