Levent Ediz, Ozcan Hiz, Murat Toprak, İbrahim Tekeoğlu, Levent Yazmalar

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

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.

Anahtar Kelimeler:

Lumbar spinal stenoz, Fizik tedavi, Rehabilitasyon, Ultrason, TENS, Terapötik egzersizler

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

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.

Keywords:

Lumbar spinal stenosis, Physical therapy, Rehabilitation, Ultrasound, TENS, Therapeutic exercises.,

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