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The Effect from Complexity Physical Therapy on Decrease of Pain By Patients With osteoporotic Lumbar Scoliosis

Research Article Open Access
Elizabeta Popova Ramova*, Biljana Angelovska and Irina Bozinovska
Department for physical therapy education, University St.Kliment Ohridski, Bitola, Macedonia
*Corresponding authors: Elizabeta Popova Ramova
Department for physical therapy education
University St.Kliment Ohridski
Bitola, Macedonia
E-mail: betiramova62@yahoo.com
 
Received December 12, 2012; Published August 25, 2012
 
Citation: Ramova EP, Angelovska B, Bozinovska I (2012) The Effect from Complexity Physical Therapy on Decrease of Pain By Patients With osteoporotic Lumbar Scoliosis. 1:284. doi:10.4172/scientificreports.284
 
Copyright: © 2012 Ramova EP, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
 
Abstract
 
Osteoporosis is an increasing public health problem which ultimately causes fractures and a significant reduction in patients health-related quality of life. The pain is common symptom in compression by asymmetric degeneration and deformity as scoliosis or kyphosis. The aim of our study is to represent rehabilitation program and its results with evaluation of pain and quality of life, by patients with scoliosis and osteoporosis.
 
Material and method: The 8 patients from 112, who were included in osteoporosis treatment program had osteoporosis, spine deformity and acute low back pain. They were examination clinical, x-ray and with labor to determinate the etiology, the size of curve and bone turnover. They were treated with local and medical analgesics, physical therapy and brace. The effect of treatment was following in base line, after 3 days, after one and six months with NAS scale for pain, and questioner for quality of life.
 
Results: Complexity therapy has significant decrease pain after 1 month, p<0.01, increase the quality of life after 6 months, P<0.01, and increase bone turnover after 6 and 12 months.
 
Conclusion: physical therapy, bracing and medical treatment can be use in treatment of osteoporosis spine deformity.
 
Keywords
 
Spine deformity; Analgesics; Bracing.
 
Introduction
 
The aims of rehabilitation in patients with osteoporosis are to reduce pain, maximize the level of muscle skeletal function, particularly following fractures decrease risk of falls and optimize quality of live and independence. The management of patients with vertebral fractures has largely concentrated on the prevention of futures fractures with drag treatment for acute and chronic back pain. Acute osteoporosis vertebral compression is more represent by patients with spine deformity. Osteoporotic spine deformity is a common presenting complaint to spinal care specialist. The physical therapy and rehabilitation have their special way of treatment by those patients. Non surgical management of the spinal acute osteoporotic pain is focus on pain control and maximizing functional outcome.
 
Calcitonin is prescribed with his analgesic effect in bone pain management. The bisphosphonates have a direct effect on bone pain too, and increase the bone mass. Acute osteoporotic vertebral pain management includes bone pain medicaments, analgesics, bracing and functional restoration.
 
The aim of this study is to represent the effect of management program for treatment of patients with acute spine pain and osteoporosis.
 
Materials and Methods
 
We had included and followed 112 patients in period of one year by questioner, clinical examination, x-ray examination and bone markers labor examination. They were treated with physical therapy and medical antiresorptive bone drugs. We have choused 8 female of them like a special group because they had spine deformity-scoliosis, acute low back pain and osteoporosis.
 
The study entry an assessment of the subjects medical history including the numbers of previous episode of acute lumbar pain, previous fracture, the first bone densitometry test, spine deformity in adolescent age, earlier medication, use of analgesics, dietary habits including alcohol consumption and nicotine use, previous diseases.
 
The patients were examination clinical with determination of level of radix compression, x-ray picture with size of curve by Cobb measurement, and level of bone turnover. Level of bone turnover have made with markers.
 
Immulite
 
Osteocalcin (reference rang 3.1-13.7 ng/ml) and Pyrilinks-D type I collagen like a pyridinoline and deoxypyridenoline (reference range female 3.0-7.4 nM DPD/mM creatinine, males 2.3-5.4 nM DPD/mM creatinine). The evaluation of bone turnover was making before, after 3, 6, and 12 months of medical treatment.
 
Treatment
 
1.Local infiltration of analgesic in painful radix area, first day, 2. Intravenous in saline central analgesic, in period of three days one daily, 3. Nasal spray of Calcitonin, one months with daily dose of 100IE, and next months alendronat sodyum, 70 mg, one time for week, 1 year.4. Calcium and D vitamin, one year with daily dose of Ca (1000mg)+Vit.D (800IE), 5. Electro therapy with analgesic and relaxant effect with education for daily activity first 10 days, and second 10 days exercises for correction of posture, stability and stretching of leg and arm musculature 6. Bracing with lumbar orthosis one month 22 houra a day.
 
The evaluation of effect of treatment was made with assessment of pain by NAS scale from 0-10 degrees (0-no pain, 10-terible pain, min. 0, max. 320 points), and quality of everyday life, with Leading- Bruckner et all questioner. The NAS scale was using to measure pain in four positions: rest, sitting, standing and walking. The questionnaire provides a disability score based on six abilities of everyday life, which are walking, bending, climbing stairs, getting up from a lying position, dressing, and carrying bags, were related from 0 to 2 (easily possible, possible with difficulties, possible only with extra help). Finally, a sum score is calculated, ranging from 0 to 16.
 
The evaluation was made before treatment, after 3 days, after first month and after six months.
 
Results
 
The results of baseline questioner are showing in (Table 1). The average of patients is 65.6±5.62 years. The x-ray pictures are showing duplex scoliosis in thoracic lumbar segment, average of curve angel was 21.4±4.5 degrease by Cobb.
 
Table 1: The results from baseline questioner.
 
We can see that the most percents from questions are 8 (100%) for Degenerative spine arthritis and concomitant analgesics. The pain is the highest health problem. They were not including in prevention program for osteoporosis, and only two of them had x-ray picture with diagnosis of spine deformity, falls with fracture had 2 of them, gynecological surgery treatment with early menopause had 2, consummate cigarettes 3 and alcohol 1. Cardiovascular disease had 2 and took medicament too, 2 of them were used physical therapy before.
 
The level of bone turnover is showing in (Table 2), at baseline and after 3, 6 and 12 months of treatment. The data was analyze with Ttest, with level of significant 0.01. The decrease of bone turnover is significant after 6 and 12 months, p<0.01, for both Osteocalcin and Pyrilinx-D.
 
 
Table 2: The level of bone turnover follows with bone markers.
 
The results of pain evaluation with NAS scale from 0-10 degrees, are showing in (Table 3). There are testing with Ttest too. The pain is significant increase after 1 month, p<0.01.
 
Table 3: The results from pain evaluation.
 
The results from assessment of quality of self care are showing in (Table 4). The quality of life is significant increase after 1 and 6 months. It is testing with Ttest too.
 
Table 4: Assessment of quality of self care.
 
Discussion
 
In new Guide for Prevention and Treatment of osteoporosis by National Osteoporosis Foundation´s the one of the highest point of interest is to goodness the quality of life by patients with osteoporosis (6). We used the screening protocol for early detection of osteoporosis from American association of women care in our department of physical therapy. Those patients were sent to us only for pain management with out diagnosis of osteoporosis.
 
We had used the clinical musculoskeletal examination, x-ray pictures and bone markers to prove the osteoporosis etiology of pain. X-ray pictures are standard for examination of bones and we had diagnosed a spine deformity too. Scoliosis from adolescent age has his linear progression in adulthood and individual natural history [1,2]. The bone markers are significant for determination of bone turnover. The blade and urinary level of some bone markers can be used to determinate bone mineral turnover and following the results of antiresorptive treatment [3,4]. We had made examination with osteocalcin and pyrilinx-D. There are one of standard markers for bone turnover.
 
The physical therapy is used in many studies for treatment of osteoporosis specially for pain management and to maximizing functional outcome [5,6]. Brace is applying in acute and chronic low back pain, and by patients for conservative treatment of pain from scoliosis in adulthood [7]. It is not so significant like a bracing after surgery treatment by patients of this condition, but we had used it in complexity treatment of scoliosis low back pain. The pain was decrease after 6 months of daily wear 21 hours in study of Weiss et al. [7], by our patients it was applying continuously 22 hours one month, because there were old people with risk of circulation disorders.
 
In pain management of osteoporosis are included drugs with analgesic effect on bones, like calcitonin and bisphosponates [5,8,9]. We had used them with aim to decrease pain and increase bone masse. They had used in standard way and their effect on bone mass are expecting not early of 6 months by consulting studies.
 
We had used a two scale for evaluation of effect of treatment: Numeric Rating Scale (NRS) score for evaluation of pain, and to assess the quality of life Lending-Bruckner questioner before and after treatment. Numeric rating scale is useful in measurement of spine pain special for scoliosis [10,11]. Lending-Bruckner questioner is useful to assess the quality of life and we had done the same by our patients to evaluate it before and after treatment: in base line, after 3 days, after 1 month, and after 6 months [12]. The quality of life was goodness by patients with Spinomed, a back orthosis after 6 months, it was the same by our study were we had use lumbar orthosis one month but also medication, education and exercises. The patients can take it by health service, and it has socioeconomic benefit. From our study we can say next conclusions: 1.Our management plane is complexity, but it is base one the last experiences of osteoporosis management.
 
2.It is acceptable for patients with socioeconomic benefit, 3. It is significant in decrease of pain, decrease of bone turnover, and increase of quality of life.
 
 
References