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

Abstract

Objectives: To systematically review randomized controlled trials that assessed the effects of Global Postural Reeducation (GPR) on patient-reported outcomes in conditions of the musculoskeletal system.

Method: An 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.

Results: Eleven 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.

Conclusion: GPR 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.

Figure 1. PRISMA flow diagram.

Figure 2. Descriptive forest-plots (pooling was not possible due to very high levels of statistical heterogeneity) for the outcomes (A) pain in trials comparing GPR versus segmental stretching for neck pain; (B) functional capacity in trials comparing GPR versus other treatments for ankylosing spondylitis; (C) disease activity in trials comparing GPR versus other treatments for ankylosing spondylitis.