Klinička efikasnost programa vežbi lumbalne stabilizacije i torakalne mobilizacije u sanaciji hroničnog lumbalnog bola

Autor: Kostadinović Stefan
Jazyk: srbština
Rok vydání: 2019
Předmět:
Druh dokumentu: Diplomová práce
Popis: Uvod: Individualno kreiran program vežbi lumbalne stabilizacije, mogao bi da doprinese boljem oporavku pacijenata sa hroničnim bolom u donjem delu leđa. Program vežbi u lečenju hroničnog lumbalnog bola je prilično raznolik, ali je dokazano da su vežbe stabilizacije najefikasnije, posebno vežbe u zatvorenom kinetičkom lancu. Cilj: je bio da se uporedi program vežbi lumbalne stabilizacije u otvorenom i zatvorenom kinetičkom lancu, u odnosu na program vežbi lumbalne stabilizacije i torakalne mobilizacije u zatvorenom kinetičkom lancu kao i da se proceni klinička efikasnost oba programa vežbi. Metode: Istraživanje je sprovedeno kao prospektivna, eksperimentalna studija na 80 ispitanika oba pola (35 muškaraca, 45 žena), prosečne životne dobi (48.45+/- 10.22 godina) sa hroničnim lumbalnim bolom. Istraživanje je sprovedeno na Klinici za rehabilitaciju „dr Miroslav Zotović“ u Beogradu u periodu od juna 2017. do marta 2018. godine. Ispitanici su podeljeni u dve grupe od 40 pacijenata. Prva grupa ispitanika je sprovodila program vežbi lumbalne stabilizacije i torakalne mobilizacije u zatvorenom kinetičkom lancu (LSTMZ), a druga program vežbi lumbalne stabilizacije u zatvorenom i otvorenom kinetičkom lancu (LSZO). Pored opštih demografskih, antropometrijskih podataka o ispitanicima, korišćeni su sledeći upitnici i testovi: za procenu intenziteta bola u leđima i donjim ekstremitetima- vizuelna analogna skala (VAS), za procenu neuropatske komponente bola- DN4 (Douleur Neuropathique en 4 Questions), za procenu funkcionalnog statusa korišćen je Osvestrijev upitnik o onesposobljenosti (ODI), procena sagitalne pokretljivosti lumbosakralne kičme Schober testom, procena mišićne snage - manuelnim mišićnom testom; Ispitivanje senzitivnosti na ključnim senzornim tačkama za dermatome je vršeno prema ASIA (American Spinal Injury Association) skali, testom istezanja ishiadičnog (Lazarevićev) i femoralnog nerva ispitivano je prisustvo kompresije nervnih korenova, za procenu stabilnosti lumbosakralne kičme- je korišćen test nestabilnosti u proniranom položaju (Prone Instability test). Ispitanici su ergonomski edukovani, sprovedena je transkutana elektro-nervna stimulacija (TENS) i primenjivana je laseroterapija male snage. Pacijentima je određena osmonedeljna kineziterapija koja je obuhvatala vežbe za jačanje dubokih stabilizatora lumbalne kičme. Retestiranje je rađeno nakon 4 i 8 nedelja. Rezultati: Kod obe grupe ispitanika u svim intervalima merenja je nađena visoka statistički značajna (p< 0,001) redukcija intenziteta bola prema VAS skali za lumbalnu kičmu i donje ekstremitete,   poboljšanje funkcionalnog statusa (Oswestry) i sagitalne pokretljivosti (Schober). Statistički značajan (p
Introduction: An individual program of lumbar stabilization exercises could contribute to a better recovery of patients with chronic lower back pain. The exercise program in the treatment of chronic lumbar pain is quite diverse, but it has been proven that stabilization exercises are most effective, especially in a closed kinetic chain. Objective: was to compare the program of lumbar stabilization exercises in the open and closed kinetic chain, in relation to the program of lumbar stabilization exercises and thoracic mobilization in a closed kinetic chain, and to evaluate the clinical efficacy of both exercise programs. Methods: The study was conducted as a prospective, experimental study of 80 subjects of both sexes (35 men, 45 women), average life expectancy (48.45 +/- 10.22 years) with chronic lumbar pain. The research was conducted at the Rehabilitation Clinic "Dr. Miroslav Zotović" in Belgrade in the period from June 2017 to March 2018. Respondents were divided into two groups of 40 patients. The first group of respondents carried out a lumbar stabilization and thoracic mobilization program in a closed kinetic chain (LSTMZ) and the second, program of lumbar stabilization exercises in closed and open kinetic chain (LSZO). In addition to general demographic, anthropometric data on respondents, the following questionnaires and tests were used: for assessing the intensity of back pain and lower extremities - visual analogue scale (VAS), for assessing the neuropathic pain component DN4 (Douleur Neuropathique en 4 Questions),  for functional status assessment was used Oswestry disability index (ODI), for assessment of sagittal mobility of the lumbosacral spine- Schober test, muscular strength assessment - manual muscle test; Sensitivity testing at key sensory points for dermatomas was performed according to the ASIA (American Spinal Injury Association) scale, stretching test of the ishiadic (Lazarević) and femoral nerves was udes for detection of nerve root irritation, and the Prone Instability test was used to assess the stability of the lumbosacral spine. Respondents were ergonomically educated, transcutaneous electrical-nerve stimulation (TENS) and low-power laser therapy were performed. Patients were given an eight-week kinesiotherapy that included exercises to strengthen the deep lumbar spine stabilizers. Retesting was done after 4 and 8 weeks. Results: In both groups of subjects, high statistically significant (p
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