Timing of Evidence-Based Nonsurgical Interventions as Part of Multimodal Treatment Guidelines for the Management of Cervical Radiculopathy: A Delphi Study

Oct 19, 2026

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Objective. Conservative management of cervical radiculopathy (CR) is a first-line option due to a less favorable risk–benefit profile for surgery. Systematic reviews and guidelines have not addressed when nonsurgical interventions should be applied across different stages. This Delphi study aimed to reach expert consensus on effective nonsurgical treatment modalities in acute, subacute, and chronic phases. Methods. Experts rated proposed modalities by stage via iterative Likert-based rounds, allowing addition of missing options, and used predefined consensus criteria for each round.

LanguageEnglish

CategoryResearch & Report

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Pages9

Reading Time23 min

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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 , Joshua A. Cleland, PT, PhD3 , Alessio Gallina, PT, PhD1 , Deborah Falla, PT, PhD1 1 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 2 Fysio-Experts, Research Department, Hazerswoude, the Netherlands 3 Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA *Address all correspondence to Erik Thoomes at: [erikthoomes@gmail.com](erikthoomes@gmail.com) Abstract Objective. 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% . Results. 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. Keywords: Treatment Modalities, Timing, Nonsurgical Management, Cervical Radiculopathy, Delphi Study Received: April 26, 2021 . Revised: October 23, 2021 . Accepted: December 21, 2021 © The Author(s) 2022 . Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: [journals.permissions@oup.com](journals.permissions@oup.com) Introduction Cervical 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

FAQs

Why focus on nonsurgical intervention timing for cervical radiculopathy?

Conservative management is typically preferred, but existing reviews and clinical practice guidelines have not considered the timing of nonsurgical treatments across acute, subacute, and chronic stages.

How was expert consensus established in the study?

Experts used an iterative Delphi process to rate proposed treatment modalities for each stage on a 5-point Likert scale, could suggest additional modalities, and applied predefined criteria for consensus in each round.

What treatment focus did experts recommend for acute, subacute, and chronic stages?

Acute: patient education, spinal manipulative therapy, specific foraminal-opening exercises, and sustained pain-relieving positions. Subacute: increasing individualized physical activity such as supervised motor control, specific exercises, and/or neurodynamic mobilization. Chronic: general aerobic exercise, focused strength training, plus consideration of postural education and vocational ergonomic assessment.

Oct 19, 2026

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