Research Article
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Diz osteoartritine bağlı nöropatik ağrısı olan hastalarda whirlpool’un etkinliği

Year 2018, Volume 2, Issue 2, 78 - 83, 16.03.2018
https://doi.org/10.28982/josam.400603

Abstract

Amaç: Hem nöropatik hem de nosiseptif mekanizmalar osteoartritteki ağrıya neden olabilir. Bu çalışmanın amacı diz osteoartritine bağlı nöropatik ağrısı olan hastalarda whirlpool uygulamasının ağrı, dizabilite, yaşam kalitesi ve uyku üzerine olan etkinliğini değerlendirmektir.

Yöntemler: Bu çalışma randomize, placebo kontrollü prospektif bir çalışmadır. Diz osteoartritine bağlı nöropatik ağrısı olan 60 hasta çalışmaya alındı ve iki gruba randomize edildi. Grup 1’deki hastalar (n=30) sıcak whirlpool, Grup 2’deki hastalar (n=30) plasebo whirlpool ile 20 dakika süreyle 15 seans boyunca tedavi edildi. Primer sonuç ölçütü ağrı idi ve görsel analog skala (GAS) ve Western Ontario and McMaster Universities  Osteoarthritis (WOMAC) indeksi ağrı skoru ile değerlendirildi. Fonksiyonel abilite için WOMAC dizabilite ve fiziksel fonksiyon skorları, yaşam kalitesi için Kısa-Form 36 (KF-36) ile; uyku, için Pittsburgh Uyku Kalitesi İndeksi (PUKİ) kullanıldı. Nöropatik ağrı varlığı DN4 anketi ile belirlendi. Değerlendirmeler tedavi öncesi ve sonrası yapıldı. 

Bulgular: Tedavinin sonunda her iki grupta da KF-36, PUKİ ve DN4 skorları ile diz EHA değerlerindeki düzelme istatiksel olarak anlamlı bulundu (p<0.05). Gruplar arasında, KF-36’nın genel sağlık skoru dışındaki tüm alt bileşenleri, PUKİ ve DN4 skorlarındaki düzelme açısından istatiksel olarak anlamlı farklılık saptanırken (p<0.05); GAS, WOMAC indeksi ve KF-36 genel sağlık skoru ile diz EHA değerlerinde istatiksel olarak anlamlı farklılık saptanmadı (p>0.05).

Sonuç: Diz osteoartritine bağlı nöropatik ağrısı olan hastalarda whirlpool tedavisinin yaşam kalitesi, uyku, nöropatik ağrı ve dizabilite üzerine olumlu etkileri mevcuttur.

References

  • 1. Nguyen US, Zhang Y, Zhu Y, Niu J, Zhang B, Felson DT. Increasing prevalence of knee pain and symptomatic knee osteoarthritis: survey and cohort data. Ann Intern Med. 2011;155:725–32.
  • 2. Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis. 2001;60:91–7.
  • 3. Felson DT. The sources of pain in knee osteoarthritis. Curr Opin Rheumatol. 2005;17:624-8.
  • 4. Bajaj P, Graven-Nielsen T, Lars Arendt-Nielsen L. Osteoarthritis and its association with muscle hyperalgesia: an experimental controlled study. Pain. 2001;93:107-14.
  • 5. Coderre TJ, Katz J, Vaccarino AL, Melzack R. Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence. Pain. 1993;52:259-85.
  • 6. Dieppe PA, Ayis S, Clarke S, Simmons D, Williams S, Fallon M, et al. Quantitative sensory testing in osteoarthritis of the knee. Osteoarthritis Cartilage. 2008;16:S204.
  • 7. Baron R. Mechanisms of disease: neuropathic pain: a clinical perspective. Nat Clin Pract Neurol. 2006;2:95–106.
  • 8. Dworkin RH, OConnor AB, Backonja M, Farrar JT, Finnerup NB, Jensen TS, et al. Pharmacologic management of neuropathic pain: evidence based recommendations. Pain. 2007;132:237–51.
  • 9. Finnerup NB, Jensen TS. Mechanisms of disease: mechanism- based classification of neuropathic pain-a critical analysis. Nat Clin Pract Neurol. 2006;2:107–15.
  • 10. Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology. 2008;70:1630–5.
  • 11. Bell AT, Horton PG. The use and abuse of hydrotherapy in athletics: review. Athl Train, JNATA. 1987;22:115-9.
  • 12. Ogiwara S. Calf muscle pumping and rest positions during and/or after whirlpool therapy. J Phys Ther Sci. 2001;13:99–105.
  • 13. Kaul MP, Herring SA. Superficial heat and cold: how to maximize the benefits. Physician Sportsmed. 1994;22:65-74.
  • 14. Lehmann JF, Warren CG, Scham SM. Therapeutic heat and cold. Clin Orthop. 1974;99:207-45.
  • 15. Myrer JW, Draper DO, Durrant E. Contrast therapy and intramuscular temperature in the human leg. J Athl Train. 1994;29:318-22.
  • 16. Beasley J. Osteoarthritis and rheumatoid arthritis: conservative therapeutic management. J Hand Ther. 2012;25:163–71.
  • 17. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Arthritis Rheum. 1986;29:1039–49.
  • 18. Kellgren JH, Lawrence JS. Radiological assessment of osteoarthritis. Ann Rheum Dis 1957; 16:494-501.
  • 19. Brazier JE, Harper R, Munro J, Walters SJ, Snaith ML. Generic and condition-specific outcome measures for people with osteoarthritis of the knee. Rheumatology (Oxford). 1999;38:870-7.
  • 20. Tüzün EH, Eker L, Aytar A, Daşkapan A, Bayramoğlu M. Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index. Osteoarthritis Cartilage. 2005;13:28-33.
  • 21. Koçyiğit H, Aydemir Ö, Fişek G, Ölmez N, Memiş A. Kısa Form-36 (KF-36)’nın Türkçe versiyonunun güvenilirliği ve geçerliliği. İlaç ve Tedavisi Dergisi. 1999;12:102-6.
  • 22. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193–213.
  • 23. Ağargün MY, Kara H, Anlar Ö. Pittsburgh Uyku Kalitesi Indeksi’nin geçerliği ve güvenirliği. Türk Psikiyatri Dergisi. 1996;7:107–15.
  • 24. Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B,Bruxelle J et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 2005;114:29-36.
  • 25. Unal-Cevik I, Sarioglu-Ay S, Evcik D. A comparison of the DN4 and LANSS questionnaires in the assessment of neuropathic pain: validity and reliability of the Turkish version of DN4. J Pain. 2010;11:1129-35.
  • 26. Woolf CJ, Salter MW. Neuronal plasticity: increasing the gain in pain. Science 2000;288:1765-9.
  • 27. Baron R, Binder A, Wasner G. Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol. 2010;9:807-19.
  • 28. McDougall JJ, Andruski B, Schuelert N, Hallgrímsson B, Matyas JR. Unravelling the relationship between age, nociception and joint destruction in naturally occurring osteoarthritis of Dunkin Hartley guinea pigs. Pain. 2009;141:222-32.
  • 29. Bradley LA, McKendree-Smith NL. Central nervous system mechanisms of pain in fibromyalgia and other musculoskeletal disorders: behavioral and psychologic treatment approaches. Curr Opin Rheumatol. 2002;14:45-51.
  • 30. Melzack R. From the gate to the neuromatrix. Pain. 1999;82(Suppl 6):S121-6.
  • 31. Becker BE: Aquatic therapy: scientific foundations and clinical rehabilitation applications. PM R. 2009;1:859–72.
  • 32. Im SH, Han EY. Improvement in Anxiety and Pain After Whole Body Whirlpool Hydrotherapy Among Patients With Myofascial Pain Syndrome. Ann Rehabil Med. 2013;37(4):534–40.
  • 33. Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150:971-9.
  • 34. Weber BC, Hoppe KM. Physical agent modalities. In: Braddom RL, editor. Physical medicine & rehabilitation. 4th ed. Philadelphia: Saunders; 2011. p. 449-67.
  • 35. Devrimsel G, Turkyilmaz AK, Yildirim M, Beyazal MS. The effects of whirlpool bath and neuromuscular electrical stimulation on complex regional pain syndrome. J Phys Ther Sci. 2015;27:27-30.
  • 36. Uçar D, Paker N, Bugdayci NS, Yalcinkaya EY. Comparison of the efficacy of whirlpool and paraffin treatments in women with symptomatic hand osteoarthritis. Turkish Journal of Physical Medicine and Rehabilitation. 2011;57:124-8.
  • 37. Howell JW: Management of the acutely burned hand for the nonspecialized clinician. Phys Ther. 1989;69:1077–90.
  • 38. Sutbeyaz ST, Koseoglu BF, Yeşiltepe E: Simultaneous upper and lower extremity complex regional pain syndrome type I in tetraplegia. Spinal Cord. 2005;43:568–72.
  • 39. Lim KO, Lee DY, Shin WS. The effects of a warm whirlpool bath on pain and stiffness of patients with chronic stroke induced knee osteoarthritis. J Phys Ther Sci. 2013;25:873-5.
  • 40. Jensen MP, Chodroff MJ, Dworkin RH. The impact of neuropathic pain on health-related quality of life: review and implications. Neurology. 2007;68:1178-82.
  • 41. O’Connor AB. Neuropathic pain. Quality-of-life impact, costs and cost effectiveness of therapy. Pharmacoeconomics. 2009;27:95–112.
  • 42. Stanley N. Importance of sleep in neuropathic pain. Somnologie. 2012;16:17-9. Kuligowski LA, Lephart SM, Giannantonio FP, Blanc RO. Effect of whirlpool therapy on the signs and symptoms of delayed-onset muscle soreness. J Athl Train. 1998;33:222-8.

The effectiveness of whirlpool for patients with neuropathic pain due to knee osteoarthritis

Year 2018, Volume 2, Issue 2, 78 - 83, 16.03.2018
https://doi.org/10.28982/josam.400603

Abstract

Aim: Both neuropathic and nociceptive mechanisms may contribute to the OA pain experience. The aim of this study is to determine the efficacy of warm whirlpool on pain, disability, quality of life (QoL) and sleep for patients with neuropathic pain. 

Methods: This is a randomized, placebo controlled prospective study. Sixty patients with neuropathic pain due to knee OA were included and randomized into two groups. Group 1 (n=30) were treated with warm whirlpool and Group 2 (n=30) were treated with placebo for 20 minutes during 15 sessions. Patients were evaluated according to pain, knee range of motions (ROM), quality of life (QoL) and sleep quality. The primer outcome measure was pain severity and was assessed using a visual analogue scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). WOMAC disability and functional scores for functional ability, Short Form-36 Health Survey (SF-36) for QoL, Pittsburgh Sleep Quality Index (PSQI) for sleep, DN4 for neuropathic pain were used for assessments. Patients were evaluated at baseline and the end of the 15 day intervention. 

Results: At the end of the therapy, there were statistically significant improvements in SF-36, PSQI, DN4 and knee ROM (active and passive) scores (p<0.05) for both groups. Also there were a statistically significant improvement for SF-36 scores except for general health score, PSQI and DN4 scores between groups (p<0.05);but this improvement was not statistically significant for VAS, WOMAC, SF-36 general health score and knee ROM between groups (p>0.05). 

Conclusion: Whirlpool provided significant improvements in QoL, sleep, neuropathic pain and disability for patients with neuropathic pain due to knee OA.

References

  • 1. Nguyen US, Zhang Y, Zhu Y, Niu J, Zhang B, Felson DT. Increasing prevalence of knee pain and symptomatic knee osteoarthritis: survey and cohort data. Ann Intern Med. 2011;155:725–32.
  • 2. Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis. 2001;60:91–7.
  • 3. Felson DT. The sources of pain in knee osteoarthritis. Curr Opin Rheumatol. 2005;17:624-8.
  • 4. Bajaj P, Graven-Nielsen T, Lars Arendt-Nielsen L. Osteoarthritis and its association with muscle hyperalgesia: an experimental controlled study. Pain. 2001;93:107-14.
  • 5. Coderre TJ, Katz J, Vaccarino AL, Melzack R. Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence. Pain. 1993;52:259-85.
  • 6. Dieppe PA, Ayis S, Clarke S, Simmons D, Williams S, Fallon M, et al. Quantitative sensory testing in osteoarthritis of the knee. Osteoarthritis Cartilage. 2008;16:S204.
  • 7. Baron R. Mechanisms of disease: neuropathic pain: a clinical perspective. Nat Clin Pract Neurol. 2006;2:95–106.
  • 8. Dworkin RH, OConnor AB, Backonja M, Farrar JT, Finnerup NB, Jensen TS, et al. Pharmacologic management of neuropathic pain: evidence based recommendations. Pain. 2007;132:237–51.
  • 9. Finnerup NB, Jensen TS. Mechanisms of disease: mechanism- based classification of neuropathic pain-a critical analysis. Nat Clin Pract Neurol. 2006;2:107–15.
  • 10. Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology. 2008;70:1630–5.
  • 11. Bell AT, Horton PG. The use and abuse of hydrotherapy in athletics: review. Athl Train, JNATA. 1987;22:115-9.
  • 12. Ogiwara S. Calf muscle pumping and rest positions during and/or after whirlpool therapy. J Phys Ther Sci. 2001;13:99–105.
  • 13. Kaul MP, Herring SA. Superficial heat and cold: how to maximize the benefits. Physician Sportsmed. 1994;22:65-74.
  • 14. Lehmann JF, Warren CG, Scham SM. Therapeutic heat and cold. Clin Orthop. 1974;99:207-45.
  • 15. Myrer JW, Draper DO, Durrant E. Contrast therapy and intramuscular temperature in the human leg. J Athl Train. 1994;29:318-22.
  • 16. Beasley J. Osteoarthritis and rheumatoid arthritis: conservative therapeutic management. J Hand Ther. 2012;25:163–71.
  • 17. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Arthritis Rheum. 1986;29:1039–49.
  • 18. Kellgren JH, Lawrence JS. Radiological assessment of osteoarthritis. Ann Rheum Dis 1957; 16:494-501.
  • 19. Brazier JE, Harper R, Munro J, Walters SJ, Snaith ML. Generic and condition-specific outcome measures for people with osteoarthritis of the knee. Rheumatology (Oxford). 1999;38:870-7.
  • 20. Tüzün EH, Eker L, Aytar A, Daşkapan A, Bayramoğlu M. Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index. Osteoarthritis Cartilage. 2005;13:28-33.
  • 21. Koçyiğit H, Aydemir Ö, Fişek G, Ölmez N, Memiş A. Kısa Form-36 (KF-36)’nın Türkçe versiyonunun güvenilirliği ve geçerliliği. İlaç ve Tedavisi Dergisi. 1999;12:102-6.
  • 22. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193–213.
  • 23. Ağargün MY, Kara H, Anlar Ö. Pittsburgh Uyku Kalitesi Indeksi’nin geçerliği ve güvenirliği. Türk Psikiyatri Dergisi. 1996;7:107–15.
  • 24. Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B,Bruxelle J et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 2005;114:29-36.
  • 25. Unal-Cevik I, Sarioglu-Ay S, Evcik D. A comparison of the DN4 and LANSS questionnaires in the assessment of neuropathic pain: validity and reliability of the Turkish version of DN4. J Pain. 2010;11:1129-35.
  • 26. Woolf CJ, Salter MW. Neuronal plasticity: increasing the gain in pain. Science 2000;288:1765-9.
  • 27. Baron R, Binder A, Wasner G. Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol. 2010;9:807-19.
  • 28. McDougall JJ, Andruski B, Schuelert N, Hallgrímsson B, Matyas JR. Unravelling the relationship between age, nociception and joint destruction in naturally occurring osteoarthritis of Dunkin Hartley guinea pigs. Pain. 2009;141:222-32.
  • 29. Bradley LA, McKendree-Smith NL. Central nervous system mechanisms of pain in fibromyalgia and other musculoskeletal disorders: behavioral and psychologic treatment approaches. Curr Opin Rheumatol. 2002;14:45-51.
  • 30. Melzack R. From the gate to the neuromatrix. Pain. 1999;82(Suppl 6):S121-6.
  • 31. Becker BE: Aquatic therapy: scientific foundations and clinical rehabilitation applications. PM R. 2009;1:859–72.
  • 32. Im SH, Han EY. Improvement in Anxiety and Pain After Whole Body Whirlpool Hydrotherapy Among Patients With Myofascial Pain Syndrome. Ann Rehabil Med. 2013;37(4):534–40.
  • 33. Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150:971-9.
  • 34. Weber BC, Hoppe KM. Physical agent modalities. In: Braddom RL, editor. Physical medicine & rehabilitation. 4th ed. Philadelphia: Saunders; 2011. p. 449-67.
  • 35. Devrimsel G, Turkyilmaz AK, Yildirim M, Beyazal MS. The effects of whirlpool bath and neuromuscular electrical stimulation on complex regional pain syndrome. J Phys Ther Sci. 2015;27:27-30.
  • 36. Uçar D, Paker N, Bugdayci NS, Yalcinkaya EY. Comparison of the efficacy of whirlpool and paraffin treatments in women with symptomatic hand osteoarthritis. Turkish Journal of Physical Medicine and Rehabilitation. 2011;57:124-8.
  • 37. Howell JW: Management of the acutely burned hand for the nonspecialized clinician. Phys Ther. 1989;69:1077–90.
  • 38. Sutbeyaz ST, Koseoglu BF, Yeşiltepe E: Simultaneous upper and lower extremity complex regional pain syndrome type I in tetraplegia. Spinal Cord. 2005;43:568–72.
  • 39. Lim KO, Lee DY, Shin WS. The effects of a warm whirlpool bath on pain and stiffness of patients with chronic stroke induced knee osteoarthritis. J Phys Ther Sci. 2013;25:873-5.
  • 40. Jensen MP, Chodroff MJ, Dworkin RH. The impact of neuropathic pain on health-related quality of life: review and implications. Neurology. 2007;68:1178-82.
  • 41. O’Connor AB. Neuropathic pain. Quality-of-life impact, costs and cost effectiveness of therapy. Pharmacoeconomics. 2009;27:95–112.
  • 42. Stanley N. Importance of sleep in neuropathic pain. Somnologie. 2012;16:17-9. Kuligowski LA, Lephart SM, Giannantonio FP, Blanc RO. Effect of whirlpool therapy on the signs and symptoms of delayed-onset muscle soreness. J Athl Train. 1998;33:222-8.

Details

Primary Language English
Subjects General and Internal Medicine
Journal Section Research article
Authors

Aslıhan Uzunkulaoğlu (Primary Author)
Ufuk University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Ankara
Türkiye


Duygu KERİM This is me
Ufuk University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Ankara
Türkiye


Saime Ay
Ufuk University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Ankara
Türkiye


Sibel Kibar
Fizyocare Physical Medicine and Rehabilitation Center, Ankara
Türkiye

Publication Date March 16, 2018
Published in Issue Year 2018, Volume 2, Issue 2

Cite

Bibtex @research article { josam400603, journal = {Journal of Surgery and Medicine}, issn = {}, eissn = {2602-2079}, address = {jsurgmed@gmail.com}, publisher = {Fatih BAŞAK}, year = {2018}, volume = {2}, pages = {78 - 83}, doi = {10.28982/josam.400603}, title = {The effectiveness of whirlpool for patients with neuropathic pain due to knee osteoarthritis}, key = {cite}, author = {Uzunkulaoğlu, Aslıhan and Kerim, Duygu and Ay, Saime and Kibar, Sibel} }
APA Uzunkulaoğlu, A. , Kerim, D. , Ay, S. & Kibar, S. (2018). The effectiveness of whirlpool for patients with neuropathic pain due to knee osteoarthritis . Journal of Surgery and Medicine , 2 (2) , 78-83 . DOI: 10.28982/josam.400603
MLA Uzunkulaoğlu, A. , Kerim, D. , Ay, S. , Kibar, S. "The effectiveness of whirlpool for patients with neuropathic pain due to knee osteoarthritis" . Journal of Surgery and Medicine 2 (2018 ): 78-83 <http://jsurgmed.com/en/pub/issue/35677/400603>
Chicago Uzunkulaoğlu, A. , Kerim, D. , Ay, S. , Kibar, S. "The effectiveness of whirlpool for patients with neuropathic pain due to knee osteoarthritis". Journal of Surgery and Medicine 2 (2018 ): 78-83
RIS TY - JOUR T1 - The effectiveness of whirlpool for patients with neuropathic pain due to knee osteoarthritis AU - Aslıhan Uzunkulaoğlu , Duygu Kerim , Saime Ay , Sibel Kibar Y1 - 2018 PY - 2018 N1 - doi: 10.28982/josam.400603 DO - 10.28982/josam.400603 T2 - Journal of Surgery and Medicine JF - Journal JO - JOR SP - 78 EP - 83 VL - 2 IS - 2 SN - -2602-2079 M3 - doi: 10.28982/josam.400603 UR - https://doi.org/10.28982/josam.400603 Y2 - 2018 ER -
EndNote %0 Journal of Surgery and Medicine The effectiveness of whirlpool for patients with neuropathic pain due to knee osteoarthritis %A Aslıhan Uzunkulaoğlu , Duygu Kerim , Saime Ay , Sibel Kibar %T The effectiveness of whirlpool for patients with neuropathic pain due to knee osteoarthritis %D 2018 %J Journal of Surgery and Medicine %P -2602-2079 %V 2 %N 2 %R doi: 10.28982/josam.400603 %U 10.28982/josam.400603
ISNAD Uzunkulaoğlu, Aslıhan , Kerim, Duygu , Ay, Saime , Kibar, Sibel . "The effectiveness of whirlpool for patients with neuropathic pain due to knee osteoarthritis". Journal of Surgery and Medicine 2 / 2 (March 2018): 78-83 . https://doi.org/10.28982/josam.400603
AMA Uzunkulaoğlu A. , Kerim D. , Ay S. , Kibar S. The effectiveness of whirlpool for patients with neuropathic pain due to knee osteoarthritis. J Surg Med. 2018; 2(2): 78-83.
Vancouver Uzunkulaoğlu A. , Kerim D. , Ay S. , Kibar S. The effectiveness of whirlpool for patients with neuropathic pain due to knee osteoarthritis. Journal of Surgery and Medicine. 2018; 2(2): 78-83.
IEEE A. Uzunkulaoğlu , D. Kerim , S. Ay and S. Kibar , "The effectiveness of whirlpool for patients with neuropathic pain due to knee osteoarthritis", Journal of Surgery and Medicine, vol. 2, no. 2, pp. 78-83, Mar. 2018, doi:10.28982/josam.400603

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