Multipl Skleroz Hastalarında Denge ve Yürüyüş Değerlendirmelerinin Hasta Hedefleri ile İlişkisinin İncelenmesi

Öz

Amaç: Çalışmanın amacı, Multipl Skleroz hastalarında denge ve yürüyüş değerlendirmelerinin hasta hedefleri ile ilişkisini belirlemektir. Gereç ve Yöntem: Çalışmaya 54 MS hastası (40 Kadın, 14 Erkek) dahil edildi. Hastalık şiddeti EDSS (Genişletilmiş Özürlülük Durum Ölçeği); denge Tek Bacak Duruş Testi, Berg Denge Ölçeği (BDÖ), Zamanlı Kalk ve Yürü Testi (ZKYT) ve Statik Posturografi; yürüyüş 10 Metre Yürüme Testi (10MYT) ve Multipl Skleroz Yürüme Skalası-12 (MSYS-12); hasta hedefleri ise Amaca Ulaşma Ölçeği (GAS) ile değerlendirildi. Sonuçlar: GAS ile TBDS arasında orta derecede pozitif ilişki (r=0,472; p<0,001), BDÖ arasında mükemmel pozitif ilişki (r=0,807; p<0,001), ZKYT arasında düşük orta düzeyde negatif ilişki (r=-0,391; p=0,003) bulundu. GAS ile 10MYT (r=-0,401; p=0,003) ve GAS ile MSYS-12 (r=-0,571; p<0,001) arasında orta derecede negatif ilişki bulundu. Tartışma: GAS değerlendirmesinin BDÖ başta olmak üzere, denge ve yürüyüşün birçok parametresi ile ilişkili olduğu gösterilmiştir. GAS değerlendirmesinin tedavi planlarının oluşturulmasında önemli bir yere sahip olması gerektiğini düşünmekteyiz.

Anahtar Kelimeler

• Denge
• Multipl Skleroz
• Rehabilitasyon
• Yürüyüş
• hedefler

Investigation of Relationship between Balance and Gait Assessments and Patient Goals in Patients with Multiple Sclerosis

Öz

Purpose: The aim of this study was to determine the relationship between balance and gait assessments and patient goals in MS patients. Material and Methods: The study included 54 MS patients (40 F, 14 M). Disease severity was assessed by EDSS (Expanded Disability Status Scale); balance was assessed by Single Leg Stance Test, Berg Balance Scale (BBS), Timed Up and Go Test (TUG) and Static Posturography; gait was assessed by 10 Metre Walking Test (10MWT) and Multiple Sclerosis Walking Scale-12 (MSWS-12); and patient goals were assessed by Goal Attainment Scale (GAS). Results: There was a moderate positive correlation between GAS and Single Leg Stance Time (r=0.472; p=0.000), an excellent positive correlation between GAS and BBS (r=0.807; p=0.000), and a low moderate negative correlation between GAS and TUG (r=-0.391; p=0.003). A moderate negative correlation was found between GAS and 10MYT (r=-0.401; p=0.003) and GAS and MSYS-12 (r=-0.571; p=0.000). Conclusion: GAS assessment has been shown to be related to many parameters of balance and gait, especially BBS. We think that GAS evaluation should have an important place in creating treatment plans.

Anahtar Kelimeler

• Balance
• Goals
• Multiple Sclerosis
• Rehabilitation
• Gait

Kaynakça

1. Berg, K., Wood-Dauphine, S., Williams, J. I., & Gayton, D. (1989). Measuring balance in the elderly: preliminary development of an instrument. Physiother Can, 41(6), 304-311. doi: 10.3138/ptc.41.6.304.
2. Bloom, L. F., Lapierre, N. M., Wilson, K. G., Curran, D., DeForge, D. A., & Blackmer, J. (2006). Concordance in goal setting between patients with multiple sclerosis and their rehabilitation team. Am J Phys Med Rehabil, 85(10), 807-813. doi: 10.1097/01.phm.0000237871.91829.30.
3. Carpinella, I., Gervasoni, E., Anastasi, D., Di Giovanni, R., Tacchino, A., Brichetto, G., et al. (2021). Instrumentally assessed gait quality is more relevant than gait endurance and velocity to explain patient reported walking ability in early stage multiple sclerosis. Eur J Neurol, 28(7), 2259-2268. doi: 10.1111/ene.14866.
4. Comber, L., Galvin, R., & Coote, S. (2017). Gait deficits in people with multiple sclerosis: a systematic review and meta-analysis. Gait & Posture, 51, 25-35. doi: 10.1016/j.gaitpost.2016.09.026.
5. Fry, D. K., Huang, M. H., & Rodda, B. J. (2016). Predictors of static balance in ambulatory persons with multiple sclerosis. Int J Rehabil Res, 39(1), 42-47. doi: 10.1097/MRR.0000000000000142.
6. Hanssen, K. T., Šaltytė Benth, J., Beiske, A. G., Landrø, N. I., & Hessen, E. (2015). Goal attainment in cognitive rehabilitation in MS patients. Neuropsychol Rehabil, 25(1), 137-154. doi: 10.1080/09602011.2014.971818.
7. Hayran, M. (2011). Sağlık araştırmaları için temel istatistik. Omega Araştırma.
8. Held Bradford, E., Finlayson, M., White Gorman, A., & Wagner, J. (2018). Maximizing gait and balance: behaviors and decision-making processes of persons with multiple sclerosis and physical therapists. Disabil Rehabil, 40(9), 1014-1025. doi: 10.1080/09638288.2017.1283448.

9. Hobart, J. C., Riazi, A., Lamping, D. L., Fitzpatrick, R., & Thompson, A. J. (2003). Measuring the impact of MS on walking ability: the 12-Item MS Walking Scale (MSWS-12). Neurology, 60(1), 31-36. doi: 10.1212/WNL.60.1.3.
10. Inojosa, H., Schriefer, D., Trentzsch, K., Klöditz, A., & Ziemssen, T. (2020). Visual feedback and postural control in multiple sclerosis. J Clin Med, 9(5), 1291. doi: 10.3390/jcm9051291.
11. Khan, F., Pallant, J. F., & Turner-Stokes, L. (2008). Use of goal attainment scaling in inpatient rehabilitation for persons with multiple sclerosis. Arch Phys Med Rehabil, 89(4), 652-659. doi: 10.1016/j.apmr.2007.09.049.
12. Kieseier, B. C., & Pozzilli, C. (2012). Assessing walking disability in multiple sclerosis. Mult Scler J, 18(7), 914-924. doi: 10.1177/1352458512444498.
13. Kiresuk, T. J., & Sherman, R. E. (1968). Goal attainment scaling: a general method for evaluating comprehensive community mental health programs. Community Ment Health J, 4, 443-453. doi: 10.1007/BF01530764.
14. Kurtzke, J. F. (1983). Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology, 33(11), 1444-1444. doi: 10.1212/wnl.33.11.1444.
15. Malec, J. F. (1999). Goal attainment scaling in rehabilitation. Neuropsychol Rehabil, 9(3-4), 253-275. doi: 10.1080/096020199389365.
16. Nilsagard, Y., Lundholm, C., Gunnarsson, L. G., & Denison, E. (2007). Clinical relevance using timed walk tests and ‘timed up and go’testing in persons with multiple sclerosis. Physiother Res Int, 12(2), 105-114. doi: 10.1002/pri.358.
17. Schmit, J., Riley, M., Shear, P., & Shockley, K. (2004). Static posturography and recurrence quantification reliably detect postural instability. In Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 48(21), 2512-2516. doi: 10.3390/ijerph20020981.
18. Tarakci, E., Yeldan, I., Huseyinsinoglu, B. E., Zenginler, Y., & Eraksoy, M. (2013). Group exercise training for balance, functional status, spasticity, fatigue and quality of life in multiple sclerosis: a randomized controlled trial. Clin Rehabil, 27(9), 813-822. doi: 10.1177/0269215513481047.
19. Thompson, A. J. (2000). The effectiveness of neurological rehabilitation in multiple sclerosis. Development, 37(4), 455-461.
20. Turner-Stokes, L. (2009). Goal attainment scaling (GAS) in rehabilitation: a practical guide. Clin Rehabil, 23(4), 362-370. doi: 10.1177/0269215508101742.
21. Wade, D. T. (1998). Evidence relating to goal planning in rehabilitation. Clin Rehabil, 12(4), 273-275. doi: 10.1191/0269215986781663.