IMAJU LI PELOIDI ULOGU U LIJEČENJU KRONIČNE NESPECIFIČNE KRIŽOBOLJE?

Ana Kolarić, Dinko Kolarić, Endi Radović, Vedrana Mužić Radović, Domagoj Sirovec

Introduction. Non-specific low back pain (NSLBP) is a type of pain that cannot be associated with a specific pathology and is likely to have a mechanical cause. Mineral mud (MM) is a form of peloids used for therapeutic purposes. The aim of this study was to evaluate the efficacy of standard kinesiotherapy and hydrotherapy for chronic NSLBP patients, treated with and without peloid therapy. Patients and methods. In this prospective randomized study, 64 patients were included: 33 received standard kinesiotherapy treatment and hydrotherapy five times a week, while 31 received additional MM therapy three times a week, instead of hydrotherapy, for three weeks. Measurements included Thomayer’s distance test, sagittal mobility (Schober’s test), bilateral lateroflexion, and indices such as the Rolland- Morris Disability Questionnaire (RMDQ), the Clinical Functioning Information Tool (ClinFit), the Depression, Anxiety, and Stress Scale (DASS 21), the EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) quality of life questionnaires, and the visual analogue scale (VAS) for pain. Paired t-tests or Wilcoxon signed-rank tests were used depending on the data’s normality distribution. Delta changes were examined using the analysis of variance (ANOVA) in order to assess the effects of treatment type, age, and sex of patients, along with the correlation analyses. Significance was set at p<0.05. Results. Overall, all measurements significantly improved after therapy, as indicated by paired tests. Univariate analyses showed treatment type to be associated with lateroflexion (p<0.05), sex with Schober’s test (p<0.05), and age with VAS pain (p<0.05). Multivariate analyses revealed a significant difference in delta changes for Thomayer’s test (p<0.01), left lateroflexion (p<0.01), and RMDQ (p=0.01), with greater improvement in the group receiving additional peloid therapy
compared to the standard therapy group. Pain reduction (VAS pain) was significantly greater in patients under 55 years of age compared to those over 55 (p=0.03). Correlation tests showed the expected improvements in patient status. Conclusion. Additional treatment with MM instead of standard kinesiotherapy and hydrotherapy leads to significantly increased mobility and improved daily functioning in patients with chronic NSLBP.

Uvod. Nespecifična križobolja (NK) je bol koja se ne može povezati s određenom patologijom, a vjerojatno ima mehanički uzrok. Mineralno blato (MB) je oblik peloida koji se koristi u terapeutske svrhe. Cilj ovog istraživanja bio je procijeniti učinkovitost kinezioterapije i hidroterapije u liječenju bolesnika s kroničnom NK, s dodatnom terapijom peloida i bez nje. Ispitanici i metode. U ovoj prospektivnoj randomiziranoj studiji sudjelovala su 64 bolesnika. Tijekom tri tjedna, 33 bolesnika primilo je standardnu kinezioterapiju s hidroterapijom pet puta tjedno, a 31 bolesnik je imao terapiju MB-om tri puta tjedno umjesto hidroterapije. Ispitivane varijable bile su: Thomayerova mjera (udaljenost prsti – pod), sagitalna pokretljivost lumbalne kralježnice (Schoberova mjera), bilateralna laterofleksija, vizualna analogna ljestvica (VAS) boli te upitnici Rolland Morris Disability Questionnaire (RMDQ), Clinical Functioning Information Tool (ClinFit), Depression, Anxiety and Stress Scale (DASS 21) i EuroQol-5 Dimensions-5 Levels (EQ-5D-5L). Sve varijable procijenjene su prije i nakon tretmana. Ovisno o distribuciji podataka, korišten je zavisni t-test ili Wilcoxonov test. Razlike u vrijednostima prije i nakon tretmana ispitane su ANOVA testom s obzirom na vrstu tretmana, dob i spol pacijenata te korelacijskim testovima. Alfa pogreška postavljena je na p < 0,05. Rezultati. Sve mjere pokazale su značajno bolje rezultate nakon tretmana MB-om. Univarijatna analiza pokazala je da su delta promjene laterofleksije (p < 0,05) značajno povezane s vrstom tretmana, Schoberova mjera (p < 0,05) bila je povezana sa spolom, a dob s VAS boli (p < 0,05). Multivarijatna analiza pokazala je značajno bolje rezultate u delta promjenama Thomayerove mjere (p < 0,01) i lijeve laterofleksije (p < 0,01) i RMDQ (p = 0,01) u skupini bolesnika tretiranoj peloidom u usporedbi sa standardnom terapijom. Također je uočeno značajno smanjenje boli (VAS boli) kod bolesnika mlađih od 55 godina u usporedbi s onima starijima od 55 godina (p = 0,03). Korelacijski testovi pokazali su očekivana poboljšanja u zdravstvenom statusu bolesnika. Zaključak. Dodatni tretman MB-om umjesto standardne kinezioterapije s hidroterapijom dovodi do značajnog povećanja opsega pokreta te boljeg funkcioniranja u svakodnevnim aktivnostima kod bolesnika s kroničnom NK.