Article Text

Timing of evidence-based non-surgical interventions as part of multimodal treatment guidelines for the management of cervical radiculopathy: a Delphi study protocol
  1. Erik Thoomes1,2,
  2. Marloes Thoomes-de Graaf2,
  3. Joshua Cleland3,
  4. Alessio Gallina1,
  5. Deborah Falla1
  1. 1School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
  2. 2Research Department, Fysio-Experts, Hazerswoude Rijndijk, Netherlands
  3. 3Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
  1. Correspondence to Erik Thoomes; ejt979{at}


Introduction Cervical radiculopathy (CR) is a clinical condition whereby motor, reflex and/or sensory changes such as radicular pain, paraesthaesia or numbness can exist. Conservative management is a preferred first treatment option as the risk–benefit ratio for surgery is less favourable. Systematic reviews and treatment guidelines gather evidence on the effectiveness of non-surgical management of patients with CR from randomised controlled trials, which do not consider the natural course of recovery to modify the management strategy accordingly. The aim of this study is to establish consensus on effective non-surgical treatment modalities for patients in different stages (acute, subacute and chronic) of CR, using the Delphi method approach.

Methods and analysis Through an iterative multistage process, experts within the field will rate their agreement with a list of proposed treatment modalities and suggest any missing treatment modalities during each round. Agreement will be measured using a five-point Likert scale. Descriptive statistics will be used to measure agreement (median, IQR and percentage of agreement). Consensus criteria will be defined a priori for each round. Data analysis at the end of round three will produce a consensus list of effective treatment modalities for the management of patients with CR in different stages of recovery.

Ethics and dissemination Ethical approval has been granted from the University of Birmingham ethics committee under ERN_20-1121. The study findings will be submitted to a peer-reviewed journal and to relevant conferences for dissemination of the study results.

  • neurological pain
  • spine
  • ultrasound
  • ultrasonography
  • musculoskeletal disorders

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  • Contributors All authors devised the focus of this Delphi study. ET is a PGR student, DF is the lead supervisor, AG is the cosupervisor, JC and MT-dG are coresearchers. ET drafted the initial protocol manuscript with lead and cosupervisors providing guidance on methodological decisions and proposed analyses. All authors have contributed subject-specific expertise. ET will recruit participants into the study. All authors will contribute to data interpretation, conclusions and dissemination. All authors have read, contributed to and agreed to the final manuscript. DF is the guarantor of the study.

  • Funding This study will be conducted as part of a Post Graduate Research project though the University of Birmingham, UK and as such received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.