Effect of Chosen Treatment Methods in Patients With Cervical Spine Osteoarthritis
Condition: Cervical Spine Osteophyte
MeSH terms: Spondylitis; Osteoarthritis; Osteophyte; Osteoarthritis, Spine; Spondylarthritis
Study type: Interventional

Summary: 
      Abstract Objective: To compare effect of PNF therapy with manual therapy on pain, associated
      symptoms, range of motion and functioning in patients with cervical spine osteoarthritis.

      Design: Parallel group, single-center, double-blinded randomized controlled trial.

      Setting: Outpatient clinic in hospital KCRiO. Subject: Eligible patients were female adults
      with chronic pain of cervical spine due to osteoarthritis of vertebral body and
      intervertebral disc confirmed by X-ray.

      Interventions: Group I (PNF group) was treated according to PNF concept, while Group II
      according to manual therapy (manual therapy group). Both groups received 10 days of
      treatment, 45 minutes each day.

      Main measures: Primary outcomes measures were Oswestry scale and range of motion (ROM).
      Secondary outcomes measures were subjective evaluation of cervical pain according to VAS
      scale and associated symptoms (headache, vertigo, ROM of shoulder joints, balance). For each
      scale results were measured at baseline, after two weeks of intervention and after a
      three-month follow-up period without therapy.

      Keywords: neck pain, PNF, manual therapy
    

Detailed description: 
      Degenerative changes of cervical spine contribute to pain and decreasing ROM. Cervical pain
      is the fourth common cause of disability in the United States and it has a significant
      socio-economic impact worldwide. Pain of cervical spine is one of the leading cause of
      decreasing quality of life and it requires more attention from medical service providers and
      researchers. Further sudies are urgently required to better understand prognostic factors and
      clinical course of neck pain especially in low-middle-income countries as well as ways how to
      prevent such ailments. Especially office workers run the risk of musculoskeletal system
      overload due to prolonged sitting position with office equipment not suited to their needs
      [4,5,6]. The annual incidence of neck pain in industrialised countries varies from 27% to 48%
      what generates high costs and becomes the key issue.

      In 50-85% patients suffering from pain of cervical spine the symptoms don't resolve
      spontaneously and in 47% they may become chronic. Common cause of neck pain is: sedentery
      lifestyle, office work, difficulty sleeping, obesity, bad posture, depression, frequent use
      of a computer, female gender. Neck pain is common in office workers and it happens annual in
      13-48% of them. As many as 42-69% experienced neck pain in last 12 months and in 34-49% they
      reported the beginning of neck pain during annual observation. Until now there are no clear
      conclusions concerning types of exercises to decrease pain and improve function of cervical
      spine in the proffesion mentioned. Neck pain often becomes chronic and it stays at least 6
      months in 10% in man and 17% in women. Considering that neck pain is a problem for the
      general population it seems appropriate to indicate a treatment which will decrease pain
      effectively and that can improve functionig in daily living.

      The goal of this study is to Compare the effect of PNF therapy with manual therapy in
      improving range of motion, decreasing pain, associated symptoms and improving ADLs in
      patients with cervical spine osteoarthtitis.

      The parallel-group, single-centered, double-blind randomized experimental study was conducted
      in Cracow Rehabilitation and Orthopedic Centre in an outpatient clinic located in Aleja
      Modrzewiowa 22 in Poland. This medical facility has i.a. Accreditation Certificate, ISO
      Certificate. Written information was delivered to the Director of the Centre who obtained
      consent. The Bioethics Commission expressed a positive opinion on conducting the studies No.
      71/KBL/OIL/2011 and follows the Declaration of Helsinki for ethical principles for medical
      research involving humans.

      Patients admitted to rehabilitation in KCRiO were screened by Physical Medicine and
      Rehabilitation physician and on the basis of entry criteria they were qualified or excluded.
      All the patients involved were asked to sign a written informed consent for the participation
      in the study and filling in baseline assessments.The patients underwent rehabilitation
      program tailored for cervical osteoarthritis. One group received PNF treatment, the second
      one manual therapy. The patients were treated individually. Additionally both groups received
      physical modalities: laser therapy and TENS on cervical spine. Time of treatment was 2 weeks-
      10 rehabilitation units 45 minutes each, once a day.

      Treatment in the Ist group (PNF) included:

        -  neck patterns with a technique: Combination of Isotonics

        -  upper extremity patterns with a technique: Combination of Isotonics

        -  neck patterns with a technique: Hold-Relax

        -  scapula patterns with techniques: Stabilizing Reversals and Contract-Relax

        -  reeducation of postural control.

      Treatment used in the IInd group (manual therapy) included:

        -  mobilisation of cervicothoracic junction

        -  cervical segmental mobilisation (flexion, extension, coupling movement)

        -  isometric exercises of cervical spine

        -  PIR (post-isometric muscle relaxation)

        -  traction of cervical spine

        -  received reeducation for postural control

      Data was collected concerning age, BMI and type of work. After randomisation patients in both
      groups were blinded with regard to kind of received treatment and the study hipothesis. They
      received information who would be their physiotherapist. Data collecter was not involved in
      the trial. Observer collecting data couldn't enter the exercise room while patients were
      treated and couldn't be prezent during randomization. Contact between a person responsible
      for randomization process and data collector, as well as between caregivers and data
      collector was avoided; it was monitored by a Head of Physiotherapy Unit.
    

Intervention name(s): PNF group; manual therapy group
Intervention type(s): Other; Other
Intervention description(s): PNF is used in treatment of musculoskeletal pain of cervical and lumbar spine. Proprioceptive neuromuscular facilitation is a rehabilitation concept widely used by physiotherapists in many countries, in which stimulation of central nervous system is to achieve the highest possible functional level; Manual therapy is used for an assessment and treatment of joint and soft tissues.
The basic therapeutic tool is mobilisation. In the study joint mobilisation according to Kaltenborn-Evjenth Manual Therapy was used. The joint were mobilised with low velocity passive movements in the whole or end range. Spinal manipulation wasn't used. Liter Exelby reports that manual therapy with joints mobilisation was quite effective in improvement of functional movements and decreasing of pain.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: PNF, manual therapy, neck pain