Selmin GÜLBAHAR, RASİM HALUK BERK, Elif PEHLİVAN, EMİNE ÖZLEM ŞENOCAK, Ömer AKÇALI, Can KOŞAY, Ayşe GÜRCAN, Serap ALPER

Lomber spinal stenozda objektif ve subjektif değerlendirme ölçütleri arasındaki ilişki

Amaç: Lomber spinal stenozda (LSS), objektif fonksiyonel değerlendirme, hasta odaklı subjektif değerlendirme ve yaşam kalitesi ölçütleri arasındaki ilişki araştırıldı. Çalışma planı: Çalışmaya, klinik ve radyolojik olarak LSS tanısı konan 30 hasta (25 kadın, 5 erkek; ort. yaş 62±9; dağılım 41-78) alındı. Ağrı değerlendirilmesi için görsel analog skala kullanıldı. Hastalar ayrıca, iki aşamalı yürüme bandı egzersiz tolerans (YBET) testi, Short Form–36 (SF-36) yaşam kalitesi sorgulama anketi, Oswestry dizabilite indeksi (ODİ) kullanılarak değerlendirildi. Objektif bir fonksiyonel değerlendirme yöntemi olan YBET testi ile hasta odaklı subjektif değerlendirme yöntemleri olan SF-36 anketi ve ODİ, yaş ve ağrı şiddeti arasındaki ilişki araştırıldı. Sonuçlar: Hastaların YBET testinde 1.9 km/saat hızdaki fonksiyonel evreleri arasında, ODİ, SF-36’nın fiziksel komponent skalası, yaş ve tercih ettikleri hızlar açısından anlamlı farklılık saptandı (p

Anahtar Kelimeler:

Testlerin kestirim değeri, Özürlülük değerlendirmesi, Engelli kişiler, Ağrı ölçümü, Spinal stenoz, Egzersiz tepkisizliği, Egzersiz testi, Yaşam kalitesi, İleriye dönük çalışma, Lumbar omurga

The relationship between objective and subjective evaluation criteria in lumbar spinal stenosis

Objectives: We evaluated the relationship between functional objective and patient-based subjective assessments and quality of life in patients with lumbar spinal stenosis (LSS). Methods: Thirty patients (25 females, 5 males; mean age 62±9 years; range 41-78 years) were prospectively studied. All were diagnosed as having LSS by clinical and radiological evaluations. Pain was assessed by a visual analog scale. The patients were evaluated by two-staged treadmill exercise tolerance (TET) test, SF-36 health status survey, and Oswestry Disability Index (ODI). The relationships between the TET test, which is an objective functional assessment, and patient-based assessments (SF-36 and ODI), pain and age were investigated. Results: There were significant differences between the functional grades of the patients at the speed of 1.9 km/hour with respect to ODI scores, the physical component scale of SF-36, age, and the preferred speed of the patients (p<0.05). These differences emerged from the fourth functional stage (p<0.01). Oswestry disability scores and the physical component scores of SF-36 worsened in parallel with the stages of the TET test. The preferred speed of the patients at the TET test was positively correlated with the physical component scores of SF-36 and negatively correlated with Oswestry disability scores (p<0.05). There was a negative correlation between the physical component scores of SF-36 and Oswestry disability scores (p<0.05). Conclusion: The TET test used to determine the functional capacity seems to be correlated well with subjective patientbased assessments. This objective tool, when combined with subjective assessments, may be helpful in the evaluation and treatment of patients with LSS.

Keywords:

Predictive Value of Tests, Disability Evaluation, Disabled Persons, Pain Measurement, Spinal Stenosis, Exercise Tolerance, Exercise Test, Quality of Life, Prospective Studies, Lumbar Vertebrae,

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1. McGregor AH, Hughes SP. The evaluation of the surgical management of nerve root compression in patients with low back pain: Part 1: the assessment of outcome. Spine 2002;27:1465-70.
2. Fritz JM, Erhard RE, Vignovic M. A nonsurgical treatment approach for patients with lumbar spinal stenosis. Phys Ther 1997;77:962-73.
3. Katz JN, Lipson SJ, Larson MG, McInnes JM, Fossel AH, Liang MH. The outcome of decompressive laminectomy for degenerative lumbar stenosis. J Bone Joint Surg [Am] 1991;73:809-16.
4. Lang E, Hilz MJ, Erxleben H, Ernst M, Neundorfer B, Liebig K. Reversible prolongation of motor conduction time after transcranial magnetic brain stimulation after neurogenic claudication in spinal stenosis. Spine 2002;27:2284-90.
5. Müslümanoğlu L. Bel ağrısının nedenleri. In: Özcan E, Ketenci A, editörler. Bel ağrısı tanı ve tedavi. İstanbul: Nobel Kitabevi; 2002. s. 147-83.
6. Yukawa Y, Lenke LG, Tenhula J, Bridwell KH, Riew KD, Blanke K. A comprehensive study of patients with surgically treated lumbar spinal stenosis with neurogenic claudication. J Bone Joint Surg [Am] 2002;84-A:1954-9.
7. Thelander U, Fagerlund M, Friberg S, Larsson S. Describing the size of lumbar disc herniations using computed tomography. A comparison of different size index calculations and their relation to sciatica. Spine 1994;19:1979-84.
8. Spivak JM. Degenerative lumbar spinal stenosis. J Bone Joint Surg [Am] 1998;80:1053-66.
9. Ketenci A. Bel ağrılarında fonksiyonel değerlendirme. In: Özcan E, Ketenci A, editörler. Bel ağrısı tanı ve tedavi. İstanbul: Nobel Kitabevi; 2002. s. 73-89.
10. Koçyiğit H, Aydemir Ö. Fişek G. Ölmez N, Memiş A. Kısa Form-36 (KF-36)’nın Türkçe versiyonunun güvenilirliği ve geçerliliği. İlaç ve Tedavi Dergisi 1999;12:102-6.
11. Deen HG, Zimmerman RS, Lyons MK, McPhee MC, Verheijde JL, Lemens SM. Use of the exercise treadmill to measure baseline functional status and surgical outcome in patients with severe lumbar spinal stenosis. Spine 1998;23:244-8.
12. Deen HG Jr, Zimmerman RS, Lyons MK, McPhee MC, Verheijde JL, Lemens SM. Measurement of exercise tolerance on the treadmill in patients with symptomatic lumbar spinal stenosis: a useful indicator of functional status and surgical outcome. J Neurosurg 1995;83:27-30.
13. Deen HG Jr, Zimmerman RS, Lyons MK, McPhee MC, Verheijde JL, Lemens SM. Test-retest reproducibility of the exercise treadmill examination in lumbar spinal stenosis. Mayo Clin Proc 2000;75:1002-7.
14. Whitehurst M, Brown LE, Eidelson SG, D’angelo A. Functional mobility performance in an elderly population with lumbar spinal stenosis. Arch Phys Med Rehabil 2001; 82:464-7.
15. Arslan Ş, Akbay A, Kutsal YG, Palaoğlu S. Lumbar spinal stenoz sendromunda yakınma, fonksiyonel özürlülük ve tedavinin değerlendirimi. Geriatri 1999;2:163-6.
16. Gatchel RJ, Mayer T, Dersh J, Robinson R, Polatin P. The association of the SF-36 health status survey with 1-year socioeconomic outcomes in a chronically disabled spinal disorder population. Spine 1999;24:2162-70.