ArticlePDF Available

Efficacia della Cura Osteopatica Centrata sulla Persona nel Low Back Pain e Neck Pain Studio Pilota

Authors:

Abstract

Obiettivi. Lo scopo di questo studio preliminare è stato studiare l’efficacia e le modalità di erogazione di Cura Osteopatica Centrata sulla Persona (COCsP) in un campione di popolazione con Low Back Pain (LBP) e Neck Pain (NP) Metodi. Un disegno di studio pilota descrittivo con revisione retrospettiva di cartelle cliniche (CC) in un campione al basale di (N=220) CC presso il setting di pratica clinica privata osteopatica è stato progettato per la verifica delle seguenti variabili di interesse. End-points (clinico): variazioni punteggio medio campionario delle scale di misura dedicate per LBP e NP pre/post somministrazione di COCsP utilizzando l’analisi della varianza (ANOVA). End-points (surrogati): numero medio OMT, tipologie di tecniche osteopatiche somministrate e verifica combinazioni modelli osteopatici Struttura Funzione (SF) Risultati. Rispettando i prestabiliti criteri di inclusione ed esclusione è stato osservato un campione finale di N=128 CC di cui: NP N=40 (31%) età media 39 (ds±15,45) e LBP N=88 (69%) età media 45 (ds±14,25). End point clinico ANOVA NP scala Neck Pain and Disability Scale (NPDI-I) N=40: (media campionaria-pre 28 [IC 95%: 23.8424 - 32.1576] media campionaria-post 10 [IC 95%: 7.12167 - 12.8783]) variazione (-18 punti %; p=.00). ANOVA LBP scala Oswestry Disability Index (ODI-I) N=72 (media campionaria-pre 26 [IC 95%: 24.1201 - 27.8799] media campionaria-post 10 [IC: 7.41514 - 12.5849]) variazione (-16 punti %; p=.00). ANOVA sottogruppo LBP scala Roland Morris (RM) N=16: (media campionaria-pre 7 [IC: 5.4014 - 8.59858] media campionaria-post 1 [IC: 0.467139 - 1.53286]) variazione (-6 punti %; p=.00). End point surrogato minimo (N=2 OMT), massimo (N=5 OMT), tecniche somministrate indirette (N=105[82%]), combinazione modelli SF Biomeccanico/Neurologico (N=105[82%]) Discussione. I dati per l’end point (clinico) per la verifica dell’ipotesi di nessun effetto della COCsP è stata rifiutata e si può affermare che la cura è efficace con un effetto statisticamente significativo. I dati per l’end point (surrogato) registrano in media (N=3) sessioni di OMT con tecniche indirette e una maggiore combinazione dei modelli SF Biomeccanico/Neurologico Conclusione. I dati significativi ottenuti per l’end point clinico e la comprensione sulle modalità di COCsP giustificano la pianificazione di studi clinici controllati randomizzati
!
!
!
!
!
!
!
!!!!!!!!!!!!!!!!!"#!"$%$&$''(!!)!*&+'$+,!!!-(./,+'!(0!!12(/&3!456+7$'$&+&$(,!+,8!9(3&./('(:;!<=>?!@A!@!>!@!!BBC!!!)!BDE!!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!8($!F!!>=#>GAEDH*&+-149#=>?#=A=>=>!!!!)!!*11I!<AED)>CEE!J(,'$,5K!)!*L1I!==G)>>>)>C)DD!!
!
449!
"#!"$%$&$''(!!
Efficacia&della&Cura&Osteopatica&Centrata&sulla&Persona&nel&Low&Back&Pain&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
e&Neck&Pain&:&&Studio&Pilota&&
*&+!-!12(/&3!456!9(!<=>?@!A@!>!!@!BBC!!)!BDE!!!@!!8($!F!>=#>GAEDH*&+-149#=>?#=A=>=>!!!!
*11I!<AED)>CEE!J(,'$,5!K!)!!*L1I!==G)>>>)>C)DD!
!
&
&
&
&
&
&
Efficacia& della& Cura& Osteopatica& Centrata& sulla& Persona&
nel&Low&Back&Pain&e&Neck&Pain&:&Studio&Pilota&&
&
Claudio&Civitillo&&1,2&&PT,&DO&
!
1!!!""#$%&'#()*+,-%#(.%$'"'/#(012%,-#2'"#34'-#+2'&%/2,(5'"%+"#(6(7%1'89(!).0:(
;(<+*--,(=2#>'#/,(012%,-#2'#($%>>,(?-,+2(@#1#2#(1*>>%()A'$%/B%8(9<=0?@):(
&&
Abstract&
Obiettivi!             di! erogazione! di! Cura!
Osteopatica!Centrata!sulla!Persona!(COCsP)!in!un!campione!di!popolazione!con!Low!Back!Pain!(LBP)!e!Neck!Pain!(NP)!
Metodi!Un!disegno!di!studio!pilota!descrittivo!con!revisione!retrospettiva!di!cartelle!cliniche!(CC)!in! un!campione! al!
basale!di!! (N=220)!CC!presso! il! setting! di!pratica!clinica!privata! osteopatica!è!stato! progettato! per!la!verifica! delle!
seguenti! variabili! di! interesse.! EndGpoints! (clinico):! variazioni! punteggio! medio! campionario! delle! scale! di! misura!
dedicate!per! LBP!e!NP! pre/post!somministrazione! di!COCsP!utilizz  Gpoints!
(surrogati):! numero! medio! OMT,! tipologie! di! tecniche! osteopatiche! somministrate! e! verifica! combinazioni! modelli!
osteopatici! Struttura! Funzione! (SF)! Risultati& Rispettando! i! prestabiliti! criteri! di! inclusione! ed! esclusione! è! stato!
osservato!un!campione!finale!di!N=128!CC!di!cui:!NP!N=40!(31%)!età!media!39!(ds±15,45)!e!LBP!N=88!(69%)!età!media!
45!(ds±14,25).!End! point!clinico!ANOVA! NP!scala!Neck!Pain!and!Disability!Scale!(NPDIGI)!N=40:!(media! campionariaG
pre!28![IC!95%:!23.8424!G!32.1576]!media!campionariaGpost!10![IC!95%:!7.12167!G!12.8783])!variazione!(G18!punti!%;!
p=.00).! ANOVA! LBP! scala! Oswestry! Disability! Index! (ODIGI)! N=72! (media! campionariaGpre! 26! [IC! 95%:! 24.1201! G!
27.8799]!media!campionariaGpost!10![IC:!7.41514!G!12.5849])!variazione!(G16!punti!%;!p=.00).!ANOVA!sottogruppo!LBP!
scala! Roland! Morris! (RM)! N=16:! (media! campionariaGpre! 7! [IC:! 5.4014! G! 8.59858]! media! campionariaGpost! 1! [IC:!
0.467139!G!1.53286])!variazione!(G6!punti!%;!p=.00).!!End!point! surrogato!minimo!(N=2!OMT),!massimo!(N=5!OMT),!
tecniche!somministrate!indirette!(N=105[82%]),!combinazione!modelli!SF!Biomeccanico/Neurologico!(N=105[82%])!
Discussione&!è!stata!rifiutata!e!si!
           
registrano! in! media! (N=3)! sessioni! di! OMT! con! tecniche! indirette! e! una! maggiore! combinazione! dei! modelli! SF!
Biomeccanico/Neurologico! ! Conclusione&            
modalità!di!COCsP!giustificano!la!pianificazione!di!studi!clinici!controllati!randomizzati!!
!
&
!
!
!
!
!
!
!
!!!!!!!!!!!!!!!!!"#!"$%$&$''(!!)!*&+'$+,!!!-(./,+'!(0!!12(/&3!456+7$'$&+&$(,!+,8!9(3&./('(:;!<=>?!@A!@!>!@!!BBC!!!)!BDE!!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!8($!F!!>=#>GAEDH*&+-149#=>?#=A=>=>!!!!)!!*11I!<AED)>CEE!J(,'$,5K!)!*L1I!==G)>>>)>C)DD!!
!
450!
"#!"$%$&$''(!!
Efficacia&della&Cura&Osteopatica&Centrata&sulla&Persona&nel&Low&Back&Pain&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
e&Neck&Pain&:&&Studio&Pilota&&
*&+!-!12(/&3!456!9(!<=>?@!A@!>!!@!BBC!!)!BDE!!!@!!8($!F!>=#>GAEDH*&+-149#=>?#=A=>=>!!!!
*11I!<AED)>CEE!J(,'$,5!K!)!!*L1I!==G)>>>)>C)DD!
!
%Introduzione%%
!
*'! 8('(/5! M5/%$M+'5! I9>! 5! $'! 8('(/5! '(N7+/5! OL9<! 3(,(! &$2('(:$5! 8$! 8('(/5! M65! M('2$3M(,(!
52$3(8$M+N5,&5!'+!/5:$(,5!M5/%$M+'5!5!'(N7+/5!8./+,&5!'+!%$&+P!5!3(,(!5,&/+N7$!M+/+&&5/$QQ+&$!8+!
25/$(8$! 8$! /5N$33$(,5! 85'! 8('(/5! 5! %+/$! :/+8$! 8$! 850$M$&! 0.,Q$(,+'5#! O+! "'+33$0$M+Q$(,5!
*,&5/,+Q$(,+'5!8$!R$3+7$'$&S!T*"RU!853M/$%5!,5$!M(8$M$!8$!8$+:,(3$!*"R)C)"V<=>A!G<A#>A!$'!I9!5!,5'!
M(8$M5!*"R)C)"V!<=>A!G<BB!$'!OL9#!V(,&$M(,5D!5!W(53?!853M/$%(,(!+N2$+N5,&5!'5!M+.35!5!$!0+&&(/$!
2/(:,(3&$M$!85'!I9!5!OL9!5!3(,(!3$,&5&$QQ+&$!,5''+!X+75''+!I>!!
&
Tabella&N1:&Cause&e&fattori&prognostici&del&NP&e&LBP&
!
         
&.&&+%$+P!$!N(8$!$,!M.$!$'!M(,M5&&(!Y!+22'$M+&(!+,M65!$,!+33$3&5,Q+!(3&5(2+&$M+!Z.(&$8$+,+!M(,&$,.+!
+!2/535,&+/5!.,+!30$8+#!!M(N5!+22/(MM$(!M'$,$M(!Y!
'+! 2(33$7$'$&S! 8$! 2/+&$M+/5! '+! M./+! M5,&/+&+! 3.'! 2+Q$5,&5GP! $,! Z.53&(! 3&.8$(! 25/! .,$0(/N+/5! '+!
&5/N$,('(:$+! Y! 3&+&+! 2/505/$&+! '+! 850$,$Q$(,5! 8$! "["39! T9\25/3(,+UP! .,! +22/(MM$(! +''+!
M(,3.'&+Q$(,5!3+,$&+/$+!$,!M.$!'5!+325&&+&$%5!85''+!25/3(,+!5!'5!2/505/5,Q5!3(,(!$,&5:/+&5! M(,!
']5325/$5,Q+! M'$,$M+! 85'! 2/(0533$(,$3&+! (3&5(2+&+&#! O+! "["39! /$M6$+N+! 0(/&5N5,&5! '+!
M(N.,$M+Q$(,5!&5/+25.&$M+!Z.+'$0$M+&+!5!M(,35,&5!+''+!25/3(,+!8$!2/5,85/5!85M$3$(,$!$,0(/N+&5P!
5!3$!+''$,5+!75,5!+,M65!M(,!$!2/$,M$2$!85''+!V58$M$,+!L+3+&+!3.''5!^%$85,Q5!T^LVUP!M65!M(N2/5,85!
33$(,$3&+!M(N5!8.5!85''5!&/5!M(N2(,5,&$!2/$,M$2+'$#!
E!
V+,$2('+&$%(![3&5(2+&$M(!T[VXU!3$!+/&$M('+!3.$!D!N(8[/:+,$QQ+Q$(,5!
V(,8$+'5! 85''+! 1+,$&S! T[V1UP! 7+3+&$! 3.'! /+22(/&(! 1&/.&&./+! _.,Q$(,5C! T1_U! 5! 3(,(! $! N(85''$F!
L$(N5MM+,$M(P! I5./('(:$M(P! L$(23$M(3(M$+'5P! 4532$/+&(/$(H"$/M('+&(/$(P! L$(5,5/:5&$M(#! X+'$!
             
/$05/$N5,&(!M65!25/N5&&+! 8$! $,&5/2/5&+/5!'+!/$'5%+,Q+!85''+! 8$+:,(3$! 8$! R$30.,Q$(,5!1(N+&$M+>=!
TR1UP!5!+22'$M+/5!'+!M./+#!*!N(85''$!1_!35N7/+,(!Z.$,8$!0(/,$/5!.,!3('$8(!Z.+8/(!
25/! 3(3&5,5/5! '+!"["39P! +,M65! 35P! '+!N$3./+! $,! M.$! Y! 
N5,(!M6$+/+.!
(
(
!
!
!
!
!
!
!
!!!!!!!!!!!!!!!!!"#!"$%$&$''(!!)!*&+'$+,!!!-(./,+'!(0!!12(/&3!456+7$'$&+&$(,!+,8!9(3&./('(:;!<=>?!@A!@!>!@!!BBC!!!)!BDE!!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!8($!F!!>=#>GAEDH*&+-149#=>?#=A=>=>!!!!)!!*11I!<AED)>CEE!J(,'$,5K!)!*L1I!==G)>>>)>C)DD!!
!
451!
"#!"$%$&$''(!!
Efficacia&della&Cura&Osteopatica&Centrata&sulla&Persona&nel&Low&Back&Pain&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
e&Neck&Pain&:&&Studio&Pilota&&
*&+!-!12(/&3!456!9(!<=>?@!A@!>!!@!BBC!!)!BDE!!!@!!8($!F!>=#>GAEDH*&+-149#=>?#=A=>=>!!!!
*11I!<AED)>CEE!J(,'$,5!K!)!!*L1I!==G)>>>)>C)DD!
!
(
Scopi&e&obiettivi&
!
            !
3M65'5&/$M(!
!
Risultati&attesi&
&
`5/$0$M+/5!35!%$!Y!%+/$+Q$(,5!3&+&$3&$M+N5,&5!3$:,$0$M+&$%+!85$!2.,&5::$!N58$!85''5!3M+'5!8$!N$3./+!
858$M+&5!$,!.,!M+N2$(,5!8$!2(2('+Q$(,5!M(,!OL9!5!I9!+!M.$!Y!3&+&+!3(NN$,$3&/+&+!'+!"["39!
&
Metodi&&
!
R$35:,(!8$!3&.8$(!!
!
1&.8$(!2$'(&+!853M/$&&$%(!T/5&/(325&&$%(!3.!"+/&5''5!"'$,$M65!J""K!U!
!
"(,&53&(!5!35&&$,:!!
!
""!8$!.,!M+N2$(,5!8$!2(2('+Q$(,5!53+N$,+&5!8+!.,(!85$!:/.22$!8$!&/$5,,$(!TaPLP"U!Ta)<==DH<==GUP!
TL)<==EH<=>=UP!T")<=>>H<=>AU!2/533(!.,(!3&.8$(!8$!2/+&$M+!2/$%+&+!(3&5(2+&$M+!
!
9+/&5M$2+,&$!
!!
!*!8+&$!85'!M+N2$(,5!8(%5%+,(!5335/5!/$05/$&$!+!""!.&$'$QQ+&5!,5''+!2/+&$M+!(3&5(2+&$M+!T[.&2+&$5,&!
[3&5(2+&6$M!1[a9! I(&5! _(/N<=U! M(N2'5&5! 8$!M(,35,3(!$,0(/N+&(!5!'+! 2/$%+M;! 3(&&(3M/$&&(!25/!
3533$(,$! 8$! (3&5(2+&$+! 25/! '+! M(,8$Q$(,5! M'$,$M+! 8$! I9! 5! OL9! 325M$0$M(! 5! ,(,! 325M$0$M(P! M(,! '+!
2/535,Q+!8$! +'N5,(! .,+!3M+'+!8$! N$3./+! 858$M+&+!2/5H2(3&!&/+&&+N5,&(!5! 0(''(b).2!&5/N$,+&(!
5,&/(!?=!:$(/,$#!!O+!/+MM('&+!8+&$!/5&/(325&&$%+!Y!3&+&+!/5+'$QQ+&+!8+!.,!(25/+&(/5!+885&&(!2/533(!
$'! 35&&$,:! 2/$%+&(! 85'! 2/$,M$2+'! $,%53&$:+&(/! 85''(! 3&.8$(#!    (3&5(2+&+!
2/(0533$(,$3&+!M(,!('&/5!>=!+,,$!8$!5325/$5,Q+!2(3&!8$2'(N+!$3M/$&&(!5!/5:$3&/+&(!+'!45:$3&/(!85:'$!
[3&5(2+&$! T4[*U! 85''+! ,+Q$(,5! 8$! +22+/&5,5,Q+! TI.N5/(! X5335/+! 4[*! >=AGU#! *! :/.22$!
/$32(,85%+,(! +''5! M+/+&&5/$3&$M65! M'$,$M65! 8$! I9! 5! OL9! 35M(,8(! $! M(8$M$! *"R! +&&$,5,&$! +''+!
M'+33$0$M+Q$(,5!85''+!8./+&+!85'!8('(/5!!
&
!
!
"+N2$(,5! 8$! 2(2('+Q$(,5! M(,! /$M6$53&+P! 3(NN$,$3&/+Q$(,5! 5! &5/N$,5! 85'! 2/(:/+NN+! 8$! M./+!
(3&5(2+&$M+! 25/! I9! 5! OL9! 325M$0$M(H,(,! 325M$0$M(! /$05/$&$! +''+! M'+33$0$M+Q$(,5! 85''+! 8./+&+! 85'!
8('(/5F!+M.&(!c!+!?!35&&$N+,5P!3.7)+M.&(!M/(,$M(!&/+!?)><!35&&$N+,5P!M/(,$M(!d!+!><!35&&$N+,5!!
!
"/$&5/$!8$!53M'.3$(,5!
!
458!_'+:3!25/!I9>E!5!OL9>C!!!!
!
!
!
!
!
!
!
!
!
!
!!!!!!!!!!!!!!!!!"#!"$%$&$''(!!)!*&+'$+,!!!-(./,+'!(0!!12(/&3!456+7$'$&+&$(,!+,8!9(3&./('(:;!<=>?!@A!@!>!@!!BBC!!!)!BDE!!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!8($!F!!>=#>GAEDH*&+-149#=>?#=A=>=>!!!!)!!*11I!<AED)>CEE!J(,'$,5K!)!*L1I!==G)>>>)>C)DD!!
!
452!
"#!"$%$&$''(!!
Efficacia&della&Cura&Osteopatica&Centrata&sulla&Persona&nel&Low&Back&Pain&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
e&Neck&Pain&:&&Studio&Pilota&&
*&+!-!12(/&3!456!9(!<=>?@!A@!>!!@!BBC!!)!BDE!!!@!!8($!F!>=#>GAEDH*&+-149#=>?#=A=>=>!!!!
*11I!<AED)>CEE!J(,'$,5!K!)!!*L1I!==G)>>>)>C)DD!
!
`+/$+7$'$!8$!$,&5/5335!^,8)2($,&3!TM'$,$M(U!
!
`+/$+Q$(,$!85'!2.,&5::$(!N58$(!M+N2$(,+/$(!2/5H2(3&!"["19!85''5!3M+'5!8$!N$3./+!25/!$'!8('(/5!
5!8$3+7$'$&S!25/!OL9!5!I9!!
!
^,8!2($,&3!T3.//(:+&(U!
!
I.N5/(!N58$(![VXP!&$2('(:$5!8$!&5M,$M65!(3&5(2+&$M65!3(NN$,$3&/+&5P!%5/$0$M+!M(N7$,+Q$(,$!
N(85''$!1_!
!
^//(/$!3$3&5N+&$M$!T7$+3U!
!
95/!/$8.//5!+'! N$,$N(! :'$!5//(/$!3$3&5N+&$M$!3(,(! 3+&$!+8(&&+&$!$!35:.5,&$!M/$&5/$F!53&/+Q$(,5! M(,!
2/(M58./5!+!3(/&5!T7.3&5!3$:$''+&5U!85$!:/.22$!8$!&/$5,,$!8+!.,!(25/+&(/5!+885&&(!+''+!/+MM('&+!8+&$!
$,!M$5M(!3$,:('(!/$325&&(!+'!2/(&(M(''(!!
!
R$N5,3$(,5!85'!M+N2$(,5!+'!7+3+'5!!
!
<<=!""!
!
V5&(8$!3&+&$3&$M$!
!
!^,8)2($,&3! TM'$,$M(U! &53&! 8$! 3$:,$0$M+&$%$&S! 25/! '+! %5/$0$M+! 8$! $2(&53$! ,.''+! T9\=P=D! )! *"! CDeU!
+22'$M+,8(!535:.$&+!M(,!$'!2/(:/+NN+!
[25,^2$![25,!1(./M5!
&
&
Risultati&&
&
"+N2$(,5!&(&+'5!(335/%+&(!I\><E!""!TDEeU!8$!M.$F!I9!I\B=!TA>eU!V\>G!TB<PDeU!5&S!N58$+!AC!
T83f>DPBDU!LV*!<?PA=!T83fDP=>UP!_\<A!TDGPDeU!5&S!N58$+!BE!T83f><P?>U!LV*!<<P?B!T83fAP>?U#!OL9!
I\EE!T?CeU!V\AC!TBBPAeU!5&S!N58$+!BD!T83f>BP<DU!LV*!<?PD?!T83!fAPB?UP!_\BCTDDPGeU!5&S!N58$+!
D=!T83f>BP=GU!LV*!<?P=>!T83fBPBBUP!$!8+&$!853M/$&&$%$!85''5!M+/+&&5/$3&$M65!85'!M+N2$(,5!$,!3&.8$(!
3(,(!3$,&5&$QQ+&$!,5''+!TX+75''+!I<U!
Tabella&N2:&Dati&descrittivi&del&campione&in&studio&&
&
&
!
!
!
!
!
!
!
!!!!!!!!!!!!!!!!!"#!"$%$&$''(!!)!*&+'$+,!!!-(./,+'!(0!!12(/&3!456+7$'$&+&$(,!+,8!9(3&./('(:;!<=>?!@A!@!>!@!!BBC!!!)!BDE!!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!8($!F!!>=#>GAEDH*&+-149#=>?#=A=>=>!!!!)!!*11I!<AED)>CEE!J(,'$,5K!)!*L1I!==G)>>>)>C)DD!!
!
453!
"#!"$%$&$''(!!
Efficacia&della&Cura&Osteopatica&Centrata&sulla&Persona&nel&Low&Back&Pain&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
e&Neck&Pain&:&&Studio&Pilota&&
*&+!-!12(/&3!456!9(!<=>?@!A@!>!!@!BBC!!)!BDE!!!@!!8($!F!>=#>GAEDH*&+-149#=>?#=A=>=>!!!!
*11I!<AED)>CEE!J(,'$,5!K!)!!*L1I!==G)>>>)>C)DD!
!
I5'!8$+:/+NN+!8$! 0'.33(! 3(,(! /$2(/&+&$!$'!,.N5/(!8$! ""! 2(&5,Q$+'N5,&5!5'5::$7$'$P!M(,05/N+&5!
M(N5!5'5::$7$'$P!$,M'.35!,5''(!3&.8$(P!M65!6+,,(!&5/N$,+&(!$'!0(''(b).2!5!M65!3(,(!3&+&5!+,+'$QQ+&5!
T_$:./+!I>U!
!
Figura&N1:&Diagramma&di&flusso!
&&&
4$3.'&+&$!2/$,M$2+'$!8+&$!8$!53$&(!TM'$,$M(U!&
1M+'5!8$!N$3./+!53&/+&&5!OL9F![3b53&/;!R$3+7$'$&;!*,85g!T[R*)*U>>!5!!4('+,8!V(//$3!T4VU><!P!I9F!I5Mh!
9+$,!+,8!R$3+7$'$&;!1M+'5!TI9R*)*U>A!#!aI[`a!2/5H2(3&!"["39!I9!
3M+'+!I9R*)*!I\B=F!TN58$+)2/5!<E!J*"!CDeF!<A#EB<B!)!A<#>DG?KU!TN58$+)2(3&!>=!J*"!CDeF!G#><>?G!
)!><#EGEAKU!%+/$+Q$(,5!)>E!2.,&$!e!T2\=#==U#!aI[`a!2/5H2(3&!"["39!25/!'+!%5/$0$M+!
,.''+! OL9! 3M+'+! [R*)*! I\G<! TN58$+)2/5! <?! J*"!CDeF! <B#><=>! )! <G#EGCCKU! TN58$+)2(3&! >=! J*"F!
G#B>D>B!)!><#DEBCKU!%+/$+Q$(,5!)>?!2.,&$!e!T2\=#==U!
!
!
^3&/+Q$(,5!""!25/!$,M'.3$(,5!3&.8$(
I\B=!I9 I\EE!OL9
i/.22(!a!) <==DH<==G
i/.22(!L!) <==EH<=>=
i/.22(!"!) <=>>H<=>A
^3&/+&&(!$'!i/.22(!T"U!
<=>>H<=>A
9(2('+Q$(,5!$,M'.3+!8+'!i/.22(!T"U!
I9HOL9!TI\<<=!""U
^3M'.35!25/!M+/5,Q+!8$!8+&$!M'$,$M$!TI\C<@42%&""U!
TI\<E!I9UTI\?B!OL9U
""!$,M'.35!25/!+,+'$3$
TI\><E@58%U
!
!
!
!
!
!
!
!!!!!!!!!!!!!!!!!"#!"$%$&$''(!!)!*&+'$+,!!!-(./,+'!(0!!12(/&3!456+7$'$&+&$(,!+,8!9(3&./('(:;!<=>?!@A!@!>!@!!BBC!!!)!BDE!!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!8($!F!!>=#>GAEDH*&+-149#=>?#=A=>=>!!!!)!!*11I!<AED)>CEE!J(,'$,5K!)!*L1I!==G)>>>)>C)DD!!
!
454!
"#!"$%$&$''(!!
Efficacia&della&Cura&Osteopatica&Centrata&sulla&Persona&nel&Low&Back&Pain&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
e&Neck&Pain&:&&Studio&Pilota&&
*&+!-!12(/&3!456!9(!<=>?@!A@!>!!@!BBC!!)!BDE!!!@!!8($!F!>=#>GAEDH*&+-149#=>?#=A=>=>!!!!
*11I!<AED)>CEE!J(,'$,5!K!)!!*L1I!==G)>>>)>C)DD!
!
!
a,+'$3$!3(&&(:/.22$!
aI[`a!  ! I\>?F! TN58$+)2/5!G!J*"F!
D#B=>B!)!E#DCEDEKU!TN58$+)2(3&!>!J*"F!=#B?G>AC!)!>#DA<E?KU!%+/$+Q$(,5!)?!2.,&$!e!T2\=#==UP!$!8+&$!
8$!53$&(!3(,(!3$,&5&$QQ+&$!,5''+!TX+75''+!IAU!
&
Tabella&N3:&Dati&di&esito&(clinico)&
&
R+&$!8$!53$&(!T3.//(:+&$U!!
V$,$N(!TI\<![VXUP!N+33$N(!TI\D![VXUP!N58$+!TI\A![VXUP!&5M,$M65!3(NN$,$3&/+&5!$,8$/5&&5!
TI\>=DJE<eKU!M(,!M(N7$,+Q$(,5!N(85''$!1_!TL$(N5MM+,$M(HI5./('(:$M(U!TI\>=DJE<eKU!
&&&&
Discussione&&
&
*!2/$,M$2+'$!(7$5&&$%$!8$!Z.53&(!3&.8$(!3(,(!3&+&$!
8$! 5/(:+Q$(,5! 8$! "["39! $,! .,! M+N2$(,5! 8$! 2(2('+Q$(,5! M(,! OL9!5! I9#! ! *! ><E! M+N2$(,$! 85''+!
2(2('+Q$(,5!$,!3&.8$(!M65!6+,,(!/$M6$53&(!'+!M./+P!6+,,(!3(&&(3M/$&&(!$'!M(,35,3(!$,0(/N+&(!8(2(!
8$3M.33$(,5! M65! /$+33.N5%+! ,5''(! 325M$0$M(F! $! M6$+/$N5,&$! 85''5! 2/(M58./5! 85''5! &5M,$M65!
(3&5(2+&$M65!8+! 3(NN$,$3&/+/5!$,!7+35!+''+!`[P!'5!5%5,&.+'$!N(8$0$M65!85'! 2$+,(!8$!M./+!8(2(!
+22/(%+Q$(,5P! '5! $,0(/N+Q$(,$! 3.$! 0(''(b).2! 25/! '+! M(,35/%+Q$(,5! 8$! .,! 7.(,! 5Z.$'$7/$(! ,5'!
&5N2(#!*! 8+&$!85'!/5:$3&/+,(! M'$,$M(!/$05/$&(!+''5!3M+'5!8$!N$3./+!I9R*)*!
9c#==P!4V!9c#==P![R*)*!2c#==!M(,!.,+!%+/$+Q$(,5!8$!N5,(!>E!2.,&$!25/M5,&.+'5!,5''+!3M+'+!I9R*)
*P! N5,(! ?! 2.,&$! 25/M5,&.+'5! ,5''+! 3M+'+! 4V! 5! N5,(! >G! 2.,&$! 25/M5,&.+'5! ,5''+! 3M+'+! [R*)*P!
39!Y!3&+&+!/$0$.&+&+!5!3$!2.j!+005/N+/5!M65!'+!M./+!Y!500$M+M5!
        3.//(:+&$! 3$! 5%$85,Q$+,(! '+!
!
!
!
!
!
!
!
!!!!!!!!!!!!!!!!!"#!"$%$&$''(!!)!*&+'$+,!!!-(./,+'!(0!!12(/&3!456+7$'$&+&$(,!+,8!9(3&./('(:;!<=>?!@A!@!>!@!!BBC!!!)!BDE!!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!8($!F!!>=#>GAEDH*&+-149#=>?#=A=>=>!!!!)!!*11I!<AED)>CEE!J(,'$,5K!)!*L1I!==G)>>>)>C)DD!!
!
455!
"#!"$%$&$''(!!
Efficacia&della&Cura&Osteopatica&Centrata&sulla&Persona&nel&Low&Back&Pain&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
e&Neck&Pain&:&&Studio&Pilota&&
*&+!-!12(/&3!456!9(!<=>?@!A@!>!!@!BBC!!)!BDE!!!@!!8($!F!>=#>GAEDH*&+-149#=>?#=A=>=>!!!!
*11I!<AED)>CEE!J(,'$,5!K!)!!*L1I!==G)>>>)>C)DD!
!
3(NN$,$3&/+Q$(,5!$,!N58$+!TI\A![VXUP!&5M,$M65!$,8$/5&&5>B!TE<eU!M(,!M(N7$,+Q$(,5!N(85''$!1_!
L$(N5MM+,$M(HI5./('(:$M(! TE<eUP! +335,Q+! 8$! /5:$3&/+Q$(,$! /$05/$&5! +! 2+/&$M('+/$! /5+Q$(,$! +'!
&/+&&+N5,&(!(!5%5,&$!+%%5/3$!8$M6$+/+&$!8+'!M+N2$(,5!&
!!
O$N$&$!
!
$N2/5M$3$(,$!T7$+3U!$,!Z.53&(!3&.8$(!2/(%5,:(,(!85'!M$5M(!
T(25/+&(/5U!/$325&&(!+''+!"["39P!8+''+!8$00$M('&S!TM+/5,Q+!8+&$!(.&M(N53U!$,M(,&/+&5!,5''+!/+MM('&+!
.,!,.N5/(!$N2(/&+,&5!8$!""!TBEeU!
!
`+,&+::$!
!

M'$,$M+P!$'!,.N5/(!N58$(!8$!&/+&&+N5,&$!5!'5!&$2('(:$5!8$!&5M,$M65!+8+&&+&5!+$!%+'(/$!5!2/505/5,Q5!
85''+!25/3(,+!$,! M./+#! *,!Z.53&$!N(85''$!1_P! :'$! +22/(MM$!&5/+25.&$M$!3(,(! M(N7$,+&$!5!+22'$M+&$!
+&&/+%5/3(! '+! "["39! 25/F! /$2/$3&$,+/5!      
5Z.$'$7/+/5!'5!+005/5,Q5!,5./+'$P!/$8.//5!(!5'$N$,+/5!:'$!$N2.'3$!,(M$M5&&$%$!!
!
*,&5/2/5&+Q$(,$!
!
*! 8+&$! 85'! 2/(M533(! (335/%+Q$(,+'5! 8$! Z.53&(! 3&.8$(! 3(,(! 3&+&$3&$M+N5,&5! 3$:,$0$M+&$%$! 5!
M'$,$M+N5,&5! /$'5%+,&$P! Z.53&$! 8+&$! $,8.M(,(! +''+! /$0'533$(,5! M65! '+! /$M5/M+! 3.''+! "["39! 85%5!
$,:'(7+/5!,5''+!2/+&$M+!M'$,$M+!Z.(&$8$+,+!3&/.N5,&$!8$!N$3./+!325M$0$M$!,5'!1[a9!M(N5!5'5N5,&(!
3&+,8+/8#&I5'! 45:,(! k,$&(P! a.3&/+'$+! 5! I.(%+! l5'+,8+! &+'$! $,8$M+Q$(,$! +! 3&+,8+/8! 8$! 2/+&$M+!
(3&5(2+&$M+! 3(,(! +8+&&+&$! 8+'! /5:('+&(/5! .&$'$QQ+,8(! '+! M./+! M5,&/+&+! 3.''+! 25/3(,+! >D)>?
!
N$:'$(/+,8(!'+!Z.+'$&S!85''+!M./+>G!
&
&
&
&Conclusione&&
!
O+!"["39!3.22(/&+&+!8+''+!M(N7$,+Q$(,5!85$!N(85''$!1_!$8(,5$!3$!$85,&$0$M+!,5$!%+'(/$!5!2/505/5,Q5!
85''+! 25/3(,+P! '5! $,0(/N+Q$(,$! 2$'(&+! /$M+%+&5! 8+! Z.53&(! 3&.8$(! 3.::5/$3M(,(! 5'5N5,&$! 8$!
0+&&$7$'$&S!25/!0.&./$!3&.8$!325/$N5,&+'$!N.'&$M5,&/$M$!!
&
&
&
&
&
&
%
%
%
&
&
!
!
!
!
!
!
!
!!!!!!!!!!!!!!!!!"#!"$%$&$''(!!)!*&+'$+,!!!-(./,+'!(0!!12(/&3!456+7$'$&+&$(,!+,8!9(3&./('(:;!<=>?!@A!@!>!@!!BBC!!!)!BDE!!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!8($!F!!>=#>GAEDH*&+-149#=>?#=A=>=>!!!!)!!*11I!<AED)>CEE!J(,'$,5K!)!*L1I!==G)>>>)>C)DD!!
!
456!
"#!"$%$&$''(!!
Efficacia&della&Cura&Osteopatica&Centrata&sulla&Persona&nel&Low&Back&Pain&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
e&Neck&Pain&:&&Studio&Pilota&&
*&+!-!12(/&3!456!9(!<=>?@!A@!>!!@!BBC!!)!BDE!!!@!!8($!F!>=#>GAEDH*&+-149#=>?#=A=>=>!!!!
*11I!<AED)>CEE!J(,'$,5!K!)!!*L1I!==G)>>>)>C)DD!
!
&
References&
1. V(,&$M(,5!VP!*(%$,5!4P!85!15,+!i!5&!+'#P!<=>A#!X65!*&+'$+,!1(M$5&;!(0!96;3$M+'!+,8!456+7$'$&+&$(,!
V58$M$,5!T1*V_^4U!/5M(NN5,8+&$(,3!0(/!,5Mh!2+$,#!i!*&+'!V58!O+%!^/:!<=>A@!ADF>P!A?)D=&&
&
2. W(53!LmP! %+,!X.'85/!VP!m! X6(N+3!1#!R$+:,(3$3! +,8!&/5+&N5,&!(0!'(b! 7+Mh!2+$,#!LV-#! -.7!>GP!!!
<==?FAA<TGDDDUF>BA=F>BABA&&
&
3. 6&&2FHHbbb#$M8C8+&+#M(NH<=>AH`('.N5>HG>=)GACHG<=)G<BHG<AHG<A#>#6&N&
&
4. 6&&2FHHbbb#$M8C8+&+#M(NH<=>AH`('.N5>HG>=)GACHG<=)G<BHG<BHG<B#<#6&&&
&
5. &V(,&$M(,5!VP!*(%$,5!4P!85!15,+!i!5&!+'#P!<=>A#!X65!*&+'$+,!1(M$5&;!(0!96;3$M+'!+,8!456+7$'$&+&$(,!
V58$M$,5!T1*V_^4U!/5M(NN5,8+&$(,3!0(/!,5Mh!2+$,#!i!*&+'!V58!O+%!^/:!<=>A@!ADF>P!A?)D=&
&&
6. W(53!LmP! %+,!X.'85/!VP!m! X6(N+3!1#!R$+:,(3$3!+,8! &/5+&N5,&!(0!'(b! 7+Mh!2+$,#!LV-#!-.7! >GP!
<==?FAA<TGDDDUF>BA=F>BABA&&
&
7. V(/+,! 4#! 45M(:,$3$,:! 2+&$5,&)M5,&/58! M+/5! $,! M'$,$M+'! &/$+'3! (0! (3&5(2+&6;)&(b+/83! +! N(/5!
2/+:N+&$M!+22/(MM6#!*-[V!<=>A!`>?P!?D)?G&&
&
E# 1+Mh5&!RO! 5&! +'#! "'$,$M+'!^2$85N$('(:;F!+!7+3$3!3M$5,M5! 0(/! M'$,$M+'!N58$M$,5#!O$&&'5!L/(b,! ^8$&(/!
>CC>!
!
9. L5,M6N+/h3!0(/!&/+$,$,:!$,!&/+8$&$(,+'HM(N2'5N5,&+/;!+,8!+'&5/,+&$%5!N58$M$,5F!75,M6N+/h3!0(/!
&/+$,$,:! $,! (3&5(2+&6;#>#<#! m(/'8! n5+'&6! [/:+,$Q+&$(,! <=>=#!
6&&2FHHbbb#b6(#$,&HN58$M$,53H+/5+3H&/+8$&$(,+'H&/No75,M6N+/h3H5,H&&
&
10. W(//!*V!<==A#!a,!5g2'$M+&$(,!(0!(3&5(2+&6$M!2/$,M$2'53#!m+/8!4"P!58#!_(.,8+&$(,3!0(/![3&5(2+&6$M!
V58$M$,5!.<,8!58#!96$'+85'26$+P!9+F!O$22$,M(&&!m$''$+N3!p!m$'h$,3@12)>G&
&
11. V(,&$M(,5! VP! L+$+/8$! 9P! _5//+/$! 1! 5&! +'#! [3b53&/;! R$3+7$'$&;! *,85g! <#>)! *&+'$+,! `5/3$(,#12$,5!
<==C@AB!T>CU!F<=C=)<=CD&
&
12. 4('+,8!VP!V(//$3!4#!a!3&.8;!(0!&65!,+&./+'!6$3&(/;!(0!7+Mh!2+$,#!12$,5!>CEA@ET<U!F>B>)>BB&
&
13. V(,&$M(,5!V!PL+$+/8$! 9!I$8(!I! 5&!+'#!R5%5'(2N5,&!(0! &65! *&+'$+,!%5/3$(,!(0! &65!I5Mh!9+$,!+,8!
R$3+7$'$&;!1M+'5P! I9R1)*F!M/(33)M.'&./+'!+8+2&+&$(,P!/5'$+7$'$&;P!+,8!%+'$8$&;#! 12$,5!T96$'+! 9+!>CG?U!
<==E!-.,!>@AA&
&
>B# >B! V5'&Q5/! W4#! 1&+,8'5;! 94#! V(85'58! /525&$&$%5! N(&$(,! 3&/+$,! +,8! $,8$/5M&! (3&5(2+&6$M!
N+,$2.'+&$%5! ! ! &5M6,$Z.53! $,! /5:.'+&$(,! (0! 6.N+,! 0$7/(7'+3&! 2/('$05/+&$(,! +,8! $,&5/'5.h$,!
35M/5&$(,#!-!aN![3&5(2+&6!a33(M#!<==G!R5M@>=GT><UFD<G)A?#!
!
15. &bbb#(3&5(2+&6$M(.,M$'#(/:#,Q@!<=>=&
&
>?# i5,5/+'![3&5(2+&6$M!"(.,M$'@!<=>>!
!
!
!
!
!
!
!
!
!!!!!!!!!!!!!!!!!"#!"$%$&$''(!!)!*&+'$+,!!!-(./,+'!(0!!12(/&3!456+7$'$&+&$(,!+,8!9(3&./('(:;!<=>?!@A!@!>!@!!BBC!!!)!BDE!!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!8($!F!!>=#>GAEDH*&+-149#=>?#=A=>=>!!!!)!!*11I!<AED)>CEE!J(,'$,5K!)!*L1I!==G)>>>)>C)DD!!
!
457!
"#!"$%$&$''(!!
Efficacia&della&Cura&Osteopatica&Centrata&sulla&Persona&nel&Low&Back&Pain&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
e&Neck&Pain&:&&Studio&Pilota&&
*&+!-!12(/&3!456!9(!<=>?@!A@!>!!@!BBC!!)!BDE!!!@!!8($!F!>=#>GAEDH*&+-149#=>?#=A=>=>!!!!
*11I!<AED)>CEE!J(,'$,5!K!)!!*L1I!==G)>>>)>C)DD!
!
17. 1&5b+/&!VP! L/(b,!-P!R(,,5/!aP!VMm6$,,5;! *P![+&53! -P!m53&(,!mP!5&!+'#!X65!$N2+M&!(0!2+&$5,&)
M5,&5/58!M+/5!(,!(.&M(N53#!-!_+N!9/+M&!<===@BCFGC?&&
&
&
18. !Wq/,5/!n#!458!0'+:3!$,!&65!8$+:,(3&$M3!(0!7+Mh!2+$,#!4+8$('(:5#!<=>B!I(%@DBT>>UF>=GE)E>&
&
19. !a'5g+,85/!^9#! n$3&(/;P!26;3$M+'!5g+N$,+&$(,P! +,8!8$005/5,&$+'!8$+:,(3$3!(0!,5Mh!2+$,#!96;3!V58!
456+7$'!"'$,!!!I!aN#<=>>!a.:@<<TAUFAEA)CA&
&
20. 1'53Q;,h$! 1+,8/+! O#! i'(,5h! X#! [.&2+&$5,&! [3&5(2+&6$M! 1[a9! I(&5! _(/NF! 9/5'$N$,+/;! 453.'&3! $,!
[3&5(2+&6$M!!![.&M(N53)L+358!4535+/M6#-a[a!`('!>=D!PI(!B!!a2/$'!<==D&
&
&
&
&
!!!!!!!!Finanziamenti&
I533.,!&$2(!8$!0$,+,Q$+N5,&(!Y!3&+&(!(&&5,.&(!25/!$'!2/535,&5!3&.8$(!
Conflitti&di&interesse&
!
Ringraziamenti&
V+33$N(!a/N5,$!R[P!25/!'+!'5&&./+!8$!/5%$3$(,5!0$,+'5!85'!N+,(3M/$&&(!
"(3&+,Q+!_/+:('+!9XP!25/!'+!/+MM('&+!8+&$!M+/&5''5!M'$,$M65!
!
!
!
!
!
!
&
!
!
!
!
!
!
!
!
!
!
!
!
!!!!!!!!!!!!!!!!!"#!"$%$&$''(!!)!*&+'$+,!!!-(./,+'!(0!!12(/&3!456+7$'$&+&$(,!+,8!9(3&./('(:;!<=>?!@A!@!>!@!!BBC!!!)!BDE!!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!8($!F!!>=#>GAEDH*&+-149#=>?#=A=>=>!!!!)!!*11I!<AED)>CEE!J(,'$,5K!)!*L1I!==G)>>>)>C)DD!!
!
458!
"#!"$%$&$''(!!
Efficacia&della&Cura&Osteopatica&Centrata&sulla&Persona&nel&Low&Back&Pain&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
e&Neck&Pain&:&&Studio&Pilota&&
*&+!-!12(/&3!456!9(!<=>?@!A@!>!!@!BBC!!)!BDE!!!@!!8($!F!>=#>GAEDH*&+-149#=>?#=A=>=>!!!!
*11I!<AED)>CEE!J(,'$,5!K!)!!*L1I!==G)>>>)>C)DD!
!
!
!
!
!
!
!
!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
!
!
ResearchGate has not been able to resolve any citations for this publication.
Article
Full-text available
The paper represents the Italian Society of Physical " and Rehabilitation Medicine (SIMFER) recommendations to Neck Pain. We searched the principal scientific databases for papers concerning the main approaches to NP, including international guidelines, clinical trials of high methodological value and systematic reviews without any temporal limits. The recommendations were graded on the basis of the National Plan for Guidelines of the Italian Istituto Superiore di Sanità, which includes the level of evidence and strength of the recommendation. The principal sections of the recommendations deal with the Evaluation and Therapy for Neck Pain. The first describes the main evidence concerning the evaluation of patients with NP with or without limb involvement and/or headache: medical history, physical examination, neurological examination, laboratory tests, electrodiagnostics, diagnostic imaging and self-administered questionnaires. The second describes the best evidence synthesis concernig the therapy for Neck Pain: education, exercise, medical therapy, manual therapy, traction, physical therapy, acupuncture, orthoses, multimodal treatment, behavioural treatment.
Article
Full-text available
Low back pain is a considerable health problem in all developed countries and is most commonly treated in primary healthcare settings. It is usually defined as pain, muscle tension, or stiffness localised below the costal margin and above the inferior gluteal folds, with or without leg pain (sciatica). The most important symptoms of non-specific low back pain are pain and disability. The diagnostic and therapeutic management of patients with low back pain has long been characterised by considerable variation within and between countries among general practitioners, medical specialists, and other healthcare professionals.1 2 w1 Recently, a large number of randomised clinical trials have been done, systematic reviews have been written, and clinical guidelines have become available. The outlook for evidence based management of low back pain has greatly improved. This review presents the current state of science regarding the diagnosis and treatment of low back pain. We used the Cochrane Library to identify relevant systematic reviews that evaluate the effectiveness of conservative, complementary, and surgical interventions. Medline searches were used to find other relevant systematic reviews on diagnosis and treatment of low back pain, with the keywords “low back pain”, “systematic review”, “meta-analysis”, “diagnosis”, and “treatment”. Our personal files were used for additional references. We also checked available clinical guidelines and used Clinical Evidence as source for clinically relevant information on benefits and harms of treatments.3 4 Most of us will experience at least one episode of low back pain during our life. Reported lifetime prevalence varies from 49% to 70% and point prevalences from 12% to 30% are reported in Western countries.w2 w3 The diagnostic process is mainly focused on the triage of patients with specific or non-specific low back pain. Specific low back pain is defined as symptoms caused by a specific pathophysiological mechanism, such …
Article
One of the problems in mounting a trial of treatment of back pain is the lack of suitable outcome measures. This paper describes the development and validation of a questionnaire designed to measure selfrated disability due to back pain. The questionnaire is short, simple, sensitive, and reliable. It would be suitable for use in future trials of treatment. (C) Lippincott-Raven Publishers.