Merziye ERGÜL, Afsun NODEHİ MOGHADAM, Akbar BIGLARIAN

MULTİPL SKLEROZLU BİREYLERDE STATİK VE FONKSİYONEL GERME EGZERSİZLERİNİN ALT EKSTREMİTE SPASTİSİTESİ VE FONKSİYONU ÜZERİNE ETKİLERİ: RANDOMİZE KONTROLLÜ BİR ÇALIŞMA

Amaç: Spastisite, Multipl Sklerozlu bireyler arasında yaygın bir sorundur. Bu çalışmanın amacı, Multipl Sklerozlu bireylerde statik germe (SG) ve fonksiyonel germenin (FG) alt ekstremite spastisitesi, fonksiyon, alt ekstremite ağrısı, aktif eklem hareket açıklığı (EHA) ve sağlıkla ilişkili yaşam kalitesi (SİYK) üzerine etkilerini karşılaştırmaktı. Yöntem: Yirmi altı katılımcı randomize edilerek iki gruba ayrıldı. SG grubuna (n=12) 4 hafta (12 seans) hamstring, quadriseps, kalça adduktor ve plantar fleksor kaslarının statik germe egzersizleri uygulandı. FG grubuna (n=12) aynı kaslar için dört haftalık (12 seans) fonksiyonel germe egzersizleri uygulandı. Sonuç ölçümü olarak Modifiye Modifiye Ashworth Skalası, Zamanlı Kalk ve Yürü Testi, Zamanlı 25 Adım Yürüme Testi, aktif EHA değerlendirilmesi, Görsel Analog Skala ve Avrupa Yaşam Kalitesi Ölçeği-5 Boyut Anketi kullanıldı. Sonuçlar: Her iki grupta da spastisitede azalma, fonksiyonel test sonuçlarında iyileşme, ağrıda azalma, EHA'nda e SİYK’nde meydana gelen artış başlangıç değerlerine kıyasla istatistiksel olarak anlamlıydı (p<0,05). Gruplar arasında, tüm değişkenlerde tedavi öncesi ve sonrası için anlamlı farklılık yoktu (p>0,05). SG grubunda spastisite azalma ve fonksiyonel iyileşme arasında güçlü bir korelasyon vardı (r=0,793, p=0.002). FG grubunda ise azalmış spastisite ile artmış EHA arasında (r=0,689, p=0.013) ve artmış EHA ile fonksiyonel iyileşme arasında (r=0,593, p=0.042) orta düzeyde korelasyon vardı. Azalan spastisite ile SİYK artışı arasında ise güçlü bir korelasyon vardı (r=0,721, p=0.006) Tartışma: Düzenli olarak dört hafta boyunca uygulanan SG veya FG, multipl sklerozlu hastalarda alt ekstremite spastisitesini azaltabilir, fonksiyonu iyileştirebilir, ağrıyı azaltabilir, aktif EHA’nı ve SİYK’ni artırabilir.

Anahtar Kelimeler:

Multipl Skleroz, Mobilite Limitasyonu, Kas Spastisitesi, Kas Germe Egzersizleri, Yaşam Kalitesi

EFFECTS OF STATIC AND FUNCTIONAL STRETCHING EXERCISES ON LOWER LIMB SPASTICITY AND FUNCTION IN PEOPLE WITH MULTIPLE SCLEROSIS: A RANDOMIZED CONTROLLED TRIAL

Purpose: Spasticity is a common problem among people with Multiple Sclerosis (MS). This study aimed to compare the effects of static stretching exercise (SSE) and functional stretching exercise (FSE) on lower limb spasticity, function, lower limb pain, active range of motion (ROM), and health-related quality of life (HRQOL) in patient with MS. Methods: Twenty-six participants were randomly allocated into two groups. SSE group (n=12) completed a four-week (12 sessions) SSE of hamstrings, quadriceps, hip adductors and plantar flexors muscles. FSE group 2 (n=12) completed a four-week (12 sessions) FSE of the same muscles. The outcome measures were Modified Modified Ashworth Scale, Timed Up and Go Test, Timed 25 Foot Walk Test, active ROM assessment, Visual Analogue Scale, and EuroQoL 5-Dimension 5-Level questionnaire. Results: In each group, decrease of spasticity, improvement of functional tests, decrease of pain, increase of ROM and increase of HRQOL were statistically significant compared to baseline (p<0.05). There were no significant differences between both groups in all variables before and after treatment (p>0.05). A strong correlation was found between decreased spasticity and functional improvement in the SSE group (r=0.793, p=0.002). In the FSE group, there were moderate correlations between decreased spasticity and increased ROM (r=0.689, p=0.013) and between increased ROM and functional improvement (r=0.593, p=0.042). There was also a strong correlation between decreased spasticity and increased HRQOL (r=0.721, p=0.006). Conclusion: The regular four-weeks of SSE or FSE can decrease lower limb spasticity, improve function, decrease pain, increase active ROM and increase HRQOL in patients with MS.

Keywords:

Mobility Limitation, Multiple Sclerosis, Muscle Spasticity, Muscle Stretching Exercises, Quality of Life,

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