An Additive Effect of Instrument-Assisted Soft Tissue Mobilization with Spinal Manipulation in Cervicogenic Headache: a Randomized Controlled Trial.

IF 4.1 2区 医学 Q1 CLINICAL NEUROLOGY
Pain and Therapy Pub Date : 2024-12-01 Epub Date: 2024-10-28 DOI:10.1007/s40122-024-00671-w
Gopal Nambi, Mshari Alghadier, Humaira Khanam, Shahul Hameed Pakkir Mohamed, Osama R Aldhafian, Naif A Alshahrani, Paramasivan Mani, Mohamed Faisal Chevidikunnan, Fayaz Khan, Alaa Jameel A Albarakati
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引用次数: 0

Abstract

Introduction: There is a multitude of evidence supporting the use of manual and manipulative therapy techniques for patients with cervicogenic headache (CGH). However, evidence in finding and comparing the efficacy of instrument assisted soft tissue mobilization with manual therapy in unilateral cervicogenic headache is lacking. Therefore, the objective of the study is to find and compare the long term effects of instrument assisted soft tissue mobilization along with spinal manipulation therapy in patients with cervicogenic headache.

Methods: It is a randomized, single-blinded controlled study conducted at University hospital. Overall, 64 participants with CGH were divided into spinal manipulation therapy group (SMT; n = 32) and spinal manipulation therapy with instrument assisted soft tissue mobilization (ISM) group (SMT + ISM; n = 32) and they received the respective treatment for 4 weeks. In addition, both groups received 10 min of heat therapy and neck isometric exercises three times a day. The primary (CGH frequency) and secondary (CGH pain intensity, CGH disability neck pain frequency, pain intensity, pain threshold, neck disability index and quality of life) scores were measured at baseline, after 4 weeks, and at 6 months.

Results: The reports of the SMT and SMT + ISM group were compared. Following 4 weeks of training, and at 6 months follow up the SMT + ISM group showed more significant changes in the primary outcome (CGH frequency) with a -4.3 [(95% confidence interval (CI) -4.80 to -3.79] and -1.7 (95% CI -1.92 to -1.47), when compared with the SMT group alone (p = 0.001). The secondary outcomes (CGH pain intensity, CGH disability, neck pain frequency, neck pain intensity, neck disability index, and quality of life) also shows more significant changes in the SMT + ISM group than the SMT group (p = 0.001). The same gradual improvement can be seen in the above variables at 6 months follow up. At the same time, neck pain threshold level does not show any improvement at 4 weeks (p ≥ 0.05) but shows a statistical difference at 6 months follow up. No such adverse effects or consequences were noted during or after the intervention.

Conclusions: The study concluded that spinal manipulation therapy with instrument assisted soft tissue mobilization provided better long-term outcomes in patients with cervicogenic headache. This study provided a piece of sound physical therapy evidence for a widespread and costly clinical condition, such as cervicogenic headache.

Clinical trial registration: The trial was registered prospectively in the Indian clinical trial registry with CTRI/2020/06/026243 on 30/06/2020.

器械辅助软组织活动与脊柱手法治疗颈源性头痛的叠加效应:随机对照试验。
导言:有大量证据支持对颈源性头痛(CGH)患者使用手法和操作治疗技术。然而,在单侧颈源性头痛的治疗中,还缺乏对器械辅助软组织活动与手法治疗的疗效进行研究和比较的证据。因此,本研究旨在发现并比较器械辅助软组织松动术与脊柱手法治疗对颈源性头痛患者的长期疗效:这是一项在大学医院进行的随机、单盲对照研究。64名颈源性头痛患者被分为脊柱手法治疗组(SMT;32人)和脊柱手法治疗配合器械辅助软组织活动(ISM)组(SMT + ISM;32人),他们分别接受了为期4周的治疗。此外,两组患者都接受了 10 分钟的热疗和颈部等长运动,每天三次。分别在基线、4周后和6个月时测量主要评分(CGH频率)和次要评分(CGH疼痛强度、CGH颈部残疾疼痛频率、疼痛强度、疼痛阈值、颈部残疾指数和生活质量):比较了 SMT 组和 SMT + ISM 组的报告。训练 4 周后和 6 个月随访时,SMT + ISM 组的主要结果(CGH 频率)与单独的 SMT 组相比有更显著的变化,分别为-4.3[(95% 置信区间(CI)-4.80 至-3.79]和-1.7(95% 置信区间(CI)-1.92 至-1.47)(P = 0.001)。次要结果(CGH 疼痛强度、CGH 残疾、颈部疼痛频率、颈部疼痛强度、颈部残疾指数和生活质量)也显示,SMT + ISM 组比 SMT 组有更显著的变化(P = 0.001)。在 6 个月的随访中,上述变量也出现了同样的逐渐改善。同时,颈痛阈值水平在 4 周时没有任何改善(p ≥ 0.05),但在 6 个月的随访中出现了统计学差异。在干预期间或之后,均未发现此类不良反应或后果:该研究得出结论,脊柱手法治疗配合器械辅助软组织活动,可为颈源性头痛患者提供更好的长期疗效。这项研究为颈源性头痛这种广泛存在且费用高昂的临床疾病提供了可靠的物理治疗证据:该试验于 2020 年 6 月 30 日在印度临床试验注册中心进行了前瞻性注册,注册号为 CTRI/2020/06/026243。
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来源期刊
Pain and Therapy
Pain and Therapy CLINICAL NEUROLOGY-
CiteScore
6.60
自引率
5.00%
发文量
110
审稿时长
6 weeks
期刊介绍: Pain and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of pain therapies and pain-related devices. Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to, acute pain, cancer pain, chronic pain, headache and migraine, neuropathic pain, opioids, palliative care and pain ethics, peri- and post-operative pain as well as rheumatic pain and fibromyalgia. The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports, trial protocols, short communications such as commentaries and editorials, and letters. The journal is read by a global audience and receives submissions from around the world. Pain and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.
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