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국문

배경: 만성 신경병증성 통증이 있는 뇌졸중 환자는 감각 이상을 일으켜 신체 기능 회복을 지연시킨다. 관절 가동술(Joint mobilization, JM)는 뇌졸중 환자의 운동 범위를 개선하기 위해 가장 흔히 사용되는 치료법이다. 침과 뜸과 같은 한의학(TKM)은 뇌졸중 환자의 신경을 자극하여 통증을 줄이는 데 효과적이다. 목적: 본 연구는 뇌졸중 후 환자의 통증, 신체 기능 및 우울증 치료에 대해 TKM과 결합된 JM의 효과를 조사하고자 한다. 방법: 총 69명의 뇌졸중 후 환자를 JM+TKM군(n=23), JM군(n=23), 대조군(n=23)으로 무작위 배정하였다. JM+TKM군과 JM군은 12주 동안 주 2회, 30분 동안 JM을 받았고, JM+TKM군은 주 1회 별도로 30분 동안 TKM을 받았다. 대조군은 JM 또는 TKM을 중재하지 않았다. 통증(VAS, SPADI 및 KWOMAC), 신체 기능(ROM, 10MWT, FGA, MFT, ADL 및 IADL) 및 우울증(CES-D 및 BDI)은 중재 12주 전후에 각 환자에 대해 평가되었다. 결과: SPADI, MFT 및 IADL은 JM군 및 대조군에 비해 JM+TKM군에서 유의하게 개선되었다(p < 0.05). KF, ADL, CES-D, BDI는 대조군에 비해 JM+TKM군과 JM군에서 유의하게 개선되었다(p<0.05). 결론: 본 연구에서 JM+TKM 치료는 뇌졸중 후 만성 신경병증성 통증 환자의 통증, 우울증 및 신체 기능을 개선했다. 이 귀중한 발견은 치료적 개입을 설계하고 잠재적인 치료 목표를 식별하기 위한 경험적 증거를 제공한다.

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Background: Stroke patients with chronic neuropathic pain cause sensory abnormalities, delaying the physical function recovery. Joint mobilization (JM) is the most frequently used treatment for improving the range of motion in stroke patients. Traditional Korean medicine (TKM), such as acupuncture and moxibustion, are effective in reducing pain by stimulating the nerves in stroke patients. Objective: We aimed to investigate the effectiveness of JM combined with TKM for treatment pain, physical function and depression in post-stroke patients. Methods: A total of 69 post-stroke patients were randomly assigned to the JM+TKM group (n = 23), the JM group (n = 23), and the control group (n = 23). Patients in the JM+TKM group and the JM group received JM for 30 minutes, twice a week for 12 weeks, and the JM+TKM group received TKM for 30 minutes separately once a week. The control group did not receive JM or TKM. Pain (VAS, SPADI and KWOMAC), physical function (ROM, 10MWT, FGA, MFT, ADL and IADL), and depression (CES-D and BDI) were assessed for each patient before and after the 12 weeks of intervention. Results: SPADI, MFT and IADL were improved significantly in the JM+TKM group compared with the JM group and the control group (p < 0.05). KF, ADL, CES-D, and BDI were improved significantly in the JM+TKM and JM groups compared with the control group (p < 0.05). Conclusions: The treatment of JM+TKM improved pain, depression, and physical function of post-stroke patients with chronic neuropathic pain in this study. This valuable finding provides empirical evidence for the designing therapeutic interventions and identifying potential therapeutic targets.

국문

관절가동술: 한방 치료를 병행한 관절 가동술 집단과 관절 가동술 집단은 어깨관절과 무릎관절의 통증완화 및 관절 가동 범위 증진을 위해 등급 2에서 4에 해당하는 방법으로 관절 가동 운동을 1회 30분간, 주 2회의 12주간에 걸쳐서 실시하였다.
한방 치료: 한방 치료를 병행한 관절 가동술 집단은 어깨 관절과 무릎 관절 주위에 한방 치료를 1회 30분간, 주 1회의 12주간에 걸쳐서 실시하였다. 침 치료는 일회용 멸균 호침 stainless steel (0.20mm x 30mm, 동방침구 제작소, Korea)을 사용하여 주1회의 12주간에 걸쳐 시행하였다. 유침은 평균 15분간 시행하였으며, 자침 길이는 부위에 따른 차이는 있었으나 평균 20mm로 시행하였다. 뜸치료는 미니뜸(태극, Korea)을 15분간 시행하였다.

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Joint mobilization treatment: For 12 weeks, the JM+TKM and JM groups received grade II–III JM for 30 min, twice weekly, to relieve pain in the shoulder and knee joints and to improve the ROM [18]. Shoulder JM was performed on the glenohumeral joint and scapulothoracic joint in the supine and prone positions. Lateral distraction, downward glide, posterior glide, and anterior glide were performed on the glenohumeral joint. Elevation, depression, protraction, retraction, upward rotation, and downward rotation were performed on the scapulothoracic joint. Knee JM was performed on the tibiofemoral joint and patellofemoral joint in the supine and prone positions. Lower distraction, posterior glide, and anterior glide were performed on the tibiofemoral joint. Downward glide, lateral glide, and medial glide were performed on the patellofemoral joint.
Traditional Korean medicine treatment: The JM+TKM group received TKM including acupuncture and moxibustion treatments around the shoulder joint and the knee joint for 30 min, once a week for 12 weeks. Acupuncture treatment was performed using disposable sterile stainless-steel needles (0.20 × 30 mm, Dongbang, Korea) for 15 min on average. The penetration depth varied according to the site, and was 20 mm deep on average. For moxibustion treatment, mini moxibustion (Taegeuk, Korea) was performed for 15 min.

상세내용 영문

Joint mobilization treatment: For 12 weeks, received grade II–III JM for 30 min, twice weekly, to relieve pain in the shoulder and knee joints and to improve the ROM [18]. Shoulder JM was performed on the glenohumeral joint and scapulothoracic joint in the supine and prone positions. Lateral distraction, downward glide, posterior glide, and anterior glide were performed on the glenohumeral joint. Elevation, depression, protraction, retraction, upward rotation, and downward rotation were performed on the scapulothoracic joint. Knee JM was performed on the tibiofemoral joint and patellofemoral joint in the supine and prone positions. Lower distraction, posterior glide, and anterior glide were performed on the tibiofemoral joint. Downward glide, lateral glide, and medial glide were performed on the patellofemoral joint.
Traditional Korean medicine treatment: The received TKM including acupuncture and moxibustion treatments around the shoulder joint and the knee joint for 30 min, once a week for 12 weeks. Acupuncture treatment was performed using disposable sterile stainless-steel needles (0.20 × 30 mm, Dongbang, Korea) for 15 min on average. The penetration depth varied according to the site, and was 20 mm deep on average. For moxibustion treatment, mini moxibustion (Taegeuk, Korea) was performed for 15 min.

상세내용 영문

Joint mobilization treatment: For 12 weeks, received grade II–III JM for 30 min, twice weekly, to relieve pain in the shoulder and knee joints and to improve the ROM [18]. Shoulder JM was performed on the glenohumeral joint and scapulothoracic joint in the supine and prone positions. Lateral distraction, downward glide, posterior glide, and anterior glide were performed on the glenohumeral joint. Elevation, depression, protraction, retraction, upward rotation, and downward rotation were performed on the scapulothoracic joint. Knee JM was performed on the tibiofemoral joint and patellofemoral joint in the supine and prone positions. Lower distraction, posterior glide, and anterior glide were performed on the tibiofemoral joint. Downward glide, lateral glide, and medial glide were performed on the patellofemoral joint.

상세내용 영문

The control group did not receive joint mobilization or traditional Korean medicine.

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Stroke

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Pain

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before and after 12 weeks

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Physical function

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before and after 12 weeks

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Depression

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before and after 12 weeks

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Visual analog scale (VAS)

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before and after 12 weeks

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Shoulder pain and disability index (SPADI)

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before and after 12 weeks

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Korean Western Ontario MacMaster universities osteoarthritis index (KWOMAC)

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before and after 12 weeks

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Range of motion (ROM)

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before and after 12 weeks

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10m walking speed test (10MWT)

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before and after 12 weeks

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Functional gait (FGA)

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before and after 12 weeks

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Manual function test (MFT)

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before and after 12 weeks

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Activities of daily living (ADL)

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before and after 12 weeks

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Instrumental activities of daily living (IADL)

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before and after 12 weeks

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Center for epidemiologic studies-depression scale (CES-D)

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before and after 12 weeks

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Beck depression inventory (BDI)

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before and after 12 weeks