Fisioterapeutiese behandeling van kroniese hoofpyne in depressiewe pasiënte; 'n vergelyking tussen individuele behandeling en 'n kombinasie van individuele behandeling en kollektiewe behandeling

Abstract

English: The incidence of depression today is so high, that it is described as "The common cold of mental illness". As Physiotherapist in a private practice, in Bloemfontein, a large part of the researchers daily work consisted of the treatment of chronic headaches in depression patients. The researcher discovered that the intensity of the patients headaches often varied occording to the frame of mind of the patient. The treatment of these headaches included individual physiotherapy that consisted of: spinal mobilization of the effected joints, pressure of the triggerpoints, massage and ultrasound. In this study the above mentioned treatments were compared to a combination of individual and collective treatments. It was determined which type of treatment was most effective in decreasing the total pain pattern (intensity, periodicity, reaction to analgesics) of the headache during treatment as well as one month after the treatment was ended. The study population consisted of patients which were diagnosed with major depression. All the depression patients that attended the two week depression programme in Hospital Park Clinic in Bloemfontein met the criteria to qualify and were referred for physiotherapy were therefore included in the study. So too were all the depression patients that attended the two week depression programme at Universitas Groupcentre in Bloemfontein that met with the necessary criteria and which were referred for physiotherapy included in the study programme. There was a total of fifteen test subjects in the control group and fifteen test subjects in the experimental group. The control group were treated individually and the experimental group received individual physiotherapy as well as collective treatment sessions. Results were obtained through evaluations, re-evaluations as well a re-evaluation that was conducted telephonically with the subjects one month after there discharge from the sentrum or clinic. Special attention was given during evaluations and re-evaluations to the total pain pattern of the test subjects headaches. From the results the observation was made that the control group and the experimental group were very comparitive groups as far as test subjects were concerned, subjective evaluations as well as objective evaluations. The two groups as median of the total pain pattern after the first evaluation were also exactly the same (II out of 15 for both groups). There was no statistical indicative difference with regard to the change of the total pain pattern from treatment to treatment between the two groups. There was a statistical indicative difference between the improvemnt of the total pain pattern from the first evaluation to the re-evaluation after one month. The control group's median of the total pain pattern one month after the treatment was 8 out of 15, while the experimentle group's median was 4 out of 15. The pain pattern of the experimental group was statistically indicative of more improvement than the control group. From this research the conclusion can therefore be made that the results from physiotherapy treatments of chronic headaches in depression patients differ during individual treatments and a combination of individual and collective treatments. A combination of individual and collective treatments deliver better long term results and therefore is the most recommended type of treatment for depression patients with chronic headaches.

Afrikaans: Die voorkomssyfer van depressie is vandag so hoog, dat dit as die "common cold of mental illness" bestempel word. As 'n fisioterapeut in 'n Privaat Praktyk, te Bloemfontein, het 'n groot deel van die navorser se daaglikse werk uit die behandeling van kroniese hoofpyne in depressiewe pasiënte bestaan. Die navorser het opgelet dat die intensiteit van die pasiënte se hoofpyne dikwels verander na gelang van die gemoedstoestand van die pasiënt. Die behandeling van hierdie hoofpyne het individuele fisioterapie ingesluit wat bestaan het uit: spinale mobilisasies van die geaffekteerde gewrigte, isgemiese druk van snellerpunte, massering en elektrotegnieke soos bv. ultraklank. In die studie is bogenoemde behandeling vergelyk met 'n kombinasie van individuele behandeling en kollektiewe behandeling. Daar is gekyk watter tipe behandeling die effektiefste was om die totale pyn patroon (intensiteit, periodisteit en reaksie op analgetika) van die hoofpyn te verminder tydens behandeling asook een maand nadat die behandeling gestaak is. Die studiepopulasie het bestaan uit pasiënte wat gediagnoseer is met major depressie. Al die depressiewe pasiënte wat in Hospitaalpark Kliniek te Bloemfontein die twee weke depressie program bygewoon het en aan al die insluitingskriteria voldoen het en vir fisioterapie verwys is, is by die studie ingesluit. So ook is al die depressiewe pasiënte wat die twee weke depressie program by Universitas Groepsentrum te Bloefontein bygewoon het en aan die insluitingskriteria voldoen het en vir fisioterapie verwys is, by die studie ingesluit. Daar was altesaam vyftien proefpersone in die kontrole groep en vyftien proefpersone in die eksperimentele groep. Die kontrole groep is slegs individueel behandel en die eksperimentele groep het individuele fisioterapie asook kollektiewe behandelingsessies ontvang. Resultate is verkry deur evaluerings en herevaluerings asook 'n herevaluering wat een maand na ontslag uit die Sentrum of Kliniek telefonies gedoen is. Daar is veral gelet tydens die evaluerings en herevaluerings op die totale pyn patroon van die proefpersone se hoofpyne. Uit die resultate het dit geblyk dat die kontrole groep en die eksperimentele groep baie vergelykbare groepe was ten opsigte van die proefpersone, subjektiewe evaluerings en objektiewe evaluerings. Die twee groepe se mediaan van die totale pyn patroon met die eerste evaluering was ook presies dieselfde (11 uit 15 vir beide groepe). Daar was geen statistiese beduidende verskil ten opsigte van die verandering van die totale pyn patroon van behandeling tot behandeling tussen die twee groepe nie. Daar was egter 'n statisties beduidende verskil tussen die verbetering van die totale pyn patroon vanaf die eerste evaluering na die herevaleuring na een maand. Die kontrole groep se mediaan van die totale pyn patroon was een maand na die behandeling 8 uit 15, terwyl die eksperimentele groep se mediaan 4 uit 15 was. Die eksperimentele groep se totale pyn patroon het statisties beduidend meer verbeter as die kontrole groep met 'n 95% vertrouensinterval van [-4 ; -1]. Uit hierdie navorsing kan daar dus die gevolgtrekking gemaak word dat die resultate van fisioterapeutiese behandeling van kroniese hoofpyne in depressiewe pasiënte verskil, tydens individuele behandeling en 'n kombinasie van individuele behandeling en kollektiewe behandeling. 'n Kombinasie van individuele behandeling en kollektiewe behandeling lewer beter langtermyn resultate en dus is dit die mees aangewese tipe behandeling vir depressiewe pasiënte met kroniese hoofpyne.