Mekanik özellikte kronik bel ağrısı olan hastaların tedavisinde bel ağrısı okulu programının etkinliği

Abstract

Amaç: Bu araştırma mekanik özellikte kronik bel ağrısı olan hastaların tedavisinde bel ağrısı okulu programının etkinliğini araştırmayı amaçlamaktadır. Hastalar ve Yöntem: Kronik mekanik bel ağrısı tanısı konulan 59 hasta (35 kadın, 24 erkek) iki gruba ayrıldı. Her iki gruba üç hafta (15 seans) sıcak paket, konvansiyonel transkutanöz elektriksel sinir stimülasyonu (TENS), terapotik ultrason uygulamalarıyla birlikte Williams ve mobilizasyon egzersizlerinden oluşan geleneksel fizik tedavi programı uygulandı. 1. gruba dahil edilen hastalara bu tedavi yöntemine ek olarak bel ağrısı okulu eğitimi verildi. Hastaların ağrısı (Görsel Analog Skala), depresyon (Beck Depresyon Ölçeği) ve fonksiyonel yetersizlik (Oswestry Sorgulama Formu) düzeyleri tedavi öncesi, sonrası ve tedavi bitiminden 4 hafta sonra değerlendirildi. Bulgular: Bel ağrısı okulu eğitimi verilen grubun ağrı skorları tedavi sonrası ve takip değerlendirmelerinde anlamlı düzeyde azaldı (p=0,000). Depresyon skorları her iki grupta da istatistiksel olarak anlamlı değişiklik göstermedi. Fonksiyonel yetersizlik düzeyi bel okulu eğitimi verilen grupta gelişme gösterdi (p=0,000). Takip değerlendirmesinde ağrı ve fonksiyonellik bakımından bel ağrısı okulu grubu daha üstün sonuçlara sahipti. Sonuç: Kronik mekanik bel ağrılı hastaların tedavisinde geleneksel fizik tedavi uygulamalarına ek olarak bel ağrısı okulu eğitimi verilmesi özellikle uzun dönemde ağrı ve fonksiyonelliğin iyileşmesinde olumlu etkiler sağlamaktadır.

Keywords

• Bel ağrısı okulu,Fizik tedavi,Kronik bel ağrısı

Efficiency of back pain-school program in the treatment of patients with chronic mechanical back pain

Abstract

Objective: The aim of the study was to investigate the efficiency of back pain-school programs in the treatment of patients with chronic mechanical back pain. Patients and Methods: Fifty nine (35 females, 24 males) patients diagnosed with chronic mechanical back pain were divided into two groups. Both groups received traditional physical therapy consisting of hot pack, conventional transcutaneous electrical nerve stimulation (TENS), therapeutic ultrasound, Williams and mobilization exercises for three weeks (15 sessions). Patients in the 1st group received back pain-school program in addition. Patients were evaluated for pain (Visual Analogue Scale), depression (Beck Depression Scale) and functional disability (Oswestry Disability Index) before, after and 4 weeks after the treatment. Results: Pain scores were significantly reduced after treatment and in the follow up assessments (p=0.000) in the back painschool group. The depression scores did not differ significantly in both groups. Functional disability improved in the back painschool group (p=0.000). The back pain-school group had superior results in pain and function scores in the follow up assessment. Conclusion: Attending the back pain-school program in addition to traditional physical therapy in the management of patients with chronic back pain has positive effects on improving pain and function, especially in the long term.

Keywords

• Back pain-school,Physical therapy,Chronic back pain

References

1. 1. Rapoport J, Jacobs P, Bell NR, Klarenbach S. Refining the measurement of the economic burden of chronic diseases in Canada. Chronic Dis Can 2004;25:13-21.
2. 2. Cabot WD, Miller JL, Kelley JF. An algorithm for conservative back care. Pain Digest 1994;4:269-75.
3. 3. Loney PL, Stratford PW. The prevalence of low back pain in adults: a methodological review of the literature. Phys Ther 1999;79:384-96.
4. 4. Borenstein DG, Wiesel SW, Boden SD. Clinical evaluation of low back pain. In: Waldman S D, editor. Low Back Pain. Medical Diagnosis and Comprehensive Management. 2nd ed. Philadelphia: WB Saunders Company, 1995: 63-182.
5. 5. Altinel L, Köse KC, Ergan V, et al. The prevalence of low back pain and risk factors among adult population in Afyon region, Turkey. Acta Orthop Traumatol Turc 2008;42:328-33.
6. 6. Kinkade S. Evaluation and treatment of acute low back pain. Am Fam Physician 2007;75:1181-8.
7. 7. Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: estimates from US national surveys 2002. Spine 2006;31:2724–7. doi: 10.1097/01.brs.0000244618.06877.cd
8. 8. Celiker R. Kronik ağrı sendromları. Türk Fiz Tıp Rehab Derg 2005; 51(özel ek): B14-18.

9. 9. Vällfors B. Acute, subacute and chronic low back pain: clinical symptoms, absenteeism and working environment. Scand J Rehabil Med 1985;11:1-98.
10. 10. McGuirk B, King W, Govind J, Lowry J, Bogduk N. The safety, efficacy, and cost-effectiveness of evidence-based guidelines for the management of acute low back pain in primary care. Spine 2001;26:2615-22.
11. 11. Bogduk N, McGuirk B. Medical management of acute and chronic low back pain: an evidence-based approach. Amsterdam: Elsevier, 2002. doi: 10.1093/occmed/kql102
12. 12. Nachemson A, Jonsson E. Neck and back pain: the scientific evidence of causes, diagnosis, and treatment. Philadelphia: Lippincott Williams and Wilkins, 2000.
13. 13. DeLisa JA. (çeviri editörü Arasıl T.) Fiziksel Tıp ve Rehabilitasyon İlkeler ve Uygulamalar. 4.baskı. Ankara: Güneş Tıp Kitabevi, 2007: 653-75.
14. 14. Özcan E. Bel ağrılı hastaların konservatif tedavisi. İçinde: Özcan E, Ketenci A, editörler. Bel Ağrısı: Tanı ve Tedavi. İstanbul: Nobel Kitabevi, 2002: 187-219.
15. 15. Andersson GBJ. Back schools. In: Jayson MIV, editor. The lumbar spine and back pain. UK: Churchill Livingstone, 1987: 315-20.
16. 16. Hazneci B. Bel ağrılarının rehabilitasyonu ve bel okulu. İçinde: Harmankaya Ç, editör. Bel Ağrıları. Ankara: GATA Basımevi, 2002:79-89.
17. 17. Ketenci A. Bel okulları. Türk Fiz Tıp Rehab Derg 1998;Mayıs Özel Sayı:60-3.
18. 18. Boonstra AM, Schiphorst Preuper HR, Reneman MF, Posthumus JB, Stewart RE. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. Int J Rehabil Res 2008;31:165-9. doi: 10.1097/MRR.0b013e3282fc0f93
19. 19. Ehrlich GE, Khaltaev NG. Low back pain initiative. Department of Noncommunicable Disease Management. Geneva: World Health Organization, 1999.
20. 20. Hisli N. Beck depresyon envanterinin geçerliği üzerine bir çalışma. Psikoloji Dergisi 1988;6:118-26.
21. 21. Fritz JM, Irrgang JJA. Comparison of a Modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale. Phys Ther 2001; 81:776-88.
22. 22. Düğer T, Yakut E, Öksüz C, et al. Doğrulama, bel ağrısı olan hastalar için Oswestry Engellilik İndeksi Türkçe versiyonu. Spine 2004; 29:581-5.
23. 23. van Tulder MW, Goossens M, Waddell G, Nachemson A. Conservative treatment of chronic low back pain. In: Nachemson A, Jonsson E, editors. Neck and Back Pain: The Scientific Evidence of Causes, Diagnosis, and Treatment. Philadelphia: Lippincott, Williams and Wilkins, 2000: 271-304.
24. 24. van Tulder MW, Scholten RJPM, Koes BW, Deyo RA. Nonsteroidal anti-inflammatory drugs for low back pain. A systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine 2000;25:2501-13.
25. 25. Moulin DE, Iezzi A, Amireh R, Sharpe WK, Boyd D, Merskey H. Randomised trial of oral morphine for chronic non-cancer pain. Lancet 1996;347:143-7. doi:10.1016/S0140-6736(96)90339-6
26. 26. Assendelft WJJ, Morton SC, Yu EI, et al. Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies. Ann Intern Med 2003;138:871-81. doi:10.7326/0003-4819- 138-11-200306030-00008
27. 27. van Tulder M, Malmivaara A, Esmail R, Koes B. Exercise therapy for low back pain. A systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine 2000;21:2784-96.
28. 28. Guzman J, Esmail R, Karjalainen K, Malmivaara A, Irvin E, Bombardier C. Multidisciplinary rehabilitation for chronic back pain: systematic review. BMJ 2001;322:1511-16.
29. 29. Tavafian SS, Jamshidi A, Mohammad K, Montazeri A. Low back pain education and short term quality of life: a randomized trial. BMC Musculoskelet Disord 2007;28:8-21. doi:10.1186/1471-2474-8-21
30. 30. Klaber Moffet JA, Chase M, Portek I, Ennis JR. A controlled, prospective study to evaluate the effectiveness of a back school in the relief of chronic low back pain. Spine 1986;11:120-2.
31. 31. Maul I, Laubli T, Oliveri M, Krueger H. Long-term effects of supervised physical training in secondary prevention of low back pain. Eur Spine J 2005;4:599–611. doi: 10.1007/s00586-004-0873-3
32. 32. Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database Syst Rev 2004;18:CD000261. doi: 10.1002/14651858.CD000261
33. 33. van Tulder MW, Koes BW, Bouter LM. Conservative treatment of acute and chronic nonspesific low back pain. A systematic review of randomized controlled trials of the most common interventions. Spine 1997;22:2128-56.
34. 34. Şahin F, Parlar D, Merdol F, Durlanık G, Kuran B. Radiküler ve nonradiküler kronik bel ağrılı hastalarda bel okulu etkinliğinin karşılaştırılması. Turk Fiz Tıp ve Reh 2001; 47:6-11.
35. 35. Ribeiro LH, Jennings F, Jones A, Furtado R, Natour J. Effectiveness of a back school program in low back pain. Clin Exp Rheumatol 2008;26:81-8.
36. 26. Ehrlich GE. Back pain. J Rheumatol Supp. 2003; 67:26-31.