RESUMEN
OBJECTIVE: To evaluate a structured physiotherapy treatment model in patients who qualify for lumbar disc surgery. DESIGN: A prospective cohort study. PATIENTS: Forty-one patients with lumbar disc herniation, diagnosed by clinical assessments and magnetic resonance imaging. METHODS: Patients followed a structured physiotherapy treatment model, including Mechanical Diagnosis and Therapy (MDT), together with graded trunk stabilization training. Study outcome measures were the Oswestry Disability Index, a visual analogue scale for leg and back pain, the Tampa Scale for Kinesiophobia, the European Quality of Life in 5 Dimensions Questionnaires, the Zung Self-Rating Depression Scale, the Self-Efficacy Scale, work status, and patient satisfaction with treatment. Questionnaires were distributed before treatment and at 3-, 12- and 24-month follow-ups. RESULTS: The patients had already improved significantly (p < 0.001) 3 months after the structured physiotherapy treatment model in all assessments: disability, leg and back pain, kinesiophobia, health-related quality of life, depression and self-efficacy. The improvement could still be seen at the 2-year follow-up. CONCLUSION: This study recommends adopting the structured physiotherapy treatment model before considering surgery for patients with symptoms such as pain and disability due to lumbar disc herniation.
Asunto(s)
Dolor de Espalda/rehabilitación , Desplazamiento del Disco Intervertebral/rehabilitación , Vértebras Lumbares/cirugía , Modalidades de Fisioterapia , Adolescente , Adulto , Dolor de Espalda/diagnóstico , Dolor de Espalda/etiología , Estudios de Cohortes , Discectomía , Femenino , Humanos , Desplazamiento del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/diagnóstico , Desplazamiento del Disco Intervertebral/cirugía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Satisfacción del Paciente , Estudios Prospectivos , Autoinforme , Encuestas y Cuestionarios , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND AND PURPOSE: Several studies have investigated outcomes after disc surgery. However, the occurrence of kinesiophobia has not been investigated previously in patients after disc herniation surgery. In this cross-sectional study, we investigated kinesiophobia in patients who had been treated surgically for lumbar disc herniation, and we related the results to established outcome measures. PATIENTS AND METHODS: 10-34 months after surgery, questionnaires were sent to 97 patients who had undergone standardized open discectomy. Outcome measures included Tampa scale for kinesiophobia (TSK); Oswestry disability index (ODI); European quality of life in 5 dimensions (EQ-5D); visual analog scale (VAS) for leg and back pain, work disability, and patient satisfaction; Zung self-rating depression scale (ZDS); pain catastrophizing scale (PCS); and a self-efficacy scale (SES). RESULTS: 36 of 80 patients reported having kinesiophobia. There were statistically significant differences in ODI, EQ-5D, VAS leg and back pain, ZDS, PCS, and SES between patients with and without kinesiophobia. INTERPRETATION: Half of the patients suffered from kinesiophobia 10-34 months after surgery for disc herniation. These patients were more disabled, had more pain, more catastrophizing thoughts, more symptoms of depression, lower self-efficacy, and poorer health-related quality of life than patients without kinesiophobia.
Asunto(s)
Discectomía/efectos adversos , Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Trastornos del Movimiento/etiología , Trastornos Fóbicos/cirugía , Complicaciones Posoperatorias/etiología , Adolescente , Adulto , Anciano , Catastrofización , Estudios Transversales , Discectomía/psicología , Discectomía/rehabilitación , Femenino , Humanos , Desplazamiento del Disco Intervertebral/rehabilitación , Masculino , Persona de Mediana Edad , Movimiento , Evaluación de Resultado en la Atención de Salud , Satisfacción del Paciente , Complicaciones Posoperatorias/psicología , Autoeficacia , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the effect on pain intensity and function of an exercise concept focusing on specific eccentric strength training of the rotator cuff in patients with subacromial impingement syndrome. DESIGN: Single-subject research design with baseline and treatment phases (AB design). SETTING: Home-based training programme supervised and supported by visits to physiotherapy clinic. SUBJECTS: Ten patients, mean (SD) age 54 (8.6) years, symptom duration 12 (9.1) months. INTERVENTION: Daily eccentric strengthening exercises of the rotator cuff during 12 weeks. PRIMARY OUTCOME MEASURES: Pain intensity, assessed with a visual analogue scale, and function, using the Patient-Specific Functional Scale. SECONDARY OUTCOME MEASURES: Shoulder function evaluated with the Constant score, and shoulder-related quality of life evaluated with the Western Ontario Rotator Cuff Index. RESULTS: Pain intensity decreased significantly in eight of the ten subjects. Function improved significantly in all ten subjects. Constant score increased in nine subjects and Western Ontario Rotator Cuff Index increased in seven subjects. Mean Constant score for the whole group increased significantly from 44 to 69 points (P = 0.008). Mean Western Ontario Rotator Cuff Index increased from 51 to 71% (P = 0.021). CONCLUSION: A 12-week eccentric strengthening programme targeting the rotator cuff and incorporating scapular control and correct movement pattern can be effective in decreasing pain and increasing function in patients with subacromial impingement syndrome. A randomized controlled trial is necessary to provide stronger evidence of the method.