Abstract
Objetivo
Comparar la efectividad de la terapia manual frente a electroestimulación nerviosa transcutánea en la disminución de la intensidad del dolor en pacientes con cervicalgia mecánica subaguda o crónica atendidos en unidades de fisioterapia de atención primaria (UFAP).
Diseño
Ensayo clínico aleatorio.
Emplazamiento
Se incluyeron 13 UFAP de 4 áreas de salud de la Comunidad de Madrid.
Participantes
Formaron parte del estudio 90 pacientes atendidos con cervicalgia mecánica subaguda o crónica. Se produjeron 3 pérdidas tras la intervención.
Intervenciones
Se asignaron aleatoriamente 47 pacientes al tratamiento con terapia manual y 43 a recibir electroestimulación nerviosa transcutánea.
Mediciones principales
Se midieron las características sociodemográficas y las variables pronóstico por grupo de intervención, así como la intensidad del dolor antes y después de la intervención con la media de los valores de la escala analógica visual (momento presente, promedio y peor dolor de las últimas 2 semanas) y los efectos adversos.
Resultados
La diferencia en la intensidad del dolor antes-después fue de 21,83 mm (intervalo de confianza [IC] del 95%, 13,71-29,95) para el grupo tratado con electroestimulación nerviosa transcutánea y de 22,87 mm (IC del 95%, 17,11-28,64) para la terapia manual. La diferencia de medias comparando la mejoría obtenida con uno y otro procedimiento fue de 1,04 (IC del 95%, de −8,66 a 10,75).
Conclusiones
Se ha observado una reducción en la intensidad del dolor percibida por los pacientes, si bien no se encontraron diferencias entre ambos tratamientos (electroestimulación nerviosa transcutánea y terapia manual). Este estudio no permite establecer la alternativa de tratamientos fisioterapéuticos en la cervicalgia mecánica atendida en atención primaria.
Palabras clave: Cervicalgia mecánica, Atención primaria, Modalidades de terapia física, Electroestimulación nerviosa transcutánea, Ensayo clínico aleatorio
Abstract
Objective
To compare the effectiveness of manual therapy (MT) versus transcutaneous electrical nervous stimulation (TENS) in reducing the intensity of pain in patients with subacute or chronic neck pain (NP) attended at primary care physiotherapy units (PCPU).
Design
Randomised clinical trial.
Setting
Thirteen PCPU in 4 health districts of the Community of Madrid, Spain.
Participants
Ninety patients with subacute or chronic NP attended. Lost after intervention:3.
Interventions
At random, 47 patients were allocated to MT treatment and 43 to TENS.
Main measurements
Social and demographic characteristics and prognosis variables in the intervention groups were measured. Intensity of pain before and after intervention was calculated by mean values on the analogue visual scale (present moment, average and worst pain of the last 2 weeks). Side-effects were also measured.
Results
Difference between before-and-after pain was 21.83 mm (95% CI, 13.71-29.95) for the group treated with Transcutaneous electrical nervous stimulation and 22.87 mm (95% CI, 17.11-28.64) for manual therapy. The difference in averages on comparing the 2 procedures for improvement was 1.04 (95% CI,−8.66% to 10.75%).
Conclusions
TENS and MT significantly reduce patients’ perceived intensity of pain, although there were no differences between the 2 groups. There are no conclusive results for the alternative physiotherapy treatments that determine a clear strategy of intervention.
Key words: Neck pain, Primary health care, Physical therapy modalities, Transcutaneous electrical nervous stimulation, Randomized clinical trial
Footnotes
Este proyecto fue financiado por el Fondo de Investigación Sanitaria/Fondos Europeos de Desarrollo Regional (PI N.°: 041320). Conflicto de intereses: ninguno.
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