Introduction: Chronic pain and psychiatric disorders frequently co-occur. Anxiety followed by chronic spinal pain is not properly addressed. The purpose of the study is to compare effectiveness of the regional approach (new approach) of physiotherapy treatment, NSAID and conventional physiotherapy approach on pain and disability status for chronic mechanical spinal pain disorder. Materials and Method: A repeated measurement ANOVA clinical trial design was carried out to test the hypothesis. 104 patients between 20-65 years old with chronic mechanical spinal pain were randomly assigned into 3 different groups. Measurements were taken before starting of intervention, middle of the intervention and at the end of the intervention. The regional group (30 patients) received 8 sessions of regional approach of Physiotherapy, conventional group (35 patients) received 8 sessions of conventional approach of physiotherapy treatment and drug group (39 patients) received 21 to 30 days NSAID as per prescription of an orthopedic Professor. To eliminate bias, clinical physiotherapists were also randomly allocated into either for regional approach physiotherapy group or as usual physiotherapy group. A treatment protocol of regional approach was developed and handed over to clinical physiotherapists for regional approach group to deliver treatment. Outcome was monitored by Hamilton Anxiety rating scale. Results: The results of the study show that the regional approach of physiotherapy treatment, NSAID and conventional physiotherapy approach are differentially effective on anxiety status (P<0.05). The outcome of anxiety was differently effective over different occasions of treatment (pretest, mid-test and posttest) for chronic mechanical spinal pain (P<0.05). Alongside the effect of time and treatment interaction of anxiety was also found to be statistically significant (P<0.05). Greater improvement of anxiety has been shown in regional group in comparison to conventional and NSAID group. Conclusion: Regional approach of treatment has been found to be a new evidence of treatment for chronic mechanical spinal pain in reduction of anxiety level. The study demonstrates short term outcome of the treatment methods. However, a further study is required to see the long term effect of those treatments.
Background: Cervical radiculopathy (CR) is one of the prevalent causes of neck pain and disability. Physiotherapy and pain medications are the common nonoperative management, and in physiotherapy, there are many concepts of assessment and management. This study aims to determine the comparative effectiveness of three specialized physiotherapy approaches or only pain medications for managing CR cases. Methods: A prospective, assessor, and participant-blind, four-arm randomized control trial (RCT) has been planned to conduct on 160 patients with chronic cervical radiculopathy in 4 specialized centers of Dhaka city recruited between July and December 2022. Four groups (n=40) will be treated through structural diagnosis and management concept (SDM), regional approaches (RA), McKenzie mechanical diagnosis and therapy (MDT) concept prescribed by advanced practice physiotherapist (APP), or pain medications prescribed by the specialist physician for 4 weeks. The outcome will be evaluated in baseline, intermediate test (14 days), and post-treatment (28 days) through Brief Pain Inventory (BPI) for pain, Goniometer reading for cervical range of motion (ROM), and Neck disability index (NDI) as the primary outcome. The secondary outcome will be quality of life measured at baseline and post-treatment by the WHO quality of life questionnaire WHOQOL-BREF. Discussion: The study will compare the efficacy of the three physiotherapy approaches with pain medications when treating chronic cervical radiculopathy. The findings will provide evidence when demining the best conservative management approach for CR. Clinical Trial Registry India: CTRI/2022/03/040922 (08/03/2022)
Background: Cervical radiculopathy (CR) is one of the prevalent causes of neck pain and disability. Physiotherapy and pain medications are the common nonoperative management, and in Physiotherapy, there are many concepts of assessment and management. This study aims to determine the comparative effectiveness of three specialized physiotherapy approaches or only pain medications for managing CR cases. Methods: A prospective, assessor, and participant-blind, four-arm Randomized control trial (RCT) has been conducted on 120 patients with chronic cervical radiculopathy in 4 specialized centers of Dhaka city recruited between July and December 2022. Four groups (n=30) was treated through structural diagnosis and management concept (SDM), regional approaches (RA), McKenzie mechanical diagnosis and therapy (MDT) concept prescribed by advanced practice physiotherapist (APP), or pain medications prescribed by the specialist physician for 4 weeks. Discussion: After 24 sessions every group shows improvement in neck pain, ROM, disability and quality of life. During intermediate analysis (14days), no group shows more significant changes than another. After post changes (24days) the pain severity score differ significantly only between Medication and RA, RA and Medication; mean pain affective interference score differ between Medication and RA, RA and Medication; and pain physical interference between Medication and RA; RA and Medication. Mean score of ROM were significantly different between medication and RA, Medication and SDM; MDT and RA, MDT and SDM; RA and Medication, RA and MDT; SDM and Medication, SDM and MDT. Besides mean score of WHOQOL Brief (physical) were significantly different between Medication and SDM (p=.000); MDT and SDM (p=.000); RA and SDM (p=.045); SDM and Medication (p=.000), SDM and MDT (p=.000), SDM and RA. Overall improvement (mean score changes) found in pain, ROM, disability, QOL among all groups. Trial registered to the Clinical Trial Registry India CTRI/2022/03/040922 on 08/03/2022.
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