Some conservative interventions are more effective than others for people with chronic non-specific neck pain: a systematic review and network meta-analysis.

QUESTION: Which is the most effective conservative intervention for patients with non-specific chronic neck pain (CNSNP)? DESIGN: A systematic review and network meta-analysis of randomised clinical trials. PARTICIPANTS: Adults with CNSNP of at least 3 months duration. INTERVENTIONS: All available pharmacological and non-pharmacological interventions. OUTCOME MEASURES: The primary outcomes were pain intensity and disability. The secondary outcome was adverse events. RESULTS: Overall, 119 RCTs (12,496 patients; 32 interventions) were included. Risk of bias was low in 50.4% of trials, unclear in 22.7% and high in 26.9%. Compared with inert treatment, a combination of active and/or passive multimodal non-pharmacological inventions (eg, exercise and manual therapy) were effective for pain on a 0-to-10 scale at 1 month (MD range 0.84 to 3.74) and at 3 to 6 months (MD range 1.06 to 1.49), and effective on disability on a 0-to-100 scale at 1 month (MD range 10.26 to 14.09) and 3 to 6 months (MD range 5.60 to 16.46). These effects ranged from possible to definite clinical relevance. Compared with inert treatment, anti-inflammatory drugs alone or in combination with another non-pharmacological treatment did not reduce pain at 1 month or 3 to 6 months. At 12 months, no superiority was found over inert treatment on both outcomes. Most mild adverse events were experienced following acupuncture/dry needling intervention. On average, the evidence varied from low to very low certainty. CONCLUSIONS: While multimodal non-pharmacological interventions may reduce pain and disability for up to 3 to 6 months of follow-up when compared with inert treatment, the evidence was very uncertain about their effects. Better quality and larger trials are needed to improve the certainty of evidence. REGISTRATION: PROSPERO CRD42019124501.

Posture and time spent using a smartphone are not correlated with neck pain and disability in young adults: A cross-sectional study.

PURPOSE: To determine the impact of smartphone use on neck impairment and functional limitation in university students. METHODS: A cross-sectional correlational study was conducted in a sample of students selected through convenience sampling between September 2016 and March 2017. The inclusion criteria were university students at the School of Medicine and Surgery, routine/daily use of mobile devices with advanced computing and connectivity capability built on an operating system, and aged 18-30 years. Participants completed questionnaires that measured general characteristics of smartphone use and demographic characteristics. Neck pain was assessed using a visual analogue pain score (VAS) and a pain drawing (PD); disability status was measured using the Neck Disability Index (NDI-I); and cervical postures while using the phone were captured using the Deluxe Cervical Range of Motion (CROM) device. RESULTS: A total of 238 volunteers were recruited (22.4 ± 2.2 years of age, 53.4% males), 35.9% of whom were overweight (>25 BMI). Regarding neck pain, 42.4% reported mild pain, 8.4% had moderate pain, and the remaining 49.2% had no pain. NDI-I and VAS were 3.8 ± 3.8 and 13.6 ± 18.4 mm, respectively. The pain categories did not influence the variables. No significant correlations were observed between the number of hours spent and posture (CROM) while using a smartphone and neck pain and NDI-I. CONCLUSION: While half of young medical students reported neck pain, the use of smartphones was not correlated with neck pain and disability. While we wait for future prospective studies, there is no reason to recommend a change in smartphone use habits among young adults in the meantime.

Vertical traction for lumbar radiculopathy: a systematic review.

BACKGROUND: Only low-quality evidence is currently available to support the effectiveness of different traction modalities in the treatment of lumbar radiculopathy (LR). Yet, traction is still very commonly used in clinical practice. Some authors have suggested that the subgroup of patients presenting signs and symptoms of nerve root compression and unresponsive to movements centralizing symptoms may benefit from lumbar traction. The aim of this study is to conduct a systematic review of randomized controlled trials (RCTs) on the effects of vertical traction (VT) on pain and activity limitation in patients affected by LR. METHODS: We searched the Cochrane Controlled Trials Register, PubMed, CINAHL, Scopus, ISI Web of Science and PEDro from their inception to March 31, 2019 to retrieve RCTs on adults with LR using VT to reduce pain and activity limitation. We considered only trials reporting complete data on outcomes. Two reviewers selected the studies, extracted the results, and performed the quality assessment using the Risk of Bias and GRADE tools. RESULTS: Three studies met the inclusion criteria. Meta-analysis was not possible due to the heterogeneity of the included studies. We found very low quality evidence for a large effect of VT added to bed rest when compared to bed rest alone (g = - 1.01; 95% CI = -2.00 to - 0.02). Similarly, VT added to medication may have a large effect on pain relief when compared to medication alone (g = - 1.13; 95% CI = -1.72 to - 0.54, low quality evidence). Effects of VT added to physical therapy on pain relief were very small when compared to physical therapy without VT (g = - 0.14; 95% CI = -1.03 to 0.76, low quality evidence). All reported effects concerned short-term effect up to 3 months post-intervention. CONCLUSIONS: With respect to short-term effects, VT may have a positive effect on pain relief if added to medication or bed rest. Long-term effects of VT are currently unknown. Future higher quality research is very likely to have an important impact on our confidence in the estimate of effect and may change these conclusions.

Effectiveness of Mechanical Traction for Lumbar Radiculopathy: A Systematic Review and Meta-Analysis.

OBJECTIVE: Lumbar radiculopathy (LR) is a pain syndrome caused by compression/irritation of the lumbar nerve root(s). Traction is a well-known and commonly used conservative treatment for LR, although its effectiveness is disputed. The purpose of this systematic review and meta-analysis of randomized controlled trials was to evaluate the effects of different types of traction added to or compared with conservative treatments on pain and disability. METHODS: Data were obtained from CENTRAL, PUBMED, CINAHL, Scopus, ISI Web of Science, and PEDro from their inception to April 2020. All randomized controlled trials on adults with LR, using mechanical traction, and without any restriction regarding publication time or language were considered. Two reviewers selected the studies, evaluated the quality assessment, and extracted the results. Meta-analysis used a random-effects model. Eight studies met the inclusion criteria, and 5 were meta-analyzed. RESULTS: Meta-analyses of results from low-quality studies indicated that supine mechanical traction added to physical therapist treatments had significant effects on pain (g = -0.58 [95% confidence interval = -0.87 to -0.29]) and disability (g = -0.78 [95% confidence interval = -1.45 to -0.11]). Analyses of results from high-quality studies of prone mechanical traction added to physical therapist intervention for pain and disability were not significant. These results were also evident at short-term follow-up (up to 3 months after intervention). CONCLUSION: The literature suggests that, for pain and disability in LR, there is short-term effectiveness of supine mechanical traction when added to physical therapist intervention. IMPACT: This systematic review may be relevant for clinical practice due to its external validity because the treatments and the outcome measures are very similar to those commonly used in a clinical context.

Evidence for managing chronic low back pain in primary care: a review of recommendations from high-quality clinical practice guidelines.

AIM: Chronic low back pain represents a major problem throughout the world which is increasing largely because of the aging world population. Clinical practice Guidelines can be powerful tools for promoting evidence-based practice, as they integrate research findings in order to support decision making. This study aimed to review recommendations for the management of Chronic low Back Pain in primary care based on high-quality recent and recently updated Clinical practice Guidelines. METHODS: CINHAL, PubMed, EMBASE, PEDro, Google Scholar, Government websites, Scientific Association websites were searched until April 2019. The retrieved documents underwent several consecutive selection steps: semi-automated duplicate screening, documents selection based on title and abstract screening. Finally, three independent investigators screened the documents for the selected inclusion criteria and reviewed the retrieved documents by means of the AGREE II instrument. RESULTS: A total of 3055 records were retrieved, of which 10 Clinical practice Guidelines met the inclusion criteria. The overall quality of these Clinical practice Guidelines was moderately variable. The recommendations of four Clinical practice Guidelines deemed as "excellent" were extracted and summarized. Although we tried to implement the most comprehensive research strategies, some Clinical practice Guidelines may be missing due to publication bias or incomplete indexing. CONCLUSIONS: This study showed a partial progress in respect of the methodological quality of the Clinical practice Guidelines. Several AGREE II domains demonstrated low scores, particularly the "applicability" and "monitoring and auditing criteria" are the domains most susceptible to amendments in future.Implications for rehabilitationClinicians should be aware that among recently published/updated clinical practice guidelines for the management of chronic low back pain in primary care only few were deemed to have high quality.Increasing evidence suggests the efficacy for self-management to improve low back pain outcome.Physical treatments are recommended in order to improve low back pain outcome while many physical modalities such as TENS, ultrasound, laser therapy are not.Psychological treatments are recommended and should be included as part of a broader treatment plan.

Effect of therapeutic exercise routine on pain, disability, posture, and health status in dentists with chronic neck pain: a randomized controlled trial.

PURPOSE: To investigate the effect of therapeutic exercise (TE) on pain, disability, posture, and health status in female dentists suffering from chronic neck pain (NP). METHODS: 48 female dentists (40-45 years) suffering from NP were randomly divided into two experimental (n = 24) and control (n = 24) groups. Experimental group received 8 weeks of TE aimed to improve (1) muscle coordination and proprioception, (2) muscular endurance, and (3) muscle strength. Control group received no specific exercises. The pain, disability, posture (forward head and protracted shoulder angles), and health status were assessed at baseline and after an 8-week TE by visual analogue scale (VAS), neck disability index (NDI), photogrammetry, and self-rated general health questionnaire, respectively. Wilcoxon and Mann-Whitney non-parametric tests were used for statistical analysis. RESULTS: There were significant between-group differences in neck pain [p = 0.003, 0.86 (0.09-1.65)], disability [p = 0.009, ES (95% CI) = 0.78 (0.020-1.37)], forward head angle [p = 0.039, ES (95% CI) = 0.61 (0.034-1.19)], protracted shoulder angle [p = 0.031, ES (95% CI) = 0.64 (0.062-1.22)], and health status [p = 0.022, ES (95% CI) = 0.68 (0.102-1.26)] favoring the corrective exercise group. There were significant within-group changes in pain, disability, posture, and health status in the experimental group. However, there were no within group changes in the control group. CONCLUSIONS: TEs successfully alleviated pain, disability, posture, and health status in female dentists suffering from chronic NP. Considering the extremely large effect size of TEs, this intervention was recommended to neck pain treatment in patients suffering from chronic NP, poor posture, and health problem.

Comparative effectiveness of conservative and pharmacological interventions for chronic non-specific neck pain: Protocol of a systematic review and network meta-analysis.

BACKGROUND: Neck Pain (NP) has been ranked as one of the top chronic pain conditions in terms of prevalence and years lived with disability in the latest Global Burden of Disease. NP has remarkable socio-economic consequences however, research efforts are limited. Discrepancies among guidelines recommendations on management of chronic neck pain exist. The purpose of this study protocol is to provide the methods for a review with network meta-analysis to identify the most effective interventions for chronic neck pain. METHODS: The following databases will be searched from their inception to February 2019: Cochrane Controlled Trials Register (CENTRAL), PubMed, CINAHL, Scopus, ISI Web of Science and PEDro.Randomized controlled trials (RCTs) on pharmacological and not pharmacological interventions will be included and their risk of bias will be evaluated using the Cochrane Risk of bias tool. Primary outcomes will be reduction in pain and disability. A network meta-analysis will be carried out and pairwise meta-analysis will be conducted using Stata 15 software. Grading of recommendations assessment, development, and evaluation (GRADE) will be applied to assess quality of the body of the evidence. RESULTS: The results of this review will be submitted to a peer-review journal for publication. CONCLUSION: This network meta-analysis will provide a comprehensive review on the most effective treatments for the management of chronic neck pain providing key evidence-based information to patients, clinicians and other relevant stakeholders. Registration: PROSPERO (registration number CRD42019124501).

Efficacy of Abdominal Control Feedback and Scapula Stabilization Exercises in Participants With Forward Head, Round Shoulder Postures and Neck Movement Impairment.

BACKGROUND: Signs and symptoms of impaired function of the musculoskeletal system may be targeted by treating dysfunction located elsewhere. HYPOTHESIS: Abdominal control feedback and scapular stabilization exercise interventions would result in positive changes in pain intensity, strength, electromyography, and flexion-relaxation phenomena in women with forward head and round shoulder postures and neck movement impairment. STUDY DESIGN: Pretest-posttest intervention. LEVEL OF EVIDENCE: Level 1. METHODS: A total of 135 women (aged 27.23 ± 1.9 years) with forward head and round shoulder postures were randomized to 3 groups. Group 1 received 6-week scapular stabilization exercises with abdominal control feedback (n = 45), group 2 received 6-week scapular stabilization exercises without abdominal control feedback (n = 45), and group 3 received active self-exercise as a control group (n = 45). Posture, pain, proprioception, strength, and electromyography were assessed before and after the interventions. RESULTS: There were significant between-group differences in pain, proprioception, strength, and electromyography favoring group 1. There were significant within-group changes in posture, pain, proprioception, strength, and electromyography in both groups 1 and 2. No significant change was observed for muscle strength. CONCLUSION: The addition of abdominal control feedback to the scapular stabilization exercises was shown to be superior to the scapular stabilization exercises alone for decreasing neck pain and restoring proper proprioception, strength, and electromyography in females with forward head and round shoulder postures and neck movement impairment. CLINICAL RELEVANCE: The addition of abdominal control feedback to scapular stabilization exercises is superior to scapular stabilization exercises alone on the neck for improving electromyography, strength, and function in females with forward head and round shoulder postures and neck movement impairment.

The effectiveness of walking versus exercise on pain and function in chronic low back pain: a systematic review and meta-analysis of randomized trials.

OBJECTIVE: Walking is commonly recommended to relieve pain and improve function in chronic low back pain. The purpose of this study was to conduct a systematic review and meta-analysis of randomized controlled trials concerning the effectiveness of walking interventions compared to other physical exercise on pain, disability, quality of life and fear-avoidance, in chronic low back pain. METHODS: Randomized controlled trials investigating the effects of walking alone compared to exercise and to exercise with added walking on adults with chronic low back pain were identified using the MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), Cochrane Central Register of Controlled Trials (CENTRAL), PsychINFO, and SPORT DiscusTM databases. Two reviewers independently selected the studies and extracted the results. Study quality was assessed using the PEDro scale and the clinical relevance of each outcome measure was evaluated. RESULTS: Meta-analysis of five randomized controlled trials meeting inclusion criteria was performed. The effectiveness of walking and exercise at short-, mid-, and long-term follow-ups appeared statistically similar. Adding walking to exercise did not induce any further statistical improvement, at short-term. CONCLUSIONS: Pain, disability, quality of life and fear-avoidance similarly improve by walking or exercise in chronic low back pain. Walking may be considered as an alternative to other physical activity. Further studies with larger samples, different walking dosages, and different walking types should be conducted. Implications for Rehabilitation Walking is commonly recommended as an activity in chronic low back pain. Pain, disability, and fear-avoidance similarly improve by walking or exercise. Adding walking to exercise does not induce greater improvement in the short-term. Walking may be a less-expensive alternative to physical exercise in chronic low back pain.

Is Propionibacterium acnes related to disc degeneration in adults? A systematic review.

BACKGROUND: The aim of this paper was to systematically review the evidence linking Propionibacterium acnes (P. acnes) with the development of symptomatic degenerative disc disease. EVIDENCE ACQUISITION: Data were obtained from MEDLINE from their inception to October 2015. Two authors independently conducted the searches, extracted data and completed methodological quality assessments. Articles were included if they investigated the presence of P. acnes in symptomatic degenerative disc disease through intra-operative cultural examination. The methodological quality of the studies was evaluated using the Newcastle-Ottawa Scale. EVIDENCE SYNTHESIS: Overall 641 articles were retrieved with 9 cross-sectional studies being included in the review. All selected studies revealed an association between P. acnes and disc degeneration. CONCLUSIONS: This study shows that there is a relationship between P. acnes and development of symptomatic degenerative disc disease. Despite this, we cannot support that P. acnes and development of symptomatic degenerative disc disease due to the low quality of the results according Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Return to work in European Cancer survivors: a systematic review.

PURPOSE: Return to work (RTW) of cancer survivors (CSs) fluctuates in different contexts. This systematic review searched for recent data on the RTW rate of CSs in Europe, investigating associated factors. METHODS: Bibliographic search covered the period from January 2010 to February 2018, with no language restrictions. European population-based studies assessing RTW rate after cancer diagnosis were included. We excluded studies focusing on a specific cancer diagnosis. RESULTS: Twelve observational studies were selected. The cohorts investigated included 280 to 46,720 individuals from Northwestern and Central Europe diagnosed with cancer from 1987 to 2010. The median interval between diagnosis and documented RTW was 2 years (0.2-23.4 years). RTW rates of CSs ranged from 39 to 77%. RTW of individuals employed at the time of diagnosis ranged from 60 to 92%, the latter registered in a sample with good prognosis. Personal factors, work-related factors, and cancer-related factors were all associated with RTW. Healthcare team interventions facilitated reintegration to work. CONCLUSIONS: Data from Mediterranean and Central European countries are urgently needed to understand whether RTW is an issue for CSs there as well and whether socio-rehabilitative interventions are required to mitigate the potential negative impact of cancer on individuals and society.

Cervical Radiculopathy: Effectiveness of Adding Traction to Physical Therapy-A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: Cervical radiculopathy (CR) is a common cervical spine disorder. Cervical traction (CT) is a frequently recommended treatment for patients with CR. Purpose: The purpose of this study was to conduct a review and meta-analysis of randomized controlled trials (RCTs) on the effect of CT combined with other physical therapy procedures versus physical therapy procedures alone on pain and disability. Data Sources: Data were obtained from COCHRANE Controlled Trials Register, PubMed, CINAHL, Scopus, ISI Web of Science, and PEDro, from their inception to July 2016. Study Selection: All RCTs on symptomatic adults with CR, without any restriction regarding publication time or language, were considered. Data Extraction: Two reviewers selected the studies, conducted the quality assessment, and extracted the results. Meta-analysis employed a random-effects model. The evidence was assessed using GRADE criteria. Data Synthesis: Five studies met the inclusion criteria. Mechanical traction had a significant effect on pain at short- and intermediate-terms (g = -0.85 [95% CI = -1.63 to -0.06] and g = -1.17 [95% CI = -2.25 to -0.10], respectively) and significant effects on disability at intermediate term (g = -1.05; 95% CI = -1.81 to -0.28). Manual traction had significant effects on pain at short- term (g = -0.85; 95% CI = -1.39 to -0.30). Limitations: The most important limitation of the present work is the lack of homogeneity in CR diagnostic criteria among the included studies. Conclusions: In light of these results, the current literature lends some support to the use of the mechanical and manual traction for CR in addition to other physical therapy procedures for pain reduction, but yielding lesser effects on function/disability.

A surveillance system model for central line-associated bloodstream infections (CLABSI) coordinated at the regional level: a pilot feasibility study.

We describe the methods used to define a surveillance model to incorporate into activities aimed at preventing central line-associated bloodstream infections (CLABSI) in non-critical care units (NCCUs) and designed to be implemented at the regional level. In 2015 we conducted a pilot feasibility study in three NCCUs based in hospitals of the Regional Health System of Emilia Romagna to evaluate the feasibility of the proposed model and to test its accuracy and cost-effectiveness in terms of resources needed to maintain the system. Our results indicate that the system is feasible at the regional level by using the available sources and instruments to collect data in clinical practice context. Observation of device utilization for at least three months in all NCCU wards is needed in order to prioritize the medical area on which to focus costs for surveillance prior to implementing it on a regular basis.

Functional evaluation of breath: spirometry and body plethysmography comparison in people with cystic fibrosis.

[Purpose] The aim of the present study was to establish up-to-date data regarding the lung function of cystic fibrosis (CF) patients. [Subjects and Methods] Forty-eight patients of both genders, with a diagnosis of CF, were recruited. As a result our sample presented, according to the GOLD criteria, 23 patients with mild lung obstruction (FEV1%pred: 89.86), 16 patients with moderate lung obstruction (FEV1%pred: 56.1) and 9 patients with severe obstruction (FEV1%pred: 32.1). [Results] All patients presented normal total lung capacity followed by an important residual volume increase. [Conclusion] Our results were important to illustrate the CF patient's lung functional status and to improve the health system strategy in treating such individuals.

Minimal Clinically Important Difference of Grip and Pinch Strength in Women With Thumb Carpometacarpal Osteoarthritis When Compared to Healthy Subjects.

PURPOSE: The primary objective of this study was to compare grip and pinch strength between women with carpometacarpal (CMC) osteoarthritis (OA) between affected and unaffected sides of the body in patients or dominant and nondominant sides in healthy subjects. The secondary aim was to establish the cutoff value scores for the minimal clinically important difference (MCID) for grip strength, tip, and tripod pinch. DESIGN: A prospective case-control study. METHODS: One hundred ten women participated in the study. The CMC OA group consisted of 57 patients, and the control group consisted of 53 healthy subjects. Grip strength, tip, and tripod pinch were assessed bilaterally. The two-way analysis of variance (ANOVA) was conducted to determine the differences between sides of the body and between the groups. FINDINGS: The post hoc analysis indicated that the patients in the CMC OA group indicated statistically significant lower scores on the grip and pinch strength (all, p < .001). The MCID from baseline score in this patient population was 0.84 kg for grip, 0.33 kg for tip, and 0.35 kg for tripod pinch for the affected right arm and 1.12 kg for grip, 0.23 kg for tip, and 0.30 kg for tripod pinch for the unaffected left side. CONCLUSIONS: Women with CMC OA have significantly decreased grip strength, tip, and tripod pinch as compared to their healthy counterparts and may experience functional consequences because of this limitation. CLINICAL RELEVANCE: Our study established the MCID for grip and pinch strength for individuals with CMC OA and their healthy counterparts.

Is there a relationship between psychological stress or anxiety and chronic nonspecific neck-arm pain in adults? A systematic review and meta-analysis.

PURPOSE: To systematically review and analyze the research evidence linking stress or anxiety to chronic nonspecific neck-arm pain (NSNAP) in adults. SUBJECTS AND METHODS: Data were obtained from Pubmed, Scopus, PsycInfo, Web of Science, Physiotherapy Evidence Database (PEDro) and The Cochrane library database from their inception to July 2015. Two authors independently conducted the searches, extracted data, and completed methodological quality assessments. The methodological quality of the cohort and case-control studies was evaluated using the Newcastle-Ottawa scale, whilst the quality of the Randomized Controlled Trial (RCT) was evaluated using the PEDro scale. RESULTS: Twenty-eight studies involving 39,166 participants met the inclusion criteria. Four studies, including 5 pair-wise comparisons, were included in the meta-analysis: Three were cohort studies and 1 was a cross-sectional study. The meta-analysis outcome demonstrated a relationship between chronic NSNAP and psychological stress. The estimate odds ratio for all studies combined was 2.33 (95% CI, 1.04-5.18; p=0.039). A high heterogeneity of the findings appeared (Q=28.94, I2=86% p=0.00). CONCLUSION: This study shows that there is a strong relationship between stress and chronic NSNAP. Despite this finding, we cannot support that stress is a risk factor for chronic NSNAP due to the low quality of the results according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). It was not possible to make a quantitative analysis comparing the relationship between anxiety and chronic NSNAP. However, according to the qualitative analysis there is a strong relationship between anxiety and chronic NSNAP.

Validation of the Italian Version of the Haemophilia Activities List.

BACKGROUND: The aim of this study was to provide an Italian version of the Haemophilia Activities List (HAL) and check its reliability in Italian medical centers. METHODS: The Italian version of this assessment was administered to 80 patients (aged 18-65 years) affected by haemophilia A and B (moderate or severe). The validation was accomplished by comparing it to the revised and expanded Arthritis Impact Measurement Scales (AIMS2). RESULTS: The internal consistency of the Italian version of the HAL had statistically high results: Cronbach's α 0.957-0.579. The highest internal consistency was measured in the domains 'leg functionality' and in the overall points of the HAL questionnaire. The correlation between the AIMS2, which has been translated into Italian, and the version of the HAL questionnaire that we proposed, yielded good results for the following correlations: AIMS2 all and HAL overall (r = 0.64), AIMS2 physical function and HAL overall (r = 0.66), AIMS2 pain and HAL overall (r = 0.66). CONCLUSION: The Italian version of the HAL questionnaire presents both internal coherence and convergent validity. It can be used in addition to other functional tests to measure outcomes in moderate and severe haemophiliac diseases or to determine the quality of life as observed in the everyday life of patients.

Effectiveness of neuromuscular taping on painful hemiplegic shoulder: a randomised clinical trial.

PURPOSE: The purpose of this trial was to investigate changes in pain, the range of motion (ROM) and spasticity in people with painful hemiplegic shoulder (PHS) after the application of an upper limb neuromuscular taping (NMT). METHODS: We conducted a randomised clinical trial. The study included 32 people, 31% female (mean ± SD age: 66 ± 9 years), with PHS after stroke with pain at rest and during functional movements. The experimental group received the application of NMT and a standard physical therapy programme (SPTP), whereas the control group received SPTP. The groups received four 45-minute long sessions over four weeks. The VAS, ROM and spasticity were assessed before and after the intervention with follow-up at four weeks. RESULTS: The experimental group had a greater reduction in pain compared to the control group at the end of the intervention, as well as at one month after the intervention (p < 0.001; all the group differences were greater than 4.5 cm, which is greater than the minimal clinically important difference of 2.0 cm). The experimental group had a significantly higher (i.e. better) ROM, by 30.0°, than the control group in shoulder flexion (95% CI: 37.3-22.7) at 4 weeks and by 24.8° (95% CI: 32.1-17.6) at 8 weeks as well as in abduction by 30.6° (95% CI: 37.5-23.7) at 4 weeks and 25.1° (95% CI: 33.8-16.3) at 8 weeks. CONCLUSION: Our study demonstrates that NMT decreases pain and increases the ROM in subjects with shoulder pain after a stroke. Implications for Rehabilitation Painful hemiplegic shoulder is a frequent complication after stroke with negative impacts on functional activities and on quality of life of people, moreover restricts rehabilitation intervention. Neuromuscular taping is a technique introduced by David Blow for the treatment of neuromuscoloskeletal problems. This study shows the reduction of pain and the improvement of range of motion after the application of an upper limb neuromuscular taping. Rehabilitation professionals who are involved in the management of painful hemiplegic shoulder may like to consider the benefits that neuromuscular taping can produce on upper limb.