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ORIJINAL ARAŞTIRMA

Transkutanöz Elektrik Sinir Stimülasyonu ve İnterferansiyel Akımın Kombine Tedavisinin Kronik Bel Ağrısına Etkisi: Randomize, Çift Kör, Sham Kontrollü Çalışma
The Effectiveness of Combined Transcutaneous Electrical Nerve Stimulation and Interferential Current Therapy on Chronic Low Back Pain: A Randomized, Double-Blind, Sham-Controlled Study
Received Date : 17 Sep 2019
Accepted Date : 09 Dec 2019
Available Online : 19 Dec 2019
Doi: 10.31609/jpmrs.2019-71464 - Makale Dili: EN
J PMR Sci. 2020;23(1):32-40
ÖZET
Amaç: Transkütanöz elektriksel sinir stimülasyonu (TENS) ve interferansiyel akım (IF) ile ilgili birçok elektroterapi çalışmalar bulunmaktadır, fakat bunların hiçbiri sinerjistik etkilerini incelememiştir. Bu araştırmada, TENS ve IF'nin kronik bel ağrısını azaltmadaki etkinliğini değerlendirmek amaçlandı. Gereç ve Yöntemler: Bu çift kör, plasebo kontrollü çalışmada toplam 123 hasta bilgisayar yöntemi kullanılarak dört gruba ayrıldı. Grup 1 TENS, Grup 2 IF, Grup 3 kombine TENS ve IFT ve Grup 4 sham olarak haftada beş kez 3 hafta boyunca tedavi aldılar. Tüm katılımcılar ayrıca sıcak paket tedavisi aldılar. Lomber hareket aralığı (EHA) inkilinometre ve modifiye Schober testi ile değerlendirildi. Aktivite sırasındaki ağrı ise hasta ve doktorun global görsel analog skalası (VAS) birlikte kullanılarak değerlendirildi. Fonksiyonel kapasiteyi belirlemek için Rolland- Morris Engellilik Anketi (RMEA) uygulandı.Bulgular: Grup 1, 2 ve 3 anlamlı düzelme gösterirken, Grup 4’te hiçbir düzelme gözlenmedi (p˂0,001). Grup 3 için değerlendirilen RMEA, hasta ve doktor global ağrı skorları Grup 2'den daha üstündü (p˂0,001). Sonuç: Kombine TENS ve IF tedavisi, kronik bel ağrılı hastalarda fonksiyonel seviyeyi arttırmada ve aktivite sırasındaki ağrıyı azaltmada IF'den daha etkiliydi, ancak sadece TENS tedavisinden daha üstün bulunmadı. Bu çalışma bize, farklı uygulama sıklıkları ve modları ile uygulanacak olan kombine TENS / IF tedavisi veya diğer kombine tedavilerle ilgili gelecekteki araştırmalara bir öngörü sunabilmektedir.
ABSTRACT
Objective: There are some electrotherapy studies regarding transcutaneous electrical nerve stimulation (TENS) and interferential current therapy (IFT), but none have examined their synergistic effects. This investigation was performed to assess the effectiveness of TENS/IFT in relieving chronic low back pain (LBP). Material and Methods: In this double-blind, placebo-controlled study, a total of 123 patients were divided into four groups using a computer method. Group 1 received TENS, Group 2 IFT, Group 3 combined TENS/IFT, and Group 4 sham TENS/IFT five times a week for 3 weeks. All participants also received hotpack therapy. Lumbar range of motion (ROM) was assessed via an inclinometer and the modified Schober test, and pain during activity was evaluated using a Visual Analog Scale (VAS) along with patient and physician global assessments. The Rolland-Morris Disability Questionnaire (RMDQ) was administered to determine functional capacity. Results: Groups 1, 2, and 3 showed significant improvement, but Group 4 showed none (p˂0.001). Group 3 was superior to Group 2 with regard to the RMDQ, VAS, and global assessments (p˂0.001). Conclusion: Combined TENS/IFT was more effective than IFT in improving functional level and decreasing pain during activity in patients with chronic LBP, however it was not superior to TENS therapy alone. The findings of this study offer insight that can be applied to future investigations concerning combined TENS/IFT therapy with different application frequencies and modes or other combined therapies. We observed marked improvement in function and pain during activity with the combination of both therapies; however, improvement was not significantly greater to that achieved with TENS therapy alone. Combined therapy was also superior to the other treatments with respect to doctor and patient global assessments, but this was not significantly different compared with that in the TENS and IFT alone groups. No improvements were found in the control (sham) group.
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