THE INFLUENCE OF THE MCKENZIE METHOD ON THE QUALITY OF LIFE OF PATIENTS WITH LUMBOSACRAL SPINE AILMENTS

Transkrypt

1 DOI: Medical and Biological Sciences, 14, 8/, ORIGINAL ARTICLE / PRACA ORYGINALNA Bartosz Kochański 1, Krystian Kałużny 1, Magdalena Hagner-Derengowska, Anna Plaskiewicz 1, Magdalena Jaworska 3, Wojciech Hagner 1 THE INFLUENCE OF THE MCKENZIE METHOD ON THE QUALITY OF LIFE OF PATIENTS WITH LUMBOSACRAL SPINE AILMENTS WPŁYW METODY MCKENZIEGO NA JAKOŚĆ ŻYCIA PACJENTÓW Z DOLEGLIWOŚCIAMI BÓLOWYMI KREGOSŁUPA W ODCINKU LĘDŹWIOWO-KRZYŻOWYM 1 Chair and Clinic of Rehabilitation of Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Head: prof. dr hab. n. med. Wojciech Hagner Chair and Department of Clinical Neuropsychology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Head: prof. dr hab. n. med. Alina Borkowska 3 1 Military Health Resort Rehabilitation Hospital in Busko Zdrój, Head: dr n. med. Bernard Solecki S u m m a r y I n t r o d u c t i o n. Ailments of lumbosacral spine are a more and more frequent problem of modern society. They very often hinder everyday functioning or even make it harder and have a negative influence on quality of patients' lives. Contemporary physical applies many methods and forms of to deal with spinal ailments. One of most renowned types is method of Mechanical Diagnosis and Therapy created by Robin McKenzie. T h e a i m of this sis is to evaluate McKenzie method's influence on quality of life of patients with M a t e r i a l s a n d m e t h o d s. The studies were conducted in group of 5 patients with lumbosacral spine ailments. The patients were divided into two groups: treatment group (5 patients) and control group (5 patients). The treatment group was composed of patients treated with McKenzie method for 3 weeks, whereas control group included patients treated with kinesio and physical according to recommendations of referring physician. The Oswestry Disability Index was used in order to assess results before and directly after rehabilitation of every patient. R e s u l t s. The average mean for treatment group before obtained on basis of Oswestry Disability Index, was (±1.677) and after was 1.8 (±9.713). The minimal value before was 3 and after was. The maximal value before was 78 and after - 46.The treatment using McKenzie method had a significant influence (p<.5) on improvement of quality of life of patients with After, patients from treatment group obtained relevantly lower results in Oswestry Disability Index than patients from control group. C o n c l u s i o n s : 1. The McKenzie method significantly improves quality of life of patients with. The McKenzie method is a more effective form of when it comes to improvement of quality patients life with lumbosacral spine ailments than kinesio and physical.

2 4 Bartosz Kochański et al. S t r e s z c z e n i e W s t ę p. Dolegliwości bólowe kręgosłupa lędźwiowokrzyżowego stają się coraz bardziej powszechnym problemem współczesnego społeczeństwa. Często utrudniają lub nawet uniemożliwiają prawidłowe funkcjonowanie człowieka oraz wpływają na obniżenie jakości życia pacjentów. Współczesna fizjoterapia wykorzystuje wiele metod i form terapii dolegliwości bólowych kręgosłupa. Jedną z nich jest metoda mechanicznego diagnozowania i terapii opracowana przez Robina McKenziego. C e l e m p r a c y jest ocena wpływu metody McKenziego na jakość życia pacjentów z dolegliwościami bólowymi kręgosłupa lędźwiowo krzyżowego. M a t e r i a ł i m e t o d y. Badania zostały przeprowadzone na grupie 5 pacjentów z dolegliwościami bólowymi kręgosłupa lędźwiowo-krzyżowego. Pacjenci zostali podzieleni na dwie grupy: badawczą - 5 osób i kontrolną - 5 osób. Grupa badawcza była objęta 3 tygodniową terapią wg metody McKenziego. Grupę kontrolną stanowili pacjenci leczeni kinezyterapią i fizykoterapią. Przed rozpoczęciem terapii i bezpośrednio po jej zakończeniu u pacjentów w celu oceny efektów terapii zastosowano kwestionariusz Oswestry. W y n i k i. Średnia wartość uzyskana dla grupy badawczej w kwestionariuszu Oswestry przed terapią to 54,96 (±1,677), zaś po terapii 1,8 (±9,713). Wartość minimalna przed terapią wynosiła 3, a po terapii, wartość maksymalna uzyskana przed leczeniem to 78, a po 46. Leczenie z wykorzystaniem metody McKenziego wpłynęło istotnie (p<,5) na poprawę jakości życia osób z dolegliwościami bólowymi kręgosłupa lędźwiowo-krzyżowego. Po terapii osoby z grupy badawczej uzyskiwały wyniki w kwestionariuszu Oswestry istotnie niższe niż osoby z grupy kontrolnej. W n i o s k i : 1. Terapia metodą McKenziego poprawia istotnie jakość życia pacjentów z dolegliwościami bólowymi odcinka lędźwiowo-krzyżowego kręgosłupa.. Terapia metodą McKenziego jest skuteczniejszą formą terapii w aspekcie poprawy jakości życia pacjentów z dolegliwościami bólowymi kręgosłupa w odcinku lędźwiowo-krzyżowym niż kinezyterapia i fizykoterapia. Key words: McKenzie method, quality of life, spinal ailments Słowa kluczowe: metoda McKenzie, jakość życia, dolegliwości bólowe kręgosłupa INTRODUCTION Spinal ailments are a more and more frequent problem of modern society. They very often hinder everyday functioning or even make it harder and have a negative influence on quality of patients' lives [1,,3]. Many authors claim that main reason for ailments of lower part of spine is associated with dynamic development of civilization causing changes in people's lifestyle [4,13]. The subject connected with lumbosacral spine ailments arouses interest and motivates many scientists. Contemporary medicine and physio dealing with spinal ailments apply many methods and forms of such as kinesio, physical, massage and or specialist methods. The McKenzie method undoubtedly deserves special attention [5,6,7]. THE MCKENZIE METHOD The McKenzie method was introduced by Robin McKenzie, a physiorapist from New Zealand. It is a very effective treatment system created for mechanical testing, and prevention of spinal ailments that puts emphasis on active participation of patients in rehabilitation process. It is based on analysis of pain patterns and factors which influence occurrence of pain. The treatment program by McKenzie consists of very thorough interview and physical examination which is conducted in accordance with own protocol. Dynamic and static testing and repeated motor exams are characteristic elements of a physical examination. Robin McKenzie divided ailments into three mechanical syndromes (derangement, dysfunction and postural) and suggested rapeutic procedures and treatment strategies. [8,9,1,11] THE AIM OF THE THESIS The aim of this sis is to evaluate McKenzie method influence on quality of life of patients with MATERIALS AND METHODS The studies were conducted in group of 5 patients with lumbosacral spine ailments, treated in local health center in Solec Kujawski. Patients were divided into two groups. Group I - treatment group was composed of patients treated with McKenzie method for 3 weeks. Before being treated, patient underwent an examination conducted in accordance with Robin McKenzie protocol. Then, each patient received an individual set of exercises and was encouraged to do se exercises systematically. Group

3 The influence of McKenzie method on quality of life of patients with lumbosacral spine ailments 43 II - control group was composed of patients with The patients from this group were treated with kinesio (general conditioning exercises) and physical (magneto, electro and photo) during a course of ten treatments. The Oswestry Disability Index () was applied before and directly after rehabilitation and assessed following: exacerbation of pain, self-care activities, lifting, walking, sitting, standing, sleeping, social life, sexual activity and travelling. Each patient may receive from to 5 points for an answer in each out of ten sections. The interpretation of results: points from all sections must be added and substituted in following formula: sum of points/ 5 x 1 = level of. Table I. The interpretation of results obtained on basis of Oswestry Disability Index Tabela I. Interpretacja wyników kwestionariusza Oswestry - % minimal level of 1-4% moderate level of 41-6% severe level of 61-8% permanent 81-1% Disablement All calculations and figures were made using SPSS Statistics Program. RESULTS Before in treatment group 48% of patients were severely disabled, 3% were permanently disabled and % were moderately disabled, according to Oswestry Disability Index. After with McKenzie method, 9% of patients were minimally disabled, 4% were moderately disabled and 4% were severely disabled. Table II. The influence of application of McKenzie method on results obtained in Oswestry Disability Index Tabela II. Wpływ leczenia metodą McKenziego na wyniki uzyskane w kwestionariuszu Oswestry BEFORE THE AFTER THE N % N % Minimal level of 3 9 Moderate level of Severe level of Permanent 8 3 Disablement Table III. The influence of treatment applying kinesio and physical on Oswestry Disability Index Table III. Wpływ leczenia kinezyterapią i fizykoterapią na wynik testu Oswestry BEFORE THE AFTER THE N % N % Minimal level of 7 8 Moderate level of Severe level of Permanent 8 3 Disablement 8 Before in control group 56% of patients were severely disabled, 3% were permanently disabled and 4% were moderately disabled, according to Oswestry Disability Index. After, 64% of patients were moderately disabled, 8% were minimally disabled and 8% were severely disabled. Table IV. Basic descriptive statistics for evaluation of results of Oswestry Disability Index in treatment group Tabela IV. Podstawowe statystyki opisowe dla oceny wyników kwestionariusza Oswestry dla grupy badawczej before after Mean N Standard deviation The standard error of mean Minimum Maximum The table above includes basic descriptive statistics for evaluation of results of Oswestry Disability Index in treatment group. The mean value obtained before is (± 1.677), whereas after it is 1.8 (± 9.713). The minimal value before was 3 and after it was, whereas maximal value before was 78 and after An intra-group T-test for dependant samples showed that means in both treatment and control groups are significantly different (p<.5).

4 44 Bartosz Kochański et al. Table V. Basic descriptive statistics for evaluation of results of Oswestry Disability Index in control group Tabela V. Podstawowe statystyki opisowe dla oceny wyników kwestionariusza Oswestry dla grupy kontrolnej before after Mean Standard deviation N The standard error of Mini mean mum Maxi mum result than those from control group. Therefore, it may be claimed that McKenzie method has a significant influence on improvement of quality of life of patients with lumbosacral spine ailments. The table above includes basic descriptive statistics for evaluation of results of Oswestry Disability Index in control group. The mean value in Oswestry Disability Index obtained before is 59.6 (±13.66), whereas after it is 6.56 (±1.8). The minimal value before was 36 and after it was, whereas maximal value before was 9 and after - 5. An intra-group T-test for dependant samples for control group, similarly to treatment group, proved significant differences before and after (p<.5). Table VI. Levene s test for homogeneity of variance and t-test for equality of means assessing Oswestry Disability Index before and after for both groups Tabela VI. Test Levene a jednorodności wariacji i Test t równości średnich dla obu grup oceniający przed i po terapii before after Levene s test for homogeneity of variance T-test for equality of means F Significance t df Significance (bilateral) The values received from Oswestry Disability Index before in treatment and control group do not differ significantly. The case is not same as far as evaluation of values is concerned. T-test showed that differences between means are statistically significant at p<.5. Thus, it can be inferred that values after in treatment and control groups are different - patients from treatment group obtained significantly lower Fig. 1. Histogram of distribution of frequency and after in both groups Ryc. 1. Histogram rozkładu częstości i po terapii po leczeniu dla obu grup The result was lower than in almost all patients from treatment group but majority of patients from control group obtained result between and 4. DISCUSSION Own studies revealed that application of McKenzie method has a significant influence (p<.5) on improvement of quality of life of patients with Nitera et al. [] and Garcia et al. [13] obtained very similar results. As far as own studies are concerned, McKenzie method is a more effective form of when it comes to improvement of quality of life of patients with lumbosacral spine ailments than kinesio and physical. Even though, when applied exclusively, McKenzie method gives positive results in improvement of quality of life, it can be supplemented by or forms of which leads to creation of even a more effective treatment tool. It is proved by work of Olczak and Kuliński [14] entitled Assessment of application methods: McKenzie and PNF in lumbar disc herniation. The study was conducted on 17 patients divided into treatment group (9 persons) and control

5 The influence of McKenzie method on quality of life of patients with lumbosacral spine ailments 45 group (8 persons). The treatment group was treated with McKenzie method toger with PNF method. The control group was treated only with McKenzie method. The results of experiment proved that applying McKenzie method supplemented by PNF method was more effective than applying only McKenzie method. Alleviation of ailments, improvement of mobility range, muscular strength and quality of life were all observed earlier in treatment group. CONCLUSIONS 1. The McKenzie method significantly improves quality of life of patients with. The McKenzie method is a more effective form of when it comes to improvement of quality of patients life with lumbosacral spine ailments than kinesio and physical. REFERENCES 1. Dziak A.: Bóle i dysfunkcje kręgosłupa. Medicina Sportiva, Kraków 7.. Nitera-Kowalik A., Smyda A., Małkowska K., Mężyńska E., Szybalska B.: Wykorzystanie metody McKenziego w kompleksowym usprawnianiu pacjentów z zespołem bólowym dolnego odcinka kręgosłupa w 1 WSzUR w Busku- Zdroju. Kwartalnik Ortopedyczny 9,, Lisiński P., Małgowska M.: Jakość życia a zespół bólowy kręgosłupa na tle przeciążeniowym. Chirurgia Narządów Ruchu i Ortopedia Polska 5, 7(5), Kochman D.: Jakość życia. Analiza teoretyczna. Zdrow. Publiczne 7, 117, Lewandowska J., Golec E., Masłoń A., Cieślak B., Chrzanowski R.: Ocena charakteru dolegliwości bólowych kręgosłupa lędźwiowo-krzyżowego u chorych z przepukliną krążka międzykręgowego. Kwartalnik Ortopedyczny 8, 4, Machado L.A.C., Kamper S.J., Herbert R.D., Maher C.G., McAuley J.H.: Analgesis effects of treatments for non-specifis low back pain: a meta-analysis of placebocontrolled randomized trials. Rheumatology 9, 48: Wiśniewska T., Kowalski I., Wiśniewska M.: Wpływ autoterapii na efektywność leczenia zespołów bólowych kręgosłupa. Fizjoterapia Polska 6, 6(), Babula G., Nagraba Ł., Stolarczyk A., Mitek T.: Analiza skuteczności metody McKenzie u pacjentów z bólem dolnego odcinka kręgosłupa na podstawie literatury. Artroskopia i Chirurgia Stawów 1, 6(1), Rucińska M.: Zastosowanie metody McKenziego w zespołach bólowych dolnego odcinka kręgosłupa. Valetudinaria- Postępy Medycyny Klinicznej i Wojskowej 9, (14), Stengert T.: Diagnostyka i leczenie zespołów bólowych kręgosłupa i kończyn metodą McKenziego. Praktyczna Fizjoterapia&Rehabilitacja 1, 1, Stengert T., Milanowska K.: Biomechaniczna diagnostyka funkcjonalna metodą McKenziego. Postępy Rehabilitacji 1998, tom XII, Kiwerski J.: Przyczyny zespołów bólowych kręgosłupa. Postępy Rehabilitacji, tom XIV, Garcia AN., Gondo FL., Costa RA., Cyrillo FN., Costa LO.: Effects of two physical interventions in patients with chronic non-specific low back pain: feasibility of a randomized controlled trial. Rev Bras Fisioter. 11, Sep-Oct;15(5): Olczak A., Kukliński W.: Ocena zastosowania metod: McKenzie i PNF w dyskopatii lędźwiowej. Acta Balneologica 1, Address for correspondence: mgr Bartosz Kochański Katedra i Klinika Rehabilitacji Collegium Medicum im. L. Rydygiera UMK w Toruniu ul. M. Curie Skłodowskiej Bydgoszcz bartosz_kochanski@o.pl tel Received: Accepted for publication: