Effect of Cervical Traction on Balance in Cervical Radiculopathy

Center of pressure of the foot sway area (Cop/SA) (mm ²)

The lateral displacement length of the center of pressure of the foot (LD) (mm)

The anteroposterior displacement length of the center of pressure of the foot (AD) (mm)

The lateral displacement velocity (LV) of the center of pressure of the foot (mm/s)

The anteroposterior velocity (AV) of the dispalcement of the center of pressure of the foot(mm/s)

For the clinical balance assessment, the Brief-BESTest was used. Six categories included in the test (8 scored):

• Biomechanical constraints: Hip strength
• Stability limits/verticality: Reach forward
• Anticipatory postural responses: Stand on one limb: left and right each scored
• Postural responses: Compensatory Stepping right and left each scored
• Sensory orientation: Stance on foam with eyes closed
• Stability in gait: Get up and Go test Each item is scored: 0 - 3 points (0 representing severe impairment and 3 representing no balance impairment).

Total score = 24 points (2 items include both a R/L component)

• Age (years)

Sex (Male or Female)

Medical History (Hypertension, diabetes, others)

Occupation (Employed, unemployed, retired)

Type of Occupation: Shift work (office work, secretary) or manual labor (heavy manual work, carrying loads)

Socioeconomic Level: Poor if the salary is below the guaranteed minimum wage (SMIG : around 400 Tunisian Dinars per month) , Average if the salary is between SMIG and three times SMIG, Good if it is more than three times SMIG.

The duration of CR is the length of radicular pain evolution in months.

The side of CR: Right, left, or bilateral

The intensity of radicular pain was assessed using a Visual Analog Scale (VAS) scored out of 100.

• Body Mass Index (BMI) (kg/m²)

Cervical ROM was measured using the Cervical Range-of-Motion Instrument (CROM; Performance Attainment Associates, St Paul, MN). With its three inclinometers, the CROM device is a useful clinical instrument for measuring the cervical spine's active mobility in flexion, extension, rotation, and lateral flexion.

Cervical proprioception was assessed using the CROM device. Patient wearing a CROM device is instructed to maintain a neutral head position while sitting (reference position). Patient is asked to close his eyes and move his head passively before returning it to the reference position by the examiner. The angle inaccuracy is measured in degrees by the examiner. The flexion and extension tests are run .

Cervical muscles strength was measured using a handheld isometric dynamometer (MicroFET2; Hoggan Health Industries). Measurements were reported in Newton. To assess the strength of the flexor muscles, the dynamometer is placed on the forehead, while for the extensor muscles, it is placed at the back of the head

HGS was measured using the Jamar hydraulic handheld dynamometer (Lafayette Instrument Company, USA) and was reported in kilograms.

The Neck disability index (NDI), a reliable instrument used in clinical practice, was used to assess patients' activities of daily living . It includes 10 items (pain intensity, personal care, lifting, reading, headaches, concentration, work status, driving, sleeping and recreation) each scored from 0 (no disability) to 5 (total disability). The total score is 50 , a higher score indicates a higher disability. The NDI is expressed by percentage. The Arabic version of NDI was delivered to patients.

The anxiety and depression profiles were assessed using the Hospital Anxiety and Depression scale (HAD). A validated Arabic version of the scale was used. The HAD includes 14 items (7 for anxiety and 7 for depression) rated from 0 to 3 each. The maximum score is 21 for each symptom, and a higher score indicates a poor psychological status . A score less than 7 indicates no depression or anxiety, a score of 8-10 indicates doubtful cases, and a score higher than 11 indicates a certain symptomatology.

The participants' QoL was assessed using the World Health Organization quality of life (WHOQOL-BREF) questionnaire with 4 domains: physical health, psychological, social relationships, and environment. Each domain is reported in percentages, with a higher score indicating better QoL, and a lower score indicating poor QoL.

The Tampa Scale for Kinesiophobia (TSK) was used to evaluate the kinesiphobia. An Arabic version was administered to patients. The TSK includes 17 items rated from 1 to 4 each, with a total score ranging from 17 to 68. Higher scores reflect greater levels of movement-related fear, and a score higher than 37 indicates the presence of kinesiophobia.