Carla Vanti

Effectiveness of global postural re-education in patients with chronic nonspecific neck pain: Randomized controlled trial

Background Global postural re-education (GPR) has shown positive results for patients with musculoskeletal disorders, but no previous randomized controlled trial (RCT) has investigated its effectiveness as the sole procedure for adult patients with chronic nonspecific neck pain (NP). Objective The purpose of this study was to evaluate the effectiveness of applying GPR compared with a manual therapy (MT) intervention to patients with chronic nonspecific NP. Design An RCT was conducted. Patients Ninety-four patients with chronic nonspecific NP (72 women and 22 men; average age=47.5 years, SD=11.3) were randomly assigned to receive either a GPR intervention or an MT intervention. Outcome Measures Pain intensity (visual analog scale), disability (Neck Disability Index), cervical range of motion, and kinesiophobia (Tampa Scale of Kinesiophobia) were assessed. Methods The experimental group received GPR, and the reference group received MT. Both groups received nine 60-minute-long sessions with one-to-one supervision from physical therapists as the care providers. All participants were asked to follow ergonomic advice and to perform home exercises. Measures were assessed before treatment, following treatment, and at a 6-month follow-up. Results No important baseline differences were found between groups. The experimental group exhibited a statistically significant reduction in pain following treatment and in disability 6 months after the intervention compared with the reference group. Limitations Randomization did not lead to completely homogeneous groups. It also was noted that the time spent integrating the movements practiced during the session into daily routines at the end of each session was requested only of participants in the GPR group and may have had an impact on patient adherence that contributed to a better outcome. Conclusions The results suggest that GPR was more effective than MT for reducing pain after treatment and for reducing disability at 6-month follow-up in patients with chronic nonspecific NP.

Can physical therapy centred on cognitive and behavioural principles improve pain self-efficacy in symptomatic lumbar isthmic spondylolisthesis? A case series.

PURPOSEnPain-related self-efficacy is defined as the beliefs held by people with chronic pain that were able to carry out certain activities, even when experiencing pain, and it is considered a relevant mediator in the relationship between pain and disability in chronic low back pain. This case series describes a treatment aiming to improve pain self-efficacy in patients with symptomatic lumbar spondylolisthesis.nnnMETHODnTen consecutive outpatients with lumbar spondylolisthesis and chronic LBP referred to a rehabilitative clinic participated in this study. Cognitive and behavioural principles were integrated with functional and graded approach in each individual physical therapy program. The outcome measures concerned clinical instability and endurance tests, pain, disability and self-efficacy.nnnRESULTSnPain self-efficacy and lumbar function improved in 7 out of 10 patients; clinical tests improved in 9 out of 10 patients.nnnCONCLUSIONnA rehabilitation program carried out by a physical therapist, centred on cognitive and behavioural principles, appeared useful in improving pain self-efficacy and lumbar function. These results may be interesting for future controlled trials.

The Italian version of the Outpatient Physical Therapy Improvement in Movement Assessment Log: Cross-cultural adaptation and psychometric properties

Instruments to measure movement abilities from a patient’s perspective are generally unavailable across diverse cultures and languages. The aim of this study was to translate, culturally adapt, and validate the Italian version of the Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL) confidence scale. This study was an observational multicenter study. The Italian version of the OPTIMAL confidence scale (OPTIMAL-I) was developed following forward–backward translation and pretesting with a small group of patients. Reliability was measured by internal consistency (Cronbach &agr;), and a factor analysis was carried out to explore the internal structure. Convergent validity was measured by comparing the OPTIMAL-I with the Italian version of the Activities-specific Balance Confidence (ABC-I). The process for obtaining the OPTIMAL-I required 3 months and it was administered to 290 outpatients in two different rehabilitation clinics. OPTIMAL-I showed high acceptability, high internal consistency (Cronbach’s &agr;=0.963), and high test–retest stability (intraclass correlation coefficient=0.92, P=0.001). Convergent validity with ABC-I was also high (r=0.56–0.86; P<0.001). Using factor analysis, we found evidence for a four-factor structure related to ‘confidence with high-loads lower-extremity mobility’, ‘confidence with low-loads lower-extremity mobility’, ‘confidence with upper-extremity mobility’, and ‘confidence with trunk mobility’ that explained 78.83% of the total variance. The OPTIMAL-I showed good psychometric properties and its use can be recommended for measuring confidence in Italian patients receiving physical therapy services. Future studies should focus on divergent validity and construct validity.

Cervical Radiculopathy: Effectiveness of Adding Traction to Physical Therapy—A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BackgroundnCervical radiculopathy (CR) is a common cervical spine disorder. Cervical traction (CT) is a frequently recommended treatment for patients with CR.nnnPurposenThe purpose of this study was to conduct a review and meta-analysis of randomized controlled trials (RCTs) on the effect of CT combined with other physical therapy procedures versus physical therapy procedures alone on pain and disability.nnnData SourcesnData were obtained from COCHRANE Controlled Trials Register, PubMed, CINAHL, Scopus, ISI Web of Science, and PEDro, from their inception to July 2016.nnnStudy SelectionnAll RCTs on symptomatic adults with CR, without any restriction regarding publication time or language, were considered.nnnData ExtractionnTwo reviewers selected the studies, conducted the quality assessment, and extracted the results. Meta-analysis employed a random-effects model. The evidence was assessed using GRADE criteria.nnnData SynthesisnFive studies met the inclusion criteria. Mechanical traction had a significant effect on pain at short- and intermediate-terms (g = -0.85 [95% CI = -1.63 to -0.06] and g = -1.17 [95% CI = -2.25 to -0.10], respectively) and significant effects on disability at intermediate term (g = -1.05; 95% CI = -1.81 to -0.28). Manual traction had significant effects on pain at short- term (g = -0.85; 95% CI = -1.39 to -0.30).nnnLimitationsnThe most important limitation of the present work is the lack of homogeneity in CR diagnostic criteria among the included studies.nnnConclusionsnIn light of these results, the current literature lends some support to the use of the mechanical and manual traction for CR in addition to other physical therapy procedures for pain reduction, but yielding lesser effects on function/disability.

Global Postural Reeducation in patients with chronic nonspecific neck pain: cross-over analysis of a randomized controlled trial

OBJECTIVEnTo compare the effects of Global Postural Reeducation (GPR) with Manual Therapy (MT) in participants with chronic nonspecific neck pain (NP).nnnMETHODSnPre- and post-treatment analysis of cross-over data from an RCT was done. Seventy-eight subjects with chronic nonspecific NP aged 18 to 80 years completed the trial. The group who had received GPR crossed-over to MT and the previous MT group received GPR for 9 sessions once or twice a week. Measures were assessed at pre-treatment and post-treatment. Outcome measures included pain intensity [Visual Analogue Scale (VAS)], disability (Neck Disability Index), cervical Range of Motion (ROM), and kinesiophobia [Tampa Scale of Kinesiophobia (TSK)].nnnRESULTSnGPR targeted to crossed-over participants produced greater improvements in pain [Diff=-8.6; 95%CI=(-13.3; -3.8)], disability [Diff=-1.5; 95%CI=-2.8; -0.1], kinesiophobia [Diff=-1.8; 95%CI=(-3.2; -0.3)], and flexion/extension neck ROM [Diff=5.6; 95%CI=(1.8; 9.3)] at post-treatment compared to the MT group. When evaluating clinical improvement, by means of Minimal Clinically Important Differences, we found that GPR relevantly reduced neck disability with respect to MT [OR=2.13; 95% CI=(1.05; 4.35)], whereas the improvement of pain did not differ between groups [OR=1.84; 95%CI=0.85; 3.99)].nnnCONCLUSIONSnThese results within the crossed-over group confirm previous findings from an RCT with the same sample. Sequence of treatment (GPR-to-MT vs MT-to-GPR) does not seem to weaken the greater effects of GPR compared to MT approach for chronic NP. Our findings suggest that GPR can induce hypoalgesic effects, reduce disability and kinesiophobia, and improve flexion/extension in neck ROM.

Responsiveness of the bridge maneuvers in subjects with symptomatic lumbar spondylolisthesis: A prospective cohort study

BACKGROUND AND PURPOSEnTo date no study was made on the responsiveness of Bridge tests (BTs) in subjects with low back pain and spondylolisthesis (SPL) submitted to a physical therapy program. The objective of this study is to examine the responsiveness of the BTs in subjects with symptomatic lumbar SPL.nnnMETHODSnOne hundred twenty patients with symptomatic SPL received physical therapy treatments for a number of sessions depending on the individual patients needs. Each session included supervised exercises and the teaching of home exercises aiming to improve the lumbar stability, for about 1xa0hr in total. At the beginning and immediately after the last session of treatment, participants completed the Oswestry Disability Index - Italian version and the Pain Numerical Rating Scale, and performed the supine bridging (SBT) and the prone bridging (PBT). The global perception of effectiveness was measured with a seven-point Likert scale Global Perceived Effect questionnaire.nnnRESULTSnThe mean post-treatment change score (95% confidence interval [CI]) was 18.2xa0s (14.5; 21.9) for the PBT and 43.9xa0s (35.1; 52.8) for the SBT, all pxa0<xa0.001. The area under the receiver operating characteristic curve for the PBT was 0.83 (95% CI 0.74-0.91) and for the SBT was 0.703 (95% CI 0.61-0.80). The optimal cutoff points were 19.5xa0s for the PBT and 62.5xa0s for the SBT. Logistic regression revealed that PBT (odds ratioxa0=xa00.952) was associated with the type of SPL. The final regression model explained 36.4% (R2 xa0=xa00.36; pxa0=xa0.001) of the variability.nnnDISCUSSIONnBridge maneuvers proved to be responsive, because their results were significantly related to pain and disability changes. BTs may be suggested to detect clinical changes after physical therapy treatment in symptomatic SPL. Copyright

The effect of Global Postural Reeducation on body weight distribution in sitting posture and on musculoskeletal pain. A pilot study

OBJECTIVEnTo quantify body weight distribution (BWD) in seated posture with an office chair instrumented with load cells and to evaluate the effects of ergonomic advice and Global Postural Reeducation (GPR) on seated BWD and on musculoskeletal pain.nnnMETHODSnNineteen healthy females were randomly assigned: nine to the experimental group and 10 to the control group. Control group (CG) received only ergonomic verbal advice (EVA) regarding BWD in a seated position. Experimental group (EG) also received EVA and furthermore attended eight GPR sessions. Difference in the effects of the different therapeutic approaches was investigated using the non-parametric Wilcoxon-Mann-Whitney test.nnnRESULTSnAfter treatments, there was no significant difference between the two groups as regards seated BWD. EG improved musculoskeletal pain significantly more than CG (p<0.005). Instead, musculoskeletal pain frequency decreased (p<0.005) only in EG (after EVA and GPR sessions), in neck, cervical, thoracic, lumbar, shoulders and wrists areas.nnnCONCLUSIONSnDespite both interventions did not induce any significant improvement on seated BWD, adding GPR to EVA was related to a better reduction on musculoskeletal pain in young health females.

Responsiveness and minimum important change of the Oswestry Disability Index in Italian subjects with symptomatic lumbar spondylolisthesis

BackgroundThis study aims to investigate the responsiveness and the minimum important change of the Italian version of the Oswestry Disability Index (ODI-I) in subjects with symptomatic specific low back pain associated with lumbar spondylolisthesis (SPL).Materials and methodsOne hundred and fifty-one patients with symptomatic SPL completed the ODI-I, a 0–100 numerical rating scale (NRS), and performed the prone and supine bridge tests. The global perception of effectiveness was measured with a 7-point Likert scale. Responsiveness was assessed by distribution methods (minimum detectable change [MDC], effect size [ES], standardized response mean [SRM]) and anchor-based methods (ROC curves).ResultsThe MDC was 4.23, the ES was 0.95 and the SRM was 1.25. ROC analysis revealed an area under the curve of 0.76 indicating moderate discriminating capacity. The best cut-off point for the dichotomous outcome was 7.5 (sensitivity 90.3%, specificity 56.7%). .ConclusionsThe ODI-I proved to be responsive in detecting changes after conservative treatment in subjects with lumbar SPL.Level of evidenceII.

Neck pain and dysphagia associated to disc protrusion and reduced functional stability: A case report

BACKGROUNDnDeglutition dysfunction like dysphagia may be associated with cervical symptoms.nnnFINDINGSnA young female complained of pain on the neck and swallowing dysfunction that was reduced by means of isometric contraction of cervical muscles. Magnetic resonance imaging revealed an anterior C5-C6 disc protrusion associated with a lesion of the anterior longitudinal ligament. Barium radiograph showed a small anterior cervical osteophyte at C6 level and dynamic X-ray excluded anatomical instability. The treatment included manual therapy and active exercises to improve muscular stability.nnnCONCLUSIONSnDiagnostic hypothesis was a combination of cervical disc dysfunction associated with C6 osteophyte and reduced functional stability.

The effectiveness of walking versus exercise on pain and function in chronic low back pain: a systematic review and meta-analysis of randomized trials

Abstract Objective: Walking is commonly recommended to relieve pain and improve function in chronic low back pain. The purpose of this study was to conduct a systematic review and meta-analysis of randomized controlled trials concerning the effectiveness of walking interventions compared to other physical exercise on pain, disability, quality of life and fear-avoidance, in chronic low back pain. Methods: Randomized controlled trials investigating the effects of walking alone compared to exercise and to exercise with added walking on adults with chronic low back pain were identified using the MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), Cochrane Central Register of Controlled Trials (CENTRAL), PsychINFO, and SPORT DiscusTM databases. Two reviewers independently selected the studies and extracted the results. Study quality was assessed using the PEDro scale and the clinical relevance of each outcome measure was evaluated. Results: Meta-analysis of five randomized controlled trials meeting inclusion criteria was performed. The effectiveness of walking and exercise at short-, mid-, and long-term follow-ups appeared statistically similar. Adding walking to exercise did not induce any further statistical improvement, at short-term. Conclusions: Pain, disability, quality of life and fear-avoidance similarly improve by walking or exercise in chronic low back pain. Walking may be considered as an alternative to other physical activity. Further studies with larger samples, different walking dosages, and different walking types should be conducted. Implications for Rehabilitation Walking is commonly recommended as an activity in chronic low back pain. Pain, disability, and fear-avoidance similarly improve by walking or exercise. Adding walking to exercise does not induce greater improvement in the short-term. Walking may be a less-expensive alternative to physical exercise in chronic low back pain.