The impact of monitoring partial weight bearing protocol with instant feedback in patients with TOL surgery on early term pain, kinesophobia and functional levels

Öz

Aim: The aim of this study was to investigate the effect of instantaneous feedback provided by remote access during walking on pain intensity, kinesiophobia and functional level in the early postoperative period in patients who were prescribed partial weight-bearing gait in the routine post-surgical treatment of Talus Osteochondral Lesion (TOL). Methods: The study was conducted with patients (n=10) who were prescribed a partial weight transfer protocol and followed remotely after microfracture surgery due to TOL. The patients were randomly divided into two groups as the feedback group (FB) and the non-feedback (NFB) group. Pain intensity was evaluated with the Visual Analogue Scale (VAS), kinesiophobia with the TAMPA Kinesiophobia Scale (TKO), and foot and ankle functional levels were assessed with the European Foot and Ankle Society EFAS Scale (EFAS). Assessments were carried out in 3 different time periods: preoperative, 3rd and 6th weeks after surgery. Mixed pattern ANOVA test was used to analyze the effect of time and group interaction of the data. Bonferroni correction applied as a post hoc test. Results: There was a significant decrease in the mean pain intensity at 3 and 6 weeks in the FB group (p= 000.5 and p= 0.002), while a significant increase was observed in the mean pain intensity at the 3rd week in the NFB group (p=0.012). A significant improvement was found in the kinesiophobia levels of the FB group at 3 and 6 weeks (p=0.033 and p=0.049), and in the EFAS scores at only 6 weeks (p= 0.004). There was no significant difference in kinesiophobia and EFAS scores’ changes of the NFB group at all measurement times. In the comparison between the groups, a significant decrease was observed in the pain intensity of the FB group compared to the NFB group at the 3rd week (p=0.003). The kinesiophobia (p=0.045) and EFAS scores of the FB group (p=0.02) showed statistically significant improvement at the 6th week compared to the NFB group. Conclusion: Management of the patients with TOL surgery who were prescribed partial weight bearing at the first post-operative 6 weeks can be supported by using the systems that enable remote monitoring of weight-bearing and provide instant feedback to patients to improve early clinical recovery.

Anahtar Kelimeler

• Talus Osteocondral Lesions
• kinesiophobia
• pain
• function
• Feedback

Proje Numarası

TDK-2020-10158

Talus Osteokondral Lezyon Cerrahisi Sonrası Uygulanan Kısmi Ağırlık Aktarma Protokolünün Anlık Geri Bildirim ile Takibinin Erken Dönem Ağrı, Kinezyofobi ve Fonksiyon Üzerine Etkisi

Öz

Amaç: Talus Osteokondral Lezyona (TOL) yönelik cerrahi sonrası rutin tedavide uygulanan kısmi ağırlık aktarmalı yürüyüş reçete edilen hastalarda yürüyüş sırasında uzaktan erişimle sağlanan anlık geri bildirimin cerrahi sonrası erken dönemde ağrı şiddeti, kinezyofobi ve fonksiyonel düzey üzerindeki etkisini araştırmaktı. Yöntemler: Araştırma TOL nedeniyle mikro kırık cerrahisi sonrası kısmi ağırlık aktarma protokolü reçete edilen ve yürüyüşleri uzaktan erişimle takip edilen hastalarla (n=10) gerçekleştirildi. Hastalar geri-bildirimli (GB) ve geri-bildirimsiz (GBZ) grup olmak üzere rastgele iki ayrı gruba ayrıldı. Hastaların Vizüel Analog skalası (VAS) ile ağrı şiddeti, TAMPA Kinezyofobi Ölçeği (TKÖ) ile kinezyofobi ve Avrupa Ayak ve Ayak Bileği Cemiyeti EFAS Ölçütü (EFAS) ile ayak, ayak bileği fonksiyonel düzeyleri değerlendirildi. Değerlendirmeler cerrahi öncesi, cerrahiden sonra 3. ve 6. hafta olmak üzere 3 ayrı zaman diliminde gerçekleştirildi. Verilerin zaman ve grup etkileşiminin etkisini analiz etmek için karma desen ANOVA testi kullanıldı. Post hoc test olarak Bonferroni düzeltmesi uygulandı. Bulgular: GB grubunda 3 ve 6.haftalarda ortalama ağrı şiddetinde anlamlı bir azalma gözlenirken (p= 000,5 ve p= 0.002) GBZ grubunda 3.haftada ortalama ağrı şiddetinde anlamlı artış tespit edildi (p=0,012). GB grubunun kinezyofobi düzeylerinde 3 ve 6. haftalarda (p=0,033 ve p=0,049), EFAS skorlarında ise sadece 6. haftada (p= 0,004) anlamlı iyileşme tespit edildi. GBZ grubunun tüm zamanlardaki ölçümlerinin kinezyofobi ve EFAS skorlarındaki değişimde anlamlı bir fark bulunmadı. Gruplar arası karşılaştırmada 3.haftada GB grubunun ağrı şiddetinde GBZ grubuna göre anlamlı azalma kaydedildi (p=0,003). GB grubunun kinezyofobi (p=0,045) ve EFAS skorları (p=0,02) GBZ grubuna göre 6.haftada istatistiksel olarak anlamlı iyileşme gösterdi. Sonuç: TOL cerrahisi sonrası hastalara kısmi ağırlık aktararak yürümenin reçete edildiği ilk 6 haftalık dönemde, ağırlık aktarım miktarlarının uzaktan takibini mümkün kılan ve hastalara anlık geri bildirimde bulunabilen sistemler ile sürecin yönetilmesi bu hasta grubunda erken dönem iyileşmeyi destekleyen bir yaklaşımdır.

Anahtar Kelimeler

• Talus Osteokondral Lezyon
• Kinezyofobi
• Ağrı
• Fonksiyon
• Geribildirim

Destekleyen Kurum

Marmara Üniversitesi, Bilimsel Araştırma Projeleri Birimi

Proje Numarası

TDK-2020-10158

Teşekkür

-/-

Kaynakça

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