INVESTIGATION OF THE RELATIONSHIP BETWEEN PAIN, KINESIOPHOBIA, BALANCE AND FUNCTIONALITY IN INDIVIDUALS WITH LOWER EXTREMITY BURN INJURY

Öz

OBJECTIVE: The pain which develops in the acute period following burn injuries leads to many problems. As a result of kinesiophobia due to pain, daily life, the level of functional independence, and balance is affected. However, studies investigating
the relationship between pain, balance and functional independence and kinesophobia after lower extremity burn injuries are
inadequate.
MATERIAL AND METHODS: Twenty-eight adults with lower extremity burns were included in this study. Individuals
were assessed with visual analogue scale for their pain severity, using the tampa kinesiophobia scale for kinesiophobia, using
the Berg balance scale for balance states, and using the functional independence measure for independence level. The relationship between pain, kinesiophobia, balance, level of functional independence and total burned surface area were examined.
RESULTS: 28 subjects (23F, 5M) were included in the study. It was found that the mean age of subjects was 34±10 years and
mean burn surface area was 4.35±2.68 %. There was a statistically significant correlation between pain severity and kinesiophobia score (p<0.001; r=0.689). There was statistically significant correlation between the pain severity and berg balance
scale (p<0.001; r=-0.752), pain severity and functional independence scale (p<0.001; r=-0.781). There was a similarly statistically significant correlation between kinesiophobia score and berg balance scale (p=0.008; r=-0.491), and kinesiophobia score
and functional independence measure (p=0.001; r=-0.603). A statistically significant correlation was also found between the
Berg balance scale score and the functional independence measure (p<0.001, r=0.768). A statistically significant correlation
was found between total burn surface area and pain (p<0.001; r=0.617), kinesiophobia (p=0.004;r=0.529), functionality
(p=0.01; r=-0.456). However there was no significant correlation between total burn surface area and balance (p>0.05).
CONCLUSION: Pain following lower limb burn injuries causes kinesiophobia in individuals. Pain and kinesophobia
are related to the level of balance and functional independence of the person. As the burned surface area increases, the
pain of the person, kinesophobia increases and the function is affected.

Anahtar Kelimeler

• Burns
• Balance
• Function
• Kinesiophobia
• Pain

ALT EKSTREMİTE YANIK YARALANMASI OLAN BİREYLERDE AĞRI, KİNEZYOFOBİ, DENGE VE FONKSİYONELLİK ARASINDAKİ İLİŞKİNİN İNCELENMESİ

Öz

AMAÇ: Yaralanmaları takiben akut dönemde oluşan ağrı birçok probleme yol açabilmektedir. Ağrıya bağlı oluşan kinezyofobi sonucunda kişinin günlük yaşamı, fonksiyonel bağımsızlık düzeyi ve denge durumu etkilenebilmektedir. Ancak alt
ekstremite yanık yaralanmaları sonrası oluşan ağrı ve kinezyofobinin denge ve fonksiyonel bağımsızlık düzeyi ile ilişkisinin
araştırıldığı çalışmalar yetersizdir.
GEREÇ VE YÖNTEMLER: Çalışmamıza alt ekstremite yanığı olan 28 hasta dahil edildi. Yaş, cinsiyet ve yanık yüzey alanları kaydedildi. Bireylerin ağrı şiddeti görsel analog ölçeği, kinezyofobileri Tampa Kinezyofobi Ölçeği, denge durumları Berg
Denge Ölçeği ve bağımsızlık düzeyleri de Fonksiyonel Bağımsızlık Ölçeği kullanılarak değerlendirildi. Ağrı, kinezyofobi, denge, fonksiyonel bağımsızlık düzeyi ve toplam yanık yüzey alanı arasındaki ilişki incelendi.
BULGULAR: Çalışmaya 28 birey (23K, 5E) dahil edildi. Bireylerin yaş ortalaması 34±10 yıl, toplam yanık yüzey ortalaması
% 4,35 ± 2,68 olarak bulundu. Ağrı şiddeti ve kinezyofobi puanı arasında istatistiksel olarak anlamlı ilişki bulundu (p<0,001;
r=0,689). Ağrı şiddeti ile Berg Denge Ölçeği (r=-0,752) ve Fonksiyonel Bağımsızlık Ölçeği (r=-0,781) arasında istatistiksel olarak anlamlı ilişki bulundu (p<0,001). Kinezyofobi puanı ile de benzer şekilde Berg Denge Ölçeği (p=0,008; r=-0,491) ve Fonksiyonel Bağımsızlık Ölçeği (p=0,001;r=-0,603) arasında istatistiksel olarak anlamlı ilişki bulundu. Berg Denge Ölçeği puanı
ve Fonksiyonel Bağımsızlık Ölçeği arasında da istatistiksel olarak anlamlı ilişki bulundu (p<0,001, r=0,768). Toplam yanık
yüzey alanı ile ağrı (p<0,001; r=0,617), kinezyofobi (p=0,004; r=0,529) ve fonksiyonellik (p=0,01; r=-0,456) arasında istatistiksel olarak anlamlı ilişki bulundu. Ancak, toplam yanık yüzey alanı ve denge arasında anlamlı ilişki bulunmadı (p>0,05).
SONUÇ: Alt ekstremite yanık yaralanmalarını takiben ortaya çıkan ağrı, bireylerde kinezyofobi oluşmasına neden olur. Ağrı
ve kinezyofobi kişinin denge ve fonksiyonel bağımsızlık düzeyi ile ilişkilidir. Yanık yüzey alanı arttıkça kişinin ağrısı, kinezyofobisi artmakta ve fonksiyonelliği azalmaktadır.  

Anahtar Kelimeler

• Ağrı
• Kinezyofobi
• Denge
• Fonksiyon
• Yanıklar

Kaynakça

1. Referans1. Ghezeljeh TN, Ardebili FM, Rafii F. The effects of massage and music on pain, anxiety and relaxation in burn patients: Randomized controlled clinical trial. Burns 2017; 43:1034 – 1043. Referans2. Richardson P, Mustard L. The management of pain in the burns unit. Burns 2009; 35:921-936. Referans3. Summer GJ, Puntillo KA, Miaskowski C,Green PG, and Levine JD. Burn Injury Pain: The Continuing Challenge. The Journal of Pain 2007; 8: 533-548. Referans4. Jain M, Khadilkar N, De Sousa A. Burn-Ralated Factors Affecting Anxiety, Depression and Self-Esteem in Burn Patients: An Explotory Study. Annals of Burns and Fire Disasters 2017; vol. 30:30-34 Referans5. Sgroi MI, Willebrand M, Ekselius L, Gersin B and Andersson G. Fear-avoidance in Recovered Burn Patients: Association with Psychological and Somatic Symptoms. Journal of Health Psychology 2005;10:491–502 Referans6. Gittings PM, Heberlien N, Devenish N and et al. The Lower Limb Functional Index – A reliable and valid functional outcome assessment in burns. Burns 2016 ;42:1233 – 1240. Referans7. Finlay V, Phillips M, Wood F, Edgar D. A reliable and valid outcome battery for measuring recovery of lower limb function and balance after burn injury. Burns;2010;36:780-786. Referans8. Ali ZMI, El-Refay BH, Ali RR. Aerobic exercise training in modulation of aerobic physical fitness and balance of burned patients. J. Phys. Ther. Sci. 2015; 27: 585–589 Referans9. Willebrand M, Sveen J. Injury-related fear-avoidance and symptoms of posttraumatic stress in parents of children with burns.Burns 2016;42:414-420. Referans10. Bijur PE, Silver W, Gallagher EJ. Reliability of the Visual Analog Scale for Measurement of Acute Pain. Academic Emergency Medicine 2001;8:1153–1157 Referans11. Yılmaz OT, Yakut Y, Uygur F, Ulug N. Tampa Kinezyofobi Ölçeği’nin Türkçe versiyonu ve test-tekrar test güvenirliği. Fizyoterapi Rehabilitasyon. 2011;22:44-49 Referans12. Voon K, Silberstein I, Eranki A, Phillips M, Wood FM, Edgar DW. Xbox KinectTM based rehabilitation as a feasible adjunct for minor upper limb burns rehabilitation: A pilot RCT. Burns 2016;42:1797-1804. Referans13. Edgar D, Zorzi LM, Wand BM and et al. Prevention of neural hypersensitivity after acute upper limb burns: development and pilot of a cortical training protocol. Burns 2011;37:698–706. Referans14. Sgori MI, Willbrand M, Ekselius L, Gerdin B, Andersson G. Fear-avoidance in recovered burn patients: association with psychological and somatic symptoms. J Health Psychol 2005;10:491–502. Referans15. Willebran M, Andersson G, Kildal M, Gerdin B, Ekselius L. Injury-related fear-avoidance, neuroticism and burnspecific health. Burns 2006;32:408–15. Referans16. Berg K, Wood-Dauphine S, Williams J, Gayton D. Measuring balance in the elderly: preliminary development of an instrument. Physiother Can 1989; 41: 304–311. Referans17. Blum L, Korner-Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review. Phys Ther 2008; 88: 559–566. Referans18. Jacobson BH, Thompson B, Wallace T, Brown L, Rial C. Independent static balance training contributes to increased stability and functional capacity in community dwelling elderly people: a randomized controlled trial. Clin Rehabil 2011; 25:549-56 Referans19. Byun SD, Jung TD, Kim CH, Lee YS. Effects of the sliding rehabilitation machine on balance and gait in chronic stroke patients – a controlled clinical trial. Clin Rehabil 2010; 25:408-15. Referans20. Leddy AL, Crowner BE, Earhart GM. Functional gait assessment and balance evaluation system test: reliability, validity, sensitivity, and specificity for identifying individuals with Parkinson disease who fall. Phys Ther 2011;91:102–13. Referans21. Blum L, Korner-Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review. Phys Ther 2008;88:559–66. Referans22. Schneider JC, Qu HD, Lowry J, Walker J, Vitale E, Zona M. Efficacy of inpatient burn rehabilitation: A prospective pilot study examining range of motion, hand function and balance. Burns 2012; 38:164-171. Referans23. Gerrard P, Goldstein R, DiVita MA and et al. Validity and Reliability of the FIM Instrument in the Inpatient Burn Rehabilitation Population. Archives of Physical Medicine and Rehabilitation 2013;94:1521-26 Referans24. Vlaeyen J.W.S, Linton S.J. Fear avoidence and its consequences in chronic musculoskeletal pain: A state of the art. Pain 2000;85:317-332. Referans25. Wadell G, Newton M, Henderson I, Somerville D, Main C. A fear avoidence beliefs Questionnaire (FABQ) and the role of fear avoidence beliefs in chronic low back pain and disability. Pain 1991;52:157-168. Referans26. Klenerman L, Slade P.D, Stanley I.M and et al. The prediction of chronicity in patients with an acute attack of low back pain in a general practice setting. Spine 1995;20:478-484.