Kronik boyun ağrılı hastalarda dinamik stabilizasyon egzersizleri ile izometrik-germe egzersizlerinin etkinliğinin karşılaştırılması
Küçük Resim Yok
Tarih
2005
Yazarlar
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Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
7. ÖZET Bu çalışmanın amacı, kronik boyun ağrılı hastalarda servikal stabilizasyon egzersizleri, izometrik egzersizler ve fizik tedavinin etkinliğini araştırmak ve karşılaştırmaktır. Bu amaçla çalışmamıza; kronik boyun ağrısı olan 57 kadın ve erkek hasta alındı, 53 hasta 1 yıllık takip periyodunu tamamladı. Hastaların çalışmaya alınmadan önce anamnezleri alınarak fizik bakıları yapıldı. Olguların tümünden ayrıntılı öyküleri alındıktan sonra fizik bakı yapıldı. Paravertebral kas spazmı, boyun hareketi ile ağrının olup olmadığı kaydedildi, transvers, sagittal ve frontal planlarda hareket açıklığı gonyometre ile ölçüldü. Boyun ağrısı şiddeti Visüel Analog Skala (VAS) ile, cm olarak ölçüldü. Olguların günlük yaşam aktiviteleri sırasındaki etkilenmeleri Boyun Sakatlık İndeksi (BSI) kullanılarak değerlendirildi. Hastaların depresif duygu durumunu değerlendirmek için Beck Depresyon İndeksinden yararlanıldı. Hastanın Tedavi memnuniyeti, Doktorun tedaviyi değerlendirmesi ve hastaların kullanmış oldukları parasetamol miktarları da kaydedildi. 17 hasta Grup I' de( fizik tedavi), 20 hasta Grup N'de (Fizik tedavi + izometrik- germe egzersizleri) 20 hasta Grup III' de (fizik tedavi + stabilizasyon egzersizleri ) olmak üzere 57 hasta randomize olarak 3 gruba ayrıldı. Hastalar tedavi öncesi, tedavi sonrası(3.hafta), 7. hafta, 3. ay, 6.ay, 9. ay ve 12. ayda aynı hekim tarafından değerlendirildiler. Boyun hareketleri sırasında ağrı olması açısından, Fizik tedavi grubu ile karşılaştırıldığında; izometrik egzersiz grubu bazı kontrollerde ve stabilizasyon egzersiz grubu da tüm kontrollerde olmak üzere istatistiksel olarak anlamlı daha fazla iyileşme gösterdi (p<0.05). Stabilizasyon ile izometrik egzersiz grupları arasında ise 1.yıl kontrolündeki stabilizasyon grubu lehine anlamlı iyileşme dışında fark saptanmadı. PVKS açısından, üç grupta da iyileşme vardı, ancak fizik tedavi grubundaki hastalarda PVKS ındaki iyileşme diğer iki egzersiz grubuna göre daha az ve daha kısa süreliydi. EHA ölçüm sonuçları açısından da, tüm gruplarda iyileşme vardı. Fizik tedavi grubunda sagittal planda 7.hafta, frontal 79planda 6. ay, transvers planda da 3. aya kadar anlamlı iyileşme saptandı (p<0.05) ve daha sonraki vizitlerde EHA ölçümlerinde gerileme eğilimi mevcuttu. Egzersiz gruplarında ise izometrik egzersiz grubunun frontal plandaki iyileşmesi dışında tüm planlarda EHA ölçümlerindeki iyileşmesi 1. yılda da devam etmekteydi. Sagittal ve transvers plan EHA'nda egzersiz gruplarındaki iyileşmenin fizik tedavi grubuna göre daha fazla olduğu ayrıca egzersiz grupları arasında da bu açıdan fark olmadığı saptandı. Frontal planda ise stabilizasyon egzersiz grubu diğer iki gruptan da daha fazla iyileşme gösterdi (p<0.05). Fizik tedavi ve izometrik egzerszi grubu arasında ise fark yoktu. Boyun ağrısının şiddeti açısından gruplar incelendiğinde; tüm gruplarda altıncı aya kadar süren anlamlı iyileşme ardından tüm gruplarda, 1. yıl değerlendirmesinde gruplar arasında fark olmaksızın anlamlı kötüleşme mevcuttu. Ağrının neden olabileceği sakatlık açısından yapılan BSİ değerlendirmesinde; Stabilizasyon grubunda tüm vizitlerde tedavi öncesine göre anlamlı iyileşme vardı (p<0.05), izometrik ve fizik tedavi gruplarındaki iyileşme daha kısa süreli ve çoğu kontrolde iyileşme istatistiksel olarak anlamlı değildi. Depresif duygu durumunu saptayabilmek için yapılan Beck Depresyon Anketi ile izik tedavi grubunda ve izometrik egzersiz grubunda (3. hafta kontrolü hariç) anlamlı iyileşme yoktu. Ayrıca fizik tedavi grubunda 9. ve 12. aylarda anlamlı kötüleşme saptandı (p<0.05). Stabilizasyon egzersiz grubunda ise 12. ay kontrolü de dahil tüm vizitlerde istatistiksel olarak anlamlı iyileşme vardı (p<0.05) Egzersiz gruplarında hasta memnuniyetinin fizik tedavi grubuna göre daha fazla, stabilizasyon grubunda da izometrik grubuna göre daha fazla olduğu saptandı. Doktora göre tedavinin değerlendirmesinde Stabilizasyon grubundaki hastaların diğer iki gruba göre tedaviden yarar görmeleri daha fazlaydı. İzometrik ve fizik tedavi grupları arasında ise anlamlı fark yoktu. 80Egzersiz grupları arasında parasetamol kullanımı açısından anlamlı fark yokken, egzersiz gruplarına göre fizik tedavi grubunda analjezik kullanımı daha fazlaydı. (p<0.05) Sonuç olarak, Bu çalışma ile stabilizasyon ve izometrik - germe egzersizlerinin, 1 yıllık takip periyodunda; EHA ölçümlerinde artış, ağrı, fiziksel sakatlık, depresif duygu durumu, paravertebral kas spazmı, analjezik kullanımı ve boyun hareketleri ile ağrı olması parametrelerinde azalma sağladığı saptanmış ve bu egzersizlerin etkinliği gösterilmiştir. Servikotorasik stabilizasyon egzersizlerinin bu parametreler üzerindeki etkisi daha belirgin ve uzun süreli olmuştur. Önemli bir gözlem de egzersizlerin haftada 3 kez yapılması ile uzun dönem kazanımlarının elde edilmesidir. 81
8. SUMMARY The aim of this study is to investigate and to compare the efficacy of cervical stabilization exercises, cervical isometric exercises and physical therapy in patients with chronic neck pain. With this scope, 57 male and female patients with chronic neck pain were enrolled in the study, 53 participated the 1 year follow up. Patients were assessed by medical history and clinical examination before entering the study. Paravertebral muscle spasm, pain with motion were recorded. Cervical mobility was assessed with a goniometer on 3 planes (sagittal, frontal and transvers). Neck pain intensity was measured with 10cm visuel analog scale (VAS). Physical impairment in daily activities was assessed with Neck Disability Index (NDI). Depression was evaluated with Beck Depression Inventory. Patients satisfaction from the therapy, global effectiveness of the therapy according to doctor, and amount of analgesics (paracetamol) used by the patients were recorded. 57 patients were randomized into 3 groups ; 17 for Grup I (physical therapy), 20 for Grup II ( physical therapy + isometric and stretching exercises), 20 for Grup III (physical therapy + cervicothoracic stabilization exercises). Patients were assessed before the therapy, after the therapy (3 th week), at 7th week, at 3th months.at 6 th months, at 9 th months and 12 th months. In regarding neck pain, patients in both exercises groups showed statistically significant improvement when compared to physical therapy group at one-year fallow up visit. Among the exercise groups, there was not any statistically significant difference except for the first year control in which the improvement was better in stabilization group. In 3 groups, there were significant improvement in paravertebral muscle spasm; however in physical therapy group, duration and degree of 82this improvement was less than exercise groups. All groups achieved statistically significant increase in ROM measurements. In physical therapy group; significant improvement was detected for the mobility at sagittal plane at 7 th week; for frontal plane at 6 th month; and for transvers plane at 3 th month. In exercise groups; improvement in all planes except for frontal, sustained at 12 th month fallow up visit. Although the improvement in mobility at sagittal and transvers planes was beter in exercise groups than physical therapy group; it was not significant among the exercise groups. In stabilization group mobility at frontal plane; improved beter than other groups which did not have any statistically discernible difference. Among the groups; pain intensity was improved significantly and sustained for 6 months; but at 1st year fallow-up; pain severity got worse in all groups. Disability due to neck pain improved significantly in all visits in stabilization group (p<0.05), However this improvement was not significant and also its duration was shorter in isometric exercise and physical therapy groups. According to beck depression index; we found statistically significant improvement in stabilization group for all visits (p<0.05); however isometric exercise and physical therapy group did not show any significant improvement. Furthermore;in 9 th month and 12 th month there was significant deterioration in physical therapy group (p<0.05) Patient's satisfaction from the therapy was better in exercise groups than phsical therapy group. Global effectiveness of the therapy according to doctor was beter in stabilization group. There was not statistically significant difference between isometric and physical therapy groups. In regarding paracetamol usage, there was no statistically significant difference between the exercise groups, but patients in physical therapy group used analgesics more than that of in exercise groups ( p<0.05). In conclusion, both isometric exercise and stabilization exercises effectively increased ROM measurements, decreased pain, disability, 83depression scores, paravertebral muscle spasm, analgesic usege and pain with neck motion in patients with chronic neck pain. And the stabilization group had achieved considerable and longer effect on these parameters when compered to isometric exercise group. An important practical observation was that long -term benefits could be obtained by training as infrequently as three times a week. 84
8. SUMMARY The aim of this study is to investigate and to compare the efficacy of cervical stabilization exercises, cervical isometric exercises and physical therapy in patients with chronic neck pain. With this scope, 57 male and female patients with chronic neck pain were enrolled in the study, 53 participated the 1 year follow up. Patients were assessed by medical history and clinical examination before entering the study. Paravertebral muscle spasm, pain with motion were recorded. Cervical mobility was assessed with a goniometer on 3 planes (sagittal, frontal and transvers). Neck pain intensity was measured with 10cm visuel analog scale (VAS). Physical impairment in daily activities was assessed with Neck Disability Index (NDI). Depression was evaluated with Beck Depression Inventory. Patients satisfaction from the therapy, global effectiveness of the therapy according to doctor, and amount of analgesics (paracetamol) used by the patients were recorded. 57 patients were randomized into 3 groups ; 17 for Grup I (physical therapy), 20 for Grup II ( physical therapy + isometric and stretching exercises), 20 for Grup III (physical therapy + cervicothoracic stabilization exercises). Patients were assessed before the therapy, after the therapy (3 th week), at 7th week, at 3th months.at 6 th months, at 9 th months and 12 th months. In regarding neck pain, patients in both exercises groups showed statistically significant improvement when compared to physical therapy group at one-year fallow up visit. Among the exercise groups, there was not any statistically significant difference except for the first year control in which the improvement was better in stabilization group. In 3 groups, there were significant improvement in paravertebral muscle spasm; however in physical therapy group, duration and degree of 82this improvement was less than exercise groups. All groups achieved statistically significant increase in ROM measurements. In physical therapy group; significant improvement was detected for the mobility at sagittal plane at 7 th week; for frontal plane at 6 th month; and for transvers plane at 3 th month. In exercise groups; improvement in all planes except for frontal, sustained at 12 th month fallow up visit. Although the improvement in mobility at sagittal and transvers planes was beter in exercise groups than physical therapy group; it was not significant among the exercise groups. In stabilization group mobility at frontal plane; improved beter than other groups which did not have any statistically discernible difference. Among the groups; pain intensity was improved significantly and sustained for 6 months; but at 1st year fallow-up; pain severity got worse in all groups. Disability due to neck pain improved significantly in all visits in stabilization group (p<0.05), However this improvement was not significant and also its duration was shorter in isometric exercise and physical therapy groups. According to beck depression index; we found statistically significant improvement in stabilization group for all visits (p<0.05); however isometric exercise and physical therapy group did not show any significant improvement. Furthermore;in 9 th month and 12 th month there was significant deterioration in physical therapy group (p<0.05) Patient's satisfaction from the therapy was better in exercise groups than phsical therapy group. Global effectiveness of the therapy according to doctor was beter in stabilization group. There was not statistically significant difference between isometric and physical therapy groups. In regarding paracetamol usage, there was no statistically significant difference between the exercise groups, but patients in physical therapy group used analgesics more than that of in exercise groups ( p<0.05). In conclusion, both isometric exercise and stabilization exercises effectively increased ROM measurements, decreased pain, disability, 83depression scores, paravertebral muscle spasm, analgesic usege and pain with neck motion in patients with chronic neck pain. And the stabilization group had achieved considerable and longer effect on these parameters when compered to isometric exercise group. An important practical observation was that long -term benefits could be obtained by training as infrequently as three times a week. 84
Açıklama
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Anahtar Kelimeler
Fiziksel Tıp ve Rehabilitasyon, Physical Medicine and Rehabilitation
