Abstract
Aim: We aimed to investigate the effectiveness of traction therapy in reducing pain by performing a systematic review with meta-analysis. We also explore the best modality for administering traction to patients with cervical radicular syndrome (CRS). Methods: We searched the Medline, Physiotherapy Evidence Database (PEDro), Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) electronic databases. Two reviewers independently selected randomized controlled trials (RCTs) that compared traction in addition to other treatments versus the effectiveness of other treatments alone for pain outcome. We calculated the mean differences (MDs) and 95% confidence intervals (CIs). We used Cochrane’s tool to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to evaluate the quality of evidence and summarize the study conclusions. Results: A total of seven studies (589 patients), one with low risk of bias, were evaluated. An overall estimate of treatment modalities showed low evidence that adding traction to other treatments is statistically significant (MD −5.93 [95% CI, −11.81 to −0.04] P = 0.05 and I2 = 57%) compared to other treatments alone. The subgroup analyses were still statistically significant only for mechanical and continuous modalities. Conclusions: Overall analysis showed that, compared to controls, reduction in pain intensity after traction therapy was achieved in patients with cervical radiculopathy. However, the quality of evidence was generally low and none of these effects were clinically meaningful.
Highlights
Cervical radicular syndrome (CRS) is characterized by pain symptoms radiating to one or both arms in a dermatomeric distribution of sensorimotor symptoms due to a conduction deficit and a dynatomeric distribution of pain [1,2,3]
In trial sequential analysis (TSA) (Figure 5), the cumulative z-curve crossed both the conventional threshold of 0.05 for statissbrIsetetentffiadanctetuaTeiicsslfcSttIitiicniAnocsciagfaiaTglltl(SprFnessAaaifiiicgifgfgnetin(uniccFoiitiarfinifngenoiccCuaifca5nnreRtn)erc,aScae5daetc(h)antdM,ineadoittdDnhnicodetut−inhhnc5meteut.ha9omumde3omldoua[tmn9ihltot5aiiieontvo%torinienvrtiCiorettnzoeorIg-zar,ico-nit−buncmt1gouhgr1euvre.nv8brnebet1dootsrcautucervorrnnaoyeo−tddsrsm0fssasao.ueere0rryddsn4ys]toub.sbftpofohovoreteethrrhrrissottusuhtrrupheisetaeepyocrtemtoi(cohirno.iereeovninr.t,ervyttbinsreteetyan(niaios.tetenim(tfio.hia,t.nee)l,nba.tc,sthelohsnrtbnoeaehtewssfrrihnottei)onhels,lgfehfdiostocahr)ool,bodrfneewst0ndroh.io0eunfofil5cg0wfcifon.io0aiargnrl5gfoar benefpiacinalinefCfeRcSt
With very low quality evidence, no differences between intervention and control were found in manual traction (Figure 6a; mean differences (MDs) −9.26 [95% confidence intervals (CIs), −38.54 to 20.03] P = 0.54 and I2 = 85%, Supplementary Table S4)
Summary
Cervical radicular syndrome (CRS) is characterized by pain symptoms radiating to one or both arms in a dermatomeric distribution of sensorimotor symptoms due to a conduction deficit and a dynatomeric distribution of pain [1,2,3]. Conservative treatment of CRS has included different interventions such as manual therapy (mobilization and manipulation), physical therapy and traction [6]. In 2013, Thoomes et al [1] focused on the effectiveness of different conservative treatments for patients with CRS, and concluded with minimal evidence that traction was no more effective than the control. In 2018, Romeo et al [33] found some support for the use of the mechanical and manual traction for CRS in addition to other physical therapy procedures for pain reduction. They performed only a subgroup analysis for mechanical and manual modalities
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