Wait & See, Neck Collar Or Physical Therapy for Cervical Radiculopathy?

What to do for neck and arm pain that started within the last 30 days?  Drum roll... which will it be the a) just wait and see what happens, b) the semi-hard collar (Cerviflex S, Bauerfeind)  which has 6 sizes to snuggly fit necks of all sizes, or c) physical therapy?  The winner is.... the Cerviflex S semi-hard collar!

In this century of effectiveness and effectiveness studies.... What a spectacular day for people who have cervical radiculopathy - just strap on a snug fitting semi-soft neck collar and life will be fabulous within 6 weeks!

I was fearful of these types of studies because the devil is in the details and as a whole, we are lazy.  Which is more realistic?  Read an abstract and believe the conclusion OR read the full study and reflect and think?  I'm betting most will read the abstract and believe the conclusion.

I liked that the subjects seemed to be a homogeneous group.  I like the fact that the same collar was consistently used.  I don't like not knowing psychosocial factors.  I really don't like the description of what physical therapy intervention was provided.  "Physiotherapy with a focus on mobilising and stabilising the cervical spine was given twice a week for six weeks, by certified physiotherapists who participated in the study. The standardised sessions were "hands off" and consisted of graded activity exercises to strengthen the superficial and deep neck muscles."  

Current literature indicates that manual intervention and exercise are key components for a successful outcome with various types of patient complaints.  Standardized sessions that are hands off do not meet the requirements of evidence.  The design of the study capturing the interventions provided by physical therapists really wasn't up to speed on the existing evidence on how physical therapists treat patients with cervical radiculopathy. 

It's a sad, sad day when the physical therapist involved in the design of the physical therapy intervention wing of a study didn't incorporate evidence into the treatment protocol.  I really have a problem with the design of the standardized physical therapy sessions!  Where was the evidence for the protocol?

So, the big question... which payer will see the abstract... which payer will deny payment for physical therapy services because physical therapy services are not cost effective and a neck collar will "effectively" take care of the patient's cervical radiculopathy?

~Selena