Alt Ekstremite Lenfödem Hastalarında Kinezyofobi, Fiziksel Performans ve Denge Arasındaki İlişki

Abstract

Purpose: Lymphedema is an important situation that causes physical and psychological lifethreatening problems. This study researches kinesiophobia in lower extremity patients and scrutinizes the relationship between kinesiophobia, physical performance and balance. Methods:This cross-sectional controlled study included 40 individuals diagnosed with lower extremity lymphedema with a mean age of 42.58±10.30 years and 31 healthy individuals with a mean age of 40.65 ± 9.53 years. The evaluation of patients with unilateral lymphedema without cognitive and visual problems and those without orthopedic and neurological disorders that would prevent walking and those without heart disease and hypertension was carried out between November 2018 and March 2019. Static balance was evaluated with standing on One leg Balance Test, fear of movement was evaluated with Tampa Scale Kinesiophobia and functional levels were evaluated with Timed Up and Go test.Results. Static balance and physical performance of lower extremity lymphedema patients were different from healthy individuals (p<0.05). Static balance and physical performance were lower in these patients than in healthy individuals. Patients with lower extremity lymphedema had a severe fear of movement (37 and above). There was a significant moderate correlation between kinesiophobia and balance (r= -0.536 p= 0.001), kinesiophobia and physical performance (r= 0.522 p= 0.001) in lower extremity lymphedema patients. And this correlation was more in healthy individuals.Conclusions: High fear of movement and decreased physical performance and balance were found in patients with lower extremity lymphedema. Early diagnosis and treatment of complications due to lymphedema is important for the clinical results of this patient group.

The relationship of kinesiophobia in patients with lymphedema: a case-control investigation

“…Lymphedema is a condition that can become chronic ( 17 – 20 ) and, therefore, requires maintenance and monitoring throughout life ( ( 17 , 21 )), characterized by being a manifestation of the failure of the lymphatic system and/or lymph transport due to primary causes (primary lymphedema), such as problems in lymphatic development, or secondary causes to another pathological condition (secondary lymphedema) ( 20 – 23 ). Lymphedemas that are not adequately treated are more likely to deteriorate ( 17 , 19 ). However, managing this condition seems complex, from diagnosis to the choice of therapeutic strategies ( 22 , 24 , 25 ).…”

“…The reference conservative treatment in the literature is Complex Decongestive Therapy, which integrates manual lymphatic drainage techniques, exercise, compression, and skin care ( 21 ). However, untreated or inadequately managed lymphedema can result in the onset or worsening of symptoms and/or comorbidities, such as cellulitis, mobility problems, decreased function of the affected extremity ( 17 ), numbness, ulcers ( 18 ), cosmetic deformities, loss of strength, reduced range of motion ( 17 , 19 ), heaviness, musculoskeletal pain, inflammation ( 17 – 19 ) and fatigue ( 18 , 19 ).…”

“…The relationship between lymphedema and kinesiophobia can be found in the literature for the upper ( 26 , 27 ) and lower limbs ( 17 – 19 , 28 ). People with lymphedema can believe that movement of the affected extremity can worsen their clinical condition, decrease the range of motion ( 19 ), and increase the severity of the edema ( 18 , 19 ), so they often avoid its use and exercise. On the other hand, people who develop lower limb lymphedema tend to be more sedentary, which can aggravate some of the symptoms and comorbidities mentioned above, such as fatigue ( 18 ).…”

“…No study was also found grading the level of kinesiophobia or analyzing the detailed beliefs or causes that lead to the development of kinesiophobic behaviors, which is relevant to understanding them and presenting strategies to mitigate them. However, four studies ( 17 – 19 , 28 ) were found that integrate (among other objectives) the study of this relationship. All studies are case-control studies using a group of individuals with lymphedema and a group of healthy people.…”

“…The first study relating lower limb lymphedema to kinesiophobia was carried out in a small sample of 17 cases and 18 controls with limitations in describing the characteristics of both groups, in which no statistically significant differences were found between mean TSK scores ( 17 ). The remaining studies, two were carried out on individuals with unilateral lymphedema of the lower limbs ( 18 , 19 ) and one only included individuals with lymphedema secondary to gynecological cancer ( 28 ). They all showed statistically significant differences in mean scores between groups, regardless of the outcome measure used to determine kinesiophobia.…”