Effectiveness of a Global Posture Reeducation Program for patients
with Low Back Pain
Francesca
1Section
1
Bonetti ,
2
Curti ,
1
Curti ,
3
Ferrari ,
1
Mattioli ,
Mirella
Stefania
Claudia
Stefano
4
1
1
Cristina Pasanisi , Carla Vanti , Paolo Pillastrini
Raffaele
1
Mugnai ,
of Occupational Medicine, Department of Internal Medicine, Geriatrics and Nephrology, University of Bologna, Italy; 2Azienda Ospedaliera 'Complesso Ospedaliero San Giovanni
Addolorata', Rome, Italy; 3A.I.R.R.I. Centro Clodio, Rome, Italy; 4Casa di cura San Domenico, Rome, Italy
Introduction
Methods
Results
Discussion & Conclusions
Approximately 70-85% of individuals will
experience low back pain (LBP) during their
lifetime, and over 80% of them will report
recurrent episodes. The Global Posture
Reeducation (GPR) is a physiotherapy approach
which consists of balancing the miofascial
tension, probably responsible for articular
overloading. The method stretches the shortened
muscles using the creep property of viscoelastic
tissue and enhances contraction of the
antagonist muscles, thus avoiding postural
asymmetry. Although this method is widely
employed in countries where Romance
languages are spoken, few studies support its
theoretical basis and clinical effectiveness.
Outcome measures were captured at baseline
and at 3/6 months by a physical therapist blind to
group allocation. Both groups received a
treatment delivered by experienced physical
therapists. The number of sessions, the duration
of each session and the total amount of
treatment were identical. Moreover, both
treatments consisted of a one-to-one supervised
exercise program actively involving the patient.
An intention to treat approach was used to
analyze participants according to the group to
which they were originally assigned.
Of the 100 initial participants, 78 completed the
study: 42 in GPR and 36 in ST group. At
baseline, the two groups did not differ
significantly with respect to gender, age, BMI and
outcome measures. At 6th-month follow-up, when
examining differences from baseline, the GPR
group revealed a significant reduction of all
outcome measures with respect to ST Group.
Our findings point to the relevance of a GPR
intervention performed by a physical therapist in
improving pain, disability and flexibility as opposed
to a ST program, in patients with LBP. These results
must be confirmed by further studies with higher
methodological standards, including randomization,
larger sample size, long-term follow-up and initial
clinical assessment for subgrouping classification.
Recommendations
A)
When considering the clinical impact of our
research, we can state that the GPR program
produced a clinically meaningful improvement. In
fact, 48% of subjects in the GPR group obtained a
reduction of at least 30% in their RMDQ and VAS
scores, compared to the 12% in the ST group.
B)
References
Purpose
The aim of this study was to evaluate the
effectiveness of a GPR program in comparison
to a physical therapy Standard Treatment (ST) in
patients with LBP at short- and mid-term followup (ie. 3 and 6 months).
Figure 2. Flow-chart of participants through the trial. GPR
Group: Global Posture Reeducation Group. ST Group: Standard
Physical Therapy Treatment
Participants
100 consecutive patients with a primary
complaint of LBP were enrolled in the study: 50
were allocated to the GPR group and 50 to the
ST group.
Acknowledgements
C)
Medical Ethics Committee of the Azienda OspedalieroUniversitaria di Bologna Policlinico S.Orsola-Malpighi
(Bologna). Sp.clin. n° 57/2008/USper - Clinical Trials
Registration: NCT00789204
Methods
A non-randomized controlled study was
conducted between March 2008 and September
2009. Primary outcome measures were Roland
and Morris Disability Questionnaire and
Oswestry Disability Index. Secondary outcome
measures were lumbar Visual Analogical Scale
and Fingertip-to-Floor test.
Bonetti F, Curti S, Mattioli S, Mugnai R, Vanti C, Violante
FS, Pillastrini P. Effectiveness of a 'Global Postural
Reeducation' program for persistent low back pain: a nonrandomized controlled trial. BMC Musculoskelet Disord.
2010 Dec 16;11:285.
Presented at World Physical Therapy 2011, Amsterdam
June 2011
Figure 1. Positions. A) lying posture with legs extension
progression: anterior muscle chain stretching; B) lying posture with
hip joints flexion progression: posterior muscle chain stretching; C)
standing posture with trunk flexion progression: posterior muscle
chain loading stretching.
Contact details
Figure 3. Distribution of definitely improved, possibly improved
and not improved subjects in the GPR and ST 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.
Prof. Paolo Pillastrini, UO Medicina del Lavoro, Policlinico
S.Orsola-Malpighi, via Palagi 9, I-40138 Bologna (Italy)
Email: [email protected]