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

Figures & data

Figure 1. Procedure and timelines for participants in Delphi study.

Visual representation of the procedure and timelines for participants in Delphi study.

Table 1. Panelist characteristics.

N =	14
Average age (range)	51 (41–63)
Continent	North Americas (USA and Canada): 4 Europe: 7 Australasia: 3
Occupation (multiple answers possible)	Academia: 10 Medicine: 2 Physiotherapy: 8 Chiropractic: 2
Highest academic qualification	PhD: 8 MD: 4 DC: 1 MSc: 1
Years of experience with LR (median, range)	28 (18–37) years

MSc: Master of Science; DC: Doctor of Chiropractic; MD: Medical Doctor; PhD: Doctor of Philosophy.

Table 2. Proposed effective interventions per stage.

	Round 3
Intervention group	Likert scale (median)	IQR (range)	Agreement (%)
Acute stage <6 weeks
Counselling, advice and behavioral therapy
Providing information	5*	1 (3)*	100*
Pain education	4*	1 (3)*	100*
Behavioral therapy	4*	1 (3)*	92.9*
Physical therapy
Individualized physical activity	5*	2 (4)	78.6*
Directional preference (MDT) exercise	5*	1 (4)*	78.6*
Medication
NSAIDs	4.5*	2 (4)	78.6*
Subacute stage 6–12 weeks
Counselling, advice and behavioral therapy
Providing information	5*	1 (3)*	100*
Pain education	4*	1 (3)*	100*
Behavioral therapy	4*	1 (3)*	92.9*
Physical therapy
Focused/targeted strength training	4.5*	2 (4)	71.4*
Individualized physical activity	5*	2 (4)	71.4*
Neurodynamic mobilization (NM)	4*	1 (4)*	64.3
Medication
NSAIDs	4*	2 (3)	71.4*
Additional interventions suggested by panelists in Round 1
Transforaminal and/or epidural corticosteroids	4*	1 (4)*	78.6*
Chronic stage >12 weeks
Counselling, advice and behavioral therapy
Providing information	5*	1 (3)*	100*
Pain education	4*	1 (3)*	100*
Behavioral therapy	4*	1 (3)*	92.9*
Physical therapy
General aerobic exercise	4.5*	2 (4)	71.4*
General strength training	4*	2 (4)	71.4*
Focused/targeted strength training	5*	1 (4)*	78.6*
Individualized physical activity	5*	1 (4)*	78.6*
Supervised exercise	4*	2 (4)	71.4*
Motor control exercise	4*	2 (3)	71.4*
SMT combined with specific exercise	4*	1 (3)*	64.3
Additional interventions suggested by panelists in Round 1
Vocational, ergonomic and postural advice	4*	1 (3)*	71.4*
biomechanical training for functional and work activities	4*	1 (2)*	85.7*

MDT: mechanical diagnosis and treatment; NSAIDs: non-steroidal anti-inflammatory drugs, e.g., ibuprofen, diclofenac, meloxicam, naproxen, celecoxib, indomethacin, etc.; opioids, e.g., codeine, hydrocodone, vicodin, morphine, oxycodone, percocet, fentanyl, etc.; anti-epileptic drugs, e.g., pregabalin, gabapentin, lyrica, etc.; tricyclic medication (amitriptyline/nortriptyline); SMT: spinal manipulative therapy; TENS: transcutaneous electrical nerve stimulation.

*Value ≥ consensus criterium for that Round.