MEME KANSERLİ HASTALARDA ADJUVAN RADYOTERAPİ ÖNCESİ ÜST EKSTREMİTE FONKSİYONELLİĞİNİN BELİRLEYİCİLERİ: KESİTSEL GÖZLEMSEL BİR ÇALIŞMA

Öz

Amaç: Meme kanserli hastalarda kapsamlı cerrahiler omuz hareketliliğinde ve üst ekstremitede kas gücünde azalmaya yol açmaktadır. Ameliyat sonrası ağrı ve ağrıya bağlı kinezyofobi de fonksiyonel bozukluklara neden olmaktadır. Bu çalışmanın amacı meme kanserli hastalarda omuz hareketliliği, kas gücü, ağrı ve kinezyofobinin üst ekstremite işlevselliği ile ilişkisini araştırmaktır. Yöntem: Bu kesitsel çalışmaya meme kanseri ameliyatından sonraki ilk 6 ay içinde olan aksiller lenf nodu diseksiyonu yapılan 89 hasta dahil edildi. Omuz eklem hareket açıklığı (EHA) dijital bir gonyometre, kas gücü manuel bir dinamometre, işlevsellik ise Kol Omuz ve El Sorunları (DASH) ölçeği kullanılarak değerlendirildi. Kinezyofobi ve ağrı yoğunluğunu değerlendirmek için sırasıyla Tampa Kinezyofobi Ölçeği (TKÖ) ve Görsel Analog Skala (GAS) kullanıldı. Bulgular: Çok değişkenli regresyon modellerinde, omuz abdüksiyon derecesi (β±SE=0.20 ± 0.09, p=0.028) ve iç rotasyon kas kuvvetindeki (β±SE=4.62± 1.51, p=0.003) artış, omuz işlevselliğinin önemli bağımsız belirleyicileriydi. Artmış kinezyofobi (β±SE=0.69± 0.28, p=0.016) ve ağrı düzeyi (β±SE=2.90±0.68, p=0.000) üst ekstremite fonksiyonel yetersizliği ile anlamlı şekilde ilişkiliydi. DASH skoru omuz fleksiyon (r=0.3), abdüksiyon (r=0.4) ve iç rotasyon (r=0.3) EHA ve omuz iç rotasyon kas gücü (r=0.4) ile negatif korelasyon gösterirken, TKS skoru (r=0.4) ve VAS (r=0.5) ile pozitif korelasyon gösterdi. Sonuç: Omuz abdüksiyon ROM'unun ve iç rotasyon kas gücünün artırılması, azalmış üst ekstremite işlevselliğini geri kazanmada daha üstün görünmektedir. Ağrı en kısıtlayıcı semptomdur, bu nedenle ağrı ile başa çıkma stratejileri rehabilitasyon programlarına entegre edilebilir ve rehabilitasyon sürecinde hastaların kinezyofobi düzeyleri göz önünde bulundurulmalıdır.

Anahtar Kelimeler

• Meme kanseri
• üst ekstremite
• fonksiyonellik
• kinezyofobi

DETERMINANTS OF UPPER EXTREMITY FUNCTIONALITY BEFORE ADJUVANT RADIOTHERAPY IN PATIENTS WITH BREAST CANCER: A CROSS-SECTIONAL OBSERVATIONAL STUDY

Abstract

Purpose: Comprehensive surgeries lead to decreased shoulder mobility and muscle strength in the upper extremity in patients with breast cancer. Post-operative pain and pain-related kinesiophobia also cause functional impairments. This study aimed was to investigate the relationship between shoulder mobility, muscle strength, pain, and kinesiophobia with upper extremity functionality. Methods: This cross-sectional study involved 89 patients undergoing axillary lymph node dissection within the first 6 months after breast cancer surgery. Shoulder range of motion (ROM) was evaluate using a digital goniometer, muscle strength with a manual dynamometer, functionality via the Disabilities of the Arm Shoulder and Hand (DASH) scale. The Tampa Kinesiophobia Scale (TKS) and Visual Analog Scale (VAS) were used to assess kinesophobia and pain intensity, respectively. Results: In multivariable regression models, the increased degree of shoulder abduction (β±SE=0.20 ± 0.09, p=0.028), and internal rotation muscle strength (β±SE=4.62± 1.51, p=0.003), were important independent predictors of shoulder functionality. Increased kinesiophobia (β±SE=0.69± 0.28, p=0.016), and pain level (β±SE=2.90±0.68, p=0.000) were significantly associated with upper extremity functional disability. DASH score was negatively correlated with shoulder flexion (r=0.3), abduction (r=0.4), and internal rotation (r=0.3) ROM and shoulder internal rotation muscle strength (r=0.4), but positively correlated with TKS score (r=0.4) and VAS (r=0.5). Conclusion: Increasing shoulder abduction ROM and internal rotation muscle strength seems superior to restoring the decreased upper extremity functionality. Pain is the most restrictive symptom so coping management strategies with pain can be integrated into the rehabilitation programs, and kinesiophobia levels of the patients should be considered during the rehabilitation process.

Keywords

• Breast cancer
• upper extremity
• functionality
• kinesiophobia

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