Alt Üriner Sistem Semptomu Olan ve Olmayan Multipl Skleroz Hastalarında Fiziksel ve Psikososyal Fonksiyonelliğin İncelenmesi

Abstract

DİLEK, Ş. Investigation of Physical and Psychosocial Functionality in Multiple Sclerosis Patients With and Without Lower Urinary Tract Symptom, Hacettepe University, Graduate School of Health Sciences, Physical Therapy and Rehabilitation Program, Master Thesis, Ankara, 2023. The aim of this study was to investigate physical and psychosocial functioning in Multiple Sclerosis (MS) patients with and without lower urinary tract (LUT) symptom. After asking the symptoms, the patients were divided into 2 groups those with (n=36) and without (n=14) LUT symptoms. Physical functioning was measured using the Timed Up and Go (TUG) test, Multiple Sclerosis Gait Scale, International Fall Efficacy Scale, Fatigue Impact Scale, and Fatigue Severity Scale. The Global Physical Activity Scale was used to evaluate physical activity level. Psychological status was measured with the Hospital Anxiety Depression Scale and quality of life was measured with the Multiple Sclerosis Quality of Life-54 Questionnaire. The duration of TUG test (p=0.031) was found to be significantly higher in MS patients with LUTS than those without LUTS (p=0.031). In the subgroup analysis, it was found that the duration of TUG test (p=0.008) and the Fall Efficacy Scale score (p=0.020) were significantly higher in patients with urinary incontinence (UI) than those without UI. The total score of the Global Physical Activity Scale was found to be significantly lower (p=0.028) in patients with urinary incontinence (UI) than those without UI. The duration of TUG test was significantly higher (p=0.014) in patients with Overactive Bladder Syndrome (OABS) than those without OABS. In MS patients with LUT symptoms, symptom severity assessed by the Neurogenic Bladder Symptom Score was moderately associated with the duration of the TUG test (r=0.356, p=0.033), MS Walking Scale score (r=0.428, p=0.009), and Fall Efficacy Scale score (r=0.469, p=0.004). Additionally, it was found that the physical health score of the MS Quality of Life Questionnaire (r=-0.557, p<0.01) decreased significantly as the symptom severity increased. In MS patients with UI symptoms, symptom severity was moderately correlated with the MS Gait Scale (r=0.400, p=0.035) and the number of falls in the last year (r=0.443, p=0.018). The physical health score of the MS Quality of Life Questionnaire was found to be strongly correlated with symptom severity (r= -0.64, p<0.01). In MS patients with OABS, symptom severity was weakly correlated with the MS Gait Scale score (r= 0.354, p=0.049), the Falls Efficacy Scale score (r=0.389, p=0.031), and the Fatigue Severity Scale score (r= 0.353, p=0.049). The work activities subscale score of the Global Physical Activity Questionnaire (r=-0.353, p=0.049) and the physical health score of the MS Quality of Life Questionnaire (r=-0.676, p<0.01) decreased significantly with increasing symptom severity. In the linear regression analysis performed using the backward method in MS patients with LUT symptoms, higher TUG test duration (β=0.410, p=0.001) and lower physical health score (β=-0.345, p=0.006) were found to be contributing factors to higher LUT symptom severity. Our study emphasizes that evaluations regarding LUT symptoms should start at the early stage of the disease in patients with MS and it is important to recommend pelvic floor rehabilitation in addition to physical therapy and rehabilitations programs which aim to improve functionality.