Učinkovitost terapevtske vadbe pri pacientih po operaciji hernije medvretenčne ploščice - pregled literature : diplomsko delo

Nemec, Lara (avtor), Vauhnik, Renata (mentor), Petrič, Maja (komentor), Kacin, Alan (recenzent)

Uvod: Hernija medvretenčne ploščice je eno od najpogostejših degenerativnih stanj, ki prizadenejo ledveni del hrbtenice. Tipično se kaže z bolečino v ledveno-križnem delu hrbta in nogi, ob pritisku na živčno korenino pa se pojavijo tudi senzorični in motorični izpadi. Hernija se najprej zdravi konzervativno, v kolikor pa le-to ni uspešno, je potrebno operativno zdravljenje. Glede optimalnega pristopa k pooperativni rehabilitaciji še vedno ni enotnega mnenja, vendar kaže, da je terapevtska vadba eden od pomembnih dejavnikov hitrejše povrnitve funkcije po operaciji. Namen: Namen diplomskega dela je bil narediti pregled in primerjavo vadbenih programov in njihovih učinkov pri pacientih po operaciji hernije v ledvenem delu hrbtenice. Metode dela: Iskanje literature je potekalo v podatkovni zbirki PubMed z izbrano kombinacijo ključnih besed. Vključili smo v celoti objavljene prosto dostopne randomizirane kontrolirane raziskave v angleškem jeziku. Rezultati: Kriterijem je ustrezalo 7 raziskav. V raziskave so bile vključene osebe po prvi enonivojski operaciji hernije medvretenčne ploščice v ledvenem delu hrbtenice brez pridruženih bolezni hrbtenice in brez sistemskih bolezni. Raziskave so primerjale učinkovitost različnih vadbenih programov. Program nadzorovane dinamične stabilizacijske vadbe oziroma kombinacija le-te s programom samostojne vadbe je bolj učinkovita v primerjavi s programom samostojne vadbe in skupinami brez intervencije. Kombinacija programa samostojne vadbe in programa nadzorovane vadbe ni pokazala boljših rezultatov od programa samostojne vadbe. Prav tako ni bilo statistično značilnih razlik med skupino z vedenjsko stopnjevano dejavnostjo in skupino s standardno obravnavo oziroma med skupino z zgodnjim programom nadzorovane vadbe in skupino brez intervencije. V skupini z zgodnjimi funkcijskimi vajami je po šestih mesecih vidna statistično značilna višja kvaliteta življenja v primerjavi s skupino z rutinskimi funkcijskimi vajami. Razprava in zaključek: Vključeni terapevtski vadbeni programi so pokazali pozitiven učinek na bolečino, funkcijsko nezmožnost, kvaliteto življenja, depresijo in kineziofobijo. Pri tem kot pomemben element vadbenih programov izpostavljamo dinamične stabilizacijske vaje, saj so se vadbeni programi izkazali za bolj učinkovite, če so zajemali dinamične stabilizacijske vaje. Zaradi heterogenosti vključenih raziskav ne moremo podati zaključkov o najbolj učinkovitem vadbenem programu, kot tudi ne o najbolj optimalnih parametrih.

• Jezik: Slovenski jezik
• Ključne besede: diplomska dela, fizioterapija, hernija medvretenčne ploščice, operacija, vadbeni program, dinamične stabilizacijske vaje
• Vrsta gradiva: Diplomsko delo/naloga
• Tipologija: 2.11 - Diplomsko delo
• Organizacija: ZF - Zdravstvena fakulteta
• Kraj izida: Ljubljana
• Založnik: [L. Nemec]
• Leto izida: 2021
• Št. strani: 25 str.
• PID: 20.500.12556/RUL-124428
• UDK: 615.8
• COBISS.SI-ID: 47985923
• Datum objave v RUL: 21.01.2021

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Effectiveness of therapeutic exercise in patients after lumbar disc herniation surgery - literature review : diploma work

Izvleček

Introduction: Disc herniation is one of the most common degenerative disorders affecting the lumbar spine. It is characterized by back and leg pain. In the case of nerve root compression, paresthesia and neurologic deficits also occur. Conservative methods are the first-choice treatment. If these methods are unsuccessful, then surgical treatment is needed. Although, there is still no consensus on the most appropriate postoperative rehabilitation protocol, therapeutic exercises seem to have an important role in faster recovery after lumbar discectomy. Purpose: To review and compare therapeutic exercise programs and their effects on patients after lumbar discectomy. Methods: The literature search was completed in the PubMed database with a selected combination of keywords. Randomized controlled trials in the English language with free full access were included. Results: Seven studies were relevant for our review. Only subjects after first single-level lumbar discectomy without spine co-morbidities and without other systemic health issues were included. The protocols and parameters of exercise programs differed between studies. Dynamic lumbar stabilization exercise program or its combination with the home-based exercise program proved to be more effective compared to the home-based exercise program alone or groups without intervention. The combination of a home-based exercise program with a clinic-based exercise program did not show any better results compared to a home-based exercise program. No statistically significant differences were found neither between the behavioral graded activity group and the usual care group nor between the early exercise program group and the group without intervention. In the early functional exercises group, a statistically significant higher quality of life was observed after six months compared to the routine functional exercises group. Discussion and conclusion: Exercise programs had positive effects on pain, disability, quality of life, depression and kinesiophobia. We have concluded that dynamic lumbar stabilization exercises are an important element of exercise programs, because exercise programs, which included stabilization exercises, proved to be more effective compared to exercise programs without them. As the studies are heterogenous, we cannot make any conclusions about the most effective exercise programs neither about the optimal parameters.

• Ključne besede: diploma theses, physiotherapy, disc herniation, surgery, exercise program, dynamic stabilization exercises