ارزيابي درمان هاي محافظه كارانه جهت كاهش علايم كوكسيدينيا : يك مرور سيستماتيك

Evaluating conservative treatments to reduce coccydynia symptoms: a systematic review

مداخلات محافظه كارانه زيادي براي كاهش علايم كوكسيدينيا وجود دارد كه هر كدام تا اندازه اي درد بيماران مبتلا را كاهش مي دهد، اما مشخص نيست كه كدام درمان مي تواند موثرتر باشد. هدف از اين مطالعه مروري بررسي انواع مداخلات محافظه كارانه و اثربخشي هر يك از آنها در كاهش علايم كوكسيدينيا مي باشد. روش بررسي جستجو براي مطالعات تحقيقاتي منتشر شده تا اكتبر 2021 با استفاده از Scopus، Science Direct، Web of Knowledge و Cochrane بدون محدوديت داده انجام شد. كيفيت مقالات با استفاده از Physiotherapy evidence database scale (PEDro) مورد ارزيابي قرار گرفت. يافته ها در نهايت 12 مقاله وارد مطالعه مروري شدند. دو مقاله از شوك ويو برون اندامي، دو مقاله از بلوك گانگليون ايمپار، سه مقاله از درمان هاي دستي و چهار مطالعه از تزريق استفاده كردند. چهار مطالعه باقي مانده از يونتوفورز با كتوپروفن، درمان بيوفيدبك، طب سوزني و فيزيوتراپي همراه كينزيوتيپينگ استفاده كردند. نتيجه گيري درمان با شوك ويو برون اندامي و بلوك گانگليون ايمپار به طور قابل توجهي درد دنبالچه را بهبود مي بخشد و اثرات دايمي تري را در علايم بيماران نشان مي دهد. درمان هاي دستي بيشتر در مواردي كه دنبالچه پايدار است كاربرد دارد. به نظر مي رسد كه رسيدن به پاسخ مطلوب به بيش از شش جلسه نياز دارد كه براي بيماران خوشايند نيست. تزريق ها، به ويژه آنهايي كه تحت هدايت فلوروسكوپي انجام مي شوند، افزون بر ناخوشايند و دردناك بودن، نياز به مهارت بالايي دارند. با اين حال، اين روش در يك جلسه انجام شده، بنابراين نيازي به مراجعه بعدي ندارد.

There are many conservative interventions to reduce the symptoms of coccydynia, but it is not clear which treatment can be more effective. The aim of this review study was to evaluate the types of conservative interventions and the effectiveness of each of them in reducing coccydynia symptoms. Methods: This systematic review was carried out based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) instruction. A search for research studies published up to October 2021 was conducted in Neuromusculoskeletal Research Center, Firoozgar General Hospital, Iran University of Medical Sciences, Tehran, Iran, using Scopus, Science Direct, Web of Knowledge and Cochrane without data constraints. The search was carried out in October 2021 and continued for seven months. The quality of the articles was evaluated using the Physiotherapy Evidence Database scale (PEDro). All prospective randomized clinical trial studies in which participants suffered from coccydynia and were treated with nonsurgical treatments were included. Results: 945 articles were found in the primary search of the databases. After eliminating 493 repetitive papers, 452 studies remained which were screened by the two researchers of this study in terms of the title and abstract. 40 studies were selected for full-text evaluation. Finally, 12 articles were included in the review study. Two papers used extracorporeal shockwave, two papers used impar ganglion block, three papers manual therapy, and four studies injection. The remaining four studies used iontophoresis with ketoprofen, biofeedback therapy, acupuncture, and physiotherapy with Kinesio taping. Conclusion: Treatment with extracorporeal shock wave and impar ganglion block significantly improve tailbone pain and show more permanent effects on patients' symptoms. Manual therapies are mostly used in cases where the tailbone is stable. It seems that achieving the desired response requires more than six sessions, which is not pleasant for patients. Injections, especially those performed under fluoroscopic guidance, require high skill in addition to being unpleasant and painful. However, this procedure is done in one session, so there is no need for the next visit