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

Yıl 2022, Cilt: 2 Sayı: 3, 60 - 67, 30.09.2022

Ender Ersin Avcı , Gazi Akgün , Eren Timurtaş , Esat Uygur , Mine Gülden Polat , İlkşan Demirbüken

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

-/-

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

Kaynakça

• Arslan BÇ, Erdoğanoğlu Y, Irgıt SK, Büyüktopçu Ö. Talus osteokondral lezyonlu hastalarda ağrı şiddeti ve taban altı basınç duyusu, postüral kontrol ve işlevsel seviyeyi etkiler mi?. 2021: Proceedigs of the 4th International Health Science and Life Congress; 2021 Kasım 4-6; Diyarbakır, Türkiye.
• Asmundson GJ, Norton PJ, Norton GR. Beyond pain: the role of fear and avoidance in chronicity. Clin Psychol Rev. 1999;19(1):97-119.
• Becher C, Thermann H. Results of microfracture in the treatment of articular cartilage defects of the talus. Foot Ankle Int. 2005;26(8):583-589.
• Bolton JE, Wilkinson RC. Responsiveness of pain scales: a comparison of three pain intensity measures in chiropractic patients. J Manipulative Physiol Ther. 1998;21(1):1-7.
• Cotchett M, Lennecke A, Medica VG, Whittaker GA, Bonanno DR. The association between pain catastrophising and kinesiophobia with pain and function in people with plantar heel pain. The Foot. 2017; 32:8-14.
• Deal Jr JB, Patzkowski JC, Groth AT, Ryan PM, Dowd TC, Osborn PM, ve ark. Early vs delayed weightbearing after microfracture of osteochondral lesions of the talus: a prospective randomized trial. Foot & ankle orthopaedics. 2019;4(2):832-838.
• Demirbüken I, Özgül B, Arıkan E, Tonga E, Polat M. Kinesiophobia Affects Range of Knee Flexion at Early Stage Following Anterior Cruciate Ligament Reconstruction. BMJ Publishing Group Ltd; 2016; 1279.
• Demirbuken I, Ozgul B, Kuru Colak T, Aydogdu O, Sari Z, Yurdalan SU. Kinesiophobia in relation to physical activity in chronic neck pain. J Back Musculoskelet Rehabil. 2016;29(1):41-7.
• Doral MN, Bilge O, Batmaz G, Donmez G, Turhan E, Demirel M, ve ark. Treatment of osteochondral lesions of the talus with microfracture technique and postoperative hyaluronan injection. Knee Surg Sports Traumatol Arthrosc. 2012;20(7):1398-403.
• Feigenbaum LA, Baraga M, Kaplan LD, Roach KE, Calpino KM, Dorsey K, ve ark. Return to Sport Following Surgery for a Complicated Tibia and Fibula Fracture in a Collegiate Women's Soccer Player with a Low Level of Kinesiophobia. Int J Sports Phys Ther. 2015;10(1):95-103.
• Güney-Deniz H, Irem Kınıklı G, Çağlar Ö, Atilla B, Yüksel İ. Does kinesiophobia affect the early functional outcomes following total knee arthroplasty? Physiotherapy theory and practice. 2017;33(6):448-453.
• Hannon CP, Smyth NA, Murawski CD, Savage-Elliott I, Deyer TW, Calder JD, ve ark. Osteochondral lesions of the talus: aspects of current management. Bone Joint J. 2014;96-B(2):164-171.
• Heida Jr KA, Tihista MC, Kusnezov NA, Dunn JC, Orr JD. Outcomes and predictors of postoperative pain improvement following particulated juvenile cartilage allograft transplant for osteochondral lesions of the talus. Foot & Ankle International. 2020;41(5):572-581.
• Hintermann B, Regazzoni P, Lampert C, Stutz G, Gachter A. Arthroscopic findings in acute fractures of the ankle. J Bone Joint Surg Br. 2000;82(3):345-351.
• Hurkmans HL, Bussmann JB, Benda E, Verhaar JA, Stam HJ. Effectiveness of audio feedback for partial weight-bearing in and outside the hospital: a randomized controlled trial. Arch Phys Med Rehabil. 2012;93(4):565-570.
• Hustedt JW, Blizzard DJ, Baumgaertner MR, Leslie MP, Grauer JN. Current advances in training orthopaedic patients to comply with partial weight-bearing instructions. Yale J Biol Med. 2012;85(1):119-125.
• Jamshidi AA, Kamali M, Akbari M, Nazari S, Razi M. The effect of functional tests on kinesiophobia in anterior cruciate ligament-deficient patients with similar quadriceps strength to healthy controls. Journal of Modern Rehabilitation. 2016;10(2):67-73.
• Kori S. Kinesiophobia: a new view of chronic pain behavior. Pain Manage. 1990;3:35-43. Lentz TA, Sutton Z, Greenberg S, Bishop MD. Pain-related fear contributes to self-reported disability in patients with foot and ankle pathology. Arch Phys Med Rehabil. 2010;91(4):557-661.
• Leontaritis N, Hinojosa L, Panchbhavi VK. Arthroscopically detected intra-articular lesions associated with acute ankle fractures. J Bone Joint Surg Am. 2009;91(2):333-339.
• Lundberg M, Larsson M, Ostlund H, Styf J. Kinesiophobia among patients with musculoskeletal pain in primary healthcare. Journal of rehabilitation medicine. 2006;38(1):37-43.
• Mussig JA, Brand A, Kroger I, Klopfer-Kramer I, Augat P. Effects of assistive insole feedback training on immediate and multi-day partial weight bearing retention during walking: A pilot study. Gait Posture. 2022;93:78-82.
• Norte GE, Solaas H, Saliba SA, Goetschius J, Slater LV, Hart JM. The relationships between kinesiophobia and clinical outcomes after ACL reconstruction differ by self-reported physical activity engagement. Physical Therapy in Sport. 2019;40:1-9.
• O'Loughlin PF, Heyworth BE, Kennedy JG. Current concepts in the diagnosis and treatment of osteochondral lesions of the ankle. Am J Sports Med. 2010;38(2):392-404.
• Pinsker E, Daniels TR. AOFAS position statement regarding the future of the AOFAS Clinical Rating Systems. Foot & ankle international. 2011;32(9):841-842.
• Polat G, Ersen A, Erdil ME, Kizilkurt T, Kilicoglu O, Asik M. Long-term results of microfracture in the treatment of talus osteochondral lesions. Knee Surg Sports Traumatol Arthrosc. 2016;24(4):1299-1303.
• Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17(1):45-56.
• Richter M, Agren P-H, Besse J-L, Cöster M, Kofoed H, Maffulli N, ve ark. EFAS Score—Multilingual development and validation of a patient-reported outcome measure (PROM) by the score committee of the European Foot and Ankle Society (EFAS). Foot and Ankle Surgery. 2018;24(3):185-204.
• Richter M, Agren PH, Besse JL, Coester M, Kofoed H, Maffulli N, ve ark. EFAS Score - validation of Finnish and Turkish versions by the Score Committee of the European Foot and Ankle Society (EFAS). Foot Ankle Surg. 2020;26(3):250-253.
• Savage-Elliott I, Ross KA, Smyth NA, Murawski CD, Kennedy JG. Osteochondral lesions of the talus: a current concepts review and evidence-based treatment paradigm. Foot Ankle Spec. 2014;7(5):414-422.
• Saxena A, Eakin C. Articular talar injuries in athletes: results of microfracture and autogenous bone graft. Am J Sports Med. 2007;35(10):1680-1687.
• Sengul YS, Unver B, Karatosun V, Gunal I. Assessment of pain-related fear in patients with the thrust plate prosthesis (TPP): Due to hip fracture and hip osteoarthritis. Archives of Gerontology and Geriatrics. 2011;53(2):249-252.
• Theunissen W, van der Steen MC, Liu WY, Janssen RPA. Timing of anterior cruciate ligament reconstruction and preoperative pain are important predictors for postoperative kinesiophobia. Knee Surg Sports Traumatol Arthrosc. 2020;28(8):2502-2510.
• Turhan B, Usgu G, Usgu S, Çınar MA, Dinler E, Kocamaz D. Investigation of Kinesiophobia, State and Trait Anxiety Levels in Patients with Lower Extremity Ligament Injury or Fracture History. Spor Hekimligi Dergisi/Turkish Journal of Sports Medicine. 2019;54(3).
• van Dijk CN, Reilingh ML, Zengerink M, van Bergen CJ. The natural history of osteochondral lesions in the ankle. Instr Course Lect. 2010;59:375-86.
• van Eekeren IC, Reilingh ML, van Dijk CN. Rehabilitation and return-to-sports activity after debridement and bone marrow stimulation of osteochondral talar defects. Sports Med. 2012;42(10):857-870.
• Verghese N, Morgan A, Perera A. Osteochondral lesions of the talus: defining the surgical approach. Foot Ankle Clin. 2013;18(1):49-65.
• Vlaeyen JW, Kole-Snijders AM, Boeren RG, Van Eek H. Fear of movement/(re) injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62(3):363-372.
• Yildiz S, Kirdi E, Bek N. Comparison of the lower extremity function of patients with foot problems according to the level of kinesiophobia. Somatosens Mot Res. 2020;37(4):284-287.
• Yilmaz ÖT, Yakut Y, Uygur F, Uluğ N. Tampa Kinezyofobi Ölçeği’nin Türkçe versiyonu ve test-tekrar test güvenirliği. Fizyoterapi Rehabilitasyon. 2011;22(1):44-49.