RESULTS OF SIX-WEEK PHYSIOTHERAPY PROGRAM IN A PATIENT WITH METABOLIC SYNDROME UNDERGOING BARIATRIC AND METABOLIC SURGERY: CASE REPORT

Abstract

In this study, the results of the physiotherapy program of a patient undergoing bariatric and metabolic surgery due to the diagnosis of Metabolic Syndrome (MetS) were discussed. A 6-week physiotherapy program (5 days/week; 1 hour/day) was applied to a 52-year-old male patient who developed bilateral lower extremity edema and widespread muscle atrophy because of surgery. The circumference measurement, manual muscle test, standing on one leg with eyes closed-opened, and fatigue severity were evaluated before treatment. Tampa Kinesophobia Scale (TKS), Nottingham Health Profile (NHP), WHO-5 Well-Being/Quality of Life Index, and the Short-Form International Physical Activity Questionnaire (IPAQ) were used. The physiotherapy program was composed of electrical stimulation, pneumatic compression, proprioceptive neuromuscular facilitation techniques. Breathing, strengthening, and balance exercises. At the end of the treatment, edema in both ankles decreased by an average of 4.5 cm. The duration of standing on one leg with eyes closed and opened increased by 7 seconds. The TKS score decreased by 6 points, The IPAQ-Short Form score increased by 246 MET-min/week. The results of the case showed that physiotherapy approaches might be useful in the management of symptoms seen after bariatric and metabolic surgery in the diagnosis of MetS.

Keywords

• Metabolic Syndrome
• Obesity
• Muscle weakness
• Quality of life

BARİATRİK VE METABOLİK CERRAHİ GEÇİREN METABOLİK SENDROMLU OLGUDA ALTI HAFTALIK FİZYOTERAPİ PROGRAMI SONUÇLARI

Abstract

Bu çalışmada Metabolik Sendrom (MetS) tanısı nedeniyle bariatrik ve metabolik cerrahi geçiren olgunun fizyoterapi programı sonuçları tartışıldı. Cerrahi sonrası bilateral alt ekstremite ödemi ve yaygın kas atrofisi gelişen 52 yaşındaki erkek olguya 6 hafta (5 gün/hafta; 1 saat/gün) fizyoterapi programı uygulandı. Tedavi öncesi çevre ölçümü, manuel kas testi, gözler açık-kapalı tek ayaküstünde durma ve yorgunluk şiddeti değerlendirmeleri yapıldı. Tampa Kinezyofobi Ölçeği (TKÖ), Nottingham Sağlık Profili (NSP), WHO-5 İyilik Hali/Yaşam Kalitesi İndeksi ve Uluslararası Fiziksel Aktivite Anketi (UFAA)-Kısa Formu kullanıldı. Fizyoterapi programı elektrik stimülasyonu, pnömatik kompresyon, proprioseptif nöromuskuler fasilitasyon teknikleri, solunum, kuvvetlendirme ve denge egzersizlerinden oluşturuldu. Tedavi sonunda her iki ayak bileğindeki ödem ortalama 4.5 cm azaldı. Gözler açık ve kapalı tek ayaküstünde durma süreleri 7 sn arttı. TKÖ 6 puan düştü. UFAA-Kısa Form skoru 246 MET-dk/hafta arttı. Olgunun sonuçları MetS tanısında bariatrik ve metabolik cerrahi sonrasında görülen bulguların yönetiminde fizyoterapi yaklaşımlarının yararlı olabileceğini gösterdi.

Keywords

• Metabolik sendrom
• Obezite
• Kas zayıflığı
• Yaşam kalitesi

References

1. 1. Prasad H, Ryan DA, Celzo MF, et al. Metabolic syndrome: definition and therapeutic implications. Postgrad Med. 2012; 124(1): 21-30.
2. 2. Patel S, Nanda R, Mohapatra E. Prevalence of metabolic syndrome and its association with various risk factors. Int J Recent Sci Res. 2017; 8(3): 16256-16260.
3. 3. Sifit FS, Tahapary DL, Trompet S, et al. The prevalence of metabolic syndrome and its association with body fat distribution in middle-aged individuals from Indonesia and the Netherlands: a cross-sectional analysis of two population-based studies. Diabetes Metab Syndr. 2020, 12(1): 1-11.
4. 4. Zota IM, Statescu C, Sascau R, et al. Exercise-based rehabilitation for metabolic syndrome-case report. Med Surg J. 2018; 122(1): 82-86.
5. 5. Kozan Ö, Oğuz A, Abacı A, et al. Prevalence of the metabolic syndrome among Turkish adults. Eur J Clin Nutr. 2007; 61: 548-553.
6. 6. Cornier MA, Dabelea D, Hernandez TL, et al. The metabolic syndrome. Endocr Rev. 2008; 29(7): 777-822.
7. 7. Khatoon R, Ming KE. A case of metabolic syndrome. Malays Fam Physician. 2006; 1: 2-3.
8. 8. Martin KA, Mani MV, Mani A. New targets to treat obesity and the metabolic syndrome. Eur J Pharmacol. 2015; 763: 64-74.

9. 9. Pittler MH, Ernst E. Dietary supplements for body-weight reduction: a systematic review. Am J Clin Nutr. 2004; 79: 529-536.
10. 10. Sauerland S, Angrisani L, Belachew M et al. Obesity surgery: evidencebased guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc. 2005; 19: 200-221.
11. 11. Yormaz S, Yılma H, Ece İ et al. Laparoscopic ileal interposition with diverted sleeve gastrectomy versus laparoscopic transit bipartition with sleeve gastrectomy for better glycemic outcomes in T2DM patients. Obes Surg. 2018; 28(1): 77-86.
12. 12. Service GJ, Thompson GB, Service FJ, et al. Hyperinsulinemic Hypoglycemia with Nesidioblastosis after Gastri cBypass Surgery. N Engl J Med. 2005; 353: 249-254.
13. 13. Güven B. Bariatrik cerrahi komplikasyonları ve hemşirelik bakımı. Hemşirelikte Eğitim ve Araştırma Dergisi. 2019; 16(2): 139-143.
14. 14. Khan A, Raza S, Khan Y, et al. Current updates in the medical management of obesity. Recent Pat Endocr Metab Immune Drug Discov. 2012; 6(2): 117-128.
15. 15. Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health. 1990; 13(4): 227-236.
16. 16. Yılmaz Tunca Ö, Yakut Y, Uygur F et al. Tampa Kinezyofobi Ölçeği’nin Türkçe versiyonu ve test-tekrar test güvenirliği. Fizyoterapi Rehabilitasyon. 2011; 22.1: 44-49.
17. 17. Fidaner H, Elbi H, Fidaner C, et al. Measuring quality of life, WHOQOL-100 and WHOQOL-BREF. J Psychiatr Psychol Psychopharmacol. 1999; 7: 5-13.
18. 18. Kücükdeveci AA, McKenna SP, Kutlay S, et al. The development and psychometric assessment of the Turkish version of the Nottingham Health Profile. Int J Rehab Res. 2000, 23: 31-38.
19. 19. Karaca A, Turnagöl HH. IPAQ anketinin geçerlilik ve güvenirlilik çalışması. Hacettepe Üniversitesi Spor Bilimleri Dergisi. 2007; 18(2): 68-84.
20. 20. Moore K. Metabolic syndrome: A case report for collaborative care. Adv Integr Med. 2014; 1: 44-47.