[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-618629-105":59,"doc-detail-618629-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","timing-of-evidence-based-nonsurgical-interventions-as-part-of-multimodal-treatment-guidelines-for-the-management-of-cervical-radiculopathy-a-delphi-study-618629","Timing of Evidence-Based Nonsurgical Interventions as Part of Multimodal Treatment Guidelines for the Management of Cervical Radiculopathy: A Delphi Study","","Conservative management is presented as a first option for cervical radiculopathy because surgical risk–benefit ratios are less favorable. The study addresses a gap in guidelines and systematic reviews that do not account for when nonsurgical treatments are applied across acute, subacute, and chronic stages. Using an iterative Delphi process, experts rated proposed modalities via Likert measures, applying predefined consensus thresholds. Results generate a stage-specific list of effective interventions, shifting from education, manipulation, and sustained pain relief to graded activity and later aerobic exercise, strength training, and ergonomic considerations.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/timing-of-evidence-based-nonsurgical-interventions-as-part-of-multimodal-treatment-guidelines-for-the-management-of-cervical-radiculopathy-a-delphi-study-618629/618629/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/timing-of-evidence-based-nonsurgical-interventions-as-part-of-multimodal-treatment-guidelines-for-the-management-of-cervical-radiculopathy-a-delphi-study-618629/618629.png","ImageObject",300,407,{"name":92,"@type":93},"WPS_1790064749","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-21","2026-10-19",true,{"@type":102,"interactionType":103,"userInteractionCount":81},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why focus on timing in nonsurgical management of cervical radiculopathy?","Question",{"text":112,"@type":113},"Systematic reviews and clinical practice guidelines have reported effectiveness of nonsurgical management, but they have not considered when these modalities are applied across different condition stages.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How did the study reach consensus among experts?",{"text":117,"@type":113},"Experts rated agreement with proposed treatment modalities by CR stage using a 5-point Likert scale, with consensus criteria defined in advance for each Delphi round and finalized based on Round 3 thresholds.",{"name":119,"@type":110,"acceptedAnswer":120},"What interventions are emphasized in the acute stage versus the chronic stage?",{"text":121,"@type":113},"In the acute stage, emphasis is on patient education, spinal manipulative therapy, specific exercises, and sustained pain-relieving positions. In the chronic stage, focus shifts to general aerobic exercise, focused strength training, and consideration of postural education and vocational ergonomic assessment.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},618629,1792597318,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":81,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":44,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144},3985747859154,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Timing of Evidence-Based Nonsurgical Interventions as Part of Multimodal Treatment Guidelines for the Management of Cervical Radiculopathy: A Delphi Study Erik Thoomes , PT, MSc1 ,2 , * , Marloes Thoomes-de Graaf, PT, PhD2 ,  \nJoshua A. Cleland, PT, PhD3 , Alessio Gallina, PT, PhD1 , Deborah Falla, PT, PhD1  \n1 Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK  \n2 Fysio-Experts, Research Department, Hazerswoude, the Netherlands  \n3 Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA  \n*Address all correspondence to Erik Thoomes at: [erikthoomes@gmail.com](erikthoomes@gmail.com)  \nAbstract  \nObjective. Conservative management of cervical radiculopathy (CR) is a first treatment option because the risk–benefit ratio for surgery is less favorable. Systematic reviews and clinical practice guidelines reporting on the effectiveness of nonsurgical management have not considered the timing of management. The aim of this study was to establish consensus on effective nonsurgical treatment modalities at different stages (ie, acute, subacute, or chronic) of CR using the Delphi method approach. Methods. Through an iterative multistage process, experts within the field rated their agreement with a list of proposed treatment modalities according to the stage of CR and could suggest missing treatment modalities. Agreement was measured using a 5-point Likert scale. Descriptive statistics were used to measure agreement (median, interquartile ranges, and percentage of agreement) . Consensus criteria were defined a priori for each round. Consensus for Round 3 was based on ≥2 of the following: a median Likert scale value of ≥4, interquartile range value of ≤ 1, and/or a percentage of agreement ≥70% .  \nResults. Data analysis produced a consensus list of effective treatment modalities in different stages of recovery. Conclusion. According to experts, the focus of multimodal management in the acute stage should consist of patient education and spinal manipulative therapy, specific (foraminal opening) exercises, and sustained pain-relieving positions. In the subacute stage, increasing individualized physical activity including supervised motor control, specific exercises, and/or neurodynamic mobilization could be added. In the chronic stage, focus should shift to include general aerobic exercise as well as focused strength training. Postural education and vocational ergonomic assessment should also be considered. Impact. Multimodal conservative management of individuals with CR should take the stage of the condition into consideration. The focus of therapeutic interventions should shift from passive pain-relieving intervention in the acute stage to increasingly more individualized physical activity and self-management in the chronic stage.  \nKeywords: Treatment Modalities, Timing, Nonsurgical Management, Cervical Radiculopathy, Delphi Study  \nReceived: April 26, 2021 . Revised: October 23, 2021 . Accepted: December 21, 2021  \n© The Author(s) 2022 . Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved.  \nFor permissions, please email: [journals.permissions@oup.com](journals.permissions@oup.com)  \nIntroduction  \nCervical radiculopathy (CR) is a clinical condition whereby motor, reflex, and/or sensory changes such as radicular pain, paresthesia, or numbness may be present and maybe provoked by neck posture(s) and/or movement(s) .1 ,2 An incidence of approximately 83 per 100,000 persons is reported3 with a prevalence of 3 .5 per 1000 persons.4 The societal burden of CR is substantial. Although direct costs for conservative care are lower for this population compared with non-specific neck pain, this group might have higher indirect costs due to a longer","cbCaimo2hZa0CeYX","https://ap.wps.com/l/cbCaimo2hZa0CeYX","pdf",682992,"English","# Abstract\n## Objective\n## Methods\n## Results\n## Conclusion\n## Keywords\n# Introduction","[{\"question\":\"Why focus on timing in nonsurgical management of cervical radiculopathy?\",\"answer\":\"Systematic reviews and clinical practice guidelines have reported effectiveness of nonsurgical management, but they have not considered when these modalities are applied across different condition stages.\"},{\"question\":\"How did the study reach consensus among experts?\",\"answer\":\"Experts rated agreement with proposed treatment modalities by CR stage using a 5-point Likert scale, with consensus criteria defined in advance for each Delphi round and finalized based on Round 3 thresholds.\"},{\"question\":\"What interventions are emphasized in the acute stage versus the chronic stage?\",\"answer\":\"In the acute stage, emphasis is on patient education, spinal manipulative therapy, specific exercises, and sustained pain-relieving positions. In the chronic stage, focus shifts to general aerobic exercise, focused strength training, and consideration of postural education and vocational ergonomic assessment.\"}]","Timing of Evidence-Based Nonsurgical Interventions as Part of Multimodal Treatment Guidelines for the Management of Cervical Radiculopathy: A Delphi Study | PDF",1792449591,23]