Efficacia del trattamento manuale dei trigger points su frequenza intensità e durata degli attacchi nelle cefalee primarie: revisione sistematica con meta-analisi di studi randomizzati controllati
Dopo due anni di intenso lavoro, è con immenso piacere che vi comunico la pubblicazione sulla prestigiosa rivista Frontiers in Neurology . La nostra è la prima revisione sistematica che affronta l’argomento del trattamento delle cefalee più diffuse come l’emicrania e la cefalea muscolo tensiva.
Scrivere bene e poi riuscire a pubblicare i risultati su riviste importanti è fondamentale al giorno d’oggi al fine di dare solidità e fondamento alla pratica basata sulle evidenze, per poter sempre offrire il miglior trattamento in termini di efficacia e appropriatezza. Ringrazio i colleghi Tommaso, Silvia, Martina e Marco per il grande risultato che insieme abbiamo raggiunto.
“Effectiveness of trigger point manual treatment on the frequency, intensity and duration of attacks in primary headaches: a systematic review and meta-analysis of randomized controlled trials” Front. Neurol. | doi: 10.3389/fneur.2018.00254
Luca Falsiroli Maistrello1,
Tommaso Geri1*, Silvia Gianola2, 3, Martina Zaninetti1, 4 and Marco Testa1
- 1Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Italy
- 2Unit of Clinical Epidemiology, Istituto Ortopedico Galeazzi (IRCCS), Italy
- 3Center of Biostatistics for Clinical Epidemiology, Scuola di Medicina e Chirurgia, Università di Milano-Bicocca, Italy
- 4UOC di Recupero e Rieducazione Funzionale, Azienda Ospedaliera Universitaria Integrata Verona, Italy
Background: A variety of interventions has been proposed for symptomatology relief in primary headaches. Among these, manual Trigger Points (TrP) treatment gains popularity but its effects have not been investigated yet.
Objective: the aim was to establish the effectiveness of manual TrP compared to minimal active or no active interventions in terms of frequency, intensity and duration of attacks in adult people with primary headaches.
Methods: We searched MEDLINE, COCHRANE, Web Of Science and PEDro databases up to November 2017 for Randomised Controlled Trials (RCTs). Two independently reviewers appraised the Risk of Bias (RoB) and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) to evaluate the overall quality of evidence.
Results: Seven RCTs that compared manual treatment vs minimal active intervention were included: 5 focused on Tension-Type Headache (TTH) and 2 on Migraine (MH); 3 out of 7 RCTs had high RoB. Combined TTH and MH results show statistically significant reduction for all outcomes after treatment compared to controls but the level of evidence was very low. Subgroup analysis showed a statistically significant reduction in attack frequency (n° of attacks per month) after treatment in TTH (MD -3.50; 95% CI from -4.91 to -2.09; 4 RCTs) and in MH (MD -1.92; 95% CI from -3.03 to -0.80; 2 RCTs). Pain intensity (0-100 scale) was reduced in TTH (MD -12.83; 95% CI from -19.49 to -6.17; 4 RCTs) and in MH (MD -13.60; 95% CI from -19.54 to -7.66; 2RCTs). Duration of attacks (hours) was reduced in TTH (MD -0.51; 95% CI from -0.97 to -0.04; 2 RCTs) and in MH (MD -10.68; 95% CI from -14.41 to -6.95; 1 RCT).
Conclusion: Manual TrPs treatment of head and neck muscles may reduce frequency, intensity and duration of attacks in TTH and MH but the quality of evidence according to GRADE approach was very low for the presence of few studies, high risk of bias and imprecision of results.
