Artroskopik rotator manşet tamiri sonrası hızlı rehabilitasyon protokolü uygulanan hastalarda eklem mobilizasyon uygulamalarının etkinliğinin belirlenmesi
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Tarih
2021
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Hatay Mustafa Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Rotator manşet (RM) yırtıklarının tedavisinde artroskopik tamir sıkça tercih edilmektedir. Tamir sonrası uygulanan rehabilitasyon protokolü immobilizasyon süresi, egzersize başlama zamanı ve uygulama hızına göre farklılık göstermektedir. Yaygın mevcut uygulamayı yansıtan egzersiz kombinasyonu; hızlı rehabilitasyon (HR) protokolüdür. HR protokolü eklem limitasyonlarının azaltılmasına ve günlük aktivitelere erken dönüşe önemli katkı sağlamaktadır. Manuel terapi (MT) yöntemi eklem limitasyonlarında yaygın kullanılan bir metod olsa da plasebo, ilaç grupları ile karşılaştırmalı az sayıda yayın mevcuttur. Bu nedenle çalışmamızda HR protokolünün yanında MT tekniklerinin ağrı, eklem hareket açıklığı (EHA), kas kuvveti ve fonksiyonel aktivite düzeyine etkisininin araştırılması amaçlanmıştır. Çalışmamıza 14 kadın, 10 erkek, yaş aralığı 40-65 yıl olan 24 hasta iki gruba dahil edilmiştir. Her grup için 12 birey randomize olarak belirlenmiştir. Kontrol (HR) ve deney (HR+MT) gruplarına yaygın uygulamayı yansıtan HR protokolü, deney grubuna ilaveten MT uygulanmıştır. Deney grubunda omuz kuşağı eklemlerin tamamına mobilizasyon teknikleri uygulanmıştır. Her iki gruptaki hastalar cerrahi sonrası 1.,3.,6. ve 12. haftalarda Vizüel Analog Skala (VAS), gonyometrik ölçümler, dijital kas kuvvet ölçümleri, Kol, Omuz ve El Sorunları anketi (DASH-T) ile değerlendirilmiştir. Verilerin analizinde Ki-kare, ANOVA ve Mann-Whitney U testleri kullanılmıştır. Yaş ortalamaları HR grubunda 54.25±8.04, HR+MT grubunda 58.25±5.44 yıl idi. Hem HR hem de HR+MT gruplarının kendi içerisinde ağrı, EHA, kas kuvveti ve DASH-T skoru parametrelerinde istatistiksel olarak anlamlı iyileşme gözlenmiştir (p<0,05). HR ve HR+MT grupları arasında 1.,3.,6. ve 12. haftalarda istirahat ve gece ağrısı yönünden anlamlı fark bulunmamıştır (P>0.05). Buna karşın HR+MT grubu lehine 6. haftada "aktivite ağrısında" istatistiksel olarak anlamlı azalma gözlenmiştir (p<0,05). HR ve HR+MT grupları arasında cerrahi sonrası 1.,3.,6.ve 12. haftalarda EHA parametresi yönünden anlamlı fark saptanamamıştır (p>0.05). Post-operatif 12.haftada etkilenen taraf omuz çevre kas kuvvet değerleri açısından gruplar arasında istatiksel fark bulunamamıştır (p>0.05). DASH-T anketine göre gruplar arasında 8. ve 12. haftalarda fark bulunmamıştır (p<0,05). MT uygulamasının sadece 16. haftada DASH-T anketinin günlük yaşam aktivitelerini içeren alt parametresinde sınırlı bir etkisi saptanmıştır (p<0.05). Sonuç olarak artroskopik cerrahi yolu ile tamir yapılan RM hastalarının fizyoterapisinde MT tekniklerinin aktivite ağrısı ve günlük yaşam aktiviteleri üzerine sınırlı bir katkısı olduğu, ancak NEH, istirahat- gece ağrısı ve kas kuvveti parametreleri açısından etkisi olmadığı; diğer bir deyiş ile egzersiz uygulamalarının kliniğe önemli bir katkısı olduğu anlaşılmıştır. Anahtar Sözcükler: Rotator Manşet; Rehabilitasyon; Egzersiz; Manuel Terapi.
Arthroscopic repair is frequently preferred in the treatment of rotator cuff (RC) tears. The rehabilitation protocol applied after the repair varies according to the immobilization time, the time to start the exercise and intervention speed. Combination of exercises reflecting common current practice; early rehabilitation (ER) protocol. The ER protocol makes a significant contribution to reducing joint limitations and early return to daily activities. Although the manual therapy (MT) method is a widely used method in joint limitations, there are few study comparing placebo and drug groups in limited study. Therefore, our study aimed to investigate the effects of MT techniques on pain, range of motion (ROM), muscle strength and functional activity level, in addition to the ER protocol. Twenty-four patients, 14 female, 10 male, aged between 40-65 years, were included in our study. Twelve individuals were randomly assigned to each group. The ER protocol, which reflects the common practice, was applied to the control (ER) and experimental (ER+MT) groups, and MT was applied to the experimental group in addition to it. In the experimental group (ER+MT), manual therapy was applied in addition to the HR protocol. Mobilization techniques were applied to all of the shoulder girdle joints in the experimental group. Patients in both groups assessment with Visual Analogue Scale (VAS), goniometric measurements, digital muscle strength measurements, Arm, Shoulder and Hand Problems Questionnaire (DASH) at 1, 3, 6 and 12 weeks. Chi-square, ANOVA and Mann-Whitney U tests were used in the analysis of the data. The mean age was 54.25±8.04 years in the ER group and 58.25±5.44 years in the ER+MT group. A statistically significant improvement was observed in pain, ROM, muscle strength and DASH-T score parameters in both ER and HR+MT groups (p<0.05). No significant difference was found in terms of resting and nighttime pain between ER and ER+MT groups at 1, 3, 6 and 12 weeks (P>0.05). On the other hand, a statistically significant decrease was observed in "activity pain" at 6 weeks in favor of the HR+MT group (p<0.05). There was no significant difference between the ER and ER+MT groups in terms of ROM parameters at 1, 3, 6 and 12 weeks after surgery (p>0.05). There was no statistical difference between the groups in terms of muscle strength values around the shoulder of the affected side at the post-operative at 12 weeks (p>0.05). According to the DASH-T questionnaire, there was no difference between the groups at 8 and 12 weeks (p<0.05). MT had a limited effect on the sub-parameter of daily living activities of the DASH-T questionnaire only at 16 weeks (p<0.05). In conclusion, MT techniques have a limited contribution to activity pain and activities of daily living in the physiotherapy of RM patients who have undergone repair by arthroscopic surgery, but have no effect on ROM, rest-night pain and muscle strength parameters; In other words, it has been understood that exercise practices have an important contribution to the clinic.
Arthroscopic repair is frequently preferred in the treatment of rotator cuff (RC) tears. The rehabilitation protocol applied after the repair varies according to the immobilization time, the time to start the exercise and intervention speed. Combination of exercises reflecting common current practice; early rehabilitation (ER) protocol. The ER protocol makes a significant contribution to reducing joint limitations and early return to daily activities. Although the manual therapy (MT) method is a widely used method in joint limitations, there are few study comparing placebo and drug groups in limited study. Therefore, our study aimed to investigate the effects of MT techniques on pain, range of motion (ROM), muscle strength and functional activity level, in addition to the ER protocol. Twenty-four patients, 14 female, 10 male, aged between 40-65 years, were included in our study. Twelve individuals were randomly assigned to each group. The ER protocol, which reflects the common practice, was applied to the control (ER) and experimental (ER+MT) groups, and MT was applied to the experimental group in addition to it. In the experimental group (ER+MT), manual therapy was applied in addition to the HR protocol. Mobilization techniques were applied to all of the shoulder girdle joints in the experimental group. Patients in both groups assessment with Visual Analogue Scale (VAS), goniometric measurements, digital muscle strength measurements, Arm, Shoulder and Hand Problems Questionnaire (DASH) at 1, 3, 6 and 12 weeks. Chi-square, ANOVA and Mann-Whitney U tests were used in the analysis of the data. The mean age was 54.25±8.04 years in the ER group and 58.25±5.44 years in the ER+MT group. A statistically significant improvement was observed in pain, ROM, muscle strength and DASH-T score parameters in both ER and HR+MT groups (p<0.05). No significant difference was found in terms of resting and nighttime pain between ER and ER+MT groups at 1, 3, 6 and 12 weeks (P>0.05). On the other hand, a statistically significant decrease was observed in "activity pain" at 6 weeks in favor of the HR+MT group (p<0.05). There was no significant difference between the ER and ER+MT groups in terms of ROM parameters at 1, 3, 6 and 12 weeks after surgery (p>0.05). There was no statistical difference between the groups in terms of muscle strength values around the shoulder of the affected side at the post-operative at 12 weeks (p>0.05). According to the DASH-T questionnaire, there was no difference between the groups at 8 and 12 weeks (p<0.05). MT had a limited effect on the sub-parameter of daily living activities of the DASH-T questionnaire only at 16 weeks (p<0.05). In conclusion, MT techniques have a limited contribution to activity pain and activities of daily living in the physiotherapy of RM patients who have undergone repair by arthroscopic surgery, but have no effect on ROM, rest-night pain and muscle strength parameters; In other words, it has been understood that exercise practices have an important contribution to the clinic.
Açıklama
Anahtar Kelimeler
Fizyoterapi ve Rehabilitasyon, Physiotherapy and Rehabilitation, Rotator Cuff; Rehabilitation; Exercise; Manual Therapy.
