EFFECTIVENESS OF A GLOBAL POSTURE REEDUCATION PROGRAM FOR PATIENTS WITH LOW BACK PAIN

Purpose: Aim of this study was to evaluate the effectiveness of a Global Posture Reeducation (GPR) program in comparison to a physical therapy Standard Treatment (ST) in patients with low back pain (LBP) at short- and long-term follow-up (i.e. 3 and 6 months). Relevance: To our knowledge, this is the first controlled study comparing a GPR program to a physical therapy ST in patients with chronic LBP. Participants: 100 consecutive patients with a primary complaint of LBP were included in the study: 50 entered the GPR group and 50 entered the ST group. Methods: A multicentre, prospective, non-randomized, rater-blinded study was conducted between March 2008 and September 2009. Primary outcome measures were Roland and Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI). Secondary outcome measures were lumbar Visual Analogical Scale (VAS) and Fingertip-to- Floor test (FFT). Outcome 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; and 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. Analysis: Continuous data were expressed as means and standard deviations (SD), while categorical data were presented as absolute numbers and percentages (%). In order to compare the baseline characteristics of the GPR and ST group, the Student’s t test was used for continuous variables, whereas categorical variables were assessed using the X2 test or the Fisher’s exact test, as appropriate. An intention to treat approach was used to analyze participants according to the group to which they were originally randomly assigned. The way of dealing with missing data was substitution with data of the 3rd-month follow-up (when available for the subject) and with the mean of the non-worsened subjects in ST group and of the non-improved subjects in RPG group. Results: Of the 100 initial participants, 78 completed the study, 42 in GPR and 36 in ST group, respectively. At baseline, the two groups did not differ significantly with respect to gender, age, BMI and outcome measures. At the 6th-month follow-up, when examining differences from baseline, the RPG group revealed a significant reduction of all the outcome measures with respect to ST Group. Conclusions: Our 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 randomisation, large sample size, long-term follow-up and initial clinical assessment for subgrouping classification. Implications: When 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