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Global postural re-education improves pain, function

Tristan Manalac
20 May 2017
Reducing back pain starts with emptying your bag

Global postural re-education (GPR) can moderately improve pain and function in spinal disorders especially when performed during intermediate follow-ups instead of immediately after initial treatment, a new meta-analysis reports.

Randomized controlled trials (RCT) or controlled clinical trials (CCT) that compared GPR with sham treatments, no treatments or other therapies were searched from the databases of PEDro, Scopus and Medline. Only those that evaluated function and pain relief in patients with spinal disorders were included.

Treatments used in the controls, duration of sessions and overall treatment and outcome measures were among the variables extracted from the studies. Risk of bias of the studies was determined using The Cochrane Collaboration Tool, and a sensitivity analysis was performed to determine heterogeneity at the different levels of methodological quality.

After applying the selection criteria, only 11 studies were eligible for inclusion. Of these, four were CCTs and seven were RCTs. Low back pain (LBP) were evaluated in four studies, neck pain (NP) in four and ankylosing spondylitis (AS) in three. Pain and function were evaluated in 10 and six studies, respectively. [Am J Phys Med Rehabil 2017;96:124–130]

High risk of bias was detected in only two studies. However, blinding to outcome measurement and concealment of the randomization sequence were the most common roadblocks to high methodological quality.

Eleven independent comparisons, across 10 studies (six RCTs, four CCTs), were reported for pain, as measured by the visual analogue and the numeric rating scales. Of these, significant differences were reported in only six comparisons.

Overall, the studies showed a moderate effect of GPR on pain (standardized mean difference [SMD], -0.63; 95 percent CI, -0.83 to -0.43; p=0.000). A sensitivity analysis was performed due to the lack of information on blinding.

The subgroup with blinding (SMD, -0.67; -0.95 to -0.39) and without information on blinding (SMD, -0.59; -0.87 to -0.31) both showed a moderate benefit of GPR on pain. Similarly, the RCT (SMD, -0.55; -0.82 to -0.28) and CCT (SMD, -0.72; -1.02 to -0.43) subgroups were consistent with this trend.

Interestingly, GPR was slightly better during follow-ups and for patients with AS compared with those who received GPR immediately and those with other disease pathologies, respectively.

Function was reported in seven independent comparisons across six studies (three CCTs, three RCTs). Only four comparisons yielded statistically significant differences. The combined results of all comparisons showed a medium effect of GPR on function (SMD, -0.48; -0.72 to -0.25; p=0.000).

Subgroup analysis showed that RCTs (SMD, -0.41; -0.76 to -0.06), CCTs (SMD, -0.54; -0.85 to -0.23), those with blinding for outcome measurement (SMD, -0.44; -0.72 to -0.15) and those without reported information on blinding (SMD, -0.58; -0.98 to -0.18) all resulted in a medium beneficial effect of GPR on function.

The findings in this study corroborate those that have already been previously reported, the authors wrote. The benefit of exercise in AS and LBP patients, for instance, has already been reported in several reviews and meta-analyses. [Clin Rehabil 2015;29:1155–67; Clin Rheumatol 2015;34:1737–44]

Moreover, that the impact of GPR, along with other interventions, is more effective in the long-term has already been reported in a previous meta-analysis. [Cochrane Database Syst Rev 2015;1:CD004250]

“Global postural re-education may be a safe method of treatment. Some of the most demanding exercises used in GPR (sedestation) may increase cardiovascular demand. However, this response may decrease to baseline values within 5 minutes after completing the exercises. In addition, the studies included in this review reported no adverse effects of GPR,” the investigators said.

Despite the high methodological quality and lack of heterogeneity among the studies, the present meta-analysis does have its limitations. Among these is the overall lack of studies that focus on the effects of GPR on pain and function, especially on other spinal disorders like spondylolisthesis and disk herniation.

“It may be advisable therefore to test the effect of GPR on these other conditions in which nonexperimental studies may show promising findings,” they recommended.

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20 Jul 2017
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