Effectiveness of extracorporeal shock wave therapy versus standard care in the treatment of neck and upper back myofascial pain: a single blinded randomised clinical trial. (2021)

PICO

Patient/Population

Unilateral or bilateral chronic neck and upper back pain (upper and middle trapezius, levator scapulae, rhomboids, infraspinatus, and upraspinatus muscles) – tangible taut band, the existence of a tender nodule in the taut band and referral pain, and visual analogue scale ⩾3 mm – lasting more than three months, aged 18 to 55 years.  (n=72)

Intervention

  •  RSWT + exercise

  • Standard care: Hot pack + Ultrasound + exercise

Comparison

  • Control: exercise

Outcomes

  • Pain

  • Disability

Translatability:   (3/3) Easy                                    

Comments: RSWT was more effective in controlling the pain intensity than the US one month after treatment. However, it had no superiority over the US in improving the neck disability index at this time point.
Limitations: Demographical limitations: small sample size and female predominance. Single-blind design: therapist is not blinded during treatments. Consideration of the more painful side in participants with bilateral neck pain may confound results. Localization of myofascial trigger points may change during intervention sessions and affect findings. Psychological variables not considered, which may affect outcomes. Pain is an individual perception and can be associated with various factors.

Appraisals:

PEDro Scale  – (8/10) Blind subjects: No; Blind therapists: No. (by PEDro – confirmed)

Low Risk of Bias, and cited by – He, P., Fu, W., Shao, H., Zhang, M., Xie, Z., Xiao, J., Li, L., Liu, Y., Cheng, Y., & Wang, Q. (2023). The effect of therapeutic physical modalities on pain, function, and quality of life in patients with myofascial pain syndrome: a systematic review. BMC musculoskeletal disorders,24(1), 376. https://doi.org/10.1186/s12891-023-06418-6

Metrics and
Journal Details:

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BTB

Intervention – 1

  • RSWT 

Dose

  • 2000 impulse and 60 mj /m2 and 5 Hz frequency

Periodicity

  • 4 sessions one session per week

Local/Technic:

Physiatrist evaluated the taut band of key muscles: upper and middle trapezius, levator scapulae, infraspinatus, and supraspinatus and applied RSWT.

    Intervention – 2

    • Standard care
    1.  Hot pack
    2. Ultrasound

    Dose

    1. 74.5ºC for 20 mn. 
    2. 1.25 to 1.5 watts/cm2 for 5 mn.

    Periodicity

    12 sessions (3 sessions per week)

    Local/Technic:

    Before the ultrasound, a hot pack was located on the subject’s cervical, para-spinal, and upper thoracic areas.

    Intervention – 3

    • All interventions and control – accurate posture and self-neck-stretching exercises

    Dose

    Self-neck-stretching exercises for 20 seconds and repeat it 10 times per session 

    Periodicity

    At home each day till the finalisation of all measurements

    Local/Technic:

    Self-neck-stretching exercises each complicated muscle group –  upper trapezius and scalene, levator scapulae, sternocleidomastoid, middle trapezius and rhomboid muscles, and posterior neck musculature (neck flexion, extension, right/left lateral flexion, right/left rotation, and pectoral muscle). Brochures comprising comprehensive descriptions of stretching exercises were given to the subjects. When patients came for treatment, they exercised under the physiatrist’s superintendence. To ensure compliance, tables for marking when each session was fulfilled were provided to participants. They also were educated on correct posture in sitting, standing, working, and sleeping.

    Citation: Rahbar, M., Samandarian, M., Salekzamani, Y., Khamnian, Z., & Dolatkhah, N. (2021). Effectiveness of extracorporeal shock wave therapy versus standard care in the treatment of neck and upper back myofascial pain: a single blinded randomised clinical trial. Clinical rehabilitation,35(1), 102–113. https://doi.org/10.1177/0269215520947074

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