Ankilozan Spondilitli Hastalarda Postüral Denge ve Düşme Riskinin Değerlendirilmesi

Amaç: Bu çalışmanın amacı Ankilozan spondilitin postüral denge ve düşme riski üzerine olan etkilerini değerlendirmektir. Gereç ve yöntem: Çalışmaya toplamda 73 birey alındı; bireylerin 36"sı Ankilozan spondilit (17 erkek, 19 kadın), 37"si ise sağlıklı gönüllülerden (19 erkek, 18 kadın) oluşmakta idi. Hastalar ve sağlıklı bireyler denge ve düşme riski açısından test edildi. Denge ve düşme riski Biodex Denge Sistemi ile değerlendirildi. Bulgular: Her iki grup arasında yaş, cinsiyet ve vücut kitle indeksleri açısından anlamlı farklılık saptanmadı (sırasıyla, p=0.308, p=0.724, p=0.766). AS ve kontrol grupları denge indeksleri açısından incelendiğinde postüral stabilite indekslerinden hiçbirinde (Genel Stabilite İndeksi (GSİ), Antero-Posterior Stabilite İndeksi (APSİ) ve Medio-Lateral Stabilite İndeksi (MLSİ)) kontrol grubuna göre istatistiksel olarak anlamlı farklılık saptanmazken (sırasıyla, p=0.190, p=0.437 ve p=0.144) Düşme Riski İndeksi (DRİ) açısından değerlendirildiğinde ise her iki grup arasında istatistiksel olarak anlamlı farklılık saptandı (p=0.001) (Tablo 1). Sonuç: Bu çalışmada, Ankilozan spondilitli hastaların postüral stabilite testlerinde her ne kadar anlamlı bozulma görülmese de düşme riski ile ilişkili olduğu saptanmıştır.

Anahtar Kelimeler:

Ankilozan spondilit, denge bozukluğu, düşme riski

Evaluation of Postural Stability and Fall Risk in Patients with Ankylosing Spondylitis

Purpose: The purpose of this study is to evaluate the influences of Ankylosing spondylitis on postural balance and the risk of falls. Methods: A total of 73 sobjects were recruited for the study, including 36 with AS (17 men, 19 women) and 37 healthy controls (19 men, 18 women). Patients were evaluated in terms of balance and risk of falls. Balance and risk of falls was assessed with the Biodex Stability System. Results: The mean age, gender and body mass index of the participants did not differ significantly between (p=0.308, p=0.724, p=0.766, respectively). When groups were evaluated in terms of postural stability indexes Overall Stability Index (OSİ), Antero-Posteior Stability Index (APSİ) and Medio-Lateral Stability Index (MLSİ) had no statistically significant difference (p=0.190, p=0.437 ve p=0.144), respectively). Fall Risk Index (FRI) evaluations showed that as patients" test scores were higher than control group (p=0.001). (Table 1). Conclusions: In this study, we present numerical data that suggests that AS are associated with risk of falling.

Keywords:

Ankylosing Spondylitis, Balance Disorder, Risk of Falling,

PDF

___

Arnett FC. Ankylosing spondylitis. (İn) Koopman WJ (ed). Arthritis and allied conditions. A textbook of rheumatology. Baltimore: Williams and Wilkins. 1997; 1197-208.
Khan MA. Ankylosing spondylitis: Clinical features. (in) Klippel JH, Dieppe PA (eds). Rheumatology. St. Louis: Mosby. 1994; 25:1-10.
Davis JC, van der Heijde D, Dougados M, Woolley JM. Reduction in health-related quality of life in patients with ankylosing spondylitis and improvements with etanercept therapy. Arthritis Rheum. 2005; 53:494-501.
Kragg G, Stokes B, Groth J, Helewa A, Goldsmith CH. The effects of comprehensive home physiotherapy and supervision on patients with ankylosing spondylitis—a randomized control trial. J Rheumatol. 1990; 17:228–33.
Russel AS. Ankylosing spondylitis: history. In: Klippel JH, Dieppe PA, (eds). Rheumatology. St Louis: Mosby. 1994; 6:14:1–2
Braun J, Sieper J. Ankylosing spondylitis. Lancet. 2007; 369:1379–90.
Van Royen BJ, De Gast A, Smit TH. Deformity planing for sagittal plane corrective osteotomies of the spine in ankylosing spondylitis. Eur Spine J. 2000; 9:492–8.
Maki BE, Holliday PJ, Topper AK. A prospective study of postural balance and risk of falling in an ambulatory and independent elderly population. J. Gerontol. 1994; 49:72-84.
Murray HC, Elliott C, Barton SE, Murray A. Do patients with ankylosing spondylitis have poorer balance than normal subjects? Rheumatology. 2000; 39:497-500.
Ferdjallah M, Harris GF, Smith P, Wertsch JJ. Analysis of postural control synergies during quiet standing in healthy children and children with cerebral palsy. Clin Biomech. 2002; 17:203-10.
Nashner LM, Black FO, Wall C. III: Adaptation to altered support and visual conditions during stance: patients with vestibular deficits, J Neurosci. 1982; 2:536-44.
Shumway-Cook A, Horak FB. Assessing the ınfluence of sensory ınteraction of balance. Phys Ther. 1986; 66:1548-50.
Briggs RC, Gossman MR, Birch R, Drews JE, Shaddeau SA. Balance performance among noninstitutionalized elderly women. Phys Ther. 1989; 69:748–56.
Hinman RS, Bennell KL, Metcalf BR, Crossley KM. Balance impairments in individuals with symptomatic knee osteoarthritis: a comparison with matched controls using clinical tests. Rheumatology. 2002; 41:1388-94.
Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in communitydwelling older adults using the timed up and go test. Phys Ther. 2000; 80:896-903.
Han GW, Zeng LW, Liang CX, Cheng BL, Yu BS, Li HM, Zeng FF, Liu SY. Serum levels of IL-33 is increased in patients with ankylosing spondylitis. Clin Rheumatol. 2011; 30:1583-8.
Cachupe JCW, Shifflet B, Kahanov L, Wughalter EH. Reliability of biodex balance system mezsures. Meas Phys Edu Exerc Sci. 2001; 5:97-108.
Aydog E, Aydog ST, Cakci A, Doral MN. Dynamic postural stability in blind athletes using the biodex stability system. Int J Sports Med. 2006; 27: 415-418.
Zochling J, van der Heijde D, Burgos-Vargas R, et al. ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis. 2006; 65:442-52
Gran JT, Husby G. Epidemiology of ankylosing spondylitis. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, (eds). Rheumatology. Mosby, Philadelphia. 2003: 1153-9.
Khan MA. Ankilosing spondylitis. In. Klippel JH, (ed). Primer on rheumatic diseases. Arthritis Foundation, Atlanta, 1997;189-93.
Vergara ME, O'Shea FD, Inman RD, Gage WH. Postural control is altered in patients with ankylosing spondylitis. Clinical Biomechanics. 2012; 27:334-40.
Bot SD, Caspers M, Van Royen BJ, Toussaint HM, Kingma I. Biomechanical analysis of posture in patients with spinal kyphosis due to ankylosing spondylitis: a pilot study. Rheumatology. 1999; 38:441-3.
Hindmarsh JJ, Estes EH JR. Falls in older persons. Causes and interventions. Arch Intern Med. 1989; 149:2217-22.
Horak FB, Shupert CL, Mirka A. Components of postural dyscontrol in the elderly: a review. Neurobiol Aging 1989; 10:727-38.
Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. J Am Geriatr Soc. 2001; 49:664-72.
Scheffer AC, Schuurmans MJ, van Dijk N, van der Hooft T, de Rooij SE. Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing. 2008; 37:19-24.
Durmus B, Altay Z, Ersoy Y, Baysal O, Dogan E. Postural stability in patients with ankylosing spondylitis. Disabil Rehabil. 2010; 32:1156-62.
Sinaki M, Brey RH, Hughes CA, Larson DR, Kaufman KR. Balance disorder and increased risk of falls in osteoporosis and kyphosis: significance of kyphotic posture and muscle strength. Osteoporosis Int. 2005; 16:1004-10.
Chen PQ, Wang JL, Tsuang YH, Liao TL, Huang PI, Hang YS. The postural stability control and gait pattern of idiopathic scoliosis adolescents. Clin Biomech. 1998; 13:52-8.
Aydog E, Depedibi R, Bal A, Eksioglu E, Unlu E, Cakci A. Dynamic postural balance in ankylosing spondylitis patients. Rheumatology. 2006; 45:445-8. Yazışma Adresi / Address for Correspondence: Dr. Ahmet İnanır Gaziosmanpaşa Üniversitesi Tıp Fakültesi Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı 60100 TOKAT Tel: 0356 2129500 e-mail: ainanir@gmail.com geliş tarihi/received :10.09.2012 kabul tarihi/accepted:.10.10.2012