Karagiannis, Christos

BackgroundThe effectiveness of both neural mobilization and intermittent cervical traction (ICT) has been previously explored in some studies of generally low methodological quality. However, the effect of simultaneous application of these techniques in people with cervical radiculopathy (CR) has not been previously investigated. AimTo investigate the effect of neural mobilization with simultaneously applied ICT on pain, disability, function, grip strength and cervical range of motion in patients with CR. DesignRandomized, controlled, assessor-blinded, clinical trial. MethodsParticipants (n = 42) diagnosed with unilateral CR were randomly allocated to intervention (neural mobilization combined with ICT, n = 21) or control (n = 21) groups. Participants in the intervention group were asked to attend for 12 treatment sessions to receive 6 sets of 60s grade II–IV ICT with simultaneously applied ‘slider’ neural mobilizations with median nerve bias. Participants randomized to the control group did not receive any type of treatment and were asked to avoid prescription or over-the-counter analgesia or anti-inflammatory medication. The Neck Disability Index (NDI), the Patient-Specific Functional Scale (PSFS), the Numeric Pain Rating Scale (NPRS), and measures of grip strength (GS) and cervical spine active range of motion (CSAROM) were administered at baseline and at 4-weeks. ResultsThe intervention group demonstrated significant improvements in NDI scores (mean difference = −16.95; 95% CI = −22.47 to −11.43, ES = 0.42), PSFS scores (mean difference = 2.88; 95% CI = 2.33 to 3.43, ES = 0.66), NPRS scores (mean difference = −3.74; 95% CI = −4.92 to −2.96, ES = 0.37), GS (mean difference = 1.87 kg; 95% CI = 0.51 to 3.23; ES = 0.07), and CSAROM (except for lateral flexion), compared to the control group where significant changes were not detected. ConclusionNeural mobilization with simultaneous ICT can improve, pain, function, disability, grip strength and cervical range of motion in people with CR. Further clinical trials comparing neural mobilization with cervical traction to other standard interventions are justified.

ObjectiveThe purpose of this study was to evaluate the test-retest reliability of handgrip strength measurement using a hydraulic hand dynamometer in patients with cervical radiculopathy (CR). MethodsA convenience sample of 19 participants (14 men and 5 women; mean ± SD age, 50.5 ± 12 years) with CR was measured using a Jamar hydraulic hand dynamometer by the same rater on 2 different testing sessions with an interval of 7 days between sessions. Data collection procedures followed standardized grip strength testing guidelines established by the American Society of Hand Therapists. During the repeated measures, patients were advised to rest their upper limb in the standardized arm position and encouraged to exert 3 maximum gripping efforts. The mean value of the 3 efforts (measured in kilogram force [Kgf]) was used for data analysis. The intraclass correlation coefficient, SEM, and the Bland-Altman plot were used to estimate test-retest reliability and measurement precision. ResultsGrip strength measurement in CR demonstrated an intraclass correlation coefficient of 0.976, suggesting excellent test-retest reliability. The small SEM in both testing sessions (SEM1, 2.41 Kgf; SEM2, 2.51 Kgf) as well as the narrow width of the 95% limits of agreements (95% limits of agreement, −4.9 to 4.4 Kgf) in the Bland-Altman plot reflected precise measurements of grip strength in both occasions. ConclusionsExcellent test-retest reliability for grip strength measurement was measured in patients with CR, demonstrating that a hydraulic hand dynamometer could be used as an outcome measure for these patients.