Primerjava učinkovitosti triažne in standardne fizioterapevtske obravnave pri pacientih z bolečino v spodnjem delu hrbta : magistrsko delo

Brekalo, Nina (author), Kacin, Alan (mentor), Drobnič, Matej (comentor)

Uvod: Bolečina v spodnjem delu hrbta je eden najpogostejših vzrokov za odsotnost z dela, zato predstavlja pomemben strokovni izziv, a tudi veliko ekonomsko breme. V Sloveniji je bil leta 2015 samo strošek nadomestil za bolniške odsotnosti na račun bolečine v hrbtu približno 42 milijonov evrov. Predvidevamo, da bi optimiziranje klinične poti za tovrstne paciente omogočilo hitrejše, učinkovitejše in bolj sledljivo zdravljenje pacientov z bolečino v spodnjem delu hrbta in s tem znižanje stroškov zdravstvene oskrbe in odsotnosti z dela. Namen: Primerjati učinkovitost spremenjene klinične poti za paciente z bolečino v spodnjem delu hrbta z obstoječo in preveriti učinkovitost trenutno uporabljane fizioterapevtske obravnave pri teh pacientih. Metode dela: V longitudinalni prospektivni raziskavi smo primerjali na novo vzpostavljeno triažno fizioterapijo s standardno fizioterapevtsko obravnavo. Med triažno in kontrolno skupino pacientov smo primerjali intenziteto bolečine, izid modificiranega vprašalnika za ocenjevanje nezmožnosti Roland Morris in test za mišično vzdržljivost trupa. Med subjektivnimi in objektivnimi merami je bil izračunan tudi Pearsonov korelacijski koeficient. Rezultati: Intenziteta bolečine se je statistično značilno zmanjšala po fizioterapiji tako v triažni (p<0,001) kot v kontrolni (p<0,001) skupini. Intenziteta bolečine pred fizioterapevtsko obravnavo se ni značilno razlikovala med triažno in kontrolno skupino (p=0,761). Intenziteta bolečine po fizioterapiji je bila značilno manjša (p<0,001) v triažni skupini v primerjavi s kontrolno. Izid vprašalnika se je po fizioterapiji značilno izboljšal (p<0,001) v triažni skupini, medtem ko v kontrolni skupini do značilnega izboljšanja ni prišlo (p=0,367). Vzdržljivost mišic trupa se je po standardni obravnavi statistično značilno izboljšala (p<0,001). Med mišično vzdržljivostjo in rezultatom vprašalnika obstaja zmerna povezanost (r=0,54, p<0,05). Razprava in zaključek: Ugotovili smo, da je triažna fizioterapija učinkovitejša od standardne obravnave kljub krajšemu trajanju. Vpeljava triažne fizioterapije v javni zdravstveni sistem v Sloveniji bi pripomogla k hitrejšemu in učinkovitejšemu zdravljenju bolečine v spodnjem delu hrbta, k skrajšanju bolniškega staleža zaposlenih in s tem k zmanjšanju ekonomskega bremena družbe.

• Language: Slovenian
• Keywords: klinična pot, bolečina v spodnjem delu hrbta, zdravstvena vzgoja, neposreden dostop, fizioterapija
• Work type: Master's thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2019
• PID: 20.500.12556/RUL-110816
• COBISS.SI-ID: 5693803
• Publication date in RUL: 20.09.2019

Secondary language

• Language: English
• Title: Efficacy comparison of triage and standard physiotherapy intervention in patients with low back pain : master thesis

Abstract

Introduction: Low back pain is one of the most frequent causes of absenteeism, which presents a great professional challenge and also a significant economic load of society. In Slovenia, in 2015, the cost of reimbursements for sick leave alone was approximately 42 million euros. We speculate that an enhanced clinical pathway would allow for faster, more efficient, and transparent treatment of patients with low back pain and hence reduced costs of healthcare and absenteeism. Purpose: To compare the efficacy of enhanced clinical pathway with the existing one and to assess the efficiency of current physiotherapy in patients with low back pain. Methods: In a prospective longitudinal study, we compared de novo established triage physiotherapy with the standard clinical pathway for low back pain. For comparison between the triage and control group of patients, we utilized a subjective measure of pain intensity with a numeric rating scale, the modified Roland-Morris questionnaire and conducted a trunk muscle performance test. Pearson’s correlation coefficients between the subjective and objective measures were also calculated. Results: The intensity of the pain was significantly reduced (p<0.001) after physiotherapy in both groups. The intensity of pain before physiotherapy treatment was not significantly different between the groups (p=0.761). The intensity of pain after physiotherapy was significantly lower (p<0.001) in the triage group compared to the control group. The total score of the questionnaire was significantly improved (p<0.001) in the triage group after physiotherapy whereas no significant improvement (p=0.367) was observed in the control group. After the standard treatment, the muscle performance test was significantly improved (p<0.001). There is a moderate correlation between muscle performance and the result of the questionnaire (r=0.54, p<0,05). Discussion and conclusion: The results suggest that triage physiotherapy is more effective than standard treatment despite its shorter duration. The introduction of triage physiotherapy to the public healthcare system in Slovenia would enhance efficiency and shorten the treatment of low back pain, reduce the absenteeism, and hence, reduce its economic load on society.

• Keywords: clinical pathway, low back pain, education, direct access, physiotherapy