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ORIJINAL ARAŞTIRMA

Başarısız Bel Cerrahisi Sendromunda Fizik Tedavi ve Kor Stabilizasyon Egzersizlerinin Etkisi
The Effect of Physical Therapy and Core Stabilization Exercises in Failed Back Surgery Syndrome
Received Date : 18 May 2021
Accepted Date : 17 Nov 2021
Available Online : 02 Dec 2021
Doi: 10.31609/jpmrs.2021-84534 - Makale Dili: EN
J PMR Sci. 2022;25(1):89-99
ÖZET
Amaç: Başarısız bel cerrahisi sendromu (BBCS), görülme sıklığı gittikçe artan önemli bir medikal ve sosyoekonomik durumdur. Çalışmamızın amacı, BBCS hastalarında lomber kor stabilizasyon egzersizleriyle kombine edilen transkutanöz elektriksel sinir stimülasyonu [transcutaneous electrical nerve stimulation (TENS)] ve “hotpack” tedavisinin; ağrı, fonksiyon ve yaşam kalitesi üzerine etkisini araştırmaktır. Gereç ve Yöntemler: Çalışmaya geçirilmiş lomber omurga ameliyatı sonrası devam eden sırt ve/veya bacak ağrısı şikâyeti olan 50 hasta dâhil edildi. Hastalar, rastgele sayılar tablosu kullanılarak 2 gruba ayrıldı. Grup 1’de lomber bölgeye TENS ve “hot-pack” uygulanarak toplam 20 seans lomber kor stabilizasyon egzersizleri yapıldı. Kontrol grubunda (Grup 2), hastalar yukarıdaki terapi veya egzersiz programlarından hiçbirini almadı. Kontrol grubundaki hastalar, etik kurul kararı ile bekleme listesine alındı. Çalışma bitiminde bu hastalara aynı tedavi uygulandı. Tüm hastalar, çalışma başlangıcından önce ve 4 ve 12 hafta sonra vizüel analog skala (VAS), Oswestry Özürlülük İndeksi (Oswestry Disability İndex (ODİ), Kısa Form-36 [Short Form- 36 (SF-36)] ile değerlendirildi. Bulgular: İki grubun karşılaştırılmasında, Grup 1’de VAS ve ODİ parametrelerinde hem 4 (p<0,001) hem de 12. (VAS p<0,001-ODİ p=0,004) haftada önemli ölçüde daha iyi gelişme saptandı. SF-36 alt parametrelerinde ise 4. haftada fiziksel rol, sosyal işlevsellik, duygusal rol ve zihinsel sağlık dışındaki parametrelerde ve 12. haftada duygusal rol, akıl sağlığı ve zihinsel bileşen hariç tüm parametrelerde Grup 1’de iyileşme daha iyi olarak gözlendi. Sonuç: Çalışmamızın sonuçları, BBCS’li hastalarda fizik tedavi ve kor stabilizasyon egzersizlerinin ağrı, fonksiyonel durum ve yaşam kalitesi üzerinde olumlu etkilerinin olduğunu göstermiştir.
ABSTRACT
Objective: Failed back surgery syndrome (FBSS) has risen steadily worldwide, it has become an important medical and socioeconomic problem. The purpose of our study was to investigate the effect of a combination of lumbar core stabilization exercises, transcutaneous electrical nerve stimulation (TENS) and hot-pack application on pain, function, and quality of life in FBSS patients. Material and Methods: Fifty patients with the complaint of back and/or leg pain that persisted after previous lumbar spine surgery were included in the study. The patiets were divided into 2 groups using the random numbers table. In Group 1, TENS and hot-pack were applied over the lumbar region and performed lumbar stabilization exercises, for a total of 20 sessions. In the control group (Group 2), the patients received none of the above therapy or exercise program. Patients in the control group were placed on the waiting list because of the ethics commitee desicion. At the end of the study, the same treatment was applied to these patients. All patients were evaluated with visual analogue scale (VAS), Oswestry Disability Index (ODI), Short Form-36 (SF-36) before, and 4 and 12 weeks after the start of the study. Results: Comparison of the 2 groups showed significantly better improvement in Group 1 for the parameters of VAS and ODI and both at 4th (p<0.001) and 12th (VAS p<0.001-ODI p=0.004) weeks. As for the SF-36 sub parameters; improvement was superior in Group 1 for all but physical role, social functionality, emotional role, and mental health at 4 weeks, and for all but emotional role, mental health, and mental component at 12 weeks. Conclusion: The results of our study showed that physical therapy and core stabilization exercises have positive effects on pain, functional status and quality of life in patients with BBCS.
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