Bel ve bacak a?r?s? olan lumbal disk hernili hastalarda n?ral mobilizasyonun etkinli?i

Ama?: Bel ve bacak a?r?s? olanlumbal disk hernili hastalarda n?ral mobilizasyonun a?r?, a?r?s?z kal?a fleksiyon derecesi, fonksiyonel durum ve ya?am kalitesi ?zerine olan etkilerini belirmektirGere? ve Y?ntem: ?al??maya, ya? ortalamas? 43.62??13.02 y?l olan toplam 40 lumbal disk hernisi tan?s? alm?? hasta dahil edildi. Al?nma kriterlerine uyan hastalar basit rastgele ?rnekleme y?ntemi ile randomize edilerek iki gruba ayr?ld?. Grup I n?ral mobilizasyon grubu (n=20), Grup II ise kontrol grubu (n=20) olarak belirlendi. Her iki gruba elektroterapi ve egzersizden olu?an standart fizyoterapi program? uygulan?rken, Grup I hastalar?na ek olarak n?ral mobilizasyon tekni?i uygulamas? ilave edildi. Standart fizyoterapi uygulamas? 15 seans, n?ral mobilizasyon tekni?i ise Grup I hastalar?na hafta da 3 seans toplam 10 seans olacak ?ekilde uyguland?. Hastalara, tedavi ?ncesi demografik ?zellikler, a?r? [McGill A?r? Anketi (MAA)], fonksiyonel durum [D?z Bacak Kald?rma Derecesi (DBKD)], 5 dk y?r?me mesafesi [5 dk y?r?me testi (5DKYT)] ve disabilite d?zeyi [Quebec Bel A?r?s? Disabilite ?l?e?i (QBAD?)], ya?am kalitesi [(K?sa form SF-36)] ve depresyon d?zeyi [Beck Depresyon ?l?e?i (BD?)] de?erlendirmeleri yap?ld?. De?erlendirmeler tedavi sonras? ve 3. ayda tekrar edilerek veriler uygun istatistiksel analiz y?ntemleri ile kar??la?t?r?ld?. Bulgular: ?al??man?n ba?lang?c?nda, iki grup aras?nda demografik ?zellikler ve de?i?kenler a??s?ndan anlaml? fark yoktu, gruplar homojendi (p>0.05). Gruplar?n farkl? zamanlarda (tedavi ?ncesi, tedavi sonras? ve 3. ay) yinelenen ?l??mleri aras?nda anlaml? bir fark olup olmad???n? belirlemek amac?yla Repeated Measure Varyans Analizi testi kullan?ld? ve sonu? istatistiksel olarak anlaml? bulundu (p<0.05). Her iki grupta da DBKD, 5DKYT ve QBAD? parametrelerinde tedavi ?ncesi-sonras?, tedavi ?ncesi-3. ay ve tedavi sonras?-3. ay ?l??mleri aras?nda istatistiksel olarak anlaml? bir fark oldu?u belirlendi (p<0.0167). Grup I ve Grup II hastalar?n?n tedavi ?ncesi-tedavi sonras? ile tedavi ?ncesi-3. ay ?l??mleri aras?ndaki de?i?im miktarlar? hesaplanarak kar??la?t?r?ld???nda DBKD ve 5DKYT'deki fark?n Grup I lehine istatistiksel olarak anlaml? oldu?u bulundu (p<0.05). A?r?, disabilite ve ya?am kalitesi skorlar?nda ise de?i?im farklar? her iki grupta benzerdi (p>0.05). Sonu?: ?al??madan elde etti?imiz sonu?lar, bel ve bacak a?r?s? olan lumbal disk hernili hastalarda, standart fizyoterapi ile kombine olarak uygulanan alt ekstremite n?ral mobilizasyon tekni?inin, a?r?s?z kal?a fleksiyon a??kl???, y?r?me mesafesi ve fonksiyonel yetersizlikler ?zerine standart tedaviye g?re daha etkili olabilece?ini ve bu etkinin 3. ayda da devam etti?ini g?stermi?tir Objective: To determine effects of neural mobilization on pain, painless hip flexion degree, functional state and quality of life in patients who have lumbar herniation with low back and leg pain. Methods: Forty patients who have lumbar disk herniation and mean age?s 43.62??13.02 years, included in this study. Patients who have inclusion criteria were randomly divided into two groups. Standard Physiotherapy and Neural mobilization techniques were applied to Group I (neural mobilization group; n=20) and standard physiotherapy program was applied to Group II (control group; n=20). Standard physiotherapy program composed of electrotherapy and combined exercises programs. Standard physiotherapy was performed 15 treatment sessions to both groups and neural mobilization technique was applied three times in a week and total 10 sessions during treatment for only Group I. Demographic characteristics of all patients were recorded and assessments of pain [McGill Pain Index (MPI)], Straight Leg Raise Degree (SLRD), 5 min-walking distance [5 min walking test (5MWT)], disability level [Quebec Back Pain Disability Scale(QBPDS)], quality of life [(Short form SF-36)] and depression [Beck Depression Invertory (BDI)] were done at the beginning treatment, after treatment and 3 months later. Data were analyzed with statistical methods. Results: At the beginning of study, there was no statistically significance in demographic characteristics and outcome measures between groups and there were homogeneous data between groups (p>0.05). To determine the repeated measures of groups at different times (before and after treatment and third months) were used Repeated Measure Variance Analysis and results showed that statistically significant (p<0.05). There were statistically significances between before-after treatment, before treatment-3rd months, after treatment-3rd months measurements of SLRD, 5MWT AND QBPDS parameters at the both of groups (p<0.0167). When exchange quantities of between before-after treatment and before treatment-3rd months measurements of Group I and Group II patients, differences of SLRD and 5MWD measurements were statistically significance in favor of Group I (p<0.05). Differences of measurements which are pain, disability and quality of life scores were similar in both of groups. Conclusions: Outcomes from study showed that neural mobilization combination with standard physiotherapy program could be more effective than only standard physiotherapy on painless hip flexion range, walking distance and functional disability at patients who have low back pain and leg pain, with lumbar disk heniation and these effects can also continue during 3rd months.

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