Sustained Natural Apophyseal Glides and Mechanical Cervical Traction in the Management of Cervical Radiculopathy
Condition: Cervical Radiculopathy
MeSH terms: Radiculopathy
Study type: Interventional

Summary: 
      Sustained natural apophyseal glides (SNAGS), is a form of manual therapy, involved a
      combination of a sustained facet glide with active motion, followed by overpressure. Natural
      apophseal glides (NAGS), a modification of SNAGS, involves a mid to end-range facet joint
      mobilisation applied anterocranially or posterioanteriorly along the plane of treatment,
      combined with a small amount of manual traction which increases movement within the spine,
      and decreases symptomatic pain . A study reported that Natural Apophyseal Glides (NAGS) and
      Sustained Natural Apophyseal Glides (SNAGS) demonstrated significant effects in reducing pain
      and disability in subjects with chronic neck pain . This technique, SNAGS, is however an
      evolving manual therapy techniques which its effectiveness has not been thoroughly
      investigated in cervical radiculopathy treatment raised author's curiosity to compare and
      document efficacy of SNAGS with cervical traction in Nigeria since comparative studies
      evaluating SNAGS and manual cervical traction relative efficacies among Nigerians are yet to
      be documented if at all available. Consequently, the quest is to look for a quicker and a
      better way of relieving cervical radiculopathy in this environment . The more reason why we
      have to compare it with a conventional mechanical traction.
    

Detailed description: 
      This is a Quasi experimental study. Participants will be patients with radiculopathy
      receiving treatment at the Usman Danfodio University Teaching Hospital Sokoto Nigeria.
      Ethical approval will be obtained from Institute of Public Health of the Obafemi Awolowo
      University Ile-Ife, Nigeria, and a copy will be taken to the site of the study. The purpose
      and protocol for the study will be explained to the participants, after their informed
      consent have been obtained. The sample size will be determined using N= 4σ2 (Zcrit+Zpwr)2/ D2
      where N is the total sample size, σ is the assumed SD of each group (assumed to be equal for
      the groups), which is assumed to be 16.63 from previous study; Zcrit is the standard normal
      deviate corresponding to the selected significance criterion, i.e 0.05(95% = 1,960), Zpwr is
      the standard normal deviate corresponding to the selected statistical power (i.e. 0.80 =
      0.842), and D is the minimum expected difference among the three means, and D =18 from a
      previous study. Therefore, N obtained will be 41.22. Fifty two participants are proposed for
      this study (making 26 participants for each group) in order to give room for attrition. The
      52 participants will be allocated to two groups (Groups A and B) using permuted block
      randomization. Subjects in group A will receive (i) Sustained Natural Apophyzeal Glides: Each
      subject in this group will be in sitting position facing the wall bar. The therapist will
      place on thumb reinforced over the spinous process of the implicated cervical vertebra. The
      therapist will then push upon the implicated spinous process. The pressure will be sustained
      for 60 seconds. Six repetitions will be carried out and maintained on each visit twice in a
      week for 6 weeks. Subjects in group B will receive over -the -door mechanical cervical
      traction in sitting position using position 10% of each patient's body weight for 15 minutes
      on each visit, twice in a week for 6 weeks. Pain intensity will be measured using visual
      analogue scale, cervical range of motions will be measured using inclinometer, functional
      disabilities will be measured using neck disabilities index questionnaires. The out come
      measures will be applied three times: pre-treatment, 3rd week and 6th week within the
      treatment period. The data obtained will be analysed using descriptive and inferential
      statistics.
    

Intervention name(s): Sustained Natural Apophyseal Glides; Mechanical Cervical Traction
Intervention type(s): Other; Other
Intervention description(s): Subjects in SNAGS group were treated with sustained natural apophyseal glides, twice weekly for six weeks; subjects in MCT received mechanical cervical traction, for 15 minutes each session twice in a week for six weeks
Other intervention name(s): SNAGS; MCT
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The study involved 47 patients with cervical radiculopathy which were purposively recruited from the Physiotherapy Department Outpatient Clinic of Usmanu Danfodio University Teaching Hospital, Sokoto for the study. Subjects were randomly allocated to Sustained Natural Apophyseal Glides (SNAGS)and Mechanical Cervical Traction (MCT) group. All the subjects were treated using cryotherapy for seven minutes. Subjects in SNAGS group were then treated with sustained natural apophyseal glides, twice weekly for six weeks while subjects in MCT received mechanical cervical traction, for 15 minutes each session twice in a week for six weeks. Visual analogue scale, neck disability index questionnaires and inclinometer were used to assess pain intensity, disability and cervical range of motion respectively at the beginning, 3rd and 6th week of treatment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Cervical Radiculopathy; Sustained Natural Apophyseal Glides; Mechanical Cervical Traction; Pain Intensity; Neck Disability