Addition of 3D Posture Corrective Orthosis to A Multimodal Program of Treatment Of NSNP.
Condition: Neck Pain
MeSH terms: Neck Pain
Study type: Interventional

Summary: 
      Nonspecific neck pain (NSNP) is one of the most common musculoskeletal problems treated by
      orthopaedic physicians and physiotherapists . NSNP has an annual incidence rate of 38 to 73%
      and a lifetime prevalence of approximately 48%, leading to both economic and social problems.
    

Detailed description: 
      Posture has emerged as a major risk factor associated with NSNP, but most previous studies
      have ignored correct posturing as an effective treatment. The few studies that used posture
      corrective strategies were based on a dated concept that did not incorporate the 3D nature of
      posture into the treatment strategy . Therefore, one of the major challenges faced by
      clinicians is how to incorporate 3D posture findings into the treatment plan.

      Harrison and colleagues reported that posture problems occurred in the head, ribs and pelvis
      in three dimensions in the form of translations and rotational displacements. Therefore, we
      should consider three-dimensional postural assessment and correction during the treatment of
      NSNP to obtain long-lasting effects and prevent the recurrence of neck pain.

      Several tools are available for objective postural measurements in clinical use, including
      simple plumb line measure, photographic techniques , moiré topography and various
      computer-assisted methods, such as electro goniometers. These methods are used in clinical
      assessments, but they have limitations, including the inability to measure neck posture as
      rotations and translations in six degrees of freedom, as mentioned by Harrison and
      colleagues.

      The current study will use a 3D analysis system called the Global Postural System (GPS) ,
      which is a novel device that investigates all postural variables at once and provides the
      managing physiotherapist with radiation-free and accurate measurements . This device also
      provides further information about foot pressure analysis and other 3D features that allow
      bracing designs to be tailored for each patient .

      Numerous studies have shown that mirror images in motion exercises, which are prescribed
      specifically to help normalize the patient's neuromuscular dysfunction and postural
      deformation via reflecting the patient's posture across different planes, are more beneficial
      than a less personalized programme.

      With these considerations in mind and to integrate the findings of 3D postural assessment
      into the treatment programme, we designed an adjustable cervico thoracic posture corrective
      orthotic (CTPCO) to be worn by the patient for a short time. The device has the ability to
      reflect all transitional displacements and rotational movements of the head. Ambulatory
      exercises will be performed using a treadmill while the CTPCO holds the patient's reverse
      posture.

      We designed a randomized two-arm pilot trial to investigate the hypothesis that the addition
      of a 3D adjustable CTPCO to a multimodal programme will produce short- and long-term
      improvement effects on NSNP management outcomes (i.e., neck pain, neck disability and 3D
      posture parameters of the head).

      The primary aim of this study is to evaluate the feasibility of conducting a larger
      randomized trial that considers recruitment, compliance to study protocols and adverse
      events. The secondary aim is to investigate the effect size of the addition of ambulatory
      mirror image functional re-training via the wearing of a 3D adjustable CTPCO compared to
      control group interventions for neck pain, disability and 3D posture parameters.
    

Intervention name(s): ambulatory mirror image functional re-training through wearing 3D adjustable cervicothoracic Posture Corrective Orthotic(CTPCO)
Intervention type(s): Device
Intervention description(s): Ambulatory a mirror image functional re-training This way of functional training will deliver via the use of adjustable cervicothoracic orthosis with the patient walking at approximately 2-3 miles per hour on a standard, motorized treadmill. The brace will reverse the abnormal posture according to the 3D posture analysis data. To facilitate tissue remodeling by reverse posture training, this called mirror image exercise.then the ambulatory exercises by using treadmill will be performed while the patient's mirror image posture will be held by the adjustable orthosis, ambulatory exercises for 20 minutes by using treadmill Based on Harrison et al and Hawes et al., approach, this program will be repeated 3 Times /week for 10 weeks.
Other intervention name(s): moist hot pack; manual therapy; Therapeutic exercise; Home program routine
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: A pilot double-blind randomized controlled trial, 24 patients will be randomized into two groups (study and control) using random number generator. The both groups will receive conventional treatment consisting of moist hot pack, soft tissue mobilization, manual therapy, therapeutic exercise. Additionally, the study group will receive ambulatory mirror image functional re-training through wearing 3D adjustable CTPCO.
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Neck pain; Ambulatory; Orthotic