INVESTIGATING THE EFFECTS OF FATIGUE PROTOCOL ON SPATIOTEMPORAL CHARACTERISTICS OF GAIT IN PATIENTS WITH CHRONIC NECK PAIN

Abstract

Purpose: Chronic neck pain (CNP) may lead to problems, such as functional limitations, disability, and fatigue. Gait maintains postural orientation; It is important to investigate the effects of fatigue on walking in patients who subjectively define a certain level of fatigue, not for a certain period. This study aimed to investigate the effects of fatigue protocol on gait spatiotemporal characteristics in patients with CNP. Methods: Fifty-three patients with CNP, and twenty-six healthy controls were included. The groups were matched with Propensity Score Matching in terms of age and fatigue threshold as 26 individuals. Pain intensity and disability were evaluated with the Visual Analog Scale, and Neck Disability Index, respectively. Gait assessment was recorded with OptoGait (1.6.4.0, Microgate, Bolzano, Italy) for one minute while individuals walked at their preferred speed on the treadmill. Individuals keep walking on the treadmill and fatigue levels were asked for Modified Borg Scale. While fatigue reached 4 points, gait assessment was recorded for one minute. A two-way repeated-measures ANOVA was used for interaction time-by-group. Results: The median pain intensity was 7(4-9), and the disability was moderate in patients. Left step length, stride length, and cadence, showed significant, similar changes within the groups over time(p<0.05), while there were differences between groups in cadence (p<0.05). There was no difference in time-group interaction in terms of gait variables (p>0.05). Conclusion: Fatigue may lead to changes in the gait parameters of patients with CNP, it may cause the development of compensation strategies to maintain the position, mobility, and stabilization of the spine.

Keywords

• Neck pain
• Fatigue
• Gait

KRONİK BOYUN AĞRILI HASTALARDA YORGUNLUK PROTOKOLÜNÜN YÜRÜYÜŞÜN ZAMAN MESAFE KARAKTERİSTİKLERİ ÜZERİNE ETKİLERİNİN ARAŞTIRILMASI

Öz

Amaç: Kronik boyun ağrısının (KBA) fonksiyonel limitasyonlar, özür, yorgunluk gibi sorunlara yol açabilmektedir. Yorgunluğun günlük yaşam aktivitelerini etkilemesi, belirli süre için değil, subjektif olarak belirli bir düzeyde yorgunluk tanımlayan hastalarda yorgunluğun postural oryantasyonu sağlayan yürüme üzerine etkilerinin araştırılması önemlidir. Bu çalışmanın amacı, KBA’lı hastalarda yorgunluk protokolünün yürüyüşün zaman mesafe karakteristikleri üzerindeki etkilerini araştırmaktır. Yöntem: Çalışmaya 53 KBA'lı, 26 sağlıklı kontrol alındı. Gruplar yaş, yorgunluk eşiği bakımından Propensity Score Matching ile 26 birey olacak şekilde eşleştirildi. Ağrı şiddeti, özür sırasıyla Görsel Analog Skala, Boyun Özür Anketi ile değerlendirildi. OptoGait (1.6.4.0, Microgate, Bolzano, İtalya) ile bireyler koşu bandında bireyler tercih ettikleri hızda yürürken yürüyüşleri önce bir dakika süreyle kaydedildi. Yorgunluk düzeyleri Modifiye Borg Skalası ile değerlendirildi. Yorgunlukları 4 puana ulaştığında tekrar 1 dakikalık yürüyüş değerlendirmesi yapıldı, yürüyüş bandı durduruldu. Zaman-grup etkileşimi değerlendirmesinde Tekrarlı Ölçümlerde iki Yönlü ANOVA analizi uygulandı. Sonuçlar: KBA’lı bireylerde ağrı şiddeti ortancası 7(4-9) idi, özür orta düzeydeydi. Sol adım uzunluğu, çift adım uzunluğu, kadans, ortalama hız gruplar içinde zamanla anlamlı, benzer değişiklikler gösterirken (p<0.05). Kadansta gruplar arası farklılık vardı (p<0.05). Zaman-grup etkileşiminde yürüyüş değişkenleri açısından fark yoktu (p>0.05). Tartışma:Yorgunluk, KBA’lı hastaların yürüme parametrelerinde değişikliklere yol açabilir. Omurganın pozisyonunu, mobilitesini, stabilizasyonunu korumak için yürüyüşte kompansasyon stratejilerinin geliştirilmesine neden olabilir.

Anahtar Kelimeler

• Boyun ağrısı
• Yorgunluk
• Yürüyüş

References

1. 1. Uthaikhup, S., Sunkarat, S., Khamsaen, K., Meeyan, K., & Treleaven, J. The effects of head movement and walking speed on gait parameters in patients with chronic neck pain. Man Ther. 2014;19(2):137-41.
2. 2. Fishbain, D. A., Cutler, R. B., Cole, B., Lewis, J., Smets, E., Rosomoff, H. L., & Rosomoff, R. S. Are Patients with Chronic Low Back Pain or Chronic Neck Pain Fatigued? Pain Med. 2004;5(2):187-195.
3. 3. Bolton P.S. The somatosensory system of the neck and its effects on the central nervous system. J Manipulative Physiol Ther. 1998;21(8):553-563.
4. 4. Hill J.M. Increase in the discharge of muscle spindles during diaphragm fatigue. Brain Res. 2001;918(1):166-170.
5. 5. Paillard T. Effects of general and local fatigue on postural control: A review. Neurosci Biobehav Rev. 2012;36(1):162-176.
6. 6. Lamoth, C. J., Meijer, O. G., Wuisman, P. I., van Dieën, J. H., Levin, M. F., & Beek, P. J. Pelvis-Thorax Coordination in the Transverse Plane During Walking in Persons With Nonspecific Low Back Pain. Spine. 2002;27(4):E92-E99.
7. 7. Al-Obaidi, S. M., Al-Zoabi, B., Al-Shuwaie, N., Al-Zaabie, N., & Nelson, R. M. The influence of pain and pain-related fear and disability beliefs on walking velocity in chronic low back pain. Int J Rehabil Res. 2003;26(2):101-108.
8. 8. Wannaprom, N., Treleaven, J., Jull, G., & Uthaikhup, S. Neck muscle vibration produces diverse responses in balance and gait speed between individuals with and without neck pain. Musculoskelet Sci Pract. 2018;35:25-29.

9. 9. Poole E., Treleaven J.,Jull G. The influence of neck pain on balance and gait parameters in community-dwelling elders. Man Ther. 2008;13(4):317-324. 10. McGill SM, Marshall L, Andersen J. Low back loads while walking and carrying: comparing the load carried in one hand or in both hands. Ergonomics. 2013;56(2):293-302.
10. 11. Ramadan, M. Z., Khalaf, T. M., Ragab, A. M.,&AbdElgawad, A. A.  Influence of Shopping Bags Carrying on Human Responses While Walking.J Healthc Eng.2018 Jun27:5340592-.
11. 12. Kimura, M., Sato, H., Ochi, M., Hosoya, S., & Sadoyama, T. Electromyogram and perceived fatigue changes in the trapezius muscle during typewriting and recovery. Eur J Appl Physiol. 2007;100(1):89-96.
12. 13. Price DD, McGrath PA, Rafii A, & Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17(1):45-56.
13. 14. Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1999;14(7):409-15.
14. 15. Lee, M. M., Song, C. H., Lee, K. J., Jung, S. W., Shin, D. C., & Shin, S. H. Concurrent Validity and Test-retest Reliability of the OPTOGait Photoelectric Cell System for the Assessment of Spatio-temporal Parameters of the Gait of Young Adults. J Phys Ther Sci. 2014;26(1):81-5.
15. 16. Bisiaux M, Moretto P. The effects of fatigue on plantar pressure distribution in walking. Gait Posture. 2008;28(4):693-8.
16. 17. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377-81.
17. 18. Hostens I, Ramon H. Assessment of muscle fatigue in low level monotonous task performance during car driving. J Electromyogr Kinesiol. 2005;15(3):266-74.
18. 19. Daneshmandi H, Choobineh AR, Ghaem H, Alhamd M, Fakherpour A. The effect of musculoskeletal problems on fatigue and productivity of office personnel: a cross-sectional study. J Prev Med Hyg. 2017;58(3):E252-E258.
19. 20. Fishbain, D. A., Cole, B., Cutler, R. B., Lewis, J., Rosomoff, H. L., & Fosomoff, R. S.  Is Pain Fatiguing? A Structured Evidence-Based Review. Pain Med. 2003;4(1):51-62.
20. 21. Yorkston KM, Johnson K, Boesflug E, Skala J, Amtmann D. Communicating about the experience of pain and fatigue in disability. Qual Life Res. 2010;19(2):243-51.
21. 22. Falla, D., Gizzi, L., Parsa, H., Dieterich, A., & Petzke, F. People With Chronic Neck Pain Walk With a Stiffer Spine. J Orthop Sports Phys Ther. 2017;47(4):268-77.
22. 23. Kirmizi M, Simsek IE, Elvan A, Akcali O, Angin S. Investigation of the effects of flat cushioning insole on gait parameters in individuals with chronic neck pain. Acta Bioeng Biomech. 2019;21(2):135-141.
23. 24. Kirmizi M, Simsek IE, Elvan A, Akcali O, Angin S. Gait speed and gait asymmetry in individuals with chronic idiopathic neck pain. Musculoskelet Sci Pract. 2019;41:23-27.
24. 25. Bhatt T, Wening JD, Pai YC. Influence of gait speed on stability: recovery from anterior slips and compensatory stepping. Gait Posture. 2005;21(2):146-56.
25. 26. Auerbach N, Tadi P. Antalgic Gait in Adults. [Updated 2020 Jul 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559243/.
26. 27. Stanos S, Mogilevsky M, Rader L, McLean J, Baum A. Chapter 73 - Physical Medicine Approaches To Pain Management. In: Smith HS, editor. Current Therapy in Pain. Philadelphia: W.B. Saunders; 2009. p. 527-40.
27. 28. Bonab M, Colak TK, Toktas ZO, Konya D. Assessment of Spatiotemporal Gait Parameters in Patients with Lumbar Disc Herniation and Patients with Chronic Mechanical Low Back Pain. Turk Neurosurg. 2020;30(2):277-284.
28. 29. Demirel A, Onan D, Oz M, Ozel Aslıyuce Y, Ulger O. Moderate disability has negative effect on spatiotemporal parameters in patients with chronic low back pain. Gait Posture. 2020;79:251-255.
29. 30. Elbaz A, Mirovsky Y, Mor A, Enosh S, Debbi E, Segal G, Barzilay Y, Debi R. A novel biomechanical device improves gait pattern in patient with chronic nonspecific low back pain. Spine. 2009;34(15):E507-12.