Omuz İmpingment Sendromlu Hastalarda Rehabilitasyon Protokolüne Eklenen Ayna Terapisi ile İlgili Sonuçlar: Prospektif Randomize Kontrollü Çalışma

Öz

Ayna tedavisi, etkilenen ekstremitenin fonksiyonelliğini artıran ve kronik ağrıların tedavisinde etkili olan bir yöntemdir. Bu çalışmada ayna tedavisinin omuz impingment sendromu üzerine etkisini araştırmayı amaçladık. Çalışma grubunda 31, kontrol grubunda 31 olmak üzere dahil edilme kriterlerine uygun 62 hasta çalışmaya dahil edildi. Çalışma grubu geleneksel fizyoterapi ve ayna tedavisi alırken, kontrol grubu yalnızca geleneksel fizyoterapi aldı. Hastalar tedaviden önce ve tedaviden hemen sonra ağrı için Vizuel Analog Skala (VAS) skoru, omuz eklem hareket açıklığı için goniometrik ölçüm, fonksiyonellik için modifiye Constant-Murley skorlaması ve kinezyofobi için Tampa Kinezyofobi Skalası (TSK) ile değerlendirildi. Tedavi sonrası VAS skorundaki değişiklik çalışma grubu için 5.51 ± 1.89, kontrol grubu için 2.80 ± 2.61 ve anlamlılık p<0.01 idi. TSK skorundaki değişim çalışma grubu için 10.83 ± 9.53 ve kontrol grubu için 1.66 ± 4.85 idi (p<0.01). Toplam Constant-Murley skorundaki değişim çalışma grubu için 23.77 ± 11.41 ve kontrol grubu için 9.60 ± 9.70 idi ve anlamlılık p<0.01 olarak hesaplandı. Bu çalışma, tek taraflı omuz impingment sendromu olan hastalarda geleneksel tedaviye ayna tedavisinin eklenmesinin ağrı şiddetini, fonksiyonelliğini ve kinezyofobi düzeylerini iyileştirebileceğini göstermiştir. İmpingment sendromunda ağrı ile birlikte hareket korkusunun azalması ayna terapinin daha önce uygulanmadığı farklı hastalıkların tedavisinde de kullanılabileceğini göstermiştir.

Anahtar Kelimeler

• Omuz impingment sendromu
• ayna terapisi
• ağrı
• kinezyofobi

Outcomes with Additional Mirror Theraphy to Rehabilitation Protocol in Patients with Shoulder Impingement Syndrome: A Prospective Randomized Controlled Study

Öz

Mirror therapy is a method that increases the functionality of the affected extremity and is effective in the treatment of chronic pain. In this study, we aimed to investigate the effect of mirror therapy on shoulder impingement syndrome. The study included 62 participants, including 31 in the intervention group (IG) and 31 in the control group (CG) who met the inclusion criteria. IG received mirror therapy with conventional physiotherapy while CG received only conventional physiotherapy. The patients were evaluated before treatment and immediately after treatment with Visual Analog Scale (VAS) score for pain, goniometric measurement for shoulder range of motion, modified Constant-Murley score for functionality, and Tampa Kinesiophobia Scale (TSK) for kinesiophobia. After treatment, the change in the VAS score was 5.51 ± 1.89 for IG, 2.80 ± 2.61 for CG, and the significance was p<0.01. The change in the TSK score was 10.83 ± 9.53 for IG and 1.66 ± 4.85 for CG (p<0.01). The change in the total Constant-Murley score was 23.77 ± 11.41 for IG and 9.60 ± 9.70 for CG, and the significance was calculated as p<0.01. This study showed that the addition of mirror therapy to conventional treatment can improve pain severity, functionality, and levels of kinesiophobia in patients with unilateral shoulder impingement syndrome. The decrease in fear of movement along with pain in impingement syndrome has shown that mirror theraphy can be used in the treatment of different diseases for which it has not been used before.

Anahtar Kelimeler

• Shoulder impingement syndrome
• mirror therapy
• pain
• kinesiophobia

Kaynakça

1. 1. Umer M, Qadir I, Azam M. Subacromial impingement syndrome Orthop. Rev.2012;4:e18. doi: 10.408.
2. 2. Michener LA, McClure PW, Karduna AR. Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clin Biomech.2003;18:369-79.
3. 3. Harrison AK, Flatow EL. Subacromial impingement syndrome. JAAOS. 2011;19:701-8.
4. 4. Steuri R, Sattelmayer M., Elsig S, et al. Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: A systematic review and meta-analysis of RCTs. BJSM.2017;51:1340-7.
5. 5. Dong W, Goost H, Lin XB, et al. Treatments for shoulder impingement syndrome: A PRISMA systematic review and network meta-analysis. Medicine 2015;94:e510.
6. 6. Ramachandran VS, Rogers-Ramachandran D, Cobb S. Touching the phantom limb. Nature 1995;377:489-90.
7. 7. Ramachandran VS, Altschuler EL. The use of visual feedback, in particular mirror visual feedback, in restoring brain function. Brain. 2009;132:1693-710.
8. 8. Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health.1990;13:227-36.

9. 9. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res.1987;214: 160-4.
10. 10. Celik, D. Turkish version of the modified Constant-Murley score and standardized test protocol:reliability and validity. Acta Orthop Traumatol Turc. 2016;50:69-75. 11. Yilmaz ÖT, Yakut Y, Uygur F et al. Tampa Kinezyofobi Ölçeği’nin Türkçe versiyonu ve test-tekrar test güvenirliği. Fiz. Rehabil. 2011; 22: 44-9.
11. 12. Başkaya MC, Ercalık C, Kır OK, et al. The efficacy of mirror therapy in patients with adhesive capsulitis: A randomized, prospective, controlled study. J Back Musculoskelet Rehabil.2018; 31:1177–82.
12. 13. Thieme H, Morkisch N, Rietz C, et al. The Efficacy of Movement Representation Techniques for Treatment of Limb Pain-A Systematic Review and Meta-Analysis. J Pain. 2016;17:167-80.
13. 14. Mc Cabe C. Mirror visual feedback theraphy. A practical approach. J Hand Ther. 2011;24:170-8.
14. 15. Louw A, Puentedura EJ, Reese D, et al. Immediate Effects of Mirror Therapy in Patients With Shoulder Pain and Decreased Range of Motion. Arch. Phys. Med. Rehabil. 2017;98:1941-7.
15. 16. Namdari S, Yagnik G, Ebaugh DD, et al. Defining functional shoulder range of motion for activities of Daily living. JSES. 2012;21:1177-83.
16. 17. Oosterwijk AM, Nieuwenhuis MK, Schouten HJ, et al. Rating scales for shoulder and elbow range of motion impairment: Call for a functional approach. Plos One. 2018;13:e0200710.
17. 18. Doğan M, Koçak M, Kılınç ÖO, et al. Functional range of motion in the upper extremity and trunk joints: Nine functional everyday tasks with inertial sensors. Gait and Posture 2019;70:141-7.
18. 19. Thoomes-de Graaf M, Scholten-Peeters G, Schellingerhout JM, et al. Evaluation of measurement properties of self-administered PROMs aimed at patients with non-specific shoulder pain and “activity limitations”: a systematic review Qual Life Res. 2016;25:2141-60.
19. 20. Gur A, Oktayoglu P. Central nervous system abnormalities in fibromyalgia and chronic fatigue syndrome: new concepts in treatment Curr. Pharm. Des. 2008;14:1274-94. 21. Sanchis MN, Lluch E, Nijs J, et al. The role of central sensitization in shoulder pain: A systematic literature review. Semin. Arthritis Rheum. 2015;44: 710-6.
20. 22. Schaible HG, Grubb BD. Afferent and spinal mechanisms of joint pain. Pain 1993; 55: 5-54.
21. 23. Saha S, Sur M, Chaudhuri GR, et al. Effects of mirror therapy on oedema,pain and functional activities in patients with post stroke shoulder‐hand syndrome:A randomized controlled trial. Physiother. Res. Int. 2021;26:e1902.
22. 24. Lentz TA, Barabas JA, Day T, et al. The relationship of pain intensity, physical impairment, and pain-related fear to function in patients with shoulder pathology. J Orthop Sports Phys Ther.2009;39:270-7.