| Popis: |
Uvod: Bolečina v križu je ena najpogostejših zdravstvenih težav v razvitem svetu, ki je povezana z nezmožnostjo, slabšo kvaliteto življenja, čustvenimi težavami in odsotnostjo od dela. Pri večini pacientov se bolečina prekine že v akutni oziroma subakutni fazi, v 2-7% primerov pa napreduje v kronično faze. Za zdravljenje kronične bolečine se najpogosteje uporablja telesna vadba. Stopnjevana aktivnost je oblika telesne aktivnosti pri kateri se izvaja stopnjevan program vadbe s principi operantnega pogojevanja, stopnjevanje pa je časovno opredeljeno. Namen: Namen diplomskega dela je bil sistematično pregledati študije, ki so preučevale učinkovitost protokola stopnjevane aktivnosti pri zdravljenju kronične nespecifične bolečine v križu. Metode dela: V diplomskem delu smo uporabili časovni okvir od leta 2004 in 2015. Literatura je bila iskana v slovenskem, angleškem in italijanskem jeziku s ključnimi besedami: graded activity, graded exercise, graded activity protocol, chronic low back pain, activity grading therapy, physiotherapy. Za iskanje literature smo uporabili spletne podatkovne baze PEDro, Medline, CINAHL, Science direct in Cochrane. Analiziranih je bilo 72 člankov, ki smo jih ocenili po lestvici PEDro. Rezultati: V pregled literature je bilo vključenih 7 študij, 4 so stopnjevano aktivnost primerjale z običajno fizioterapijo, 2 z drugo obliko aktivne vadbe in ena s soočanjem s strahom pred aktivnostjo. Po vseh protokolih vadb se je pacientom zmanjšala bolečina in izboljšala nezmožnost. Rezultati so bili pri vseh meritvah statistično in klinično nepomembni. Poleg tega se je pacientom skrajšal čas bolniškega staleža in zmanjšala stopnja kineziofobije. Rezultati teh dveh merite kažejo na statistično in klinično pomembno prednost stopnjevane aktivnosti. Razprava in zaključek: Rezulatati so pokazali, da stopnjevana aktivnost ni učinkovitejša od drugih vrst terapije pri zmanjševanju bolečine in izboljšanju nezmožnosti. Boljši, tako kratkoročen kot dolgoročen, učinek stopnjevane aktivnosti je opazen pri zmanjšanju kineziofobije in skrajšanju bolniškega staleža. Smiselno bi bilo, da bi fizioterapevt pri izbiri programa terapije upošteval tudi stopnjevano aktivnost, kot obliko terapije, ki je primerna za delovno aktivne paciente in paciente z veliko straha pred aktivnostjo. Introduction: Low back pain is one of the most common health problems in the developed world that is associated with disability, lower quality of life, emotional disorders and absence from work. With most patients the pain resolves in the acute or subacute phase, in 2-7% of cases the pain progresses to the chronic phase. Physical activity is the most commonly used conservative method to treat chronic low back pain. Graded activity is a form of physical activity that consists of a graded exercise programme with operant conditioning principles and is time contingent. Purpose: The purpose of the study was to systematically review articles that studied the effectiveness of graded activity protocol in the treatment of chronic low back pain. Methods: The time frame used in this study was between the years 2004 and 2015. We searched articles in Slovenian, Italian and English with the following key words: graded activity, graded exercise, graded activity protocol, chronic low back pain, activity grading therapy, physiotherapy. A literature search of PEDro, Medline, CINAHL, Science direct and Cochrane databases was conducted to find randomized controlled trials. 72 articles were analyzed and scored on the PEDro scale. Results: 7 articles were included in the literature review, 4 compared graded activity with standard physiotherapy, 2 with others forms of physical activity and one with exposure in vivo. Patients in all treatments groups reported reduction of pain and disability. Results were clinically and statistically insignificant at all stages. Patients also reported lower levels of kinesiophobia and fewer days’ absence off work. These two measurements showed a statistically and clinically significant advantage of the graded activity protocol at all stages. Discussion and conclusion: Results showed that graded activity protocol is not more effective than other forms of treatment on reduction of pain and disability. Graded activity was more effective on the reduction of kinesiophobia. Patients that followed a graded activity protocol also reported fewer days off work. The results show that graded activity protocol should be considered when forming the treatment plan, especially when the patient shows higher level of kinesiophobia or is economically active. |
