‹nmeli Hastalarda Yaflflam Kalitesini Etkileyen ... - FTR Dergisi

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23. Ulusal Fiziksel T›p ve Rehabilitasyon Kongresi / 23 rd National Physical Medicine & Rehabilitation Congress
Türk Fiz Rehab Derg 2011:57Özel Say›; 1-334 /Turk J Phys Med Rehab 2011:57Suppl; 1-334
P-033
Omuz a¤r›s›nda Yüz A¤r› Ölçe¤inin Geçerlilik ve Güvenilirli¤i
fiebnem Koldafl Do¤an 1, Saime Ay 1, Deniz Evcik 1, Yeflim Kurtaifl 2,
Derya Gökmen Öztuna 3
1 Ufuk Üniversitesi T›p Fakültesi Fiziksel T›p ve Rehabilitasyon Anabilim Dal›, Ankara
2 Ankara Üniversitesi T›p Fakültesi Fiziksel T›p ve Rehabilitasyon Anabilim Dal›, Ankara
3 Ankara Üniversitesi T›p Fakültesi Biyoistatistik Anabilim Dal›, Ankara
AMAÇ: Öznel bir semptom olan a¤r›n›n yetersiz de¤erlendirimi etkin a¤r› tedavisini olumsuz
etkileyebilmektedir. Kullan›lan a¤r› ölçe¤inin basit, anlafl›l›r ve geçerli olmas›, a¤r› fliddetindeki
zamanla veya tedavi ile olan de¤ifliklikleri saptayabilmesi ve hedef hasta kitlesine kültürel
olarak uyarlanabilme kapasitesine sahip olmas› gereklidir. Bu çal›flman›n amac› kronik a¤r›s›
olan hastalarda, basit ve okuma-yazmas› olmayan hastalara bile uygulanabilecek Yüz A¤r›
Ölçe¤i (YAÖ) de¤iflime duyarl›l›¤›n› da belirleyerek klinik kullan›m›n› de¤erlendirmek ve bu
hastalarda kronik a¤r›n›n psikolojik durum ve yaflam kalitesi üzerine etkisi olup olmad›¤›n›
araflt›rmakt›r.
GEREÇ-YÖNTEM: 30 hasta (18 kad›n, 12 erkek, yafl ortalamas› 52) çal›flmaya dahil edildi. A¤r›
modeli olarak kronik omuz a¤r›s› seçildi. Detayl› klinik muayenenin ard›ndan a¤r› fliddeti
geçerlili¤i ve güvenilirli¤i olan YAÖ ve görsel analog skala (VAS) ile, psikolojik durum Beck
Depresyon Anketi (BDE) ile, yaflam kalitesi ise K›sa Form-36 (SF-36) ile de¤erlendirildi. Tüm
hastalara 15 gün boyunca s›cak paket, ultrason, transkutanöz elektrik stimülasyonu (TENS) ve
egzersizden oluflan fizik tedavi program› uyguland›. Tüm de¤erlendirmeler tedavi öncesi ve
sonras› yap›ld›.
BULGULAR: Yüz a¤r› ölçe¤i ile tedavi öncesi ve sonras› VAS (s›ras›yla; r=0,618 ve 0,728),
SF-36 (r=-0,578-0,800) ve BDE skorlar› (r=0,398) aras›nda iyi-orta düzeylerde korelasyon
saptand›. Her iki a¤r› ölçe¤i ile de¤erlendirilen a¤r› fliddetinde tedavi sonras›nda istatistiksel
olarak anlaml› azalma saptand› (p=0,000). Tedavi sonras› ortalama YAÖ de¤erlerindeki azalma
(3.8±1,4-1,4±0,7, p=0,000) ve standardize yan›t ortalamas›n›n (SRM=2,35) de¤eri nedeni ile
ölçe¤in de¤iflimi de¤erlendirmede yeterli oldu¤u kabul edildi. Tedavi sonras›nda BDE
skorlar›nda (p=0,000) ve SF-36 alt skorlar›nda (fiziksel fonksiyon, fiziksel rol, vücut a¤r›s›,
genel sa¤l›k, sosyal fonksiyon ve emosyonel rol; s›ras›yla p= 0,000, 0,001, 0,000, 0,009, 0,049
ve 0,023) anlaml› düzelme gözlendi.
SONUÇ: Yüz a¤r› ölçe¤i kronik omuz a¤r›s› olan hastalarda a¤r› fliddetini belirlemede
kolayl›kla kullan›labilen, geçerli, zamanla veya tedaviye ba¤l› olarak a¤r› fliddetindeki
de¤ifliklikleri belirleyebilme özelli¤ine sahip basit bir ölçektir. Di¤er a¤r›l› durumlarda da, özellikle
e¤itim düzeyi yetersiz bireylerde, kullan›lmas› önerilebilir.
Anahtar Kelimeler: A¤r›, depresyon, yaflam kalitesi, yüz a¤r› ölçe¤i
P-034
Lomber Omurgada Sessiz Bir Monostotik Fibröz Displazi: Olgu Sunumu
Reyhan Çeliker1, Nurten Korkmaz1, Serdar Özgen2, Ercan Karaaslan 3,
Behram Kaya2, Yeflim Sa¤l›can 4, Abdullah Yakupo¤lu 3
1Maslak Ac›badem Hastanesi Fizik Tedavi ve Rehabilitasyon Bölümü, ‹stanbul
2Maslak Ac›badem Hastanesi Nöroflirurji Bölümü, ‹stanbul
3Maslak Ac›badem Hastanesi Radyoloji Bölümü, ‹stanbul
4Maslak Ac›badem Hastanesi Patoloji Bölümü, ‹stanbul
Fibröz displazi(FD), kemik trabeküler dokusunun fibröz doku ile yer de¤ifltirmesi ile oluflan iyi
huylu bir kemik hastal›¤›d›r. Monostotik ad› verilen formda tek bir odak vard›r. Polistotik formda
ise birden fazla bölgede görülmektedir. Lezyonlar s›kl›kla kostalarda, femurda, tibiada,
maksillada ve kalvariumda bulunmaktad›r. Monostotik FD, polistotik formdan daha yayg›n
olmas›na karfl›n, omurgada monostotik lezyonlar çok nadir bulunmaktad›r ve literatürde tek
olgu raporlar› fleklinde bildirilmifltir. Sundu¤umuz olgu lomber omurgada gözlenen nadir
bildirilmifl sessiz bir monostotik FD olgusudur. Otuz yedi yafl›nda erkek hasta poliklini¤imize 2
ayd›r süren s›rt ve sol kürek kemi¤i üzerinde a¤r› flikayetiyle baflvurmufltur. Fizik
incelemesinde sol supraspinatus kas› üzerinde tetik nokta ve gergin bant saptanm›fl, nörolojik
muayenesi normal bulunmufltur. Servikal ve dorsal vertebra X ray'lerinde L1 vertebra korpusunun
yüksekli¤inde azalma gözlenmifltir. Bunun üzerine hastaya spinal MR yap›lm›flt›r.
Servikal MR'da C5-6 ve C6-7 de sol paramedian köklere bas› yapan disk protrüzyonu
gözlenirken, lomber MR'da L1 vertebra korpusunda, sa¤ pedikül, lamina ve transvers proseste
ekspansil, 4,5x7,2 cm boyutlar›nda ölçülen, heterojen sinyalli, yo¤un kontrast madde tutan
tümöral kitle gözlenmifltir. Nöroflirurji bölümüne konsülte edilen hastadan biyopsi al›nm›fl ve
sonucu FD ile uyumlu bulunmufltur. Hastan›n MR bulgular› 16 ay önce çekilen lomber MR bulgular›
ile karfl›laflt›r›lm›fl ve lezyonda anlaml› büyüme gözlenmemifltir. Nöroflirurji bölümünce
hastaya cerrahi giriflim önerilmifltir. Omurgada gözlenen ve osteolitik lezyonlar› taklit eden
monostotik FD'ler, genellikle sessiz lezyonlar olduklar›ndan, baflka nedenlerle yap›lan
incelemelerde saptanmaktad›rlar. Nadir olan ve tesadüfen belirlenen bu lezyonlar›n do¤al
seyirleri ve ideal tedavileri konusunda net bir bilgi oluflturulamam›flt›r. Omurgadaki monostotik
FD olgular›n›n bildirimi bu tümörlerin karekteristiklerini belirlemek ve uzun süreli izlem
ile de¤iflimlerini gözlemlemek aç›s›ndan önem tafl›maktad›r.
Anahtar Kelimeler: Vertebra, fibröz displazi, vertebra tümörleri
P-033
The Validity And Reliability of Face Pain Scale in Shoulder Pain
fiebnem Koldafl Do¤an 1, Saime Ay 1, Deniz Evcik 1, Yeflim Kurtaifl 2,
Derya Gökmen Öztuna 3
1 Ufuk University School of Medicine Department of Physical
Medicine and Rehabilitation, Ankara
2 Ankara University School of Medicine Department of Physical
Medicine and Rehabilitation, Ankara
3 Ankara University School of Medicine Department of Biostatistics, Ankara
OBJECTIVE: Inadequate assessment of pain which is a subjective symptom, hampers
effective pain management. A pain scale should be easy, simple, valid, able to detect changes
in pain severity over time or after treatment, and culturally adaptable to the target patient
population. The aim of this study was to investigate the clinical utility of Face Pain Scale (FPS)
that can be applied even to illiterate patients, to determine sensitivity to change in patients
with shoulder pain and to determine whether chronic pain had effects on psychologic status
and quality of life of these patients.
MATERIALS-METHODS: Thirty patients (18 females, 12 males, mean age 52) were included in
the study. Chronic shoulder pain was chosen as a chronic pain model. After detailed clinical
examination, pain, psychologic status and quality of life were evaluated with reliable and valid
tools of Faces Pain Scale (FPS) and Visual Analogue Scale (VAS), Beck Depression Inventory
(BDI) and Short Form-36 (SF-36). Physical therapy program including hotpack, ultrasound,
transcutaneous electrical stimulation and exercises were applied to all patients during 15 sessions.
All assessments were done before and after the treatment.
RESULTS: Good-moderate correlations were detected between FPS and VAS (r=0.618 and
0.728, respectively) SF-36 scores (r=-0.578-0.800) before and after the treatment and BDI
scores (r=0.398) before the treatment. There was a statistically significant decrease in pain
severity after the treatment as indicated by both pain scales (p=0.000). The scale was
accepted as sufficient in evaluating change because of the reduction in mean FPS values
(3.8±1.4-1.4±0.7, p=0.000) and standardized response mean (SRM) value of FPS of 2.35. There
were also statistically significant improvements in BDI scores (p=0.000) and in subscales of
SF-36 (physical functioning, physical role, bodily pain, general health, social functioning and
emotional role; p=0.000, p=0.001, p=0.000, p=0.009, p=0.049 and p=0.023, respectively).
CONCLUSION: Face Pain Scale is a simple and a valid scale with ease of use that has the ability
to detect changes in pain severity over time or due to the treatment in patients with shoulder
pain. The use of this scale can be suggested in other painful conditions, especially in individuals
with low education levels.
Keywords: Pain, depression, quality of life, faces pain scale
P-034
A case of silent monostotic fibrous dysplasia of the lumbar spine
Reyhan Çeliker 1, Nurten Korkmaz 1, Serdar Özgen 2, Ercan Karaaslan 3,
Behram Kaya 2, Yeflim Sa¤l›can 4, Abdullah Yakupo¤lu 3
1 Maslak Ac›badem Hospital Physical Medicine and Rehabilitation, Istanbul
2 Maslak Ac›badem Hospital Neurosurgery, Istanbul
3 Maslak Ac›badem Hospital Radiology, Istanbul
5 Maslak Ac›badem Hospital Pathology,Istanbul
Fibrous dysplasia is a benign disorder of bone in which proliferating fibrous tissue replaces
the bony spongiosa. It may occur as a solitary lesion, which is called monostotic fibrous
dysplasia. It can also present in multiple or polyostotic form. Lesions are most commonly
encountered in ribs, femur, tibia, maxilla and calvaria. Although the monostotic form is more
common than polyostotic form, monostotic lesions occur extremely rare in the spine and
most cases of monostotic fibrous dysplasia documented in the literature appear as a few
case reports. We described a case of silent, rarely reported, monostotic fibrous dysplasia of
the lumbar spine. A 37 year old man was admitted to our clinic with the complaint of back
pain lasting more than two months. On clinical examination, there was a trigger point and
taut band on the left supraspinatus muscle, there was no neurological deficit. On X-ray of the
cervical and thoracic spine, a decrease in height of corpus of first lumbar vertebra was
detected. Subsequently, magnetic resonance imaging (MRI) of the entire vertebral
column was performed. On lumbar MRI, an expansile tumoral lesion measured 4.5x7.2 cm in
diameter, showing intense contrast accumulations with heterogenous signal was
demonstrated in the corpus of L1 vertebra, right pedicle, lamina and transverse process.
Patient was consulted by the department of Neurosurgery and a tissue sample was obtained
from the lesion. The pathological diagnosis was fibrous dysplasia. Previous lumbar MRI which
was performed 16 months earlier was compared with the current scan and no significant
change was reported. Surgical resection was recommmended by the department of
Neurosurgery. Since these non-neoplastic conditions which are observed on spine and simulate
osteolytic tumors of the bone are ordinary silent lesions, they are usually identified incidentally
during examinations or imaging studies performed for other unrelated medical conditions.
As they are very rare and usually diagnosed incidentally, a common consensus is not
reached about the ideal treatment and the natural history of these lesions. Reporting these
fibrous dysplasia cases is very important for determination of their characteristics and long
term follow up of their possible malignant transformation.
Keywords: Vertebra, fibrous dysplasia, vertebral tumor