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 Table of Contents  
ORIGINAL ARTICLE
Year : 2023  |  Volume : 16  |  Issue : 1  |  Page : 103-110

Evaluation of functional disability in cervical radiculopathy patients


Department of Physiotherapy, Rajeev Gandhi College, Bhopal, Madhya Pradesh, India

Date of Submission15-Mar-2022
Date of Acceptance26-May-2022
Date of Web Publication21-Jan-2023

Correspondence Address:
Dr. Prachi Khandekar Sathe
Department of Physiotherapy, Rajeev Gandhi College, Bhopal, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_163_22

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  Abstract 


AIM: The main aim of this study was to evaluate functional disability in patients with cervical radiculopathy. Our second aim was to compare neck disability between males and females.
METHODS: The study included 35 participants of both sexes, in which 21 were female and 14 male. We have used three scales for the evaluation of neck disability: (1) Cervical radiculopathy Impact Scale (CRIS), (2) Neck Pain and Disability (NPAD) Scale, and (3) Copenhagen Neck Functional Disability (CNFD) Scale.
RESULTS: The mean scores of CRIS were 14.35 ± 15.59 in males and 33.22 ± 17.58 in females. The NPAD Scale scores were 14.35 ± 15.59 in males and 33.22 ± 17.58 in females. The mean scores of the CNFD Scale were 7.92 ± 5.56 in males and 13.50 ± 5.61 in females. All three scales showed a significant difference between the scores of the two genders, indicating more disability in female patients as compared with the male patients.
CONCLUSION: Our results showed 26.22% and 25.88% disability as per CRIS and Neck Pain and Disability Scale, respectively. We found mild-to-moderate disability in our subjects according to the CNFD Scale. The study concluded that females have more disability in cervical radiculopathy as compared to males.

Keywords: Cervical radiculopathy, functional disability, neck pain, nerve root compression


How to cite this article:
Singh S, Sathe PK, Sathe A, Kumar D V. Evaluation of functional disability in cervical radiculopathy patients. Indian J Health Sci Biomed Res 2023;16:103-10

How to cite this URL:
Singh S, Sathe PK, Sathe A, Kumar D V. Evaluation of functional disability in cervical radiculopathy patients. Indian J Health Sci Biomed Res [serial online] 2023 [cited 2023 Jan 28];16:103-10. Available from: https://www.ijournalhs.org/text.asp?2023/16/1/103/368316




  Introduction Top


Cervical radiculopathy is a condition resulting from compression of cervical nerve roots. It is the most common condition in younger patients.[1] It causes severe radiating pain in the arms or hands, which can be accompanied by motor or sensory deficits.[2] The cervical radiculopathy symptoms are caused by compression of the nerve root by a cervical herniated disc or by degenerative osteophytes.[3] The cervical spine is the most superior portion of the vertebral column, which lies between the cranium and the thoracic vertebrae.

Major functions of cervical spine include supporting and cushioning loads to the head/neck while allowing for rotation, and protecting the spinal cord extending from the brain.[3] The lateral area of the cervical canal is covered by the lateral aspects of a superior and inferior lamina. The ligamentum flavum is attached to the anterior two-thirds of the superior lamina, and inferiorly it is attached to the superior margin of the lower lamina.[3] The cervical foramen is surrounded anteriorly by the superior and inferior vertebral bodies, and the intervertebral disc is covered with posterior longitudinal ligament, posteriorly by the superior and inferior facets, and cephalad and caudad by pedicles.[4] Cervical radiculopathy is a dysfunction of a nerve root in the cervical spine, and it is a disorder with various mechanisms of pathology and the two main mechanisms of the nerve root irritation or impingement are degeneration of cervical spondylosis which leads to stenosis or bony spurs and is most commonly seen in older patients and disc herniation which is more common in younger patients[5] with or without extruded disc fragments. C7 nerve root is most commonly affected nerve root due to disc herniation, as compared to C6 nerve root.[6]

Biomechanically, the disc and the facet lie between the vertebrae and help in transmission of external forces. They make the cervical spine mobile. Symptoms which are related to radiculopathy or myelopathy are caused due to formation of bony spur (osteophyte) that compromises the diameter of spinal canal. This compromise partially develops the degenerative process and causes mechanical pressure on spinal cord at one or multiple levels, and this pressure can produce neurological damage or ischemic changes and thus it can lead to a spinal cord disruption.[7]

The annual incidence of cervical radiculopathy was 107.3/100,000 for men and 63.5/100,000 for women.[1] A more recent study from the US military found an incidence of 1.79/1000 person-years. Risk factors for cervical radiculopathy include white race, cigarette smoking, and prior lumbar radiculopathy.[1]

Repeated and prolonged movements, such as long hours working at a computer, make it hard to focus and get through the day.[8] Neck pain can be debilitating and may interfere with day-to-day life, including our ability to sleep, feel productive, and enjoy time with friends and family.

There are many activities in day-to-day life which involve neck movements such as flexion, extension, side flexion, and neck rotation which get impaired due to neck pain. When women do household works such as cooking and laundry works, it involves many movements which get limited or restricted due to neck pain.[8]

There are various types of scales used to assess cervical radiculopathy such as Visual Analog Scale, Disabilities of the Arm, Shoulder, and Hand Scale, Numeric Pain Rating Scale, Neck Disability Index Scale, Neck Bournemouth Questionnaire, and Roland–Morris Questionnaire[9] but commonly used to assess neck pain scales such as Neck Pain and Disability (NPAD) Scale, Cervical Radiculopathy Impact Scale (CRIS), and Copenhagen Neck Functional Disability (CNFD) Scale.[10] NDI and NPDS are sensitive scales to evaluate the level of rehabilitation in the patients with cervical radiculopathy symptoms.[11] Thus, the main aim of this study was to evaluate functional disability in patients with cervical radiculopathy. Our second aim was to compare neck disability between males and females.


  Methods Top


The study included 35 participants of both sexes, in which 21 were female and 14 male. It was an observational study, and the data were collected from the Department of Physiotherapy, Rajeev Gandhi College Bhopal (Madhya Pradesh). The study was approved by the institutional Ethics committee of Rajeev Gandhi College, Bhopal (Numbered: REC-24/7, dated: 06/09/2021).

Inclusion and exclusion criteria

Patients were included if they showed clinical and radiological signs that indicated nerve root compression including radiating pain, numbness, or paresthesia across the distribution of cervical nerve roots. Patients with muscular weakness, whiplash or other traumatic injuries, pregnant women, psychiatric diseases, and smokers were excluded. We have used three scales for the evaluation of neck disability: (1) CRIS, (2) NPAD Scale, and (3) CNFD Scale.

The CRIS is used for measurement of symptoms and limitations of activities in patients with cervical pain because of radiating pain, tingling sensations, or sensory loss in arms with neck pain. There are 42 items divided into 3 subscales: (1) symptoms, (2) activity/posture, and (3) pain. The scores range from 0 to 5, in which 0 is no pain and 5 severe.

Questions included in the Cervical Radiculopathy Impact Scale

  1. A tingling or numb sensation or “pins and needles” in your arm, hand, or fingers?
  2. Loss of strength in your arm, hand, or fingers?
  3. Stiffness in your neck or shoulder?
  4. How often did you experience pain in your neck?
  5. What was the degree of the pain in your neck, as a whole?
  6. What was the degree of the pain in your neck when it was at its worst?
  7. What was the degree of the pain in your neck, when it was at its least?
  8. How often did you experience pain in your shoulder?
  9. What was the degree of the pain in your shoulder, as a whole?
  10. What was the degree of the pain in your shoulder, when it was at its worst?
  11. What was the degree of the pain in your shoulder, when it was at its least?
  12. How often did you experience pain in your arm, hand, or fingers?
  13. What was the degree of the pain in your arm, hand, or fingers, as a whole?
  14. What was the degree of the pain in your arm, hand, or finger, when it was at its worst?
  15. What was the degree of the pain in your arm, hand, or finger when at its least?
  16. How often did you experience headaches?
  17. What was the degree of pain due to movements?
  18. All activities took longer, for example, domestic tasks, personal care, or work.
  19. Everything I did use more energy.
  20. I had to lie down in bed or on the sofa more often.
  21. I had no interest in doing things.
  22. I avoided postures or activities out of fear that my symptoms would worsen.
  23. Looking over your shoulder?
  24. Keep your head upright or gaze upward?
  25. Flex your neck and gaze downward?
  26. Lifting up things, like children, a laundry basket, or heavy boxes?
  27. Carrying things, like groceries or a shoulder bag?
  28. Walking a longer distance?
  29. Writing using a pen?
  30. Working at a computer?
  31. Cutting using a knife, e.g., vegetables or meat?
  32. Opening a jar with a screw-top lid?
  33. Holding a book or a newspaper?
  34. Holding things in your hands without dropping them?
  35. Finding a comfortable position when lying in bed?
  36. Using means of transportation, like the car, scooter, bike, or public transport?
  37. Self-care like taking shower, washing hair, putting on cloth, or brushing teeth?
  38. Domestic chores, like making dinner, doing laundry, cleaning, small chores, or taking care of children or family?
  39. Social activities with friends or family?
  40. Your usual recreational activities, like sports or hobbies?
  41. Focus on the tasks you are performing?
  42. Work (paid work, caregiving, or voluntary work).


Neck Pain and Disability Scale

This scale was used to measure the intensity of neck pain and the related disability. There are 21 items in the scale, participants respond to each item of the NPAD Scale, and the score ranges from (0 to 5), in which 0 is no pain and 5 is severe pain. The possible range is 0 (no pain)–100 (maximal pain). It is used to measure problems such as neck movements, neck pain intensity, effect of neck pain on emotion and cognition, and level of interference with daily life activities. The NPAD is a measure used to evaluate outcomes in patients with neck pain.

Questionnaire of Neck Pain and Disability Scale

S. NO Questions

  1. How bad is your pain today?
  2. How bad is your pain on average?
  3. How bad is your pain at its worst?
  4. Does your pain interfere with your sleep?
  5. How bad is your pain with standing?
  6. How bad is your pain in walking?
  7. Does your pain interfere with driving or riding in a car?
  8. Does your pain interfere with social activities?
  9. Does your pain interfere with recreational activities?
  10. Does your pain interfere with work activities?
  11. Does your pain interfere with personal care?
  12. Does your pain interfere with personal relationships?
  13. How has your pain changed your outlook on life and future?
  14. Does pain affect your emotions?
  15. Does your pain affect your ability to think or concentrate?
  16. How stiff is your neck?
  17. How much trouble do you have turning your neck?
  18. How much trouble do you have looking up and down?
  19. How much trouble do you have working overhead?
  20. How much do pain pills help?


The CNFD Scale is a form of questionnaire used to measure the level of functional disabilities in patients with neck pain. The questions in this scale are related to changes in the activities of daily living, occurrence of headache, inability to sleep and also some psychosocial questions such as; emotional relationship, social contact in the patients with cervical radiculopathy. There are 15 items in this scale; the answers to the items are given as “yes,” “occasionally,” or “no” individually; for questions from 1 to 5, a “yes” indicates a good function, and for 6–15, a “no” indicates a good function. A score of 0 indicates a good function, and a poor function receives a score of 2 and occasionally receives score 1. The score ranges from 0 to 30. A “0” means there is no pain and a score “30” means severe pain which indicates that the patient is extremely disabled. The higher the score, the greater the disability.

Questionnaire of Copenhagen

Questions

  1. Can you sleep at night without neck pain interfering?
  2. Can you manage daily activity without neck pain reducing activity levels?
  3. Can you manage daily activity without help from others?
  4. Can you manage putting on your clothes in the morning without taking more time than usual?
  5. Can you bend over the washing basin in order to brush your teeth without getting neck pain?
  6. Do you spend more time than usual at home because of neck pain?
  7. Are you prevented from lifting objects waiting from 2 to 4 kg due to neck pain?
  8. Have you reduced your reading activity due to neck pain?
  9. Have you been bothered by a headache during the time you have had neck pain?
  10. Do you feel your ability to concentrate is reduced due to neck pain?
  11. Are you prevented from participating in your usual leisure time activities due to neck pain?
  12. Do you remain in bed longer than usual due to neck pain?
  13. Do you feel that neck pain has influenced your emotional relationship with your nearest family?
  14. Have you had to give up social contact with other people during the past 2 weeks due to neck pain?
  15. Do you feel that neck pain will influence your future?


Statistical analysis

We analyzed the data using SPSS version 21 (IBM, Chicago, IL, USA). The normality distribution of the data was analyzed using Shapiro–Wilk test. The data were presented in the form of mean ± standard deviation. Neck disability scores between males and females were compared using independent t-test. The significance level was kept at P < 0.05.


  Results Top


There was no significant difference in the demographic variables [Table 1] between males and females except for weight where males had higher weights as compared to females.
Table 1: Demographic data of the participants

Click here to view


Cervical Radiculopathy Impact Scale

The mean scores of several questions of CRIS scale for the comparison between males and females are presented in [Appendix 1], and the scores of CRIS are explained in [Figure 1]. We found that the mean scores of CRIS were 14.35 in males and 33.22 in females and there was a significant difference between the scores of the two groups which indicates more disability in female patients as compared with the male patients.

Figure 1: Difference between males and females for Cervical Radiculopathy Impact Scale

Click here to view


[Figure 1] represents mean values of 14.35 in males and 33.22 in females. Error bars represent standard deviation values.

Neck Pain and Disability Scale

The mean scores of several questions of NPDI scale for the comparison between males and females are presented in [Appendix 2], and the scores of the Neck Pain and Disability Scale (NPDS) are explained in [Figure 2]. We found that the mean scores of the NPAD Scale were 14.35 in males and 33.22 in females and there was a significant difference between the scores of the 2 groups which indicates more disability in female patients as compared with the male patients.

Figure 2: Difference between males and females for Neck Pain and Disability Scale scores

Click here to view


[Figure 2] represents the mean values of 14.35 in males and 33.22 in females. Error bars represent standard deviation values.

Copenhagen Neck Functional Disability Scale

The mean scores of several questions of Copenhagen Neck Functional Disability Scale for the comparison between males and females are presented in [Appendix 3], and the scores of Copenhagen are explained in [Figure 3]. We found that the mean scores of CNFD Scale were 7.92 in males and 13.50 in females and there was a significant difference between the scores of the two groups which indicates more disability in female patients as compared with the male patients.

Figure 3: Difference between males and females for Copenhagen Neck Functional Disability Scale

Click here to view


[Figure 3] represents the mean values of 14.35 in males and 33.22 in females. Error bars represent standard deviation values.


  Discussion Top


The aim of this study was to evaluate functional disability in cervical radiculopathy patients. The second aim of this study was to compare neck disability between males and females. The study included 35 participants of both sexes, in which 21 were female and 14 were male. The data were collected from the Department of Physiotherapy, Rajeev Gandhi College, Bhopal. In this study, three scales were used in questionnaire form such as CRIS with 42 items, NPAD Scale with 20 items, and CNFD Scale with 15 items. The mean scores of all the three scales showed that there was a significant difference between the two groups. Female patients had a higher score than the male patients, which according to the scales indicates a greater disability in females as compared to the males.

We found that the normative values and Standard Error for the Cervical Radiculopathy Impact Scale was 26.22 ± 19.22. The authors Gartner et al., 2019, found the value of the total score as 41.56 ± 25.53. The sample size of their study was large as compared to our study, and the subjects in our study showed symptoms which were acute and in the very initial stage as compared to the abovementioned study. This explains the difference in the findings of our study from the mentioned study.

We found the total score for the NPAD Scale to be 25.88 ± 19.05 (mean ± standard deviation). The authors Monticone et al., 2012, found the values of the total score of scale to be 28.0 ± 17.2 which were closely similar to our findings. The authors included Italian patients with chronic nonspecific neck pain. The findings from our study indicated similarity in disability indices due to neck pain in the Italian and Indian populations.

We found that the normative value of the total score for the CNFD Scale was 11.43 ± 6.15. We found that the normative values and Standard Error for the Cervical Radiculopathy Impact Scale was 26.22 ± 19.22. This difference can be attributed to the difference in stage of neck disorder. The authors in the abovementioned study[10] included chronic neck pain patients, whereas patients with neck pain in our study were in their initial stage of neck impairment.

As per all the three scales, i.e., CRIS, NPAD Scale, and CNFD Scale, more disability was seen in females as compared to males in our study. The results were similar to the findings of Oe et al., 2010, who demonstrated findings of greater disability in females as compared to males. The reason could be lesser physical activity and greater sedentary behavior in females as compared to males.[12] In daily life, many physical activities are done by females like repeated and overuse work which causes poor posture and increases the pressure on cervical spine. Age-related degeneration of the intervertebral disc and cervical spinal components can also play an important role in the disability progression. In the cervical spine, degenerative changes occur due to surrounding structures, including joint, facet joints, ligaments, and ligamentum flavum; all these structures cause narrowing of the cervical spine which causes compression of nerve root. In the cervical spine, the center of gravity passes anterior to the atlanto-occipital joint (C0–C1) through dens of C2 posterior to cervical vertebrae through C7-T1. Previous literature suggests that linear and areal dimensions of cervical vertebrae are different in females, compared to males, and thus, females are more susceptible to cervical soft tissue acute and overuse injuries.[13] According to anatomical structures, females have a lesser bone mineral density as compared to males and therefore they are more prone to injury.


  Conclusion Top


Our results showed 26.22% and 25.88% disability as per CRIS and NPDS, respectively. We found mild-to-moderate disability in our subjects according to the CNFD Scale. The study concluded that females have more disability in cervical radiculopathy as compared to males.

Future scope

Several clinical implications can be derived from the findings of this research, including the ways to reduce functional disabilities in the patients with cervical radiculopathy. These patients can improve their functional abilities by changing many activities of their daily routine such as; the use of good posture and ergonomics to prevent neck pain.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Iyer S, Kim HJ. Cervical radiculopathy. Curr Rev Musculoskelet Med 2016;9:272-80.  Back to cited text no. 1
    
2.
Gärtner FR, Marinus J, van den Hout WB, Vleggeert-Lankamp C, Stiggelbout AM. The Cervical Radiculopathy Impact Scale: Development and evaluation of a new functional outcome measure for cervical radicular syndrome. Disabil Rehabil 2020;42:1894-905.  Back to cited text no. 2
    
3.
Eubanks JD. Cervical radiculopathy: Nonoperative management of neck pain and radicular symptoms. Am Fam Physician 2010;81:33-40.  Back to cited text no. 3
    
4.
Frost BA, Camarero-Espinosa S, Foster EJ. Materials for the spine: Anatomy, problems, and solutions. Materials (Basel) 2019;12:253.  Back to cited text no. 4
    
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Woods BI, Hilibrand AS. Cervical radiculopathy. J Spinal Disord Tech 2015;28:E251-9.  Back to cited text no. 5
    
6.
Kuijper B, Tans JT, Beelen A, Nollet F, de Visser M. Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: Randomised trial. BMJ 2009;339:b3883.  Back to cited text no. 6
    
7.
Shedid D, Benzel EC. Cervical spondylosis anatomy: Pathophysiology and biomechanics. Neurosurgery 2007;60 Suppl 1:S1-7.  Back to cited text no. 7
    
8.
Savva C, Giakas G. The effect of cervical traction combined with neural mobilization on pain and disability in cervical radiculopathy. A case report. Man Ther 2013;18:443-6.  Back to cited text no. 8
    
9.
Young IA, Cleland JA, Michener LA, Brown C. Reliability, construct validity, and responsiveness of the neck disability index, patient-specific functional scale, and numeric pain rating scale in patients with cervical radiculopathy. Am J Phys Med Rehabil 2010;89:831-9.  Back to cited text no. 9
    
10.
Akaltun MS, Kocyigit BF. Assessment of the responsiveness of four scales in geriatric patients with chronic neck pain. Rheumatol Int 2021;41:1825-31.  Back to cited text no. 10
    
11.
Monticone M, Ambrosini E, Vernon H, Brunati R, Rocca B, Foti C, et al. Responsiveness and minimal important changes for the Neck Disability Index and the Neck Pain Disability Scale in Italian subjects with chronic neck pain. Eur Spine J 2015;24:2821-7.  Back to cited text no. 11
    
12.
Oe S, Togawa D, Yoshida G, Hasegawa T, Yamato Y, Yasuda T, et al. Cut-off values of and factors associated with a negative influence on Neck Disability Index. Eur Spine J 2018;27:1423-31.  Back to cited text no. 12
    
13.
Stemper BD, Yoganandan N, Pintar FA, Maiman DJ, Meyer MA, DeRosia J, et al. Anatomical gender differences in cervical vertebrae of size-matched volunteers. Spine (Phila Pa 1976) 2008;33:E44-9.  Back to cited text no. 13
    


    Figures

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