The effect of medical rehabilitation on quality of life of surgically and non-surgically treated patients suffering from lumbar radiculopathy

Uvod: Sindrom lumbalne radikulopatije obuhvata disfunkciju nervnog korena lumbalne kičme, prouzrokovano kompresijom, nastalom usled hernijacije (protruzije, prolapsa) intervertebralnog diska ili zbog inflamatornih i degenerativnih promena (najčešće osteofita) u foraminalnom otvoru. Kvalitet života predstavlja savremeni koncept posmatranja ishoda oboljenja i uspešnosti terapijske procedure kako u svim oblastima medicine, tako i u problematici lumbalne radikulopatije. Cilj: Proceniti kvalitet života operativno i neoperativno lečenih pacijenata sa lumbalnom radikulopatijom na početku lečenja i 3 meseca, odnosno 6 meseci nakon sprovedene medicinske rehabilitacije. Metode: Istraživanje predstavlja prospektivnu kliničku studiju kojom je analiziran kvalitet života bolesnika sa lumbalnom radikulopatijom. Obuhvaćen je randomiziran i stratifikovan uzorak pacijenata sa lumbalnom radikulopatijom diskalne geneze starosti 20 do 65 godina, oba pola (n=100), lečenih u Specijalnoj bolnici za progresivne mišićne i neuromišićne bolesti Novi Pazar. Jedna grupa ispitanika (n=50) lečena je isključivo neoperativnim metodama, dok je druga grupa bolesnika (n=50) lečena hirurškim i neoperativnim metodama. Kod svih pacijenata sproveden je konzervativni tretman primenom fizikalnih procedura, kineziterapijskih procedura, ergonomske edukacije. Medikamentna terapija je kod svih bila identična. Za procenu stanja pacijenata, kvaliteta života i efekta rehabilitacionog tretmana korišćena su dva standardizovana upitnika: opšti zdravstveni upitnik Medical Outcomes Study Short Form 36 (SF 36) i upitnik specifičan za oboljenje The Oswestry Disability Index (ODI). Rezultati: Vrednosti SF-36 upitnika prikazanih sumarnim fizičkim (SFS) i mentalnim (SMS) skorom, i kod neoperativno lečenih ispitanika (FSFS=450,221 i p<0,001; FSMS=106,543 i p<0,001), ali i kod operativno lečenih (FSFS=490,721 i p<0,001; FSMS=72,055 i p<0,001) značajno su se menjale u toku ispitivanja. Vrednosti SFS kod neoperativno lečenih pacijenata (početak tretmana, 3 meseca, 6 meseci): 35,5 / 44,7 / 50,8; kod operativno lečenih: 28,8 / 42,8 / 49,2. Vrednosti SMS kod neoperativno lečenih pacijenata: 40,6 / 44,8 / 52,6; kod operativno lečenih: 37,8 / 45,2 / 52,5. Najveće poboljšanje SFS, kod obe grupe pacijenata, je registrovano u prva tri meseca od početka rehabilitacionog tretmana, dok je najveći napredak SMS registrovan u prva tri meseca od početka rehabilitacionog tretmana kod druge grupe pacijenata. Vrednosti skora Osvestri indeksa nesposobnosti (ODI), i kod pacijenata prve grupe (F=432,810 i p<0,001), ali i kod pacijenata druge grupe (F=1341,180 i p<0,001) značajno su se menjale u toku ispitivanja. Vrednosti ODI kod neoperativno lečenih pacijenata su: 51,5% / 36% / 22,5%; a kod pacijenata druge grupe: 56,1% / 38,9% / 23,7%. Najveće poboljšanje je registrovano u prva tri meseca od početka rehabilitacionog tretmana kod druge grupe pacijenata. Postoje statistički značajne korelacije glavnih sumarnih skorova i domena SF-36 (SFS i SMS) i ODI skorova. Zaključak: Kvalitet života i funkcionalni status i neoperativno i operativno lečenih pacijenata je značajno bolji u komparaciji stanja, na 3 meseca i na 6 meseci u odnosu na početak rehabilitacije, kao i na 6 meseci u odnosu na stanje na 3 meseca.Introduction: The syndrome of lumbar radiculopathy involves dysfunction of nerve roots of the lumbar spine, caused by compression, resulting due to herniation (protrusion, prolapse) intervertebral disc, or due to inflammatory and degenerative changes (usually osteophytes) in foraminal opening. Quality of life is the modern concept of observing the outcome of disease and therapeutic procedures in performance in all areas of medicine, as well as the problems of lumbar radiculopathy. Aim: Assess the quality of life for surgically and conservatively treated patients with lumbar radiculopathy at initiation of treatment and 3 months, and 6 months after conducting medical rehabilitation. Methods: The study is a prospective clinical study, which analyzed the quality of life of patients with lumbar radiculopathy. Also included is randomized and stratified sample of patients with lumbar radiculopathy of discal genesis aged 20 to 65 years, of both sexes (n=100) treated at the Special Hospital for progressive muscular and neuromuscular diseases Novi Pazar. One group of patients (n=50) were treated exclusively non-surgical methods, while the second group of patients (n=50) treated with surgical and non-surgical methods. In all patients was conducted by applying the conservative treatment of physical procedures, kinesitherapy procedures, ergonomic education. Medication treatment is at all were identical. To assess the condition of patients, quality of life and the effect of rehabilitation treatment used two standardized questionnaires: a general health questionnaire Medical Outcomes Study Short Form 36 (SF 36) and disease-specific questionnaire The Oswestry Disability Index (ODI). Results: Values SF-36 questionnaire presented summary physical (SFS) and mental (SMS) scores, with non-surgical treated subjects (FSFS=450.221, p<0.001; FSMS=106.543, p<0.001), but also at surgical treated (FSFS=490.721, p<0.001; FSMS=72.055, p<0.001) were significantly changed during the study. Values at SFS non-surgical treated patients (beginning of treatment, 3 months, 6 months): 35.5 / 44.7 / 50.8; at surgical treated: 28.8 / 42.8 / 49.2. Values SMS with the non-surgical treated patients: 40.6 / 44.8 / 52.6; with surgical treated: 37.8 / 45.2 / 52.5. The biggest improvement of SFS, in both groups of patients were registered in the first three months of the start of the rehabilitation treatment, while the biggest progress SMS is registered in the first three months of the start of treatment in other patient groups. The Oswestry Disability Index (ODI) values score, in patients of the first group (F=432.810, p<0.001), and in second group of patients (F=1341.180, p<0.001) were significantly changed during the study. ODI values at non-surgical treated patients were: 51.5% / 36% / 22.5%; the second group of patients: 56.1% / 38.9% / 23.7%. The bigest improvement was registered in the first three months of the start of treatment in second group patients. There are statistically significant correlations main summary scores and SF-36 domains (SFS and SMS) and ODI scores. Conclusion: The quality of life and functional status of both groups patients was significantly better in comparison to the situation, at 3 months and 6 months compared to the beginning of rehabilitation, as well as at 6 months compared to 3 months

Efekat korektivnih vežbi na funkcionalne deformitete kičmenog stuba kod dece predškolskog i školskog uzrasta

Introduction. Poor muscle development, accompanied by insuffcient physical activity and non-physiological forces which act on the bone and joint system, often causes improper body posture. Objectives. To examine whether performing corrective exercises which stretch shortened and strengthen weakened muscles regularly can improve body posture in preschool and school-aged children. Methods. The prospective study included 110 children, 63 (57.2%) boys and 47 (42.8%) girls (the average age being 6.6 ± 2.4). Corrective exercises were performed four times a week for six months, in periods of 90 minutes. We used somatoscopy and somatometry methods to assess body posture. Results. On the initial checkup it was found that 18 children (16.4%) had some kind of spine deformity; 11 of them (10%) had scoliosis, six (5.5%) had kyphosis and 1(0.9%) had lordotic body posture. The first follow-up checkup was performed 3 months later when we found a decrease in the number of children with a bad body posture. The second follow-up checkup was repeated 6 months later. Out of 18 children (16.4%) who had been registered at the beginning, 4 (3.6%) had scoliotic, 2 (1.8%) had kyphotic and 1 (0.9%) had lordotic posture 6 months later. Conclusion. Based on the obtained results, it can be said that regular performance of corrective exercises (strengthening weakened and stretching shortened muscles) for six months had a positive effect on certain spine deformities. Kyphosis correction was visible after only three months, scoliosis correction was visible after six months, while lordosis correction was not achieved by corrective exercises in the only registered case.Uvod: Slaba razvijenost mišića, praćena nedovoljnom fzičkom aktivnošću i nefziološkim silama koje deluju na koštano-zglobni sistem, često uzrokuje nepravilno držanje tela. Cilj: Ispitati da li se redovnim izvođenjem korektivnih vežbi kojima se isteže skraćena, a jača oslabljena muskulatura, može popraviti držanje tela kod dece predškolskog i školskog uzrasta. Ispitanici i metode: Prospektivna studija obuhvatila je uzorak od 110 dece, od kojih je 63 (57.2%) dečaka i 47 (42.8%) devojčica (prosečne starosti 6.6 ± 2.4 godina). Korektivne vežbe su izvođene u periodu od šest meseci, četiri puta nedeljno, u trajanju od 90 minuta. Za procenu držanja primenjivane su metode somatoskopije i somatometrije. Rezultati: Na inicijalnom pregledu utvrđeno je da 18 (16.4%) dece ima neki od deformiteta kičme. Njih 11 (10%) imalo je skoliozu, šest (5.5%) kifozu i jedno (0.9%) lordozu. Prvi kontrolni pregled obavljen je posle tri meseca, kada je zabeležen pad broja dece s lošim držanjem. Drugi kontrolni pregled ponovljen je nakon šest meseci. Od ukupno 18 (16.4%) registrovanih na početku, nakon šest meseci njih četvoro (3.6%) imalo je skoliozu, dvoje (1.8%) kifozu i jedno (0.9%) lordozu. Zaključak: Na osnovu dobijenih rezultata može se reći da je redovnim izvođenjem korektivnih vežbi (jačanjem oslabljenih i istezanjem skraćenih mišića) u trajanju od šest meseci ostvaren pozitivan efekat na određene deformitete kičmenog stuba. Korekcija kifoze je bila vidljiva već nakon tri meseca, skolioze nakon šest meseci, dok korekcija lordoze u jedinom zabeleženom slučaju nije postignuta korektivnim vežbama

The effect of medical rehabilitation on quality of life of surgically and non-surgically treated patients suffering from lumbar radiculopathy

Uvod: Sindrom lumbalne radikulopatije obuhvata disfunkciju nervnog korena lumbalne kičme, prouzrokovano kompresijom, nastalom usled hernijacije (protruzije, prolapsa) intervertebralnog diska ili zbog inflamatornih i degenerativnih promena (najčešće osteofita) u foraminalnom otvoru. Kvalitet života predstavlja savremeni koncept posmatranja ishoda oboljenja i uspešnosti terapijske procedure kako u svim oblastima medicine, tako i u problematici lumbalne radikulopatije. Cilj: Proceniti kvalitet života operativno i neoperativno lečenih pacijenata sa lumbalnom radikulopatijom na početku lečenja i 3 meseca, odnosno 6 meseci nakon sprovedene medicinske rehabilitacije. Metode: Istraživanje predstavlja prospektivnu kliničku studiju kojom je analiziran kvalitet života bolesnika sa lumbalnom radikulopatijom. Obuhvaćen je randomiziran i stratifikovan uzorak pacijenata sa lumbalnom radikulopatijom diskalne geneze starosti 20 do 65 godina, oba pola (n=100), lečenih u Specijalnoj bolnici za progresivne mišićne i neuromišićne bolesti Novi Pazar. Jedna grupa ispitanika (n=50) lečena je isključivo neoperativnim metodama, dok je druga grupa bolesnika (n=50) lečena hirurškim i neoperativnim metodama. Kod svih pacijenata sproveden je konzervativni tretman primenom fizikalnih procedura, kineziterapijskih procedura, ergonomske edukacije. Medikamentna terapija je kod svih bila identična. Za procenu stanja pacijenata, kvaliteta života i efekta rehabilitacionog tretmana korišćena su dva standardizovana upitnika: opšti zdravstveni upitnik Medical Outcomes Study Short Form 36 (SF 36) i upitnik specifičan za oboljenje The Oswestry Disability Index (ODI). Rezultati: Vrednosti SF-36 upitnika prikazanih sumarnim fizičkim (SFS) i mentalnim (SMS) skorom, i kod neoperativno lečenih ispitanika (FSFS=450,221 i p<0,001; FSMS=106,543 i p<0,001), ali i kod operativno lečenih (FSFS=490,721 i p<0,001; FSMS=72,055 i p<0,001) značajno su se menjale u toku ispitivanja. Vrednosti SFS kod neoperativno lečenih pacijenata (početak tretmana, 3 meseca, 6 meseci): 35,5 / 44,7 / 50,8; kod operativno lečenih: 28,8 / 42,8 / 49,2. Vrednosti SMS kod neoperativno lečenih pacijenata: 40,6 / 44,8 / 52,6; kod operativno lečenih: 37,8 / 45,2 / 52,5. Najveće poboljšanje SFS, kod obe grupe pacijenata, je registrovano u prva tri meseca od početka rehabilitacionog tretmana, dok je najveći napredak SMS registrovan u prva tri meseca od početka rehabilitacionog tretmana kod druge grupe pacijenata. Vrednosti skora Osvestri indeksa nesposobnosti (ODI), i kod pacijenata prve grupe (F=432,810 i p<0,001), ali i kod pacijenata druge grupe (F=1341,180 i p<0,001) značajno su se menjale u toku ispitivanja. Vrednosti ODI kod neoperativno lečenih pacijenata su: 51,5% / 36% / 22,5%; a kod pacijenata druge grupe: 56,1% / 38,9% / 23,7%. Najveće poboljšanje je registrovano u prva tri meseca od početka rehabilitacionog tretmana kod druge grupe pacijenata. Postoje statistički značajne korelacije glavnih sumarnih skorova i domena SF-36 (SFS i SMS) i ODI skorova. Zaključak: Kvalitet života i funkcionalni status i neoperativno i operativno lečenih pacijenata je značajno bolji u komparaciji stanja, na 3 meseca i na 6 meseci u odnosu na početak rehabilitacije, kao i na 6 meseci u odnosu na stanje na 3 meseca.Introduction: The syndrome of lumbar radiculopathy involves dysfunction of nerve roots of the lumbar spine, caused by compression, resulting due to herniation (protrusion, prolapse) intervertebral disc, or due to inflammatory and degenerative changes (usually osteophytes) in foraminal opening. Quality of life is the modern concept of observing the outcome of disease and therapeutic procedures in performance in all areas of medicine, as well as the problems of lumbar radiculopathy. Aim: Assess the quality of life for surgically and conservatively treated patients with lumbar radiculopathy at initiation of treatment and 3 months, and 6 months after conducting medical rehabilitation. Methods: The study is a prospective clinical study, which analyzed the quality of life of patients with lumbar radiculopathy. Also included is randomized and stratified sample of patients with lumbar radiculopathy of discal genesis aged 20 to 65 years, of both sexes (n=100) treated at the Special Hospital for progressive muscular and neuromuscular diseases Novi Pazar. One group of patients (n=50) were treated exclusively non-surgical methods, while the second group of patients (n=50) treated with surgical and non-surgical methods. In all patients was conducted by applying the conservative treatment of physical procedures, kinesitherapy procedures, ergonomic education. Medication treatment is at all were identical. To assess the condition of patients, quality of life and the effect of rehabilitation treatment used two standardized questionnaires: a general health questionnaire Medical Outcomes Study Short Form 36 (SF 36) and disease-specific questionnaire The Oswestry Disability Index (ODI). Results: Values SF-36 questionnaire presented summary physical (SFS) and mental (SMS) scores, with non-surgical treated subjects (FSFS=450.221, p<0.001; FSMS=106.543, p<0.001), but also at surgical treated (FSFS=490.721, p<0.001; FSMS=72.055, p<0.001) were significantly changed during the study. Values at SFS non-surgical treated patients (beginning of treatment, 3 months, 6 months): 35.5 / 44.7 / 50.8; at surgical treated: 28.8 / 42.8 / 49.2. Values SMS with the non-surgical treated patients: 40.6 / 44.8 / 52.6; with surgical treated: 37.8 / 45.2 / 52.5. The biggest improvement of SFS, in both groups of patients were registered in the first three months of the start of the rehabilitation treatment, while the biggest progress SMS is registered in the first three months of the start of treatment in other patient groups. The Oswestry Disability Index (ODI) values score, in patients of the first group (F=432.810, p<0.001), and in second group of patients (F=1341.180, p<0.001) were significantly changed during the study. ODI values at non-surgical treated patients were: 51.5% / 36% / 22.5%; the second group of patients: 56.1% / 38.9% / 23.7%. The bigest improvement was registered in the first three months of the start of treatment in second group patients. There are statistically significant correlations main summary scores and SF-36 domains (SFS and SMS) and ODI scores. Conclusion: The quality of life and functional status of both groups patients was significantly better in comparison to the situation, at 3 months and 6 months compared to the beginning of rehabilitation, as well as at 6 months compared to 3 months

The quality of life of patients after lumbar microdiscectomy

Introduction/Objective. The quality of life (QL) is a modern concept of observing the outcome of the disease and the success of the therapeutic procedure in all fields of medicine. The aim was to assess the QL of surgically treated patients with lumbar radiculopathy (LR) at the beginning of treatment and three and six months after the initiation of prescribed and applied medical rehabilitation. Methods. The study group included randomized and stratified sample of 50 patients treated with lumbar microdiscectomy (LM). Conservative treatment was carried out using physical therapy procedures, and kinetic and ergonomic therapeutic procedures and educational training program in ergonomics were carried out in all the patients. To assess the condition of the patients, the QL and the efficacy of the rehabilitation treatment, we used two standardized questionnaires, the Short Form Survey Instrument (SF-36) and the Oswestry Disability Index (ODI). Results. The lowest values of the SF-36 – PCS, SF-36 – MCS, and of the ODI were recorded at the beginning of the rehabilitation (PCS: 28.8; MCS: 37.8; ODI: 56.1%). The most significant improvements of the scores were observed three months after the treatment initiation (PCS: 42.8; MCS: 45.2; ODI: 38.9%). At six months of treatment, the scores were slightly higher (PCS: 49.2; MCS: 52.5; ODI: 23.7%) (p < 0.001). Conclusion. The QL and the functional status of patients after LM are significantly better after three and six months in comparison with the beginning of rehabilitation, and the state for six months compared to the state for three months