Exploring the causes of kinesiophobia in patients with breast cancer-related lymphedema: a comprehensive study

Year 2024, , 626 - 631, 27.10.2024

Songül Keskin Kavak , Lale Aktekin

https://doi.org/10.32322/jhsm.1541324

Abstract

Aims: Breast cancer is the most common cancer in women worldwide. Breast cancer survivors often experience arm and shoulder pain, limited shoulder range of motion, and lymphedema as the most common post-treatment morbidities. All these morbidities can be considered as the main causes of the fear of movement, called kinesiophobia. This is the first study aims to evaluate the biological and psychological causes of kinesiophobia in breast cancer-related lymphedema (BCRL), the relationship between kinesiophobia and BCRL, and the impact of kinesiophobia on patients’ upper extremity function and quality of life. The biological and psychological causes of kinesiophobia in women with breast cancer-related lymphoedema were investigated for the first time in the literature.
Methods: Patients with BCRL were included in the study. Demographic and clinical information including age, educational status, body-mass index (BMI), and dominant upper extremity were recorded. BCRL stage (International Society of Lymphology (ISL) Scale), Quality of Life Scale [European Organisation for Research and Treatment of Cancer Quality of Life (EORTC QLO-C30)], upper extremity functional status [Quick-Disabilities of the Arm, Shoulder and Hand Score (Quick-DASH)], Tampa Kinesiophobia Scale (TKS), Kinesiophobia Causes Scale (KCS) were assessed.
Results: The mean age of the 114 patients included in the study was 58.25±9.41 years. A total of 100 patients exhibited a TKS score above 37, indicative of kinesiophobia. There was a statistically significant positive correlation between age and BMI and total TKS score (p<0.05). The TKS score (46.18±6.61) was significantly higher in 66 patients with a dominant limb affected by BCRL (p<0.05). No significant correlation was found between the lymphedema stage (ISL) and quick-DASH (p>0.05). However, the relationship between the Quick-DASH score and the TKS score was significant (p<0.05). A strong significant positive correlation was observed between the TKS score and the KCS score (p=0.0001).
Conclusion: In our study, the severity of kinesiophobia was higher in patients with more limited upper limb function. Psychological (self-acceptance, self-assessment of motor predispositions, body care) and biological causes (morphological, individual need for stimulation, energetic substrates, power of biological drivers) increased the severity of kinesiophobia. Biological causes were found to cause more kinesiophobia and affect upper limb function in MKBL. In particular, impairment in the strength of biological impulses was found to be one of the main causes of kinesiophobia. Understanding the causes of kinesiophobia in MDL may improve rehabilitation programs and lead to the development of new strategies to help patients support treatment to reduce fear of movement.

Keywords

Breast cancer, Kinesiophobia Causes Scale, Tampa Kinesiophobia Scale, lymphedema, EORTC QLO-C30

Meme kanserine bağlı lenfödemi olan hastalarda kinesiofobinin nedenlerinin araştırılması: kapsamlı bir çalışma

Abstract

Amaç: Meme kanseri dünya genelinde kadınlarda en sık görülen kanserdir. Meme kanseri tedavisi sonrası en sık görülen morbiditeler olarak kol ve omuz ağrısı, omuz hareket açıklığında kısıtlanma ve lenfödem gibi komplikasyonlar gelişebilir.Tüm bu morbiditeler, kinezyofobi olarak adlandırılan hareket korkusuna yol açabilir. Bu çalışma, meme kanserine bağlı lenfödemde (MKBL) kinezyofobinin biyolojik ve psikolojik nedenlerini ve kinezyofobinin üst ekstremite fonksiyonu ve yaşam kalitesi üzerindeki etkisini değerlendirmeyi amaçlamaktadır.Meme kanserine bağlı lenfödemi olan kadınlarda kinezyofobinin biyolojik ve psikolojik nedenleri literatürde ilk kez araştırılmıştır.
Yöntemler: Çalışmaya MKBL'li hastalar dahil edildi. Yaş, eğitim durumu, vücut kitle indeksi (VKİ) ve dominant üst ekstremite gibi demografik ve klinik bilgiler kaydedildi. MKBL evresi (International Society of Lymphology (ISL) ölçeği), yaşam kalitesi ölçeği (European Organisation for Research and Treatment of Cancer Quality of Life (EORTC QLO-C30)), üst ekstremite fonksiyonel durumu (Quick-Disabilities of the Arm, Shoulder and Hand Score (QUICK-DASH)), Tampa Kinesiophobia Scale (TKS), Kinesiophobia Causes Scale (KCS) değerlendirildi.
Bulgular: Çalışmaya dahil edilen 114 hastanın yaş ortalaması 58.25±9.41 yıl idi. Toplam 100 hastada kinezyofobinin göstergesi olan TKS skoru 37'nin üzerindeydi. Yaş ve VKİ ile toplam TKS puanı arasında istatistiksel olarak anlamlı pozitif bir korelasyon vardı (p<0.05). TKS skoru (46.18±6.61), dominant ekstremitesi lenfödemden etkilenen 66 hastada anlamlı derecede yüksekti (p<0.05). Lenfödem evresi (ISL) ile QUICK-DASH arasında anlamlı bir korelasyon bulunmamıştır (p>0.05). Ancak, QUICK-DASH skoru ile TKS skoru arasındaki ilişki anlamlıydı (p<0.05). TKS skoru ile KCS skoru arasında güçlü ve anlamlı bir pozitif korelasyon gözlenmiştir (p=0.0001).
Sonuç: Çalışmamızda, üst ekstremite fonksiyonu daha kısıtlı olan hastalarda kinezyofobi şiddeti daha yüksekti. Kinezyofobiye eşlik eden psikolojik (kendini kabul etme, motor yatkınlığın öz değerlendilmesi, vücut bakımı) ve biyolojik nedenler (morfolojik, harekete geçmek için bireysel ihtiyaç, enerji kaynakları, biyolojik dürtülerin gücü) kinezyofobinin şiddetini artırmıştır. MKBL'de biyolojik nedenlerin daha fazla kinezyofobiye neden olduğu ve üst ekstremite fonksiyonunu etkilediği bulunmuştur. Özellikle, biyolojik dürtülerin gücündeki bozulmanın kinezyofobinin ana nedenlerinden biri olduğu bulunmuştur. MKBL'de kinezyofobinin nedenlerinin anlaşılması rehabilitasyon programlarını iyileştirebilir ve hastaların hareket korkusunu azaltmak için tedaviyi desteklemelerine yardımcı olacak yeni stratejilerin geliştirilmesine yol açabilir.

Keywords

Meme kanseri, Kinezyofobi Nedenleri Ölçeği, Tampa Kinezyofobi Ölçeği, Lenfödem, EORTC QLO-C30

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