Cervical Radiculopathy: Effectiveness of Adding Traction to Physical Therapy. A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background. Cervical radiculopathy (CR) is a common cervical spine disorder. Cervical traction (CT) is a frequently recommended treatment for patients with CR. Purpose. The purpose of this study was to conduct a review and meta-analysis of randomized controlled trials (RCTs) on the effect of CT combined with other physical therapy procedures versus physical therapy procedures alone on pain and disability. Data Sources. Data were obtained from COCHRANE Controlled Trials Register, PubMed, CINAHL, Scopus, ISI Web of Science, and PEDro, from their inception to July 2016. Study Selection. All RCTs on symptomatic adults with CR, without any restriction regarding publication time or language, were considered. Data Extraction. Two reviewers selected the studies, conducted the quality assessment, and extracted the results. Meta-analysis employed a random-effects model. The evidence was assessed using GRADE criteria. Data Synthesis. Five studies met the inclusion criteria. Mechanical traction had a significant effect on pain at short- and intermediate-terms (g = –0.85; 95% CI = –1.63 to –.06 and g = –1.17; 95% CI = –2.25 to –0.10, respectively) and significant effects on disability at intermediate term (g= –1.05; 95% CI = –1.81 to –0.28). Manual traction had significant effects on pain at short- term (g = –0.85; 95% CI = –1.39 to –0.30). Limitations. The most important limitation of the present work is the lack of homogeneity in CR diagnostic criteria among the included studies. Conclusions. In light of these results, the current literature lends some support to the use of the mechanical and manual traction for CR in addition to other physical therapy procedures for pain reduction, but yielding lesser effects on function/disability.