Abstract
BackgroundMany patients with cervical disc disease require leave from work, due to long-lasting, complex symptoms, including chronic pain and reduced levels of physical and psychological function. Surgery on a few segmental levels might be expected to resolve disc-specific pain and reduce neurological deficits, but not the non-specific neck pain and the frequent illness. No study has investigated whether post-surgery physiotherapy might improve the outcome of surgery. The main purpose of this study was to evaluate whether a well-structured rehabilitation programme might add benefit to the customary post-surgical treatment for cervical disc disease, with respect to function, disability, work capability, and cost effectiveness.Methods/DesignThis study was designed as a prospective, randomised, controlled, multi-centre study. An independent, blinded investigator will compare two alternatives of rehabilitation. We will include 200 patients of working age, with cervical disc disease confirmed by clinical findings and symptoms of cervical nerve root compression. After providing informed consent, study participants will be randomised to one of two alternative physiotherapy regimes; (A) customary treatment (information and advice on a specialist clinic); or (B) customary treatment plus active physiotherapy. Physiotherapy will follow a standardised, structured programme of neck-specific exercises combined with a behavioural approach. All patients will be evaluated both clinically and subjectively (with questionnaires) before surgery and at 6 weeks, 3 months, 6 months, 12 months, and 24 months after surgery. The main outcome variable will be neck-specific disability. Cost-effectiveness will also be calculated.DiscussionWe anticipate that the results of this study will provide evidence to support physiotherapeutic rehabilitation applied after surgery for cervical radiculopathy due to cervical disc disease.Trial registrationClinicalTrials.gov identifier: NCT01547611
Highlights
Many patients with cervical disc disease require leave from work, due to long-lasting, complex symptoms, including chronic pain and reduced levels of physical and psychological function
We anticipate that the results of this study will provide evidence to support physiotherapeutic rehabilitation applied after surgery for cervical radiculopathy due to cervical disc disease
Several studies have reported that surgeries reduced pain intensity and neurological deficits, and the overall outcome was good in approximately 80% of cases [9]
Summary
Many patients with cervical disc disease require leave from work, due to long-lasting, complex symptoms, including chronic pain and reduced levels of physical and psychological function. Secondary outcomes Neck pain intensity, arm pain, headache, and dizziness, all measured with a Visual Analogue Scale (VAS) (0–100 mm) [34,38]; Pain distribution, measured on a drawing, where the patient indicates symptom locations [39]; Self-efficacy in daily activities, measured with the Self-efficacy Scale [40]; Symptom satisfaction, related to neck problems (how would the patient feel about experiencing the current neck symptoms for the rest of his/her life), rated on a seven-grade scale [41]; Psychological and psycho-somatic distress, measured with the Distress and Risk Assessment Method (DRAM) [42]; Coping strategies, measured with the Coping Strategies Questionnaire (CSQ) [43]; Work capability, measured with the Work Ability Index (WAI) [44]; Sick-leave, measured as the number of days off work; Health related quality of life, assessed with the EuroQol five dimensions self-report (EQ-5D) and Current health status, measured with the EuroQol vertical VAS (0–100 mm) [45]; Impact on social relationships, measured with the West Haven Multidimensional Pain Inventory, Swedish version (MPI-S), the MPI-S for impact on significant others, and open questions [46]. They will be asked about whether they expect to remain in their present occupation and work place
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