• Åsa Dedering, Anneli Peolsson, Joshua A Cleland, Marie Halvorsen, Mikael A Svensson, and Marie Kierkegaard.
• Allied Health Professionals Function, Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institute, Stockholm, Sweden. Electronic address: Asa.dedering@ki.se.
• Arch Phys Med Rehabil. 2018 Dec 1; 99 (12): 2447-2456.

ObjectiveTo compare the effects of a neck-specific training program to prescribed physical activity with both groups receiving a cognitive behavioral approach, on pain and disability in patients with cervical radiculopathy (CR).DesignParallel-group randomized clinical trial with follow-up at 3, 6, 12, and 24 months.SettingRecruitment and assessments of participants were performed at a university hospital. Interventions were performed in primary care setting at outpatient physiotherapy clinics.ParticipantsPatients (N=144) with CR were recruited to participate in this clinical trial.InterventionsPatients were randomly assigned to 3 months of either of a neck-specific training program or prescribed physical activity.Main Outcome MeasuresPrimary outcomes included self-rated neck and arm pain as collected by the visual analog scale (VAS). Secondary outcomes were self-rated headache measured with the VAS, the Neck Disability Index, the EuroQol 5D, the Fear Avoidance Beliefs Questionnaire, and the Hospital Anxiety and Depression Scale. Assessments were performed at baseline and at 3-, 6-, 12-, and 24-month follow-up periods.ResultsIntention-to-treat and per-protocol analyses showed no significant interaction (group × time) or group effects. There were, however, significant time effects indicating improvement over time for both groups for all outcomes except for levels of depression.ConclusionsThe study revealed that neck-specific training as well as prescribed physical activity both including additional cognitive behavioral approach decreased the pain in patients with CR, that is, participants improved regardless of the intervention received. There is a lack of consensus of how to best manage individuals with CR. However, our findings suggest that CR has a natural favorable long-term outcome when patients are prescribed neck-specific training and exercise in combination with a behavioral approach.Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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