背景:神经根型颈椎病最初通常是保守治疗。当保守治疗失败或有严重/进行性神经系统体征时,应进行手术。个性化多模式物理治疗可能是一种有前途的保守策略。然而,与有/没有术后物理治疗的手术相比,缺乏个性化多模式物理治疗的(成本)有效性的综合证据.
目的:系统总结有关个性化多模式物理治疗与有或没有手术后物理治疗的颈神经根病患者的(成本)有效性的文献。
方法:PubMed,Embase,CINAHL,PsycINFO和WebofScience从开始到2023年3月1日进行了搜索。主要结果是成本方面的有效性,手臂疼痛强度和残疾。颈部疼痛强度,感知到的恢复,生活质量,神经症状,运动范围,重返工作岗位,药物使用,(再)手术和不良事件被认为是次要结局.包括比较个性化多模式物理治疗与有/没有手术后物理治疗的手术方法的随机临床试验。两名独立的审阅者进行了研究选择,数据提取,以及使用CochraneRoB2和综合卫生经济评估报告标准声明进行偏差风险评估。使用建议分级来确定证据的确定性,评估,开发和评估。
结果:来自2109条记录,来自两个原始试验的八篇论文,共有117名参与者被纳入.低确定性证据表明,手臂疼痛强度和残疾没有显着差异,除了与“繁重工作”相关的残疾(12个月)和5-8年的残疾。未评估成本效益。有低确定性证据表明,理疗对颈部疼痛强度的改善明显较少,与有/没有物理治疗的手术相比,感觉丧失和感觉恢复。低确定性证据表明,麻木没有显著差异,运动范围,药物使用,和生活质量。未报告不良事件。
结论:考虑到准确管理建议的临床重要性和当前的低确定性水平,需要高质量的成本效益研究。
BACKGROUND: 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.
OBJECTIVE: 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.
CONCLUSIONS: Considering the clinical importance of accurate management recommendations and the current low level of certainty, high-quality cost-effectiveness studies are needed.