Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
The Evaluation of Walking Energy Consumption and Plantar Pressure Distribution in Patients with Lumbar Spinal Stenosis: A cross-sectional, case control study
Lomber Spinal Stenozlu Hastalarda Yürüme Enerji Tüketimi ve Plantar Basınç Dağılımının Değerlendirilmesi: Kesitsel vaka kontrol çalışması
Özge Göksu KÖRLÜa, Uğur DALb, Figen DAĞc, Zeynep ALTINKAYAb, Anıl ÖZGÜRd, Havva Didem ÇELİKCANe, Özlem Bölgen ÇİMENc
aClinic of Physical Medicine and Rehabilitation, Adana Training and Research Hospital, Adana, TURKEY
bDepartment of Physiology, Mersin University Faculty of Medicine, Mersin, TURKEY
cDepartment of Physical Medicine and Rehabilitation, Mersin University Faculty of Medicine, Mersin, TURKEY
dDepartment of Radiology, Mersin University Faculty of Medicine, Mersin, TURKEY
eDepartment of Biostatistics and Medical Informatics, Mersin University Faculty of Medicine, Mersin, TURKEY
Turkiye Klinikleri J Med Sci. 2021;41(2):158-65
doi: 10.5336/medsci.2021-82021
Article Language: EN
Full Text
ABSTRACT
 Objective: To evaluate the alterations of walking energy expenditure and plantar pressure distribution of patients with lumbar spinal stenosis. Material and Methods: Twenty-six subjects of both genders were included in the study, 13 patients suffering from lumbar spinal stenosis served as patient group and 13 healthy participants served as a control group. Preferred walking speeds were determined on the over ground. Oxygen consumption was recorded via a metabolic analyzer during walking on a treadmill for 2 km at preferred walking speed that determined on the over ground. Net oxygen consumption and oxygen cost were calculated for obtaining walking energy consumption. Plantar area was subdivided into six zones to measure plantar pressure distribution with a pedobarography device. Results: Compared with control group, patient group had significantly lower preferred walking speed (62.56±13.90 m/minimum and 76.66±10.90 m/minimum, p=0.008) and maximum walking distance [674.6 (105.0- 2000.0) m and 2000.0 (2000.0-2000.0) m, p=0.019]. However, there were no statistically significant differences between groups in terms of energy expenditure parameters during walking at preferred walking speed (p>0.05). Similar findings were recorded between right and left foot with regard to weight distribution (%) to forefoot/hindfoot in patient group in the static pedobarographic measurements (p>0.05). Contact area value was significantly different between the affected and unaffected side at lateral forefoot in patient group (22.73±2.97 and 24.90±2.9, p=0.001). Conclusion: Patients with lumbar spinal stenosis do not exhibit more pressure on unaffected side compared to healthy subjects in both static and dynamic condition except contact area of lateral forefoot. Patient group optimized energy expenditure and oxygen cost by reducing their preferred walking speed owing to the pain.

Keywords: Spinal stenosis; pain; quality of life; energy metabolism
ÖZET
 Amaç: Lomber spinal stenozlu hastaların yürüme enerji tüketimi ve plantar basınç dağılımındaki değişiklikleri değerlendirmek. Gereç ve Yöntemler: Çalışmaya her iki cinsiyetten 26 kişi dâhil edildi, lomber spinal stenoza sahip 13 birey hasta grubu, 13 sağlıklı katılımcı ise kontrol grubu olarak çalışmaya dâhil edildi. Zeminde tercih edilen yürüme hızları belirlendi. Oksijen tüketimi, normal zeminde belirlenen tercih edilen yürüme hızında 2 km boyunca bir koşu bandı üzerinde yürürken, bir metabolik analizör aracılığıyla kaydedildi. Yürüme enerji tüketiminin belirlenebilmesi için yürüme sırasındaki net oksijen tüketimi ve oksijen maliyeti hesaplandı. Plantar bölge, bir pedobarografi cihazı ile plantar basınç dağılımlarını ölçmek için 6 bölgeye ayrıldı. Bulgular: Kontrol grubu ile karşılaştırıldığında, hasta grubunun tercih edilen yürüme hızı (62,56±13,90 m/minimum ve 76,66±10,90 m/minimum, p=0,008) ve maksimum yürüme mesafesi [674,6 (105,0-2000,0) m ve 2000,0 (2000,0-2000,0) m, p=0,019] anlamlı olarak daha düşüktü. Ancak tercih edilen yürüme hızındaki yürüme sırasında enerji tüketimi parametreleri açısından gruplar arasında istatistiksel olarak farklılık yoktu (p>0,05). Statik pedobarografik ölçümlerde hasta grubunda sağ ve sol ayak arasında ön ayak/arka ayak ağırlık dağılımı (%) açısından benzer bulgular kaydedildi (p>0,05). Hasta grubun etkilenen ve etkilenmeyen tarafa ait plantar bölge temas alanı sadece ön ayak laterali için anlamlıydı. (22,73±2,97 ve 24,90±2,9, p=0,001). Sonuç: Lomber spinal stenozu olan hastalar, yan ön ayak temas alanı dışında hem statik hem de dinamik durumda sağlıklı bireylerle karşılaştırıldığında etkilenmeyen ayağa fazla baskı uygulamazlar. Hasta grubu ağrı nedeniyle tercih ettikleri yürüme hızlarını azaltarak enerji tüketimini ve oksijen maliyetini optimize etmiştir.

Anahtar Kelimeler: Spinal stenoz; ağrı; yaşam kalitesi; enerji metabolizması
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