Fall Risk, Postural Control, Muscle Strength and Cognitive Function in Patients with Liver Cirrhosis

Yıl 2024, Cilt: 8 Sayı: 3, 611 - 619, 30.09.2024

Meriç Yıldırım , Nihal Gelecek , Mesut Akarsu

https://doi.org/10.30621/jbachs.1452565

Öz

Purpose: Falls are common in liver cirrhosis. Our aim was to investigate fall risk, postural control, muscle strength and cognitive function in cirrhosis, compare the results to healthy controls and investigate the inter-relationships.
Materials and Methods: Twenty-four patients (12 males, 12 females) and 24 healthy controls (11 males, 13 females) were enrolled. Fall risk was assessed with Falls Efficacy Scale (FES) and Timed Up and Go Test (TUGT). Postural control was assessed using posturography. Quadriceps Femoris and Tibialis Anterior strength were assessed with dynamometer. Cognitive function was evaluated with Stroop test. Disease severity was assessed with Child-Pugh and Model for End-Stage Liver Disease scores.
Results: Postural sway velocity (PSV) on foam surface eyes open (FSEO), FES score and TUGT duration were higher in patients (p<0.05). TUGT duration was correlated with disease severity. Lower extremity muscle strength was lower in patients (p<0.05). Dynamic postural control was deteriorated in patients (p<0.05). Lower extremity muscle strength was correlated with PSV-FSEO and FES score (p<0.05).
Conclusion: Patients with liver cirrhosis present significant decrease in muscle strength independent from disease severity, associated with static postural control on an unstable surface and fear of falling. Dynamic postural control is significantly deteriorated in liver cirrhosis, not in relation to muscle strength.

Anahtar Kelimeler

Fall risk, postural control, muscle strength, cognitive function, liver cirrhosis

Kaynakça

• Falls. In: WHO Fact sheets [Internet]. Geneva: World Health Organization; 2018 [Accessed date: 05 October 2023] Available from: URL: https://www.who.int/newsroom/ fact sheets/detail/falls#:~:text=Key%20facts,greatest%20number%20of%20fatal%20falls.
• Pollock AS, Durward BR, Rowe PJ, Paul JP. What is balance? Clin Rehabil 2000;14(4):402-406.
• Frith J, Kerr S, Robinson L, et al. Primary biliary cirrhosis is associated with falls and significant fall related injury. QJM 2010;103(3):153-161.
• Fukui H, Saito H, Ueno Y, et al. Evidence-based clinical practice guidelines for liver cirrhosis 2015. J Gastroenterol 2016;51(7):629-650.
• Aref WM, Naguib M, Hosni NA, El-Basel M. Dynamic posturography findings among patients with liver cirrhosis in Egypt. Egypt J Intern Med 2012;24:100-104.
• Schmid M, Mittermaier C, Voller B, Fialka-Moser V, Gangl A, Peck-Radosavljevic M. Postural control in patients with liver cirrhosis: a posturographic study. Eur J Gastroenterol Hepatol 2009;21(8):915-922.
• Urios A, Mangas-Losada A, Gimenez-Garzo C, et al. Altered postural control and stability in cirrhotic patients with minimal hepatic encephalopathy correlate with cognitive deficits. Liver Int 2017;37(7):1013-1022.
• Vidal-Cevallos P, Chávez-Tapia NC, Uribe M. Current approaches to hepatic encephalopathy. Ann Hepatol 2022;27(6):100757.
• Yildirim M. Falls in patients with liver cirrhosis. Gastro Nurs 2017;40(4):306-310.
• Soriano G, Roman E, Cordoba J et al. Cognitive dysfunction in cirrhosis is associated with falls: a prospective study. Hepatology 2012;55(6):1922-1930.
• Roman E, Cordoba J, Torrens M et al. Minimal hepatic encephalopathy is associated with falls. Am J Gastroenterol 2011;106(3):476-482.
• Butterworth RF. Liver: Risk of falls in cirrhosis predicted by psychometric testing. Nat Rev Gastroenterol Hepatol 2012;9(4):197-198.
• Peng S, Plank LD, McCall JL, Gillanders LK, McIlroy K, Gane EJ. Body composition, muscle function, and energy expenditure in patients with liver cirrhosis: a comprehensive study. Am J Clin Nutr 2007;85(5):1257-1266.
• Jacobsen EB, Hamberg O, Quistorff B, Ott P. Reduced mitochondrial adenosine triphosphate synthesis in skeletal muscle in patients with Child-Pugh class B and C cirrhosis. Hepatology 2001;34(1):7-12.
• Ciocîrlan M, Cazan AR, Barbu M, Mănuc M, Diculescu M, Ciocîrlan M. Subjective Global assessment and handgrip strength as predictive factors in patients with liver cirrhosis. Gastroenterol Res Pract 2017;2017:8348390.
• Wiesinger GF, Quittan M, Zimmermann K et al. Physical performance and health-related quality of life in men on a liver transplantation waiting list. J Rehabil Med 2001;33(6):260-265. Fudeyasu K, Kawae T, Fukuhara K, Daisuke I. The effect of liver dysfunction on muscle strength in liver disease patients. Physiotherapy 2016;102S:eS67–eS282.
• Smith A, Baumgartner K, Bositis C. Cirrhosis: Diagnosis and management. Am Fam Physician 2019;100(12):759-770.
• Peng Y, Qi X, Guo X (2016) Child-Pugh versus MELD score for the assessment of prognosis in liver cirrhosis: A systematic review and metaanalysis of observational studies. Medicine (Baltimore) 2016;95(8):e2877.
• Ulus Y, Durmus D, Akyol Y, Terzi Y, Bilgici A, Kuru O. Reliability and validity of the Turkish version of the Falls Efficacy Scale International (FES-I) in community-dwelling older persons. Arch Gerontol Geriatr 2012;54(3):429-33.
• Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the timed up & go test. Phys Ther 2000;80(9):896-903.
• Instruction for use: Balance master. System operator’s manual. Version 8.1. Copyright ˝2003, NeuroCom. International, Inc.
• Andrews AW, Thomas MW, Bohannon RW Normative values for isometric muscle force measurements obtained with hand-held dynamometers. Phys Ther 1996;76(3):248-259.
• Amodio P, Schiff S, Del Piccolo F, Mapelli D, Gatta A, Umiltà C. Attention dysfunction in cirrhotic patients: an inquiry on the role of executive control, attention orienting and focusing. Metab Brain Dis 2005;20(2):115-27.
• Jensen AR. Scoring the Stroop test. Acta Psychol (Amst) 1965;24(5):398-408.
• Sadowska D, Osiński W, Gumny M. Muscle strength of lower limbs as a predictor of postural stability and fear of falling in physically active and inactive older men and women. Top Geriatr Rehabil 34(2):124-130.
• Muehlbauer T, Gollhofer A, Granacher U. Associations between measures of balance and lower-extremity muscle strength/power in healthy individuals across the lifespan: A systematic review and meta-analysis. Sports Med 45(12):1671-1692.
• Andersen H, Borre M, Jakobsen J, Andersen PH, Vilstrup H. Decreased muscle strength in patients with alcoholic liver cirrhosis in relation to nutritional status, alcohol abstinence, liver function, and neuropathy. Hepatology 1998;27(5):1200-6.
• Tarter RE, Panzak G, Switala J, Lu S, Simkevitz H, Van Thiel D. Isokinetic muscle strength and its association with neuropsychological capacity in cirrhotic alcoholics. Alcohol Clin Exp Res 1997;21(2):191-6.
• Ganesan M, Kanekar N, Aruin AS. Direction-specific impairments of limits of stability in individuals with multiple sclerosis. Ann Phys Rehabil Med 2015;58(3):145–150.
• Felipo V, Urios A, Valero P et al. Serum nitrotyrosine and psychometric tests as indicators of impaired fitness to drive in cirrhotic patients with minimal hepatic encephalopathy. Liver Int 2013;33(10):1478-1489.