PERİFERAL VESTİBÜLER HİPOFONKSİYONDA VERTİGO, DİZZİNESS VE DENGE BOZUKLUĞU İLE FİZİKSEL AKTİVİTE, EGZERSİZ KAPASİTESİ, GÜNLÜK YAŞAM AKTİVİTELERİ VE YAŞAM KALİTESİ ARASINDAKİ İLİŞKİ

Öz

Amaç: Periferik vestibüler hipofonksiyon’da (PVH) vertigo (V), dizziness (D) ve denge bozukluğu çeşitli fonksiyonel limitasyonlara ve inaktiviteye neden olur. Bu çalışmanın amacı, PVH’li hastalarda V, D, denge bozukluğu, fiziksel aktivite düzeyi, fonksiyonel egzersiz kapasitesi, günlük yaşam aktiviteleri (GYA) ve yaşam kalitesi (YK) arasındaki ilişkiyi araştırmaktı. Yöntem: Otuz dokuz PVH hastası ve PVH hastası olmayan 32 birey çalışmaya dahil edildi. V/D şiddeti ve sıklığı Vizüel Analog Skalası (VAS) ve denge Modifiye Kliniğine Uyarlanmış Denge-Duyusal Etkileşim Testi (M-CTSIB) ve Aktiviteye Spesifik Denge Güvenlik Ölçeği (ABC) ile değerlendirildi. Fiziksel aktivite düzeyi Uluslararası Fiziksel Aktivite Anketi (UFAA) ve fonksiyonel egzersiz kapasitesi altı dakika yürüme testi (6DKYT) ile ölçüldü. GYA Vestibüler Bozukluklarda Günlük Yaşam Aktiviteleri Ölçeği (VGYA) ve YK Baş Dönmesi Engellilik Envanteri (BEE) ile değerlendirildi. Sonuçlar: PVH'li hastalarda M-CTSIB, ABC, UFAA, 6DYT, VGYA ve BEE skorlarının kontrol grubuna göre daha düşük olduğu görüldü (p<0,05). V şiddeti ve frekansı UFAA (r=-0,602, r=-0,321), VGYA (r=0,626, r=0,492) ve BEE (r=0,640, r=0,578) ile ilişkili bulundu (p<0,05). D şiddet ve frekansı UFAA (r=-0,493 and r=-0,487), VGYA (r=0,565 and r=0,408) ve BEE (r=0,627 and r=0,566) ile korele idi (p<0,05). V ve D şiddeti 6DYT ile ilişkili idi (sırasıyla; r=-0,339 ve r=-0,336, p<0,05). Somatosensör ve görsel duyular azaldığı zaman; denge 6DYT (r=-0,412); VGYA (r=0,545) ve BEE (r=0,422) ile ilişkili bulundu (p<0,05). Tartışma: PVH'de V, D ve denge bozukluğu fiziksel aktivite düzeyi, fonksiyonel egzersiz kapasitesi, GYA ve YK ile ilişkilidir. Vestibüler rehabilitasyon programlarının, fiziksel aktivite ve fonksiyonel egzersiz kapasitesinin iyileştirilmesine etkisini araştıran ileri çalışmalara ihtiyaç bulunmaktadır.

Anahtar Kelimeler

• Günlük Yaşam Aktiviteleri; Dizziness; Fonksiyonel Egzersiz Kapasitesi; Periferal Vestibüler Hipofonksiyon; Fiziksel Aktivite Düzeyi

RELATION OF VERTIGO, DIZZINESS, AND IMBALANCE WITH PHYSICAL ACTIVITY, EXERCISE CAPACITY, ACTIVITIES OF DAILY LIVING, AND QUALITY OF LIFE IN PERIPHERAL VESTIBULAR HYPOFUNCTION

Abstract

Purpose: Vertigo (V), dizziness (D), and imbalance cause functional limitation and participation in peripheral vestibular hypofunction (PVH). The aim was to investigate the relation of V, D, imbalance, with physical activity, exercise capacity, activities of daily living (ADL), and quality of life (QoL) in patients with PVH. Methods: Thirty-nine subjects with and 32 without PVH were included. The V and D severity and frequency using Visual Analogue Scale (VAS), balance using Modified Clinical Test of Sensory Interaction and Balance (M-CTSIB), and Activity Specific Balance Confidence Scale (ABC) were assessed. Physical activity using the International Physical Activity Questionnaire (IPAQ) and functional exercise capacity using the 6-minute walk test (6MWT) were evaluated. ADL using the Vestibular Disorders ADL Scale (VADL) and QoL using the Dizziness Handicap Inventory (DHI) were determined. Results: M-CTSIB, ABC, IPAQ, 6MWT, VADL, and DHI were lower in patients with PVH as compared to the control group (p<0.05). V-severity and -frequency were related to IPAQ (r=-0.602 and r=-0.321), VADL (r=0.626 and r=0.492), and DHI (r=0.640 and r=0.578, respectively, p<0.05). Both D-severity and -frequency was correlated with IPAQ (r=-0.493 and r=-0.487), VADL (r=0.565 and r=0.408), and DHI (r=0.627 and r=0.566, respectively, p<0.05). V- and D-severity was associated with 6MWT (r=-0.339 and r=-0.336, respectively, p<0.05). When somatosensory and visual sensations decreased, the balance was correlated with 6MWT (r=-0.412), VADL (r=0.545), and DHI (r=0.422, p<0.05). Conclusion: The V, D, and imbalance are associated with physical activity level, functional exercise capacity, ADL, and QoL in PVH. Further study is needed to investigate the effects of vestibular rehabilitation programs to improve physical activity and functional exercise capacity.

Keywords

• postural balance
• vertigo
• dizziness

Kaynakça

1. 1. McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev. 2015;13(1):1-115.
2. 2. Alghadir AH, Iqbal ZA, Whitney SL. An update on vestibular physical therapy. J Chin Med Assoc. 2013;76(1):1-8.
3. 3. Han BI, Song HS, Kim JS. Vestibular rehabilitation therapy: review of indications, mechanisms, and key exercises. J Clin Neurol. 2011;7(4):184-96.
4. 4. Hall CD, Herdman SJ, Whitney SL, Cass SP, Clendaniel RA, Fife TD, et al. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline: FROM THE AMERICAN PHYSICAL THERAPY ASSOCIATION NEUROLOGY SECTION. J Neurol Phys Ther. 2016;40(2):124-55.
5. 5. Ekwall A, Lindberg Å, Magnusson M. Dizzy–why not take a walk? Low level physical activity improves quality of life among elderly with dizziness. Gerontology. 2009;55(6):652-9.
6. 6. Kollén L, Hörder H, Möller C, Frändin K. (2016). Physical functioning in older persons with dizziness: a population-based study. Aging Clin Exp Res. 2017;29(2):197-205.
7. 7. Ward BK, Agrawal Y, Hoffman HJ, Carey JP, Della Santina CC. Prevalence and impact of bilateral vestibular hypofunction: results from the 2008 US National Health Interview Survey. JAMA Otolaryngol Head Neck Surg. 2013;139(8):803-10.
8. 8. Gill-Body KM, Beninato M, Krebs DE. Relationship among balance impairments, functional performance, and disability in people with peripheral vestibular hypofunction. Phys Ther. 2000;80(8):748-58.

9. 9. Santos EM, Gazzola JM, Ganança CF, Caovilla HH, Ganança FF. Impact of dizziness on the life quality of elderly with chronic vestibulopathy. Pro Fono. 2010;22(4):427-32.
10. 10. Cohen HS, Kimball KT. Changes in a repetitive head movement task after vestibular rehabilitation. Clin Rehabil. 2004;18(2):125-31.
11. 11. BioSway Portable Balance System Operations Manual [Web site]. Available at: http://www.biodex.com/sites/default/files/950460man_10202revd.pdf. Accessed Sep 4, 2019.
12. 12. Powell LE, Myers AM. The Activities-specific Balance Confidence (ABC) Scale. J Gerontol A Biol Sci Med Sci. 1995;50(1):28-34.
13. 13. Karapolat H, Eyigor S, Kirazli Y, Celebisoy N, Bilgen C, Kirazli T. Reliability, validity, and sensitivity to change of Turkish Activities-specific Balance Confidence Scale in patients with unilateral peripheral vestibular disease. Int J Rehabil Res. 2010;33(1):12-8.
14. 14. American Thoracic Society. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111–7.
15. 15. Gibbons WJ, Fruchter N, Sloan S, Levy RD. Reference values for a multiple repetition 6-minute walk test in healthy adults older than 20 years. J Cardiopulm Rehabil. 2001;21(2):87-93.
16. 16. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381-95.
17. 17. Saglam M, Arikan H, Savci S, Inal-Ince D, Bosnak-Guclu M, Karabulut E, et al. International physical activity questionnaire: reliability and validity of the Turkish version. Percept Mot Skills. 2010;111(1):278-84.
18. 18. Cohen HS. Use of the Vestibular Disorders Activities of Daily Living Scale to describe functional limitations in patients with vestibular disorders. J Vestib Res. 2014;24(1):33-8.
19. 19. Çiçek Çınar B, Kaya Ş, Pektaş Sjöstrand A, Alpar R, Aksoy S. Vestibüler Bozukluklarda Günlük Yaşam Aktiviteleri Ölçeği Türkçe Geçerlik ve Güvenirlik Çalışması. Turk J Physiother Rehabil. 2017; 28(1)1-11.
20. 20. Jacobson GP, Newman CW. The development of the dizziness handicap inventory. Arch Otolaryngol Head Neck Surg. 1990;116(4):424-7.
21. 21. Karapolat H, Eyigor S, Kirazlı Y, Celebisoy N, Bilgen C, Kirazli T. Reliability, Validity and Sensitivity to Change of Turkish Dizziness Handicap Inventory (DHI) in Patients with Unilateral Peripheral Vestibular Disease. J Int Adv Otol. 2009;5(2):237-45.
22. 22. Hu M, Chen T, Dong H, Wang W, Xu K, Lin P. Clinical values of the sensory organization test in vestibular diseases. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015;50(9):712-7.
23. 23. Cohen HS, Kimball KT, Adams AS. Application of the vestibular disorders activities of daily living scale. Laryngoscope. 2000;110(7):1204-9.
24. 24. Guinand N, Boselie F, Guyot JP, Kingma H. Quality of life of patients with bilateral vestibulopathy. Ann Otol Rhinol Laryngol. 2012;121(7):471-7.
25. 25. Neuhauser HK, von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, et al. Epidemiology of vestibular vertigo: a neurotologic survey of the general population. Neurology. 2005;65(6):898-904.
26. 26. Grigol TA, Silva AM, Ferreira MM, Manso A, Ganança MM, Caovilla HH. Dizziness Handicap Inventory and Visual Vertigo Analog Scale in Vestibular Dysfunction. Int Arch Otorhinolaryngol. 2015;20(3):241-3.