Multiple skleroz hastalarında düşme sıklığının araştırılması ve belirleyicilerinin tespit edilmesi
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Tarih
2023
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Yayıncı
İzmir Bakırçay Üniversitesi Lisansüstü Eğitim Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Düşme, MS'li bireylerde sık gözlenen, ciddi bir sağlık sorunudur. Düşmenin algılanan nedenlerinin ve niteliğinin daha iyi anlaşılması düşmeleri önlemek için yönetim stratejilerinin oluşturulmasını kolaylaştırır. Bu nedenle çalışmanın amacı, MS hastalarında düşme sıklığını belirlemek ve düşmenin belirleyicilerini tespit etmektir. Gereç – Yöntem: Araştırmaya 87 MS'li birey dahil edildi. Araştırmada kullanılan anket ve değerlendirme yöntemleri yüz yüze olarak tek bir görüşmede toplandı. Katılımcıların klinik ve demografik bilgileri MS değerlendirme formuna kaydedildi. Bireylerin yürüyüşlerini değerlendirmek için 12 Maddeli MS Yürüme Ölçeği (12-MSYÖ), Zamanlı 25 Adım Yürüme Testi (Z25YT), Zamanlı Kalk ve Yürü Testi (ZKYT) ve 6 Dakika Yürüme Testi (6DYT) kullanıldı. Katılımcılarda denge Aktiviteye Özgü Denge Güven Ölçeği (AÖDGÖ) ve Dinamik Yürüme İndeksi (DYİ) kullanılarak, düşme korkusu Uluslararası Düşme Etkinlik Ölçeği (UDEÖ) kullanılarak, alt ekstremite kas kuvveti Beş Tekrarlı Oturup Kalkma Testi (5xOKT) kullanılarak ve yorgunluk ise Modifiye Yorgunluk Etki Ölçeği (MYEÖ) kullanılarak değerlendirildi. Katılımcılara 3 ay boyunca düşmelerini kaydetmeleri için bir takip çizelgesi verildi ve her ayın sonunda doldurulan çizelgelerin araştırmacıya internet yoluyla iletilmesi istendi. Bulgular: Araştırmaya yaş ortalaması 40 olan 71 kadın, 16 erkek MS'li birey dahil edilmiştir. Katılımcıların retrospektif 3 aydaki düşme oranı %32,19 iken prospektif 3 aydaki düşme oranı %27,58'dir. Düşen bireylerin düşmeyenlere kıyasla yürüme hızları (p=0,037) ve mesafelerinin (p=0,001) anlamlı ölçüde azaldığı, alt ekstremite kas kuvvetlerinin de (p=0,009) daha zayıf olduğu saptandı. Düşen bireyler farklı aktiviteler sırasında dengelerine daha az güvendiğini belirtti (p=0,000). Buna ek olarak düşen bireylerin dengeleri daha zayıfken (p=0,003), düşme korkuları (p=0,000) ve yorgunluk düzeylerinin (p=0,002) ise istatistiksel olarak anlamlı derecede daha fazla olduğu bulundu. Düşmelerin nitelikleri incelendiğinde MS'li bireylerin en sık öğle saatlerinde, iç mekanlarda ve ayakları takıldığı için düştüğü saptandı. ZKYT, AÖDGÖ, 5xOKT ve MYEÖ'yü bağımsız değişkenler olarak içeren lojistik regresyon modeli düşme olasılığındaki varyansın %41,8'ini açıkladı ve vakaların %79'unu doğru şekilde sınıflayabildi. Modele istatistiksel olarak anlamlı katkı sağlayan tek değişken AÖDGÖ' ydü. Yalnızca AÖDGÖ'yü bağımsız değişken olarak içeren model ise düşme olasılığındaki varyansın %40,7'sini açıkladı ve vakaların %79'unu doğru şekilde sınıflayabildi. Sonuç: MS'li bireylerin düşme niteliklerinin bilinmesi düşmeleri önlemek için önemlidir. MS'li bireylerde düşmeleri önlemek amacıyla yapılan fizyoterapi ve rehabilitasyon müdahalelerinde bireylerin en sık neden, nasıl ve nerede düştüğü bilgisi fizyoterapistler için rehabilitasyon programı oluşturmada yol gösterici olacaktır. Fizyoterapistlerin MS'li bireylerde AÖDGÖ ölçeğini kullanması, düşme riski yüksek olanları belirlemeye yardımcı olabilir.
Objective: Falling is a serious health problem that is frequently observed in individuals with MS. A better understanding of the perceived causes and nature of falls facilitates the establishment of management strategies to prevent falls. Therefore, the aim of the study is to determine the frequency of falls in MS patients and to identify the determinants of falls. Materials and Methods: Eigthy-seven individuals with MS were included in the study. The questionnaire and evaluation methods used in the research were collected in a single interview face-to-face. The clinical and demographic information of the participants were recorded in the MS evaluation form. The 12-Item Multiple Sclerosis Walking Scale (12-MSWS), the Timed 25-Foot Walk (T25-FW), the Timed Up and Go Test (TUG), and the 6 Minute Walk Test (6MWT) were used to evaluate individuals' gait. Participants were evaluated with the Activity-Specific Balance Confidence Scale (ABC) and Dynamic Gait Index (DGI) for balance; International Fall Efficiency Scale (FES-I) for fear of falling; Five-Repeat Sit-Up Test (5xSTS) for lower extremity muscle strength and Modified Fatigue Impact Scale (MFIS) for fatigue. Participants were given a follow-up chart to record their falls for 3 months, and at the end of each month, the completed charts were requested to be forwarded to the researcher via the internet. Results: Seventy-one female and sixteen male people with MS with an average age of 40 were included in the study. While the fall rate of the participants in the retrospective 3 months was 32.19%, the fall rate in the prospective 3 months was 27.58%. It was determined that the walking speed (p=0.037) and distance (p=0.001) of the individuals who fell were significantly reduced compared to those who did not fall, and their lower extremity muscle strength was also weaker (p=0.009). Falling individuals stated that they had less confidence in their balance during different activities (p=0.000). In addition, it was found that individuals who fell had weaker balance (p=0.003), while their fear of falling (p=0.000) and fatigue levels (p=0.002) were statistically significantly higher. When the characteristics of falls were examined, it was found that individuals with MS fell most frequently at noon, indoors and because their feet were tripped. The logistic regression model, which included TUG, ABC, 5xSTS, and MFIS as independent variables, explained 41.8% of the variance in the probability of falling and was able to correctly classify 79% of the cases. The only variable that made a statistically significant contribution to the model was ABC scale. The model, which included only ABC scale as an independent variable, explained 40.7% of the variance in the probability of falling and was able to correctly classify 79% of the cases. Conclusion: Knowing the fall characteristics of individuals with MS is important to prevent falls. In the physiotherapy and rehabilitation interventions performed to prevent falls in individuals with MS, the knowledge of the most common why, how and where individuals fall will be a guide for physiotherapists in creating a rehabilitation program. Physiotherapists' use of the ABC scale in individuals with MS can help identify those at high risk of falling.
Objective: Falling is a serious health problem that is frequently observed in individuals with MS. A better understanding of the perceived causes and nature of falls facilitates the establishment of management strategies to prevent falls. Therefore, the aim of the study is to determine the frequency of falls in MS patients and to identify the determinants of falls. Materials and Methods: Eigthy-seven individuals with MS were included in the study. The questionnaire and evaluation methods used in the research were collected in a single interview face-to-face. The clinical and demographic information of the participants were recorded in the MS evaluation form. The 12-Item Multiple Sclerosis Walking Scale (12-MSWS), the Timed 25-Foot Walk (T25-FW), the Timed Up and Go Test (TUG), and the 6 Minute Walk Test (6MWT) were used to evaluate individuals' gait. Participants were evaluated with the Activity-Specific Balance Confidence Scale (ABC) and Dynamic Gait Index (DGI) for balance; International Fall Efficiency Scale (FES-I) for fear of falling; Five-Repeat Sit-Up Test (5xSTS) for lower extremity muscle strength and Modified Fatigue Impact Scale (MFIS) for fatigue. Participants were given a follow-up chart to record their falls for 3 months, and at the end of each month, the completed charts were requested to be forwarded to the researcher via the internet. Results: Seventy-one female and sixteen male people with MS with an average age of 40 were included in the study. While the fall rate of the participants in the retrospective 3 months was 32.19%, the fall rate in the prospective 3 months was 27.58%. It was determined that the walking speed (p=0.037) and distance (p=0.001) of the individuals who fell were significantly reduced compared to those who did not fall, and their lower extremity muscle strength was also weaker (p=0.009). Falling individuals stated that they had less confidence in their balance during different activities (p=0.000). In addition, it was found that individuals who fell had weaker balance (p=0.003), while their fear of falling (p=0.000) and fatigue levels (p=0.002) were statistically significantly higher. When the characteristics of falls were examined, it was found that individuals with MS fell most frequently at noon, indoors and because their feet were tripped. The logistic regression model, which included TUG, ABC, 5xSTS, and MFIS as independent variables, explained 41.8% of the variance in the probability of falling and was able to correctly classify 79% of the cases. The only variable that made a statistically significant contribution to the model was ABC scale. The model, which included only ABC scale as an independent variable, explained 40.7% of the variance in the probability of falling and was able to correctly classify 79% of the cases. Conclusion: Knowing the fall characteristics of individuals with MS is important to prevent falls. In the physiotherapy and rehabilitation interventions performed to prevent falls in individuals with MS, the knowledge of the most common why, how and where individuals fall will be a guide for physiotherapists in creating a rehabilitation program. Physiotherapists' use of the ABC scale in individuals with MS can help identify those at high risk of falling.
Açıklama
Anahtar Kelimeler
Fizyoterapi ve Rehabilitasyon, Physiotherapy and Rehabilitation, Multiple Sclerosis, Fall, Falling risk, Balance, Gait, Multiple Skleroz, Düşme, Düşme riski, Denge, Yürüme
