(精选)Cervical Radiculopathy – a review of best evidence to guide Primary Care practice教学课件.pptVIP

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(精选)Cervical Radiculopathy – a review of best evidence to guide Primary Care practice教学课件.ppt

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Research Gaps Primary Care practice patterns in Ireland Pharmacology Surgical referral Pain Specialist referral 0-12 weeks RCTs needed: MMT + Pharma vs. Pharma Sub-group responders Somatosensory biopsychosocial profile Surgery Recurrence Lack of guidance for secondary prevention Key Messages Best evidence Approach Assessment: History taking for arm pain vs. neck pain, Categorise pain mechanisms (screening tools) and aetiology (MRI) Sensory testing Diagnosis – CPR to rule in (MRI to confirm) and ULNT1 to rule out Self-report outcome measures – VAS (neck arm), NDI Key Messages Best evidence Approach Conservative Rx: Reassurance Pharmacology – high level of evidence 0-12 weeks – RCT evidence has not yet established efficacy of MMT vs. time. Exercise (/ collar) has efficacy in spondylotic CR. 12 weeks - Multimodal PT more evidence Surgical Referral: Major motor radiculopathy, suspected myelopathy, failure of 6/52 Cons Rx, patient profile (non-tolerable pain) RCT of Multimodal Physiotherapy for Acute or Sub-Acute Cervical Radiculopathy www.rcsi.ie/PACeRtrial Prof. Ciaran Bolger, Consultant Neurosurgeon, Beaumont Hosp Dr. Dara Meldrum, RCSI Dr. Catherine Doody, UCD, Caroline Treanor, Clinical Specialist Physiotherapist, Julie Sugrue, Senior Physiotherapist, Beaumont Hosp @UqLouise References BONO, C. M., GHISELLI, G., GILBERT, T. J., KREINER, D. S., REITMAN, C., SUMMERS, J. T., BAISDEN, J. L., EASA, J., FERNAND, R., LAMER, T., MATZ, P. G., MAZANEC, D. J., RESNICK, D. K., SHAFFER, W. O., SHARMA, A. K., TIMMONS, R. B. TOTON, J. F. 2011. An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders. Spine J, 11, 64-72. BOYLES, R., TOY, P., MELLON, J., JR., HAYES, M. HAMMER, B. 2011. Effectiveness of manual physical therapy in the treatment of cervical radiculopathy: a systematic review. J Man Manip Ther, 19, 135-42. CHIEN, A., ELIAV, E. STERLING, M. 2008. Whiplash (Grade II)