Spinal Mobilization With Arm Movement and Positional SNAGS in Cervical Radiculopathy Patients

Study Overview
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Brief Summary
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Data will be collected in Hussain Memorial Hospital by taking informed consent. Randomised clinical trial is conducted taking thirty patients of both genders with confirmed diagnoses of cervical radiculopathy, their ages ranged from 25 to 60. A cluster of winner to rule out patient with cervical radiculopathy. They will be randomly assigned into two groups by the lottery method. Group A will receive conventional treatment and of spinal mobilization with arm movement (intervention 1) Group B will receive conventional treatment and positional SNAGs (intervention 2). The treatment will be conducted at a frequency of three sessions per week for four weeks. Two values will be taken, one as baseline and the other at end of the session. Then follow up the patient to rule out which intervention is more effective than the other. Neck Disability Index, Numeric Pain Rating Scale and ROM will be used to measure outcomes.

Detailed Description
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the objective of the study is To compare the effect of spinal mobilization with arm movement and positional SNAGs on pain and disability in cervical radiculopathy patients. The study design will be Randomized ClinicalTrial The sampling Technique will be Consecutive sampling technique Tool: The Neck Disability Index (NDI): used for measuring functional improvement in the neck. Numeric Pain Rating Scale (NPRS): used for measuring pain. Inclinometer: used for measuring Range of motion of cervical region. Data will be collected in Hussain Memorial Hospital by taking informed consent. Randomised clinical trial is conducted taking thirty patients of both genders with confirmed diagnoses of cervical radiculopathy, their ages ranged from 25 to 60. A cluster of winner criteria will be used to rule out patient with cervical radiculopathy. They will be randomly assigned into two groups by the lottery method. Group A will receive conventional treatment and of spinal mobilization with arm movement (intervention 1) Group B will receive conventional treatment and positional SNAGs (intervention 2). The treatment will be conducted at a frequency of three sessions per week for four weeks. Two values will be taken, one as baseline and the other at end of the session. Then follow up the patient to rule out which intervention is more effective than the other. Neck Disability Index, Numeric Pain Rating Scale and ROM will be used to measure outcomes.

Official Title
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Comparison of Spinal Mobilization With Arm Movement and Positional SNAGS on Pain and Disability in Cervical Radiculopathy Patients

Conditions
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Radiculopathy, Cervical

Intervention / Treatment
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* Other: Sustained Natural Apophyseal Glides
* Other: shoulder Mobilization with arm movement


Participation Criteria
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Eligibility Criteria
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INCLUSION CRITERIA Symptoms duration more than 6 months. Age 25 -60 The patient has confirm the diagnosis of Radiculopathy of cervical origin, VAS more than 5 A cluster of Wainner 3 positive out of 4 EXCLUSION CRITERIA Malignancy Infection (such as osteomyelitis or diskettes) Osteoporosis Inflammatory arthritis Fracture Pregnancy Uncontrolled hypertension or cardiovascular disease Carotid or vertebral artery disease. Trauma cases

Ages Eligible for Study
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Minimum Age: 25 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: spinal mobilization with arm movement<br>conventional treatment and of spinal mobilization with arm movement | Other: shoulder Mobilization with arm movement<br>* The patient is seated. The therapist contacts the length of the spinous process with the medial aspect of the thumb. A transverse glide is applied by the therapist's index finger against the thumb contacting the spinous process. The direction of the glide is to the contralateral side of the pain. While the mobilisation is sustained the patient moves their arm through a pain-free abduction range. 3-5 sets of 6-10 repetitions may be performed.<br>|
| Active Comparator: positional SNAGs<br>conventional treatment and positional SNAGs | Other: Sustained Natural Apophyseal Glides<br>* The patient sits well supported in a chair. The cervical spine and head are set in a neutral position. A painless passive posterior to anterior (PA) glide is applied in the plane of the facets on either the spinous process or the articular pillar/cervical lamina. While the glide is sustained the patient actively moves their neck in the direction that previously produced the symptoms. If symptom-free, the patient applies over-pressure further into the movement restriction. 3-6 repetitions are performed<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numeric Pain Rating Scale (NPRS) | The numeric pain rating scale (NPRS) is a measurement scale that is used to measure a characteristic or attitude of pain. it is a 0-10 point scale. 0 mean no pain and 10 mean unbearable pain. Change from Baseline for pain Assessment at 4 weeks. | 4 weeks. | 
| Neck Disability Index(NDI) | NDI questionnaire has been designed to give us information as to how your neck pain has affected your ability to manage in everyday life. It had 10 sections with total 50 scores. The test can be interpreted as a raw score, with a maximum score of 50, or as a percentage. 0 points or 0% means : no activity limitations , 50 points or 100% means complete activity limitation. Change from Baseline for disability Assessment at 4 weeks. | 4 weeks. | 
| Inclinometer for range of motion | It's a range measuring tool used for the Range of Motion of neck flexion, extension and rotation. If the angle increases its mean improving. Change from Baseline for Range of Motion Assessment at 4 weeks. | 4 weeks. |