Global Postural Reeducation for patients with musculoskeletal conditions: a systematic review of randomized controlled trials.

Rodrigo G P Barreto,Giovanni E Ferreira,Rodrigo D M Plentz,Marcelo F Silva,Caroline C Robinson

doi:10.1590/bjpt-rbf.2014.0153

Abstract

ABSTRACTObjectivesTo systematically review randomized controlled trials that assessed the effects of Global Postural Reeducation (GPR) on patient-reported outcomes in conditions of the musculoskeletal system.MethodAn electronic search of MEDLINE (via PubMed), EMBASE, Cochrane CENTRAL, and SciELO was performed from their inception to June 2015. Randomized controlled trials that analyzed pain and patient-reported outcomes were included in this review. The Cochrane Collaboration’s Risk of Bias Tool was used to evaluate risk of bias, and the quality of evidence was rated following the GRADE approach. There were no language restrictions.ResultsEleven trials were included totaling 383 patients. Overall, the trials had high risk of bias. GPR was superior to no treatment but not to other forms of treatment for pain and disability. No placebo-controlled trials were found.ConclusionGPR is not superior to other treatments; however, it is superior to no treatment. Due to the lack of studies, it is unknown if GPR is better than placebo. The quality of the available evidence ranges from low to very low, therefore future studies may change the effect estimates of GPR in musculoskeletal conditions.

Highlights

Disorders of the musculoskeletal system represent a high societal and economic burden, accounting for a high prevalence of disability. In disorders such as low back pain[1], ankylosing spondylitis[2,3], neck pain[4], and temporomandibular disorders[2,5,6], physical therapy has been recommended as a first-line treatment
The philosophy of Global Postural Reeducation (GPR) lies in three fundamental principles: (1) Individuality, which considers each person as unique; (2) Causality, which states that the true cause of a musculoskeletal condition may arise from distant sites; and (3) Totality, which determines that a body should be treated in its entirety
The goal of this paper is to systematically review randomized controlled trials that assessed the effects of GPR on conditions of the musculoskeletal system

Summary

Introduction

Disorders of the musculoskeletal system represent a high societal and economic burden, accounting for a high prevalence of disability. In disorders such as low back pain[1], ankylosing spondylitis[2,3], neck pain[4], and temporomandibular disorders[2,5,6], physical therapy has been recommended as a first-line treatment. Among the various methods of treatment, Global Postural Reeducation (GPR) is of particular interest. This method was empirically developed by Phillippe Souchard in 19817 and is currently used in countries like Brazil, Spain, France, and Portugal[8,9]. GPR considers the existence of different muscle chains

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