تاثیر الکتروتراپی و تمرین قدرتی عضلات منتخب اندام تحتانی بر درد و تعادل زنان سالمند مبتلابه استئوآرتریت زانو با تاکید بر نوع کانون توجه

نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشجوی دکتری بیومکانیک ورزشی، دانشگاه آزاد اسلامی واحد تهران مرکزی، تهران، ایران

2 استادتمام گروه بیومکانیک و آسیب شناسی ورزشی، دانشگاه خوارزمی، تهران، ایران ، استادتمام گروه بیومکانیک ورزشی، پژوهشکده علوم حرکتی، دانشگاه خوارزمی، تهران، ایران

3 استادیار گروه فیزیوتراپی، دانشگاه علوم بهزیستی و توانبخشی، تهران، ایران

4 استاد فیزیولوژی ورزشی، گروه فیزیولوژی ورزشی، واحد تهران مرکزی، دانشگاه آزاد اسلامی، تهران، ایران

چکیده

مقدمه و اهداف
با توجه به اینکه استئوآرتریت زانو به عنوان یکی از شایع ترین بیماری های مفصلی دربین سالمندان، با ایجاد درد و کاهش تعادل منجر به ایجاد اختلال در عملکرد روزانه این گروه از افراد می شود، هدف این تحقیق، تعیین اثر دوشیوه کارآزمایی بالینی الکتروتراپی و تمرینات قدرتی عضلات منخب اندام تحتانی بر درد وتعادل زنان سالمند مبتلا به استئوآرتریت زانو با تاکید بر نوع کانون توجه بود
مواد و روش ها
31 سالمندزن 60 تا 80 سال مبتلا به استئوآرتریت زانو از مرکز سالمندان شهر کرمان, به صورت تصادفی در دو گروه تمرینی صورت تصادفی به دو زیر گروه کانون توجه بیرونی و کانون توجه درونی تقسیم شدند. تمرینات سه بار درهفته و به مدت هشت هفته انجام شد. برای ارزیابی درد از مقیاس بصری درد ، بررسی تعادل ایستا، پویا وکل به ترتیب از تستهای رومبرگ،زمان برخاستن ورفتن وتعادل کل در پیش آزمون و پس آزمون استفاده شد. برای تحلیل آماری داده ها از آمون تی تست وابسته برای مقایسه درون گروهی و تی تست مستقل برای مقایسه بین گروهی برای داده های نرمال و برای دادهای غیر نرمال از آزمون من ویتنی و ویلکاکسون سطح معنی داری 05/0 p≤ استفاده شد.
یافته ها
یافته ها، کاهش میزان درد در هر دو گروه تمرینی و در هر دونوع کانون توجه بیرونی و درونی را نشان داد. در تعادل پویا و کل، بهبودی دیده شد (05/0p≤). تفاوت معناداری در متغیر درد بر اساس مقیاس سنجش عددی بین گروه تمرینات چهارسر و گروه تمرینات دورکننده ران را نشان نداد(05/0˃p). در حالی که بین کانون توجه درونی و بیرونی تفاوت معنادار بود (05/0p≤). نتایج تفاوت معناداری در هیچ یک از شاخص های تعادل بین دو گروه تمرین را نشان نداد (05/0˃p)، اما بین گروه توجه درونی و بیرونی در تعادل پویا، تفاوت بین دو گروه معنادار شد(05/0p≤).
نتیجه گیری
با توجه به نتایح تحقیق، تمرین قدرتی عضلات دور کننده ران همراه با درمانهای رایج الکتروتراپی و دستورالعملهای کانون توجه، برای مدیریت درد و ارتقاء سطح عملکرد سالمندان مبتلابه استئوآرتریت زانو، را می توان توصیه کرد.

کلیدواژه‌ها

موضوعات


عنوان مقاله [English]

Effect of Electrotherapy and Strength Training of Selected Lower Limb Muscles on Pain and Balance in Elderly Women with Knee Osteoarthritis with Emphasis on the Type of Focus of Attention

نویسندگان [English]

  • Homa Pouradeli 1
  • Heydar Sadeghi 2
  • Yahya Sokhangouei 3
  • Mohammad Ali Azarbayjani 4
1 PhD Candidate in Sports Biomechanics, Faculty of Physical Education and Sport Sciences, Central Branch of Azad University, Tehran, Iran
2 Full Professor, Department of Sport and Injury Biomechanics, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran, Full Professor, Department of Sport and Injury Biomechanics, Kinesiology Research Center,
3 Assistant Professor, Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
4 Professor in Exercise Physiology, Department of Exercise Physiology, Tehran Central Branch, Islamic Azad University, Tehran, Iran
چکیده [English]

Background and Aim: Given that knee osteoarthritis, as one of the most common joint diseases in the elderly, causes pain and imbalance, leading to disruption of daily activities and performance of this group of society, the objective of this study was to investigate the effect of electrotherapy and strength training of the knee extensor and thigh extensor muscles on pain and balance in elderly women with osteoarthritis of the knee with emphasis on the type of focus of attention.
Materials and Methods: In the current study 31 elderly women aged 60 to 80 years with osteoarthritis of the knee from the elderly center of Kerman after filling out the consent form, accidentally participated in two research groups as subjects in this study. The individuals in each group were randomly divided into two subgroups: the external focus and the internal focus. The exercises were performed three times a week for eight weeks. To assess pain, a VAS scale, and to assess a static, dynamic and total balance, Rumberg, TGUG, and TBT tests were used before and after the test, respectively. For statistical analysis of the data with SPSS software, version 20 and dependent ammonia test were used for intragroup comparison and independent test for intergroup comparison for normal data and for non-normal data, Mann-Whitney and Wilcoxon tests were used. For all tests, a significance level was p≤0/05.
Results: : The results showed a decrease in the amount of pain in both electrotherapy and strength training of the quadriceps muscles and hip abductors group, both of which showed external and internal focus. An improvement was seen in the equilibrium index, in the dynamic and total equilibrium (p≤0.05). The results of the independent t-test for comparing the groups did not show a significant difference in the pain variable based on the numerical measurement scale between the quadriceps training group and the hip abductor training group (p ˃ 0.05). While the difference between internal and external attention was significant (p ≤0.05). The results did not show a significant difference in the balance index in any of the balance indicators between the two groups of quadriceps and hip abductor (p˃0.05), but between the internal and external attention group in the dynamic balance index (TGUG), The difference between the two groups became significant (p ≤ 0.05).
Conclusion: According to the results of the research, strength training of the hip abductor muscles along with common electrotherapy treatments and attention-oriented guidelines can be recommended for pain management and improving the level of performance of the elderly with osteoarthritis of the knee.

کلیدواژه‌ها [English]

  • knee osteoarthritis
  • strength training
  • Pain
  • Balance
  • attention focus
  1. sabeti Dehkordi A.Effect of a training course on water balance in older men and knee joint position sense in Ahwaz[M.A thesis]Islamic Azad University Central Tehran Branch: Spring  2012.[In Persian].##

2. Jamtvedt G, Dahm KT, Christie A, Moe RH, Haavardsholm E, Holm I, et al. Physical therapy interventions for patients with osteoarthritis of the knee: an overview of systematic reviews. Physical Therapy 2008; 88(1): 123-36. ##

3.  Song R, Lee E-o, Bae S-C .Effects of tai chi exercise on pain , balance, muscle strength , and perceived difficulties in physical functioning in older woman with osteoarthritis: A randomized clinical trial .Journal of  Rheumatology 2003;30)9):2039-44. ##

4. Jordan JM, Linder GF, Renner JB, Fryer JG. The impact of arthritis in rural population. Arthritis Care Research 1995;8(4):242-50##

5. Flugsrud GB, Nordsletten L, Reinholt FP, Risberg MA, Rydevic K, Uhlig T. Osteoarthritis. Tidsskr Nor Laegeforen 2010;130(21):2136-40##

6. Hertling D, Kessler RM. Management of common musculoskeletal disorders. 3 rd ed. NewYork, Lippincott, 1996,pp:363-365##

7. Fransen M, Crosbie J, Edmonds J. Physical therapy is effective for patients with osteoarthritis of the knee: a randomized controlled clinical trial. Journal of Rheumatology 2001 Jan; 28(1): 156-64##

8. Pollard CD, Sigward SM, Powers CM. Gender differences in hip joint kinematics and kinetics during side-step cutting maneuver. Clinical Journal of Sport Medicine 2007;17(1):38-42##

9. Thorp LE, Wimmer MA, Foucher KC, Sumner DR, Shakoor N, Block JA. The biomechanical effects of focused muscle training on medial knee loads in OA of the knee: A pilot, proof of concept study. Journal of Musculoskeletal and Neuronal Interaction 2010;10(2):166–73##

10. Sled EA, Khoja L, Deluzio KJ, Olney SJ, Culham EG. Effect of a home program of hip abductor exercises on knee joint loading, strength, function, and pain in people with knee osteoarthritis: a clinical trial.physical  therapy 2010;90(6):895-904##

11. Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Annals of Rheumic Diseases. 2003 Dec; 62(12): 1145-55. ##

12. Hinman R S, Bennell K L, Metcalf B R,and Crossley K.M. Balance impairments in individuals with symptomatic knee osteoarthritis :A comparison with matched controls using clinical tests. Journal of Rheumatology 2002; 41:1388-139. ##

13.Masui T, Hasegawa Y,Yamaguchi J. Increasing postural sway in rural- community dwelling elderly persons with knee osteoarthritis .Journal of Orthopaedic Science 2006;11:353-358. ##

14. Harringe ML, Halvorsen K, Renstrom P, Werner S. Postural control measured as the center of pressure excursion in young female gymnasts with low back pain or lower extremity injury. J Gait & Posture. 2008;28:38-45. ##

15. Wulf G. Attention and motor skill learning[Farrokhi A, Mahzoon M,trans].Tehran:Nersi press; 2009.[In Persian] ##

16. Wulf G. Attentional focus and motor learning: a review of 10 years of research. Journal Beweyung and Training 2007;1:4-14. ##

17. Laufer Y, Shtraker H, Gabyzon ME. The effects of exercise and neuromuscular electrical stimulation in subjects with knee osteoarthritis: a 3-month follow-up study. Clinical Interv Aging. 2014 Jul 17;9:1153-61. ##

 18.  Bennell K, Hunt M, Wrigley T, Hunter D, McManus F, Hodges P, et al. Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: a randomised controlled trial. Osteoarthritis and Cartilage 2010;18(5):621-8. ##

19. Bennell KL, Hunt MA, Wrigley TV, Hunter DJ, Hinman RS. The effects of hip muscle strengthening on knee load, pain, and function in people with knee osteoarthritis: a protocol for a randomized, single-blind controlled trial. BMC Musculoskeletal Disorders 2007;8(1):121. ##

20.  Pisters MF, Veenhof C, Schellevis FG, Bakker DH De, Dekker J. Long-term effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a randomized controlled trial comparing two different physical therapy interventions. Osteoarthr Cartil. Elsevier Ltd; 2010;18(8):1019–26. ##

21. Sadeghi H, Mousavi Kh, Nabavinick H. Sport biomechanics laboratory manual.Tehran:Hatmi press;2015.[In Persian].##

22. Yalfani A, Naderi E, Shayesterudi Y. Comparing the effectiveness of hydrotherapy and physiotherapy in the management of knee osteoarthritis. Journal of Research in Rehabilitation Sciences 2011; 8(2): 328-336.[In Persian] ##

 23. Bennell KL, Kyriakides M, Metcalf B, Egerton T, Wrigley TV, Hodges PW, et al. Neuromuscular versus quadriceps strengthening exercise in patients with medial knee osteoarthritis and varus malalignment: a randomized controlled trial. Artheritis & Rhoumatology 2014;66(4):950-9. ##

24. Sled EA, Khoja L, Deluzio KJ, Olney SJ, Culham EG. Effect of a home program of hip abductor exercises on knee joint loading, strength, function, and pain in people with knee osteoarthritis: a clinical trial. Physical Therapy 2010;90(6):895-904. ##

25. Braghin RMB, Libardi EC, Junqueira C, Nogueira-Barbosa MH,deAbreu DCC. Exercise on balance and function for knee osteoarthritis:A randomized controlled trial.Journal of Bodywork &Movement Therapies 2018;22:76-82##

26. .Verma S, Agarwal S. The effect of hip abductors strengthening exercise on knee pain and function in people with knee osteoarthritis. Journal of Romanian Sports Medicine Society 2013;9(2):2123-9. ##

27. Ashok C. Effects of Hip Abductor Muscle Strengthening Exercises in Patients with Osteoarthritic Knee Joints. Indian Journal of Physiotherapy & Occupational Therapy 2012;6(4):32-7. ##

28. Zarei P, Rahnama N. Comparison of the effect of the two strengthening and balanced, strengthening, balanced and core-stability exercise protocols on the balance and fear of falling in women with knee osteoarthritis. The Journal of Paramedical Science and Rehabilitation 2017;7(2): 43-54.[In Persian] ##

29. Hinman RS, Hunt MA, Creaby MW, Wrigley TV, McManus FJ, Bennell KL, et al. Hip muscle weakness in individuals with medial knee osteoarthritis. Arthritis Care & Research 2010;62(8):1190-3. ##

30. Sturmberg C, Marquez J, Heneghan N, Snodgrass S, van Vliet P. Attentional focus of feedback and instructions in the treatment of musculoskeletal dysfunction: a systematic review. Manual Therapy 2013;18(6):458-67. ##

31. Maxwell J.P, Masters R.S.External versus internal focus instruction: is the learner paying attention?. International of applied sport sciences 2002;14:70-88##

32. Wulf G. Attentional focus and motor learning: A review of 10 years of research. Gabriele Wulf on attentional focus and motor learning [Target article] E-Journal Bewegung and Training 2007;1: 4-14. ##

33. Olivier I, Palluel E, Nougier V. Effects of attentional focus on postural sway in children and adults. Experimental Brain Research. 2008;185(2):341-5. ##

34. Beilock SL, Bertenthal BI, McCoy AM, Carr TH. Haste does not always make waste: Expertise, direction of attention, and speed versus accuracy in performing sensorimotor skills. Psychonomic Bulletin & Review. 2004;11(2):373-9. ##

35. Perkins-Ceccato N, Passamore SR, Lee TD. Effects of focus of attention depend on golfers’ skill. Journal of Sports Sciences 2003; 21:593–600. ##