Conservative management for lumbar radiculopathy based on the stage of the disorder: a Delphi study

Abstract

Purpose

Conservative management of lumbar radiculopathy (LR) is the first treatment option. To date, systematic reviews and clinical practice guidelines have not considered the most appropriate timing of management. This study aimed to establish consensus on effective conservative treatment modalities across different stages (i.e., acute, sub-acute, or chronic) of LR.

Materials and methods

Through an iterative multistage Delphi process, experts rated agreement with proposed treatment modalities across stages of LR and could suggest additional treatment modalities. The 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.

Results

Fourteen panelists produced a consensus list of effective treatment modalities across stages of LR. Acute stage management should focus on providing patients with information about the condition including pain education, individualized physical activity, and directional preference exercises, supported with NSAIDs. In the sub-acute stage, strength training and neurodynamic mobilization could be added and transforaminal/epidural injections considered. In the chronic stage, spinal manipulative therapy, specific exercise, and function-specific physical training should be combined with individualized vocational, ergonomic and postural advice.

Conclusions

Experts agree effectiveness of interventions differs through the evolution of LR.

IMPLICATIONS FOR REHABILITATION

• To date clinical guideline for conservative management of lumbar radiculopathy do not consider the evolution of the condition.

• Acute stage management of lumbar radiculopathy should focus on providing information about the condition and support individualized physical activity with pain medication.

• Sub-acute management should add neurodynamic mobilization to strength training, while transforaminal and/or epidural injections could be considered.

• Chronic stage management should consider spinal manipulative therapy and focus on restoring personalized functional capacity.

Keywords:

• Lumbar radiculopathy
• sciatica
• conservative management
• Delphi procedure
• expert opinion

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was conducted as part of a Post Graduate Research project through 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.