Izvedljivost indeksa premičnosti de Morton in 2-minutnega testa hoje pri pacientih s srčnim popuščanjem v kliničnem okolju : magistrsko delo

Fazlić, Sebiha (avtor), Puh, Urška (mentor), Brvar, Miran (komentor), Jakovljević, Miroljub (recenzent)

Uvod: Z napredovanjem srčnega popuščanja se povečujeta utrujenost in zadihanost. Zaradi strukturnih ali funkcionalnih nepravilnosti delovanja srca se poveča delovanje različnih hormonov in simpatičnega živčevja. Zmanjšana telesna dejavnost povzroča izgubo mišične mase, pojavijo se motnje ravnotežja in težave pri hoji. Za oceno premičnosti od akutne do rehabilitacijske bolnišnične obravnave odraslih na nizki in osnovni ravni funkcioniranja se že uporabljata indeks premičnosti de Morton (DEMMI) in 2-minutni test hoje (2MWT). Namen: Proučiti izvedljivost DEMMI in 2MWT pri pacientih s srčnim popuščanjem na oddelku intenzivne nege, ugotoviti njun učinek tal, povezanost z Indeksom Barthlove (BI) in šestminutnim testom hoje (6MWT) ter odzivnost. Metode dela: V raziskavi je sodelovalo 35 preiskovancev s srčnim popuščanjem (starih 47 – 93 let), ki so bili v šestih mesecih obravnavani na oddelku intenzivne nege. Pred prvo fizioterapevtsko obravnavo in pred odpustom z oddelka intenzivne nege smo jih ocenili z DEMMI in BI ter, če so bili sposobni vsaj hoje z občasnim lahnim dotikom, še z 2MWT in 6MWT, ki smo ju izvajali hkrati. Rezultati: V povprečju so imeli 6,6 ± 2,9 fizioterapevtskih obravnav. Izidi vseh testov so se ob odpustu izboljšali: DEMMI iz 57,5 na 65,4 točk (p < 0,01) BI iz 12,4 na 15,6 točk (p < 0,01), 2MWT iz 61,2 na 76,1 m (p < 0,01), 6MWT iz 148,8 na 196,3 m (p < 0,01). Pri DEMMI in 2MWT nismo ugotovili učinka tal 0 %. Povezanost DEMMI z BI je bila odlična oziroma zelo visoka (ocenjevanje 1: r = 0,89; ocenjevanje 2: r = 0,80), s 2MWT visoka oziroma zelo visoka (ocenjevanje 1: r = 0,71, ocenjevanje 2: r = 0,83), s 6MWT visoka oziroma zelo visoka (ocenjevanje 1: r = 0,74, ocenjevanje 2: r = 0,85). Povezanost 6MWT z 2MWT zelo visoka (ocenjevanje 1: r = 0,81, ocenjevanje 2: r = 0,85). Velikost učinka vseh testov je bila nizka (DEMMI: ES = 0,45; 2MWT: ES = 0,48; 6MWT: ES = 0,43), za BI pa zmerna (ES = 0,65). Med ocenjevanji nismo zabeležili neželenih dogodkov. Zaključek: DEMMI in 2MWT sta izvedljivi merilni orodji pri pacientih s srčnim popuščanjem na oddelku intenzivne nege. Nimata učinka tal in imata visoko sočasno veljavnost z BI ter 6MWT ter nizko odzivnost. DEMMI priporočamo za uporabo v klinični praksi pri pacientih s srčnim popuščanjem, 6MWT pa bi lahko nadomestili z 2MWT.

• Jezik: Slovenski jezik
• Ključne besede: magistrska dela, fizioterapija, srčno popuščanje, DEMMI, Indeks Barthelove, 2-minutni test hoje, 6-minutni test hoje
• Vrsta gradiva: Magistrsko delo/naloga
• Tipologija: 2.09 - Magistrsko delo
• Organizacija: ZF - Zdravstvena fakulteta
• Kraj izida: Ljubljana
• Založnik: [S. Fazlić]
• Leto izida: 2022
• Št. strani: 50 str., [4] str. pril.
• PID: 20.500.12556/RUL-140584
• UDK: 615.8
• COBISS.SI-ID: 121902595
• Datum objave v RUL: 16.09.2022

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Feasibility of de Morton mobility index and 2-minute walking test in patients with heart failure in the clinical setting : master thesis

Izvleček

Introduction: As heart failure progresses, shortness of breath and fatigue increase. Due to structural and functional irregularities in heart functions, the activities of different hormones and sympathetic nervous system increase. The reduction of physical activity results in the loss of muscle mass, balance disturbances and difficulties in walking. To evaluate the mobility in adults on the low and basic level of functioning, from the acute phase to the clinical rehabilitation treatments, we currently use the de Morton mobility index – DEMMI and the two-minute walk test – 2MWT. Purpose: To validate the feasibility of the DEMMI and the 2MWT in patients with heart failure in the intensive care unit, and to evaluate the effects of the floor effect, their validity with the Barthel Index – BI and the six-minute walk test – 6MWT, and responsiveness. Methods: The research, which lasted six months, was performed on 35 patients, aged 47 – 93, with heart failure, who were treated in the intensive care unit. They were assessed with the DEMMI and the BI before their first physiotherapeutic treatment and when they were discharged from the intensive care. In case they were able to walk, even when they could only occasionally briefly touch the floor, we assessed them also with the 2MWT and the 6MWT, which were carried out simultaneously. Results: On average, the patients had 6.6 ± 2.9 physiotherapeutic treatments. The results of all tests improved when the patients were discharged: the DEMMI changed from 57.5 to 65.4 points (p < 0.01), the BI from 12.4 to 15.6 points (p < 0.01), the 2MWT from 61.2 to 76.1 m (p < 0.01), and the 6MWT from 148.8 to 196.3 m (p < 0.01). When testing with the DEMMI and the 2MWT there was no floor effect detected (0%). The convergent validity between the DEMMI and the BI was excellent or very high (assessment 1: r = 0.89), (assessment 2: r = 0.80), the convergent validity with the 2MWT was high or very high (assessment 1: r = 0.71), (assessment 2: r = 0.83), with the 6MWT was high or very high (assessment 1: r = 0.74), (assessment 2: r = 0.85). The convergent validity between the 6MWT and 2MWT was very high (assessment 1: r = 0.81), (assessment 2: r = 0.85). The size of all effects was rather low. Conclusion: The DEMMI in the 2MWT are applicable measuring devices to be used in intensive care unit in patients with heart failure. Both have no floor effect, have equal convergent validity as the BI and the 6MWT, and low responsiveness. Therefore, we recommend the DEMMI to be used in clinical practice in patients with heart failure, while the 6MWT should be replaced with the 2MWT.

• Ključne besede: master's theses, physiotherapy, heart failure, DEMMI, Barthel Index, two-minute walk test, six-minute walk test