Kronik Radiküler Olmayan Bel Ağrısında Ekstrakorporeal Şok Dalgası Tedavisinin Etkinliği

Abstract

Amaç: Ekstrakorporeal şok dalgası tedavisi (ESWT), kas-iskelet sistemi rahatsızlıklarının tedavisinde faydalı olan yeni ve modern bir fizik tedavi yöntemidir. Bu çalışmada, radyal ESWTt’nin kronik radiküler olmayan bel ağrısında ağrı, engellilik ve depresyon üzerindeki etkinliğini değerlendirmeyi amaçladık.
Gereç ve Yöntemler: Kronik radiküler olmayan bel ağrısı olan 69 hasta çalışmaya dahil edildi ve rESWT (grup 1) veya plasebo (sham) ESWT (grup 2) alacak şekilde iki gruba randomize edildi. Toplam 62 hasta çalışmayı tamamladı; müdahale grubu olan grup 1 (n=30, yaş ortalaması 45,7±10,7 yıl) rESWT ile, kontrol grubu olan grup 2 (n=32, yaş ortalaması 47,0±10,1 yıl) ise plasebo ESWT ile tedavi edildi. Sonuç parametreleri Görsel Analog Skalası (VAS), Oswestry Engellilik İndeksi (ODI) ve Hastane Anksiyete ve Depresyon Ölçeği (HADS) içeriyordu. Değerlendirmeler tedavi öncesinde, tedavi sonrasında ve tedaviyi takiben 1. ayda yapıldı. Bulgular:  Çalışmayı toplam 62 hasta tamamladı (rESWT, n=30; sham ESWT, n=32). Ağrı şiddetindeki azalma rESWT grubunda hem tedavi sonrasında (VAS değişimi: 2,9±1,3'e karşı 1,8±1,4, p=0,002) hem de 1. ay kontrolünde (3,3±1,7'ye karşı 2,3±1,9, p=0,035) anlamlı olarak daha fazlaydı. Fonksiyonel yetersizlikteki iyileşme de rESWT grubunda daha belirgindi (ODI değişimi; tedavi sonrası: 6,5 [4,0-12,0]'ye karşı 2.0 [-2,0-3,5], p<0,001; 1.ay: 8,0 [0,0-12,5]'ye karşı 0,0 [0,0-5,5], p=0,014). Anksiyete skorlarındaki iyileşme tedavi sonrasında rESWT grubunda daha fazla olmasına rağmen (p=0,036), bu fark 1. ayda devam etmedi (p=0,184). Depresyon skorlarındaki değişim açısından ise tedavi sonrası (p=0,994) ve 1. ayda (p=0,177) gruplar arasında anlamlı fark saptanmadı.
Sonuç: rESWT, ağrı ve sakatlığı azaltmada etkili bir müdahale gibi görünmektedir ve plasebo tedavisine kıyasla kısa vadeli sonuçları daha üstündür. Bununla birlikte, anksiyete üzerindeki etkileri geçicidir ve depresyon için ek bir fayda gözlemlenmemiştir. rESWT, bu hasta popülasyonunda ağrı ve fonksiyonu iyileştirmek için güvenli ve etkili bir yardımcı tedavi olarak düşünülebilir.

Keywords

• Bel Ağrısı
• Ekstrakorporeal Şok Dalgası Tedavisi
• Plasebo (Sham) Tedavi
• Ağrı
• Engellilik

Project Number

TABED 2-24-246

Ethical Statement

The ethics committee of Ankara Bilkent City Hospital approved the study on July 10, 2024 (reference number: TABED-2-24-246).

EFFICACY OF EXTRACORPOREAL SHOCK WAVE THERAPY IN CHRONIC NON-RADICULAR LOW BACK PAIN

Abstract

Objective: Extracorporeal shock wave therapy (ESWT) is a modern physical therapy modality used to treat musculoskeletal conditions. In this study, we aimed to assess the effectiveness of radial ESWT on pain, disability and depression in chronic non-radicular low back pain (LBP).
Material and Methods: Sixty-nine patients with chronic nonradicular LBP were included in the study and randomized to two groups: rESWT (group 1) or sham ESWT (group 2). A total of 62 patients completed the study; the intervention group (n=30, mean age of 45.7±10.7 years) received rESWT, and the control group (n=32, mean age of 47.0±10.1 years) received sham ESWT. Outcome parameters included the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Hospital Anxiety and Depression Scale (HADS). The evolutions were made before treatment, after treatment, and 1st month after treatment. 
Results: Sixty-two patients completed the study (rESWT, n=30; sham ESWT, n=32). Pain intensity decreased significantly more in the rESWT group than in the sham group both immediately after treatment (VAS change: 2.9±1.3 vs. 1.8±1.4, p=0.002) and at 1-month follow-up (3.3±1.7 vs. 2.3±1.9, p=0.035). Functional disability also improved significantly more with rESWT (ODI change after treatment: 6.5 [4.0-12.0] vs. 2.0 [-2.0-3.5], p<0.001; at 1 month: 8.0 [0.0-12.5] vs. 0.0 [0.0-5.5], p=0.014). Although anxiety improved more in the rESWT group immediately after treatment (p=0.036), this difference was not maintained at 1 month (p=0.184). No significant between-group differences were observed in depression scores either after treatment (p=0.994) or at 1 month (p=0.177).
Conclusion: rESWT appears to be an effective intervention for reducing pain and disability, with superior short-term outcomes compared to sham treatment. However, its effects on anxiety were transient, and no additional benefit was observed for depression. rESWT may be considered a safe and effective adjunctive 
treatment for improving pain and function in this patient population.

Keywords

• Low Back Pain
• Extracorporeal Shock Wave Therapy
• Sham Therapy
• Pain
• Disability

Project Number

TABED 2-24-246

Ethical Statement

The ethics committee of Ankara Bilkent City Hospital approved the study on July 10, 2024 (reference number: TABED-2-24-246).

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