Original Article| Volume 32, ISSUE 9, P723-733, November 2009

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A Nonsurgical Approach to the Management of Patients With Lumbar Radiculopathy Secondary to Herniated Disk: A Prospective Observational Cohort Study With Follow-Up

  • Donald R. Murphy
    Submit requests for reprints to: Donald R. Murphy, DC, Rhode Island Spine Center, 600 Pawtucket Avenue, Pawtucket, RI 02860
    Clinical Director, Rhode Island Spine Center, Pawtucket, RI

    Clinical Assistant Professor, Department of Community Health, Warren Alpert Medical School of Brown University, Providence, RI

    Adjunct Associate Professor, Department of Research, New York Chiropractic College, Seneca Falls, NY
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  • Eric L. Hurwitz
    Associate Professor of Epidemiology, Department of Public Health Sciences and Epidemiology, John A. Burns School of Medicine, University of Hawaii, Mānoa, Hawaii
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  • Ericka E. McGovern
    Staff Chiropractic Physician, Rhode Island Spine Center, Pawtucket, RI
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      This study presents the outcomes of patients with lumbar radiculopathy secondary to disk herniation treated after a diagnosis-based clinical decision rule.


      A prospective observational cohort study was conducted at a multidisciplinary, integrated clinic that includes chiropractic and physical therapy health care services. Data on 49 consecutive patients were collected at baseline, at the end of conservative, nonsurgical treatment and a mean of 14.5 months after cessation of treatment. Disability was measured using the Bournemouth Disability Questionnaire (BDQ) and pain using the Numerical Rating Scale for pain. Fear beliefs were measured with the Fear-Avoidance Beliefs Questionnaire (FABQ). Patients also self-rated improvement.


      Mean duration of complaint was 60.5 weeks. Mean self-rated improvement at the end of treatment was 77.5%. Improvement was described as “good” or “excellent” in nearly 90% of patients. Mean percentage improvement on the BDQ was 60.4%. Numerical Rating Scale improved 4.1 points and FABQ improved 4.8 points. Clinically meaningful improvements in pain and disability were seen in 79% and 70% of patients, respectively. Mean number of visits was 13.2. After an average long-term follow-up of 14.5 months, mean self-rated improvement was 81.1%. “Good” or “excellent” improvement was reported by 80% of patients. Mean percentage improvement in BDQ was 67.4%. Numerical Rating Scale improved 4.2 points and FABQ 4.5 points. Clinically meaningful improvements in pain and disability were seen in 79% and 73% of patients, respectively.


      Management based on the decision rule yielded favorable outcomes in this cohort study. Improvement appeared to be maintained over the long term.

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