Examinando por Autor "Falla, Deborah"

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  • Miniatura
    Ítem
    Are baseline clinical tests associated with the relative effectiveness of manual therapy and neck-specific exercise for people with chronic non-specific neck pain?: secondary analysis of a randomized controlled trial
    (Elsevier Ltd, 2025-09-03) Villanueva Ruiz, Iker; Falla, Deborah; Saez, Marc; Araolaza Arrieta, Maialen; Azkue Barrenetxea, Jon Jatsu; Arbillaga Etxarri, Ane; Lersundi Artamendi, Ana; Lascurain-Aguirrebeña, Ion
    Objective: To evaluate whether baseline clinical tests are associated with the relative effectiveness of manual therapy versus neck-specific exercise for people with chronic non-specific neck pain (NSNP). Design: Pre-planned secondary analysis of a single-blind, parallel, randomized clinical trial with two treatment arms, adhering to CONSORT guidelines. Methods: 65 participants with NSNP were randomly allocated with a 1:1 allocation ratio to a programme of either manual therapy or neck-specific exercise. A battery of clinical tests was performed pre-treatment. The manual therapy group had four 30-min sessions, while the exercise group followed a four-week program with physiotherapist-led sessions and daily home exercises. Outcomes measured at baseline, two weeks, four weeks, and 12 weeks post-treatment included pain intensity, disability, patient-perceived improvement, quality of life, and kinesiophobia. Patients were categorized into either responders or non-responders according to pain intensity, disability and patient-perceived improvement. Results: Patients with NSNP that reported bilateral pain, no blocking sensation and greater pain at end of range, showed side flexion or rotation range of movement asymmetry, and whose symptoms could be reproduced during the specific neck movements, were more likely to be classified as responders if they received manual therapy when compared to neck-specific exercise. Adjusted odds ratios (Prob >0.95) varied considerably (range 7.01xe-14 to 0.32) depending on clinical tests and the follow up time point. Conclusion: A battery of clinical tests showed significant associations with the relative effectiveness of manual therapy versus neck-specific exercise in patients with NSNP.
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    Ítem
    Effectiveness of specific neck exercise for nonspecific neck pain: usefulness of strategies for patient selection and tailored exercise: a systematic review with meta-analysis
    (NLM (Medline), 2022-02) Villanueva Ruiz, Iker; Falla, Deborah; Lascurain-Aguirrebeña, Ion
    Ojective: Specific neck exercises (SNE) targeting deep cervical flexors and extensors are commonly used for the treatment of nonspecific neck pain (NSNP). However, whether SNE are more effective than alternative exercise interventions (AEI) remains unclear. Furthermore, it has been postulated that SNE may be most effective when they are tailored and targeted to patients with evidence of motor control dysfunction, yet this notion also remains unproven. The objectives of this study were to compare the effectiveness of SNE with that of AEI for reducing pain and disability in people with NSNP and to assess whether the effectiveness of SNE is increased when the exercises are tailored and provided to patients with evidence of motor control dysfunction. Methods: For this systematic review with meta-analysis, Medline, Web of Science, Scopus, and Physiotherapy Evidence Database were searched. Eligibility criteria included randomized controlled trials evaluating the effectiveness of SNE against that of AEI in people with NSNP. Meta-analysis included subgroup analyses to determine the effect of exercise tailoring and participant selection criteria on the effectiveness of SNE. Results: Twelve studies were included. Meta-analysis revealed greater effectiveness of SNE in the short to medium term for reducing pain (pooled standardized mean difference [SMD] = -0.41; 95% CI = -0.76 to -0.06; P = .02) and disability (pooled SMD = -0.41; 95% CI = -0.78 to -0.04; P = .03) but no differences in the long term for pain (pooled SMD = -1.30; 95% CI = -3.35 to 0.75; P = .21) and disability (pooled SMD = -1.81; 95% CI = -4.29 to 0.67; P = .15), although evidence was limited for the latter. The effectiveness of SNE was not superior in studies that included only participants with motor control dysfunction or when exercises were tailored to each participant. Overall, the studies were of low quality. Grading of Recommendations Assessment, Development and Evaluation revealed low certainty, serious risk of bias, and inconsistency of findings for short- to medium-term effects and very low certainty, serious risk of bias, and very serious inconsistency for long-term effects. Conclusion: The preferential use of SNE may be recommended to achieve better short- to medium-term outcomes, although the low quality of evidence affects the certainty of these findings. Currently used strategies for selecting patients and tailoring SNE are not supported by the evidence and therefore cannot be recommended for clinical practice. Impact: SNE are more effective than AEI for reducing pain and disability in patients with NSNP in the short to medium term, but overall evidence is of low quality, affecting the certainty of the findings. Tests of muscle dysfunction (mostly the craniocervical flexion test) currently used in studies to select patients and tailor SNE do not result in greater effectiveness of these exercises. Lay summary: Evidence suggests SNE are more effective than other forms of exercise, although evidence is overall of low quality. Use of the craniocervical flexion test in isolation to select participants and/or tailor SNE cannot be recommended.
  • Miniatura
    Ítem
    Manual therapy and neck-specific exercise are equally effective for treating non-specific neck pain but only when exercise adherence is maximised: a randomised controlled trial
    (Elsevier Ltd, 2025-03-21) Villanueva Ruiz, Iker; Falla, Deborah; Saez, Marc; Araolaza Arrieta, Maialen; Azkue Barrenetxea, Jon Jatsu; Arbillaga Etxarri, Ane; Lersundi Artamendi, Ana; Lascurain-Aguirrebeña, Ion
    Objective: To assess the effectiveness of manual therapy versus a progressive, tailored neck-specific exercise program with high adherence for treating non-specific chronic neck pain (NSNP) and to examine the relationship between exercise adherence and treatment outcome. Design: Single-blind, parallel, randomized clinical trial with two treatment arms, adhering to CONSORT guidelines. Methods: 65 NSNP participants were randomly allocated to manual therapy or exercise. They received four treatment sessions of either manual therapy or neck-specific exercise, once a week for four weeks. Outcomes measured at baseline, two weeks, four weeks, and 12 weeks post-treatment included pain intensity, disability, patient-perceived improvement, quality of life, kinesiophobia and the craniocervical flexion test (CCFT) performance. In addition to evaluating each individual outcome, patients were categorized into either responders or non-responders according to pain intensity, disability and patient-perceived improvement. Exercise adherence was recorded. Results: There were no differences between groups in individual outcomes. Treatment outcome in the exercise group was associated with exercise adherence. Patients receiving manual therapy were more likely to be classified as responders than those receiving exercise at all measured time points (odds ratio, 2 weeks: 0.14; 95 % CI: 0.02–0.79; treatment completion: 0.31; 95 % CI: 0.12–0.82; 12 weeks after treatment completion: 0.19; 95 % CI: 0.05–0.65), however these differences were no longer present when only patients whose exercise adherence was ≥95 % were analysed. Exercise was more effective than manual therapy in improving CCFT performance but only if patients with ≥95 % adherence were considered. Conclusion: A four-week intervention of manual therapy was more effective than exercise, however when exercise adherence was ≥95 %, the interventions were equally effective. Manual therapy may only be superior to specific-exercise when high exercise adherence cannot be assured.