INVESTIGATION OF CHANGES IN KINESOPHOBIA, SLEEP QUALITY AND LIFE QUALITY AFTER LUMBAR DISC HERNIA SURGERY

Yıl 2022, , 494 - 512, 01.12.2022

Duygu Korkem , Hamide Elif Öztürk Nurgül Dürüstkan Elbaşı

https://doi.org/10.25279/sak.1040104

Öz

Aim: This study aims to investigate the changes in kinesiophobia, daily living activities and sleep quality in patients diagnosed with lumbar disc herniation (LDH) and undergone microdiscectomy surgery. Materials & Methods: The patients with indication for surgery of LDH were included in this study. The patients were evaluated preoperatively and postoperatively at the 1st, 3rd, and 6th months. Short form Mcgill pain questionnaire, visual analogue scale (VAS), Oswestry disability index (ODI), Tampa kinesiophobia scale (TKS), SF-36, and Pittsburg Sleep Quality Index (PSQI) were employed as assessment scales. Goniometric lumbar flexion-extension and lateral flexion angles (ROM) were recorded for each patient. In addition, postoperative recommendations and home exercise program were given to the patients. Results: The changes in scores of TKS, PSQI over time was significant in all scores of SF-36. There was a significant increase of ROM postoperatively compared to preoperative evaluations. Statistically significant relationship was detected between the preoperative lumbar flexion movement and the TKS total score; between preoperative VAS score and PSQI total score; between VAS scores and PSQI total score, SF-36 emotional well-being subscale; (p <0.05). Mc-Gill sensorial sub-parameter as well as SF-36 sub-component due to total body pain were significantly correlated (p <0.05). At the 6th month, a statistically significant correlation was between PUKI score with SF-36 subcomponent due to physical problems restrictions and SF-36 Health Perception subcomponent; (p<0.05). Conclusion: Home exercise programs started early after LDH surgery and increased gradually during the postoperative period provided significant improvements in subjective and objective findings of the patients.

Anahtar Kelimeler

Lumbar disc hernia, lumbar disc surgery, home exercise program, quality of life

LOMBER DİSK HERNİSİ CERRAHİSİ SONRASI KİNEZYOFOBİ, UYKU KALİTESİ VE YAŞAM KALİTESİNDEKİ DEĞİŞİMİN ARAŞTIRILMASI

Öz

Amaç: Lomber disk hernisi (LDH) tanısı koyulan ve mikrodiskektomi cerrahisi geçiren bireylerde kinezyofobi, günlük yaşam aktiviteleri ve uyku kalitesinin değişimini araştırmaktır. Materyal&Method: LDH cerrahisi endikasyonu olup, cerrahi olan 30 hasta çalışmaya dahil edildi. Hastalar ameliyattan önce, ameliyat sonrası birinci, üçüncü ve altıncı aylarda değerlendirildi. Hastaların değerlendirilmesinde kısa form Mcgill ağrı anketi, görsel ağrı skalası (VAS), Oswestry disabilite indeksi (ODİ), Tampa kinezyofobi ölçeği (TKÖ), SF-36 yaşam kalitesi ölçeği ve Pittsburg Uyku Kalitesi İndeksi (PUKİ) kullanıldı. Ayrıca hastaların lomber fleksiyon-ekstansiyon ve lateral fleksiyon normal eklem hareket açıları (NEH) kaydedildi. Hastalara ameliyat sonrası önerilerde bulunuldu. Ev egzersiz programı verildi. Bulgular: Değerlendirmeler sonucunda SF-36’nın bütün alt parametrelerinde, TKÖ, PUKİ ve NEH’lerinin zaman içindeki değişimi anlamlı bulundu (p<0.05). Ameliyat öncesi lomber bölge fleksiyon hareketi ile TKÖ, ODİ Toplam Skoru arasında; VAS skoru ile PUKİ toplam skoru ve SF-36 Emosyonel iyilik hali alt bileşeni arasında; VAS değeri ile PUKİ toplam skoru ve SF-36 Emosyonel iyilik hali alt bileşeni arasında; Mc-Gill duyusal (sensory) alt parametresi ile SF-36 Vücut ağrısı alt bileşeni arasında; Mc-Gill algısal alt parametresi ile TKÖ, Mc-Gill toplam Skoru ile SF-36 Fiziksel problemler nedeniyle olan kısıtlanma alt bileşeni arasında anlamlı ilişki bulundu (p<0,05). 6. ayda PUKİ skoru ile SF-36 Fiziksel problemler nedeniyle olan kısıtlanma ve SF-36 Genel Sağlık Algısı alt bileşeni arasında; SF-36 Emosyonel iyilik hali ve SF-36 Genel Sağlık Algısı alt bileşeni arasında istatistiksel olarak anlamlı ilişki bulundu (p<0,05). Sonuç: LDH cerrahisi ve sonrasında erken dönemden itibaren verilen, aşamalı olarak arttırılan ev egzersiz programı bireylerin subjektif ve objektif bulgularında önemli düzeyde iyileşmeler sağladı.

Anahtar Kelimeler

Lomber disk hernisi, mikrodiskektomi, ev egzersiz programı, yaşam kalitesi

Kaynakça

• Ağargün MY, Kara H, Anlar O. Pittsburgh Uyku Kalitesi İndeksi’nin Geçerliği ve Güvenirliği. Turk Psikiyatri Derg 1996;7: 107-11.
• Akca N, Aydın G, Gümüş K. Lomber disk hernili hastaların vücut mekanikleri bilgi düzeyleri ile ağrı şiddeti arasındaki ilişki. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2013;2:66-77.
• Bränström, H., & Fahlström, M. (2008). Kinesiophobia in patients with chronic musculoskeletal pain: differences between men and women. Journal of rehabilitation medicine, 40(5), 375-380.
• Buysse, D. J., Hall, M. L., Strollo, P. J., Kamarck, T. W., Owens, J., Lee, L., ... & Matthews, K. A. (2008). Relationships between the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and clinical/polysomnographic measures in a community sample. Journal of clinical sleep medicine, 4(06), 563-571.
• Casso, G., Cachin, C., van Melle, G., & Gerster, J. C. (2004). Return-to-work status 1 year after muscle reconditioning in chronic low back pain patients. Joint Bone Spine, 71(2), 136-139.
• Dammers, R., & Koehler, P. J. (2002). Lumbar disc herniation: level increases with age. Surgical neurology, 58(3-4), 209-212.
• Dolan, P., Greenfield, K., Nelson, R. J., & Nelson, I. W. (2000). Can exercise therapy improve the outcome of microdiscectomy? Spine, 25(12), 1523-1532.
• Dönmez, Y. C., Dolgun, E., Kabataş, M., & Özbayır, T. (2010). Lomber disk hernili hastalarda risk faktörlerinin incelenmesi. Fırat Üniversitesi Sağlık Bilimleri Tıp Dergisi, 24(2), 89-92.
• Filiz, M., Cakmak, A., & Ozcan, E. (2005). The effectiveness of exercise programmes after lumbar disc surgery: a randomized controlled study. Clinical rehabilitation, 19(1), 4-11.
• Göksoy, T. (2000). Fiziksel Tıp ve Rehabilitasyon. 2. Baskı, İstanbul, Güneş kitabevi, 67-70.
• Greenfield III, R. T., Capen, D. A., Thomas Jr, J. C., Nelson, R., Nagelberg, S., Rimoldi, R. L., & Haye, W. (1998). Pedicle screw fixation for arthrodesis of the lumbosacral spine in the elderly: an outcome study. Spine, 23(13), 1470-1475.
• Güçlü, D. G., Şenormancı, Ö., Gönüllü, O., Çırak, M., Şenormancı, G., & Koktürk, F. (2017). Fear avoidance beliefs and quality of life after lumbar disc surgery. JCBPR, 6(1), 1-8.
• Güven, M. B., Çırak, B., Işık, H. S., & Kıymaz, N. (1999). Lomber disk hernilerinde retrospektif bir çalışma. Van Tıp Dergisi, 6(1), 20-23.
• Hayden, J. A., Van Tulder, M. W., & Tomlinson, G. (2005). Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Annals of internal medicine, 142(9), 776-785.
• Hicks, G. E., Fritz, J. M., Delitto, A., & McGill, S. M. (2005). Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Archives of physical medicine and rehabilitation, 86(9), 1753-1762.
• Hong, J. H., Kim, H. D., Shin, H. H., & Huh, B. (2014). Assessment of depression, anxiety, sleep disturbance, and quality of life in patients with chronic low back pain in Korea. Korean journal of anesthesiology, 66(6), 444.
• Huang, W., Qian, Y., Zheng, K., Yu, L., & Yu, X. (2016). Is smoking a risk factor for lumbar disc herniation?. European Spine Journal, 25(1), 168-176.
• Johannsen, F., Remvig, L., Kryger, P., Beck, P., Lybeck, K., Larsen, L. H., ... & Dreyer, V. (1994). Supervised endurance exercise training compared to home training after first lumbar diskectomy: a clinical trial. Clinical and experimental rheumatology, 12(6), 609-614.
• Kahanovitz, N., Viola, K., & Gallagher, M. (1989). Long-term strength assessment of postoperative diskectomy patients. Spine, 14(4), 402-403.
• Karadağ, M., & Aksoy, G.(2002) Lomber Disk Herni Ameliyatında Hastaların Evde İyileşmelerini Halandırmada Hemşirenin Eğitici Rolünün Etkisi. Düşünen Adam, 15(4), 245-253.
• Kavcic, N., Grenier, S., & McGill, S. M. (2004). Quantifying tissue loads and spine stability while performing commonly prescribed low back stabilization exercises. Spine, 29(20), 2319-2329.
• Kim, Y. S., Park, J., & Shim, J. K. (2010). Effects of aquatic backward locomotion exercise and progressive resistance exercise on lumbar extension strength in patients who have undergone lumbar diskectomy. Archives of physical medicine and rehabilitation, 91(2), 208-214.
• Koçyiğit, H., Aydemir, Ö., Fişek, G., Ölmez, N., & Memiş, A. K. (1999). Form-36 (KF-36)’nın Türkçe versiyonunun güvenilirliği ve geçerliliği. Ilaç ve tedavi dergisi, 12(2), 102-6.
• Leboeuf-Yde, C. (2000), Body weight and low back pain, Spine 15, 25(2), 226-37.
• Loupasis, G. A., Stamos, K., Katonis, P. G., Sapkas, G., Korres, D. S., & Hartofilakidis, G. (1999). Seven-to 20-year outcome of lumbar discectomy. Spine, 24(22), 2313.
• Manniche, C., Asmussen, K., Lauritsen, B., Vinterberg, H., Karbo, H., Abildstrup, S., & Ibsen, K. (1993). Intensive dynamic back exercises with or without hyperextension in chronic back pain after surgery for lumbar disc protrusion. A clinical trial. Spine, 18(5), 560-567.
• Marin, R., Cyhan, T., & Miklos, W. (2006). Sleep disturbance in patients with chronic low back pain. American Journal of Physical Medicine & Rehabilitation, 85(5), 430-435.
• Maroon, J. C. (2002). Current concepts in minimally invasive discectomy. Neurosurgery, 51(suppl_2), S2-137.
• O'Donoghue, G. M., Fox, N., Heneghan, C., & Hurley, D. A. (2009). Objective and subjective assessment of sleep in chronic low back pain patients compared with healthy age and gender matched controls: a pilot study. BMC musculoskeletal disorders, 10(1), 122.
• Pellino, T. A., Gordon, D. B., Engelke, Z. K., Busse, K. L., Collins, M. A., Silver, C. E., & Norcross, N. J. (2005). Use of nonpharmacologic interventions for pain and anxiety after total hip and total knee arthroplasty. Orthopaedic Nursing, 24(3), 182-190.
• Pfingsten, M., Kröner-Herwig, B., Leibing, E., & Kronshage, U. (2000). Validation of the German version of the fear-avoidance beliefs questionnaire (FABQ). European Journal of Pain, 4(3), 259-266.
• Pincus, T., Vogel, S., Burton, A. K., Santos, R., & Field, A. P. (2006). Fear avoidance and prognosis in back pain: a systematic review and synthesis of current evidence. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 54(12), 3999-4010.
• Rabini, A., Aprile, I., Padua, L., Piazzini, D. B., Maggi, L., Ferrara, P. E., ... & Bertolini, C. (2007). Assessment and correlation between clinical patterns, disability and health-related quality of life in patients with low back pain. Europa medicophysica, 43(1), 49.
• Sade,R.,Otman,A.S.,( 1991 ) “Serebral Paralizi’de Değerlendirme ve Tedavi Yöntemleri”, 2. Baskı, H.Ü. Fizik Tedavi ve Rehabilitasyon Y.O. Yayınları, Ankara
• Sarı, S., & Aydoğan, M. (2015). Bel ağrısının önemli bir sebebi: lomber disk hernisi. TOTBİD Dergisi, 14, 298–304
• Schiltenwolf, M. (1999). Aspects of conservative sciatic pain. Der Orthopäde, 28(11), 966-974.
• Smith, B. H., Elliott, A. M., Hannaford, P. C., Chambers, W. A., & Smith, W. C. (2004). Factors related to the onset and persistence of chronic back pain in the community: results from a general population follow-up study. Spine, 29(9), 1032-1040.
• Vereščiagina, K., Ambrozaitis, K., & Špakauskas, B. (2007). Health-related quality-of-life assessment in patients with low back pain using SF-36 questionnaire. Medicina, 43(8), 607.
• Ware Jr, J. E., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical care, 473-483.
• Weinstein, J. N., Tosteson, T. D., Lurie, J. D., Tosteson, A. N., Hanscom, B., Skinner, J. S., ... & Deyo, R. A. (2006). Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial. Jama, 296(20), 2441-2450.
• Yakut, E., Düger, T., Öksüz, Ç., Yörükan, S., Üreten, K., Turan, D., ... & Yakut, Y. (2004). Validation of the Turkish version of the Oswestry Disability Index for patients with low back pain. Spine, 29(5), 581-585.
• Yakut, Y., Yakut, E., Bayar, K., & Uygur, F. (2007). Reliability and validity of the Turkish version short-form McGill pain questionnaire in patients with rheumatoid arthritis. Clinical rheumatology, 26(7), 1083-1087.
• Yılmaz, F., Yılmaz, A., Merdol, F., Parlar, D., Sahin, F., & Kuran, B. (2003). Efficacy of dynamic lumbar stabilization exercise in lumbar microdiscectomy. J Rehabil Med, 35, 163-167.
• 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.
• Yozbatiran, N., Yildirim, Y., & Parlak, B. (2004). Effects of fitness and aquafitness exercises on physical fitness in patients with chronic low back pain. The Pain Clinic, 16(1), 35-42.