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Nervmobilisering som fysioterapeutisk behandling vid karpaltunnelsyndrom / Neural mobilization as physiotherapeutic treatment for carpal tunnel syndromeArvidsson, Hanna, Norberg, Felicia January 2021 (has links)
Bakgrund: Karpaltunnelsyndrom är den vanligaste typen av perifera nervinklämningar och orsakas av att medianusnerven blir klämd i karpaltunneln. De symtom som kännetecknar karpaltunnelsyndrom är nattliga domningar och smärta i hand och fingrar. Syfte: Att undersöka effekt och evidens för nervmobilisering som behandling vid karpaltunnelsyndrom. Metod: Sökningar genomfördes i databaserna PudMed, PEDro, CINAHL, AMED och Scopus med målet att identifiera randomiserade kontrollerade studier där nervmobilisering som behandling vid karpaltunnelsyndrom undersökts. Inkluderade artiklar kvalitetsgranskades enligt PEDro och de med hög kvalitet evidensgraderades enligt GRADEstud. Resultat: Nio studier inkluderades i översikten. I alla studier observerades en positiv effekt av nervmobilisering avseende symtom och/eller funktion och en signifikant skillnad sågs mellan grupperna i 7 av 9 studier. Sex av nio studier hade hög kvalitet och tre hade låg kvalitet enligt PEDro-skalan. Evidensgraderingen visade att nervmobilisering som behandling vid karpaltunnelsyndrom har måttligt hög tillförlitlighet (+++). Små studier med få deltagare resulterade i ett poängs avdrag för bristande precision. Slutsats: Nervmobilisering tycks ge positiva effekter på funktion och symtom vid karpaltunnelsyndrom och har enligt GRADEstud måttligt hög tillförlitlighet. Nervmobilisering kan ge effekt även på lång sikt och kan minska behovet av operation men fler större studier med god kvalitet behövs för att kunna bekräfta detta. Nyckelord: Carpal tunnel syndrome, CTS, neural mobilization, nerve gliding / Background: Carpal tunnel syndrome is the most common type of peripheral neuropathy caused by compression of the median nerve in the carpal tunnel. The condition is characterized by night time tingling and pain in the hand and fingers. Objective: The purpose of this study was to investigate the effects and evidence of neural mobilization as a treatment for carpal tunnel syndrome. Methods: Searches were made in the databases PubMed, PEDro, CINAHL, AMED and Scopus to try and find randomized controlled trials that investigated neural mobilization as treatment for carpal tunnel syndrome. All of the included articles were appraised by the PEDro-scale and the level of evidence was graded using GRADEstud. Results: Nine studies were included in this review. In all of the included studies a positive effect could be seen by neural mobilization on symptoms and/or function with a significant difference between groups in seven out of the nine studies. Six out of the nine studies had high quality and three had low quality according to the PEDro-scale. The grading of evidence showed that neural mobilization as treatment for carpal tunnel syndrome has a moderately high level of evidence (+++). Few studies with few participants resulted in one point deduction for lack of precision. Conclusion: Neural mobilization could have positive effects on symptoms and function in patients with carpal tunnel syndrome and has a moderately high level of evidence according to GRADEstud. Neural mobilization may have positive effects long term and could reduce need for surgery but more high quality research is needed to confirm this. Key words: Carpal tunnel syndrome, CTS, neural mobilization, nerve gliding.
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Efeito da mobilização neural em indivíduos com lombalgia crônica. / Effect of neural mobilization in individuals with chronic low back pain.Ramos, Marina 19 September 2018 (has links)
A lombalgia tem consequências como dor, incapacidade funcional e diminuição da qualidade de vida, que pode acometer cerca de 70 a 90% da população brasileira em algum período de sua vida. A fisioterapia dispõe de inúmeros recursos dentre eles a Mobilização Neural, que facilita a condutibilidade nervosa, melhorando consequentemente o quadro álgico. O tratamento consiste em restaurar a mobilidade e a elasticidade do sistema nervoso periférico por meio de tensões, oscilações e angulações articulares. Neste sentido, este estudo teve como objetivo avaliar os efeitos da técnica e avaliar o comportamento álgico, bem como o possível envolvimento de citocinas pró e anti-inflamatórias após o tratamento. A técnica foi aplicada três vezes por semana, num total de 10 intervenções, com duração de dez minutos cada sessão. Participaram deste estudo 46 indivíduos (28 mulheres e 18 homens), que foram alocados em três grupos: grupo MOB, grupo MOB+MED e Grupo CONTROLE. Foram utilizadas ferramentas para avaliar tais efeitos, dentre elas: Escala Visual Analógica (EVA); Teste da Distância do 3º dedo ao solo; Goniometria; Fotogrametria; Avaliação da qualidade de vida - WHOQOL-bref; Questionário de incapacidade de Roland Morris; Índice de Oswestry sobre Incapacidade e Ensaios de Multiplex para a dosagem de citocinas no tecido sanguíneo.Os resultados demonstraram uma melhora significativa na intensidade da dor (p<0,02) e mobilidade lombar (p<0,04), quando comparamos as medidas antes e após o tratamento, e consequentemente, uma melhora significativa na qualidade de vida e incapacidade dos pacientes. Ao analisarmos as citocinas (p<0,05), houve uma redução estatisticamente significativa nas citocinas pró-inflamatórias (IL-1β, IL-6 e TNFα) e aumento estatisticamente significativo de citocina anti-inflamatória (IL-4). Esperamos, por meio deste estudo, contribuir e compreender alguns mecanismos envolvidos durante o processo de reabilitação com a Mobilização Neural. / Low back pain has consequences such as pain, functional disability and decreased quality of life, which can affect approximately 70 to 90% of the Brazilian population in some period of their life. Physiotherapy has innumerable resources, among them Neural Mobilization, which facilitates the nervous conductivity, consequently improving the pain. The treatment consists in restoring the mobility and the elasticity of the peripheral nervous system through tensions, oscillations and articular angulations. In this sense, this study aimed to evaluate the effects of the technique and to evaluate the algic behavior, as well as the possible involvement of pro and anti-inflammatory cytokines after treatment. The technique was applied three times a week, in a total of 10 interventions, lasting ten minutes each session. A total of 46 individuals (28 women and 18 men) participated in this study, which was allocated in three groups: MOB group, MOB + MED group and CONTROL group. Tools were used to evaluate such effects, among them: Visual Analog Scale (EVA); 3rd finger distance test to the ground; Goniometry; Photogrammetry; Quality of life assessment - WHOQOL-bref; Roland Morris Inaptation Questionnaire; Oswestry Index on Disability and Multiplex Assays for dosing cytokines in blood tissue. The results showed a significant improvement in pain intensity (p <0.02) and lumbar mobility (p <0.04), when we compared the measures before and after treatment, and consequently, a significant improvement in the quality of life and disability of patients. When we analyzed the cytokines (p <0.05), there was a statistically significant reduction in the proinflammatory cytokines (IL-1β, IL-6, and FTNα) and a statistically significant increase in anti-inflammatory cytokine (IL-4). We hope, through this study, to contribute and understand some mechanisms involved during the rehabilitation process with Neural Mobilization.
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