Effects Of Global Postural Re-Education (GPR) On Patients With Non-Specific Neck Pain.

Study Overview
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Brief Summary
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Pain is an unpleasant sensory and emotional experience (associated with actual or potential tissue damage. Chronic pain is a sensation of hyperalgia to muscles, ligaments and skin on both active and passive movements. Chronic pain has a tendency to prevent people from working and exercising

Detailed Description
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Neck pain is a very common clinical condition which equals the economic, social cost and level of disability to that of low back pain.Mechanical neck pain that occurs without an identifiable underlying disease and anatomical abnormality is termed as non-specific neck pain (NS-NP).Mechanical neck pain commonly arises insidiously and is generally multifactorial in origin.Two most common complains associated with chronic specific and non-specific neck pain are Kinesiophobia (fear of movement) and Postural asymmetry (forward head posture). Medical, surgical and physical therapy treatments are recommended for addressing chronic non-specific neck pain. Within the scope of physical therapy conventional management consist of many different techniques such as therapeutic exercises, electrotherapy, Pilates, yoga and manual therapy. Manual therapy is among the most common used method for treating musculoskeletal conditions including chronic neck pain. Manual therapy consists of stretching techniques, joint mobilization/manipulation, isometric/dynamic strengthening exercises and fascial manipulation or release. Global Postural Re-education (GPR) is an alternative therapeutic strategy based on the concept that postural muscles are organized in the form of 'muscle chains' located on the anterior and posterior aspect of the spine. It involves the global stretching of the anti-gravitational muscles and the kinetic muscle chains.

Official Title
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Effects Of Global Postural Re-Education (GPR) On Patients With Non-Specific Neck Pain.

Conditions
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Neck Pain

Intervention / Treatment
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* Other: Global Positional Re-education
* Other: Conventional Physical Therapy Program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Chronic non-specific neck pain ≥ 3 months. No prior medication and Physical Therapy interventions from last 3 months. Pain: moderate level (6 on NPRS). Exclusion Criteria: History of any trauma . History of any psychological condition. Specific causes of Neck Pain (e.g., systemic, rheumatic, neuromuscular diseases). Presence of central and peripheral neurological sign. Spinal surgery

Ages Eligible for Study
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Minimum Age: 25 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Global Positional Re-education<br>Global Positional Re-education | Other: Global Positional Re-education<br>* A series of gentle active movements and postures aimed at realigning joints and stretching shortened muscles. GPR includes 8 therapeutic postures in lying, sitting and standing.<br>|
| Active Comparator: Conventional Physical Therapy Program<br>Conventional therapy will consist of a combination of manual techniques | Other: Conventional Physical Therapy Program<br>* Axial traction will be given for 5 minutes, followed by mobilization of the muscle fascia along with static stretching of the scalene, levator scapulae, upper trapezius, sternocleidomastoid and pectoralis minor muscles.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numeric pain rating scale | The NPRS is an 11-point numeric scale, it is the segmented numeric version of the visual analog scale. Subjects will be asked to mark/select a whole number for 0-10 that best describes their perceived pain intensity of the last 24 hours. Assessment to be done at baseline, after 1st session, at 3rd week and at 6th week | six weeks | 
| Neck Disability Index | it is a 10-item self-report questionnaire that measures the patient's disability related to his/her neck pain. It is the most commonly used questionnaire for neck disability; its reliability and validity has been demonstrated in many literatures and languages. Assessment to be done at baseline, after 1st session, at 3rd week and at 6th week | six weeks | 
| Goniometer for Cervical Range of Motion | The active cervical range of motion (CROM) will be measured in sitting posture by using a universal goniometer, which consists of two arms; one that is stationary and one that is moveable. Assessment to be done at baseline, after 1st session, at 3rd week and at 6th week | six weeks | 
| Tampa Scale of Kinesiophobia | Tampa Scale of Kinesiophobia (TSK). TSK is a 17-items questionnaire based on the evaluation of fear of movement, fear of physical activity and fear of re-injury in patients suffering from chronic musculoskeletal pain. It is the most widely used fear avoidance behavior questionnaire with good level of reliability and validity as documented in different literatures. TSK is composed of 17 items with score ranging from 1to 4 for each item, ultimately having a total score ranging from 17-68.Assessment to be done at baseline, after 1st session, at 3rd week and at 6th week | six weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Forward Head Posture: | Ruler method. This method involves measuring the distance from the wall to the tragus of the ear (Tragus to wall test) and from wall to the posterior aspect of acromion of shoulder by a ruler in standing position. The normal distance of Tragus to wall (TTW) in males is 10.55 cm and in females is 10.00 cm, whereas the normal distance of shoulder from wall in relaxed standing position should be less than 5 cm.Assessment to be done at baseline, after 1st session, at 3rd week and at 6th week | six weeks | 
| Global Perceived Effect Questionnaire: | Perceived effect of the intervention will be assessed by using the Global Perceived Effect Questionnaire (GPE), a 5-point Likert-type scale evaluating the subjective self-reported improvement or deterioration after the intervention. GPE is widely used in the physical therapy literature. Assessment to be done at baseline, after 1st session, at 3rd week and at 6th week | six week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Pain, Range of motion, Kinesiophobia, Forward head posture