Diagnostic Accuracy of Ultrasound Imaging and Shear Wave Elastography to Discriminate Patients with Chronic Neck Pain from Asymptomatic Individuals.

OBJECTIVES: The aim of this study was to determine and compare the capability of several B-mode ultrasound (US) and shear wave elastography (SWE) metrics to differentiate subjects with chronic non-specific neck pain from asymptomatic subjects. METHODS: A diagnostic accuracy study recruiting a sample of patients with chronic neck pain and asymptomatic controls was conducted. Data collection included sociodemographic information (i.e., gender, age, height, weight and body mass index), clinical information (pain intensity assessed using the Visual Analogue Scale and pain-related disability using the Neck Disability Index) and B-mode ultrasound and shear wave elastography features of the cervical multifidus muscle (cross-sectional area, perimeter, mean echo intensity, fat infiltration, shear wave speed and Young's modulus). After analyzing between-group differences for left/right sides, cases and controls, and males and females, the area under the receiver operating characteristic (ROC) curve, the optimal cut-off point, the sensitivity, the specificity, the positive likelihood ratio (LR) and negative LR for each metric were calculated. A total of 316 individuals were recruited in this study (n = 174 cases with neck pain and n = 142 asymptomatic controls). RESULTS: No significant differences (p > 0.05) were found between cases and controls for most variables, except for fatty infiltration, which was significantly higher in chronic neck pain cases (p < 0.001). Gender differences were significant across all US and SWE metrics (all, p < 0.001 except p = 0.015 for fatty infiltrates). A slight asymmetry was observed between the left and right sides for area (p = 0.038). No significant interactions between group, gender and side (all metrics, p > 0.008) were identified. Fatty infiltration was the most effective discriminator, with a ROC value of 0.723, indicating acceptable discrimination. The optimal cut-off point for fatty infiltration was 25.77, with a moderate balance between sensitivity (59.8%) and specificity (20.5%). However, its positive likelihood ratio (LR) of 0.75 suggests limited usefulness in confirming the condition. CONCLUSIONS: Fatty infiltration was significantly higher in individuals with chronic idiopathic neck pain compared to those without symptoms, while other muscle metrics were similar between both groups. However, since fat infiltration had moderate diagnostic accuracy and the other metrics showed poor discriminatory power, US cannot be used solely to discriminate patients with idiopathic neck pain.

MyofAPPcial: Construct validity of a novel technological aid for improving clinical reasoning in the management of myofascial pain syndrome.

BACKGROUND: Physiotherapists encounter challenges in diagnosing myofascial trigger points (MTrPs), which are crucial for managing myofascial pain but difficult due to their complex referred pain patterns. We aimed to assess if an interactive software (MyofAPPcial) can enhance the ability of physical therapists specialized in musculoskeletal disorders (as clinicians and as researchers and educators) to identify referred pain patterns associated with specific MTrPs and to explore their opinion about incorporating this technology regularly into their professional setting. METHODS: After developing the app, a descriptive cross-sectional survey study was conducted. Participants were asked about their demographic characteristics, professional experience, two knowledge tests (first without and later with MyofAPPcial support) and the 18-item mHealth app usability questionnaire. RESULTS: Fifty-nine participants completed the survey (47.5% clinicians and 62.5% researchers/educators). Groups were comparable in terms of age, gender and professional experience (p > .05). However, clinicians coursed shorter specific MPS trainings (p = .007) and handle more cases a week (p < .001). In the first knowledge test, participants in both the groups were more accurate in identifying pain maps of highly prevalent MTrPs than those with a moderate or low prevalence (p < .001), with no differences between the groups for individual items (all, p > .05) nor the total score (p > .05). In the second knowledge test, perfect scores were obtained for all items in both the groups. Finally, MyofAPPcial scored high satisfaction and app usefulness, with no difference between clinicians and researchers/educators (except greater convenience of use for researchers/educators p = .02). CONCLUSIONS: MyofAPPcial enhances physiotherapists' ability to accurately identify MTrPs, with a good acceptation among clinicians and researchers/educators.

Educational, Exercise, and Occupational Therapy-Based Telerehabilitation Program Versus "Wait-and-See" for Improving Self-perceived Exertion in Patients With Post-COVID Fatigue and Dyspnea: A Randomized Clinical Trial.

OBJECTIVE: The aim of the study was to compare the effectiveness of a telerehabilitation exercise program versus "wait-and-see" on physical exertion, quality of life, dyspnea severity, heart rate, and oxygen saturation in patients with post-COVID fatigue and dyspnea. DESIGN: Sixty-four patients were enrolled in this randomized clinical trial. A telerehabilitation program based on patient education, physical activity, airway clearing, and breathing exercise interventions was conducted. Self-perceived physical exertion during daily living activities, dyspnea severity, health-related quality of life and physiological outcomes, and the 6-min walking test were assessed at baseline, after the program and at 1- and 3-mo follow-up periods. RESULTS: The experimental group experienced greater improvements in self-perceived physical exertion during daily living activities, dyspnea severity, health-related quality of life, and 6-min walking test (all, P < 0.001). In addition, patients undergoing the telerehabilitation program reported lower exertion scores at rest and after the 6-min walking test (both, P < 0.001). Between-group oxygen saturation differences were found at rest ( P < 0.001), but not after the 6-min walking test ( P = 0.024). Finally, significant between-group differences were found for heart rate after the 6-min walking test ( P < 0.001). CONCLUSIONS: Although both groups showed a significant improvement after 3 mos of follow-up, the group receiving the telerehabilitation program described a greater improvement compared with the group receiving no intervention.

Reliability of Panoramic Ultrasound in Assessing Rectus Femoris Size, Shape, and Brightness: An Inter-Examiner Study.

Extended field-of-view ultrasound (US) imaging, also known as panoramic US, represents a technical advance that allows for complete visualization of large musculoskeletal structures, which are often limited in conventional 2D US images. Currently, there is no evidence examining whether the experience of examiners influences muscle shape deformations that may arise during the glide of the transducer in panoramic US acquisition. As no studies using panoramic US have analyzed whether two examiners with differing levels of experience might obtain varying scores in size, shape, or brightness during the US assessment of the rectus femoris muscle, our aim was to analyze the inter-examiner reliability of panoramic US imaging acquisition in determining muscle size, shape, and brightness between two examiners. Additionally, we sought to investigate whether the examiners' experience plays a significant role in muscle deformations during imaging acquisition by assessing score differences. Shape (circularity, aspect ratio, and roundness), size (cross-sectional area and perimeter), and brightness (mean echo intensity) were analyzed in 39 volunteers. Intraclass correlation coefficients (ICCs), standard error of measurements (SEM), minimal detectable changes (MDC), and coefficient of absolute errors (CAE%) were calculated. All parameters evaluated showed no significant differences between the two examiners (p > 0.05). Panoramic US proved to be reliable, regardless of examiner experience, as no deformations were observed. Further research is needed to corroborate the validity of panoramic US by comparing this method with gold standard techniques.

The Added Value of Face-to-Face Supervision to a Therapeutic Exercise-Based App in the Management of Patients with Chronic Low Back Pain: A Randomized Clinical Trial.

Low back pain (LBP) is a significant global health challenge due to its high prevalence, and chronicity and recurrence rates, with projections suggesting an increase in the next years due to population growth and aging. The chronic and recurrent nature of LBP, responsible for a significant percentage of years lived with disability, underscores the need for effective management strategies, including self-management strategies advocated by current guidelines, to empower patients and potentially improve healthcare efficiency and clinical outcomes. Therefore, the aim of this study was to analyze the added value of face-to-face visits in patients with chronic LBP undergoing a self-management program based on therapeutic exercises on pain intensity, disability, quality of life and treatment adherence and satisfaction. A randomized clinical trial was conducted, allocating 49 patients into a experimental group with a mobile health (mHealth) app usage and face-to-face sessions and 49 patients into an active control group without face-to-face sessions. Pain intensity, disability and quality of life were assessed at baseline, 4 weeks postintervention and 12 weeks postintervention. Patients' satisfaction and adherence were assessed at the end of the study. The multivariate general model revealed no statistically significant time × group interaction for any outcome (p > 0.0068) but mental quality of life (p = 0.006). Within-group differences revealed significant improvements for all the clinical indicators (all, p < 0.001). Patients allocated to the experimental group reported greater satisfaction and adherence (both, p < 0.001) compared to the control group. The use of mHealth apps such as Healthy Back® as part of digital health initiatives may serve as a beneficial approach to enhance the management of LBP.

Immediate effects of percutaneous electrical nerve stimulation in patients with lateral elbow pain.

INTRODUCTION: Ultrasound guided-percutaneous electrical nerve stimulation appears to be effective in the treatment of chronic musculoskeletal pain. OBJECTIVE: To investigate the immediate effects of one session of percutaneous electrical nerve stimulation on the radial nerve in patients with lateral elbow pain. METHODS: A randomized clinical trial was conducted. Sixty patients with chronic lateral elbow pain were allocated into real-percutaneous electrical nerve stimulation (n = 30) or sham-percutaneous electrical nerve stimulation (n = 30) where the patients received one-single session of the real or sham percutaneous stimulation on the radial nerve, respectively. Pressure pain thresholds, pain intensity, pain-free grip strength, and the self-perceived improvement were evaluated after the intervention. RESULTS: Significant differences between groups for pain intensity (-11.55, 95% CI -21.79 to -1.30, p < .028), but not for pressure pain threshold or pain-free grip strength, were found. Patients receiving real-percutaneous stimulation had significant improvement in pain-free grip strength on the treated side. The proportion of individuals reporting moderate to large self-perceived improvement (≥4) was significantly higher (p = .026) after real-percutaneous stimulation than after sham-percutaneous stimulation. CONCLUSION: A single session of real-percutaneous electrical nerve stimulation targeting the radial nerve in subjects with lateral elbow pain decreased pain intensity between groups and increased pain-free grip strength on the treated side but not between groups.

Aerobic Exercise and Neuropathic Pain: Insights from Animal Models and Implications for Human Therapy.

This narrative review explores the complex relationship between aerobic exercise (AE) and neuropathic pain (NP), particularly focusing on peripheral neuropathies of mechanical origin. Pain, a multifaceted phenomenon, significantly impacts functionality and distress. The International Association for the Study of Pain's definition highlights pain's biopsychosocial nature, emphasizing the importance of patient articulation. Neuropathic pain, arising from various underlying processes, presents unique challenges in diagnosis and treatment. Our methodology involved a comprehensive literature search in the PubMed and SCOPUS databases, focusing on studies relating AE to NP, specifically in peripheral neuropathies caused by mechanical forces. The search yielded 28 articles and 1 book, primarily animal model studies, providing insights into the efficacy of AE in NP management. Results from animal models demonstrate that AE, particularly in forms like no-incline treadmill and swimming, effectively reduces mechanical allodynia and thermal hypersensitivity associated with NP. AE influences neurophysiological mechanisms underlying NP, modulating neurotrophins, cytokines, and glial cell activity. These findings suggest AE's potential in attenuating neurophysiological alterations in NP. However, human model studies are scarce, limiting the direct extrapolation of these findings to human neuropathic conditions. The few available studies indicate AE's potential benefits in peripheral NP, but a lack of specificity in these studies necessitates further research. In conclusion, while animal models show promising results regarding AE's role in mitigating NP symptoms and influencing underlying neurophysiological mechanisms, more human-centric research is required. This review underscores the need for targeted clinical trials to fully understand and harness AE's therapeutic potential in human neuropathic pain, especially of mechanical origin.

Psychometric Properties and Clinical Usefulness of the Spanish Version of the Toe Walking Tool.

BACKGROUND: The Toe Walking Tool (TWT) was developed in Australia as a valid and reliable screening tool for children who toe-walk. However, psychometric properties of the Spanish version of the TWT have not been studied. The aim of this study was to assess psychometric properties and clinical usefulness of the Spanish version of the TWT. METHODS: A cross-sectional study was conducted. Twelve children were assessed with the TWT. Intrarater and interrater reliability and agreement were calculated using the intraclass correlation coefficient (ICC) and the Fleiss kappa method for multiple raters. Internal consistency and construct validity were assessed with the Kuder-Richardson formula 20 coefficient and known-group methods, respectively. Sensitivity and specificity were analyzed using the receiver operating characteristic curve. The Content Validity Index was calculated to determine clinical usefulness. RESULTS: An excellent intrarater (ICC = 1) and interrater reliability (ICC = 0.8), moderate interrater agreement (Fleiss kappa, 0.6), strong internal consistency (Kuder-Richardson formula 20 coefficient, 0.86), and very good construct validity were found. Sensitivity and specificity results were appropriate (area under the curve, 0.845). The Content Validity Index was 0.906, suggesting high usefulness. CONCLUSIONS: The Spanish version of the TWT was found to be a valid, reliable and useful screening tool for children who toe-walk, providing evidence for its recommendation.

Electromyographic Activity of the Pelvic Floor Muscles and Internal Oblique Muscles in Women during Running with Traditional and Minimalist Shoes: A Cross-Over Clinical Trial.

The study aimed to investigate the effects of footwear on the electromyographic (EMG) activity of pelvic floor muscles (PFMs) and internal oblique (IO) muscles during running at different speeds. The study also aimed to explore the correlation between EMG activity of PFMs and IO muscles and participants' morphological characteristics. Ten nulliparous female runners were included in the study. The participants ran for 90 s at speeds of 9, 11, and 13 km/h wearing both traditional and minimalist shoes. EMG outcomes were presented as a percentage of maximum voluntary contraction (%MVC). Comparative analysis was conducted using the Wilcoxon rank test. Correlational analysis was performed using the Rho-Spearman correlation coefficient. The %MVC for the IO muscles was significantly lower when using minimalist shoes compared to traditional shoes (p = 0.04). No statistically significant differences were found for the PFMs (p > 0.05). The study also observed large correlations between age and %MVC of the PFMs and IO muscles (rho = -0.64; p = 0.04). Minimalist shoes decreased the activity of IO muscles in female runners. However, no significant differences in EMG activity of PFMs were found when comparing traditional and minimalist footwear. The long-term effects of minimalist footwear on EMG activity of PFMs and IO muscles, as well as their relationship to morphological characteristics, require further investigation.

Convergent Validity between Electromyographic Muscle Activity, Ultrasound Muscle Thickness and Dynamometric Force Measurement for Assessing Muscle.

Muscle fatigue is defined as a reversible decline in performance after intensive use, which largely recovers after a resting period. Surface electromyography (EMG), ultrasound imaging (US) and dynamometry are used to assess muscle activity, muscle morphology and isometric force capacity. This study aimed to assess the convergent validity between these three methods for assessing muscle fatigue during a manual prehension maximal voluntary isometric contraction (MVIC). A diagnostic accuracy study was conducted, enrolling 50 healthy participants for the measurement of simultaneous changes in muscle thickness, muscle activity and isometric force using EMG, US and a hand dynamometer, respectively, during a 15 s MVIC. An adjustment line and its variance (R2) were calculated. Muscle activity and thickness were comparable between genders (p > 0.05). However, men exhibited lower force holding capacity (p < 0.05). No side-to-side or dominance differences were found for any variable. Significant correlations were found for the EMG slope with US (r = 0.359; p < 0.01) and dynamometry (r = 0.305; p < 0.01) slopes and between dynamometry and US slopes (r = 0.227; p < 0.05). The sample of this study was characterized by comparable muscle activity and muscle thickness change between genders. In addition, fatigue slopes were not associated with demography or anthropometry. Our findings showed fair convergent associations between these methods, providing synergistic muscle fatigue information.

Effects of minimalist shoes on pelvic floor activity in nulliparous women during running at different velocities: a randomized cross-over clinical trial.

In the last decade, minimalist shoes have gained popularity as an alternative to traditional shoes. The aim of the present study was to determine the short-term effects of minimalist shoes in femur range of motion (ROM) and cadence. The secondary objectives were the assessment of the electromyographic activity of the pelvic floor muscles (PFM) in nulliparous women. A randomized, prospective cross-over clinical trial design was used for the study. A total of 51 participants were randomly allocated into a two-sequence crossover design (AB/BA crossover design). Femur ROM, cadence and PFM activity were recorded. The femur ROM at 6 km/h was greater with the minimalist shoes by 1.62 degrees than with the traditional ones (p = 0.001). There was a main effect of the type of shoe (p = 0.015) systematically observing a higher running cadence with the minimalist shoe compared to the traditional one. Electromyographic activity of the PFM revealed significant differences for 11 km/h for the total average (p = 0.027) and the minimum peaks at 9 km/h (p = 0.011) and 11 km/h (p = 0.048) for the minimalist shoe with respect to the traditional shoes. Minimalist shoes produce immediate effects on the biomechanical variables of running. An increase was observed in the femur ROM at 6 km/h and in the cadence at 11 km/h with the use of minimalist shoes. The use of minimalist shoes increased the electromyographic activation of the PFM in the minimum peaks at speeds of 9 and 11 km/h and in the total average at speeds of 11 km/h compared to the traditional shoe.

A tele-health primary care rehabilitation program improves self-perceived exertion in COVID-19 survivors experiencing Post-COVID fatigue and dyspnea: A quasi-experimental study.

BACKGROUND: Current evidence suggests that up to 70% of COVID-19 survivors develop post-COVID symptoms during the following months after infection. Fatigue and dyspnea seem to be the most prevalent post-COVID symptoms. OBJECTIVE: To analyze whether a tele-rehabilitation exercise program is able to improve self-perceived physical exertion in patients with post-COVID fatigue and dyspnea. METHODS: Sixty-eight COVID-19 survivors exhibiting post-COVID fatigue and dyspnea derived to four Primary Health Care centers located in Madrid were enrolled in this quasi-experimental study. A tele-rehabilitation program based on patient education, physical activity, airway clearing, and breathing exercise interventions was structured on eighteen sessions (3 sessions/week). Self-perceived physical exertion during daily living activities, dyspnea severity, health-related quality of life and distance walked and changes in oxygen saturation and heart rate during the 6-Minute walking test were assessed at baseline, after the program and at 1- and 3-months follow-up periods. RESULTS: Daily living activities, dyspnea severity and quality of life improved significantly at all follow-ups (p<0.001). Additionally, a significant increase in oxygen saturation before and after the 6-Minute Walking test was found when compared with baseline (P<0.001). Heart rate adaptations at rest were found during the follow-up periods (P = 0.012). Lower perceived exertion before and after the 6-Minute Walking test were also observed, even if larger distance were walked (P<0.001). CONCLUSION: Tele-rehabilitation programs could be an effective strategy to reduce post-COVID fatigue and dyspnea in COVID-19 survivors. In addition, it could also reduce the economic burden of acute COVID-19, reaching a greater number of patients and releasing Intensive Unit Care beds for prioritized patients with a severe disease. STUDY REGISTRATION: The international OSF Registry registration link is https://doi.org/10.17605/OSF.IO/T8SYB.

Translation and Validation of the Spanish Movement Imagery Questionnaire Revised Second Version (MIQ-RS).

BACKGROUND: Motor imagery, which emphasizes mental rehearsal of motor skills to improve function, is frequently used in clinical practice. Because of its increasing use, reliable and valid tools are necessary to evaluate motor imagery abilities. However, there are few questionnaires translated and validated into Spanish language. OBJECTIVE: To translate, transculturally adapt, and validate the Spanish version of the Movement Imagery Questionnaire-Revised Second Version (MIQ-RS). DESIGN: A single-center observational study. SETTING: University community. PARTICIPANTS: One hundred fifty-five healthy participants were recruited. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Spanish translation of the MIQ-RS and psychometric performances of the questionnaire were tested using concurrent-criterion and content validity, construct validity, internal consistency, and test-rest reliability. Internal consistency, concurrent-criterion validity, construct validity, and test-rest reliability were assessed with Cronbach´s alpha, Spearman´s correlation coefficient, confirmatory factor analysis, and intraclass correlation coefficient (ICC), respectively. RESULTS: Results showed satisfactory internal consistency (Cronbach α = 0.90), test-retest reliability (ICC for visual items = 0.844 and for kinesthetic items = 0.70) and content and criterion-concurrent validity (Spearman´s correlation coefficient for visual items, 0.60 and for kinesthetic items, 0.81) of the MIQ-RS Spanish version. The two-factor structure was supported by confirmatory factor analysis. Statistically significant gender differences were observed in mean kinesthetic motor imagery scores and in mean visual motor imagery scores according to sports practice. No significant differences for gender, age, and sports, musical, and dance practice were reported. CONCLUSIONS: The Spanish version of the MIQ-RS is a valid and reliable tool to assess motor imagery abilities in healthy young people.

Effects of Cervico-Mandibular Manual Therapy in Patients with Temporomandibular Pain Disorders and Associated Somatic Tinnitus: A Randomized Clinical Trial.

OBJECTIVE: This randomized clinical trial investigated the effects of adding cervico-mandibular manual therapies into an exercise and educational program on clinical outcomes in individuals with tinnitus associated with temporomandibular disorders (TMDs). METHODS: Sixty-one patients with tinnitus attributed to TMD were randomized into the physiotherapy and manual therapy group or physiotherapy alone group. All patients received six sessions of physiotherapy treatment including cranio-cervical and temporomandibular joint (TMJ) exercises, self-massage, and patient education for a period of one month. Patients allocated to the manual therapy group also received cervico-mandibular manual therapies targeting the TMJ and cervical and masticatory muscles. Primary outcomes included TMD pain intensity and tinnitus severity. Secondary outcomes included tinnitus-related handicap (Tinnitus Handicap Inventory [THI]), TMD-related disability (Craniofacial Pain and Disability Inventory [CF-PDI]), self-rated quality of life (12-item Short Form Health Survey [SF-12]), depressive symptoms (Beck Depression Inventory [BDI-II]), pressure pain thresholds (PPTs), and mandibular range of motion. Patients were assessed at baseline, one week, three months, and six months after intervention by a blinded assessor. RESULTS: The adjusted analyses showed better outcomes (all, P < 0.001) in the exercise/education plus manual therapy group (large effect sizes) for TMD pain (η 2 P = 0.153), tinnitus severity (η 2 P = 0.233), THI (η 2 P = 0.501), CF-PDI (η 2 P = 0.395), BDI-II (η 2 P = 0.194), PPTs (0.363 < η 2 P < 0.415), and range of motion (η 2 P = 0.350), but similar changes for the SF-12 (P = 0.622, η 2 P = 0.01) as the exercise/education alone group. CONCLUSIONS: This clinical trial found that application of cervico-mandibular manual therapies in combination with exercise and education resulted in better outcomes than application of exercise/education alone in individuals with tinnitus attributed to TMD.

Effectiveness of the Godelieve Denys-Struyf (GDS) method in people with low back pain: cluster randomized controlled trial.

BACKGROUND: The Godelieve Denys-Struyf method (GDS) is a motor learning intervention that may be applied in group or individualized sessions. OBJECTIVE: The study objective was to compare the effectiveness of routine physical therapy, group GDS (GDS-G) sessions, and group and individualized GDS (GDS-I) sessions. DESIGN: This was a cluster randomized controlled trial. SETTING: The study took place in 21 primary care physical therapy units ("clusters") of the Spanish National Health Service (SNHS). PARTICIPANTS: The participants were 461 people with subacute and chronic low back pain (LBP). INTERVENTION: Clusters were randomized into 3 groups. All participants received medical treatment and a 15-minute group education session on active management. Additional interventions were as follows: control (fifteen 40-minute sessions of transcutaneous electrical nerve stimulation, microwave treatment, and standardized exercises), GDS-G (eleven 50-minute group GDS sessions), and GDS-I (the same 11 sessions plus four 50-minute individualized GDS sessions). MEASUREMENTS: Primary outcomes at baseline and 2, 6, and 12 months later were LBP and pain referred down the leg (separate pain intensity numeric rating scales) and disability (Roland-Morris Questionnaire [RMQ]). Secondary outcomes were use of medication and self-reported health (mental and physical component summaries of the 12-Item Short-Form Health Survey [SF-12]). Separate linear mixed models for LBP, pain referred down the leg, and disability were developed to adjust for potential confounders. Randomization, outcome assessment, and data analyses were masked. RESULTS: At 12 months, disability improved 0.7 (95% confidence interval [CI]=-0.4, 1.8) RMQ point in the control group, 1.5 (95% CI=0.4, 2.7) RMQ points in the GDS-I group, and 2.2 (95% CI=1.2, 3.2) RMQ points in the GDS-G group. There were no differences in pain. LIMITATIONS: The amount of exercise was smaller in the control group, and GDS-I sessions were provided by junior physical therapists. CONCLUSIONS: The improvement in disability was slightly higher with group GDS sessions than with the program routinely used in clusters within the SNHS. Adding individualized GDS sessions eliminated this advantage. Further studies should compare the GDS with other types of exercise.

Effectiveness of the physical therapy Godelive Denys-Struyf method for nonspecific low back pain: primary care randomized control trial.

STUDY DESIGN: A simple blind, random controlled clinical trial. OBJECTIVE: To assess the effectiveness of physiotherapy treatment based on the muscular and articular chains Godelive Denys-Struyf (GDS) method for nonspecific low back pain (LBP) in primary care. SUMMARY OF BACKGROUND DATA: Despite a systematic review by the European COST ACTION B13 "Low back pain: guidelines for its management," there are still many unresolved questions regarding the effectiveness of the different physical therapy treatments used for LBP. SETTING: 21 physicians and physiotherapists in 7 Primary Care Centers and 6 researches in the Complutense University of Madrid (Spain). PARTICIPANTS: 137 patients diagnosed with nonspecific LBP. METHODS: The control group underwent 15 sessions of conventional physiotherapy in Primary Care Centers, and the experimental group received 15 GDS treatment sessions. Pain was evaluated by Visual Analogical Scale (VAS), functional disability by Oswestry questionnaire, and quality of life by the physical and mental components of SF-36 questionnaire. Outcome measures were assessed before treatment (A1), at the end of treatment (A2), and at 3 months (A3), and 6 months (A4) of follow-up. RESULTS: Repeated measures analysis of variance revealed that at the end of treatment and 3 months later, subjects in both groups showed less pain, reduced functional disability, and an improved quality of life, though improvements were greater in the GDS group.Six months after treatment, patients in the GDS group continued to show reduced pain (VAS(A4-A1) = -3.54, 95% CI: -4.18 to -2.90) while VAS scores in the control group returned to initial values (VAS(A4-A1) = 0.15, 95% CI: -0.36 to 0.67). CONCLUSION: Treatment of nonspecific LBP using the GDS method provides greater improvements in the midterm (6 months) in terms of the pain, functional ability, and quality of life perceived by patients than the conventional treatment based administered in primary care.