Publication: Hemiplejik hastalarda solunum fonksiyon testi ve ultrasonografik diyafram ölçümlerinin korelasyonu ile solunum egzersizlerinin bu parametrelere etkilerinin araştırılması / Investigate the correlation of diaphragm ultrasound with pulmonary function test and the effects of pulmonaty rehabilitation on these parameters in hemiplegic patients
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KILIÇOĞLU, Mehmet Serkan
Bezmialem Vakıf University
Objective: The aim of this study was to investigate the correlation of diaphragm ultrasound with pulmonary function test, and the effects of pulmonary rehabilitation on these parameters in hemiplegic patients. For this purpose, the correlation between diaphragm ultrasound (DUS) measurements and pulmonary function test (PFT) and the effects of pulmonary rehabilitation on these parameters were investigated in hemiplegic patients. Materials and Methods: The approval for the study was obtained from the Non-Interventional Clinical Research Ethics Committee of Bezmialem Vakif University. Our single-blind, randomized, prospective study reviewed 59 patients between the ages of 18-80 years who were admitted to the outpatient clinics of our clinic, developed hemiplegia due to the first stroke, had no cardiac and/or pulmonary diseases and had a mini mental score (MMT) above 24 and a Brunnstrom lower extremity value above stage 3. Of these patients, 9 were excluded from the study since they did not meet the study inclusion criteria and 5 were excluded because of refusing to participate in the study, so a total of 45 patients were randomized for the study. All patients included in the study were informed about the purpose of the study in detail and written consent was obtained. In the clinical evaluation, the Brunnstrom staging, mini-mental state examination (MMSE) for cognitive evaluation, Functional Ambulation Scale (FAS), and Functional Independence Measure (FIM) were used. All patients underwent DUS measurements. The affected side and the non-affected side were measured 3 times at end inspiration and at end expiration, and these measurements were averaged. After DUS measurement, PFT measurement was performed on the same day. Neurological rehabilitation and pulmonary rehabilitation programs were administered to the treatment group. Whereas, only neurological rehabilitation program was administered to the control group. The rehabilitation program was administered in 30 sessions, 5 days a week for 6 weeks. During the follow-ups, 4 patients left the study, 1 patient in the treatment group left the study voluntarily and 1 patient left the study because of the requirement for intensive care. In the control group, 1 patient left the study voluntarily and 1 patient left due to the development of hip fracture after a fall. After six weeks of follow-up, 41 patients completed the study. FVC, FEV1, diaphragm thickness measurement at end inspiration, diaphragm thickness measurement at end expiration, diaphragm thickening fraction were used as the measurement parameters. All patients were evaluated before and after treatment. Results: The results were compared both within and between groups. The affected side at end inspiration (p <0.01), the non-affected side at end inspiration (p=0.01), the affected side at end expiration (p=0.01), the non-affected side at end expiration (p=0.01), the affected side diaphragm thickening fraction (ΔKdi) (p=0.01), the non-affected side ΔKdi value (p = 0.01), which were measured with DUS in our study, were better in the treatment group than in the control group after treatment compared to the pre-treatment period (p=0.05). Similarly, the PFT parameters of FVC (p<0.01), FVC(%) (p<0.01), FEV1 (p=0.03), FEV1 (%) (p=0.02), FEV1/FVC (p=0.04) were better in the treatment group than in the control group after treatment compared to the pre-treatment period (p=0.05). In addition, the DUS measurement of the affected side diaphragm at end inspiration was positively correlated with the PFT parameter of FVC before treatment (r=0.38, p=0.03) and after treatment (r=0.460, p=0.02). (p<0.05). The DUS measurement of the affected side diaphragm at end inspiration was positively correlated with the PFT parameter of FEV1 before treatment (r=0.35, p=0.02) and after treatment (r=0.39, p=0.03). The DUS measurement of the affected side ΔKdi value was positively correlated with the PFT parameter of FVC before treatment (r=0.448, p=0.01) and after treatment (r=0.32, p=0.04). The DUS measurement of the affected side ΔKdi value was positively correlated with the PFT parameter of FVC before treatment (r=0.448, p=0.01) and after treatment (r=0.32, p=0.04). Conclusion: It is thought that DUS measurements can be used to evaluate respiratory problems in stroke patients. In addition, it was demonstrated that pulmonary rehabilitation improved these parameters in stroke patients, and this could be followed up with DUS. Keywords: Hemiplegia, Diaphragm Ultrasound, Pulmonary Function Test, Pulmonary Rehabilitation.
Thesis (Medical)--Bezmialem Vakıf University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Istanbul, 2020
Fiziksel Tıp ve Rehabilitasyon = Physical Medicine and Rehabilitation, Hemipleji = Hemiplegia, Prospektif çalışmalar = Prospective studies, Solunum fonksiyon testleri = Respiratory function tests, Solunum tedavisi = Respiratory theraphy, Ultrasonografi = Ultrasonography