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Učinkovitost vidno taktilne iluzije na zmanjšanje fantomske bolečine pri osebah po amputaciji spodnjega uda : magistrsko delo
ID Kavšek, Nika (Author), ID Jakovljević, Miroljub (Mentor) More about this mentor... This link opens in a new window, ID Enova, Dušan (Comentor), ID Bavec, Andrej (Comentor), ID Kovačič, Tine (Reviewer)

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Abstract
Uvod: Bolečina fantomskega uda je kronična bolečina na mestu odstranjenega dela telesa. Čas, potreben za razvoj bolečine fanotmskega uda je nepredvidljiv in se lahko pojavi v različnih časovnih obdobjih. Prvi znaki za pojav fantomske bolečine se lahko izrazijo že v prvem mesecu po posegu ali leta zatem. Zdravljenje je kompleksno in zahteva večidisciplinarni pristop, saj ni dokazov, da je ena terapija bolj učinkovita od druge. Glede na porast uporabe medikamentov za uravnavanje bolečine lahko naša raziskava pomembno vpliva na nadaljnji razvoj nefarmakoloških pristopov za zmanjšanje bolečine fantomskega uda. Namen: Ugotoviti učinkovitost metode masaže z vidno-taktilno iluzijo na bolečino fantomskega uda in funkcijsko zmogljivost pri pacientih z amputacijo spodnjega uda. Metode dela: V raziskavo, ki temelji na pilotni študiji, so bili vključeni odrasli preiskovanci po transtibialni ali transfemoralni amputaciji spodnjega uda v subakutni in kronični fazi zaradi zapletov sladkorne bolezni, žilnih vzrokov ali travmatske poškodbe s prisotno bolečino fantomskega uda. V raziskavo je bilo izbranih 13 preiskovancev, od tega štiri v poskusni skupini in devet v primerjalni skupini. V celotnem vzorcu je bilo osem moških in pet žensk s povprečno starostjo 69,5 let. Za oceno bolečine fantomskega uda smo uporabili vidno analogno lestvico in McGill-Melzakov vprašalnik o bolečini, za oceno funkcijske zmogljvosti pa test hoje na 10 metrov, 6-minutni test hoje, Lestvico funkcijske neodvisnosti in Lestvico za napoved izida rehabilitacije po ampuciji spodnjega uda z ali brez protetične oskrbe. Meritve smo izvedli pred začetkom obravnave in zadnji dan. Preiskovanci poskusne skupine so poleg običajne protibolečinske terapije in drugih obravnav pri članih večdiscplinirane ekipe izvajali še metodo Masaže z vidno taktilno iluzijo, medtem ko preiskovanci primerjalne skupine niso bili vključeni v intervencijo. Preiskovanci primerjalne skupine so prejemali le običajno protibolečinsko terapijo, saj je bil njihov namen omogočiti primerjavo učinka metode Masaže z vidno taktilno iluzijo na zmanjšanje bolečine fantomskega uda in izolirati vpliv metode. Poleg tega pa so bili deležni tudi drugih obravnav pri članih večdisciplinarne ekipe. Komisija RS za medicinsko etiko je podala soglasje za izvedbo raziskave (Št.:0120-597/2020/3). Rezultati: Obstajale so statistično pomembne razlike v spremembi občutenja bolečine po končani interveciji med preiskovanci poskusne in primerjalne skupine (p = 0,022). Ugotovili smo, da je zmanjšanje bolečine fantomskega uda statistično pomembno večje v poskusni skupini v primerjavi s primerjalno. V prvem tednu je povprečno izboljšanje bolečine za 1,79 (SO=0,34) cm, v drugem tednu pa 1,96 (SO=0,66) cm. Preiskovanci iz poskusne skupine so po intervenciji poročali o statistično pomembno nižji bolečini kot pred intervencijo (p = 0,014), med tem ko preiskovanci iz preiskovalne o tem niso poročali. Povprečni rezultati, ki so jih preiskovanci obeh skupin dosegli na Lestvici funkcijske neodvisnosti – stopnice in Lestvici funkcijske neodvinosti - hoja so bile ob odpustu praviloma višje kot ob sprejemu. V poskusni skupini je bil napredek večji, rezultat pa statistično značilen (p = 0,036), medtem ko v primerjalni skupini nismo zaznali statistično značilne razlike. Pri 6-minutnem testu hoje je bil opazen napredek v obeh skupinah, le-ta pa je bolj izrazit v poskusni skupini. V hitrosti hoje je napredovala poskusna skupina, medtem ko v primerjalni ni prišlo do izboljšanja v hitrosti hoje. Razprava in zaključek: Raziskali smo alternativno različico zdravljenja bolečine fantomskega uda, pri kateri smo uporabili vidno-taktilno stimulacijo. Metoda je učinkovita za zmanjšanje bolečine fantomskega uda. Glede na porast uporabe medikamentov za uravnavanje bolečine, lahko naše ugotovitve pomembno vplivajo na nadaljnji razvoj nefarmakoloških pristopov, s katerimi bi zmanjšali bolečino fantomskega uda in znižali uporabo farmakološkega zdravljenja.

Language:Slovenian
Keywords:magistrska dela, fizioterapija, amputacija, bolečina fantomskega uda, masaža, vidno-taktilna iluzija
Work type:Master's thesis/paper
Typology:2.09 - Master's Thesis
Organization:ZF - Faculty of Health Sciences
Place of publishing:Ljubljana
Publisher:[N. Kavšek]
Year:2023
Number of pages:60 str., [12] str. pril.
PID:20.500.12556/RUL-150414 This link opens in a new window
UDC:615.8
COBISS.SI-ID:164980483 This link opens in a new window
Publication date in RUL:17.09.2023
Views:910
Downloads:103
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Secondary language

Language:English
Title:Effectiveness of a visual-tactile illusion in reducing phantom pain in lower limb amputees : master thesis
Abstract:
Introduction: Phantom limb pain is chronic pain at the site of the removed body part. The time it takes for phantom limb pain to develop is unpredictable and can occur at different times. The first signs of phantom limb pain can appear in the first months after the procedure or years afterwards. The treatment is complex and requires a multidisciplinary approach, as there is no evidence that one therapy is more effective than another. Because of the increase in the use of pain management medications, out study may have an important implications for the further development of non-pharmacological approaches to reduce phantom limb pain. Purpose: To determine the effectiveness of the visual-tactile illusion massage method on phantom limb pain and functional capacity in patients with lower limb amputation. Methods: In our pilot study we include adults with transibial or transfemoral lower limb amputation and with phantom limb pain in subacute and chronic phase due to complications of diabetes mellitus, vascular causes or traumatic injury. 13 subjects were recruited, four in the experimental group and nine in the control group. The total sample was made up of eight men and five women with an average age of 69,5 years. We used the Visual analogue scale and the McGill-Melzack pain questionnaire to assess phantom limb pain, and the 10-metre walk test, 6-minute walk test, Functional independece measure and Amputee mobility predictor with or without prostetic care to assess functional capacity. Measurements were taken before the treatment and on the last day. The experimental group received the visual-tactile illusion massage method in addition to conventional pain management and other treatments of the musltidisciplinary team members, while the control group did not receive the intervention. They had only received conventional pain management. The aim was to compare the effect of visual-tactile illusion massage method on phantom limb pain reduction. In addition, they received other treatments of the multidisciplinary team. The Medical Ethics Committee of Refuplic of Slovenia has given its approval for the research (No: 0120-597/2020/3). Results: There were statistically significant differences in the change in pain perception after the end of the intervention between the experimental and comparison groups (p < 0,05; p = 0,022). We found that the reduction in phantom limb pain was statistically significantly greater in the experimental group compared to control group. If we distinguish between the first and second week, the average improvement in pain was 1,79 (SO = 0,34) cm in the first week and 1,96 (SO = 0,66) cm in the second week. Individuals in the experimental group reported statistically significantly lower pain after the intervention than before the intervention (p = 0,14), while individuals in the control group did not. The scores achieved by the subjects in both groups on the Functional independence measurement – stairs and the Functional independece measurement – walk were generally higher at the discharge than at admission. In the experimental group, the progress was greater and the result is statistically significant (p=0,036), while in the control group we report no statistically significant result. In the 6-minute walk test, there is a marked improvement in both groups, more so in the experimental group. The experimental group improved in walking speed, while the control group showed no improvement in walking speed. Discussion and conclusion: We investigated an alternative treatment for phantom limb pain using visual-tactile stimulation. The method is effective for reducing phantom limb pain. Our findings may have important implications for the further development of non-pharmacological approaches to reduce phantom limb pain and to reduce the use of pharmacological treatments.

Keywords:master's theses, physiotherapy, amputation, phantom limb pain, massage, visual-tactile illusion

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