Simoni G, Bozzolan M, Bonnini S, Grassi A, Zucchini A, Mazzanti C, Oliva D, Caterino F, Gallo A, Da Roit M
Physiotherapist Freelance in Ferrara, Italy; School of Physiotherapy University of Ferrara, Italy.
Azienda Ospedaliero Universitaria S.Anna Ferrara, Italy; School of Physiotherapy University of Ferrara, Italy.
J Bodyw Mov Ther. 2021 Apr;26:481-491. doi: 10.1016/j.jbmt.2020.12.032. Epub 2021 Feb 16.
Literature concerning the effect of diaphragm treatment to reduce neck pain symptoms is scarce. Aim of this trial was to investigate the effects of diaphragm manual therapy associated with standard physiotherapy treatment on pain in patients with Chronic Neck Pain (CNP).
In a private practice clinic, subjects with CNP were randomly assigned to receive three 30-min treatment sessions of standard cervical physiotherapy and Diaphragm Manual Therapy (DMT) or Sham Diaphragm Technique (SDT). Participants and assessors were blinded to the assignment. Primary outcome was pain, secondary outcomes were cervical active range of motion, pain pressure threshold, disability and quality of life measured at baseline, before and after each session, at 3 and 6-months. Adverse events were monitored. A non-parametric multivariate approach (combined permutation test) was applied to assess the effect of the treatment on all the outcomes. An intention to treat analysis was performed.
Forty patients were randomly allocated to DMT and SDT groups. Combined permutation test showed a significant higher improvement in DMT group compared to SDT group (p-value = 0.0002). The between-group comparisons on single outcomes showed a statistically significant improvement only for pain pressure threshold on upper trapezius (adjusted p-value = 0.029). No adverse events related to the intervention were registered.
In patients with CNP, addition of diaphragm manual techniques to standard cervical treatment seems to give a better global outcome, but this improvement is of unclear clinical relevance; the primary outcome seems not to have a role. Further studies are needed to confirm and clarify these results.
Release Date: July 18, 2017 Registered in ClinicalTrial.gov database ID: NCT03223285A.
关于膈肌治疗对减轻颈部疼痛症状效果的文献较少。本试验的目的是研究膈肌手法治疗联合标准物理治疗对慢性颈部疼痛（CNP）患者疼痛的影响。
在一家私人诊所，患有CNP的受试者被随机分配接受三个30分钟的标准颈椎物理治疗和膈肌手法治疗（DMT）疗程，或假膈肌技术（SDT）。参与者和评估者对分组情况不知情。主要结局指标为疼痛，次要结局指标为颈椎主动活动范围、疼痛压力阈值、功能障碍及生活质量，分别在基线、每个疗程前后、3个月和6个月时进行测量。监测不良事件。采用非参数多变量方法（联合排列检验）评估治疗对所有结局指标的影响。进行意向性分析。
40名患者被随机分配至DMT组和SDT组。联合排列检验显示，与SDT组相比，DMT组有显著更高的改善（p值 = 0.0002）。组间单一结局指标比较显示，仅上斜方肌的疼痛压力阈值有统计学显著改善（校正p值 = 0.029）。未记录到与干预相关的不良事件。
对于CNP患者，在标准颈椎治疗中加入膈肌手法技术似乎能带来更好的整体效果，但这种改善的临床相关性尚不清楚；主要结局指标似乎未起作用。需要进一步研究来证实和阐明这些结果。
发布日期：2017年7月18日 在ClinicalTrial.gov数据库中注册，ID：NCT03223285A。
