Diz osteoartritinde yüksek yoğunluklu lazer tedavisinin eklem hareket açıklığı, ağrı, yaşam kalitesi, kas gücü ve femoral kıkırdak kalınlığı üzerine etkisinin değerlendirilmesi
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Tarih
2022
Yazarlar
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmada diz osteoartriti olan hastalarda yüksek yoğunluklu lazer tedavisinin (YYLT) eklem hareket açıklığı, ağrı, yaşam kalitesi, kas gücü ve femoral kıkırdak kalınlığı üzerine etkisinin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Kasım 2021-Nisan 2022 tarihleri arasında başvuran anamnez, fizik muayene ve görüntüleme yöntemleriyle diz osteoartriti tanısı alan 60 çalışmaya alındı. Çalışma şartlarını oluşturan hastalar randomize edilerek her grupta 30'ar hasta olacak şekilde iki gruba ayrıldı. İlk gruba 3 hafta (haftada 5 gün toplam 15 seans) süre ile hotpack, transkutanöz elektriksel sinir stimülasyonu (TENS), egzersiz ve yüksek yoğunluklu lazer tedavisi (YYLT) (haftada 3 gün toplam 9 seans), ikinci gruba 3 hafta (haftada 5 gün toplam 15 seans) süre ile hotpack, TENS, egzersiz ve plasebo lazer tedavisi uygulandı. Hastalar belirlenen ölçeklerle tedavi öncesi, tedavi bitimi ve tedaviden 3 ay sonra değerlendirildi. Eklem hareket açıklığı ölçümü için gonyometre, ağrı için vizüel analog skala (VAS), ağrı ve fonksiyonu değerlendirmek için WOMAC Osteoartrit İndeksi, yaşam kalitesi için SF-36 Yaşam Kalitesi ölçeği, diz fleksiyon ekstansiyon kas gücü ölçümü için Biodex System 3 izokinetik cihaz ve femoral kıkırdak kalınlığı ölçümü için ultrasonografi cihazı kullanıldı. Bulgular: Tedavi sonrası her iki tedavi grubunda da diz fleksiyon açısı, VAS, WOMAC Osteoartrit İndeksi, SF-36 Yaşam Kalitesi Ölçeği, izokinetik kas gücü ve femoral kıkırdak kalınlığı ölçümlerinde düzelme gözlendi. Diz fleksiyon açısı YYLT grubunda istatistiksel olarak anlamlı artış gösterdi, sham lazer grubunda ise tedavi sonrası-3.ay karşılaştırıldığında istatistiksel olarak anlamlı saptanmadı. Femoral kıkırdak kalınlığında YYLT grubu tedavi öncesi-sonrası karşılaştırma hariç her iki grupta da istatistiksel olarak anlamlı artış sağlandı. SF-36 fiziksel komponent ölçümlerinde YYLT grubu tedavi öncesi-sonrası karşılaştırma hariç diğer karşılaştırmalarda her iki grupta da istatistiksel olarak anlamlı iyileşme saptandı. SF-36 mental komponent ölçümlerinde ise her iki grupta da tedavi öncesi-sonrası karşılaştırmalar hariç istatistiksel olarak anlamlı iyileşme görüldü. WOMAC Osteoartrit İndeksi ağrı alt ölçeği, sertlik alt ölçeği ve total skorlarında sham lazer grubunda tedavi öncesi-sonrası karşılaştırma hariç her iki grupta da istatistiksel olarak anlamlı iyileşme saptandı. WOMAC Osteoartrit İndeksi fiziksel fonksiyon alt ölçeği skorlarında ise her iki grupta da tedavi öncesi-sonrası karşılaştırmalar hariç diğer skorlarda istatistiksel olarak anlamlı iyileşme gözlendi. VAS puanlarında her iki grupta da tüm zamanlarda istatistiksel olarak anlamlı gelişme sağlandı. İzokinetik kas gücü ölçümlerinde Peak Tork ve Peak Tork/Vücut Ağırlığı fleksiyon 60° açısal hızda tedavi öncesi-sonrası iki grupta da istatistiksel olarak anlamlı diğer tüm zamanlarda anlamlı saptanmadı. Peak Tork ve Peak Tork/Vücut Ağırlığı ölçümlerinde ekstansiyon 60°, ekstansiyon 180° ve fleksiyon 180° açısal hızlarda istatistiksel olarak anlamlı fark oluşmadı. Ortalama Peak Tork ekstansiyon 60° açısal hızda sham lazer grubunda tedavi öncesi-3.ay karşılaştırmada anlamlı saptandı, fleksiyon 60° açısal hızda her iki grupta da tedavi öncesi- sonrası ve tedavi öncesi-3.ay karşılaştırmalarda istatistiksel olarak anlamlı tespit edildi. Ekstansiyon ve fleksiyon 180° açısal hızlarda ortalama Peak Tork değerlerinde iki grupta da istatistiksel anlamlı farklılık oluşmadı. Sonuç: Diz osteoartriti tedavisinde kanıt düzeyi yüksek olan egzersiz her zaman ön planda olmalıdır. Hastalara uygulanan hotpack ve TENS tedavisi de diz osteoartriti tedavisinde etkilidir. YYLT tedavisi ve sham lazer tedavisinin etkinliğinde belirgin faklılık saptanmadı.
The aim of this study was to evaluate the effects of high intensity laser therapy (HILT) on range of motion, pain, quality of life, muscle strength and femoral cartilage thickness in patients with knee osteoarthritis. Material and Methods: Sixty patients who were admitted between November 2021 and April 2022 and diagnosed with knee osteoarthritis based on anamnesis, physical examination and imaging methods were included in the study. The patients who formed the study conditions were randomized and divided into two groups with 30 patients in each group. Hotpack, transcutaneous electrical nerve stimulation (TENS), exercise and HILT (total 9 sessions 3 days a week) for 3 weeks (5 days a week for a total of 15 sessions) for the first group, and for the second group hotpack, TENS, exercise and placebo laser treatment were applied for 3 weeks (5 days a week for a total of 15 sessions). The patients were evaluated with the determined scales before the treatment, at the end of the treatment and at the 3rd month. Goniometer for joint range of motion measurement, visual analog scale (VAS) for pain, WOMAC Osteoarthritis Index to assess pain and function, SF-36 Quality of Life scale for quality of life, Biodex System 3 isokinetic device for knee flexion extension muscle strength measurement, and ultrasonography was used for femoral cartilage thickness measurement. Results: Knee flexion angle showed a statistically significant increase in the HILT group, but it was not statistically significant in the sham laser group when compared to the after treatment-3rd month. There was a statistically significant increase in femoral cartilage thickness in both groups, except for the comparison before-after treatment in the HILT group. Statistically significant improvement was found in both groups in SF-36 physical component measurements, except for the comparison before-after the treatment in the HILT group. In SF-36 mental component measurements, statistically significant improvement was observed in both groups, except before-after treatment comparisons. Statistically significant improvement was found in vii both groups in the WOMAC Osteoarthritis Index pain subscale, stiffness subscale and total scores, except for the pre-post treatment comparison in the sham laser group. A statistically significant improvement was observed in the WOMAC Osteoarthritis Index physical function subscale scores in both groups, except for the pre-post treatment comparisons. There was a statistically significant improvement in VAS scores at all times in both groups. In the isokinetic muscle strength measurements, Peak Torque and Peak Torque/Body Weight were not statistically significant at all other times in both groups before-after the treatment at flexion 60° angular velocity. In the measurements of Peak Torque and Peak Torque/Body Weight, there was no statistically significant difference in the angular velocities of extension 60°, extension 180° and flexion 180°. Average Peak Torque extension was found to be significant in the sham laser group at 60° angular velocity in the pretreatment-3 month comparison, while flexion at 60° angular velocity was found to be statistically significant in both groups pre-post treatment and pretreatment-3.month comparisons. There was no statistically significant difference between the two groups in the average Peak Torque values at extension and flexion 180° angular velocities. Conclusion: Exercise, which has a high level of evidence, should always be at the forefront in the treatment of knee osteoarthritis. Hotpack and TENS therapy applied to patients are also effective in the treatment of knee osteoarthritis. There was no significant difference in the efficacy of HILT and sham laser treatment.
The aim of this study was to evaluate the effects of high intensity laser therapy (HILT) on range of motion, pain, quality of life, muscle strength and femoral cartilage thickness in patients with knee osteoarthritis. Material and Methods: Sixty patients who were admitted between November 2021 and April 2022 and diagnosed with knee osteoarthritis based on anamnesis, physical examination and imaging methods were included in the study. The patients who formed the study conditions were randomized and divided into two groups with 30 patients in each group. Hotpack, transcutaneous electrical nerve stimulation (TENS), exercise and HILT (total 9 sessions 3 days a week) for 3 weeks (5 days a week for a total of 15 sessions) for the first group, and for the second group hotpack, TENS, exercise and placebo laser treatment were applied for 3 weeks (5 days a week for a total of 15 sessions). The patients were evaluated with the determined scales before the treatment, at the end of the treatment and at the 3rd month. Goniometer for joint range of motion measurement, visual analog scale (VAS) for pain, WOMAC Osteoarthritis Index to assess pain and function, SF-36 Quality of Life scale for quality of life, Biodex System 3 isokinetic device for knee flexion extension muscle strength measurement, and ultrasonography was used for femoral cartilage thickness measurement. Results: Knee flexion angle showed a statistically significant increase in the HILT group, but it was not statistically significant in the sham laser group when compared to the after treatment-3rd month. There was a statistically significant increase in femoral cartilage thickness in both groups, except for the comparison before-after treatment in the HILT group. Statistically significant improvement was found in both groups in SF-36 physical component measurements, except for the comparison before-after the treatment in the HILT group. In SF-36 mental component measurements, statistically significant improvement was observed in both groups, except before-after treatment comparisons. Statistically significant improvement was found in vii both groups in the WOMAC Osteoarthritis Index pain subscale, stiffness subscale and total scores, except for the pre-post treatment comparison in the sham laser group. A statistically significant improvement was observed in the WOMAC Osteoarthritis Index physical function subscale scores in both groups, except for the pre-post treatment comparisons. There was a statistically significant improvement in VAS scores at all times in both groups. In the isokinetic muscle strength measurements, Peak Torque and Peak Torque/Body Weight were not statistically significant at all other times in both groups before-after the treatment at flexion 60° angular velocity. In the measurements of Peak Torque and Peak Torque/Body Weight, there was no statistically significant difference in the angular velocities of extension 60°, extension 180° and flexion 180°. Average Peak Torque extension was found to be significant in the sham laser group at 60° angular velocity in the pretreatment-3 month comparison, while flexion at 60° angular velocity was found to be statistically significant in both groups pre-post treatment and pretreatment-3.month comparisons. There was no statistically significant difference between the two groups in the average Peak Torque values at extension and flexion 180° angular velocities. Conclusion: Exercise, which has a high level of evidence, should always be at the forefront in the treatment of knee osteoarthritis. Hotpack and TENS therapy applied to patients are also effective in the treatment of knee osteoarthritis. There was no significant difference in the efficacy of HILT and sham laser treatment.
Açıklama
Anahtar Kelimeler
Diz osteoartriti, Lazer, YYLT, Egzersiz, Femoral kıkırdak kalınlığı, İzokinetik kas gücü, Knee osteoarthritis, Laser, HILT, exercise, Femoral cartilage thickness, Isokinetic muscle strength
Kaynak
WoS Q Değeri
Scopus Q Değeri
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Künye
Ekici, B. (2022). Diz osteoartritinde yüksek yoğunluklu lazer tedavisinin eklem hareket açıklığı, ağrı, yaşam kalitesi, kas gücü ve femoral kıkırdak kalınlığı üzerine etkisinin değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, Konya.
