Diz Osteoartritli Hastalarda Denge, Kinezyofobi, Düşme ve Fiziksel Aktivitenin Sağlıklı Bireylerle Karşılaştırılması

Yıl 2022, Cilt: 2 Sayı: 3, 345 - 357, 27.12.2022

İbrahim Halil Akçay Musa Güneş Mustafa Oğuz Kethüdaoğlu Ertuğrul Demirdel

Öz

Osteoartrit (OA), sinovyal eklemlerde, kıkırdağın yapısal değişiklikleri ile karakterize kronik, ilerleyici, sistemik olmayan bir hastalıktır. Eklem kıkırdak dejenerasyonuna bağlı olarak eklemde meydana gelen bulgu ve semptomların bir bütünü olarak tanımlanmıştır. Bu çalışmada diz OA’lı hastaların egzersiz algısı, fiziksel aktivite seviyesi, kinezyofobi ve denge düzeylerinin sağlıklı bireylerle karşılaştırılması amaçlanmıştır. Araştırmaya, Kellegren Lawrence radyolojik evrelendirme kriterlerine göre Evre 3 ve Evre 4 OA’ya sahip olan 45-65 yaş arasında bulunan 30 birey ve 21 sağlıklı birey dâhil edildi. Veri toplanırken Vizüel Analog Skala, Tek Ayak Üzerinde Durma Testi, Y Denge Testi, Zamanlı Kalk ve Yürü Testi, Uluslararası Düşme Etkinlik Ölçeği, Tampa Kinezyofobi Ölçeği ve Uluslararası Fiziksel Aktivite Anketi- Kısa Form kullanıldı. OA grubunda kinezyofobi seviyesinin ve düşme korkusunun kontrol grubuna kıyasla daha fazla olduğu saptandı (p<0,05). Her iki grubun fiziksel aktivite düzeyleri açısından istatistiksel olarak anlamlı düzeyde fark belirlendi (p<0,05). Gruplar arasında denge açısından istatistiksel olarak anlamlı düzeyde fark saptandı (p<0,05). Diz OA’sına sahip bireyler, sağlıklı bireylere kıyasla dengede bozulmalar göstermekte, fiziksel aktivite seviyesinde azalmalar ile birlikte egzersiz algısı değişiklik göstermektedir. Aynı zamanda kinezyofobi ve düşme korkusunun daha fazla olduğu belirlenmiştir. OA’lı bireyler için ağrıyı azaltıcı müdahalelerin gerekli olduğu düşünülmektedir. Ek olarak rehabilitasyon programlarının denge ve fiziksel fonksiyon üzerinde yoğunlaşmasının, ilerleyen yaşlarda meydana gelebilecek kayıpların giderilmesinde yardımcı olacağı düşünülmektedir.

Anahtar Kelimeler

Denge, Fiziksel aktivite, Kinezyofobi, Osteoartit

Comparison of Balance, Kinesiophobia, Fall and Physical Activity in Patients with Knee Osteoarthritis and Healthy Individuals

Öz

Osteoarthritis (OA) is a chronic, progressive, non-systemic disease characterized by structural changes of cartilage in synovial joints. It has been defined as a whole of signs and symptoms occurring in joint due to articular cartilage degeneration. In this study, it was aimed to compare exercise perception, physical activity level, kinesiophobia and balance levels of patients with knee OA with healthy individuals. According to Kellegren Lawrence radiological staging criteria, 30 individuals between ages of 45-65 who had Stage 3 and Stage 4 OA and 21 healthy individuals were included in study. While data were collected, Visual Analogue Scale, One Leg Standing Test, Y Balance Test, Timed Get Up and Go Test, International Fall Efficiency Scale, Tampa Kinesiophobia Scale and International Physical Activity Questionnaire-Short Form was used. Level of kinesiophobia and fear of falling were found to be higher in OA group compared to control group (p<0.05). A statistically significant difference was determined in terms of physical activity levels of both groups (p<0.05). There was a statistically significant difference between the groups in terms of balance (p<0.05). Individuals with knee OA show deterioration in balance compared to healthy individuals, and exercise perception changes with decreases in physical activity level. At the same time, it was determined that kinesiophobia and fear of falling were more common. Pain-reducing interventions are considered necessary for individuals with OA. In addition, it is thought that focusing rehabilitation programs on balance and physical function will help in eliminating losses that may occur in later ages.

Anahtar Kelimeler

Balance, Physical activity, Kinesiophobia, Osteoarthritis

Kaynakça

• Alaca, N. (2019). The relationships between pain beliefs and kinesiophobia and clinical parameters in Turkish patients with chronic knee osteoarthritis: a cross-sectional study. J Pak Med Assoc, 69(6), 823-827.
• Alcalde, G. E., Fonseca, A. C., Bôscoa, T. F., Gonçalves, M. R., Bernardo, G. C., Pianna, B.F., …, Arca, E. A. (2017). Effect of aquatic physical therapy on pain perception, functional capacity and quality of life in older people with knee osteoarthritis: study protocol for a randomized controlled trial. Trials, 18(1), 1-6. https://doi.org/10.1186/s13063-017-2061-x.
• Al-Khlaifat, L., Herrington, L. C., Tyson, S. F., Hammond, A., & Jones, R. K. (2016). The effectiveness of an exercise programme on dynamic balance in patients with medial knee osteoarthritis: A pilot study. The Knee, 23(5), 849-856. https://doi.org/10.1016/j.knee.2016.05.006.
• Aljehani, M. S., Crenshaw, J. R., Rubano, J. J., Dellose, S. M., & Zeni, J. A. (2021). Falling risk in patients with end-stage knee osteoarthritis. Clinical rheumatology, 40(1), 3-9. https://doi.org/10.1007/s10067-020-05165-6.
• Areeudomwong, P., & Buttagat, V. (2017). Reliability and validity of the cross-culturally adapted thai version of the tampa scale for kinesiophobia in knee osteoarthritis patients. The Malaysian journal of medical sciences: MJMS, 24(2), 61. https://doi.org/10.21315/mjms2017.24.2.8.
• Bennie, S., Bruner, K., Dizon, A., Fritz, H., Goodman, B., & Peterson, S. (2003). Measurements of balance: comparison of the Timed" Up and Go" test and Functional Reach test with the Berg Balance Scale. Journal of Physical Therapy Science, 15(2), 93-97. https://doi.org/10.1589/jpts.15.93.
• Clagg, S., Paterno, M. V., Hewett, T. E., & Schmitt, L. C. (2015). Performance on the modified star excursion balance test at the time of return to sport following anterior cruciate ligament reconstruction. Journal of orthopaedic & sports physical therapy, 45(6), 444-452. https://doi.org/10.2519/jospt.2015.5040.
• Çolak, İ. , Karakoç, Z. B. , Mete, E. , Özen, T. , Bulut, G. & Kuru Çolak, T. (2020). Primer Diz Osteoartritinde Total Diz Artroplastisi ve Konservatif Tedavi Sonrası Ağrı, Fiziksel Aktivite Düzeyi ve Fonksiyonellik . Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 10 (3), 319-325. https://doi.org/10.33631/duzcesbed.644577.
• Dunlop, D. D., Song, J., Semanik, P. A., Sharma, L., & Chang, R. W. (2011). Physical activity levels and functional performance in the osteoarthritis initiative: a graded relationship. Arthritis & Rheumatism, 63(1), 127-136. https://doi.org/10.1002/art.27760.
• French, H. P., Hager, C., Venencie, A., Fagan, R., & Meldrum, D. (2020). Psychometric properties and domains of postural control tests for individuals with knee osteoarthritis: a systematic review. Osteoarthritis and Cartilage, 28, S173. https://doi.org/10.1016/j.joca.2020.02.282.
• Gay, C., Guiguet-Auclair, C., Mourgues, C., Gerbaud, L., & Coudeyre, E. (2019). Physical activity level and association with behavioral factors in knee osteoarthritis. Annals of physical and rehabilitation medicine, 62(1), 14-20. https://doi.org/10.1016/j.rehab.2018.09.005.
• Gunn, A. H., Schwartz, T. A., Arbeeva, L. S., Callahan, L. F., Golightly, Y., Goode, A., Hill, C., Huffman, K., Iversen, M.,Pathak, A., Taylor, S. & Allen, K. D. (2017). Fear of movement and associated factors among adults with symptomatic knee osteoarthritis. Arthritis care & research, 69(12), 1826-1833. https://doi.org/10.1002/acr.23226.
• Haksever, B., Düzgün, İ., Yüce, D., & Baltacı, G. (2017). Sağlıklı Bireylere Standart Denge Eğitiminin Dinamik, Statik Denge ve Fonksiyonellik Üzerine Etkileri. Gazi Sağlık Bilimleri Dergisi, 2(3), 40-49.
• Hart, H. F., Collins, N. J., Ackland, D. C., & Crossley, K. M. (2015). Is impaired knee confidence related to worse kinesiophobia, symptoms, and physical function in people with knee osteoarthritis after anterior cruciate ligament reconstruction?. Journal of Science and Medicine in Sport, 18(5), 512-517. https://doi.org/10.1016/j.jsams.2014.09.011.
• Hatfield, G. L., Morrison, A., Wenman, M., Hammond, C. A., & Hunt, M. A. (2016). Clinical tests of standing balance in the knee osteoarthritis population: systematic review and meta-analysis. Physical therapy, 96(3), 324-337. https://doi.org/10.2522/ptj.20150025.
• Hawker, G. A., Mian, S., Kendzerska, T., & French, M. (2011). Measures of adult pain: Visual analog scale for pain (vas pain), numeric rating scale for pain (nrs pain), mcgill pain questionnaire (mpq), short‐form mcgill pain questionnaire (sf‐mpq), chronic pain grade scale (cpgs), short form‐36 bodily pain scale (sf‐36 bps), and measure of intermittent and constant osteoarthritis pain (icoap). Arthritis care & research, 63(S11), S240-S252. https://doi.org/10.1002/acr.20543.
• Helminen, E. E., Sinikallio, S. H., Valjakka, A. L., Väisänen-Rouvali, R. H., & Arokoski, J. P. (2016). Determinants of pain and functioning in knee osteoarthritis: a one-year prospective study. Clinical rehabilitation, 30(9), 890-900. https://doi.org/10.1177/0269215515619660.
• Huang, K. H., Hsieh, R. L., & Lee, W. C. (2015). Pain, physical function, and health in patients with knee osteoarthritis. Rehabilitation Nursing. 0, 1-8. https://doi.org/10.1002/rnj.234.
• Kim, H. S., Yun, D. H., Yoo, S. D., Kim, D. H., Jeong, Y. S., Yun, J. S., ... & Choi, S. H. (2011). Balance control and knee osteoarthritis severity. Annals of rehabilitation medicine, 35(5), 701-709. doi:10.5535/arm.2011.35.5.701.
• Özyakup, B., & Angın, E. (2019). Farklı Yaş Gruplarındaki Diz Osteoartriti Olan Bireylerin Denge, Fiziksel Performans, Ağrı ve Yaşam Kalitelerinin Karşılaştırılması. Sağlık ve Toplum Dergisi, 29(2), 34-42.
• Smith, T. O., Higson, E., Pearson, M., & Mansfield, M. (2018). Is there an increased risk of falls and fractures in people with early diagnosed hip and knee osteoarthritis? Data from the Osteoarthritis Initiative. International journal of rheumatic diseases, 21(6), 1193-1201. https://doi.org/10.1111/1756-185X.12871.
• Somers, T. J., Keefe, F. J., Pells, J. J., Dixon, K. E., Waters, S. J., Riordan, P. A., ... & Rice, J. R. (2009). Pain catastrophizing and pain-related fear in osteoarthritis patients: relationships to pain and disability. Journal of pain and symptom management, 37(5), 863-872. https://doi.org/10.1016/j.jpainsymman.2008.05.009.
• Erden, A., Altuğ, F., Malkoç, A., & Kocabal, A. A. (2016). Diz osteoartritli bireylerde kinezyofobi, ağrı şiddeti, anksiyete-depresyon durumu ve yaşam kalitesinin incelenmesi. International Refereed Journal of Orthopaedic Traumatology and Sports Medicine,(7),1-17. https://doi.org/10.17372/OTSHD.2016.7.16650.
• Taglietti, M., Dela Bela, L. F., Dias, J. M., Pelegrinelli, A. R. M., Nogueira, J. F., Batista Júnior, J. P., ... & Cardoso, J. R. (2017). Postural sway, balance confidence, and fear of falling in women with knee osteoarthritis in comparison to matched controls. PM&R, 9(8), 774-780. https://doi.org/10.1016/j.pmrj.2016.11.003.
• Tasci Bozbas, G., Sendur, O. F., & Aydemir, A. H. (2017). Primary knee osteoarthritis increases the risk of falling. Journal of Back and Musculoskeletal Rehabilitation, 30(4), 785-789. doi:10.3233/BMR-150413.
• Ulus, Y., Durmus, D., Akyol, Y., Terzi, Y., Bilgici, A., & Kuru, O. (2012). Reliability and validity of the Turkish version of the Falls Efficacy Scale International (FES-I) in community-dwelling older persons. Archives of gerontology and geriatrics, 54(3), 429-433. https://doi.org/10.1016/j.archger.2011.06.010.
• Uritani, D., Kasza, J., Campbell, P. K., Metcalf, B., & Egerton, T. (2020). The association between psychological characteristics and physical activity levels in people with knee osteoarthritis: a cross-sectional analysis. BMC musculoskeletal disorders, 21(1), 1-7. https://doi.org/10.1186/s12891-020-03305-2.
• Vellas, B. J., Wayne, S. J., Romero, L., Baumgartner, R. N., Rubenstein, L. Z., & Garry, P. J. (1997). One‐leg balance is an important predictor of injurious falls in older persons. Journal of the American Geriatrics Society, 45(6), 735-738. https://doi.org/10.1111/j.1532-5415.1997.tb01479.x.
• Yardley, L., Beyer, N., Hauer, K., Kempen, G., Piot-Ziegler, C., & Todd, C. (2005). Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age and ageing, 34(6), 614-619. https://doi.org/10.1093/ageing/afi196.
• Yilmaz, Ö. T., Yakut, Y., Uygur, F., & Uluğ, N. (2011). Tampa Kinezyofobi Ölçeği’nin Türkçe versiyonu ve test-tekrar test güvenirliği. Fizyoterapi Rehabilitasyon, 22(1), 44-9.