190 research outputs found
NefarmakoloÅ”ko lijeÄenje osteoartritisa utemeljeno na dokazima
Osteoarthritis (OA ) is the most common rheumatic joint disease, but also a disease that affects the entire joint and all structures surrounding the joint (periarticular structures). Literature dealing with this topic most commonly includes results related to the treatment of knee osteoarthritis (OA ), while other localisations of degenerative changes of the joints are not researched in such a detailed way. In addition to that, these degenerative changes exhibit less evidence strength, so the same will be used in this review. According to the latest 2019 ESCEO guidelines for the treatment of OA , non-pharmacological treatment (NPT) has an important role in OA treatment and it is a part of all OA treatment algorithms, and it has to be a part of evidence-based medicine (EBM). With technological progress in rehabilitation medicine, new solutions have appeared, as well as new forms of NPT aimed at helping patients, relieving pain, increasing the patientsā functional ability and improving their quality of life. Due to this, in this literature review, which was accessed through the Cochrane library, PEDro database and PubMed search, we mostly found discussions about new technologies in OA treatment. During that search, we can easily conclude that results of many systematic reviews and meta-analyses about the use of conventional methods of physical therapy did not change much compared to the methods used 10 years ago. When it comes to all of these methods, medical exercise is considered to be the most effective one, with the highest evidence strength. Nowadays, as opposed to literature sources in the past, in most literature we are able to find a significantly more accurate and precise definition of the term āphysical activityā. It is defined as an activity performed
during an individualās stay at their workplace, during transport, while doing oneās chores or housework, and during leisure time. We believe that the newest, modern technologies in rehabilitation medicine, such as the following ones: high-intensity laser therapy (HILT ), extracorporeal shock wave therapy (ESWT), radio frequency (RF) and electromagnetic therapy super inductive system (SIS ), present the biggest challenge in the NPT of OA today. These treatment methods, according to the available EBM data, have shown outstanding efficiency in the treatment of OA by reducing the patientsā pain, improving patientsā functional ability as well as their quality of life, with minimal adverse effects. Today, the general opinion is that we should give advantage to modern technologies in combination with already well- known and defined medical exercises with implementing preventive activitieOsteoartritis (OA ) najÄeÅ”Äa je reumatska bolest zgloba i svih okolozglobnih struktura. U literaturi su najÄeÅ”Äe zastupljeni rezultati vezani uz lijeÄenje OA koljena, a ostale lokalizacije degenerativnih promjena zglobnih struktura manje su istraživane. Pritom su i dokazi manje snage pa Äe tako biti i u ovome preglednom Älanku. Prema ažuriranim smjernicama ESCEO-a iz 2019. g., bitnu ulogu u lijeÄenju bolesnika s OA ima i nefarmakoloÅ”ko lijeÄenje (NFL) ā dio svih algoritama lijeÄenja OA , uz preporuku da mora biti utemeljeno na dokazima (EBM). TehnoloÅ”ki napredak u rehabilitacijskoj medicini nudi neka nova rjeÅ”enja, nove oblike NFL-a radi pomoÄi bolesnicima, uklanjanja boli i poveÄanja funkcionalnih moguÄnosti, Äime se poboljÅ”ava i kvaliteta života. Zbog toga se u literaturi koja je dostupna pregledom Cochraneove knjižnice, baze PEDro i tražilice PubMed danas najÄeÅ”Äe raspravlja o novim tehnologijama u lijeÄenju OA . PrimjeÄujemo da se rezultati brojnih sustavnih pregleda i metaanaliza o primjeni konvencionalne fizikalne terapije nisu bitno promijenili u odnosu prema onima u sliÄnim analizama i prije 10-ak godina. NajuÄinkovitijom metodom, uz najkvalitetniju snagu dokaza, smatra se medicinska vježba. No, za razliku otprije, danas u literaturi nalazimo znatno toÄniju i precizniju definiciju pojma tjelesne aktivnosti: to je aktivnost tijekom boravka na radnome mjestu, za vrijeme transporta, tijekom obavljanja kuÄanskih poslova i u slobodno vrijeme. NajveÄi izazov u NFL-u OA danas jesu
moderne tehnologije u rehabilitacijskoj medicini, a to su terapije laserom visokog intenziteta (HILT ), udarnim valom (ESWT), radiofrekvencijom (RF) i elektromagnetskim poljem visokog intenziteta (SIS ). Te metode lijeÄenja, prema dostupnim podatcima EBM-a, pokazale su izrazitu uÄinkovitost u lijeÄenju OA : reduciranu bol kod ispitanika, poboljÅ”ane funkcionalne sposobnosti i kvalitetu života bolesnika. Sve to uz izrazito malo neželjenih dogaÄaja. Danas je uvriježeno miÅ”ljenje da treba davati prednost modernim tehnologijama, dobro definiranim medicinskim vježbama i provoÄenju
preventivnih aktivnosti
Patophysiology of osteoarthritis
Osteoartritis (OA) je kroniÄna, polagano progredirajuÄa bolest zglobne hrskavice i okolozglobnih struktura, koju karakterizira postepen nastanak zglobne boli, ukoÄenosti zgloba i ograniÄenost pokreta.
Muskuloskeletne bolesti su jedan od vodeÄih medicinskih, socijalnih i ekonomskih problema danaÅ”njice, a upravo je OA najuÄestalija meÄu njima, karakteristiÄna po svojoj incidenciji i utjecaju na promjenu kvalitete življenja.
Zbog toga u reumatologiji postoji veliki interes za sve aspekte te bolesti, a poglavito za patofiziologiju OA. Namjera ovog Älanka je bila da sagleda najvažnije aspekte patofizioloÅ”kog dogaÄanja u zglobu, jer poznavanje patofiziologije nam omoguÄava ispravno promiÅ”ljanje terapijskih postupaka i farmakoterapije OA, usmjerenih na prevenciju, smanjenje simptoma i lijeÄenje posljedica OA.Osteoarthritis (OA) is slowly evolving disease of articular cartilage degneration characterized by the gradual development of joint pain, stiffness and limitation of motion.
Musculoskeletal diseases are growing medical, social and economic problem. OA among them takes leading position with incidence, morbidity and poor quality of life.
In the last few decades there is increasing interest for better knowledge of all aspects of the disease, especially with regard to its pathophysiology. This paper focuses the recent aspects of patophysiology of OA, because knowledge of patophysiology means the challenge for the clinician to find a way to best prevent articular cartilage degradation, preserve joint function, treat joint pain and treat concurrent inflammation
Spondyloarthropathies - clinical evaluation and physical therapy
Spondiloartropatijama nazivamo skupinu heterogenih, kroniÄnih, autoimunih reumatskih bolesti gdje spadaju ankilozantni spondilitis, reaktivni artritis, psorijatiÄki artritis i artritisi povezani s upalnim crijevnim i oÄnim bolestima. Iako se radi o kliniÄki, meÄusobno bitno razliÄitim entitetima, ova velika skupina bolesti ima brojna zajedniÄka kliniÄka, radioloÅ”ka i genetska obilježja, kojima se jasno razlikuje od ostalih upalnih reumatskih bolesti. Jedan od najvažnijih pristupa u praÄenju bolesnika sa spondiloartropatijom jest kontrola i praÄenje njihovog funkcijskog statusa i opÄeg zdravlja, Å”to se najlakÅ”e postiže koriÅ”tenjem brojnih, bolesti prilagoÄenih upitnika, Oni uvažavaju sve promjene na lokomotornom sustavu i zahvaÄenim zglobovima, stavljajuÄi te promjene u odnos spram drugih dimenzija zdravlja (psihiÄki status, socijalni status, emocionalni status, aktivnosti dnevnog življenja). Pri tome se najÄeÅ”Äe koriste:
1. S-HAQ prilagoÄeni HAQ upitnik za bolesnike sa spondioloartritisom;
2. DFI funkcijski indeks za ankilozantni spondilitis;
3. Leeds upitnik o ometenosti, koji ukljuÄuje funkcijske parametre i držanje bolesnika s ankilozantnim spondilitisom;
4. BASFT upitnik za aktivnosti dnevnog življenja.
Fizikalna terapija je jedan od najkorisnijih terapijskih pristupa u rehabilitacijskom postupku i lijeÄenju bolesnika sa spondiloartropatijom, poglavito kinezioterapija. Uz taj oblik fizikalne terapije koristi se i Äitav niz ostalih procedura, koje znaÄajno upotpunjuju korisno djelovanje medicinske gimnastike (ultrazvuk, krioterapija, elektroterapija, laserā¦) na poveÄanje funkcijskog kapaciteta lokomotornog statusa.Spondyloarthropathy is a group of chronic autoimmune disorders including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, arthritis associated with inflammatory bowel disease, acute anterior uveitis and undifferentiated spondyloarthropathies. The spondyloarthropathies share common clinical, radiological, and genetic features that are clearly distinct from other inflammatory rheumatic diseases. The major goal in the management of patients with rheumatic disorders is to control or cure the disease and to preserve and control function and health status. To measure treatmentsā efficacy standardized assessment of organ morphology, function, and of health status are required. The instruments for measuring health status or quality of life cover a variety of dimensions of health, including physical, social, and emotional functioning. Measurements used to evaluate the efficacy of treatments in ankylosing spondylitis include spinal and chest movement, duration and severity of morning stiffness, and quality of sleep. Health status indices such as the HAQ or AIMS are not readily applicable to spondyloarthropaties. It is reason to use some others:
1. Functional status measure S-HAQ for patients with spondylitis by adding five items to the HAQ, to cover the activities identified as most problematic;
2. Functional index for the assessment of ankylosing spondylitis (Dougados Functional Index - DFI) - it is valid and reliable and shows sufficient responsiveness; S-HAQ appears at least as sensitive to change as the Dougados Index;
3. The Leeds Disability Questionnaire assesses disability in ankylosing spondylitis, inquiring about four areas of function: mobility, bending down, reaching up and neck movements, and postures;
4. The Bath Ankylosing Spondylitis Functional Index (BASFI) 10 item self-administered questionnaire to assess function and activities of daily living in patients with ankylosing spondylitis.
Physical therapy is one of the most important way to restore function and health status in patients with spondyloarthropathies, esspecially individual kinesitherapy. We use and many other procedures combine them with kinesitherapy (ultrasound, cryotherapy, electrotherapy, laser...)
Non-pharmacological treatment of osteoporosis
Kompleksnost uzroka, patofiziologije i kliniÄke slike osteoporoze (OP) razlog je i posljediÄno kompleksnog lijeÄenja bolesti. Stoga, osim farmakoterapije, u procesu lijeÄenja OP-a veliku ulogu ima i prevencija i nefarmakoloÅ”ko lijeÄenje. Pri tome najviÅ”e mislimo na lijeÄenje najteže posljedice bolesti ā prijeloma. U tu svrhu koriste se razliÄiti oblici fizikalne terapije i razliÄiti rehabilitacijski modeli usmjereni na smanjenje bola i poveÄanje funkcijskih moguÄnosti bolesnica. Spomenutim metodama treba pridodati i koriÅ”tenje razliÄitih funkcijskih pomagala, koja znaÄajno olakÅ”avaju aktivnosti dnevnog življenja.The complexity of causes, pathophysiology and clinical picture of osteoporosis (OP) have been the reasons of consequently complex treatment of the disease. Therefore, except pharmacotherapy, prevention and non-pharmacological cure have a big role in the process of OP treatment. By this is mostly meant of how to treat fracture, as the most severe consequence.
For that purpose, various forms of physical therapy have been applied, as well as different rehabilitation modes aimed at pain lessening and enhancement of patientsā functional abilities. Various function-aids must be added to the aforementioned methods, which significantly ease the activities of everyday living
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