NİLGÜN BEK, İBRAHİM ENGİN ŞİMŞEK, SUAT EREL, YAVUZ YAKUT, Fatma UYGUR

Home-based general versus center-based selective rehabilitation in patients with posterior tibial tendon dysfunction

Amaç: Çalışmamızın amacı 1 ila 3. evre arası tibialis posterior tendon disfonksiyonu (TPTD) olan hastalarda, ev egzersiz programı ile fizyoterapist denetiminde uygulanan rehabilitasyon programının etkinliğini karşılaştırmaktı. Çalışma planı: Çalışmaya TPTD tanısı konarak ortopedi uzmanı tarafından fizyoterapi departmanına yönlendirilmiş 49 olgu katıldı. Olgular rastgele ev egzersiz programı (21 olgu; ortalama yaş: 33.56±17.59) ve fizyoterapist denetiminde rehabilitasyon (28 olgu; ortalama yaş: 28.57±14.74) gruplarına alındı. Ev egzersizi grubuna soğuk uygulaması, tibialis posterior ve intrinsik kaslar için kuvvetlendirme egzersizleri ve subtalar nötralde germe egzersizi içeren bir ev programı verildi. Fizyoterapist denetimindeki gruba, ev programına ek olarak, fonksiyonel olmayan tibialis posterior kasının yeniden eğitimini içeren teknikler kapsamında, proprioseptif nöromusküler fasilitasyon yöntemleri, elektrik stimülasyonu, eklem mobilizasyonu ve bantlama tekniklerini içeren tedavi protokolü uygulandı. Her iki gruptaki olgulara da problemlerine uygun spesifik ortezler verildi. Olguların tümü, tedavi öncesi ve sonrası ağrı, kas kuvvetleri, ayak fonksiyon indeksi (AFİ) ve TPTD’ye özel testler açısından değerlendirildi. Bulgular: İstatistiksel analizler sonucunda, fizyoterapist denetimli grupta, olguların ağrı, 1. metatarsofalangeal açı, ön ayak abdüksiyon açısı, AFİ skoru ve tüm kasların kuvveti gibi göstergeler açısından ve ev egzersizi grubunda da tibialis posterior kas kuvveti açısından, tedavi öncesi ve sonraki ölçümleri istatistiksel olarak anlamlı fark göstermekteydi (p0.05). Çıkarımlar: 1 ila 3. evre arası TPTD tanısı alan hastalar için, ev programı olarak uygulanan ve fizyoterapist denetimindeki iki yaklaşımın da ağrının azaltılması ve fonksiyonelliğin geliştirilmesi konusunda eşit derecede tatmin edici olduğu görülmüştür. Hastanın spesifik gereksinimleri gözetilerek hazırlanmış, fizyoterapist denetimindeki bir program, tibialis posterior gücü açısından, evde gerçekleştirilecek bir rehabilitasyondan daha etkili olabilir.

Tibialis posterior tendon disfonksiyonunda ev egzersiz programı ve fizyoterapist denetimli rehabilitasyonun karşılaştırılması

Objective: The aim of this study was to compare the effect of home-based and supervised center-based selective rehabilitation in patients with Grade 1 to 3 posterior tibial tendon dysfunction (PTTD). Methods: The study included 49 subjects diagnosed with PTTD and referred to physiotherapy by an orthopedic surgeon. Subjects were randomly assigned into a home-based rehabilitation (21 cases; mean age: 33.56±17.59) group or center-based rehabilitation (28 cases; mean age: 28.57±14.74 years). The patients in the home-based rehabilitation group followed a home program of cold application, strengthening exercises for the posterior tibial and intrinsic muscles, and stretching in the subtalar neutral position. The patients in the center-based rehabilitation group followed a selective, supervised treatment consisting of the home protocol plus re-education of the non-functional tibialis posterior, proprioceptive neuromuscular facilitation methods, electrical stimulation, joint mobilization and taping techniques. Both groups received appropriate orthotics. All subjects were assessed before and after treatment for pain, muscle strength, foot function index (FFI) scores and specific tests for PTTD. Results: Statistical analysis showed significant differences between pre- and post-treatment results for pain, first metatarsophalangeal angle, forefoot abduction angle, FFI scores and foot and ankle muscle strengths in the center-based group and for the tibialis posterior muscle strength in the home-based group (p<0.05). Intergroup comparison, however, showed no differences between the groups at the end of the treatment program with the exception of posterior tibial muscle strength (p<0.05). Conclusion: Home- and center-based forms of rehabilitation seem to be equally effective in relieving pain and improving functional outcome in patients with Grade 1 to 3 PTTD. A patient-selective, supervised program may provide a better improvement in tibialis posterior strength than home-based rehabilitation.

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