Effectiveness of a Global Posture Reeducation Program for patients with Low Back Pain

Francesca Bonetti1, Mirella Curti2, Stefania Curti1, Claudia Ferrari3, Stefano Mattioli1, Raffaele Mugnai1, Cristina Pasanisi4, Carla Vanti1, Paolo Pillastrini1

1Section 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

AcknowledgementsMedical Ethics Committee of the Azienda Ospedaliero-Universitaria di Bologna Policlinico S.Orsola-Malpighi (Bologna). Sp.clin. n° 57/2008/USper - Clinical Trials Registration: NCT00789204

Presented at World Physical Therapy 2011, Amsterdam June 2011

ReferencesBonetti 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 non-randomized controlled trial. BMC Musculoskelet Disord. 2010 Dec 16;11:285.

Participants100 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.

IntroductionApproximately 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.

MethodsOutcome 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.

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ResultsOf 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.

Discussion & ConclusionsOur 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.

RecommendationsWhen 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.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 follow-up (ie. 3 and 6 months).

Contact detailsProf. Paolo Pillastrini, UO Medicina del Lavoro, Policlinico S.Orsola-Malpighi, via Palagi 9, I-40138 Bologna (Italy) Email: paolo.pillastrini@unibo.it

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.

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.

Figure 2. Flow-chart of participants through the trial. GPR Group: Global Posture Reeducation Group. ST Group: Standard Physical Therapy Treatment

MethodsA 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.