Mišično-skeletna fizioterapija 2 / Musculoskeletal physiotherapy 2 Fizioterapija 2013, letnik 21, suppl 1 Program stopnjevane vadbe v vodi pri poskusni multidisciplinarni obravnavi sindroma fibromialgije – poročilo o primeru Nuša Klar, dipl. fiziot.1; pred. Mojca Divjak, viš. fiziot, univ. dipl. org.2 1 Univerzitetni rehabilitacijski institut Republike Slovenije – Soča, Ljubljana, Slovenija; 2Zdravstvena fakulteta, Univerza v Ljubljani, Slovenija Korespondenca/Correspondence: Nuša Klar; e-pošta: klar.nusa@gmail.com Uvod: Sindrom fibromialgije je opredeljen kot kronično razširjen bolečinski sindrom, ki prizadene mehkotkivne strukture. Zdravljenje je dolgotrajno in večplastno. Najboljši rezultati se dosežejo z multidisciplinarnim pristopom, ki povezuje delo različnih zdravstvenih delavcev: zdravnika, fizioterapevta, delovnega terapevta, psihologa in socialnega delavca (1). Za zmanjšanje simptomov so pomembni redna vsakodnevna telesna vadba, edukacija bolnika, vedenjsko-kognitivna terapija in, če je treba, še medikamentozna terapija (1). Vadba v vodi ima blagodejne učinke na telo (2), ki trajajo dalj časa (3), zmanjšujejo se simptomi bolečine, depresije, prestrašenosti in dnevne utrujenosti, izboljšajo pa se splošna telesna pripravljenost, čas hoje (4), moč, ravnotežje in gibljivost (5). Namen dela je bil predstaviti program stopnjevane vodene vadbe v vodi v poskusni multidisciplinarni obravnavi bolnika s sindromom fibromialgije. Metode: Sodeloval je 54-letni bolnik s sindromom fibromialgije. Fizioterapevtska ocena pred obdobjem obravnave in po njem je vsebovala inspekcijo, 6-minutna testa hoje v telovadnici in v bazenu ter oceno bolečine z numerično vidno lestvico pred izvedbo 6-minutnega testa hoje in hoje v bazenu ter po njej. Program hidrogimnastike je trajal 4 tedne, 4-krat na teden po 1 uro. Rezultati: Preiskovancu se je stanje ob koncu programa v primerjavi z začetkom izboljšalo na področju ocene bolečine, merjene pred izvedbo 6-minutnega testa hoje (z 10 na 3; 75 %) in hoje v bazenu (z 9 na 4; 56,6 %) in po njej. Primerjava ocene bolečine ob koncu programa v telovadnici in bazenu pokaže razliko za 8,4 % v korist bazena. Vzdržljivost pri hoji se je povečala enako kot pri hoji v bazenu (38,6 %). Zaključki: Prvič uporabljeni multidisciplinarni pristop v obravnavi sindroma fibromialgije se je izkazal kot zelo uspešen, saj se je pri predstavljenem bolniku pomembno izboljšala splošna telesna pripravljenost ter zmanjšala ocena doživljanja bolečine. To kaže na pravilen izbor fizioterapevtskih postopkov v telovadnici in bazenu, ki so bili usklajeni z delom drugih članov tima. Prvič je bil tudi uporabljen prilagojen 6-minutni test hoje v bazenu, ki se je izkazal kot dober pokazatelj splošne telesne pripravljenosti in bi ga po ustrezni standardizaciji lahko uporabljali za spremljanje bolnikovega napredka. Smiselno bi bilo dodati še spremljanje bolnikovega počutja med vadbo, na primer s preverjanjem srčnega utripa. Hidroterapija je področje z manj kakovostnimi raziskavami, zato predlagamo še dodatne za dvig kakovosti dela. Ključne besede: kronično razširjen bolečinski sindrom, hidroterapija, vodena vadba, multidisciplinaren pristop, 6-minutni test hoje v bazenu. Mišično-skeletna fizioterapija 2 / Musculoskeletal physiotherapy 2 Fizioterapija 2013, letnik 21, suppl 1 Progressive programme of hidrotherapy in first trial multidisciplinary approach of fibromyalgia syndrome – a case report Background: The fibromyalgia syndrome is defined as a chronic widespread pain syndrome which affects soft-tissue structures. The treatment is long lasting and often very comprehensive. The best results are achieved with multidisciplinary approach which combines various health professionals; a physician, a physiotherapist, an occupational therapist, a psychologist and a social worker (1). Factors for reducing fibromyalgia syndrome are: regular exercise (on daily basis), education of the patient, behavioural-cognitive therapy and often pharmacological therapy if needed (1). Exercising in water has a lot of pleasant effects on the body (2) and it seems to have more advantages in long-term pain management (3). Improvement was found in pain, depression, anxiety, number of days feeling good, cardiovascular capacity and walking time (4). It also effects on strength, balance and joint mobility (5). The purpose of the report was to present the stepwise programme of hydrotherapy in the first trial multidisciplinary approach of fibromyalgia syndrome treatment. Methods: A 54-year-old patient with fibromyalgia syndrome participated in the study. The methods included physiotherapeutic assessment composed by inspection, endurance assessment in gym and pool and also assessment of pain before and after having a 6-minute walk test in gym and in pool, too. The hydrotherapy programme duration was 4 weeks, 4 days per week for 1 hour. Results: The patient’s condition was assessed at the beginning and at the end of the treatment. Comparison showed that pain evaluated by visual numeral scale decreased from 9 to 4 (56.6%) measured in a pool and from 10 to 3 (75.0%) measured in a gym. Comparison of pain at the end of the programme showed the difference between gym and pool for 8.4% better for pool. The patient’s endurance assessed by a 6-minute walk test increased for 38.6% in both – a swimming pool and in gym. Conclusions: A case report of a 54-year-old patient showed the significant improvement in his endurance and decreasing his pain. The multidisciplinary approach of fibromyalgia syndrome was used for the first time. The outcomes show efficient selection of physiotherapy methods and techniques in gym and pool which were also coordinated with other members of the team. For the very first time, the adapted 6-minute walk test in a pool was used. It becomes evident that it should be used in working with patients with fibromyalgia syndrome to evidence and attend the patient's progress. Attending of patient's feeling during exercising appears to be bad therefore pulse rate should be monitored. Hydrotherapy is an area with less qualitative researches, so we recommend further should be done to improve the quality of work. Keywords: chronic widespread pain syndrome, hydrotherapy, guide exercises, multidisciplinary approach, 6-minute walk test in pool. Literatura/References: 1. Logar D (2007). Novosti v razumevanju patogeneze in zdravljenja sindroma fibromialgije V: Rehabilitacija poškodovancev z nihajno poškodbo vratne hrbtenice: učna delavnica. Strokovno srečanje fizioterapevtov mariborske regije, Maribor, 19. April 2007. Maribor: Splošna bolnišnica, Oddelek za fizikalno in rehabilitacijsko medicino, 77–88. 2. McVeigh JG, McGaughey H, Hall M, Kane P (2008). The effectiveness of hydrotherapy in the management of fibromyalgia syndrome: a systematic review. Rheumatol Int 29 (2): 119–30. 3. Evcik D, Yigit I, Pusak H, Kavuncu V (2008). Effectiveness of aquatic therapy in the treatment of fibromyalfgia syndrome: a randomized controlled open study. Rheumatol Int 28 (9): 885–90. 4. Stanos SP, McLean J, Rader L (2007). Physical medicine rehabilitation approach to pain. Anesthesiol Clin 25 (4): 721–59. 5. Geytenbeek J (2002). Evidence for effective hydrotherapy. Physiotherapy 88 (9): 514–29.