Marcos-Martín Fernando, González-Ferrero Luis, Martín-Alcocer Noelia, Paris-Alemany Alba, La Touche Roy
a Departamento de Fisioterapia , Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid , Aravaca , Madrid , Spain.
b Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle , Universidad Autónoma de Madrid , Aravaca , Madrid , Spain.
Physiother Theory Pract. 2018 Sep;34(9):671-681. doi: 10.1080/09593985.2017.1423522. Epub 2018 Jan 17.
The purpose of this prospective case series was to observe and describe changes in patients with chronic cervico-craniofacial pain of muscular origin treated with multimodal physiotherapy based on a biobehavioral approach. Nine patients diagnosed with chronic myofascial temporomandibular disorder and neck pain were treated with 6 sessions over the course of 2 weeks including: (1) orthopedic manual physiotherapy (joint mobilizations, neurodynamic mobilization, and dynamic soft tissue mobilizations); (2) therapeutic exercises (motor control and muscular endurance exercises); and (3) patient education. The outcome measures of craniofacial (CF-PDI) and neck disability (NDI), kinesiophobia (TSK-11) and catastrophizing (PCS), and range of cervical and mandibular motion (ROM) and posture were collected at baseline, and at 2 and 14 weeks post-baseline. Compared to baseline, statistically significant (p < 0.01) and clinically meaningful improvements that surpassed the minimal detectable change were observed at 14 weeks in CF-PDI (mean change, 8.11 points; 95% confidence interval (CI): 2.55 to 13.69; d = 1.38), in NDI (mean change, 5 cm; 95% CI: 1.74-8.25; d = 0.98), and in the TSK-11 (mean change, 6.55 cm; 95% CI: 2.79-10.32; d = 1.44). Clinically meaningful improvements in self-reported disability, psychological factors, ROM, and craniocervical posture were observed following a multimodal physiotherapy treatment based on a biobehavioral approach.
本前瞻性病例系列研究的目的是观察和描述采用基于生物行为方法的多模式物理治疗对肌肉源性慢性颈颅面部疼痛患者的治疗效果。9例被诊断为慢性肌筋膜性颞下颌关节紊乱和颈部疼痛的患者在2周内接受了6次治疗，包括：（1）骨科手法物理治疗（关节松动术、神经动力学松动术和动态软组织松动术）；（2）治疗性锻炼（运动控制和肌肉耐力锻炼）；以及（3）患者教育。在基线时、基线后2周和14周收集颅面部疼痛和功能障碍指数（CF-PDI）、颈部功能障碍指数（NDI）、运动恐惧（TSK-11）和灾难化思维（PCS）、颈椎和下颌运动范围（ROM）以及姿势等结局指标。与基线相比，在14周时CF-PDI（平均变化8.11分；95%置信区间（CI）：2.55至13.69；d=1.38）、NDI（平均变化5cm；95%CI：1.74 - 8.25；d=0.98）和TSK-11（平均变化6.55cm；95%CI：2.79 - 10.32；d=1.44）均观察到具有统计学意义（p<0.01）且具有临床意义的改善，超过了最小可检测变化。采用基于生物行为方法的多模式物理治疗后，患者在自我报告的功能障碍、心理因素、ROM和颅颈姿势方面均出现了具有临床意义的改善。
