COVID-19 Pandemisi Nedeniyle Evlerinde Sosyal İzolasyon Yaşayan ve Daha Önceden Fibromyalji Sendromu Tanısı Almış Bireylere Uygulanan Tele-Rehabilitasyonun Etkinliğinin Araştırılması

Öz

Fibromyalji hastalarındaTele-rehabilitasyon uygulamasının hastalığın semptomları üzerine olan etkisinin araştırılması amaçlanmıştır. Olgular kuvvetlendirme (n=20), germe-gevşeme (n=20) ve kontrol (n=20) olmak üzere üç grup olarak randomize edildi. Çalışma 55 kişi ile sonlandırıldı. Tüm olgularda; Fibromyalji Etki Sorgulama Ölçeği (FIQ), Görsel Analog Skala (VAS), Yaşam Kalitesi Ölçeği (SF-36), Beck Depresyon Envanteri (BDE), Pittsburgh Uyku Kalite İndeksi (PUKİ) ve Pozitif-Negatif Duygu Durumu Ölçeği (PANAS), 5 Defa Otur-Kalk Testi (5-DOKT), Zamanlı Kalk ve Yürü Testi (TUG) ve V-Otur-Uzan Testi (VOUT) kullanıldı. Grupların demografik ve klinik özellikleri açısında istatistiksel olarak anlamlı bir fark bulunmadı (p>0,05). Grup içi değerlendirmelerde kuvvetlendirme grubunda FIQ skoru (p=0,01), PUKİ skoru (p=0,01), VAS skoru (p=0,00), PANAS pozitif-negatif (p=0,01), 5-DOKT, TUG, VOUT (p=0,01) skorları ile SF-36 ölçeğinin bütün alt skorlarında anlamlı farklılık bulunmuştur. Germe-gevşeme grubunda PUKİ (p=0,01), SF-36 Fiziksel fonksiyon (p=0,01), SF-36 Rol Kısıtlaması (Fiziksel) (p=0,03), SF-36 Vitalite (Enerji) (p=0,01) ve SF-36 Mental Sağlık (p=0,01) alt skorlarında istatistiksel olarak anlamlı farklılık bulundu. Gruplar arası karşılaştırmada, BDE (p=0,03), VOUT (p=0,006) ile SF-36 Ağrı (p=0,04), Vitalite (Enerji) (p=0,00) ve Mental Sağlık (p=0,01) alt skorlarında istatistiksel olarak anlamlı farklılık bulundu. Fibromyalji hastalarında uygulanan farklı egzersiz içeriklerine sahip Tele-rehabilitasyon uygulamaları, sağlık durumu, ağrı, uyku kalitesi, depresyon, duygu-durum, fiziksel performans ve yaşam kalitesi sonuçlarını olumlu etkilemektedir. Kas kuvvetlendirme egzersizleri verilen grupta diğer gruplara göre yaşam kalitesi ve depresyon yönünden; germe- gevşeme egzersizi verilen grupta ise esneklik yönünden daha fazla iyileşme olduğu gözlenmiştir. Kliniğe ulaşımın zor olduğu durumlarda Tele-rehabilitasyon uygulaması faydalı ve güvenli bir tedavi seçeneği olarak tercih edilebilir.

Anahtar Kelimeler

• Fibromiyalji
• Tele-rehabilitasyon
• Fiziksel Aktivite
• Egzersiz
• Kuvvetlendirme
• Germe
• Gevşeme Egzersizi

Investigation of the Effectiveness of Tele-Rehabilitation in Individuals Experiencing Social Isolation at Home Due to the COVID-19 Pandemic and Previously Diagnosed with Fibromyalgia Syndrome

Öz

It was aimed to investigate the effect of Tele-rehabilitation application on the symptoms of the disease in patients with fibromyalgia. The cases were randomized into three groups as strengthening (n=20), stretching-relaxation (n=20) and control (n=20). The study was terminated with 55 people. In all cases; Fibromyalgia Impact Inquiry Scale (FIQ), Visual Analogue Scale (VAS), Quality of Life Scale (SF-36), Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI) and Positive-Negative Affect Scale (PANAS), 5 The Sit-to-Go Test (5-TSBS), Timed Up and Go Test (TUG) and V-Sit-Reach Test (VSR) were used. There was no statistically significant difference in terms of demographic and clinical characteristics of the groups (p>0,05). The intragroup assessment showed that in strengthening group, FIQ score (p=0,01), PSQI score (p=0,01), VAS score (p=0,00), PANAS positive-negative (p=0,01), 5-TSBS, TUG, VSR (p=0,01) scores and all sub-scores of the SF-36 scale were found to be significantly different. In the stretching-relaxation group, PSQI (p=0,01), SF-36 Physical function (p=0,01), SF-36 Role Restriction (p=0,03), SF-36 Vitality (p=0,01) and SF-36 Mental Health (p=0,01) sub-scores were found to be statistically significant. In comparison between groups, BDI (p=0,03), VSR (p=0,006) and SF-36 Pain (p=0,04), Vitality (p=0,00) and Mental Health (p=0,01) sub-scores were found to be statistically significant. Tele-rehabilitation applications with different exercise contents applied in patients with fibromyalgia positively affect the health status, pain, sleep quality, depression, mood, physical performance and quality of life results. In terms of quality of life and depression in the group given muscle strengthening exercises compared to the other groups; In the group that was given stretching-relaxation exercise, more improvement was observed in terms of flexibility. In cases where access to the clinic is difficult, Tele-rehabilitation application can be preferred as a useful and safe treatment option.

Anahtar Kelimeler

• Fibromyalgia
• Tele-rehabilitation
• Physical Activity
• Exercise
• Strengthening
• Stretching
• Relaxation Exercise

Kaynakça

1. Shanmugaraj, B., Malla, A., & Phoolcharoen, W. Emergence of novel coronavirus 2019-nCoV: need for rapid vaccine and biologics development. Pathogens. 2020; 9(2), 148.
2. https://covid19.who.int/; Erişim tarihi: 06.01.2021
3. Pope JE. What Does the COVID-19 Pandemic Mean for Rheumatology Patients? Curr Treatm Opt Rheumatol. 2020 Apr 30:1-4. doi: 10.1007/s40674-020-00145-y. Epub ahead of print. PMID: 32355607; PMCID: PMC7191545
4. Kharko, A. Y., Hansford, K. J., Furlong, P. L., Hall, S. D., & Roser, M. E. The Anxiety and Pain of Fibromyalgia Patients during the COVID-19 Pandemic. medRxiv,2020.
5. Mease P. Fibromyalgia syndrome: review of clinical presentation, pathogenesis, outcome measures, and treatment. J Rheumatol Suppl. 2005 Aug;75:6-21. Erratum in: J Rheumatol Suppl. 2005 Oct;32(10):2063. PMID: 16078356
6. Contreras CM, Metzger GA, Beane JD, Dedhia PH, Ejaz A, Pawlik TM. Telemedicine: Patient-Provider Clinical Engagement During the COVID-19 Pandemic and Beyond. J Gastrointest Surg. 2020 Jul;24(7):1692-1697. doi: 10.1007/s11605-020-04623-5. Epub 2020 May 8. PMID: 32385614; PMCID: PMC7206900
7. Brennan D, Tindall L, Theodoros D, Brown J, Campbell M, Christiana D, Smith D, Cason J, Lee. A blueprint for telerehabilitation guidelines. International journal of telerehabilitation. 2010;2(2):31.
8. Özden, F., & Lembarki, Y. The Ethical Necessities and Principles in Telerehabilitation. Sağlık Hizmetleri ve Eğitimi Dergisi. 2020; 3(2), 35-37

9. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. ArthritisCare&Research 2010;62(5):600‐10.
10. Sarmer, S., S. Ergin, and G. Yavuzer. "The validity and reliability of the Turkish version of the Fibromyalgia Impact Questionnaire." Rheumatology international 2000; 20.1 (2000): 9-12
11. Wewers ME, Lowe NK. A critical review of visual analog scales in the measurement of clinical phenomena. Research in Nursing&Health 13: 227-236, 1990.
12. H. Koçyiğit, Ö Aydemir, G. Fişek, et al. Kisa form-36 (KF-36)’nm Türkçe versiyonunun güvenilirliği ve geçerliliği: romatizmal hastaliği olan bir grup ile çalişma İlaç ve Tedavi Dergisi, 1999; 12 (1999), p. 102
13. Beck AT, Guth D, Steer RA, Ball R. Screening for majör depression disorders in medical inpatients with the Beck Depression Inventory for Primary Care. Behav Res Ther 1997; 35: 785-91
14. Ağargün MY, Kara H, Anlar Ö. Pittsburgh Uyku Kalitesi Indeksi'nin Geçerliliği ve Güvenirliği. Türk Psikiyatri Dergisi 1996; 7: 107-15
15. Watson, D., Clark, L. A., & Tellegen, A. Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 1988; 54(6), 1063.
16. Gençöz, T. Pozitif-Negatif Duygu Ölçeği: Geçerlik ve Güvenirlik Araştırması. Türk Psikoloji Dergisi, 2000; 15(46),19-26
17. Arreghini M, Manzoni GM, Castelnuovo G, Santovito C, Capodaglio P (2014) Impact of fibromyalgia on functioning in obese patients undergoing comprehensive rehabilitation. PLoS ONE 9(3):e91392.
18. Lusardi MM, Pellecchia GL, Schulman M. Functional performance in community-living older adults. J Geriatr Phys Ther. 2003;26: 14-2.
19. Hui SS-C, Yuen PY. Validity of the modified back-server sit and reach test: a comparison with other protocols, Medicine and Science in Sport and Exercise,2000;Vol. 32, No.9:1655-1659.
20. American College of Sports Medicine. ACSM guidelines for exercise testing and prescription. 7th ed. Baltimore: Lippincott, Williams & Wilkins; 2006.
21. American College of Sports Medicine. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009 Mar;41(3):687-708. doi: 10.1249/MSS.0b013e3181915670. PMID: 19204579.
22. Assumpcao, A., Matsutani, L. A., Yuan, S. L., Santo, A. S., Sauer, J., Mango, P., & Marques, A. P. Muscle stretching exercises and resistance training in fibromyalgia: which is better? A three-arm randomized controlled trial. European journal of physical and rehabilitation medicine. 2017; 54(5), 663-670.
23. Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I. M., ... & Swain, D. P. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Medicine and science in sports and exercise. 2011;43(7), 1334.
24. http://hedwig.mgh.harvard.edu/sample_size/size.html.
25. Sañudo B, Galiano D, Carrasco L, Blagojevic M, de Hoyo M, Saxton J. Aerobic exercise versus combined exercise therapy in women with fibromyalgia syndrome: a randomized controlled trial. Arch Phys Med Rehabil. 2010 Dec;91(12):1838-43. doi: 10.1016/j.apmr.2010.09.006. PMID: 21112423.
26. Adamse C, Dekker-Van Weering MG, van Etten-Jamaludin FS, Stuiver MM. The effectiveness of exercise-based telemedicine on pain, physical activity and quality of life in the treatment of chronic pain: a systematic review. J Telemed Telecare. 2018;24:511–526
27. Turolla, A., Rossettini, G., Viceconti, A., Palese, A., & Geri, T. (2020). Musculoskeletal physical therapy during the COVID-19 pandemic: is telerehabilitation the answer?. Physical therapy, 100(8), 1260-1264.
28. Izquierdo-Alventosa, R., Inglés, M., Cortés-Amador, S., Gimeno-Mallench, L., Chirivella-Garrido, J., Kropotov, J., & Serra-Añó, P. Low-Intensity Physical Exercise Improves Pain Catastrophizing and Other Psychological and Physical Aspects in Women with Fibromyalgia: A Randomized Controlled Trial. International Journal of Environmental Research and Public Health 2020;17(10), 3634.
29. Jones, K. D., Burckhardt, C. S., Clark, S. R., Bennett, R. M., & Potempa, K. M. A randomized controlled trial of muscle strengthening versus flexibility training in fibromyalgia. The Journal of rheumatology, 2002; 29(5), 1041-1048.
30. Bircan, Ç., Karasel, S.A., Akgün, B., EL, Ö., & Alper, S., 2008. Effects of muscle strengthening versus aerobic exercise program in fibromyalgia. Rheumatol. Int. 28 (6) 527-532, http://dx.doi.org/10.1007/s00296-007-0484-5.
31. Pereira, S.M.P., Geoffroy, M.C., Power, C. Depressive symptoms and physical activity during 3 decades in adult life: bidirectional associations in a prospective cohort study. JAMA Psychiatry 2014;71 (12), 1373-1380, http://dx.doi.org/10.1001/jamapsychiatry.2014.1240.
32. Borchers, A.T., Gershwin, M., E. Fibromyalgia: A Critical and Comprehensive Review. Clin. Rev. Allergy. Immunol.2015; 49 (2), 100-151, http://dx.doi.org/10.1007/s12016-015-8509-4.
33. Montoro, C.I., Del Paso, G.A.R. Personality and fibromyalgia: Relationships with clinical, emotional, and functional variables. Pers. Individ. Dif. 2015;85, 236-244, http://dx.doi.org/10.1016/j.paid.2015.05.017.
34. Häkkinen A, Häkkinen K, Hannonen P, Alen M. Strength training induced adaptations in neuromuscular function of premenopausal women with fibromyalgia: comparison with healthy women. Ann Rheum Dis. 2001 Jan;60(1):21-6. doi: 10.1136/ard.60.1.21. PMID: 11114277; PMCID: PMC1753355.
35. Andrade A, Sieczkowska SM, Vilarino GT. Resistance Training Improves Quality of Life and Associated Factors in Patients With Fibromyalgia Syndrome. PM R. 2019 Jul;11(7):703-709. doi: 10.1016/j.pmrj.2018.09.032. Epub 2019 Feb 22. PMID: 30266345.