Мръцкова-Делиева, Галина; Mratskova- Delieva, Galina
Сравнително проучване на ефектите при терапията с дълбока осцилация /Deep oscillation/ и някои преформирани физикалнн фактори при лечението и рехабилитацията на пациенти с остеоартроза
Comparative study of the deep oscillation therapy effects and some preformed physical factors in treatment and rehabilitation of patients with osteoarthritis
остеоартроза; осцилация; дълбока осцилация; лечение; рехабилитация; преформирани физикални фактори
Osteoarthritis (OA) is the most common rheumatic disease with a predilection for the joints of lower limbs, knee and hip. OA of knee joint (KJ) is the cause of a severe, long-term pain, a decrease in daily functional activity, a deterioration in quality of life, and a treatment and rehabilitation cost increase. Among the priorities of modern Physical and Rehabilitation Medicine are development and application of new methods in complex treatment and rehabilitation of degenerative joint disease. Low frequency pulsation electrostatic field is the basis of the Deep Oscillation(DO) treatment method. Main therapeutic effects are realized as a result of the electric field pulse generated with low frequency from 5 to 250 Hz, with small amperage 5–7 μA and biphasic mode. Therapeutic effects depend on the frequency range. Rapid and sustained pain relief, improvement of microcirculation and reduction of swelling is achieved. The fibrinolytic effect and increased tissue elasticity lead to normalization of the muscle tone and improves mobility of joints system. Anti-inflammatory and immune-stimulating effect is observed. The aim of the research project is to investigate the therapeutic effects of the application of Low frequency pulsation electrostatic field using the DO method in patients with OA of KJ and to compare the therapeutic effects of the application of Deep Oscillation, Interference Current (IFC) and placebo-DO. Material and methods The study includes 144 patients diagnosed with radiologically proven gonarthrosis II and III degree of Kellgren-Lawrence scale median age (mean ± SD) of 66.0 ± 10.3 years, 101 female and 43 male. Patients were divided into three groups at random: Test Group (TG, n=57), performs ten days Deep Oscillation treatment using a hand applicator - 9.5 cm. The KJ, the surrounding tissues and the m.Quadriceps femoris area are treated. Therapeutic Modes: Variable frequency 100-144 Hz 5 min, constant frequency 85 Hz 5 min., Variable frequency 14-20 Hz 4 min, modulation mode 1: 1 (slight vibrations). Routine Group(RG, n=54) conducts 10 procedures with IFC with variable frequency 90-100Hz, followed by 0-100 Hz. The Control Group(CG; n=33) conducted a ten-day Placebo-DO course, in the treated area there were no vibrations in the depth of the tissues. The therapeutic course for all three groups includes 10 kinesitherapy procedures (KT) carried out immediately after electrotherapy. The KT procedure includes: Aerobic exercises; Analytical gymnastics for femoral muscles, with emphasis on Vstus medialis et lateralis m. Quadriceps femoris; Relaxing techniques for shortened muscles; Exercises against resistance; Exercises to increase the volume of movement in the KJ. The results were tracked four times before and after treatment, at I-st and III-rd month, for all of the three groups and objectified by Manual Muscle Test, measuring the circumference of the knee, Range of Motion, pain assessment at rest and physical activity (walking along, descending and climbing stairs) through VAS(a Visual-Analogue Scale for pain) and questionnaire WOMAC(Western Ontario and McMaster Universities Osteoarthritis Index). A comparison of the therapeutic effects of the application of the electrical physical factors (DO, IFC and Placebo-DO) and kinesitherapy(applied to all three groups) was performed. The relevant value of the reformed physical factor on the basis of the KT was evaluated. A statistically significant decrease in edema, increased range of motion(flexion) in KJ, and m. Quadriceps femoris muscle weakness for three-time periods(TTP) versus baseline (p<0.001) was obsereved in the TG, as well as a tendency to a better influence of the levels of muscle weakness and range of motion in the KJ for the groups (test and routine) in which patients received complex physiotherapeutic treatment: electro-procedure and KT. A statistically significant reduction in pain after treatment in ТG, I and III months at rest(p<0.001), motion(p<0.001), descent(p<0.001) and ascending(p<0.001) were reported compared to baseline values and retention of post-treatment outcomes and at month III. In the RG, there was a significant reduction pain in rest until the end of the first month(p<0.001), retention of I month(p=0.152) and III month(p=0.265) versus post-therapy and increase of III versus I-st month(p<0.001). When walking a reduction was observed in I-month(p>0.001) versus baseline, a retention on the III-month(p=0.039) versus post-therapy and an increase in III versus I month(p=0.386). When descending on stairs a decrease from baseline for the three post-treatment time points, I and III months post-treatment(p<0.001), retention of I month versus post-treatment(p=1,000), and increase of III month compared to posttreatment and I Month (p & lt; 0.001). When climbing up stairs, a reduction in the TTP from baseline(p<0.001), retention on I month(p=1.000) versus post-treatment and increase of III vs. I month(p=0.028). The CG showed a reduction in pain at rest (p<0.001) for the three time periods, compared to baseline values, increase in the III month compared to posttreatment(p=0.002), pain-motion reduction after treatment and increase in the III month compared to posttreatment(p=0.001), pain-down stairs reduction for TTP, compared to baseline(p<0.001), increase in III month versus post-therapy(p=0.016), pain-up stairs decrease in TTP (p <0.001), and retention of the effect achieved up to 1 month after treatment(p=1.00). The total WOMAC Index for TG shows a statistically significant reduction in the TTP score (p<0.001) as well as retention of the effect on III month post-therapy (p=1.00) versus post treatment was observed. In RG WOMAC Index reduction was observed in the three time periods(p <0.001), retention of the effect by the end of I month(p<0.001) and increase of the III versus I month(p<0.001). In CG, a significant reduction after treatment(p<0.001), on I month (p<0.001) was observed and no statistically significant difference on III month compared to baseline was found(p=0.170). Deep Oscillation effectively reduces edema, stiffness, pain in rest position, and physical activity in gonarthrosis. The complex application of KT and DO permanently affects the muscle imbalance and the volume of movement in the affected joint. The established therapeutic effects of DO are comparable to a comprehensive rehabilitation course involving MFIC. They have a long-term effect (at least 3 months) vs placebo-DO. The inclusion of DO in the complex rehabilitation leads to improved patient self-esteem for daily activity and quality of life. Deep Oscillation is well tolerated by patients, without side effects in compliance with safety rules. The studied methodology can be easily applied in practical conditions.