Influence of the Generation of Motor Mental Images on Physiotherapy Treatment in Patients with Chronic Low Back Pain.

BACKGROUND: Patients with nonspecific chronic low back pain (NCLBP) have greater difficulty generating kinesthetic and visual motor imagery. OBJECTIVES: The main aim of this study was to determine whether the ability to generate mental motor imagery (MIab) influences psychological, motor, and disability variables in patients with NCLBP. The secondary aim was to determine whether an approach based on therapeutic exercise (TE) and therapeutic education (TEd) could improve the MIab in those patients with less ability to perform it. STUDY DESIGN: Cross-sectional and quasiexperimental study. SETTING: Physical Therapy Unit of primary health care center in Madrid, Spain. METHODS: A total of 68 patients were divided into 2 groups according to a greater (n = 34) or lesser (n = 34) MIab. Treatment was based on TEd and TE for the group with less ability to generate kinesthetic and visual motor imagery. The outcome measures were imagery requested time, self-efficacy, disability, pain intensity, lumbar strength, psychological variables, and MIab. RESULTS: The group with lesser MIab showed lower levels of self-efficacy (P = 0.04; d, -0.47) and lower levels of lumbar strength and extension strength (P = 0.04; d, -0.46 and P = 0.02; d, -0.52, respectively). After the intervention with TE and TEd, MIab (both kinesthetic and visual) improved significantly, with a moderate to large effect size (P <= 0.01; d, -0.80 and P <= 0.01; d, -0.76, respectively), as did pain intensity, lumbar strength, disability, and psychological variables (P < 0.05), but not levels of self-efficacy (P > 0.05). Based on the results, the patients with NCLBP with lesser MIab achieved lower levels of self-efficacy and lower strength levels. LIMITATIONS: The results of this study should be interpreted with caution because of its quasiexperimental design and a bias selection. CONCLUSIONS: A clinical TE approach, coupled with a TEd program, resulted in significant improvement in MIab (both kinesthetic and visual), reduced pain intensity, increased lumbar strength, reduced disability, and improved psychological variables, but it did not significantly improve self-efficacy levels in the patients with NCLBP. KEY WORDS: Chronic low back pain, motor imagery, disability, lumbar strength.

Comparison of Dry Needling versus Orthopedic Manual Therapy in Patients with Myofascial Chronic Neck Pain: A Single-Blind, Randomized Pilot Study.

Objective. The aim of this study was to compare the efficacy of three interventions for the treatment of myofascial chronic neck pain. Methods. Thirty-six patients were randomly assigned to one of three intervention groups: orthopedic manual therapy (OMT), dry needling and stretching (DN-S), and soft tissue techniques (STT). All groups received two treatment sessions with a 48 h time interval. Outcome measures included neck pain intensity measured using a visual analogue scale, cervical range of motion (ROM), pressure pain threshold for measuring mechanical hyperalgesia, and two self-reported questionnaires (neck disability index and pain catastrophizing scale). Results. The ANOVA revealed significant differences for the group × time interaction for neck disability, neck pain intensity, and pain catastrophizing. The DN-S and OMT groups reduced neck disability. Only the OMT group showed decreases in mechanical hyperalgesia and pain catastrophizing. The cervical ROM increased in OMT (i.e., flexion, side-bending, and rotation) and DN-S (i.e., side-bending and rotation) groups. Conclusions. The three interventions are all effective in reducing pain intensity. Reduction in mechanical hyperalgesia and pain catastrophizing was only observed in the OMT group. Cervical ROM improved in the DN-S and OMT groups and also neck disability being only clinically relevant for OMT group.

Effectiveness of therapeutic patient education for adults with migraine. A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: Our aim was to systematically review and meta-analyze the effectiveness of therapeutic patient education for migraine. METHODS: A literature search of multiple electronic databases (MEDLINE, EMBASE, PEDro, CINAHL, and PsychINFO) was conducted to identify randomized control trials (RCTs) published in the English and Spanish languages up to and including May 2013. Two reviewers independently selected the studies, conducted the quality assessment (Delphi list), and extracted the results. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses method was used throughout the systematic review and meta-analysis. Standardized mean difference (SMD) and 95% confidence intervals (CIs) were calculated for relevant outcome measures (headache frequency, headache disability, self-efficacy, depressive symptoms, and quality of life) and pooled in a meta-analysis using the random effects model. RESULTS: Fourteen RCTs were included in the systematic review. Only nine studies were included in the meta-analysis. The median quality score was 6.14 ± 1.29 (range: 5-9). There was strong-moderate evidence for intermediate-term effectiveness of therapeutic patient education on headache frequency (five studies: N = 940, SMD = -0.24, 95% CI of -0.48 to -0.01, P = 0.03), headache disability (four studies: N = 799, SMD = -1.02, 95% CI of -1.95 to -0.08, P = 0.03), and quality of life (three studies: N = 674, SMD = 0.36, 95% CI of 0.05-0.67, P = 0.02). There was no evidence for either short-term or intermediate-term effectiveness of therapeutic patient education on self-efficacy or depressive symptoms. CONCLUSION: This systematic review revealed strong-moderate evidence for intermediate-term effectiveness of therapeutic patient education for migraine. Further high-quality RCTs are required for conclusive determination of its effectiveness.

Is one better than another?: A randomized clinical trial of manual therapy for patients with chronic neck pain.

Our purpose was to compare the effectiveness of three manual therapy techniques: high velocity, low amplitude (HVLA), mobilization (Mob) and sustained natural apophyseal glide (SNAG) in patients with chronic neck pain (CNP). The randomized controlled trial included patients with mechanically reproducible CNP, who were randomized to the treatment group. Outcome measures were the Visual Analogue scale (VAS), Neck Disability Index (NDI), Global Rating of Change (GROC) and Cervical Range of Motion (CROM). Two-way repeated measures analysis of variance compared outcomes at baseline, at the end of treatment and 1, 2 and 3 months after treatment. A total of 51 subjects completed the trial. No significant differences were found between HVLA, Mob and SNAG at the end of treatment and during the follow-up in any of the analysed outcomes. There were no differences in satisfaction for all techniques. The results lead to the conclusion that there is no long-term difference between the application of HVLA, Mob and SNAG in pain, disability and cervical range of motion for patients with CNP.

[Therapeutic exercise as treatment for migraine and tension-type headaches: a systematic review of randomised clinical trials]. / Ejercicio terapéutico como tratamiento de las migrañas y cefaleas tensionales: revisión sistemática de ensayos clínicos aleatorizados.

AIM. To analyse the effectiveness of therapeutic exercise on migraines and tension-type headaches (TTH). MATERIALS AND METHODS. Electronic databases were used to search the literature for relevant articles. Eligibility criteria were: controlled randomised clinical trials (RCT), conducted on patients with migraine or TTH, in which the therapeutic intervention was based on therapeutic exercise, and the papers had been published in English and Spanish. Two independent reviewers performed the analysis of the methodological quality using the Delphi scale. RESULTS. Ten RCT were selected, seven of which offered good methodological quality. According to all the studies analysed, the intensity and frequency of pain diminished in comparison to the situation prior to establishing therapeutic exercise, and in five studies the effect was higher than in the control group. The qualitative analysis showed strong evidence of the absence of adverse events following the application of therapeutic exercise. Furthermore, strong evidence was also found of the effect of physiotherapeutic treatment, including therapeutic exercise, in lowering the intensity, frequency and duration of pain in patients with TTH. Limited evidence was also found of the effectiveness of aerobic exercise in patients with migraine, although it was not better than the effects derived from other forms of treatment. CONCLUSIONS. Results show that therapeutic exercise is a safe treatment that provides beneficial effects on migraines or TTH. Further RCT are required in the future with appropriate methodological designs to confirm these results.

TITLE: Ejercicio terapeutico como tratamiento de las migrañas y cefaleas tensionales: revision sistematica de ensayos clinicos aleatorizados.Objetivo. Analizar la efectividad que tiene el ejercicio terapeutico sobre las migrañas y las cefaleas de tipo tensional (CTT). Materiales y metodos. La busqueda de articulos se realizo utilizando bases de datos electronicas. Los criterios de inclusion fueron: estudios clinicos aleatorizados (ECA) controlados, realizados en pacientes con migrañas o CTT, donde la intervencion terapeutica se basara en ejercicio terapeutico y publicados en ingles y español. Dos revisores independientes realizaron el analisis de la calidad metodologica utilizando la escala Delphi. Resultados. Se seleccionaron 10 ECA, de los cuales siete presentaron una calidad metodologica buena. Segun todos los estudios analizados, el ejercicio terapeutico disminuyo la intensidad y frecuencia del dolor comparado con la situacion previa, y en cinco estudios el efecto fue mayor que en la comparativa con el grupo control. El analisis cualitativo muestra evidencia fuerte acerca de la ausencia de eventos adversos tras la aplicacion de ejercicio terapeutico. Ademas, se encontro evidencia fuerte acerca del efecto del tratamiento de fisioterapia, incluyendo el ejercicio terapeutico, para disminuir la intensidad, la frecuencia y la duracion del dolor en pacientes con CTT. Se observo evidencia limitada acerca de la efectividad del ejercicio aerobico sobre los pacientes con migraña sin ser superior el efecto al de otros tratamientos. Conclusiones. Los resultados muestran que el ejercicio terapeutico es un tratamiento seguro, que presenta efectos beneficiosos sobre las migrañas o las CTT. Es necesario que futuros ECA con diseños metodologicos adecuados confirmen estos resultados.