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Iskiasoireyhtymäpotilaiden yleisenä hoitosuosituksena pidetään ohjeistusta pysyä normaalisti aktiivisena. Liikkumisen pelolla on todettu yhteys heikkoon kuntoutumisennusteeseen iskiaspotilailla. Lisäksi liikkumisen pelkoa kokevilla on todettu esiintyvän muun muassa enemmän toimintakyvyn rajoitteita, kipua, katastrofisia ajatuksia ja masennusoireita kuin iskiaspotilailla, joilla ei esiinny liikkumisen pelkoa. Tämän tutkielman tarkoituksena oli arvioida Mekaanisen diagnostisointi ja terapia (MDT) -menetelmän vaikutusta liikkumisen pelon kokemiseen iskiaspotilailla verrattuna ohjeistukseen pysyä normaalisti aktiivisena. Lisäksi tutkielmassa tarkasteltiin liikkumisen pelkoa selittäviä tekijöitä.
Tutkimukseen satunnaistettiin 136 tutkittavaa, joilla iskiasvaiva oli kestänyt vähintään kuusi viikkoa. Analyysissä oli mukana 56 % (n=37) interventioryhmäläisistä ja 44 % (n=31) kontrolliryhmäläisistä. Interventioryhmäläiset osallistuivat maksimissaan seitsemän kertaa (ka 6,4, kh 1,4) ohjattuun MDT -hoitoon. Sekä interventioryhmäläisille että kontrolliryhmäläisille annettiin tietoa iskiaskivusta ja sen hyvästä paranemisennusteesta. Liikkumisen pelkoa arvioitiin alkututkimuksen ja 3 kk seurannan yhteydessä Tampa scale for kinesiophobia (TSK) -kyselylomakkeella (17-68 p) sisältäen TSK-AA (activity avoidance) liikuntaan liittyvien uskomusten osion (8-32 p) ja TSK-SF (somatic focus) somaattisen osion (5-20 p). Intervention vaikuttavuutta arvioitiin lisäksi toimintakyvyn (Oswestryn toimintakykyindeksi) ja kivun (Visual analogue scale -kipujana) suhteen. Ryhmien välistä eroa testattiin parittomien otosten t-testillä ja liikkumisen pelon muutosta selittäviä tekijöitä selvitettiin lineaarisella regressioanalyysillä.
Ryhmien välillä ei esiintynyt tilastollisesti merkitsevää eroa liikkumisen pelon, toimintakyvyn tai kivun muutoksessa 3 kk seurannan aikana. TSK kokonaispisteet olivat alkutilanteessa MDT -ryhmällä 34,7 (7,1) ja kontrolliryhmällä 35,2 (7,5). TSK kokonaispisteet vähenivät vain MDT -ryhmällä tilastollisesti merkitsevästi (-3,5 p, p=0,01) ja erityisesti TSK-AA osiossa (-1,9 p, p=0,01). Kontrolliryhmällä muutos (-2,4, p=0,14) oli merkitsevä vain TSK-SF osiossa (-1,3, p=0,03). Liikkumisen pelon muutosta selittivät eniten toimintakyvyn koheneminen (β=0,48, p<0,01) ja miessukupuoli (β=-0,26, p=0,02), joiden selitysaste oli 27,3 % (p<0,001).
Kolmen kuukauden lyhytaikaisessa seurannassa MDT -hoito ei tuonut lisähyötyä verrattuna pelkkään ohjeistukseen pysyä aktiivisena tutkittaessa liikkumisen pelon muutosta iskiaspotilailla. Kummassakin ryhmässä liikkumisen pelkoa kokevien iskiaspotilaiden määrä väheni, kipu aleni ja toimintakyky koheni, joten iskiaspotilaille annettavaa ohjeistusta ja neuvontaa voidaan suositella. Alkutilanteessa liikkumisen pelon kokeminen oli melko yleistä ja liikkumisen pelon kartoittaminen olisikin tärkeää sisällyttää osaksi iskiaspotilaiden ohjausta. MDT:n vaikuttavuudesta iskiaspotilaiden kuntoutuksessa tarvitaan lisätutkimusta myös pitempikestoisemmalla seuranta-ajalla.
Asiasanat: Iskiasoireyhtymä, Mekaaninen diagnostisointi ja terapia, McKenzie menetelmä, liikkumisen pelko, kinesiofobia.
It is generally recommended that patients with sciatica should remain to be normally active. A high level of fear of movement has been associated with poor recovery in patients with sciatica symptoms. In addition, patients with sciatica and high level of fear of movement also are found to have more disability, pain, catasptrophic thoughts and depressive symptoms than those with low level of fear of movement. The purpose of this Masters’s thesis was to assess the impact of Mechanical diagnosis and therapy (MDT) on the experience of fear of movement in patients with sciatica compared to the guidline to stay normally active. Other aim of this thesis was to examine explanatory variables of fear of movement.
The study was randomized by 136 subjects who had had sciatica symptoms for at least six weeks. The analysis included 56 % (n = 37) of the intervention group and 44 % (n = 31) of the control group subjects. Intervention group participated maximum seven times (mean 6,4, SD 1,4) in the MDT treatment. Both the intervention and control groups were given information about the sciatica and of its good prognosis. Fear of movement at baseline and after three months follow-up was measured with the Tampa scale for kinesiophobia (TSK) questionnaire (17-68 p) including TSK-AA activity avoidance part (8-32 p) and TSK-SF questions with somatic focus (5-20 p). In addition, the effectiveness of the intervention was evaluated in terms of disability (Oswestry disability index) and pain (Visual analogue scale). The difference between two groups was measured with independent samples t-test and the explanatory variables of change in fear of movement was defined with regression analysis.
There was not statistically significant difference between these two groups in the change of fear of movement, disability or pain in the three months follow-up. At baseline the TSK index was 34,7 (7,1) in the MDT group and 35,2 (7,5) in the control group. TSK index decreased significantly only in the MDT group (-3,5 p, p= 0,01), and particularly in TSK-AA part (-1,9 p, p= 0,01). In control group the change (-2,4 p, p=0,14) was significant only in the TSK-SF part (-1,3 p, p=0,03). The change in fear of movement was explained by the improvement in functional disability status (β=0,48, p<0,01) and male gender (β=-0,26, p=0,02) with a coefficient of determination of 27,3 % (p<0,001).
In this short-term follow-up the MDT treatment did not prove any additional benefit to the decrease in fear of movement in the patients with sciatica. The number of patients with fear of movement decreased as well as pain decreased, and functional disability status improved in both groups. This means that the advice and information given to patients with sciatica can be recommended. At baseline the fear of movement was quite common. It would be important to pay attention of fear of movement when giving guidance to patients with sciatica. Further research of MDT effectiveness in patients with sciatica rehabilitation is needed also in long-term follow-up.
Key words: Sciatica, Mechanical diagnosis and therapy, McKenzie method, fear of movement, kinesiophobia.
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[{"key": "dc.contributor.advisor", "value": "H\u00e4kkinen, Arja", "language": "", "element": "contributor", "qualifier": "advisor", "schema": "dc"}, {"key": "dc.contributor.author", "value": "Airaksinen, Leena", "language": "", "element": "contributor", "qualifier": "author", "schema": "dc"}, {"key": "dc.date.accessioned", "value": "2020-03-10T09:53:22Z", "language": null, "element": "date", "qualifier": "accessioned", "schema": "dc"}, {"key": "dc.date.available", "value": "2020-03-10T09:53:22Z", "language": null, "element": "date", "qualifier": "available", "schema": "dc"}, {"key": "dc.date.issued", "value": "2019", "language": "", "element": "date", "qualifier": "issued", "schema": "dc"}, {"key": "dc.identifier.uri", "value": "https://jyx.jyu.fi/handle/123456789/68114", "language": null, "element": "identifier", "qualifier": "uri", "schema": "dc"}, {"key": "dc.description.abstract", "value": "Iskiasoireyhtym\u00e4potilaiden yleisen\u00e4 hoitosuosituksena pidet\u00e4\u00e4n ohjeistusta pysy\u00e4 normaalisti aktiivisena. Liikkumisen pelolla on todettu yhteys heikkoon kuntoutumisennusteeseen iskiaspotilailla. Lis\u00e4ksi liikkumisen pelkoa kokevilla on todettu esiintyv\u00e4n muun muassa enemm\u00e4n toimintakyvyn rajoitteita, kipua, katastrofisia ajatuksia ja masennusoireita kuin iskiaspotilailla, joilla ei esiinny liikkumisen pelkoa. T\u00e4m\u00e4n tutkielman tarkoituksena oli arvioida Mekaanisen diagnostisointi ja terapia (MDT) -menetelm\u00e4n vaikutusta liikkumisen pelon kokemiseen iskiaspotilailla verrattuna ohjeistukseen pysy\u00e4 normaalisti aktiivisena. Lis\u00e4ksi tutkielmassa tarkasteltiin liikkumisen pelkoa selitt\u00e4vi\u00e4 tekij\u00f6it\u00e4. \n\nTutkimukseen satunnaistettiin 136 tutkittavaa, joilla iskiasvaiva oli kest\u00e4nyt v\u00e4hint\u00e4\u00e4n kuusi viikkoa. Analyysiss\u00e4 oli mukana 56 % (n=37) interventioryhm\u00e4l\u00e4isist\u00e4 ja 44 % (n=31) kontrolliryhm\u00e4l\u00e4isist\u00e4. Interventioryhm\u00e4l\u00e4iset osallistuivat maksimissaan seitsem\u00e4n kertaa (ka 6,4, kh 1,4) ohjattuun MDT -hoitoon. Sek\u00e4 interventioryhm\u00e4l\u00e4isille ett\u00e4 kontrolliryhm\u00e4l\u00e4isille annettiin tietoa iskiaskivusta ja sen hyv\u00e4st\u00e4 paranemisennusteesta. Liikkumisen pelkoa arvioitiin alkututkimuksen ja 3 kk seurannan yhteydess\u00e4 Tampa scale for kinesiophobia (TSK) -kyselylomakkeella (17-68 p) sis\u00e4lt\u00e4en TSK-AA (activity avoidance) liikuntaan liittyvien uskomusten osion (8-32 p) ja TSK-SF (somatic focus) somaattisen osion (5-20 p). Intervention vaikuttavuutta arvioitiin lis\u00e4ksi toimintakyvyn (Oswestryn toimintakykyindeksi) ja kivun (Visual analogue scale -kipujana) suhteen. Ryhmien v\u00e4list\u00e4 eroa testattiin parittomien otosten t-testill\u00e4 ja liikkumisen pelon muutosta selitt\u00e4vi\u00e4 tekij\u00f6it\u00e4 selvitettiin lineaarisella regressioanalyysill\u00e4. \n\nRyhmien v\u00e4lill\u00e4 ei esiintynyt tilastollisesti merkitsev\u00e4\u00e4 eroa liikkumisen pelon, toimintakyvyn tai kivun muutoksessa 3 kk seurannan aikana. TSK kokonaispisteet olivat alkutilanteessa MDT -ryhm\u00e4ll\u00e4 34,7 (7,1) ja kontrolliryhm\u00e4ll\u00e4 35,2 (7,5). TSK kokonaispisteet v\u00e4heniv\u00e4t vain MDT -ryhm\u00e4ll\u00e4 tilastollisesti merkitsev\u00e4sti (-3,5 p, p=0,01) ja erityisesti TSK-AA osiossa (-1,9 p, p=0,01). Kontrolliryhm\u00e4ll\u00e4 muutos (-2,4, p=0,14) oli merkitsev\u00e4 vain TSK-SF osiossa (-1,3, p=0,03). Liikkumisen pelon muutosta selittiv\u00e4t eniten toimintakyvyn koheneminen (\u03b2=0,48, p<0,01) ja miessukupuoli (\u03b2=-0,26, p=0,02), joiden selitysaste oli 27,3 % (p<0,001).\n\nKolmen kuukauden lyhytaikaisessa seurannassa MDT -hoito ei tuonut lis\u00e4hy\u00f6ty\u00e4 verrattuna pelkk\u00e4\u00e4n ohjeistukseen pysy\u00e4 aktiivisena tutkittaessa liikkumisen pelon muutosta iskiaspotilailla. Kummassakin ryhm\u00e4ss\u00e4 liikkumisen pelkoa kokevien iskiaspotilaiden m\u00e4\u00e4r\u00e4 v\u00e4heni, kipu aleni ja toimintakyky koheni, joten iskiaspotilaille annettavaa ohjeistusta ja neuvontaa voidaan suositella. Alkutilanteessa liikkumisen pelon kokeminen oli melko yleist\u00e4 ja liikkumisen pelon kartoittaminen olisikin t\u00e4rke\u00e4\u00e4 sis\u00e4llytt\u00e4\u00e4 osaksi iskiaspotilaiden ohjausta. MDT:n vaikuttavuudesta iskiaspotilaiden kuntoutuksessa tarvitaan lis\u00e4tutkimusta my\u00f6s pitempikestoisemmalla seuranta-ajalla. \n\nAsiasanat: Iskiasoireyhtym\u00e4, Mekaaninen diagnostisointi ja terapia, McKenzie menetelm\u00e4, liikkumisen pelko, kinesiofobia.", "language": "fi", "element": "description", "qualifier": "abstract", "schema": "dc"}, {"key": "dc.description.abstract", "value": "It is generally recommended that patients with sciatica should remain to be normally active. A high level of fear of movement has been associated with poor recovery in patients with sciatica symptoms. In addition, patients with sciatica and high level of fear of movement also are found to have more disability, pain, catasptrophic thoughts and depressive symptoms than those with low level of fear of movement. The purpose of this Masters\u2019s thesis was to assess the impact of Mechanical diagnosis and therapy (MDT) on the experience of fear of movement in patients with sciatica compared to the guidline to stay normally active. Other aim of this thesis was to examine explanatory variables of fear of movement.\n\nThe study was randomized by 136 subjects who had had sciatica symptoms for at least six weeks. The analysis included 56 % (n = 37) of the intervention group and 44 % (n = 31) of the control group subjects. Intervention group participated maximum seven times (mean 6,4, SD 1,4) in the MDT treatment. Both the intervention and control groups were given information about the sciatica and of its good prognosis. Fear of movement at baseline and after three months follow-up was measured with the Tampa scale for kinesiophobia (TSK) questionnaire (17-68 p) including TSK-AA activity avoidance part (8-32 p) and TSK-SF questions with somatic focus (5-20 p). In addition, the effectiveness of the intervention was evaluated in terms of disability (Oswestry disability index) and pain (Visual analogue scale). The difference between two groups was measured with independent samples t-test and the explanatory variables of change in fear of movement was defined with regression analysis.\n\nThere was not statistically significant difference between these two groups in the change of fear of movement, disability or pain in the three months follow-up. At baseline the TSK index was 34,7 (7,1) in the MDT group and 35,2 (7,5) in the control group. TSK index decreased significantly only in the MDT group (-3,5 p, p= 0,01), and particularly in TSK-AA part (-1,9 p, p= 0,01). In control group the change (-2,4 p, p=0,14) was significant only in the TSK-SF part (-1,3 p, p=0,03). The change in fear of movement was explained by the improvement in functional disability status (\u03b2=0,48, p<0,01) and male gender (\u03b2=-0,26, p=0,02) with a coefficient of determination of 27,3 % (p<0,001).\n\nIn this short-term follow-up the MDT treatment did not prove any additional benefit to the decrease in fear of movement in the patients with sciatica. The number of patients with fear of movement decreased as well as pain decreased, and functional disability status improved in both groups. This means that the advice and information given to patients with sciatica can be recommended. At baseline the fear of movement was quite common. It would be important to pay attention of fear of movement when giving guidance to patients with sciatica. Further research of MDT effectiveness in patients with sciatica rehabilitation is needed also in long-term follow-up.\n\nKey words: Sciatica, Mechanical diagnosis and therapy, McKenzie method, fear of movement, kinesiophobia.", "language": "en", "element": "description", "qualifier": "abstract", "schema": "dc"}, {"key": "dc.description.provenance", "value": "Submitted by Miia Hakanen (mihakane@jyu.fi) on 2020-03-10T09:53:22Z\nNo. of bitstreams: 0", "language": "en", "element": "description", "qualifier": "provenance", "schema": "dc"}, {"key": "dc.description.provenance", "value": "Made available in DSpace on 2020-03-10T09:53:22Z (GMT). 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