Kronik boyun ağrılı hastalarda temel vücut farkındalığı terapisi ile konvansiyonel tedavinin ağrı, hareket korkusu ve eklem hareket açıklığı üzerine etkileri

Abstract

Amaç: Kronik boyun ağrısı olan hastalarda Temel Vücut Farkındalığı Terapisi (TVFT) ile Konvansiyonel Tedavinin (KT) ağrı, kinezyofobi ve eklem hareket açıklığı (EHA) üzerine olan etkilerini karşılaştırmaktır.

Yöntem: Çapraz tasarım yapılan çalışmada hastalar, A (n=17) ve B (n=18) grubuna ayrılmıştır. A grubundaki hastalara 6 hafta süresince haftada 2 gün TVFT, B grubundakilere aynı gün ve sürede KT programı uygulanmıştır. 5 haftalık aranın ardından A grubundakilere KT, B grubundakilere TVFT uygulanmıştır. Ağrı; Vizüel Analog Skalasıyla (VAS), kinezyofobisi Tampa Kinezyofobi Ölçeğiyle (TKÖ), servikal EHA; Cervical Range of Motion Deluxe (CROM) cihazıyla değerlendirilmiştir. Değerlendirmeler, birinci ve ikinci tedavinin önce ve sonrasında yapılmıştır.

Bulgular: İlk tedaviler sonrasında aktivite ağrısı şiddeti TVFT alan A grubunda daha düşük bulunmuştur (p=0,024). A grubunda TVFT'nin etkisi sonraki tedaviye yansımıştır (p=0,038). Gruplar arasında ikinci tedavilerden sonra fleksiyon ve sağ rotasyon dereceleri, B grubunda TVFT alan hastalarda daha yüksek bulunmuştur (p<0,05). Grup içi tedaviler sonrası sonuçlar karşılaştırıldığında, A grubunda TVFT sonrasında fleksiyon, sağ-sol lateral fleksiyon ve sol rotasyon dereceleri daha yüksek bulunmuştur (p<0,05).

Tartışma: TVFT, servikal bölgenin aktif EHA üzerinde KT’den daha etkilidir. TVFT'nin aktivite ağrısı üzerindeki etkisi daha uzun sürmektedir. Bununla birlikte her iki tedavinin de ağrı, kinezyofobi ve aktif EHA üzerinde olumlu etkileri vardır.

Keywords

• Boyun ağrısı
• eklem hareket açıklığı
• farkındalık
• Egzersiz

Effects of conventional treatment and basic body awareness therapy on pain, kinesiophobia and joint range of motion in patients with chronic neck pain

Abstract

Purpose: To compare the effects of Basic Body Awareness Therapy (BBAT) and Conventional Therapy (CT) on pain, kinesiophobia and joint range of motion (ROM) in patients with chronic neck pain.

Methods: As a cross-over design, patients were divided into A (n=17) and B (n=18) groups. BBAT program has been implemented two days a week for 6 weeks to patients within group A while group B received the CT program during the same period. After a 5-week interval, group A was treated with CT and group B was treated with BBAT. Pain, kinesiophobia and cervical joint ROM were assessed with Visual Analogue Scale (VAS), Tampa Scale for Kinesiophobia (TSK), Cervical Range of Motion Deluxe (CROM), respectively. The evaluations were conducted before and after the first and second treatment.

Results: After the first treatments, the activity pain level was found to be lower in the A group receiving BBAT (p=0.024). The effect of TVFT in group A was reflected in the subsequent treatment (p=0.038). In comparison of groups after the second treatment, flexion and right rotation degrees were higher in patients receiving BBAT in Group B (p<0.05). When the results of intra-group treatments were compared, flexion, right-left lateral flexion and left rotation degrees were found to be higher in Group A after BBAT (p<0.05).

Conclusion: BBAT is more effective than CT in the active ROM of the cervical region. The effect of TVFT on activity pain lasts longer. Moreover, both treatments have positive effects on pain, kinesiophobia and active ROM.

Keywords

• Neck pain
• Range of motion
• Awareness
• Exercise

References

1. 1. Haldeman S, Carroll L, Cassidy JD. Findings from the bone and joint decade 2000 to 2010 task force on neck pain and its associated disorders. J Occup Environ Med. 2010;52:424-427.
2. 2. Childs JD, Cleland JA, Elliott JM, et al. Neck pain: Clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38:A1-A34.
3. 3. Gallego Izquierdo T, Pecos-Martin D, Lluch Girbes E, et al. Comparison of cranio-cervical flexion training versus cervical proprioception training in patients with chronic neck pain: A randomized controlled clinical trial. J Rehabil Med. 2016;48:48-55.
4. 4. Sjolander P, Michaelson P, Jaric S, et al. Sensorimotor disturbances in chronic neck pain--range of motion, peak velocity, smoothness of movement, and repositioning acuity. Man Ther. 2008;13:122-131.
5. 5. Malmstrom EM, Karlberg M, Melander A, et al. Cervicogenic dizziness - musculoskeletal findings before and after treatment and long-term outcome. Disabil Rehabil. 2007;29:1193-1205.
6. 6. Steilen D, Hauser R, Woldin B, et al. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. Open Orthop J. 2014;8:326-345.
7. 7. Metikaridis TD, Hadjipavlou A, Artemiadis A, et al. Effect of a stress management program on subjects with neck pain: A pilot randomized controlled trial. J Back Musculoskelet Rehabil. 2017;30:23-33.
8. 8. Alpayci M, Ilter S. Isometric Exercise for the Cervical Extensors Can Help Restore Physiological Lordosis and Reduce Neck Pain A Randomized Controlled Trial. Am J Phys Med Rehab. 2017;96:621-626.

9. 9. Oh HT, Hwangbo G. The effect of short-term upper thoracic self-mobilization using a Kaltenborn wedge on pain and cervical dysfunction in patients with neck pain. J Phys Ther Sci. 2018;30:486-489.
10. 10. Li X, Lin C, Liu C, et al. Comparison of the effectiveness of resistance training in women with chronic computer-related neck pain: a randomized controlled study. Int Arch Occup Environ Health. 2017;90:673-683.
11. 11. Jamal AN, Feldman BM, Pullenayegum E. The Use of Neck Support Pillows and Postural Exercises in the Management of Chronic Neck Pain. J Rheumatol. 2016;43:1871-1873.
12. 12. Falla D, Jull G, Russell T, et al. Effect of neck exercise on sitting posture in patients with chronic neck pain. Phys Ther. 2007;87:408-417.
13. 13. Ambolt A, Gard G, Hammarlund CS. Therapeutically efficient components of Basic Body Awareness Therapy as perceived by experienced therapists - A qualitative study. J Bodyw Mov Ther. 2017;21:503-508.
14. 14. Gyllensten AL, Skar L, Miller M, et al. Embodied identity--a deeper understanding of body awareness. Physiother Theory Pract. 2010;26:439-446.
15. 15. Courtois I, Cools F, Calsius J. Effectiveness of body awareness interventions in fibromyalgia and chronic fatigue syndrome: a systematic review and meta-analysis. J Bodyw Mov Ther. 2015;19:35-56.
16. 16. Gard G. Body awareness therapy for patients with fibromyalgia and chronic pain. Disabil Rehabil. 2005;27:725-728.
17. 17. Skjaerven LH, Kristoffersen K, Gard G. An eye for movement quality: a phenomenological study of movement quality reflecting a group of physiotherapists' understanding of the phenomenon. Physiother Theory Pract. 2008;24:13-27.
18. 18. Lindvall MA, Carlsson AA, Forsberg A. Basic Body Awareness Therapy for patients with stroke: Experiences among participating patients and physiotherapists. J Bodyw Mov Ther. 2016;20:83-89.
19. 19. Yagci G, Ayhan C, Yakut Y. Effectiveness of basic body awareness therapy in adolescents with idiopathic scoliosis: A randomized controlled study1. J Back Musculoskelet Rehabil. 2018;31:693-701.
20. 20. Malmgren-Olsson EB, Armelius BA, Armelius K. A comparative outcome study of body awareness therapy, feldenkrais, and conventional physiotherapy for patients with nonspecific musculoskeletal disorders: changes in psychological symptoms, pain, and self-image. Physiotherapy Theory an d Practice. 2001:77-95.
21. 21. Seferiadis A, Ohlin P, Billhult A, et al. Basic body awareness therapy or exercise therapy for the treatment of chronic whiplash associated disorders: a randomized comparative clinical trial. Disabil Rehabil. 2016;38:442-451.
22. 22. Bravo C, Skjaerven LH, Espart A, et al. Basic Body Awareness Therapy in patients suffering from fibromyalgia: A randomized clinical trial. Physiother Theory Pract. 2018:1-11.
23. 23. Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short‐Form McGill Pain Questionnaire (SF‐MPQ), Chronic Pain Grade Scale (CPGS), Short Form‐36 Bodily Pain Scale (SF‐36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care & Research. 2011;63(S11):S240-S252.
24. 24. Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000;85:317-332.
25. 25. Yılmaz ÖT, Yakut Y, Uygur F, et al. Tampa Kinezyofobi Ölçeği’nin Türkçe versiyonu ve test-tekrar test güvenirliği. Fizyoterapi Rehabilitasyon. 2011;22:44-49.
26. 26. Rheault W, Albright B, Beyers C, et al. Intertester reliability of the cervical range of motion device. J Orthop Sports Phys Ther. 1992;15:147-150.
27. 27. Danielsson L, Rosberg S. Opening toward life: experiences of basic body awareness therapy in persons with major depression. Int J Qual Stud Health Well-being. 2015;10:27069.
28. 28. Galindez-Ibarbengoetxea X, Setuain I, Ramirez-Velez R, et al. Short-term effects of manipulative treatment versus a therapeutic home exercise protocol for chronic cervical pain: A randomized clinical trial. J Back Musculoskelet Rehabil. 2018;31:133-145.
29. 29. Caputo GM, Di Bari M, Naranjo Orellana J. Group-based exercise at workplace: short-term effects of neck and shoulder resistance training in video display unit workers with work-related chronic neck pain-a pilot randomized trial. Clin Rheumatol. 2017;36:2325-2333.
30. 30. Hakkinen A, Kautiainen H, Hannonen P, et al. Strength training and stretching versus stretching only in the treatment of patients with chronic neck pain: a randomized one-year follow-up study. Clin Rehabil. 2008;22:592-600.
31. 31. Hoving JL, de Vet HC, Koes BW, et al. Manual therapy, physical therapy, or continued care by the general practitioner for patients with neck pain: long-term results from a pragmatic randomized clinical trial. Clin J Pain. 2006;22:370-377.
32. 32. Chung S, Jeong YG. Effects of the craniocervical flexion and isometric neck exercise compared in patients with chronic neck pain: A randomized controlled trial. Physiother Theory Pract. 2018;34:916-925.
33. 33. Duray M, Simsek S, Altug F, et al. Effect of proprioceptive training on balance in patients with chronic neck pain. Agri. 2018;30:130-137.
34. 34. Lauche R, Wayne PM, Fehr J, et al. Does Postural Awareness Contribute to Exercise-Induced Improvements in Neck Pain Intensity? A Secondary Analysis of a Randomized Controlled Trial Evaluating Tai Chi and Neck Exercises. Spine (Phila Pa 1976). 2017;42:1195-1200.
35. 35. Moseley GL, Flor H. Targeting cortical representations in the treatment of chronic pain: a review. Neurorehabil Neural Repair. 2012;26:646-652.
36. 36. Grande-Alonso M, Moral Saiz B, Minguez Zuazo A, et al. Biobehavioural analysis of the vestibular system and posture control in patients with cervicogenic dizziness. A cross-sectional study. Neurologia. 2018;33:98-106.
37. 37. Taimela S, Takala EP, Asklof T, et al. Active treatment of chronic neck pain: a prospective randomized intervention. Spine (Phila Pa 1976). 2000;25:1021-1027.
38. 38. Bahat HS, Takasaki H, Chen XQ, et al. Cervical kinematic training with and without interactive VR training for chronic neck pain - a randomized clinical trial. Manual Ther. 2015;20:68-78.
39. 39. Ulug N, Yilmaz OT, Kara M, et al. Effects of Pilates and yoga in patients with chronic neck pain: A sonographic study. J Rehabil Med. 2018;50:80-85.