Comparison of Different Treatment Methods in Lumbal Disc Herniation Treatment

Study Overview
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Brief Summary
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The aim of this study is to determine the effectiveness of three different treatment methods which consists spinal decompression, deep friction massage and exercise. The patients were separated three groups Group one received non-surgical spinal decompression therapy, group two received non-surgical spinal decompression, lumbar stabilization exercises and manual therapy, group three received manual therapy and lumbar stabilization exercises. All groups completed 15 sessions of therapy. In each session, pain severity was assessed with numeric analog scale, straight leg raise test applied and the degree of the hip flexion where the patient reported pain were recorded, respectively. Static, dynamic muscle strength-endurance tests were applied before the treatment sessions started, after the treatment sessions ended, six weeks after and three months after the study. Oswestry Disability Scale (ODI), Back Performance Scale (BPS), Lanss Neuropathic pain Questionnaire, Fear-Avoidance-Beliefs Questionnaire (FABQ) and McGill Pain Questionnaire were applied before the treatment sessions started, after the treatment sessions ended and three months after the study. Gradient of disc height and thickness of the herniation were assessed segmentally with magnetic resonance imagination (MRI) before the study and three months after the study.

Official Title
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Lumbal Disk Herniasyonunda Farklı Tedavi Yöntemlerinin Karşılaştırılması

Conditions
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Lumbar Disc Herniation

Intervention / Treatment
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* Other: non -surgical spinal decompression therapy
* Other: deep friction massage,
* Other: electrotherapy
* Other: exercise


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: clinical diagnosis of lumbar disc herniation without strengthening loss Exclusion Criteria: clinical diagnosis of osteoporosis have scoliosis and spondylolisthesis any surgery related spine any neurological diseases causes sensory loss

Ages Eligible for Study
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Minimum Age: 25 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: spinal decompression group<br>only 15 sessions of spinal decompression therapy were applied. | Other: non -surgical spinal decompression therapy<br>* it is a kind of traction therapy, it has an special traction design which can provide intermittent traction as to herniation levels.<br>|
| Experimental: combine group<br>10 patients participated in this group. for two weeks electrotherapy, deep friction massage and traction and last two weeks electrotherapy and exercise totally 15 session of treatment were applied. | Other: non -surgical spinal decompression therapy<br>* it is a kind of traction therapy, it has an special traction design which can provide intermittent traction as to herniation levels.<br>Other: deep friction massage,<br>* deep friction massage is a kind of massage targeting deep muscles for decreasing pain and increasing function<br>Other: electrotherapy<br>* electrotherapy is consist of hot pack, ultrasound and TENS. electrotherapy agents were help decreasing pain, increasing metabolism of tissues.<br>Other: exercise<br>* special lumbar stabilization exercises were applied in advanced protocol.<br>|
| Experimental: exercise group<br>10 patients participated in this group. for two weeks electrotherapy, deep friction massage and last two weeks electrotherapy and exercise totally 15 session of treatment were applied whi | Other: deep friction massage,<br>* deep friction massage is a kind of massage targeting deep muscles for decreasing pain and increasing function<br>Other: electrotherapy<br>* electrotherapy is consist of hot pack, ultrasound and TENS. electrotherapy agents were help decreasing pain, increasing metabolism of tissues.<br>Other: exercise<br>* special lumbar stabilization exercises were applied in advanced protocol.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| magnetic resonance imaging changes | changes recorded in micrometrical measurements. | change from baseline in disc height and size of herniation at 3 months. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| disability | Oswestry Disability Index used to assess the changes in function and disability levels. Scores range from 0 to 100. scores between 0 and 20 described as minimal disability, scores between 21and 40 described as moderate disability,scores between 41and 60 described as severe disability,scores between 61 and 80 described as crippled and scores between 81 and 100 described as  bed bounded | up to 3 months. | 
| performance | back performance scale used to assess the changes in performance. Scores range from 0 to 15. The lower scores described good performance and higher scores described bad performance. | up to 3 months. | 
| pain | McGill Pain Questionnaire used to asses the changes in pain levels. scores range from 0 to 78. The higher the pain score the greater the pain. | up to 3 months. | 
| straight leg raise test for mobility | Therapist raised patient's leg passively and the pain felt by the patient measured with goniometer and the angle recorded. | up to 3 months | 
| neuropathic pain | The Leeds Assessment of Neuropathic Symptom and Signs (LANSS) Pain Scale used to assess neuropathic pain. Scores range from 0 to 24. scores higher from 12 described neuropathic pain. | up to 3 months. | 
| fear avoidance beliefs | FABQ used to assess fear related attitudes of the patients. Scores range from 0 to 42 . Higher points described high fear avoidance beliefs. | up to 3 months. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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exercise, deep friction massage, spinal decompression, non-surgical spinal decompression