The Efficacy of Physical Therapy to Alleviate Symptomatic Thoracic Radiculopathy: A Systematic Review and Meta-Narrative Analysis

Overview

Journal Ann Rehabil Med

Specialty Rehabilitation Medicine

Date 2024 Apr 8

PMID 38589206

Authors

Karson A Mostert

Jacob Perera

Jennifer Dens Higano

Patrick T Davis

Ryan J Buus

Danielle Gerberi

James Meiling

Cara Prideaux

Affiliations

Soon will be listed here.

Abstract

To evaluate the efficacy of physical therapy (PT) to alleviate symptomatic thoracic radiculopathy (TR) without the use of invasive procedures. Database search was conducted by an experienced medical librarian from inception until January 27, 2023, in EBSCO CINAHL with Full Text, Ovid Cochrane Central Register of Controlled Trials, Ovid Embase, Ovid MEDLINE, Scopus, and Web of Science Core Collection. Inclusion criteria included studies that involved adult patients (age≥18) who had a magnetic resonance imaging-confirmed TR and underwent a structured, supervised PT program of any length. All types of studies were included. Study quality and risk of bias were assessed using the National Heart, Lung, and Blood Institute (NHLBI) Study Quality of Assessment Tool. Certainty in evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. A meta-analysis was not performed. A total of 1,491 studies were screened and 7 studies met inclusion criteria, 5 case studies and 2 cohort studies. All studies showed improvement or resolution of the TR with PT. Quantitative improvements were not noted in most studies and PT regimens were sparsely described. Overall quality assessment demonstrated 3 studies had "good," 1 "fair," and 3 "poor" quality evidence. Certainty of evidence was "low" due to risk of bias. A dedicated PT program may help to alleviate symptomatic TR; however due to limited evidence, risk of bias, and low certainty in evidence, the data is too weak to support a definite conclusion.

References

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

Khorami A, Oliveira C, Maher C, Bindels P, Machado G, Pinto R . Recommendations for Diagnosis and Treatment of Lumbosacral Radicular Pain: A Systematic Review of Clinical Practice Guidelines. J Clin Med. 2021; 10(11). PMC: 8200038. DOI: 10.3390/jcm10112482. View

OConnor R, Andary M, Russo R, DeLano M . Thoracic radiculopathy. Phys Med Rehabil Clin N Am. 2002; 13(3):623-44, viii. DOI: 10.1016/s1047-9651(02)00018-9. View

Murad M . Clinical Practice Guidelines: A Primer on Development and Dissemination. Mayo Clin Proc. 2017; 92(3):423-433. DOI: 10.1016/j.mayocp.2017.01.001. View

Taso M, Sommernes J, Kolstad F, Sundseth J, Bjorland S, Pripp A . A randomised controlled trial comparing the effectiveness of surgical and nonsurgical treatment for cervical radiculopathy. BMC Musculoskelet Disord. 2020; 21(1):171. PMC: 7076994. DOI: 10.1186/s12891-020-3188-6. View

Murad M, Sultan S, Haffar S, Bazerbachi F . Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med. 2018; 23(2):60-63. PMC: 6234235. DOI: 10.1136/bmjebm-2017-110853. View

Levin J, Chan J, Huynh L, Smuck M, Koltsov J, Kesikburun B . Thoracic transforaminal epidural steroid injection for management of thoracic spine pain: A multicenter cross-sectional study of short-term outcomes. Interv Pain Med. 2024; 1(1):100004. PMC: 11411569. DOI: 10.1016/j.inpm.2021.100004. View

Kato K, Otoshi K, Hakozaki M, Konno S . Progressive enlargement of thoracic ossification of the ligamentum flavum in professional baseball pitchers: a report of two cases. J Int Med Res. 2021; 49(11):3000605211059465. PMC: 8661027. DOI: 10.1177/03000605211059465. View

Fitzpatrick J, Birch N, Botchu R . Abdominal wall pseudohernia - One secondary to a thoracic extraforaminal disc herniation and other due to thoracic paracentral disc protrusion. J Clin Orthop Trauma. 2022; 30:101897. PMC: 9133734. DOI: 10.1016/j.jcot.2022.101897. View

10.

Brown C, Deffer Jr P, Akmakjian J, DONALDSON D, Brugman J . The natural history of thoracic disc herniation. Spine (Phila Pa 1976). 1992; 17(6 Suppl):S97-102. DOI: 10.1097/00007632-199206001-00006. View

11.

Quint U, Bordon G, Preissl I, Sanner C, Rosenthal D . Thoracoscopic treatment for single level symptomatic thoracic disc herniation: a prospective followed cohort study in a group of 167 consecutive cases. Eur Spine J. 2011; 21(4):637-45. PMC: 3326138. DOI: 10.1007/s00586-011-2103-0. View

12.

Pirti O, Barlas A, Kuru S, Temel S, Urhan M, Kismet K . Mastalgia Due to Degenerative Changes of the Spine. Adv Clin Exp Med. 2016; 25(5):895-900. DOI: 10.17219/acem/28820. View

13.

Murad M, Mustafa R, Schunemann H, Sultan S, Santesso N . Rating the certainty in evidence in the absence of a single estimate of effect. Evid Based Med. 2017; 22(3):85-87. PMC: 5502230. DOI: 10.1136/ebmed-2017-110668. View

14.

Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O, Peacock R . Storylines of research in diffusion of innovation: a meta-narrative approach to systematic review. Soc Sci Med. 2005; 61(2):417-30. DOI: 10.1016/j.socscimed.2004.12.001. View

15.

Van Zundert J, Hartrick C, Patijn J, Huygen F, Mekhail N, van Kleef M . Evidence-based interventional pain medicine according to clinical diagnoses. Pain Pract. 2011; 11(5):423-9. DOI: 10.1111/j.1533-2500.2011.00490.x. View

16.

McGuinness L, Higgins J . Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods. 2020; 12(1):55-61. DOI: 10.1002/jrsm.1411. View

17.

Polston D . Cervical radiculopathy. Neurol Clin. 2007; 25(2):373-85. DOI: 10.1016/j.ncl.2007.01.012. View