Pillastrini Paolo, de Lima E Sá Resende Fernanda, Banchelli Federico, Burioli Anna, Di Ciaccio Emanuele, Guccione Andrew A, Villafañe Jorge Hugo, Vanti Carla
P. Pillastrini, PT, MSc, Occupational Medicine Unit, Department of Biomedical and Neurological Sciences, University of Bologna, via P. Palagi 9-40138 Bologna, Italy.
F. de Lima e Sá Resende, PT, PhD, Occupational Medicine Unit, Department of Biomedical and Neurological Sciences, University of Bologna.
Phys Ther. 2016 Sep;96(9):1408-16. doi: 10.2522/ptj.20150501. Epub 2016 Mar 24.
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).
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.
An RCT was conducted.
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.
Pain intensity (visual analog scale), disability (Neck Disability Index), cervical range of motion, and kinesiophobia (Tampa Scale of Kinesiophobia) were assessed.
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.
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.
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.
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.
整体姿势再教育（GPR）已被证明对肌肉骨骼疾病患者有积极效果，但此前尚无随机对照试验（RCT）研究其作为成人慢性非特异性颈部疼痛（NP）唯一治疗方法的有效性。
本研究旨在评估将GPR与手法治疗（MT）干预应用于慢性非特异性NP患者的有效性。
进行了一项随机对照试验。
94例慢性非特异性NP患者（72名女性和22名男性；平均年龄 = 47.5岁，标准差 = 11.3）被随机分配接受GPR干预或MT干预。
评估疼痛强度（视觉模拟量表）、功能障碍（颈部功能障碍指数）、颈椎活动范围和运动恐惧（坦帕运动恐惧量表）。
实验组接受GPR，对照组接受MT。两组均接受9次每次60分钟的治疗，由物理治疗师进行一对一监督作为护理提供者。所有参与者均被要求遵循人体工程学建议并进行家庭锻炼。在治疗前、治疗后以及6个月随访时进行测量。
两组之间未发现重要的基线差异。与对照组相比，实验组在治疗后疼痛和干预6个月后功能障碍方面均有统计学显著降低。
随机分组并未导致完全同质的组。还注意到，仅要求GPR组的参与者在每次治疗结束时将治疗期间练习的动作融入日常生活中所花费的时间，这可能对患者的依从性产生了影响，从而促成了更好的结果。
结果表明，对于慢性非特异性NP患者，GPR在治疗后减轻疼痛以及6个月随访时减轻功能障碍方面比MT更有效。
