What we know about Cervical Radiculopathy

The prevalence of Cervical Radiculopathy (CR), a problem that results when a nerve in the neck is compressed or irritated as it leaves the spinal canal, is low, but some patients who experience CR require treatment. Physiotherapy is known to be beneficial for chronic CR.

What we are not sure about

While the majority of patients with cervical radiculopathy improve within the first 12 weeks with rest and medication, the added impact of early, non-provocative physiotherapy has yet to be established.

What the PACeR study is exploring

We aim to investigate the effect of a multimodal physiotherapy package (manual therapy, exercise, upper limb unloading tape and advice to stay active) on pain and disability, in those with acute or sub-acute CR.

Why is this study important?

This trial will clarify whether physiotherapy is of additional benefit to patients with acute or sub-acute CR, when compared with advice and medication only, and as a result, inform GP’s future decision-making on early physiotherapy referral.

Who can take part?

Adults with suspected single-level cervical radiculopathy of 2 to 12 weeks symptom duration, who have not yet received physical treatment e.g. physiotherapy, osteopathy etc. Confirmation of CR by an MRI is not required.

Study design and recruitment

PACeR is a randomised controlled trial of a multimodal physiotherapy package (manual therapy, exercise, upper limb unloading tape and advice to stay active) versus a control group of advice to stay active and medication. Recruitment is primarily via GPs and those interested in taking part should contact Louise Keating (PI), Lecturer in Physiotherapy, RCSI (lkeating@rcsi.ie; 087 6180348)

What will the study involve for practices and patients who take part?

GPs in Dublin postal areas 1, 2, 3, 4, 5, 6, 6W, 7, 8, 9, 10, 11, 13, 14, 15, 16, 17, 18 and north county Dublin are invited to pass study information to potential participants or GPs are also free to contact the study team directly with patient contact details, subject to patients’ permission.

Patient assessments will take place at the participant’s most convenient location: Beaumont Hospital, RCSI (St. Stephen’s Green) or Premier Physiotherapy clinic in Ballinteer. Patients randomised to the intervention will receive 4 weeks of treatment (6-8 sessions) with a clinical specialist physiotherapist at the most convenient centre: Beaumont Hospital, or physio clinics in Whitehall, Ballsbridge, Ranelagh or Ballinteer. Control group participants will be offered physiotherapy treatment at 12 weeks. Participants will also benefit from a fast-track referral to Prof. Ciaran Bolger, Consultant Neurosurgeon, Beaumont Hospital, in the case of clinical deterioration.

For more information

If you are a GP interested in referring a patient(s) to the study, please email lkeating@rcsi.ie or phone 01 402 2259 / 087 6180348 to receive more information, including participant information leaflets.

Additional trial information is also available at www.rcsi.ie/PACeRtrial

Co-investigators include Prof. Ciaran Bolger, Consultant Neurosurgeon, Beaumont Hospital, Dr. Catherine Doody, UCD and Dr. Dara Meldrum, RCSI. This trial is funded by EuroSpine – the Spine Society of Europe and has been approved by the ICGP Research Ethics Committee and Beaumont Hospital’s Ethics (Medical Research) Committee.