Primer Diz Osteoartritinde İzokinetik Egzersiz, Lazer ve Diklofenak İyontoforezi Uygulamalarının Etkilerinin ve Etkinliklerinin Karşılaştırılması

Yıl 2013, Cilt: 15 Sayı: 3, 15 - 21, 01.12.2013

Metin Yavuz Safinaz Ataoğlu Ali Erdem Baki Mustafa Özşahin

Öz

Amaç: Diz osteoartritinin (OA) konservatif tedavisi, farmakolojik tedavi ve farmakolojikolmayan tedavi ana başlıkları altında toplanır. Bu nonfarmokolojik yöntemlerin etkinlikleride yeterince çalışılmamış olmasına rağmen etkileri birbirleriyle hiç karşılaştırılmamıştır. Buçalışmanın amacı da diz OA’lı hastalarda izokinetik egzersiz programı, lazer ve iyontoforezyöntemlerinin ağrı ve fonksiyonel durum üzerine etkileri ve bu etkilerinin birbirlerineüstünlüklerinin olup olmadığını saptamaktır.Materyal ve Metot: Diz OA tanılı, yaşları 40 ile 70 arasında değişen 160 hasta 40’ar kişilikdört gruba randomize edildi. Altı hafta süreyle birinci gruba izokinetik egzersiz, ikinci grubaiyontoforez, üçüncü gruba lazer ve dördüncü gruba (kontrol grubu) psödoiyontoforezuygulandı. Ağrı, hastalık şiddeti, eklem tutukluluğu ve fonksiyonel durumu tedavi öncesi vetedavi sonrası VAS, WOMAC ve Lequesne diz eklem şiddet indeksi ile değerlendirildi.Bulgular: Tedavi sonrası dört grubun da VAS skorlarında (p:0,001) tedavi öncesine göreistatistiksel olarak anlamlı düzeyde azalma saptandı (p

Anahtar Kelimeler

Diz osteoartriti, egzersiz, lazer, iyontoforez, psödoiyontoforez

Compared Effects and Effectiveness in Applications of Isokinetic Exercise, Laser, and Diclophenac Iontophoresis in Primary Osteoarthritis of Knee

Öz

Objective: The conservative therapy of the osteoarthritis (OA) of the knee is classified underthe main headings of pharmacological treatment and non-pharmacological treatment. Theefficacies of different non-pharmacological methods are neither thoroughly studied norcompared to each other. The aim of this study was to evaluate the effects of isokinetic exerciseprogram, the laser therapy, and the iontophoresis method on pain and functional status inpatients with OA of the knee, and to compare and contrast these methods.Material and Method: A total of 160 patients with OA of the knee, between the ages of 40and 70, were randomized into four groups. For a period of six weeks, the first group wastreated with isokinetic exercise, the second group with iontophoresis, the third group withlaser, and the fourth group (control group) with pseudo-iontophoresis. Pain, disease severity,joint stiffness, and functional status were evaluated with the visual analogue scale (VAS),Western Ontario and McMaster Universities Arthritis Index (WOMAC), and the Lequesneknee joint severity index before and after the treatment.Results: After the treatment, the VAS scores of all groups (p = 0.001) decreased significantlycompared to the baseline (p

Anahtar Kelimeler

Knee osteoarthritis, Exercise, Laser, Iontophoresis, Pseudoiontophoresis

Kaynakça

• Akyüz G. Osteoartroz tanımı, sınıflandırması ve epidemiyolojisi, Gökçe-Kutsal Y. (eds.) Fiziksel Tıp ve Rehabilitasyon. Güneş Kitabevi Ltd. Şti, Ankara 2000: 13-18.
• Garnero P, Piperno M, Gineyts E, et al. Cross sectional evaluation of biochemical markers of bone, cartilage, and synovial tissue metabolism in patients with knee osteoarthritis: relations with disease activity and joint damage. Ann Rheum Dis 2001; 60: 619-626.
• Grainger R, Cicuttini FM. Medical management of osteoarthritis of the knee and hip joints. Med J Aus 2004; 180: 232-236.
• McAlindon TE, Cooper C, Kirwan JR, Dieppe PA.. Determinants of disability in osteoarthritis of the knee. Ann Rheum Dis 1993; 52: 258-262.
• Kellgren JH, Lawrence JS. Radiological Assessment of Osteo- Arthritis. Ann Rheum Dis 1957; 16: 494–502.
• Tüzün EH, Eker L, Aytar A, Daşkapan A, Bayramoğlu M. Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index. Osteoarthritis Cartilage 2005; 13: 28-33.
• Lequesne M. Indices of severity and disease activity for osteoarthritis. Semin Arthritis Rheum 1991; 20: 48-54.
• Van Baar ME, Assendelft WJ, Dekker J, Oostendorp RA, Bijlsma JW. Effectiviness of exercise therapy in patients with osteoarthritias of the hip or knee, a systematic review of radomized clinical trials. Arthritis Rheum 1999; 42: 1361- 1369.
• Tan J, Balci N, Sepici V, Gener FA. Isokinetic and isometric strength in osteoarthrosis of the knee. A comperative study with healthy women. Am J Phys Med Rehabil 1995; 74: 364- 369.
• Fisher NM, Pendergast DR, Gresham GE, et al. Muscle rehabilitation: Its effects on muscular and functional performance of patients with knee OA. Arch Phys Med Rehabil 1991; 72: 367-374.
• O'Reilly SC, Jones A, Muir KR, Doherty M.. Quadriceps weakness in knee osteoarthritis: the effect on pain and disability. Ann Rheum Dis 1998; 57: 588-594.
• Slemanda C, Brandt KD, Heilman DK, et al. Quadriceps weakness and osteoarthritis of the knee. Ann Intern Med 1997; 127: 97-104.
• Eyigor S, Hepguler S, Capaci K. A comparison of muscle training methods in patients with knee osteoarthritis. Clin Rheumatol 2004; 23: 109-115.
• Ytterberg SR, Mahowald ML, Krug HE. Exercise for arthritis. Balliers Clin Rheumatol 1994; 8: 161-189.
• Mauer BT, Stern AG, Kinossian B, Cook KD, Schumacher HR Jr. Osteoarthritis of the knee:isokinetic quadriseps exercise versus an educational intervation. Arch Phys Med Rehabil 1999; 80: 1293-1299.
• Henrich WL, Agodaoa LE, Barret B, et al. Analgesics and the kidney: summary and recommendations to the Scientific Advisory Board of the National Kidney Foundation from an Ad Hoc Committee of the National Kidney Foundation. AM J Kidney Dis 1996; 27: 162-165.
• Lievens P. The influence of laser treatment on the lymphatic system and on wound healing. Laser 1988; 1: 6-12.
• Stelian J, Gil I, Habot B, et al. Improvement of pain and disability in elderly patients with degenerative osteoarthritis of the knee treated with narrow-band light therapy. J Am Geriatr Soc 1992; 40: 23-26.
• Taşçıoğlu F, Armağan O, Tabak Y, Corapci I, Oner C. Low power laser treatment in patients with knee osteoarthritis. Swiss Med Wkly 2004; 134: 254-258.
• Yıldırım K, Karatay S, Şisecioğlu M, Uğur M, Şenel K. Diz osteoartritli hastaların tedavisinde iyontoforez ve fonoforez. Türk Fiziksel Tıp ve Reh Derg 2004; 50: 13-16.
• Trnavský K, Fischer M, Vögtle-Junkert U, Schreyger F. Efficacy and safety of 5% ibuprofen cream treatment in knee osteoarthritis. Results of a randomized, double-blind, placebo- controlled study. J Rheumatol 2004; 31: 565-572.
• Niethard FU, Gold MS, Solomon GS, et al. Efficacy of topical diclofenac diethylamine gel in osteoarthritis of the knee. J Rheumatol 2005; 32: 2384-2392.