Splošne teme / General themes Fizioterapija 2015, letnik 23, suppl 1 55 Šestminutni test hoje v bazenu pri obravnavi pacientov s kronično razširjeno nerakavo bolečino na URI - Soča – poročilo o primeru Nuša Klar, dipl. fiziot. Univerzitetni rehabilitacijski inštitut Republike Slovenije - Soča, Ljubljana Korespondenca/Correspondence: Nuša Klar; e-pošta: klar.nusa@gmail.com Uvod: Kronično razširjen bolečinski sindrom prizadene mehkotkivne strukture. Sprožijo ga bolečinski in nebolečinski dražljaji, pri čemer se čutne zaznave v osrednjem živčevju nepravilno procesirajo (1), zato so bolnikove psihofizične sposobnosti močno zmanjšane. Zdravljenje je dolgotrajen in večplasten proces, v katerem se poudarja multidisciplinaren pristop z načeli interdisciplinarnosti. Od leta 2013 na URI - Soča potekata dva programa za obravnavo oseb s kronično razširjeno nerakavo bolečino: 4-tedenski prilagojeni interdisciplinarni rehabilitacijski program (PIRP) in 5-tedenski interdisciplinarni program funkcionalne obnove (IPFO). Progresivna vadba v vodi (2) in učenje sproščanja v njej (3) pomembno pripomoreta k izboljšanju pacientovega počutja. Za spremljanje pacientovega napredka in vrednotenje fizioterapevtskih postopkov v bazenu ni razvitih enostavnih testov (4), zato je namen poročila o primeru prispevka predstaviti 6-minutni test hoje v bazenu za oceno vzdržljivosti pacientov, vključenih v PIRP. Metode: 45-letna pacientka s sindromom fibromialgije je bila vključena v 4-tedenski PIRP. Za oceno vzdržljivosti smo izvedli 6-minutni test hoje v bazenu z osnovno analizo hoje (dolžina koraka, dostop, gibanje rok, koordinacija gibanja, drža telesa) pred začetkom PIRP-a in po njem. Pred testiranjem so bila dana kratka ustna navodila za izvedbo testa. Med izvajanjem je fizioterapevt spremljal pacientko ob bazenu in jo vsaki 2 minuti opozoril na preostanek časa. Test se je izvajal v bazenu, globokem od 120 do 140 cm in dolgem 15 m, s temperaturo vode od 31 do 33 °C. Ocena bolečine je bila izvedena pred začetkom in po koncu 6-minutnega testa hoje. Rezultati testa, ocena bolečine in osnovna analiza hoje so se zapisali v obrazec. Ob koncu programa so bili rezultati testiranja vključeni v končno fizioterapevtsko poročilo. Rezultati: Ob začetku programa je preiskovanka prehodila 85 m, ocena bolečine pred testom in po njem je bila 7/8; po koncu programa je prehodila 105 m z oceno bolečine 5/5,5. Primerjava pokaže, da je prehojena razdalja povečana za 23 odstotkov ob hkratnem zmanjšanju bolečine za 34 odstotkov. Zaključki: 6-minutni test hoje v bazenu je enostaven za izvedbo in razumljiv. Dobro pokaže bolnikovo splošno telesno pripravljenost in njegovo osnovno gibanje po doprsno globokem bazenu. Primeren je za spremljanje napredka bolnikov s kronično razširjeno nerakavo bolečino v času rehabilitacije. Na URI - Soča so rezultati 6-minutnega testa hoje vključeni v končno fizioterapevtsko poročilo. Test še ni standardiziran. V prihodnje bi bilo koristno test standardizirati, tako za ovrednotenje bolnikovega napredka kot za zapisovanje fizioterapevtskega dela v bazenu. Ključne besede: 6-minutni test hoje v bazenu, hidroterapija, kronično razširjena nerakava bolečina. Splošne teme / General themes 56 Fizioterapija 2015, letnik 23, suppl 1 Six-minute walk test in a swimming pool in a trial of patients with chronic widespread non-cancer pain in URI - Soča – case report A chronic widespread syndrome affects soft-tissue structures and is caused by pain and non-pain irritation, which provokes false sensual perception in central nervous system (1). Because of that, the patient’s psycho-physical capabilities are very weak. The treatment is long-lasting and often very comprehensive where the best results are achieved with multidisciplinary approach combined with interdisciplinary principles. In URI - Soča two interdisciplinary programmes for patients with chronic widespread non-cancer pain have been developed since 2013: 4-weeks’ adapted interdisciplinary rehabilitation programme (PIRP) and 5-weeks’ interdisciplinary programme of physical restoration (IPFO). Progressive exercising programme in water (2) and teaching of relaxation in it (3) help a lot to improve the patient’s state of health. There are no easy tests in written form to evidence and to attend the patient´s progress and the physiotherapist´s work in pool, too (4). The purpose of the report was to present the 6-minute walk test in pool to assess the patient endurance in PIRP programme. METHODS: A 45- year-old woman was included in 4-weeks’ PIRP. To assess the endurance, a 6-minute walking test in pool was used combined with basic walking analysis (step length, a touch of foot, an arm moving, a coordination of movement, a posture) before the beginning of the PIRP and after. Before starting the test, the patient was given short oral instructions; while walking the patient was attended from outside the pool by the physiotherapist, every 2 minutes, the patient was reminded about how much time was left. The test was done in a pool, which was 120 to 140 cm deep and 15 m long, with the water temperature 31°-33°C. Assessment of pain was done before and after the walking test. The results of each test, the pain assessment and the basic gait analysis were noted. At the end of the programme, all the results were included in the main physiotherapist´s report. RESULTS: At the beginning of the programme, the included patient walked 85 m, the pain assessment was before/after the test 7/8. At the end of the programme, she walked 105 m and the pain was assessed 5/5.5. The comparison showed that the walking length increased for 23% and the pain decreased for 34%. The results of each test and the walking analysis were noted. At the end of the programme, everything was included in the physiotherapist's main report. CONCLUSION: The 6-minute walking test in a pool is an easily usable test. It showed the patient’s endurance and his basic movement in a chest-deep pool well. It is suitable to assess the improvement of patients with chronic widespread non-cancer pain during their rehabilitation. In URI - Soča the results of the 6-minute walking test are included in the main physiotherapist´s report. The standardisation hasn´t been done yet. It is necessary to do the standardisation to evidence the patient’s improvement and the physiotherapist’s work as well. Key words: 6-minute walk test in a pool, hydrotherapy, chronic widespread non-cancer pain. Literatura/References: 1. Logar D (2007). Novosti v razumevanju patogeneze in zdravljenju 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. Rosenstein AA, Water exercise for fibromyalgia: the gentle way to relax and reduce pain. Enumclaw, WA: Idyll Arbor, 2006. 3. Gangaway J (2011). Aquatic therapy supports fibromyalgia patients. http://physical- therapy.advanceweb.com/features/Articles/Aquatic-Therapy-Supports-Fibromyalgia-Patients.aspx. <8. 3. 2012>. 4. Klar N, Divjak M (2012). Program stopnjevane vadbe v vodi pri poskusni multidisciplinarni obravnavi sindroma fibromialgije. Diplomsko delo. Ljubljana: Zdravstvena fakulteta, Oddelek za fizioterapijo.