Mechanisms of recovery after neck-specific or general exercises in patients with cervical radiculopathy

Research output: Contribution to journalArticlepeer-review


  • Bernard X W Liew
  • Anneli Peolsson
  • Joshua A Cleland
  • Marco Scutari
  • Marie Kierkegaard
  • Asa Dedering

External organisations

  • Tufts University School of Medicine
  • Istituto Dalle Molle di Studi sull'Intelligenza Artificiale (IDSIA), Manno, Switzerland.
  • Karolinska Institutet
  • University of Essex
  • Linköping University


Background: The mechanisms of action that facilitate improved outcomes after conservative rehabilitation are unclear in individuals with cervical radiculopathy (CR). This study aims to determine the pathways of recovery of disability with different exercise programs in individuals with CR. 

Methods: We analysed a dataset of 144 individuals with CR undergoing conservative rehabilitation. Eleven variables collected at baseline, 3, 6 and 12 months follow-up were used to build a Bayesian Network (BN) model: treatment group (neck-specific vs. general exercises), age, sex, self-efficacy, catastrophizing, kinesiophobia, anxiety, neck–arm pain intensity, headache pain intensity and disability. The model was used to quantify the contribution of different mediating pathways on the outcome of disability at 12th months. 

Results: All modelled variables were conditionally independent from treatment groups. A one-point increase in anxiety at 3rd month was associated with a 2.45-point increase in 12th month disability (p <.001). A one-point increase in head pain at 3rd month was associated with a 0.08-point increase in 12th month disability (p <.001). Approximately 83% of the effect of anxiety on disability was attributable to self-efficacy. Approximately 88% of the effect of head pain on disability was attributable to neck–arm pain. 

Conclusions: No psychological or pain-related variables mediated the different treatment programs with respect to the outcome of disability. Thus, the specific characteristics investigated in this study did not explain the differences in mechanisms of effect between neck-specific training and prescribed physical activity. The present study provides candidate modifiable mediators that could be the target of future intervention trials. 

Significance: Psychological and pain characteristics did not differentially explain the mechanism of effect that two exercise regimes had on disability in individuals with cervical radiculopathy. In addition, we found that improvements in self-efficacy was approximately five times more important than that of neck–arm pain intensity in mediating the anxiety-disability relationship. A mechanistic understanding of recovery provides candidate modifiable mediators that could be the target of future intervention trials. 

Trials registration: identifier: NCT01547611.

Bibliographic note

Funding Information: The authors acknowledge financial support from the Stockholm County Council. Publisher Copyright: © 2021 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC ®. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.


Original languageEnglish
Pages (from-to)1162–1172
JournalEuropean Journal of Pain
Issue number5
Early online date3 Feb 2021
Publication statusPublished - May 2021

ASJC Scopus subject areas