Efectividad de la terapia manual frente al TENS (Estimulación Eléctrica Transcutánea del Nervio) en el estado funcional de los pacientes con cervicalgia mecánica

Resumen

BACKGROUND: The neck pain is a common health problem associated with lifestyle that accompanies modern times now days. In adult population prevalence of neck pain along life ranges between 50% and 70%, and from 50% and 85% of those who experiences neck pain will suffer a new episode in the next five years. If pain relief is the only objetive in treatment of cervical pain, functional alterations may persist as precursors of future biomechanical deficiencies, and therefore of recurrence and chronicity. It appears that interventions that focus on functional recovery are relatively more effective than those without this approach. The purpose of this Doctoral Thesis is to increase knowledge about the effectiveness of Manual therapy and TENS in the functional status of patients with subacute and chronic mechanical cervical pain without neurological signs, in order to base the clinical actuation on effectivity results for adapting properly the care resources planning. METHODOLOGY: Randomized clinical trial with blind evaluation of the response variable developed in mechanical neck pain patients diagnosed with subacute or chronic without neurological signs in the Physiotherapy Units which were 1, 3, 7 and 9 Health Areas of the Community of Madrid. The intervention consisted of 10 sessions from 30 to 60 minutes on alternate days and a total duration of approximately one month. In the Manual therapy group were applied neuromuscular technique, stretching postisometric, spray and stretching and technique of Jones. In the TENS group was used TENSMED911 ® Portable Digital Enraf-Nonius with a frequency of 80 Hz, a duration phase of ≤ 150µs and adjusted amplitude. All patients in both groups were taught isometric exercises and mobilization and postural care to make at home. Sociodemographic variables, health status of patients, and characteristics of the current episode of neck pain were collected at base line, while the variables of patient's functional status (disability, active mobility and functional cervical strength) were collected also after intervention and six months after the same one. The Neck Disability Index was used for the assessment of cervical disability, the CROM Basic inclinometer (Cervical Range of Motion Instrument, Performance Attainment Associates product) was used to asses active cervical mobility, and the Functional strength of cervical spine test of Palmer and Epler was used to assess cervical functional strength of patients. The data analysis was performed for the description and comparison of sociodemographic, health status of patients, characteristics of the current episode of neck pain and response variables between the intervention groups at baseline. Besides a protocol analysis of the effectiveness of the interventions of the study was performed, as well as the success rate, patients satisfaction and adverse effects, in each group and between the intervention groups, both short and medium term. RESULTS: A total of 90 patients were included in the study, 47 in the Manual therapy group and 43 in the TENS group. Of the 47 patients included in the Manual therapy group, 95,7% (45 patients) completed the treatment and evaluation was performed after the intervention, and 78,7% (37 patients) was assessed at six months after the end of the intervention. In the TENS group, of the 43 patients who began the study, 97,7% (42 patients) completed treatment and perform the short-term assessment and 81.4% (35 patients) could also be assessed the medium term. In the description of the sample at baseline were not significant differences between intervention groups on sociodemographic variables, health status, description of the current episode of neck pain and functional status of patients, with the exception of myofascial trigger points in left upper trapezius and cervical functional strength in frontal plane. Both Manual therapy group as TENS group statistically significant differences were found in cervical disability of patients after intervention and at 6 months after the same one. Only in the Manual therapy group were statistically significant differences in functional strength after intervention (sagittal plane: p=0.001; frontal plane: p<0.001; transverse plane: p=0.004) and 6 months after the same (sagittal plane: p=0.004; frontal plane: p=0.010; transverse plane: p=0.016) and in active cervical mobility in the short term in all three spatial planes (sagittal plane: p<0.001; frontal plane: p=0.009; transverse plane: p=0.021) and medium term in the sagittal plane (p=0.037). By comparing the effects of both interventions in presence of other variables in the study, Manual Therapy improved more than TENS the active cervical mobility after the intervention (β= -6,58, p=0,03) and 6 months after the same (β= -10,08, p=0,04), as well as the cervical functional strength in the short term (β= -0,84, p=0,01) and medium term (β= -0,56, p<0,001). Both Manual therapy as TENS achieved a clinical improvement in cervical functional status in approximately half of patients, but no differences in success rates between them were found. The satisfaction of patients after intervention in Manual therapy group was higher than in TENS group significantly (p=0.033), although in the medium term this difference was not found between intervention groups. The adverse effects found in both groups were similar, all rare and mild. CONCLUSIONS: Population with subacute or chronic neck pain is mainly composed of middle-aged women with a level of mental and physical health below the population reference levels. Patients in both intervention groups improved cervical disability significantly. Manual therapy was more effective than TENS improving active mobility and functional strength cervical short and medium term, as well as patient satisfaction after intervention.