Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
Unilateral Radikal Mastektomi Sonrası Lenfödemi olan Kadınlarda Torakal Kifoz, Denge ve Üst Ekstremite Fonksiyonları Arasındaki İlişki: Bir Pilot Çalışma
The Relationship BetweenThoracic Kyphosis, Balance, and Upper Extremity Functions in Women with Lymphedema After Unilateral Radical Mastectomy: A Pilot Study
Şeyda TOPRAK ÇELENAYa, Cansu ŞAHBAZ PİRİNÇÇİb, Meltem DALYANc, Sibel ÜNSAL DELİALİOĞLUc
aAnkara Yıldırım Beyazıt Üniversitesi Sağlık Bilimleri Fakültesi, Fizyoterapi ve Rehabilitasyon Bölümü, Ankara, TÜRKİYE b
bAnkara Şehir Hastanesi Fiziksel Tıp ve Rehabilitasyon Kliniği, Ankara, TÜRKİYE c
cSağlık Bilimleri Üniversitesi Ankara Fizik Tedavi ve Rehabilitasyon Eğitim ve Araştırma Hastanesi, Fizik Tedavi ve Rehabilitasyon Kliniği, Ankara, TÜRKİYE
Turkiye Klinikleri J Health Sci. 2021;6(1):62-8
doi: 10.5336/healthsci.2020-74886
Article Language: TR
Full Text
ÖZET
 Amaç: Unilateral radikal mastektomi sonrası lenfödemi (LÖ) olan kadınlarda torakal kifoz ile denge ve üst ekstremite fonksiyonları arasındaki ilişkiyi incelemekti. Gereç ve Yöntemler: Unilateral radikal mastektomi sonrası LÖ (yaş: 55,06±8,17 yıl; beden kitle indeksi: 28,78±4,53 kg/m2 )'sü olan 30 kadın dâhil edildi. Hastalar, Haziran ve Aralık 2019 tarihleri arasında değerlendirildi. LÖ şiddeti çevre ölçümü ve Frustum metodu ile torakal kifoz açısı, Baseline dijital inklinometre, denge Mini-Denge Değerlendirme Sistemler Testi (Mini-DDSTest) ile üst ekstremite fonksiyonları ise Kol, Omuz ve El Sorunları [Disability of the Arm, Shoulder and Hand (DASH)] Anketi ile değerlendirildi. İki kol arasındaki volüm farkı 200-250 mL ise hafif, 250 mL'den büyük ve 500 mL'den küçük ise orta, 500 mL'den büyük ise şiddetli olarak sınıflandı. Pearson korelasyon analizi kullanıldı. Bulgular: Torakal kifoz ile Mini-DDSTest'in alt skorları olan sezgisel (p=0,003; r=-0,523) ve duyusal oryantasyon skorları (p=0,003, r=-0,521) arasında orta şiddetli bir ilişki; torakal kifoz ile toplam denge skoru (p=0,045, r=-0,369) arasında ise zayıf bir ilişki bulundu. Torakal kifoz ile Mini-DDSTest'in reaktif postüral kontrol, dinamik yürüyüş parametreleri ve DASH skoru arasında ilişki yoktu (p>0,05). Sonuç: LÖ'lü kadınlarda torakal kifoz ile bazı denge parametrelerinin ilişkili olduğu, ancak üst ekstremite fonksiyonlarının ilişkili olmadığı görüldü. Üst ekstremite LÖ'sü olan hastalarda torakal kifozun dengeyi etkileyebileceği göz önünde bulundurulmalıdır. Ayrıca daha büyük örneklemlerde ileriki çalışmalara ihtiyaç vardır.

Anahtar Kelimeler: Lenfödem; postür; postüral denge
ABSTRACT
 Objective: To investigate the relationship between thoracic kyphosis and balance and upper extremity functions in woman with lymphedema after unilateral radical mastectomy. Material and Methods: Thirty women with lymphedema (age: 55.06±8.17 years; body mass index: 28.78±4.53 kg/m2 ) after unilateral radical mastectomy were included. The patients were evaluated between June to December 2019. The severity of the lymphoedema with circumferential measurements and Frustum model, thoracic kyphosis angle with Baseline Digital Inclinometer, balance with Mini Balance Evaluation Systems Test (Mini-BESTest), upper limb functions with the Disability of the Arm, Shoulder and Hand (DASH) questionnaire were evaluated. Results were classified as light if the volume difference between the two arms is 200-250 mL; medium if greater than 250 mL and less than 500 mL, and severe if greater than 500 mL. Pearson correlation analysis was used. Results: A moderate correlation between the thoracic kyphosis and intuitive (p=0.003, r =-0.523) and sensory orientation (p=0.003, r =-0.521) scores which are sub-scores of Mini-BESTest; a weak correlation between the thoracic kyphosis and total balance score (p=0.045, r=-0.369) were found. There was no relation between the thoracic kyphosis and reactive postural control and dynamic gait parameters of Mini-BESTest, and DASH score (p>0.05). Conclusion: It was seen that the thoracic kyphosis was associated with some balance parameters; however, it was no associated with the upper extremity functions in women with lymphedema. It should be taken into account that the thoracic kyphosis may affect the balance in patients with upper limb lymhedema. Besides, further studies are needed for larger samples.

Keywords: Lymphedema; posture; postural balance
REFERENCES:
  1. Executive Committee. The Diagnosis and Treatment of Peripheral Lymphedema: 2016 consensus document of the ınternational society of lymphology. Lymphology. 2016;49(4):170-84.[PubMed] 
  2. Shoman H, Ellahham S. Lymphedema: a mini-review on the pathophysiology, diagnosis and treatment. Vascul Dis Ther. 2017;2(3):1-2.[Crossref] 
  3. Gillespie TC, Sayegh HE, Brunelle CL, Daniell KM, Taghian AG. Breast cancer-related lymphedema: risk factors, precautionary measures, and treatments. Gland Surg. 2018;7(4):379-403.[Crossref] [PubMed] [PMC] 
  4. Celenay ST, Ucurum SG, Kaya DO. Comparison of spinal alignment and mobility in women with and without post modified radical mastectomy unilateral lymphoedema. Clin Breast Cancer. 2020;20(3):e295-e300.[Crossref] [PubMed] 
  5. Angin S, Karadibak D, Yavuzşen T, Demirbüken I. Unilateral upper extremity lymphedema deteriorates the postural stability in breast cancer survivors. Contemp Oncol (Pozn). 2014;18(4):279-84.[Crossref] [PubMed] [PMC] 
  6. Fu MR. Breast cancer-related lymphedema: Symptoms, diagnosis, risk reduction, and management. World J Clin Oncol. 2014;5(3):241-7.[Crossref] [PubMed] [PMC] 
  7. Haddad CA, Saad M, Perez Mdel C, Miranda Júnior F. Assessment of posture and joint movements of the upper limbs of patients after mastectomy and lymphadenectomy. Einstein (Sao Paulo). 2013;11(4):426-34.[Crossref] [PubMed] [PMC] 
  8. Neto CM, Pezarat P, Oliveira R. Effects of breast cancer treatment on shoulder function: what to expect and how to treat?. International Journal of Physical Therapy & Rehabilitation. 2018;4:147.[Crossref] 
  9. Shamley D, Lascurain-Aguirrebe-a I, Oskrochi R, Srinaganathan R. Shoulder morbidity after treatment for breast cancer is bilateral and greater after mastectomy. Acta Oncol. 2012;51(8):1045-53.[Crossref] [PubMed] 
  10. Fisher MI, Levangie PK. Oncology section task force on breast cancer outcomes: scapular assessment. Rehabilitation Oncology. 2013;30(4):11-8.[Crossref] 
  11. Zhang M, Zhou JJ, Zhang YM, Wang JH, Zhang QY, Chen W. Clinical effectiveness of scapulothoracic joint control training exercises on shoulder joint dysfunction. Cell Biochem Biophys. 2015;72(1):83-7.[Crossref] [PubMed] 
  12. Malmström EM, Olsson J, Baldetorp J, Fransson PA. A slouched body posture decreases arm mobility and changes muscle recruitment in the neck and shoulder region. Eur J Appl Physiol. 2015;115(12):2491-503.[Crossref] [PubMed] 
  13. Kaulesar Sukul DM, den Hoed PT, Johannes EJ, van Dolder R, Benda E. Direct and indirect methods for the quantification of leg volume: comparison between water displacement volumetry, the disk model method and the frustum sign model method, using the correlation coefficient and the limits of agreement. J Biomed Eng. 1993;15(6):477-80.[Crossref] [PubMed] 
  14. Ramos SM, O'Donnell LS, Knight G. Edema volume, not timing, is the key to success in lymphedema treatment. Am J Surg. 1999;178(4):311-5.[Crossref] [PubMed] 
  15. Azadinia F, Kamyab M, Behtash H, Saleh Ganjavian M, Javaheri MR. The validity and reliability of noninvasive methods for measuring kyphosis. J Spinal Disord Tech. 2014;27(6):E212-8.[Crossref] [PubMed] 
  16. Franchignoni F, Godi M, Guglielmetti S, Nardone A, Giordano A. Enhancing the usefulness of the Mini-BESTest for measuring dynamic balance: a Rasch validation study. Eur J Phys Rehabil Med. 2015;51(4):429-37.[PubMed] 
  17. Düger T, Yakut E, Öksüz Ç, Yörükan S, Bilgütay BS, Ayhan Ç, et al. [Reliability and validity of the Turkish version of Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire]. Turk J Physiother Rehabi. 2006;17(3):99-107.[Link] 
  18. Choi J, Peters M, Mueller RO. Correlational analysis of ordinal data: from Pearson's r to Bayesian polychoric correlation. Asia Pacific Education Review. 2010;11(4):459-66.[Crossref] 
  19. McQuade KJ, Borstad J, de Oliveira AS. Critical and Theoretical perspective on scapular stabilization: what does ıt really mean, and are we on the right track? Phys Ther. 2016;96(8):1162-9.[Crossref] [PubMed] 
  20. Yaman O, Dalbayrak S. Kyphosis and review of the literature. Turk Neurosurg. 2014;24(4):455-65.[PubMed] 
  21. J Jackson RP, Hales C. Congruent spinopelvic alignment on standing lateral radiographs of adult volunteers. Spine (Phila Pa 1976). 2000;25(21):2808-15.[Crossref] [PubMed] 
  22. Sinaki M, Brey RH, Hughes CA, Larson DR, Kaufman KR. Balance disorder and increased risk of falls in osteoporosis and kyphosis: significance of kyphotic posture and muscle strength. Osteoporos Int. 2005;16(8):1004-10.[Crossref] [PubMed] 
  23. Gündoğdu M, Öncel S, Şahin E, Baydar M, Dilek B. [The effect of posture support corset on balance, quality of life, dorsal kyphosis in patients with kyphosis due to osteoporosis]. Turkish Journal of Geriatrics. 2013;16(3):253-9.[Link] 
  24. Wang F, Li C, Liu Z, Zhang J, Han F, Qu X, et al. Comparison of efficacy for ankylosing spondylitis kyphosis with preoperative osteotomy designs using the Photoshop software or papercut/splice. Int J Clin Exp Med. 2017;10(1):618-27.[Link] 
  25. Toprak Çelenay Ş, Özer Kaya D. An 8-week thoracic spine stabilization exercise program improves postural back pain, spine alignment, postural sway, and core endurance in university students:a randomized controlled study. Turk J Med Sci. 2017;47(2):504-13.[Crossref] [PubMed] 
  26. Wang MY, Greendale GA, Kazadi L, Salem GJ. Yoga improves upper-extremity function and scapular posturing in persons with hyperkyphosis. J Yoga Phys Ther. 2012;2(3):117.[PubMed] [PMC] 
  27. Kanlayanaphotporn R. Changes in sitting posture affect shoulder range of motion. J Bodyw Mov Ther. 2014;18(2):239-43.[Crossref] [PubMed] 
  28. Worland RL, Lee D, Orozco CG, SozaRex F, Keenan J. Correlation of age, acromial morphology, and rotator cuff tear pathology diagnosed by ultrasound in asymptomatic patients. J South Orthop Assoc. 2003;12(1):23-6.[PubMed] 
  29. Finley MA, Lee RY. Effect of sitting posture on 3-dimensional scapular kinematics measured by skin-mounted electromagnetic tracking sensors. Arch Phys Med Rehabil. 2003;84(4):563-8.[Crossref] [PubMed] 
  30. Bartynski WS, Heller MT, Grahovac SZ, Rothfus WE, Kurs-Lasky M. Severe thoracic kyphosis in the older patient in the absence of vertebral fracture: association of extreme curve with age. AJNR Am J Neuroradiol. 2005;26(8):2077-85.[PubMed] 
  31. Surmeli M, Ozdemir OC. Examination of the relationship between upper limb function, posture and quality of life in patients with and without lymphedema after breast cancer surgery. Konuralp Tıp Dergisi. 2019;11(3):432-9.[Crossref] 
  32. Vaughn DW, Brown EW. The influence of an in-home based therapeutic exercise program on thoracic kyphosis angles. Journal of Back and Musculoskeletal Rehabilitation. 2007; 20(4),155-65.[Crossref] 

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