Global postural re-education in spine diseases

PICHON RIVIERE, A.; AUGUSTOVSKI, F.; GARCIA MARTI, S.; GLUJOVSKY, D.; ALCARAZ, A.; LOPEZ, A.; BARDACH, A.; CIAPPONI, A; URTASUN, M

Documento de Evaluación de Tecnologías Sanitarias

IECS

Año: 2012 p. 1 - 30

1668-2793

Back pain is a common reason for medical consultation. Depending on pain location, it may be low back pain, middle back pain or upper back pain. There are different diseases that may cause back pain such as hernia, radiculitis, sacroiliitis, spondylitis, skoliosis, lordosis, kyphosis, etc. Approximately 70 to 85% of subjects experience low back pain in their lives. Eighty to ninety percent of subjects recover within a 6-week period regardless of the type of treatment; however, 5 to 15% will develop chronic low back pain (three months or longer). Global Postural Re-education is postulated both as preventive and curative interventions in spine disorders. Technology Global Postural Re-education (RPG®) is a physical therapy method in which entire muscle chains are extended or elongated in order to improve the contraction of antagonistic muscles thus avoiding postural asymmetry. To make these extensions, different body postures actively performed by the subject are used with the guidance and correction of a qualified therapist. Sessions usually take 50 minutes to one hour. Purpose The purpose of this report is to assess the evidence available on the efficacy, safety and coverage policy related aspect on the use of RPG® in patients with spine disorders focusing on deviations of the vertebral column (skoliosis, kyphosis), disc pathologies and chronic low back pain/lumbalgia. Methods A bibliographic search was carried out on the main databases: DARE, NHS EED, on Internet general search engines, in health technology evaluation agencies and health sponsors. Priority was given to the inclusion of systematic reviews (SR); controlled, randomized clinical trials (RCTs); health technology assessments and economic evaluations; clinical practice guidelines and coverage policies of other health systems. Results One SR, three RCTs and one non randomized clinical trial were included in this report. No clinical practice guidelines, health technology assessments or coverage policies were found. One systematic review published in 2011 assessed the effect of RPG® in all the indications. No significant differences were found in the results of pain, mobility and flexibility for the different spine disorders between conventional therapy and RPG® therapy, except for the case of ankylosing spondylitis, where RPG® proved to be more effective for these results in a small RCT described below. The rest of the identified evidence is exposed as follows: Lumbar Spine The only two studies found include a non randomized clinical trial on low back pain and a small case series report on disc hernia. Both showed a slight improvement in the measured performance status, activity and pain favoring RPG®. Cervical Spine One small RCT comparing RPG® versus conventional physical therapy was published in 2010. Thirty-five were included. After six-week follow up, no significant differences were found in any of the assessed items: pain, range of movement or quality of life. Deviations of the Vertebral Column No studies evaluating the use of RPG® in the treatment of skoliosis, lordosis or kyphosis have been found. Ankylosing Spondylitis In 2006, one small RCT assessing the impact of RPG® on the performance and movement results versus conventional exercise therapy after 12-month follow up in 40 patients included in a previous RCT conducted by the same authors was published. Statistically significant differences were found benefiting the group treated with RPG® in terms of performance status and pain indexes after a 12-month follow up. No Clinical Practice Guidelines, Health Technology Assessments or Coverage Policies on the use of RPG® in column diseases have been found. Conclusions The evidence found was not enough and of poor quality. Its main limitations include the fact that the standard of care has not been consistently described in addition to physical therapy management in the assessed groups; this may include administration of NSAIDs, corticosteroids or rest. The poor size of the studies also limits the potential to specifically assess response in the subgroups with different levels of disease. It is also impossible to determine the optimal number and length of sessions or if it is more effective under supervision or carried out in groups or individually. This prevents clarification of the technology in the management of spine diseases.