Tesis

Hubungan antara Karakteristik Klinis dan Skor Bone Mineral Density pada Pasien dengan Defisit Neuromuskular Pascastroke = Relationship Between Clinical Characteristics and Bone Mineral Density Score in Patients with Post-Stroke Neuromuscular Deficit.

Latar Belakang: Kondisi disuse osteoporosis pada pasien hemiparesis dapat menyebabkan morbiditas yang signifikan, sehingga berakibat pada penurunan kualitas hidup pasien. Karakteristik klinis pada pasien stroke sangat beragam. Metode: Penelitian ini merupakan studi observasional analitik dengan metode crosssectional pada pasien stroke dengan hemiparesis yang diambil secara total sampling di RSCM pada periode 2018 - 2019. Bone mineral density (gr/cm 2 ) dinilai menggunakan Dual Energy X-ray Absorptiometry (DEXA) pada tulang belakang dan kedua sisi ekstremitas. Kami melakukan analisis hubungan dan korelasi skor BMD dan delta BMD (selisih BMD sisi sehat dengan sisi sakit) terhadap karakteristik klinis yaitu usia, jenis kelamin, awitan stroke, kekuatan motorik, dan kepatuhan rehabilitasi. Kami menggunakan uji regresi linear untuk menilai korelasi antar variabel. Hasil: Terdapat 34 subjek dalam penelitian ini dengan rerata usia 54,71 ± 7,5 tahun, rerate awitan 17,32 ± 4,4 bulan. Mayoritas subjek merupakan perempuan (53%), total subjek yang mengalami paresis sesuai dengan sisi tangan dominan sebanyak 19 orang (56%). Rerata nilai BMD (g/cm 2 ) wrist sisi sehat dan sakit adalah 0,8 ± 0,15 dan 0,74 ± 0,15; hip sisi sehat dan sakit adalah 0,83 ± 0,15 dan 0,77 ± 0,16; serta spine adalah 1,005 ± 0,20. Terdapat perbedaan bermakna antara BMD sisi sehat dengan sisi sakit baik pada hip maupun wrist (p < 0,001). Didapatkan korelasi positif yang kuat antara awitan hemiparesis dengan delta BMD wrist dan hip (r= 0,779 p=0,001 dan r=0,791 p=0,001). Terdapat juga hubungan bermakna antara delta BMD dengan usia dan kekuatan motorik. Pada uji multivariat didapatkan bahwa usia dan awitan hemiparesis merupakan faktor prediktor utama terhadap delta BMD (aR 2 wrist= 0,486, aR 2 hip= 0,614). Diskusi: Nilai rata-rata BMD pada sisi hemiparesis mengalami penurunan sebesar 7,36% dibandingkan sisi non-paresis. Nilai BMD di bawah normal ditemukan pada 7 dari 10 pasien dengan defisit neuromuskular pascastroke. Kesimpulan: Usia, kekuatan motorik ekstremitas, awitan hemiparesis, dan kepatuhan rehabilitasi mempengaruhi penurunan nilai BMD. Osteoporosis terdeteksi pada onset hemiparesis 10 bulan dan usia pasien termuda adalah 45 tahun. Selain itu, usia dan awitan hemiparesis menjadi faktor prediktor utama terhadap penurunan nilai BMD. Faktor-faktor ini sebaiknya menjadi salah satu pertimbangan utama dalam manajemen diagnostik dan tatalaksana disuse osteoporosis pada pasien stroke
Kata kunci: Disuse osteoporosis; BMD; hemiparesis; stroke


Introduction: Disuse osteoporosis in hemiparetic patients often results in significant morbidity and decreased quality of life. The clinical characteristics among stroke patient varies from one person to other. Methods: This was an analytical observational study with cross-sectional method evaluating hemiparetic patients taken by total sampling at RSCM during the period of 2018 to 2019. Bone mineral density (gr/cm 2 ) was assessed using Dual Energy X-ray Absorptiometry (DEXA) on spine and both sides of the body. An analysis of the relationship and correlation between BMD and delta BMD scores (healthy side BMD difference with the pain side) with clinical characteristics, namely age, sex, stroke onset, motor strength, and adherence to rehabilitation was performed. Linear regression test was used to assess the correlation between variables. Results: A total of 34 subjects were recruited for this study. The mean age was 54.71 ± 7.5 years, and the mean onset of stroke was 17.32 ± 4.4 months. Of the subjects, 18 (53%) were female,19 (56%) experienced paresis in accordance with the dominant hand side. The mean BMD value (g / cm2) of the healthy and paretic side of the wrist was 0.8 ± 0.15 and 0.74 ± 0.15; healthy and paretic hip was 0.83 ± 0.15 and 0.77 ± 0, 16); and the spine was 1.005 ± 0.20. There was a significant difference between the healthy and paretic side of BMD of both hip and wrist (p < 0.001). There was a strong positive correlation between the onset of hemiparesis and wrist and hip delta BMD (r = 0.779 p = 0.001 and r = 0.791 p = 0.001). There was also a statistically significant association between delta BMD and age and motor strength. Multivariate analysis demonstrated that the onset of hemiparesis was a strong predictor of delta BMD (aR2 wrist = 0.486, aR2 hip = 0.614). Discussions: There was a 7,36% decrease in mean score of BMD on the paretic side compared to non-paretic side. Low BMD score is prevalent in 7 out of 10 patients with post-stroke neuromuscular deficit. Conclusion: Age, limb strength, the onset of hemiparesis, and rehabilitation compliance are associated with the decreased BMD among patients with post-stroke neuromuscular deficit. Osteoporosis was detected as early as 10 months after onset of hemiparesis and the youngest patient was 45 years old. In addition, age and the onset of hemiparesis are major predictors of accelerated BMD loss, which can be used to calculate delta BMD score. These factors should perhaps become the main issues addressed in the diagnosis or treatment of disuse osteoporosis among stroke patient.
Keywords: Disuse osteoporosis; BMD; hemiparesis; stroke