BibTex RIS Kaynak Göster

Comparison of the efficacies of two different Physical Therapy Treatment Programs in Patients With Lumbar Spinal Stenosis.

Yıl 2011, Cilt: 1 Sayı: 2, 59 - 63, 01.06.2011
https://doi.org/10.5505/sakaryamj.2011.65375

Öz

Aim: To assess the effectiveness of therapeutic exercises and TENS alone and in combination with ultrasound in patients with lumbar spinal stenosis.Materials and Methods: In this randomized, prospective, controlled clinical trial which performed in Department of Physical Medicine and Rehabilitation, University Hospital, fourty-eight patients presenting with symptoms of neurological claudication and magnetic resonance image-proven lumbar spinal stenosis were randomized to one of two 6-week (30 sessions, 5 session each week) physical therapy programs. One program included exercise+TENS group (group 1, n=24), while the other included exercise+TENS plus ultrasound (group 2, n=24). Stretching and strengthening exercises for lumbar, abdominal, leg muscles were given as therapeutic exercises. TENS was applied countinously with 80 MHz frequency for 30 minutes. Ultrasound was applied with 1 mHz, 1.5W/cm2 intensity, in continuous mode on the back muscle for 10 minutes in group 2. Recovery was evaluated by Oswestry, a numerical pain rating scale (VAS), and a treadmill walking test. Testing occurred at baseline, 6 weeks, and 3 month.Results: Statistically significant improvements were found in all of the post-treatment parameters (the leg pain score, Oswestry Disability Index score, treadmill walking distance) in both groups compared with the pre-treatment values in 6-weeks and 3-month follow-up evaluations (P < 0.05), Improvements in disability, satisfaction, VAS favored the exercise, TENS and US group at all follow-up points.Conclusion: The results of our study suggest that patients with lumbar spinal stenosis can benefit from physical therapy. Therapeutic exercises and TENS are effective for pain and disability in patients with lumbar spinal stenosis and that addition of ultrasound to exercise therapy and TENS may further improve recovery outcome measures in these patients.

Kaynakça

  • Miyamoto M, Genbum Y, Ito H. Diagnosis and treatment of lumbar spinal canal stenosis. J Nipon Med Sch 2002;69:583-7.
  • Fritz JM, Delitto A, Welch WC, et al. Lumbar spinal stenosis: a review of current concepts in evaluation, management, and outcome measurements. Arch Phys Med Rehabil 1998;79:700-8.
  • Porter RW. Spinal stenosis and neurogenic claudication. Spine 1996;21:2046-52.
  • Katz J, Lipson S, Chang L, et al. Seven to 10 year outcome of decompressive surgery for degenerative lumbar spinal stenosis. Spine 1996;21:92-8.
  • Tuite GF, Doran SE, Stern JD, et al. Outcome after laminectomy for lumbar spinal stenosis: II. Radiographic changes and clinical correlations. J Neurosurg 1994;81:707-15.
  • Johnsson KE, Uden A, Rosen I. The effect of decompression on the natural course of spinal stenosis: a comparison of surgically treated and untreated patients. Spine 1991;16:615-9.
  • Bodack M, Monteiro M. Therapeutic exercise in the treatment of patients with lumbar spinal stenosis. Clin Orthop Relat Res 2001:384:144-52.
  • Reindl R, Steffen T, Cohen L, et al. Elective lumbar spinal decompression in the elderly: is it a high-risk operation? Can J Surg 2003;46:43-6.
  • Whitman JM, Flynn TW, Childs JD et al. A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis. Spine 2006;31:2541-49.
  • Swezey RL. Outcome for lumbar spinal stenosis: a 5-year follow-up study. J Clin Rheumatol 1996;2:129-34.
  • Simotas AC, Dorey FJ, Hansraj KK, Cammisa F. Nonoperative treatment for lumbar spinal stenosis: clinical outcome results and 3-year survivorship analysis. Spine 2000;25:197-204.
  • Fritz JM, Erhard RE, Vignovic M. A nonsurgical treatment approach to patients with lumbar spinal stenosis. Phys Ther 1997;77:962-73.
  • Atlas SJ, Deyo RA, Keller RB et al. The Maine lumbar spine study, Part III: 1-year outcomes of surgical and nonsurgical management of lumbar spinal stenosis. Spine 1996;21:1787-94.
  • Atlas SJ, Keller RB, Wu AY, Deyo RA, Singer DE. Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the maine lumbar spine study. Spine 2005;30:936-43.
  • Fairbank JC, Couper J, Davies JB, O’Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy 1980;66:271-73.
  • Pratt RK, Fairbank JCT, Virr A. The reliability of the shuttle walking test, the Swiss spinal stenosis questionnaire, the Oxford Spinal Stenosis Score, and the Oswestry Disability Index in the assessment of patients with lumbar spinal stenosis. Spine 2002;27:84-91.
  • Fritz JM, Erhard RE, Delitto A, Welch WC, Nowakowski PE.Preliminary results of the use of a two-stage treadmill test as a clinical diagnostic tool in the differential diagnosis of lumbar spinal stenosis. J Spinal Disord 1997;10:410-6.
  • Swezey RL. Outcome for lumbar spinal stenosis: a 5-year follow-up study. J Clin Rheumatol 1996;2:129-34.
  • Atlas SJ, Deyo RA, Keller RB et al. The Maine lumbar spine study, Part III: 1-year outcomes of surgical and nonsurgical management of lumbar spinal stenosis. Spine 1996;21:1787-94.
  • Tadokoro K, Miyamoto H, Sumi M, Shimomura T. The prognosis of conservative treatments for lumbar spinal stenosis. Spine 2005;30:2458-63.
  • Pua YH, Cai CC, Lim KC. Treadmill walking with body weight support is no more effective than cycling when added to an exercise program for lumbar spinal stenosis: a randomised controlled trial. Aust J Physiother 2007;53:83-89.
  • Onel D, Sari H, Donmez C. Lumbar spinal stenosis: clinical/radiologic therapeutic evaluation in 145 patients. Conservative treatment or surgical intervention? Spine 1993;18:291-98.
  • Pua YH, Cai CC, Lim KC. Treadmill walking with body weight support is no more effective than cycling when added to an exercise program for lumbar spinal stenosis: a randomised controlled trial. Aust J Physiother 2007;53:83-89.
  • Athiviraham A, Yen D. Is spinal stenosis beter treated surgically or nonsurgically? Clin Orthop Relat Res 2007;458:90-93.
  • Hunter SJ, Fritz JM, Brennan GP. Variables associated with outcomes of physical therapy for patients with lumbar spinal stenosis. J Orthop Sports Phys Ther 2005;35:A14.
  • Creighton DS, Krauss J, Marcoux B. Management of lumbar spinal stenosis through the use of translatoric manipulation and lumbar flexion exercises: a case series. J Manual Manip Ther 2006; 14:E1–E10.
  • Pua YH, Cai CC, Lim KC. Treadmill walking with body weight support is no more effective than cycling when added to an exercise program for lumbar spinal stenosis: a randomised controlled trial. Aust J Physiother 2007;53:83-89.
  • Bodack MP, Monteiro M. Therapeutic exercise in the treatment of patients with lumbar spinal stenosis. Clin Orthop Relat Res 2001;384:144-52.
  • Shabat S, Folman Y, Leitner Y, Fredman B, Gepstein R. Failure of conservative treatment for lumbar spinal stenosis in elderly patients. Arch Gerontol Geriatr 2007;44:235-41.

Lumbar spinal stenozlu hastalarda iki farklı fizik tedavi programının etkinliklerinin karşılaştırılması.

Yıl 2011, Cilt: 1 Sayı: 2, 59 - 63, 01.06.2011
https://doi.org/10.5505/sakaryamj.2011.65375

Öz

Amaç: Lumbar spinal stenozlu hastalarda yalnızca terapötik egzersizler ve TENS ile birlikte US kombinasyonunun lumbar spinal stenozlu hastalarda etkinliğinin tespit edilmesi Materyal ve metod: Üniversite hastanesi, Fiziksel tıp ve rhabilitasyon bölümünde yapılan bu randomize, prospektif, controllü klinik çalışmada, nörolojik kladikasyo semptomlu ve MRI ile ispatlı lumbar spinal stenozlu 48 hasta iki 6 haftalık (30 seans, her hafta 5 seans) fizik tedavi programından birine randomize edildiler. Bir program egzersiz+TENS grubunu içerir iken (grup 1, n=24) diğeri egzersiz+TENS ek olarak ultrason grubunu içerdi (grup 2, n=24). Bel, karın, bacak kasları için germe ve güçlendirme egzersizleri terapötik egzersiz olarak verildi. TENS sürekli, 80 MHz frekansta 30 dakika süre ile uygulandı. Grup 2 ye ultrason 1 mHz, 1.5W/cm2 yoğunlukta, sürekli modda 10 dk. süre ile bel kaslarına uygulandı. İyileşme Oswestry, nümerik bir ağrı oranlama skalası (VAS), ve Treadmill yürüme testi kullanılarak değerlendirildi. Değerlendirme testleri başlangıçta, 6. haftada ve 3. ayda yapıldı.Bulgular: Tüm tedavi parametrelerinde (bacak ağrısı puanı, Oswestry Engellilik Endeksi puanı, koşu bandı yürüme mesafesi) 6. hafta ve 3 aylık takip değerlendirmelerinde tedavi öncesi değerlerle karşılaştırıldığında her iki grupta da istatistiksel olarak anlamlı gelişmeler, bulundu (P < 0.05), Disabilite, memnuniyet, VAS taki gelişmeler tüm takip noktalarında egzersiz,TENS ve US grubundan yanaydı.Sonuç: Çalışmamızın sonuçları lomber spinal stenozlu hastaların fizik tedaviden yarar sağlayabileceklerini düşündürmektedir. Terapötik egzersizler ve TENS ağrı ve disabilite için lomber spinal stenozlu hastlarda etkilidir ve ultrasonun, egzersiz ve TENS tedavisine eklenmesi bu hastalarda tedavi takip parametrelerini dahada geliştirebilir.

Kaynakça

  • Miyamoto M, Genbum Y, Ito H. Diagnosis and treatment of lumbar spinal canal stenosis. J Nipon Med Sch 2002;69:583-7.
  • Fritz JM, Delitto A, Welch WC, et al. Lumbar spinal stenosis: a review of current concepts in evaluation, management, and outcome measurements. Arch Phys Med Rehabil 1998;79:700-8.
  • Porter RW. Spinal stenosis and neurogenic claudication. Spine 1996;21:2046-52.
  • Katz J, Lipson S, Chang L, et al. Seven to 10 year outcome of decompressive surgery for degenerative lumbar spinal stenosis. Spine 1996;21:92-8.
  • Tuite GF, Doran SE, Stern JD, et al. Outcome after laminectomy for lumbar spinal stenosis: II. Radiographic changes and clinical correlations. J Neurosurg 1994;81:707-15.
  • Johnsson KE, Uden A, Rosen I. The effect of decompression on the natural course of spinal stenosis: a comparison of surgically treated and untreated patients. Spine 1991;16:615-9.
  • Bodack M, Monteiro M. Therapeutic exercise in the treatment of patients with lumbar spinal stenosis. Clin Orthop Relat Res 2001:384:144-52.
  • Reindl R, Steffen T, Cohen L, et al. Elective lumbar spinal decompression in the elderly: is it a high-risk operation? Can J Surg 2003;46:43-6.
  • Whitman JM, Flynn TW, Childs JD et al. A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis. Spine 2006;31:2541-49.
  • Swezey RL. Outcome for lumbar spinal stenosis: a 5-year follow-up study. J Clin Rheumatol 1996;2:129-34.
  • Simotas AC, Dorey FJ, Hansraj KK, Cammisa F. Nonoperative treatment for lumbar spinal stenosis: clinical outcome results and 3-year survivorship analysis. Spine 2000;25:197-204.
  • Fritz JM, Erhard RE, Vignovic M. A nonsurgical treatment approach to patients with lumbar spinal stenosis. Phys Ther 1997;77:962-73.
  • Atlas SJ, Deyo RA, Keller RB et al. The Maine lumbar spine study, Part III: 1-year outcomes of surgical and nonsurgical management of lumbar spinal stenosis. Spine 1996;21:1787-94.
  • Atlas SJ, Keller RB, Wu AY, Deyo RA, Singer DE. Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the maine lumbar spine study. Spine 2005;30:936-43.
  • Fairbank JC, Couper J, Davies JB, O’Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy 1980;66:271-73.
  • Pratt RK, Fairbank JCT, Virr A. The reliability of the shuttle walking test, the Swiss spinal stenosis questionnaire, the Oxford Spinal Stenosis Score, and the Oswestry Disability Index in the assessment of patients with lumbar spinal stenosis. Spine 2002;27:84-91.
  • Fritz JM, Erhard RE, Delitto A, Welch WC, Nowakowski PE.Preliminary results of the use of a two-stage treadmill test as a clinical diagnostic tool in the differential diagnosis of lumbar spinal stenosis. J Spinal Disord 1997;10:410-6.
  • Swezey RL. Outcome for lumbar spinal stenosis: a 5-year follow-up study. J Clin Rheumatol 1996;2:129-34.
  • Atlas SJ, Deyo RA, Keller RB et al. The Maine lumbar spine study, Part III: 1-year outcomes of surgical and nonsurgical management of lumbar spinal stenosis. Spine 1996;21:1787-94.
  • Tadokoro K, Miyamoto H, Sumi M, Shimomura T. The prognosis of conservative treatments for lumbar spinal stenosis. Spine 2005;30:2458-63.
  • Pua YH, Cai CC, Lim KC. Treadmill walking with body weight support is no more effective than cycling when added to an exercise program for lumbar spinal stenosis: a randomised controlled trial. Aust J Physiother 2007;53:83-89.
  • Onel D, Sari H, Donmez C. Lumbar spinal stenosis: clinical/radiologic therapeutic evaluation in 145 patients. Conservative treatment or surgical intervention? Spine 1993;18:291-98.
  • Pua YH, Cai CC, Lim KC. Treadmill walking with body weight support is no more effective than cycling when added to an exercise program for lumbar spinal stenosis: a randomised controlled trial. Aust J Physiother 2007;53:83-89.
  • Athiviraham A, Yen D. Is spinal stenosis beter treated surgically or nonsurgically? Clin Orthop Relat Res 2007;458:90-93.
  • Hunter SJ, Fritz JM, Brennan GP. Variables associated with outcomes of physical therapy for patients with lumbar spinal stenosis. J Orthop Sports Phys Ther 2005;35:A14.
  • Creighton DS, Krauss J, Marcoux B. Management of lumbar spinal stenosis through the use of translatoric manipulation and lumbar flexion exercises: a case series. J Manual Manip Ther 2006; 14:E1–E10.
  • Pua YH, Cai CC, Lim KC. Treadmill walking with body weight support is no more effective than cycling when added to an exercise program for lumbar spinal stenosis: a randomised controlled trial. Aust J Physiother 2007;53:83-89.
  • Bodack MP, Monteiro M. Therapeutic exercise in the treatment of patients with lumbar spinal stenosis. Clin Orthop Relat Res 2001;384:144-52.
  • Shabat S, Folman Y, Leitner Y, Fredman B, Gepstein R. Failure of conservative treatment for lumbar spinal stenosis in elderly patients. Arch Gerontol Geriatr 2007;44:235-41.
Toplam 29 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Makaleler
Yazarlar

Levent Ediz Bu kişi benim

Ozcan Hiz Bu kişi benim

Murat Toprak Bu kişi benim

İbrahim Tekeoğlu Bu kişi benim

Levent Yazmalar Bu kişi benim

Yayımlanma Tarihi 1 Haziran 2011
Gönderilme Tarihi 7 Eylül 2015
Yayımlandığı Sayı Yıl 2011 Cilt: 1 Sayı: 2

Kaynak Göster

AMA Ediz L, Hiz O, Toprak M, Tekeoğlu İ, Yazmalar L. Lumbar spinal stenozlu hastalarda iki farklı fizik tedavi programının etkinliklerinin karşılaştırılması. Sakarya Tıp Dergisi. Haziran 2011;1(2):59-63. doi:10.5505/sakaryamj.2011.65375

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