Clinical effectiveness of high-intensity laser therapy in patients with cervical radiculopathy: Randomized controlled trial

Objectives: The aim of this study was to investigate the clinical effectiveness of HILT combined with exercise on pain, functionality, and quality of life in the short and long term in patients with subacute-chronic cervical radiculopathy compared to placebo and singly exercise. Design: Randomized, double-blind, placebo-controlled study Material and methods: The study included 90 patients, aged 18-65 years, with a history of arm pain and/or neck pain for over 1 month, clinical evaluation and cervical MRI findings compatible with cervical radiculopathy. Patients were randomized to three treatment groups. Patients assigned into three groups and were treated with HILT plus exercise (HILT + EX), placebo laser plus exercise (PL + EX), and exercise alone in groups 1, 2, and 3, respectively. In each 3 groups consisted of 30 patients were treated five times a week for a period of 4 weeks. All participants were evaluated with respect to pain in the neck and arm (at rest, movement, and night) by visual analog scale, measurement of active range of motion of the cervical joint using a goniometer; the level of neuropathic pain by the Pain Detect; the effect of radicular symptoms on functionality with the Cervical Radiculopathy Impact Scale (CRIS); the disability status with the Neck Disability Index (NDI) and the quality of life with SF36. All evaluation parameters performed three times pre-treatment (T0), posttreatment (T1: at 4th week) and at the end of the treatment 12th week (T2). Within the study design, patients and the researcher who performed the assessments were blind to the treatment groups. Results: A total of 90 patients participated in this study, with a mean (SD) age of 48.9±9.3 years, 60 (66.7%) of them were women; 30 (33.3%) were male. The groups showed homogeneous distribution in terms of gender and age. Pain intensity in the arm and neck (VAS), neuropathic (Pain detect) and radicular pain levels (CRIS), and neck functional disability level (NDI) showed a significant improvement in both the short and long-term in all three groups (p<0.05). Exclusively, these improvements were found to be statistically significantly higher in the HILT group in the short and long term (p<0.05). In all sub-parameters of the quality of life scale, both in the shortterm and the long-term the HILT and placebo groups showed significant improvement; on the other hand, the exercise group showed significant improvement in emotional role limitation and social functionality, and pain sub-parameters (p<0.05). As the group that received HILT combined exercise therapy showed a significant improvement in all sub-parameters of SF-36, both in the short and long term, as against singly exercise therapy; in the long term, it was determined as against the placebo group showed significant superiority (p<0.05). In the HILT and sham HILT groups were determined that there were a notable recovery in the cervical range of motions in the sagittal, coronal, and transverse planes in the short and long term (p<0.05). In the singly exercise group, a considerable recovery was detected in the measurement of cervical right/left rotation in the short term; as a significant recovery was observed in the measurement of extension and left rotation in the long term (p<0.05). There was no superiority of HILT over placebo in cervical ROM values measured in short and long-term in all 3 planes (p>0.05); however, it was detected that exercise combined with HILT had remarkable superiority over the short and long-term sagittal and coronal cervical range of motion compared to exercise alone (p<0.05). Furthermore, the Cervical Radiculopathy Impact Scale (CRIS), which we utilized to evaluate the effect of radicular symptoms on functionality, was established that VAS, PD, and some sub-parameters of SF-36 showed a moderate-high level of significant correlation with the results before and after the treatment (p<0.05). Conclusions: HILT combined with exercise in patients with cervical radiculopathy is more effective in improving radicular pain, functional disability, and quality of life in the short and long term than either alone exercise or placebo. As well, the Cervical Radiculopathy Impact Scale (CRIS) can be applied to the measurement, treatment, and follow-up of symptom-related limitations of patients with cervical radiculopathy. Key Words: Cervical radiculopathy, High Intensity Laser Therapy, Radicular pain, Neck pain