{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T20:06:49Z","timestamp":1791058009130,"version":"4.1.0"},"reference-count":45,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2021,3,16]],"date-time":"2021-03-16T00:00:00Z","timestamp":1615852800000},"content-version":"unspecified","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,2,22]]},"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cervical radiculopathy (CR) is a clinical condition whereby motor, reflex and\/or sensory changes such as radicular pain, paraesthaesia or numbness can exist. Conservative management is a preferred first treatment option as the risk\u2013benefit ratio for surgery is less favourable. Systematic reviews and treatment guidelines gather evidence on the effectiveness of non-surgical management of patients with CR from randomised controlled trials, which do not consider the natural course of recovery to modify the management strategy accordingly. The aim of this study is to establish consensus on effective non-surgical treatment modalities for patients in different stages (acute, subacute and chronic) of CR, using the Delphi method approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>Through an iterative multistage process, experts within the field will rate their agreement with a list of proposed treatment modalities and suggest any missing treatment modalities during each round. Agreement will be measured using a five-point Likert scale. Descriptive statistics will be used to measure agreement (median, IQR and percentage of agreement). Consensus criteria will be defined a priori for each round. Data analysis at the end of round three will produce a consensus list of effective treatment modalities for the management of patients with CR in different stages of recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval has been granted from the University of Birmingham ethics committee under ERN_20-1121. The study findings will be submitted to a peer-reviewed journal and to relevant conferences for dissemination of the study results.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-043021","type":"journal-article","created":{"date-parts":[[2021,3,16]],"date-time":"2021-03-16T13:14:22Z","timestamp":1615900462000},"page":"e043021","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Timing of evidence-based non-surgical interventions as part of multimodal treatment guidelines for the management of cervical radiculopathy: a Delphi study protocol"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6375-2267","authenticated-orcid":false,"given":"Erik","family":"Thoomes","sequence":"first","affiliation":[{"name":"School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK"},{"name":"Research Department, Fysio-Experts, Hazerswoude Rijndijk, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2865-5389","authenticated-orcid":false,"given":"Marloes","family":"Thoomes-de Graaf","sequence":"additional","affiliation":[{"name":"Research Department, Fysio-Experts, Hazerswoude Rijndijk, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Cleland","sequence":"additional","affiliation":[{"name":"Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1945-5518","authenticated-orcid":false,"given":"Alessio","family":"Gallina","sequence":"additional","affiliation":[{"name":"School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1689-6190","authenticated-orcid":false,"given":"Deborah","family":"Falla","sequence":"additional","affiliation":[{"name":"School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,3,16]]},"reference":[{"key":"2025121408355168000_11.3.e043021.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2008.02365.x"},{"key":"2025121408355168000_11.3.e043021.2","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1007\/s00586-012-2297-9","article-title":"Lack of uniform diagnostic criteria for cervical radiculopathy in conservative intervention studies: a systematic review","volume":"21","author":"Thoomes","year":"2012","journal-title":"Eur Spine J"},{"key":"2025121408355168000_11.3.e043021.3","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/117.2.325"},{"key":"2025121408355168000_11.3.e043021.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1996.tb10629.x"},{"key":"2025121408355168000_11.3.e043021.5","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2474-15-129","article-title":"CASINO: surgical or nonsurgical treatment for cervical radiculopathy, a randomised controlled trial","volume":"15","author":"van Geest","year":"2014","journal-title":"BMC Musculoskelet Disord"},{"key":"2025121408355168000_11.3.e043021.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2014.02.032"},{"key":"2025121408355168000_11.3.e043021.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2010.10.023"},{"key":"2025121408355168000_11.3.e043021.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.math.2010.09.005"},{"key":"2025121408355168000_11.3.e043021.9","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0b013e31828441fb"},{"key":"2025121408355168000_11.3.e043021.10","first-page":"Cd001466","article-title":"Surgery for cervical radiculopathy or myelopathy","volume":"24","author":"Nikolaidis","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121408355168000_11.3.e043021.11","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-012-2553-z"},{"key":"2025121408355168000_11.3.e043021.12","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/pzx118"},{"key":"2025121408355168000_11.3.e043021.13","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2017.0302"},{"key":"2025121408355168000_11.3.e043021.14","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-017-5121-8"},{"key":"2025121408355168000_11.3.e043021.15","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2018-099878"},{"key":"2025121408355168000_11.3.e043021.16","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-017-5433-8"},{"key":"2025121408355168000_11.3.e043021.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2008.01.008"},{"key":"2025121408355168000_11.3.e043021.18","doi-asserted-by":"publisher","DOI":"10.1198\/016214508000000733"},{"key":"2025121408355168000_11.3.e043021.19","doi-asserted-by":"publisher","DOI":"10.1353\/pbm.0.0132"},{"key":"2025121408355168000_11.3.e043021.20","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.316.7126.201"},{"key":"2025121408355168000_11.3.e043021.21","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1055\/s-0034-1387807","article-title":"Optimal duration of conservative management prior to surgery for cervical and lumbar radiculopathy: a literature review","volume":"4","author":"Alentado","year":"2014","journal-title":"Global Spine J"},{"key":"2025121408355168000_11.3.e043021.22","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1249\/JSR.0000000000000083","article-title":"Lower extremity nerve entrapments in athletes","volume":"13","author":"Meadows","year":"2014","journal-title":"Curr Sports Med Rep"},{"key":"2025121408355168000_11.3.e043021.23","doi-asserted-by":"publisher","DOI":"10.1186\/s12998-016-0126-7"},{"key":"2025121408355168000_11.3.e043021.24","doi-asserted-by":"publisher","DOI":"10.1287\/mnsc.9.3.458"},{"key":"2025121408355168000_11.3.e043021.25","doi-asserted-by":"publisher","DOI":"10.1177\/0269216317690685"},{"key":"2025121408355168000_11.3.e043021.26","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2006.03716.x"},{"key":"2025121408355168000_11.3.e043021.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.nedt.2013.02.016"},{"key":"2025121408355168000_11.3.e043021.28","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.1994.tb01207.x"},{"key":"2025121408355168000_11.3.e043021.29","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-033547"},{"key":"2025121408355168000_11.3.e043021.30","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.math.2014.04.013","article-title":"A modified Delphi consensus study to identify UK osteopathic profession research priorities","volume":"19","author":"Rushton","year":"2014","journal-title":"Man Ther"},{"key":"2025121408355168000_11.3.e043021.31","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-011764"},{"key":"2025121408355168000_11.3.e043021.32","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2016-097131"},{"key":"2025121408355168000_11.3.e043021.33","doi-asserted-by":"crossref","first-page":"3168","DOI":"10.1111\/jan.13381","article-title":"The use of advanced web-based survey design in Delphi research","volume":"73","author":"Helms","year":"2017","journal-title":"J Adv Nurs"},{"key":"2025121408355168000_11.3.e043021.34","doi-asserted-by":"publisher","DOI":"10.1155\/2005\/836030"},{"key":"2025121408355168000_11.3.e043021.35","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-5-37"},{"key":"2025121408355168000_11.3.e043021.36","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-017-5121-8"},{"key":"2025121408355168000_11.3.e043021.37","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-016-4467-7"},{"key":"2025121408355168000_11.3.e043021.38","first-page":"29","article-title":"The Delphi methodology (Part one): a useful administrative approach","volume":"7","author":"Jairath","year":"1994","journal-title":"Can J Nurs Adm"},{"key":"2025121408355168000_11.3.e043021.39","doi-asserted-by":"crossref","unstructured":"De Vet HC , Terwee CB , Mokkink LB . Measurement in medicine: a practical guide: Cambridge university press 2011.","DOI":"10.1017\/CBO9780511996214"},{"key":"2025121408355168000_11.3.e043021.40","first-page":"226","article-title":"Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms","volume":"3","author":"Merskey","year":"1986","journal-title":"Pain"},{"key":"2025121408355168000_11.3.e043021.41","unstructured":"IASP . Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms: IASP press 1994."},{"key":"2025121408355168000_11.3.e043021.42","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199709150-00012"},{"key":"2025121408355168000_11.3.e043021.43","doi-asserted-by":"publisher","DOI":"10.1007\/s10459-010-9222-y"},{"key":"2025121408355168000_11.3.e043021.44","first-page":"64","article-title":"Likert scales and data analyses","volume":"40","author":"Allen","year":"2007","journal-title":"Quality progress"},{"key":"2025121408355168000_11.3.e043021.45","doi-asserted-by":"publisher","DOI":"10.1177\/152715440000100409"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-043021","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T16:35:58Z","timestamp":1765730158000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-043021"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3]]},"references-count":45,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3,16]]},"published-print":{"date-parts":[[2021,3]]}},"alternative-id":["10.1136\/bmjopen-2020-043021"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-043021","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3]]}}}