LOMBER SPİNAL STENOZLU OLGULARDA FİZİK TEDAVİ VE EGZERSİZ PROGRAMININ KLİNİK BULGULAR, FONKSİYONEL DURUM VE ÖZÜRLÜLÜK ÜZERİNE ETKİSİ

Lomber spinal stenozlu LSS hastalarda fizik tedavi ve fleksiyon egzersizlerinin ağrı, ağrısız yürüme mesafesi, fonksiyonel durum ve özürlülük üzerine etkilerini araştırmak. LSS tanısı konulan 50 hasta randomize olarak iki gruba ayrıldı. Grup 1’deki hastalara fizik tedavi ultrason, TENS ve infraruj 3 hafta süre ile haftada 5 seans ile fleksiyon egzersizleri, grup 2’deki hastalara ise sadece fleksiyon egzersizleri verildi. Üçüncü haftanın sonunda fizik tedavi programı sonlandırıldı ve tüm hastaların egzersiz programına 5 hafta süre ile devam etmeleri önerildi. Hastalar; tedavi öncesi, 3. hafta 1. kontrol ve 8. hafta sonunda 2. kontrol istirahatte ağrı VAS , ağrısız yürüme mesafesi yürüme bandı egzersiz tolerans testi , fonksiyonel durum ve özürlülük İsviçre Spinal Stenoz Anketi, Oxford Spinal Stenoz Skoru ve Oswestry Dizabilite İndeksi açısından değerlendirildi. Grup 1’deki hastaların ağrı düzeylerinde tedavi öncesine göre kontrollerde anlamlı düzelme saptanırken p0.05 . Gruplar arası karşılaştırmada ise ağrı düzeyleri açısından iki grup arasında grup 1 lehine anlamlı farklılık saptandı p

Anahtar Kelimeler:

Lomber spinal stenoz, fizik tedavi, egzersiz

THE EFFECTS OF PHYSICAL THERAPY AND EXERCISE PROGRAM ON CLINICAL FINDINGS, FUNCTIONAL STATUS AND DISABILITY IN PATIENTS WITH LUMBAR SPINAL STENOSIS

To investigate the effects of physical therapy and flexion exercises on pain, walking distance without pain WDP , functional status and disability in patients with lumbar spinal stenosis LSS . Fifty patients who had LSS diagnosis were randomized into two groups. The patients in Group I received physical therapy ultrasound, TENS, and infrared for 5 sessions a week, during three weeks and performed flexion exercises whereas those in Group 2 only performed flexion exercises. At the end of the third week, the physical therapy program was terminated and all patients were recommended to continue the exercise program for 5 weeks. The patients were evaluated in terms of rest pain VAS , WDP treadmill exercise tolerance test , functional status, and disability Swiss Spinal Stenosis Questionnaire, Oxford Spinal Stenosis Score, Oswestry Disability Index before the treatment, in the 3rd weeks 1st control , and at the end of the 8th weeks 2nd control . For the pain levels of the patients in Group 1, significant improvement was detected in the controls compared to pre-treatment p0.05 . For the inter-group comparisons, significant difference was found between two groups regarding to pain level p

Keywords:

Lumbar spinal stenosis, physical therapy, exercise,

PDF

___

) Shabat S, Leitner Y, Nyska M, Berner Y, Fredman B, Gepstein R. Surgical treatment of lumbar spinal stenosis in patients aged 65 years and older. Arch Gerontol Geriatr 2002; 35:143-52.
) Onel D, Sari H, Donmez C. Lumbar spinal stenosis
evaluation in145 patients. Conservative treatment or surgical intervention? Spine 1993; 18: 291–98.
therapeutic 3) Watters WC 3rd, Baisden J, Gilbert TJ, Kreiner S, Resnick DK, Bono CM, et al. North American Spine Society. Degenerative lumbar spinal stenosis: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis. Spine J 2008; 8:305-10.
) Miyamoto M, Genbum Y, Ito H. Diagnosis and treatment of lumbar spinal canal stenosis. J Nippon Med Sch 2002; 69:583-7.
) Fritz JM, Delitto A, Welch WC, Erhard RE. 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.
) Bodack MP, Monteiro M. Therapeutic exercise in the treatment of patients with lumbar spinal stenosis. Clin Orthop Relat Res 2001; 384:144-52.
) Yuan PS, Booth RE Jr, Albert TJ. Nonsurgical and surgical management of lumbar spinal stenosis. Instr Course Lect 2005; 54:303-12.
) Theodoridis T, Krämer J, Kleinert H. Conservative treatment of lumbar spinal stenosis -a review. Z Orthop Unfall 2008; 146:75-9.
) EdizL, HızO, Toprak M, Tekeoğlu İ, Yazmalar L. Comparison of the efficacies of two different physical therapy treatment programs in patients with lumbar spinal stenosis. Sakarya Med J 2011; 1: 59-63.
) Akyol Y, Durmuş D, Alaylı G, Tander B, Ulus Y, Cantürk F. Lomber spinal stenozlu hastalarda fizik tedavi ajanlarının etkinliği. Türk Fiz Tıp Rehab Derg 2009; 55:141-6.
) Smorgick Y, Mirovsky Y, Rand N. Degenerative lumbar spinal stenosis-review of the current diagnosis and treatment. Harefuah 2005; 144:279-84.
) Deen HG, Zimmerman RS, Lyons MK, McPhee MC, Verheijde JL, Lemens SM. Use of the exercise treadmill to measure baseline functional status and surgical outcome in patients with severe lumbar spinal stenosis. Spine 1998; 23:244-8.
)Deen HG Jr, Zimmerman RS, Lyons MK, McPhee MC, Verheijde JL, Lemens SM. Measurement of exercise tolerance on the treadmill in patients with symptomatic lumbar spinal stenosis: a useful indicator of functional status and surgical outcome. J Neurosurg 1995; 83:27-30.
)Stucki G, Daltroy L, Liang MH, Lipson SJ, Fossel AH, Katz JN. Measurement properties of a self-administered outcome measure in lumbar spinal stenosis. Spine 1996; 21:796- 803.
) Pratt RK, Fairbank JC, 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.
) Yakut E, Düger T, Oksüz C, Yörükan S, Ureten K, Turan D, et al. Validation of the Turkish version of the Oswestry Disability Index for patients with low back pain. Spine 2004; 29:581-5.
) Tadokoro K, Miyamoto H, Sumi M, Shimomura T. The prognosis of conservative treatments for lumbar spinal stenosis: analysis of patients over 70 years of age. Spine 2005; 30:2458-63.
) 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.
) Chang Y, Singer DE, Wu YA, Keller RB, Atlas SJ. The effect of surgical and nonsurgical
outcomes of lumbar spinal stenosis over 10 years. J Am Geriatr Soc 2005; 53:785-92.
) Bresnahan BW, Rundell SD, Dagadakis MC, Sullivan SD, Jarvik JG, Nguyen H, et al. A systematic review to assess comparative effectiveness studies in epidural steroid injections for lumbar spinal stenosis and to estimate reimbursement amounts. PM R 2013;5:705-14. 22) exercise.
Philadelphia, FA Davis Company, 1985; pp. 191-2. and techniques. 23)
program: exercise effective againts back pain. J Musculosceletal Med 1987; 4:62-74. 24)
Variables associated with outcomes of physical therapy for patients with lumbar spinal stenosis. J Orthop Sports Phys Ther 2005; 35: A14.
) Michlovitz SL, Wolf SL. Thermal agents in rehabilitation. Philadelphia, FA Davis Company, 1986. 26)
Findikoglu G, Ardic F. Efficacy of exercise and ultrasound in patients with lumbar spinal stenosis: a prospective randomized controlled trial. Clin Rehabil 2010; 24:623-31.
Yazının alınma tarihi:21.01.12014
Kabül tarihi:12.02.2014
Online basım:15.02.2014