Primerjava učinkovitosti triažne in standardne fizioterapevtske obravnave pri pacientih z bolečino v vratu in zgornjem delu hrbta

Fink, Urška (author), Kacin, Alan (mentor), Drobnič, Matej (co-mentor)

Uvod: Za nespecifično bolečino v vratu in zgornjem delu hrbta je značilna bolečina brez znakov ali simptomov večjih strukturnih nepravilnosti. Bolečina je pogosto ponavljajoča ali kronična, kar je pogost vzrok za odsotnosti z dela in visoke stroške zdravljenja. Z daljšimi čakalnimi dobami za fizioterapevtsko obravnavo se zmanjšuje učinkovitost zdravljenja nespecifične bolečine. Z uvedbo fizioterapevtske triaže bolnikov lahko skrajšamo čakalno dobo do prve fizioterapevtske obravnave, s čimer izboljšamo učinkovitost zdravljenja in paciente opolnomočimo za samoobvladovanje bolečine. Namen: V longitudinalni prospektivni raziskavi smo primerjali učinkovitost triažne in standardne klinične poti za paciente z nespecifično bolečino v vratu in zgornjem delu hrbta ter preverili učinkovitost standardne fizioterapevtske obravnave pri teh pacientih. Metode dela: V raziskavo je bilo vključenih 81 pacientov z bolečino v vratu in zgornjem delu hrbta. 58 pacientov (starost 46 ± 12 let) je bilo obravnavanih po novi klinični poti s triažno fizioterapevtsko obravnavo (triažna skupina), preostalih 23 (starost 50 ± 11 let) pa je imelo standardno fizioterapevtsko obravnavo (kontrolna skupina). Pri vseh pacientih smo opravili anamnezo in fizioterapevtski pregled ter meritve obsega gibljivosti vratne hrbtenice, oceno bolečine s številsko ocenjevalno lestvico (NRS) in izpolnjevanje vprašalnika zmanjšane zmožnosti zaradi bolečine v vratu (NDI). Meritve so bile izvedene pred fizioterapevtsko obravnavo in po njej. Rezultati: Zmanjšanje maksimalne intenzitete bolečine, ocenjene z NRS, je bilo pri pacientih v triažni skupini statistično in klinično pomembno (p < 0,001) večje kot pri pacientih v kontrolni skupini. Rezultat NDI se je statistično in klinično pomembno zmanjšal le v triažni skupini (p < 0,001). S fizioterapevtsko obravnavo se je statistično in klinično pomembno povečal obseg gibljivosti vratne hrbtenice (p < 0,05). Ugotovili smo zmerno negativno povezanost (r = -0,55, p < 0,05) med meritvami obsega gibljivosti vratne hrbtenice v sagitalni ravnini in NDI. Razprava in zaključek: Triažna fizioterapevtska obravnava je učinkovitejša pri zdravljenju bolečine v vratu in zgornjem delu hrbta v primerjavi s standardno fizioterapevtsko obravnavo. Slednja je učinkovita pri povečevanju obsega gibljivosti vratne hrbtenice pri pacientih z nespecifično bolečino. Triažno fizioterapevtsko obravnavo bi bilo smiselno uvesti v mrežo javnega zdravstva v RS.

• Language: Slovenian
• Keywords: Triažna fizioterapevtska obravnava, standardna fizioterapevtska obravnava, nespecifična bolečina v vratu in zgornjem delu hrbta, neposreden dostop
• Work type: Master's thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2019
• PID: 20.500.12556/RUL-110815
• COBISS.SI-ID: 5693547
• Publication date in RUL: 20.09.2019

Secondary language

• Language: English
• Title: Efficacy comparison of triage and standard physiotherapy intervention in patients with neck and upper back pain

Abstract

Introduction: Unspecific pain in the neck and upper back is associated with pain without signs and symptoms suggestive of mayor structural pathology. Pain often occurs recurrently or chronically, which leads to an increase of number of sick leaves and treatment costs. Long waiting lists for a physiotherapist appointment result in a decrease of efficacy in treatment of unspecific pain. With triage physiotherapy intervention the waiting time until the first appointment can be reduced, which increases treatment efficacy and educates the patient on self-care. Purpose: In a prospective longitudinal study we compared the efficacy of triage and standard physiotherapy intervention in patients with neck and upper back pain and evaluate the existing physiotherapy treatment of such patients. Methods: The research included 81 patients with neck and upper back pain. 58 patients (aged 46 ± 12 years) underwent triage physiotherapy intervention (triage group), while the remaining 23 (aged 50 ± 11 years) were subjected to standard physiotherapy intervention (control group). The patients’ anamneses were recorded and physiotherapeutic examination was performed, consisting of measurements of range of motion of the neck and rating the intensity of pain using the numeric rating scale (NRS). Furthermore, the neck disability index (NDI) was also evaluated. The measurements were performed before and after physiotherapy intervention. Results: The decrease of maximum pain intensity, evaluated through the NRS, was greater among patients subjected to triage physiotherapy with statistical and clinical significance (p < 0,001) in comparison with the patients having undergone standard physiotherapy intervention. A reduction of the number of NDI points was statistically and clinically significant (p < 0,001) only in the triage group. The range of motion of the neck increases with both statistical and clinical significance among patients undergoing physiotherapy intervention (p < 0,05). We found a moderately negative relationship (r = 0,55, p < 0,05) between the neck’s range of motion in sagittal plane and the NDI. Discussion and conclusions: Triage physiotherapy intervention is more effective than standard physiotherapy in treating unspecific pain in the neck and upper back. We established that the standard physiotherapy intervention is effective in increasing the range of motion of the neck in patients suffering from unspecific pain. It would be reasonable to introduce triage physiotherapy intervention in the public health care system in Slovenia.

• Keywords: Triage physiotherapy intervention, standard physiotherapy intervention, unspecific neck and upper back pain, direct access