Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
Meme Kanseri Cerrahisi Sonrası Lenfödem Gelişen Hastalarda Ev-Temelli Tedavi Programının Lenfödem, Üst Ekstremite Fonksiyonları ve Yaşam Kalitesi Üzerine Etkileri
The Effects of Home-Based Treatment Program on Lymphedema, Upper Extremity Functions and Quality of Life in Patients with Lymphedema After Breast Cancer Surgery
Emine KÜTÜKÜTa, Gözde İYİGÜNa
aDoğu Akdeniz Üniversitesi Sağlık Bilimleri Fakültesi, Fizyoterapi ve Rehabilitasyon Bölümü, Gazimağusa, KKTC
Turkiye Klinikleri J Health Sci. 2020;5(1):63-72
doi: 10.5336/healthsci.2018-63377
Article Language: TR
Full Text
ÖZET
 Amaç: Meme kanseri cerrahisi sonrası lenfödem gelişen hastalarda ev-temelli tedavi programının lenfödem, üst ekstremite fonksiyonları ve yaşam kalitesi üzerine olan etkilerinin araştırılmasıdır. Gereç ve Yöntemler: Üst ekstremitesinde lenfödem gelişmiş bireylere (n=19) hasta eğitimi, kendi kendine masaj uygulaması ve egzersiz programını içeren toplam 4-haftalık ev-temelli bir tedavi programı uygulandı. Üst ekstremite hacim ölçümünde kesik koni hacim düzeyi, üst ekstremite fonksiyonlarının belirlenmesinde 'Kol, Omuz ve El Sorunları Anketi' ve yaşam kalitesinin değerlendirilmesinde 'Avrupa Kanser Araştırma ve Tedavi Organizasyonu Yaşam Kalitesi Ölçeği' kullanıldı. Bulgular: Uygulanan ev-temelli tedavi programının lenfödem üzerinde tedavi sonrasında tedavi öncesine göre distal, dirsek çevresi ve total lenfödem hacimlerinde istatistiksel olarak anlamlı bir azalma meydana geldiği, klinik etki açısından ise distal, dirsek çevresi ve total lenfödem hacim miktarında orta-büyük (r'ler=0,4), proksimalde ise küçük-orta (r=0,2) etki meydana geldiği görüldü. Üst ekstremite fonksiyonlarında istatistiksel olarak anlamlı olmayan klinik gelişim meydana geldiği belirlendi. Yaşam kalitesi açısından ise fiziksel fonksiyon, rol fonksiyonu ve sosyal fonksiyonlarda anlamlı gelişim elde edildiği (p>0,05), klinik etki büyüklükleri açısından ise fiziksel fonksiyon, rol fonksiyonu ve sosyal fonksiyon parametrelerinde orta-büyük (r'ler=0,3), kognitif fonksiyon ve genel sağlık parametrelerinde küçük-orta (r'ler=0,1) ve emosyonel fonksiyon parametresinde küçük (r=0,06) etki meydana geldiği görüldü. Sonuç: Meme kanseri cerrahisi sonrasında üst ekstremitesinde lenfödem gelişen hastalarda uygulanan ev-temelli tedavi programının lenfödemin azaltılması, üst ekstremite fonksiyonlarının artırılması ve yaşam kalitesinin geliştirilmesinde klinik etki yarattığı görüldü. Hastaların tedaviye erişiminin mümkün olmadığı durumlarda ev-temelli tedavi programının öğretilmesi yarar sağlayabilmektedir.

Anahtar Kelimeler: Lenfödem; fonksiyonun geri kazanılması; yaşam kalitesi
ABSTRACT
 Objective: To investigate the effects of home-based treatment program on lymphedema, upper extremity functions and quality of life in patients with lymphedema after breast cancer surgery. Material and Methods: A total of 4-week home-based treatment program including patient education, self-massage and home exercise program was applied to individuals with upper extremity lymphedema (n=19). Truncated cone volume measurement was used for measuring upper extremity volume, the Disabilities of the Arm, Shoulder and Hand Questionnaire for upper extremity functions and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 for quality of life. Results: When comparing the pre and post-treatment the home-based treatment program was found to have a statistically significant effect on decreasing the lymphedema volume at distal, elbow and total, and to have a clinical effect which was moderate-to-high (r's=0.4) at distal, elbow and total and smallto- moderate (r=0.2) at proximal upper extremity. It was observed that there was a clinical improvement for upper extremity functions that was statistically non-significant. There was a significant improvement on physical functions, role functions and social functions parameters of quality of life (p>0.05), the clinical effects were medium-to-high (r's=0.3) for physical function, role function and social function, small-to-medium (r's=0,1) for cognitive function and general health, and small (r=0.06) on emotional function parameters. Conclusion: The home-based treatment program was found to have a clinical effect in decreasing lymphedema, increasing upper limb functions and quality of life in patients with upper extremity lymphedema after breast cancer surgery. It may be beneficial to apply the home-based treatment program in cases where the access of the patients to the treatment is not possible.

Keywords: Lymphedema; recovery of function; quality of life
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