Diz Osteoartritli Hastalarda Yüksek Yoğunluklu Lazer Terapisinin Ağrı, Fonksiyonellik ve Yaşam Kalitesi Üzerine Etkisi

Öz

Giriş ve Amaç: Osteoartrit; yaşlanmayla birlikte sık görülen dejeneratif hastalıklardan biridir. Bu çalışmanın amacı, diz osteoartritli bireylerde konvansiyonel fizyoterapi programına eklenen yüksek yoğunluklu lazer terapisinin ağrı, fonksiyonellik ve yaşam kalitesi üzerine etkisini araştırmaktı. Gereç ve Yöntemler: Çalışmaya dahil edilme kriterlerini karşılayan diz osteoartrit tanılı 50 hasta dahil edildi. Olgular kontrol ve çalışma olmak üzere iki gruba randomize edildi. Kontrol grubuna (n=25) konvansiyonel fizyoterapi (hotpack, ultrason, tens, vakum enterferansiyel akım, egzersiz); çalışma grubuna (n=25) konvansiyonel fizyoterapi ve yüksek yoğunluklu lazer terapisi uygulandı. Her iki grupta 3 hafta boyunca, haftada 5 seans tedavi aldı. Olgular tedavi öncesi ve sonrası olmak üzere iki kez değerlendirildi. Bu kapsamda ağrı eşiği ölçümü için ‘algometre’, kas kuvveti için ‘myometre’, eklem hareket açıklığı için ‘gonyometre’, yaşam kalitesi için ‘Kısa Form 36 (SF-36)’ ve fonksiyonellik için ‘Western Ontario ve McMaster Üniversiteleri Osteoartrit (WOMAC) İndeksi’ kullanıldı. Bulgular: Tedavi sonrası her iki grubun da ölçülen tüm parametrelerinde anlamlı iyileşme olduğu gözlemlendi (p<0.05). Gruplar arası karşılaştırmada ise anlamlı farklılık bulunmadı (p>0.05). Sonuç: Uygulanan tedavi yöntemlerinden iki grup da fayda gördü fakat tedavilerin etkinliği açısından birbirlerine üstünlüğü olmadığı belirlendi.

Anahtar Kelimeler

• diz osteoartriti
• egzersiz
• fizyoterapi
• laser terapi
• rehabilitasyon

Effect of High Intensity Laser Therapy on Pain, Functionality and Quality of Life in Patients with Knee Osteoarthritis

Öz

Aim: Osteoarthritis is one of the common degenerative diseases associated with aging. The aim of this study is to investigate the effects of high-intensity laser therapy added to a conventional physiotherapy program on pain, functionality and quality of life in individuals with knee osteoarthritis. Method: Fifty patients diagnosed with knee osteoarthritis who met the inclusion criteria were enrolled in the study. The patients were randomized into two groups: a control group and a study group. The control group (n=25) received conventional physiotherapy (hotpack, ultrasound, tens, vacuum interference current, exercise), while the study group (n=25) received both conventional physiotherapy and high-intensity laser therapy. Both groups underwent treatment for 3 weeks, with 5 sessions per week. The cases were evaluated twice, before and after treatment. In this context, ‘algometer’ was used for pain threshold measurement, ‘myometer’ for muscle strength, ‘goniometer’ for joint range of motion, ‘Short Form 36 (SF-36)’ for quality of life and ‘Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index’ for functionality. Results: After treatment, a significant improvement was observed in all measured parameters in both groups (p<0.05). No significant difference was found in the comparison between the groups (p>0.05). Conclusion: Both groups benefited from the applied treatment methods, but there was no superiority of one treatment over the other in terms of effectiveness.

Anahtar Kelimeler

• knee osteoarthritis
• exercise
• physiotherapy
• laser therapy
• rehabilitation

Kaynakça

1. 1. Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393(10182):1745-1759.
2. 2. Busija L, Bridgett L, Williams SR. Osteoarthritis. Best Practice & Research. Clinical Rheumatology. 2010; 24(6):757-768.
3. 3. Uysal FG, Basaran S. Knee osteoarthritis/diz osteoartriti. Turkish Journal of Physical Medicine and Rehabilitation. 2009; 1-8.
4. 4. Spinoso DH, Bellei NC, Marques NR, Navega MT. Quadriceps muscle weakness influences the gait pattern in women with knee osteoarthritis. Advances in Rheumatology. 2018; 58:1-6.
5. 5. Clark GP. Treatment options for symptomatic knee osteoarthritis in adults. JAAPA. 2023; 36(11): 1-6. 6. Amelinda MJ, Eka P, Hartono TE. Current Non-surgical Management of Knee Osteoarthritis. Cureus. 2023; 15(6).
6. 7. Yildiz SK, Ozkan FU, Aktas I, Silte AD, Kaysin MY, Bilgin NB. The effectiveness of ultrasound treatment for the management of knee osteoarthritis: a randomized, placebo-controlled, double-blind study. Turkish Journal of Medical Science. 2015;45(6):1187-1191.
7. 8. Kim ED, Won YH, Park SH, Seo JH, Kim DS, Ko MH, et al. Efficacy and Safety of a Stimulator Using Low‐Intensity Pulsed Ultrasound Combined with Transcutaneous Electrical Nerve Stimulation in Patients with Painful Knee Osteoarthritis. Pain research and management. 2019; (1): 7964897.
8. 9. Nazari A, Moezy A, Nejati P, Mazaherinezhad A. Efficacy of high-intensity laser therapy in comparison with conventional physiotherapy and exercise therapy on pain and function of patients with knee osteoarthritis: a randomized controlled trial with 12-week follow up. Lasers in Medical Science. 2018; 34: 505-516.

9. 10. Wyszyńska J, Bal-Bocheńska M. Efficacy of High-Intensity Laser Therapy in Treating Knee Osteoarthritis: A First Systematic Review. Photomedicine and Laser Surgery. 2018; 36(7): 343-353.
10. 11. Angelova A, Ilieva EM. Effectiveness of High Intensity Laser Therapy for Reduction of Pain in Knee Osteoarthritis. Pain Research and Management. 2016; 9163618.
11. 12. Stiglić-Rogoznica N, Stamenković D, Frlan-Vrgoc L, Avancini-Dobrović V, Vrbanić TS. Analgesic effect of high intensity laser therapy in knee osteoarthritis. Collegium antropologicum. 2011; 35 (2):183-185.
12. 13. Kheshie A, Salaheldien M. High-intensity versus low-level laser therapy in the treatment of patients with knee osteoarthritis: a randomized controlled trial. Lasers in Medical Science. 2014;29:1371-1376.
13. 14. Khalilizad M, Hosseinzade D, Abadi MMA. Efficacy of High-Intensity and Low-Level Laser Therapy Combined With Exercise Therapy on Pain and Function in Knee Osteoarthritis: A Systematic Review and Network Meta-analysis: Laser therapy plus exercise for knee osteoarthritis. Journal of Lasers in Medical Sciences. 2024; 15: e34.
14. 15. Akaltun MS, Altindag O, Turan N, Gursoy S, Gur A. Efficacy of high intensity laser therapy in knee osteoarthritis: a double-blind controlled randomized study. Clinical rheumatology. 2021; 40: 1989-1995.
15. 16. Cai P, Wei X, Wang W, Cai C, Li H. High-intensity laser therapy on pain relief in symptomatic knee osteoarthritis: A systematic review and meta-analysis. Journal of Back and Musculoskeletal Rehabilitation. 2023; 36(5): 1011-1021.
16. 17. Dos Santos RA, Derhon V, Brandalize M, Brandalize D, Rossi LP. Evaluation of knee range of motion: Correlation between measurements using a universal goniometer and a smartphone goniometric application. Journal of Bodywork and Movement Therapies. 2017; 21(3): 699-703.
17. 18. Kinser AM, Sands WA, Stone MH. Reliability and validity of a pressure algometer. The Journal of Strength & Conditioning Research. 2009; 23(1): 312-314.
18. 19. Hébert LJ, Maltais DB, Lepage C, Saulnier J, Crête M, Perron M. Isometric muscle strength in youth assessed by hand-held dynamometry: A feasibility, reliability, and validity study. Pediatric Physical Therapy. 2011; 23(3): 289-299.
19. 20. Tüzün E, Eker L, Aytar A, Daşkapan A, Bayramoğlu M. Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index. Osteoarthritis and cartilage. 2005; 13(1): 28-33.
20. 21. Kaya BB, İçağasıoğlu A. Reliability and validity of the Turkish version of short form 36 (SF-36) in patients with rheumatoid arthritis. Journal of Surgery and Medicine. 2018; 2(1): 11-16.
21. 22. Ciplak ED, Akturk S, Buyukavci R, Ersoy Y. Efficiency of high intensity laser therapy in patients with knee osteoarthritis. Medicine Science. 2018; 7(4): 724-727. 23. Chen HL, Yang FA, Lee TH, Liou TH, Escorpizo R, Chen HC. Effectiveness of interferential current therapy in patients with knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Scientific Reports. 2022; 12(1): 9694. 24. Abdel-Aziem AA, Soliman ES, Mosaad DM, Draz AH. Effect of a physiotherapy rehabilitation program on knee osteoarthritis in patients with different pain intensities. Journal of Physical Therapy Science. 2018; 30(2):307-312.
22. 25. Sifta P, Danilov D. Effects of high-intensity laser on gonarthrosis. Energy Health. 2015; 14: 18-22.
23. 26. Ekici B, Ordahan B. Evaluation of the effect of high-intensity laser therapy (HILT) on function, muscle strength, range of motion, pain level, and femoral cartilage thickness in knee osteoarthritis: randomized controlled study. Lasers in Medical Science. 2023; 38(1): 218.
24. 27. Poenaru D, Sandulescu MI, Potcovaru CG, Cinteza D. High-Intensity Laser Therapy in Pain Management of Knee Osteoarthritis. Biomedicines. 2024; 12(8): 1679.