Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2010

Open Access 01-12-2010 | Research article

Effectiveness of a 'Global Postural Reeducation' program for persistent Low Back Pain: a non-randomized controlled trial

Authors: Francesca Bonetti, Stefania Curti, Stefano Mattioli, Raffaele Mugnai, Carla Vanti, Francesco S Violante, Paolo Pillastrini

Published in: BMC Musculoskeletal Disorders | Issue 1/2010

Login to get access

Abstract

Background

The aim of this non-randomized controlled trial was to evaluate the effectiveness of a Global Postural Reeducation (GPR) program as compared to a Stabilization Exercise (SE) program in subjects with persistent low back pain (LBP) at short- and mid-term follow-up (ie. 3 and 6 months).

Methods

According to inclusion and exclusion criteria, 100 patients with a primary complaint of persistent LBP were enrolled in the study: 50 were allocated to the GPR group and 50 to the SE group. Primary outcome measures were Roland and Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI). Secondary outcome measures were lumbar Visual Analogue Scale (VAS) and Fingertip-to-floor test (FFT). Data were collected at baseline and at 3/6 months by health care professionals unaware of the study. An intention to treat approach was used to analyze participants according to the group to which they were originally assigned.

Results

Of the 100 patients initially included in the study, 78 patients completed the study: 42 in the GPR group and 36 in the SE group. At baseline, the two groups did not differ significantly with respect to gender, age, BMI and outcome measures. Comparing the differences between groups at short- and mid-term follow-up, the GPR group revealed a significant reduction (from baseline) in all outcome measures with respect to the SE group.
The ordered logistic regression model showed an increased likelihood of definitive improvement (reduction from baseline of at least 30% in RMDQ and VAS scores) for the GPR group compared to the SE group (OR 3.9, 95% CI 2.7 to 5.7).

Conclusions

Our findings suggest that a GPR intervention in subjects with persistent LBP induces a greater improvement on pain and disability as compared to a SE program. These results must be confirmed by further studies with higher methodological standards, including randomization, larger sample size, longer follow-up and subgrouping of the LBP subjects.

Trial registration

NCT00789204
Appendix
Available only for authorised users
Literature
1.
Liddle SD, Baxter GD, Gracey JH: Exercise and chronic low back pain: what works?. Pain. 2004, 107 (1-2): 176-90. 10.1016/j.pain.2003.10.017.CrossRefPubMed
2.
Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G: COST B13 Working Group on Guidelines for Chronic Low Back Pain. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006, 15 (Suppl 2): S192-300. 10.1007/s00586-006-1072-1.CrossRefPubMedPubMedCentral
3.
Merskey H, Bogduk N: Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definition of Pain Terms. 1994, Seattle: IASP Press, 2
4.
Andersson HI: The epidemiology of chronic pain in a Swedish rural area. Qual Life Res. 1994, 3 (Suppl 1): S19-26. 10.1007/BF00433371.CrossRefPubMed
5.
Dagenais S, Caro J, Haldeman S: A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J. 2008, 8 (1): 8-20. 10.1016/j.spinee.2007.10.005.CrossRefPubMed
6.
Henchoz Y, Kai-Lik So A: Exercise and nonspecific low back pain: a literature review. Joint Bone Spine. 2008, 75 (5): 533-9. 10.1016/j.jbspin.2008.03.003.CrossRefPubMed
7.
8.
Hayden JA, Dunn KM, van der Windt DA, Shaw WS: What is the prognosis of back pain?. Best Pract Res Clin Rheumatol. 2010, 24 (2): 167-79. 10.1016/j.berh.2009.12.005.CrossRefPubMed
9.
Hides JA, Jull GA, Richardson CA: Long-term effects of specific stabilizing exercises for first-episode low-back pain. Spine. 2001, 26: E243-8. 10.1097/00007632-200106010-00004.CrossRefPubMed
10.
Bergmark A: Stability of the lumbar spine: a study in mechanical engineering. Acta Ortop Scand. 1989, 230 (69): 20-24.
11.
Ferreira PH, Ferreira ML, Maher CG, Herbert RD, Refshauge K: Specific stabilisation exercise for spinal and pelvic pain: a systematic review. Aust J Physiother. 2006, 52 (2): 79-88.CrossRefPubMed
12.
Costa LO, Maher CG, Latimer J, Hodges PW, Herbert RD, Refshauge KM, McAuley JH, Jennings MD: Motor control exercise for chronic low back pain: a randomized placebo-controlled trial. Phys Ther. 2009, 89 (12): 1275-86. 10.2522/ptj.20090218.CrossRefPubMed
13.
Ferreira ML, Ferreira PH, Latimer J, Herbert RD, Hodges PW, Jennings MD, Maher CG, Refshauge KM: Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain: a randomized trial. Pain. 2007, 131: 31-37. 10.1016/j.pain.2006.12.008.CrossRefPubMed
14.
Kumar S, Sharma VP, Negi MP: Efficacy of dynamic muscular stabilization techniques (DMST) over conventional techniques in rehabilitation of chronic low back pain. J Strength Cond Res. 2009, 23 (9): 2651-9. 10.1519/JSC.0b013e3181b3dde0.CrossRefPubMed
15.
Neto J, Pastre CM, Monteiro HL: Postural alterations in male Brazilian athletes who have participated in international muscular power competitions. Rev Bras Med Esporte. 2004, 10 (3): 199-201.
16.
Souchard P-E, Meli O, Sgamma D, Pillastrini P: Rieducazione posturale globale. 2009, EMC (Elsevier Masson SAS, Paris), Medicina Riabilitativa, 26-061-A-15
17.
Zuil Escobar JC, Rodriguez Fernandez AL, Martinez Cepa CB, Lopez Andrino J: Study of the relation between playing football and muscle shortening. Fisioterapia. 2004, 26 (6): 340-8.CrossRef
18.
Vanti C, Generali A, Ferrari S, Nava T, Tosarelli D, Pillastrini P: Rééducation Posturale Globale in musculoskeletal diseases: scientific evidence and clinical practice. Reumatismo. 2007, 59 (3): 192-201.PubMed
19.
Fernandez-de-las-Peñas C, Alonso-Blanco C, Morales-Cabezas M, Miangolarra JC-Page: Two exercise interventions for the management of patients with ankylosing spondylitis: a randomized controlled trial. Am J Phys Med Rehabil. 2005, 84 (6): 407-19.CrossRefPubMed
20.
Fernandez-de-Las-Peñas C, Alonso-Blanco C, Alguacil-Diego IM, Miangolarra-Page JC: One-year follow-up of two exercise interventions for the management of patients with ankylosing spondylitis: a randomized controlled trial. Am J Phys Med Rehabil. 2006, 85 (7): 559-67.CrossRefPubMed
21.
Apuzzo D, Franzini M, Di Lucente L, Gioia MC, Cerasa A, Sabatini U: Combined effect of O2/O3 and GPR in treatment of lumbar disc herniation: anatomical, clinical and patient-self-report evaluation. Eur J Clin Invest. 2003, 33 (Suppl 1): 46-
22.
Marques AP, Mendonca LLF, Cossermelli W: Muscular stretching exercises in patients with fibromyalgia from a training of Postural Global Reeducation (PGR). Rev Bras Reumatol. 1994, 34 (5): 232-4.
23.
Cabral CMN, Yumi C, Sacco ICN, Casarotto RA, Marques AP: Eficácia de duas técnicas de alongamento muscular no tratamento da síndrome femoropatelar: um estudo comparativo. Fisioter Pesq. 2007, 14: 48-56.
24.
Fozzatti MCM, Palma P, Herrmann V, Dambros M: Impacto da reeducação postural global no trattamento da incontinência urinária de esforço feminina. Rev Assoc Med Bras. 2008, 54 (1): 17-22. 10.1590/S0104-42302008000100015.CrossRefPubMed
25.
Cunha AC, Burke TN, França FJ, Marques AP: Effect of global posture reeducation and of static stretching on pain, range of motion, and quality of life in women with chronic neck pain: a randomized clinical trial. Clinics. 2008, 63 (6): 763-70. 10.1590/S1807-59322008000600010.CrossRefPubMedPubMedCentral
26.
Durmus D, Alayli G, Uzun O, Tander B, Cantürk F, Bek Y, Erkan L: Effects of two exercise interventions on pulmonary functions in the patients with ankylosing spondylitis. Joint Bone Spine. 2009, 76: 150-155. 10.1016/j.jbspin.2008.06.013.CrossRefPubMed
27.
Moreno MA, Catai AM, Teodori RM, Borges BL, Cesar Mde C, da Silva E: Effect of a muscle stretching program using the Global Postural Reeducation method on respiratory muscle strength and thoracoabdominal mobility of sedentary young males. J Bras Pneumol. 2007, 33 (6): 679-86. 10.1590/S1806-37132007000600011.CrossRefPubMed
28.
Padua R, Padua L, Ceccarelli E, Romanini E, Zanoli G, Bondì R, Campi A: Italian version of the Roland Disability Questionnaire, specific for low back pain: crosscultural adaptation and validation. Eur Spine J. 2002, 11: 26-9. 10.1007/s005860100262.
29.
Roland M, Morris R: A study of the natural history of back pain, part I: development of a reliable and sensitive measure of disability in low back pain. Spine. 1983, 8: 141-4. 10.1097/00007632-198303000-00004.CrossRefPubMed
30.
Riddle DL, Stratford PW: Roland-Morris scale reliability. Phys Ther. 2002, 82: 512-7.PubMed
31.
Stratford PW, Binkley JM: A comparison study of the Back Pain Functional Scale and Roland Morris Questionnaire. North American Orthopaedic Rehabilitation Research Network. J Rheumatol. 2000, 27: 1928-36.PubMed
32.
Monticone M, Baiardi P, Ferrari S, Foti C, Mugnai R, Pillastrini P, Vanti C, Zanoli G: Development of the Italian version of the Oswestry Disability Index (ODI-I): A cross-cultural adaptation, reliability, and validity study. Spine. 2009, 34 (19): 2090-5. 10.1097/BRS.0b013e3181aa1e6b.CrossRefPubMed
33.
Fairbank JC, Davies JB, O'Brien JP: The Oswestry Low Back Pain Disability Questionnaire. Physiotherapy. 1980, 66: 271-3.PubMed
34.
Fairbank JC, Pynsent PB: The Oswestry Disability Index. Spine. 2000, 25 (22): 2940-52. 10.1097/00007632-200011150-00017.CrossRefPubMed
35.
36.
Perret C, Poiraudeau S, Fermanian J, Colau MM, Benhamou MA, Revel M: Validity, Reliability, and Responsiveness of the Fingertip-to-Floor Test. Arch Phys Med Rehabil. 2001, 82 (11): 1566-70. 10.1053/apmr.2001.26064.CrossRefPubMed
37.
Poiraudeau S, Rannou F, Revel M: Functional restoration programs for low back pain: asystematic review. Ann Readapt Med Phys. 2007, 50: 425-29.CrossRefPubMed
38.
Ostelo RW, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, Bouter LM, de Vet HC: Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine. 2008, 33 (1): 90-4. 10.1097/BRS.0b013e31815e3a10.CrossRefPubMed
39.
Shaughnessy M, Caulfield B: A pilot study to investigate the effect of lumbar stabilisation exercise training on functional ability and quality of life in patients with chronic low back pain. Int J Rehabil Res. 2004, 27 (4): 297-301. 10.1097/00004356-200412000-00007.CrossRefPubMed
40.
Yang EJ, Park WB, Shin HU, Lim JY: The effect of back school integrated with core strengthening in patients with chronic low-back pain. Am J Phys Med Rehab. 2010, 89 (9): 744-54. 10.1097/PHM.0b013e3181e72239.CrossRef
41.
Koumantakis GA, Watson PJ, Oldham JA: Trunk muscle stabilization training plus general exercise versus general exercise only: randomized controlled trial of patients with recurrent low back pain. Phys Ther. 2005, 85 (3): 209-25.PubMed
42.
Hayden JA, van Tulder MW, Malmivaara A, Koes BW: Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev. 2005, 20 (3): CD000335-
43.
Marshall PW, Murphy BA: Muscle activation changes after exercise rehabilitation for chronic low back pain. Arch Phys Med Rehabil. 2008, 89 (7): 1305-13. 10.1016/j.apmr.2007.11.051.CrossRefPubMed
44.
Mayer JM, Haldeman S, Tricco AC, Dagenais S: Management of chronic low back pain in active individuals. Curr Sports Med Rep. 2010, 9 (1): 60-6.CrossRefPubMed
45.
Weiner SS, Nordin M: Prevention and management of chronic back pain. Best Pract Res Clin Rheumatol. 2010, 24 (2): 267-79. 10.1016/j.berh.2009.12.001.CrossRefPubMed
46.
Jensen GM, Shepard KF, Hack LM: The novice versus the experienced clinician: insights into the work of the physical therapist. Phys Ther. 1990, 70: 314-323.PubMed
47.
Jensen GM, Shepard KF, Gwyer J, Hack LM: Attribute dimensions that distinguish master and novice physical therapy clinicians in orthopaedic settings. Phys Ther. 1992, 72: 711-722.PubMed
48.
Jensen GM, Gwyer J, Shepard KF, Hack LM: Expert practice in physical therapy. Phys Ther. 2000, 80: 28-52.PubMed
49.
Resnik L, Hart DL: Using clinical outcomes to identify expert physical therapists. Phys Ther. 2003, 83: 990-1002.PubMed
50.
Resnik L, Liu D, Mor V, Hart DL: Predictors of physical therapy clinic performance in the treatment of patients with low back pain syndromes. Phys Ther. 2008, 88 (9): 989-1004. 10.2522/ptj.20070110.CrossRefPubMedPubMedCentral
51.
Liddle SD, Baxter GD, Gracey JH: Chronic low back pain: patients' experiences, opinions and expectations for clinical management. Disabil Rehabil. 2007, 29 (24): 1899-909. 10.1080/09638280701189895.CrossRefPubMed
52.
May S: Patients' attitudes and beliefs about back pain and its management after physiotherapy for low back pain. Physiother Res Int. 2007, 12 (3): 126-35. 10.1002/pri.367.CrossRefPubMed
53.
Escolar-Reina P, Medina-Mirapeix F, Gascón-Cánovas JJ, Montilla-Herrador J, Jimeno-Serrano FJ, de Oliveira Sousa SL, del Baño-Aledo ME, Lomas-Vega R: How do care-provider and home exercise program characteristics affect patient adherence in chronic neck and back pain: a qualitative study. BMC Health Serv Res. 2010, 10: 60-10.1186/1472-6963-10-60.CrossRefPubMedPubMedCentral
54.
Medina-Mirapeix F, Escolar-Reina P, Gascón-Cánovas JJ, Montilla-Herrador J, Jimeno-Serrano FJ, Collins SM: Predictive factors of adherence to frequency and duration components in home exercise programs for neck and low back pain: an observational study. BMC Musculoskelet Disord. 2009, 10: 155-10.1186/1471-2474-10-155.CrossRefPubMedPubMedCentral
Metadata
Title
Effectiveness of a 'Global Postural Reeducation' program for persistent Low Back Pain: a non-randomized controlled trial
Authors
Francesca Bonetti
Stefania Curti
Stefano Mattioli
Raffaele Mugnai
Carla Vanti
Francesco S Violante
Paolo Pillastrini
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2010
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-11-285

Other articles of this Issue 1/2010

BMC Musculoskeletal Disorders 1/2010 Go to the issue

Research article

Low back pain in junior Australian Rules football: a cross-sectional survey of elite juniors, non-elite juniors and non-football playing controls

Research article

Modular titanium alloy neck adapter failures in hip replacement - failure mode analysis and influence of implant material

Research article

Management of giant pseudomeningoceles after spinal surgery

Research article

Role of the supine lateral radiograph of the spine in vertebroplasty for osteoporotic vertebral compression fracture: a prospective study

Research article

Effects of plasma magnesium and prolactin on quantitative ultrasound measurements of heel bone among schizophrenic patients

Research article

Impregnation of bone chips with antibiotics and storage of antibiotics at different temperatures: an in vitro study