Manual Therapy for Cervical Radiculopathy: Effects on Neck Disability and Pain – A Systematic Review and Network Meta-Analysis

Xueliang Xu,1 Yan Ling2 1Department of Rehabilitation III, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, 610072, People’s Republic of China; 2Department of Pediatrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, 610072, People’s Republic of ChinaCorrespondence: Yan Ling, Department of Pediatrics, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, Sichuan Province, 610072, People’s Republic of China, Tel +86-13881816924, Email [email protected]: To evaluate the application effects of different manual therapy approaches in the treatment of cervical radiculopathy using a network meta-analysis.Methods: Prospective randomized controlled trials on manual therapy for cervical radiculopathy published in PubMed, the Cochrane Library, and Embase databases were retrieved. The neck disability index and visual analogue scale for neck pain were collected and subjected to network meta-analysis.Results: A total of 8 eligible studies involving 632 participants with a mean age range of 40– 47 years were included. The intervention duration ranged from 4 to 6 weeks. Three intervention groups were defined: Group C (exercise and other therapies without manual therapy), Group M (manual therapy without traction), and Group MT (manual therapy with traction). Larger circles indicate more patients, and thicker lines show more studies comparing interventions. Group M had the highest probability (68.1%) of improving the neck disability index, followed by Group MT (29.1%), with Group C the lowest (2.8%). Compared to Group C, neck disability index scores improved by 0.58 (95% CI: − 0.17, 1.33) in Group M and by 0.36 (95% CI: − 0.39, 1.11) in Group MT. The difference between Group M and Group MT was not significant (0.22, 95% CI: − 0.59, 1.03). For neck pain (visual analogue scale score), Group M had the highest probability (59.5%) of improvement, followed by Group MT (39.6%), with Group C the lowest (0.9%). Compared to Group C, the visual analogue scale score improved by 0.74 (95% CI: − 0.04, 1.52) in Group M and by 0.61 (95% CI: − 0.18, 1.40) in Group MT. The difference between Group M and Group MT was not significant (0.13, 95% CI: − 0.72, 0.98). Egger’s regression test showed no apparent publication bias.Conclusion: Manual therapy is an effective approach for improving neck pain and neck disability index in patients with cervical radiculopathy, but more evidence-based support is needed regarding the use of cervical traction.Keywords: radiculopathy, musculoskeletal manipulations, posterior neck pains