İnmeli hastalarda sarkopeninin denge ve fonksiyonel durumla ilişkisi
The relationship of sarcopenia with balance and functional status in stroke patients
Yazar: MUHAMMED KILIÇ
Danışman: PROF. DR. ZEYNEP AYDAN KURTARAN
Sağlık Bilimleri Üniversitesi / Ankara Bilkent Şehir Hastanesi / Fizik Tedavi ve Rehabilitasyon Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2022
Konu: Fiziksel Tıp ve Rehabilitasyon = Physical Medicine and Rehabilitation
Dizin: Denge = Equilibrium ; Fonksiyonel yetkinlik = Functional competency ; Kas distrofileri = Muscular dystrophies ; Postural denge = Postural balance ; İnme = Stroke

Özet:
Amaç: Sarkopeni sıklıkla geriatrik yaş gurubunda görülen önemli bir morbidite nedeni olmasına karşın inmeli hastalarda daha yaygın ve daha erken yaşlarda ortaya çıkabileceği gösterilmiştir. Çalışmamızın amacı inmeli hastalarda sarkopeninin denge ve fonksiyonel durumla ilişkisini ortaya koymaktır.
 Gereç ve Yöntem: Kesitsel çalışma olarak planlanan bu çalışma inme rehabilitasyon kliniğinde yatan 68 inmeli hasta ile yürütüldü. Hastaların kas gücü, kas kütlesi, ambulasyon durumu, fonksiyonel bağımsızlık düzeyi,denge durumu, bilişsel durum sırasıyla el dinamometresi ve tekrarlayann sandalyeden kalkma testi, biyoelektrik impedans analizi (BİA), Fonksiyonel Ambulasyon Skalası (FAS), Fonksiyonel Bağımsızlık Ölçeği (FBÖ), Berg Denge Ölçeği (BDÖ), Mini Mental Durum Değerlendirme (MMDD) ve Brunsstrom Hemipleji İyileşme Değerlendirmesi (BRS) ile değerlendirildi.  Sarkopeni tanısı Avrupa Yaşlılarda Sarkopeni Çalışma Grubu 2 (EWGSOP2) kriterleriyle konuldu.
 Bulgular: Çalışmamıza dahil edilen hastaların 28'i (%41,2) kadın, 40'ı (%58,8) erkekti. Hastaların yaş aralığı 40 ile 76 arası değişmekte olup ortanca değer olarak 63 yaş idi. Sarkopenisi olan hastaların yaşı, sarkopenisi olmayan hastalara göre istatistiksel olarak anlamlı şekilde daha ileri bulundu (p=0,001). Sarkopenisi olan inmeli hastalarda FBÖ, MMDD, BDÖ, Apendiküler iskelet kas kütlesi (AİKK), toplam iskelet kas kütlesi (TKK), AİKK/h2 değerleri istatistiksel olarak anlamlı şekilde düşük bulundu. (Sırasıyla (p<0,001), (p=0,008), (p<0,001), (p<0,001), (p<0,001), (p<0,001)).
 Sonuç: Sarkopeni inmeli hastalarda olumsuz fonksiyonel durum ve denge ile ilişkilidir.
  Anahtar kelimeler: İnme, sarkopeni, denge, fonksiyonel durum

Abstract:
Objectives: Although sarcopenia is an important cause of morbidity frequently seen in the geriatric age group, it has been shown that it can occur more commonly and at earlier ages in stroke patients. The aim of our study is to reveal the relationship between sarcopenia and balance and functional status in stroke patients.
Material and Methods: This study, which was planned as a cross-sectional study, was conducted with 68 stroke patients hospitalized in the stroke rehabilitation clinic. Each patient was assessed in their initial examination. Patients' muscle strength was determined by hand dynamometer and repetitive chair rise test, muscle mass by bioelectrical impedance analysis, ambulation status by Functional Ambulation Scale (FAC), functional independence level by Functional Independence Scale (FIM), balance status by Berg Balance Scale (BBS), cognitive status by Mini Mental State Exam (MMSE), and Brunsstrom Hemiplegia Recovery Evaluation. The diagnosis of sarcopenia was made according to the criteria of the European Working Group on Sarcopenia in older people.
Results: Of the patients included in our study, 28 (41.2%) were female and 40 (58.8%) were male. The age range of the patients ranged from 40 to 76 years, with a median age of 63 years. The age of the patients with sarcopenia was statistically significantly older than the patients without sarcopenia (p=0.001). In stroke patients with sarcopenia, FIM (p<0,001), MMSE (p<0,001), BBS (p<0,001), appendicular skeletal muscle mass (ASM) (p<0,001), total body skeletal muscle mass (SMM) (p<0,001), ASM/h2 (p<0,001) values were found to be statistically significantly lower.
Conclusion: Sarcopenia is associated with adverse functional status and balance in stroke patients.
ABSTRACT
Objectives: Although sarcopenia is an important cause of morbidity frequently seen in the geriatric age group, it has been shown that it can occur more commonly and at earlier ages in stroke patients. The aim of our study is to reveal the relationship between sarcopenia and balance and functional status in stroke patients.
	Material and Methods: This study, which was planned as a cross-sectional study, was conducted with 68 stroke patients hospitalized in the stroke rehabilitation clinic. Each patient was assessed in their initial examination. Patients' muscle strength was determined by hand dynamometer and repetitive chair rise test, muscle mass by bioelectrical impedance analysis, ambulation status by Functional Ambulation Scale (FAC), functional independence level by Functional Independence Scale (FIM), balance status by Berg Balance Scale (BBS), cognitive status by Mini Mental State Exam (MMSE), and Brunsstrom Hemiplegia Recovery Evaluation. The diagnosis of sarcopenia was made according to the criteria of the European Working Group on Sarcopenia in older people.
	Results: Of the patients included in our study, 28 (41.2%) were female and 40 (58.8%) were male. The age range of the patients ranged from 40 to 76 years, with a median age of 63 years. The age of the patients with sarcopenia was statistically significantly older than the patients without sarcopenia (p=0.001). In stroke patients with sarcopenia, FIM (p<0,001), MMSE (p<0,001), BBS (p<0,001), appendicular skeletal muscle mass (ASM) (p<0,001), total body skeletal muscle mass (SMM) (p<0,001), ASM/h2 (p<0,001) values were found to be statistically significantly lower.
	Conclusion: Sarcopenia is associated with adverse functional status and balance in stroke patients.
        Keywords: Stroke, sarcopenia, balance, functional status