Nörodejeneratif Hastalıklarda Rehabilitasyonun Psikososyal Yönleri ve Yaklaşım Alanları

Psikososyal sağlık, Dünya Sağlık Örgütü'nün sağlık tanımı içerisinde yer alan bir kavram olup duygusal ve sosyal açıdan iyi olma halini kapsamaktadır. Nörolojik bozukluk kapsamında psikososyal sağlık ise sosyal bütünleşme ve psikolojik uyumu ifade eder. Nörolojik hastalıkların yaşam kalitesinde, sosyal ilişkiler kurma ve sürdürme yeteneğinde azalma ve yüksek depresyon, stres ve kaygı düzeylerinde artış gibi olumsuz psikososyal sağlık sonuçları ile ilişkili olduğunu bildiren çalışmalar son yıllarda artış göstermektedir. Bu sebeple nörodejeneratif hastalığı olan kişilerin psikososyal sağlığını iyileştirebilecek müdahaleler üzerinde düşünmek önemlidir. Günümüzde hangi psikososyal yaklaşımların kesin olarak olumlu sonuçlar verebileceği açık değildir. Bu çalışmanın amacı klinikte en sık karşılaşılan nörodejeneratif hastalıklar olan Multiple Skleroz ve Parkinson’lu bir birey olmanın rehabilitasyon sürecinde psikososyal sağlığı ne yönde etkilediğini ve kanıta dayalı mevcut psikososyal yaklaşımları irdelemektir. Bu amaçla, belirlenen veri tabanlarında son 10 yılda yayınlanan psikoterapötik, psikososyal ve farkındalık temelli müdahaleler, stres yönetimi ile ilgili anahtar sözcükler ile İngilizce ve Türkçe makaleler makaleler taranarak tanımlayıcı bir derleme hazırlandı. Yapılan çalışmalarda sosyal bütünleşmenin ve uyumlu başa çıkma stratejilerinin kazanılmasına yönelik müdahaleler, bilişsel ve sosyal davranışçı terapi yöntemlerinin, konsantrasyon ve hareket temelli zihin beden egzersizlerinin uygulanması gibi psikososyal yaklaşımların nörodejeneratif hastalıkların rehabilitasyonunda etkili olduğu görülmüştür. Bu yaklaşımların anksiyete, depresyon ve yorgunluğu azaltmada, uyku kalitesi ve yaşam kalitesini, ilişkileri, istihdamı, egzersiz ve fiziksel aktiviteye katılım düzeyi, motivasyonu ve öz-yeterliliğini artırmada, fiziksel fonksiyonları iyileştirmede, yaşanan zor ve kişisel deneyimleri ve yeni yaşama adaptasyonu kolaylaştırmada faydaları olduğu ve daha fazla kanıta dayalı çalışmalara ihtiyaç olduğu bildirilmiştir.

Anahtar Kelimeler:

Multiple skeroz, Parkinson hastalığı, Psikososyal müdahaleleri, Rehabilitasyon

Psychosocial Aspects of Rehabilitation in Neurodegenerative Diseases and Fields of Approach

Psychosocial health is a concept included in definition of health by World Health Organization and corresponds to state of emotional and social well-being. In the context of neurological disorder, psychosocial health refers to social reintegration and psychological adjustment. Studies reporting that neurological diseases are associated with negative psychosocial health outcomes such as a decrease in the quality of life, a decrease in ability to establish and maintain social relationships, and an increase in high levels of depression, stress and anxiety have increased in recent years. Therefore, it is important to consider programs and interventions that can improve the psychosocial health of people with neurodegenerative diseases. Currently, it is not clear which psychosocial approaches can produce definitively positive results. The aim of this study is to examine how being an individual with Multiple Sclerosis and Parkinson's, which are the most common neurodegenerative diseases in the clinic, affects psychosocial health in the rehabilitation process and the existing evidence-based psychosocial approaches. For this purpose, a descriptive review was prepared by scanning English and Turkish articles with keywords on psychotherapeutic, psychosocial and mindfulness-based interventions and stress management, published in the determined databases in the last 10 years. Studies have shown that psychosocial approaches such as interventions for acquisition of social integration and adaptive coping strategies, cognitive and social behavioral therapy methods, concentration and movement-based mind-body exercises are effective in rehabilitation of neurodegenerative diseases. These approaches were reported to have benefits in reducing anxiety, depression and fatigue, improving sleep quality and quality of life, relationships, employment, level of participation, motivation and self-efficacy in exercise and physical activity, improving physical functions, facilitating difficult and personal experiences and adaptation to new life in rehabilitation processes and more evidence-based studies are needed.

Keywords:

Multiple sclerosis, Parkinson, psychosocial interventions, rehabilitation,

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Amatya B, Khan F, Galea M et al. (2017) Rehabilitation for people with multiple sclerosis: an overview of Cochrane systematic reviews. Cochrane Database of Syst Rev, 14;1:CD012732.
Amatya B, La Mantia L, Demetrios M, Khan F (2013) Non pharmacological interventions for spasticity in multiple sclerosis. Cochrane Database of Syst Rev, 28;(2):CD009974.
Asano M, Finlayson ML (2014) Meta-analysis of three different types of fatigue management interventions for people with multiple sclerosis: exercise, education, and medication. Mult Scler Int, 2014:798285.
Barten LJ, Allington DR, Procacci KA, Rivey MP (2010). New approaches in the management of multiple sclerosis. Drug Des Devel Ther, 24(4):343–66.
Beer S, Khan F, Kesselring J (2012) Rehabilitation interventions in multiple sclerosis: an overview. J Neurol, 259:1994–2008.
Berrigan LI, Fisk JD, Patten SB et al (2016). Health-related quality of life in multiple sclerosis: Direct and indirect effects of comorbidity. Neurology, 86(15), 1417–1424.
Bogosian A, Chadwick P, Windgassen S et al. (2015) Distress improves after mindfulness training for progressive MS: a pilot randomised trial. Mult Scler, 21:1184-1194.
Brown RF, Tennant CC, Sharrock M et al. (2006) Relationship between stress and relapse in multiple sclerosis. II. Direct and indirect relationships. Mult Scler, 12:465–475.
Bulut B (2016) Parkinson Hastalığı Non-motor Semptomlar (motor olmayan bulgular) Ölçeği Türkçe versiyonunun geçerlilik ve güvenilirlik çalışması. (Tıpta uzmanlık). Marmara Üniversitesi Tıp Fakültesi, İstanbul.
Casey B, Coote S, Shirazipour C et al. (2017) Modifiable Psychosocial Constructs Associated With Physical Activity Participation in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil., 98(7):1453-1475.
Casey B, Uszynski M, Hayes S et al. (2018) Do Multiple Sclerosis Symptoms Moderate the Relationship Between Self-Efficacy and Physical Activity in People With Multiple Sclerosis? Rehabil Psychol, 63(1):104-110.
Chaudhuri KR, Schapira AHV (2009) Non-motor symptoms of Parkinson’s disease: dopaminergic pathophysiology and treatment. Lancet Neurol, 8:464–474.
Coote S, Gallagheri S, Msetfi R et al. (2014) A randomized controlled trial of an exercise plus behavior change intervention in people with multiple sclerosis: the step it up study protocol. BMC Neurol, 21;14:241.
Dlugonski D, Motl RW, McAuley E (2011) Increasing physical activity in multiple sclerosis: replicating Internet intervention effects using objective and self-report outcomes. J Rehabil Res Dev, 48: 1129-1136.
Ellis T, Motl RW (2013) Physical activity behavior change in persons with neurologic disorders: Overview and examples from Parkinson disease and multiple sclerosis. J Neurol Phys Ther, 37, 85–90.
Garrett M, Hogan N, Larkin A et al. (2013) Exercise in the community for people with multiple sclerosis–a follow-up of people with minimal gait impairment. Mult Scler, 19: 790-798.
Genever RW, Downes TW, Medcalf P (2005) Fracture rates in Parkinson’s disease compared with age-and gender-matched controls: a retrospective cohort study. Age Ageing, 34(1):21–24.
Grech LB, Kiropoulos LA, Kirby KM et al (2017) Target coping strategies for interventions aimed at maximizing psychosocial adjustment in people with multiple sclerosis. Int J MS Care, 20(3):109-119.
Guerra S (2013) Management of psychosocial adjustment among people with multiple sclerosis: A critical analysis. Br J Neurosci Nurs, 9(2), 89–92.
Hassed C (2013) Mind-body therapies: use in chronic pain management. Aust Fam Physician, 42(3):112–117.
Hatano T, Kubo SI, Shimo Y et al. (2009) Unmet needs of patients with Parkinson’s disease: interview survey of patients and caregivers. J Int Med Res, 37(3):717–726.
Hindle JV, Petrelli A, Clare L et al. (2013) Nonpharmacological enhancement of cognitive function in Parkinson’s disease: a systematic review. Mov Disord, 28(8):1034–1049.
Holland DP, Schlüter DK, Young CA et al.; TONiC study group (2019) Use of coping strategies in multiple sclerosis: Association with demographic and disease-related characteristics. Mult Scler Relat Disord, 27:214-222.
Hyarat SY (2018) Health Related Quality of Life Among Patients With Multiple Sclerosis: The Role of Psychosocial Adjustment to Illness. Arch Psychiatr Nurs, 33(1):11-16.
Kalia LV, Lang AE (2015). Parkinson's disease. Lancet, 29;386(9996):896-912.
Khan F, Amatya B, Turner-Stokes L (2011) Symptomatic therapy and rehabilitation in primary progressive multiple sclerosis. Neurol Res Int, 2011:1–22.
Khan F, McPhail T, Brand C et al. (2006) Multiple sclerosis: disability profile and quality of life in an Australian community cohort. Int J Rehabil Res, 29(2):87–96.
Kolokotroni P, Anagnostopoulos F, Missitzis I (2017) Psychosocial adjustment to illness scale: Factor structure, reliability, and validity assessment in a sample of Greek breast cancer patients. Women & Health, 57(6), 705–722.
Kwok JY, Choi KC, Chan HY (2016) Effects of mind-body exercises on the physiological and psychosocial well-being of individuals with Parkinson's disease: A systematic review and meta-analysis. Complement Ther Med, 29:121-131.
Lakhani A, Norwood M, Watling DP et al. (2018) Using the natural environment to address the psychosocial impact of neurological disability: A systematic review. Health Place, 55:188-201.
Langeskov-Christensen M, Bisson EJ, Finlayson ML, Dalgas U (2017) Potential pathophysiological pathways that can explain the positive effects of exercise on fatigue in multiple sclerosis: a scoping review. J Neurol Sci, 373:307-320.
Latimer-Cheung AE, Ginis KAM, Hicks AL et al. (2013) Development of evidence-informed physical activity guidelines for adults with multiple sclerosis. Arch Phys Med Rehabil, 94:1829-1836.
Li MPM, Jelinek GA, Weiland TJ et al. (2010) Effect of a residential retreat promoting lifestyle modifications on health-related quality of life in people with multiple sclerosis. Qual Prim Care, 18(6), 379.
Liua XJ, Yea HX, Lib WP et al. (2009) Relationship between Psychosocial Factors and Onset of Multiple Sclerosis. Eur Neurol, 62:130–136.
Maes S, Leventha H, De Ridder D (1996) Coping with chronic diseases. In: Zeidner M, Endler NS, eds. Handbook of Coping: Theory, Research, Application. New York, NY: John Wiley & Sons Inc.; :221-252.
Marrie RA, Reingold S, Cohen J et al (2015) The incidence and prevalence of psychiatric disorders in multiple sclerosis: A systematic review. Mult Scler, 21(3), 305–317.
McCarthy ML, Dikmen SS, Langlois JA et al. (2010) Self-reported psychosocial health among adults with traumatic brain injury. Arch Phys Med Rehabil, 87(7):953-61.
Milanlioglu A, Ozdemir PG, Cilingir V et al. (2014) Coping strategies and mood profiles in patients with multiple sclerosis. Arq Neuropsiquiatr, 72(7): 490-495.
Morone NE, Greco CM (2007) Mind–body interventions for chronic pain in older adults: a structured review. Pain Med, 8(4):359–375.
Motl RW (2014). Lifestyle physical activity in persons with multiple sclerosis: The new kid on the MS block. Mult Scler, 20, 1025–1029.
Motl RW, Dlugonski D (2011) Increasing physical activity in multiple sclerosis using a behavioral intervention. Behav Med, 37: 125-31.
Navarta-Sánchez MV, Ursua ME, Riverol Fernández M et al. (2018) Implementation of a multidisciplinary psychoeducational intervention for Parkinson's disease patients and carers in the community: study protocol. BMC Fam Pract, 5;19(1):45.
Northrup DT, Purkis ME (2001) Building the science of health promotion practice from a human science perspective. Nursing Philosophy, 2(1), 62–71.
Noyce AJ, Bestwick JP, Silveira-Moriyama L et al. (2012) Meta-analysis of early nonmotor features and risk factors for Parkinson disease. Ann Neurol, 72: 893–901.
Ode K, Bru E, Klevan G et al. (2009) Depressive symptoms and coping in newly diagnosed patients with multiple sclerosis. Mult Scler, 15: 638-643.
Osborne TL, Jensen MP, Ehde DM et al. (2007) Psycho-social factors associated with pain intensity, pain-related interference, and psychological functioning in persons with multiple sclerosis and pain. Pain, 127: 52–62.
Pickering RM, Fitton C, Ballinger C et al. (2013) Self reported adherence to a home-based exercise programme among people with Parkinson’s disease. Parkinsonism Relat Disord, 19(1):66–71.
Postuma RB, Aarsland D, Barone P et al. (2012) Identifying prodromal Parkinson’s disease: pre-motor disorders in Parkinson’s disease. Mov Disord, 27:617–26.
Rooney S, Moffat F, Wood L, Paul L (2019) Effectiveness of Fatigue Management Interventions in Reducing Severity and Impact of Fatigue in People with Progressive Multiple Sclerosis: A Systematic Review. Int J MS Care, 21(1):35-46.
Rumrill PD, Kaleta DA, Battersby JC (1996) Etiology, incidence, and prevalence; in Rumrill PD, (ed): Employment Issues and Multiple Sclerosis. New York, Demos Vermande, pp 1–18.
Schure MB, Christopher J, Christopher S (2008) Mind-body medicine and the art of self-care: teaching mindfulness to counseling students through yoga, meditation, and qigong. J Couns Dev, 86(1):47–56.
Sharma NK, Robbins K, Wagner K et al. (2015) A randomized controlled pilot study of the therapeutic effects of yoga in people with Parkinson’s disease. Int J Yoga, 8(1):74.
Simpson J, Lekwuwa G, Crawford T (2014) Predictors of quality of life in people with Parkinson’s disease: evidence for both domain specific and general relationships. Disabil Rehabil, 36(23):1964–1970.
Simpson R, Booth J, Lawrence M (2014) Mindfulness based interventions in multiple sclerosis: a systematic review. BMC Neurol, 14:1-9.
Soundy A, Stubbs B, Roskell C (2014) The experience of Parkinson’s disease: a systematic review and meta-ethnography. Sci World J, 2014:613592.
Strenge H (2001) The relationship between psychological stress and the clinical course of multiple sclerosis. An update. Psychother Psychosom Med Psychol, 51:166–175.
Sullivan CL, Wilken JA, Rabin BM et al. (2004) Psychosocial adjustment to multiple sclerosis: The contributions of coping style, perceived uncertainty, and social support. Int J MS Care, 6(3), 98–105.
Vanage S, Gilbertson K, Mathiowetz V (2003) Effects of an energy conservation course on fatigue impact for persons with progressive multiple sclerosis. Am J Occup Ther, 57:315-323.
Wassem R, Dudley W (2003) Symptom management and adjustment of patients with multiple sclerosis: A 4-year longitudinal intervention study. Clin Nurs Res, 12(1), 102–117.
Weintraub D, Moberg P, Duda J et al. (2004) Effect of psychiatric and other non-motor symptoms on disability in Parkinson’s disease. J Am Geriatr Soc, 52:784–788.
World Health Organization (2008). Atlas: multiple sclerosis resources in the world. https://apps.who.int/iris/bitstream/handle/10665/43968/9789241563758_eng.pdf (20 Haziran 2022’de ulaşıldı).
World Health Organization (2011) World Report on Disability. https://apps.who.int/iris/handle/10665/44575 (20 Haziran 2022’de ulaşıldı).
Yang S, Sajatovic M, Walter BL (2012) Psychosocial interventions for depression and anxiety in Parkinson's disease. J Geriatr Psychiatry Neurol, 25(2):113-21.