Effectiveness of a 'Global Postural Reeducation' program for persistent low back pain: a non-randomized controlled trial

Francesca Bonetti, Stefania Curti, Stefano Mattioli, Raffaele Mugnai, Carla Vanti, Francesco S Violante, Paolo Pillastrini, Francesca Bonetti, Stefania Curti, Stefano Mattioli, Raffaele Mugnai, Carla Vanti, Francesco S Violante, Paolo Pillastrini

Abstract

Background: The aim of this non-randomized controlled trial was to evaluate the effectiveness of a Global Postural Reeducation (GPR) program as compared to a Stabilization Exercise (SE) program in subjects with persistent low back pain (LBP) at short- and mid-term follow-up (ie. 3 and 6 months).

Methods: According to inclusion and exclusion criteria, 100 patients with a primary complaint of persistent LBP were enrolled in the study: 50 were allocated to the GPR group and 50 to the SE group. Primary outcome measures were Roland and Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI). Secondary outcome measures were lumbar Visual Analogue Scale (VAS) and Fingertip-to-floor test (FFT). Data were collected at baseline and at 3/6 months by health care professionals unaware of the study. An intention to treat approach was used to analyze participants according to the group to which they were originally assigned.

Results: Of the 100 patients initially included in the study, 78 patients completed the study: 42 in the GPR group and 36 in the SE group. At baseline, the two groups did not differ significantly with respect to gender, age, BMI and outcome measures. Comparing the differences between groups at short- and mid-term follow-up, the GPR group revealed a significant reduction (from baseline) in all outcome measures with respect to the SE group.The ordered logistic regression model showed an increased likelihood of definitive improvement (reduction from baseline of at least 30% in RMDQ and VAS scores) for the GPR group compared to the SE group (OR 3.9, 95% CI 2.7 to 5.7).

Conclusions: Our findings suggest that a GPR intervention in subjects with persistent LBP induces a greater improvement on pain and disability as compared to a SE program. These results must be confirmed by further studies with higher methodological standards, including randomization, larger sample size, longer follow-up and subgrouping of the LBP subjects.

Trial registration: NCT00789204.

Figures

Figure 1
Figure 1
Positions. Lying posture with legs extension progression: anterior muscle chain stretching.
Figure 2
Figure 2
Positions. Lying posture with hip joints flexion progression: posterior muscle chain stretching.
Figure 3
Figure 3
Positions. Standing posture with trunk flexion progression: posterior muscle chain loading stretching.
Figure 4
Figure 4
Flow-chart of participants through the trial. GPR Group: Global Postural Reeducation Group. SE Group: Stabilization Exercise Group.
Figure 5
Figure 5
Distribution of definitely improved, possibly improved and not improved subjects in the GPR and SE group. Definitely improved: reduction of at least 30% on RMDQ and VAS scores from baseline. Possibly improved: reduction of at least 30% on RMDQ score from baseline.

References

    1. Liddle SD, Baxter GD, Gracey JH. Exercise and chronic low back pain: what works? Pain. 2004;107(1-2):176–90. doi: 10.1016/j.pain.2003.10.017.
    1. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G. COST B13 Working Group on Guidelines for Chronic Low Back Pain. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15(Suppl 2):S192–300. doi: 10.1007/s00586-006-1072-1.
    1. Merskey H, Bogduk N. Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definition of Pain Terms. 2. Seattle: IASP Press; 1994.
    1. Andersson HI. The epidemiology of chronic pain in a Swedish rural area. Qual Life Res. 1994;3(Suppl 1):S19–26. doi: 10.1007/BF00433371.
    1. Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J. 2008;8(1):8–20. doi: 10.1016/j.spinee.2007.10.005.
    1. Henchoz Y, Kai-Lik So A. Exercise and nonspecific low back pain: a literature review. Joint Bone Spine. 2008;75(5):533–9. doi: 10.1016/j.jbspin.2008.03.003.
    1. Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ. 2006;332(7555):1430–4. doi: 10.1136/bmj.332.7555.1430.
    1. Hayden JA, Dunn KM, van der Windt DA, Shaw WS. What is the prognosis of back pain? Best Pract Res Clin Rheumatol. 2010;24(2):167–79. doi: 10.1016/j.berh.2009.12.005.
    1. Hides JA, Jull GA, Richardson CA. Long-term effects of specific stabilizing exercises for first-episode low-back pain. Spine. 2001;26:E243–8. doi: 10.1097/00007632-200106010-00004.
    1. Bergmark A. Stability of the lumbar spine: a study in mechanical engineering. Acta Ortop Scand. 1989;230(69):20–24.
    1. Ferreira PH, Ferreira ML, Maher CG, Herbert RD, Refshauge K. Specific stabilisation exercise for spinal and pelvic pain: a systematic review. Aust J Physiother. 2006;52(2):79–88.
    1. Costa LO, Maher CG, Latimer J, Hodges PW, Herbert RD, Refshauge KM, McAuley JH, Jennings MD. Motor control exercise for chronic low back pain: a randomized placebo-controlled trial. Phys Ther. 2009;89(12):1275–86. doi: 10.2522/ptj.20090218.
    1. Ferreira ML, Ferreira PH, Latimer J, Herbert RD, Hodges PW, Jennings MD, Maher CG, Refshauge KM. Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain: a randomized trial. Pain. 2007;131:31–37. doi: 10.1016/j.pain.2006.12.008.
    1. Kumar S, Sharma VP, Negi MP. Efficacy of dynamic muscular stabilization techniques (DMST) over conventional techniques in rehabilitation of chronic low back pain. J Strength Cond Res. 2009;23(9):2651–9. doi: 10.1519/JSC.0b013e3181b3dde0.
    1. Neto J, Pastre CM, Monteiro HL. Postural alterations in male Brazilian athletes who have participated in international muscular power competitions. Rev Bras Med Esporte. 2004;10(3):199–201.
    1. Souchard P-E, Meli O, Sgamma D, Pillastrini P. Rieducazione posturale globale. EMC (Elsevier Masson SAS, Paris), Medicina Riabilitativa, 26-061-A-15; 2009.
    1. Zuil Escobar JC, Rodriguez Fernandez AL, Martinez Cepa CB, Lopez Andrino J. Study of the relation between playing football and muscle shortening. Fisioterapia. 2004;26(6):340–8.
    1. Vanti C, Generali A, Ferrari S, Nava T, Tosarelli D, Pillastrini P. Rééducation Posturale Globale in musculoskeletal diseases: scientific evidence and clinical practice. Reumatismo. 2007;59(3):192–201.
    1. Fernandez-de-las-Peñas C, Alonso-Blanco C, Morales-Cabezas M, Miangolarra JC-Page. Two exercise interventions for the management of patients with ankylosing spondylitis: a randomized controlled trial. Am J Phys Med Rehabil. 2005;84(6):407–19.
    1. Fernandez-de-Las-Peñas C, Alonso-Blanco C, Alguacil-Diego IM, Miangolarra-Page JC. One-year follow-up of two exercise interventions for the management of patients with ankylosing spondylitis: a randomized controlled trial. Am J Phys Med Rehabil. 2006;85(7):559–67.
    1. Apuzzo D, Franzini M, Di Lucente L, Gioia MC, Cerasa A, Sabatini U. Combined effect of O2/O3 and GPR in treatment of lumbar disc herniation: anatomical, clinical and patient-self-report evaluation. Eur J Clin Invest. 2003;33(Suppl 1):46.
    1. Marques AP, Mendonca LLF, Cossermelli W. Muscular stretching exercises in patients with fibromyalgia from a training of Postural Global Reeducation (PGR) Rev Bras Reumatol. 1994;34(5):232–4.
    1. Cabral CMN, Yumi C, Sacco ICN, Casarotto RA, Marques AP. Eficácia de duas técnicas de alongamento muscular no tratamento da síndrome femoropatelar: um estudo comparativo. Fisioter Pesq. 2007;14:48–56.
    1. Fozzatti MCM, Palma P, Herrmann V, Dambros M. Impacto da reeducação postural global no trattamento da incontinência urinária de esforço feminina. Rev Assoc Med Bras. 2008;54(1):17–22. doi: 10.1590/S0104-42302008000100015.
    1. Cunha AC, Burke TN, França FJ, Marques AP. Effect of global posture reeducation and of static stretching on pain, range of motion, and quality of life in women with chronic neck pain: a randomized clinical trial. Clinics. 2008;63(6):763–70. doi: 10.1590/S1807-59322008000600010.
    1. Durmus D, Alayli G, Uzun O, Tander B, Cantürk F, Bek Y, Erkan L. Effects of two exercise interventions on pulmonary functions in the patients with ankylosing spondylitis. Joint Bone Spine. 2009;76:150–155. doi: 10.1016/j.jbspin.2008.06.013.
    1. Moreno MA, Catai AM, Teodori RM, Borges BL, Cesar Mde C, da Silva E. Effect of a muscle stretching program using the Global Postural Reeducation method on respiratory muscle strength and thoracoabdominal mobility of sedentary young males. J Bras Pneumol. 2007;33(6):679–86. doi: 10.1590/S1806-37132007000600011.
    1. Padua R, Padua L, Ceccarelli E, Romanini E, Zanoli G, Bondì R, Campi A. Italian version of the Roland Disability Questionnaire, specific for low back pain: crosscultural adaptation and validation. Eur Spine J. 2002;11:26–9. doi: 10.1007/s005860100262.
    1. Roland M, Morris R. A study of the natural history of back pain, part I: development of a reliable and sensitive measure of disability in low back pain. Spine. 1983;8:141–4. doi: 10.1097/00007632-198303000-00004.
    1. Riddle DL, Stratford PW. Roland-Morris scale reliability. Phys Ther. 2002;82:512–7.
    1. Stratford PW, Binkley JM. A comparison study of the Back Pain Functional Scale and Roland Morris Questionnaire. North American Orthopaedic Rehabilitation Research Network. J Rheumatol. 2000;27:1928–36.
    1. Monticone M, Baiardi P, Ferrari S, Foti C, Mugnai R, Pillastrini P, Vanti C, Zanoli G. Development of the Italian version of the Oswestry Disability Index (ODI-I): A cross-cultural adaptation, reliability, and validity study. Spine. 2009;34(19):2090–5. doi: 10.1097/BRS.0b013e3181aa1e6b.
    1. Fairbank JC, Davies JB, O'Brien JP. The Oswestry Low Back Pain Disability Questionnaire. Physiotherapy. 1980;66:271–3.
    1. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine. 2000;25(22):2940–52. doi: 10.1097/00007632-200011150-00017.
    1. Huskisson EC. Measurement of pain. Lancet. 1974;2:1127–31. doi: 10.1016/S0140-6736(74)90884-8.
    1. Perret C, Poiraudeau S, Fermanian J, Colau MM, Benhamou MA, Revel M. Validity, Reliability, and Responsiveness of the Fingertip-to-Floor Test. Arch Phys Med Rehabil. 2001;82(11):1566–70. doi: 10.1053/apmr.2001.26064.
    1. Poiraudeau S, Rannou F, Revel M. Functional restoration programs for low back pain: asystematic review. Ann Readapt Med Phys. 2007;50:425–29.
    1. Ostelo RW, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, Bouter LM, de Vet HC. Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine. 2008;33(1):90–4. doi: 10.1097/BRS.0b013e31815e3a10.
    1. Shaughnessy M, Caulfield B. A pilot study to investigate the effect of lumbar stabilisation exercise training on functional ability and quality of life in patients with chronic low back pain. Int J Rehabil Res. 2004;27(4):297–301. doi: 10.1097/00004356-200412000-00007.
    1. Yang EJ, Park WB, Shin HU, Lim JY. The effect of back school integrated with core strengthening in patients with chronic low-back pain. Am J Phys Med Rehab. 2010;89(9):744–54. doi: 10.1097/PHM.0b013e3181e72239.
    1. Koumantakis GA, Watson PJ, Oldham JA. Trunk muscle stabilization training plus general exercise versus general exercise only: randomized controlled trial of patients with recurrent low back pain. Phys Ther. 2005;85(3):209–25.
    1. Hayden JA, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev. 2005;20(3):CD000335.
    1. Marshall PW, Murphy BA. Muscle activation changes after exercise rehabilitation for chronic low back pain. Arch Phys Med Rehabil. 2008;89(7):1305–13. doi: 10.1016/j.apmr.2007.11.051.
    1. Mayer JM, Haldeman S, Tricco AC, Dagenais S. Management of chronic low back pain in active individuals. Curr Sports Med Rep. 2010;9(1):60–6.
    1. Weiner SS, Nordin M. Prevention and management of chronic back pain. Best Pract Res Clin Rheumatol. 2010;24(2):267–79. doi: 10.1016/j.berh.2009.12.001.
    1. Jensen GM, Shepard KF, Hack LM. The novice versus the experienced clinician: insights into the work of the physical therapist. Phys Ther. 1990;70:314–323.
    1. Jensen GM, Shepard KF, Gwyer J, Hack LM. Attribute dimensions that distinguish master and novice physical therapy clinicians in orthopaedic settings. Phys Ther. 1992;72:711–722.
    1. Jensen GM, Gwyer J, Shepard KF, Hack LM. Expert practice in physical therapy. Phys Ther. 2000;80:28–52.
    1. Resnik L, Hart DL. Using clinical outcomes to identify expert physical therapists. Phys Ther. 2003;83:990–1002.
    1. Resnik L, Liu D, Mor V, Hart DL. Predictors of physical therapy clinic performance in the treatment of patients with low back pain syndromes. Phys Ther. 2008;88(9):989–1004. doi: 10.2522/ptj.20070110.
    1. Liddle SD, Baxter GD, Gracey JH. Chronic low back pain: patients' experiences, opinions and expectations for clinical management. Disabil Rehabil. 2007;29(24):1899–909. doi: 10.1080/09638280701189895.
    1. May S. Patients' attitudes and beliefs about back pain and its management after physiotherapy for low back pain. Physiother Res Int. 2007;12(3):126–35. doi: 10.1002/pri.367.
    1. Escolar-Reina P, Medina-Mirapeix F, Gascón-Cánovas JJ, Montilla-Herrador J, Jimeno-Serrano FJ, de Oliveira Sousa SL, del Baño-Aledo ME, Lomas-Vega R. How do care-provider and home exercise program characteristics affect patient adherence in chronic neck and back pain: a qualitative study. BMC Health Serv Res. 2010;10:60. doi: 10.1186/1472-6963-10-60.
    1. Medina-Mirapeix F, Escolar-Reina P, Gascón-Cánovas JJ, Montilla-Herrador J, Jimeno-Serrano FJ, Collins SM. Predictive factors of adherence to frequency and duration components in home exercise programs for neck and low back pain: an observational study. BMC Musculoskelet Disord. 2009;10:155. doi: 10.1186/1471-2474-10-155.

Source: PubMed

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