Učinki zgodnjega aktivnega in aktivno-asistiranega gibanja na izide zdravljenja po rekonstrukciji rupture rotatorne manšete - pregled literature : diplomsko delo

Ošlak, Andreja (author), Kacin, Alan (mentor), Brezovar, Tjaž (co-mentor), Hlebš, Sonja (reviewer)

Uvod: Tetive mišic rotatorne manšete v veliki meri skrbijo za dinamično stabilnost glenohumeralnega sklepa, zato lahko ruptura povzroči nestabilnost in disfunkcijo. Glavni cilj rekonstrukcije rupture rotatorne manšete je obnovitev njene funkcije, na uspeh pa pomembno vpliva pooperativna fizioterapija. V grobem obstajata dva možna pristopa zdravljenja in sicer tradicionalen pristop z omejevanjem gibanja ali bolj agresiven pristop z zgodnjo aktivacijo mišic. V literaturi je možno zaslediti dokaze o negativnih in pozitivnih učinkih zgodnjega aktivnega gibanja. Namen: Namen diplomskega dela je analizirati izsledke raziskav o učinkih zgodnjega aktivnega in aktivno asistiranega gibanja na izide rehabilitacije po rekonstrukciji rupture rotatorne manšete. Metode dela: Iskanje literature je potekalo s pregledom podatkovnih zbirk PubMed, PEDro in CINAHL. V pregled so bile vključeni randomizirani kontrolirani poskusi v angleškem jeziku, ki so bili objavljeni od leta 2000 do vključno decembra 2021. Rezultati: V pregled je bilo vključenih pet raziskav. Zasnove raziskav so paciente razdelile na skupino, ki je izvajala zgodnje aktivno gibanje in skupino, ki je z aktivnim gibanjem začela pozneje. Merjeni izidi so bili bolečina, raven funkcijske aktivnosti, kakovost življenja, zadovoljstvo pacientov, obseg pasivne in aktivne gibljivosti, mišična jakost, stanje rekonstruirane tetive in časovno vezana uspešnost celjenja tetive. Ugotovitve raziskav o učinkovitosti zgodnjega aktivnega gibanja na posamezno mero izida v posameznih časovnih obdobjih niso soglasne. V preiskovalnih skupinah raziskav je bilo prisotno hitrejše pridobivanje obsega gibljivosti, rezultati hkrati kažejo na mogoče pozitivne učinke hitrejšega lajšanja bolečine. Raziskave poročajo o odsotnosti statistično pomembnih razlik med skupinama v številu ponovnih ruptur. Razprava in zaključek: Zgodnje aktivno gibanje pozitivno vpliva na izide zdravljenja po rekonstrukciji rupture RM pri čemer povečano tveganje za ponovno rupturo ni dokazano. Na podlagi rezultatov raziskav lahko trdimo, da zgodnje aktivno gibanje v primerjavi z manj agresivnim pristopom prispeva k hitrejšemu vračanju obsega gibljivosti ramenskega sklepa. O kratkoročnih in dolgoročnih učinkih na bolečino, kakovost življenja in mišično jakost raziskave niso soglasne. Heterogenost raziskav otežuje primerjavo in interpretacijo rezultatov. Na podlagi sistematičnega pregleda ni mogoče nedvomno opredeliti, da sta zgodnje gibanje in mišična aktivnost klinično uspešnejša. Za opredelitev tega so potrebne nadaljnje raziskave na tem področju.

• Language: Slovenian
• Keywords: diplomska dela, fizioterapija, ruptura rotatorne manšete, pooperativna rehabilitacija, zgodnje aktivno gibanje, zgodnje aktivno asistirano gibanje
• Work type: Bachelor thesis/paper
• Typology: 2.11 - Undergraduate Thesis
• Organization: ZF - Faculty of Health Sciences
• Place of publishing: Ljubljana
• Publisher: [A. Ošlak]
• Year: 2022
• Number of pages: 34 str.
• PID: 20.500.12556/RUL-139549
• UDC: 615.8
• COBISS.SI-ID: 120243459
• Publication date in RUL: 04.09.2022

Secondary language

• Language: English
• Title: Effects of early active and active assisted movement on treatment outcomes after reconstruction of a rotator cuff rupture - literature review : diploma work

Abstract

Introduction: The rotator cuff muscles with their tendons hold greater responsibility for dynamic stability of the glenohumeral joint, therefore a rupture can cause instability and dysfunction. The main goal of the reconstructive procedure is to restore function. Physiotherapy in the post-operative period has a big impact on the success of the repair. There are two main possible exercise approaches, the first one is traditional, with limitation of movement and the second one, which is more aggressive, with early muscle activation. The evidence about effects of early active movement on outcomes in literature differs. Purpose: The purpose of this diploma work is to analyze findings of researches about effects of early active and actively assisted movement on treatment outcomes after reconstruction of a rotator cuff rupture. Methods: We searched databases PubMed, PEDro in CINAHL and included randomized controlled trials published in English in period from year 2000 till including December 2021. Results: Five studies were included. The study designs divided patients into early motion group and in delayed motion group. Measured outcome were pain, level of function, life quality, patients’ satisfaction, active and passive range of motion, muscle strength, re-tear rates and time course of tendon healing. Studies’ findings relating to the different measured outcomes varied at different points in time. The early motion groups presented faster gain in range of motion at the same time results suggesting the possible positive effect of quicker pain relive. Statistically significant difference of number of re-tears in both groups was not found. Discussion and conclusion: Early active movement has positive effects on treatment outcomes after reconstruction of rotator cuff tears, an increased risk for re-tears is not proven. From the found results we can claim that early active motion can contributes to the faster gain of range of motion. Researches are in conflict about short-term and long-term effects on pain, functional activity and muscle strength. The heterogeneity of the research makes it difficult to compare and interpret the results. Based on this systematic review, it is not possible to clearly determine if early active movement is a better approach to use in clinical practice. Further research in this area is needed for more precise conclusions.

• Keywords: diploma theses, physiotherapy, rotator cuff rupture, post-operative rehabilitation, early active movement, early active assisted movement