Pediatric Dysphagia Risk Screening Instrument (PDRSI) in Children With Cerebral Palsy

This study aimed to evaluate whether the Pediatric Dysphagia Risk Screening Instrument (PDRSI) was a suitable test for children with cerebral palsy (CP) and assess the instrument's Turkish validity and reliability. One-hundred twenty-six children with CP participated in this study. "Cronbach's alpha (ɑ)," "Cronbach's ɑ when one item is deleted," "inter-item correlation," and "corrected item-to-total correlation" were used to assess internal consistency. In addition, inter-rater agreement tests (Cohen's kappa coefficient) were conducted for reliability. Construct validity was used to assess the validity. Moreover, flexible fiberoptic endoscopic evaluation of the swallowing method was used to describe the receiver operating characteristic curve analysis and calculate the sensitivity and specificity of T-PDRSI. It was found that the PDRSI had adequate validity and reliability. The PDRSI can be used in children with CP as a valid and reliable instrument with high sensitivity and specificity.

Best Practice Recommendations for Dysphagia Management in Intensive Care Unit (ICU): A Delphi Study from Multidisciplinary Experts in Turkey

There is no study about all aspects of oropharyngoesophageal (OPE) dysphagia from diagnosis to follow-up in a multidisciplinary manner in the world. In order to close this gap, we aimed to create a recommendation study that can be used in clinical practice, addressing all aspects of dysphagia in the ICU in detail with the opinion of experienced multidisciplinary experts. This recommendation paper was generated by a multidisciplinary team, using the seven-step process and a three-modified Delphi round via e-mail. Firstly, 15 open-ended questions were created, and then detailed recommendations including general principles, management, diagnosis, rehabilitation, and follow-up were created with the answers from these questions, Each recommendation item was voted on by the experts as overall consensus (strong recommendation), approaching consensus (weak recommendation), and divergent consensus (not recommended).In the first Delphi round, a questionnaire consisting of 413 items evaluated with a scale of 0-10 was prepared from the opinions and suggestions given to 15 open-ended questions. In the second Delphi round, 55.4% were accepted and revised suggestions were created. At the end of the third Delphi round, the revised suggestion form was approved again and the final proposals containing 133 items were created. This study includes comprehensive and detailed recommendations, including a broad perspective from diagnosis to treatment and follow-up, as detailed as possible, for management of dysphagia in patients with both oropharyngeal- and esophageal-dysphagia in ICU.

Reliability and Usefulness of ChatGPT for Inflammatory Bowel Diseases: An Analysis for Patients and Healthcare Professionals

AIM

We aimed to evaluate the performance of Chat Generative Pre-trained Transformer (ChatGPT) within the context of inflammatory bowel disease (IBD), which is expected to become an increasingly significant health issue in the future. In addition, the objective of the study was to assess whether ChatGPT serves as a reliable and useful resource for both patients and healthcare professionals.

METHODS

For this study, 20 specific questions were identified for the two main components of IBD, which are Crohn's disease (CD) and ulcerative colitis (UC). The questions were divided into two sets: one set contained questions directed at healthcare professionals while the second set contained questions directed toward patients. The responses were evaluated with seven-point Likert-type reliability and usefulness scales.

RESULTS

The distribution of the reliability and utility scores was calculated into four groups (two diseases and two question sources) by averaging the mean scores from both raters. The highest scores in both reliability and usefulness were obtained from professional sources (5.00± 1.21 and 5.15±1.08, respectively). The ranking in terms of reliability and usefulness, respectively, was as follows: CD questions (4.70±1.26 and 4.75±1.06) and UC questions (4.40±1.21 and 4.55±1.31). The reliability scores of the answers for the professionals were significantly higher than those for the patients (both raters, p=0.032).  Conclusion: Despite its capacity for reliability and usefulness in the context of IBD, ChatGPT still has some limitations and deficiencies. The correction of ChatGPT's deficiencies and its enhancement by developers with more detailed and up-to-date information could make it a significant source of information for both patients and medical professionals.

Factors influencing the willingness to participate in rehabilitation in patients with subacute stroke

OBJECTIVE

The aim of this study was to examine the parameters that may influence the willingness of patients to participate in post-stroke rehabilitation.

METHODS

Patients in the subacute phase of stroke who underwent inpatient rehabilitation for one month were included in this study. The primary outcome measure was the level of rehabilitation participation as measured on the Pittsburgh Rehabilitation Participation Scale (PRPS). Other outcome measures evaluated were Mini-Mental State Examination (MMSE) for cognitive functions, Brunnstrom stage for motor recovery, modified Rankin Scale (mRS) for disability, Functional Independence Measure for functionality, Pittsburgh Sleep Quality Index for sleep quality, and Beck Depression Inventory for emotional state.

RESULTS

A total of 38 patients with first-time stroke were studied. A negative correlation was found between the participation in rehabilitation and body mass index (BMI) (r: -0.398p = 0.012), myocardial infarction (MI) history (r: -0.387p = 0.015) and mRS (r: -0.351p = 0.031), while a positive correlation was determined with MMSE (r: 0.432P = 0.007). A 1-unit increase in BMI, MI history, and mRS resulted in a 0.176, 0.673, and 0.294-unit decrease in participation in rehabilitation, respectively. In addition, a 1-unit increase in MMSE provided an increase of 0.606-unit in participation.

CONCLUSION

BMI within normal limits, prevention/treatment of cardiovascular diseases, and well-being of physical and cognitive functions might be the factors that positively influence participation in rehabilitation process. We consider that it would be appropriate to evaluate these parameters with particular emphasis in stroke patients in the subacute period to be rehabilitated.

The importance of myofascial trigger points in chronic neck pain: An ultrasonography preliminary study

BACKGROUND

Ultrasonographic evaluation of trigger points detected by physical examination in patients with myofascial pain syndrome is being used more frequently in clinical care. However, the sonographic appearance of trigger points, in association with pain and disability, has not been adequately described.

OBJECTIVE

To reveal the presence of trigger points with ultrasonography in those with myofascial pain syndrome and to determine if ultrasound images can help discriminate between demographic and disease characteristics.

METHODS

Fifty-two participants with chronic neck pain (NP) were in this cross-sectional study. The pain intensity was evaluated using a 0-10 cm visual analog scale (VAS). The neck disability index measured the NP-induced disability status of the participants. Ultrasonography was used to measure the thicknesses of the paraspinal muscles and the presence of hypoechoic areas within these muscles.

RESULTS

There was a positive correlation between the VAS scores of the participants and the ultrasonographic detection of myofascial trigger points (MTPs) in the multifidus and middle trapezius muscles (right/left r = .30, p = .027; r = .29, p = .029; r = .32, p = .009, r = .30, p = .011, respectively). These features correlated with the disability levels of the participants and the MTPs on both the right and left sides of the splenius, multifidus, upper trapezius, and middle trapezius (r = .32, p = .028; r = .38, p = .013, r = .25, p = .027; r = .33, p = .016; r = .25, p = .025, r = .32, p = .018, r = .28, p = .013, r = .29, p = .016, respectively). A significant correlation was present between the detection of MTP at ultrasonography and decreased muscle thickness in the relevant muscles (between p = .001 and p = .034).

CONCLUSION

The detection of MTPs with ultrasonography is associated with the severity of pain and disability in those with chronic NP. Features on ultrasound include hypoechoic changes within muscle and reduced muscle thickness associated with MTPs.

Assessment of the quality and reliability of the information on spasticity on youtube

BACKGROUND

Youtube has become an influential source of health. This study aimed to evaluate the reliability and quality of YouTube videos on spasticity.

METHODS

The keywords " spasticity, spasticity treatment, spasticity exercises" were used to search for videos. According to the search results, 180 videos were analyzed, videometric characteristics of the videos were recorded, and 2 groups were formed as health professionals and non-health professionals according to the video source. In addition, low, medium and high quality groups were formed using the global quality score (GQS). The reliability of the videos was evaluated using the modified DISCERN (mDISCERN) scale. Video popularity was assessed using the video power index (VPI).

RESULTS

After excluding videos that met the exclusion criteria, the remaining 68 videos were analyzed. The videos were uploaded by healthcare professionals (n = 47, 69.1%) and non-healthcare professionals (n = 21, 30.9%). The popularity (VPI), reliability (mDISCERN) and quality (GQS) of videos uploaded by healthcare professionals were significantly higher (p = 0.002, p = 0.001, p = 0.021, respectively). Most of the videos were of high quality according to GQS (n = 40, 58.8%). All of the high quality videos were of healthcare professionals. The number of sources from healthcare professionals was significantly higher in high quality videos than in both low (p = 0.001) and medium (p = 0.001) quality videos.

CONCLUSION

We can conclude that most of the YouTube videos on spasticity are reliable and of high quality. However, it should be kept in mind that patients may be exposed to low-quality and unreliable videos with misleading content.

"Dr ChatGPT": Is it a reliable and useful source for common rheumatic diseases?

AIM

It is inevitable that artificial intelligence applications will be used as a source of information in the field of health in the near future. For this reason, we aimed to evaluate whether ChatGPT, a new Large Language Model, can be used to obtain information about common rheumatic diseases.

MATERIALS AND METHODS

Common rheumatic diseases were identified using the American College of Rheumatology and European League against Rheumatism guidelines. Osteoarthritis (OA), rheumatoid arthritis, ankylosing spondylitis (AS), systemic lupus erythematosus, psoriatic arthritis, fibromyalgia syndrome, and gout were identified by using Google trends for the four most frequently searched keywords on Google. The responses were evaluated with seven-point Likert-type reliability and usefulness scales developed by us.

RESULTS

The highest score in terms of reliability was OA (mean ± standard deviation 5.62 ± 1.17), whereas the highest score in terms of usefulness was AS (mean 5.87 ± 0.17). There was no significant difference in the reliability and usefulness of the answers given by the ChatGPT (p = .423 and p = .387, respectively). All scores ranged between 4 and 7.

CONCLUSIONS

Although ChatGPT is reliable and useful for patients to obtain information about rheumatic diseases, it should be kept in mind that it may give false and misleading answers.

Ultrasonographic measurement of median nerve and wrist skin thickness in patients with carpal tunnel syndrome: relationship with clinical, electrophysiologic and functionality

The study aimed to investigate the relationship between the proximal and distal cross-sectional area (CSA) of the median nerve and wrist skin thickness measured by ultrasound in patients with carpal tunnel syndrome (CTS), demographics, disease characteristics, electrophysiological measurements, symptom severity, functionality, and symptom severity. 98 patients with electrophysiological diagnoses of CTS in the dominant hand were included in the study. Proximal and distal CSAs of the median nerve and wrist skin thickness were measured ultrasonographically. Demographic and disease characteristics of the patients were recorded. Patients were evaluated with the Historical-Objective scale (Hi- Ob) for clinical staging, the Functional status scale (FSS) for functional status, and the Boston symptom severity scale (BSSS) for symptom severity. Ultrasonographic findings were correlated with demographic and disease characteristics, electrophysiological findings, Hi-Ob scala, Functional status scale (FSS), and Boston symptom severity scale (BSSS). Proximal median nerve CSA median was 11.0 (7.0-14.0) mm2, distal median nerve CSA median was 10.5 (5.0-18.0) mm2, and wrist skin thickness was measured 1.10 (0.6-1.40) mm. Median nerve CSAs were positively correlated with the CTS stage and FSS, negatively correlated with the sensory nerve action potential of the median nerve (SNAP) and the compound muscle action potential of the median nerve (CMAP) ( p<0.05). Wrist skin thickness was positively correlated with disease characteristics, including the presence of paresthesia and loss of dexterity and FSS and BSSS levels. Ultrasonographic measurements in CTS are associated with functionality rather than demographics. Especially the increase in wrist skin thickness leads to an increase in symptom severity.

Association between swallowing muscle mass and dysphagia in older adults: A case-control study

BACKGROUND

Swallowing function is formed by the synergistic, coordinated, and complex movements of approximately 30 muscles. However, There is no study on which one(s) of these muscles can predict the possibility of dyspfagia.

OBJECTIVES

The purpose of this study was to investigate whether there is a relation between dysphagia and ultrasonographic measurements of swallowing muscles mass, and to determine which muscle mass would predict the possibility of dysphagia.

METHODS

This prospective and controlled study was performed on 87 older people (aged >65 years). Clinical (Eating assessment tool-10 and The Gugging Swallowing Screen test), endoscopic, electrophysiological (dysphagia limit and swallowing intervals), and ultrasonographic (masseter [MM], genioglossus [GGM], geniohyoid [GHM], myohyoid [MH] and anterior digastric muscles [ADM]) evaluations were performed on all patients. The relationship between ultrasound measurements and demographic/swallowing characteristics and presence of dysphagia were investigated.

RESULTS

The muscle mass measurement which was associated with dysphagia was contracted masseter muscle. In terms of diagnostic performance, the sensitivity was the highest in GHM (92.3%) and the specificity was the highest in contracted MM thickness (90.3%). The probability of dysphagia increases from 54% to 80-89% with a decrease in contracted MM thickness, and the probability of dysphagia increased from 48% to 72% with a decrease in contracted GGM thickness. In addition, the highest AUC level was detected in contracted MM and contracted GGM muscles. Moreover, it was determined that the risk of dysphagia increased from 9.6 to 14.1 times with one unit decrease in muscle thickness in contracted MM muscles, and the risk of dysphagia increased 9.1 times with one unit decrease in contracted GGM muscles.

CONCLUSION

Decreased swallowing muscle mass in older adults are independent risk factors for dysphagia. Especially the decrease in the thickness of the contracted MM increases the possibility of dysphagia at high rate.

Pediatric dysphagia overview: best practice recommendation study by multidisciplinary experts

BACKGROUND

Currently, there is no comprehensive and multidisciplinary recommendation study covering all aspects of pediatric dysphagia (PD). This study aimed to generate PD management recommendations with methods that can be used in clinical practice to fill this gap in our country and in the world, from the perspective of experienced multidisciplinary experts.

METHODS

This recommendation paper was generated by a multidisciplinary team, using the seven-step process and a three-round modified Delphi survey via e-mail. First, ten open-ended questions were created, and then detailed recommendations including management, diagnosis, treatment, and follow-up were created with the answers from these questions. Each recommendation item was voted on by the experts as overall consensus (strong recommendation), approaching consensus (weak recommendation) and divergent consensus (not recommended).

RESULTS

In the 1st Delphi round, a questionnaire of 414 items was prepared based on the experts' responses to ten open-ended questions. In the 2nd Delphi round, 59.2% of these items were accepted as pre-recommendation. In the 3rd Delphi round, 62.6% of 246 items were accepted for inclusion in the proposals. The final version recommendations consisted of 154 items.

CONCLUSIONS

This study includes comprehensive and detailed answers for every problem that could be posed in clinical practice for the management of PD, and recommendations are for all pediatric patients with both oropharyngeal and esophageal dysphagia.

Foot Deformity in Patients With Ankylosing Spondylitis: Is It Associated With Functionality and Disease Activity?

Foot involvement affects mobility and functionality in patients with ankylosing spondylitis but it remains unknown if foot deformities in ankylosing spondylitis patients affect functionality, disease activity, and quality of life. The aim of this study was to evaluate in detail the presence of a relationship between radiologically detected foot deformities in ankylosing spondylitis patients and both clinical and electrophysiological findings. The cross-sectional study included 110 patients with ankylosing spondylitis who were diagnosed according to the Assessment in Spondyloarthritis International Society criteria and were followed in our hospital. Demographic and clinical data of all patients were recorded. Bilateral lateral foot x-rays and electrophysiology examinations were evaluated in all subjects. The arch in the dominant foot of the patients was classified in 3 groups as pes cavus, pes planus, or normal. The clinical outcomes, physical examination and electrophysiological findings were compared between the groups, and correlations were examined of the foot deformities with these parameters. Foot deformities were determined at a high rate (74.5%). These deformities affected foot pain, disability and quality of life. Pes cavus deformity was found to be associated with hip pain and enthesopathy. In the electrophysiological studies, the presence of pes planus was found to be associated with the findings of the tibial and sural nerve conduction studies, and the presence of pes cavus with the findings of the peroneal nerve conduction study. In conclusion, foot deformities may have an effect on the quality of life and functionality in ankylosing spondylitis patients.

Is superficial radial nerve affected in patients with hand osteoarthritis?

INTRODUCTION

Patients with superficial radial neuropathy (SRN) have pain and abnormal sensation on the hand similar to hand osteoarthritis (HOA).

PURPOSE OF THE STUDY

The aim of the present study was to evaluate the presence of SRN in patients with HOA and to determine the factors associated with electrophysiological parameters of the radial nerve.

STUDY DESIGN

This is a case-control study.

METHODS

A total of 138 patients were included in this study. Only the dominant hand of each patient was evaluated. Patients were divided into 2 groups: Group 1 (without SRN) or Group 2 (with SRN) by electrophysiological examination. The presence of osteoarthritis in the first carpometacarpal (1st CMC) joint was investigated. Radiological features of the hands were evaluated with Kellgren-Lawrence grading system. Sonographically, the presence of synovitis in the 1st CMC joint was examined with gray scale and synovial blood flow signal by power Doppler imaging. Erosion and osteophyte scoring were performed for 15 joints. The 1st extensor compartment of wrist's cross-sectional area was measured.

RESULTS

SRN was detected in 68.8% of the patients. High Kellgren-Lawrence scores (P = .027), presence of synovitis in the 1st CMC joint (P = .003), and increased cross-sectional area of the 1st extensor compartment of wrist (P = .005) were found to be independent risk factors for reduced superficial radial nerve conduction velocity.

CONCLUSIONS

Sensory symptoms in patients with HOA might be due to the involvement of the superficial branch of the radial nerve.

Factors associated with paravertebral muscle cross-sectional area in patients with chronic low back pain

Background

This study was performed to reveal the relationships between the cross-sectional areas (CSAs) of the paraspinal muscles and the severity of low back pain (LBP), including the level of disability.

Methods

This single-center cross-sectional study was conducted on 164 patients with chronic LBP. The effects of demographic characteristics, posture, level of physical activity, disc herniation type, and sarcopenia risk on the CSAs of paraspinal muscles were evaluated along with the relationship between the CSAs and severity of pain and disability in all patients. The CSAs of paraspinal muscles were evaluated using the software program Image J 1.53.

Results

A negative significant correlation was found between age and the paraspinal muscle’s CSA (P < 0.05), whereas a positive correlation was present between the level of physical activity and the CSA of the paraspinal muscle at the L2-3 and L3-4 levels. The CSAs of paraspinal muscles in patients with sarcopenia risk was significantly lower than those in patients without sarcopenia risk (P < 0.05). The CSAs of paraspinal muscles at the L2-3 and L3-4 levels in obese patients were significantly higher than those in overweight patients (P = 0.028, P = 0.026, respectively). There was no relationship between the CSAs of paraspinal muscles and pain intensity or disability.

Conclusions

Although this study did not find a relationship between paraspinal CSAs and pain or disability, treatment regimens for preventing paraspinal muscles from atrophy may aid pain physicians in relieving pain, restoring function, and preventing recurrence in patients with chronic LBP.

Effectiveness of Functional Electrical Stimulation - Cycling Treatment in Children with Cerebral Palsy

Aim

The purpose of this study was to evaluate the effects of functional electrical stimulation (FES) bicycle therapy system on motor function, gait pattern, spasticity, daily living activities, and aerobic capacity in children with cerebral palsy (CP) and to compare the results with sham stimulation and standard treatment.

Methods

Patients with cerebral palsy who received botulinum toxin type-A injections to lower extremities and those with Gross Motor Function Measure Classification System (GMFCS) levels I – III, were included in the study. Twenty-five patients were randomly assigned into three treatment groups for 4-weeks: Group 1, FES-cycling and standard treatment; Group 2, Sham stimulus FES-cycling and standard treatment; Group 3, Standard treatment. Clinical assessment tools included the Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS), Pediatric Functional Independence Measure (WeeFIM), GMFCS, Gross Motor Function Measure-88 (GMFM-88), selective motor control tests, 6-minute walk test, and Visual Gait Analysis (VGA).

Results

In all groups, there were significant improvements in MAS, MTS, WeeFIM, GMFM-88, 6-minute walk test, and VGA scores. No changes in GMFCS levels were observed in any group. At the end of the study, there was no significant difference among the groups in terms of any clinical assessment parameter.

Conclusions

All groups showed statistically significant improvements in motor function, walking pattern, spasticity, daily living activities, and aerobic capacity in patients with CP following the rehabilitation period. Although FES-cycling demonstrated no superiority over the other approaches and provided no additional benefit to the results, FES appears to be safe and well-tolerated in children with CP, at least as much as standard exercise treatment.

Functional electrical stimulation cycling in patients with chronic spinal cord injury: a pilot study

OBJECTIVE

To examine the therapeutic value of lower extremity functional electrical stimulation (FES) - evoked cycling on functional independence, health status, gait parameters, pulmonary functions, and biochemical values in patients with chronic complete/incomplete spinal cord injury (SCI).

MATERIALS AND METHODS

Fifteen patients with SCI (duration of more than 6 months) who were able to stand up and walk with long leg braces or assistive devices and had stable neurological status and trunk balance undertook FES cycling for 6 weeks (three times per week). The main outcomes were: Functional Independence Measure (FIM), Nottingham Health Profile (NHP), 6-minute walk test (6MWT), and 20-meter walk test (20MWT). Secondary outcomes include measurements of pulmonary function tests and biochemical values. All parameters were evaluated at the beginning and end of the program.

RESULTS

Improvements were seen in motor and total scores of FIM (p = 0.007), physical mobility subscale of NHP (p = 0.011), 6MWT (p = 0.001), and 20MWT (p = 0.011). In pulmonary functions, only forced vital capacity (FVC) levels demonstrated a significant increase compared with baseline (p = 0.011). Biochemical values reached no significant level.

CONCLUSION

The results of this study showed that the FES cycling exercise program improves motor and total FIM scores, gait parameters, and FVC values of pulmonary functions in patients with chronic SCI experience. The FES cycle might be a valuable and well-tolerated intervention in clinical rehabilitation.

Effect of Local and Systemic Dimethylsulfoxide on Peripheral Nerve Repair: A Controlled Randomized Experimental Study

INTRODUCTION

We investigated the possible beneficial effect of dimethylsulfoxide (DMSO) on peripheral nerve repair in rats. Methods: Seventy rats were divided into four groups: control, sham, DMSO-L, and DMSO-IP. Except in the control group, nerve repair was done at the right sciatic nerve. DMSO was administered locally and intraperitoneally for 12 weeks to the DMSO-L and DMSO-IP groups, respectively. No therapeutic agent was administered to the other groups. Nerve regeneration was assessed by behavioral, electrophysiological, histopathological, and immunohistochemical tests. Results: With the exception of S-100 protein expression, all results indicate that DMSO has a beneficial effect on peripheral nerve regeneration. Functional nerve recovery was notably more evident in the DMSO-L than in the DMSO-IP group. Under macroscopic examination, nerve scores of the regeneration area in the DMSO-L group was also better than in the others. Discussion: We believe that DMSO can improve peripheral nerve regeneration in rats.

Is Dysphagia in Older Patients with Parkinson's Disease Associated With Sarcopenia ?

BACKGROUND

Parkinson's Disease (PD) and sarcopenia share a number of common pathways, and they can potentially affect each other.

OBJECTIVE

We aimed to investigate the relationship between dysphagia and sarcopenia in elderly patients with PD compared to healthy controls.

METHODS

This case-control study was conducted on 54 elderly PD patients and age-, sex- and body mass index-matched 54 healthy elder persons. Demographic and disease characteristics such as disease duration, stage of disease and Unified Parkinson's disease rating scale were recorded. All subjects were assessed by 10- item Eating Assessment Tool, Gugging Swallowing Screen tests and flexible fiberoptic endoscopic evaluation of swallowing (FEES) as well as Mini nutritional test short form. Also, A simplified screening tool for assessing sarcopenia (SARC-F), five times sit-to-stand and gait speed tests as well as lumbar magnetic resonance imaging (MRI) cross-sectional area of psoas and paraspinal muscles were used for evaluation of sarcopenia. Patients were divided as «with normal swallowing» or «with dysphagia» according to the FEES results. Three groups were compared among themselves in terms of evaluation methods.

RESULTS

Sarcopenia evaluation parameters were significantly higher in patient groups compared to the control group. Moreover, muscle measurements evaluated by MRI in patients with dysphagia are lower than both patients with normal swallowing and control group (p value between 0.001 and 0.011).

CONCLUSIONS

Patients with PD have lower muscle mass compared to healthy controls, and the situation is more pronounced in dysphagic PD patients.

Short-Term Efficacy of Kinesiotaping versus Extracorporeal Shockwave Therapy for Plantar Fasciitis: A Randomized Study

BACKGROUND

Plantar fasciitis is a degenerative condition that is one of the most common causes of heel and foot pain. Among noninvasive management of plantar fasciitis, extracorporeal shockwave therapy (ESWT) has been extensively studied and found to be effective, but few studies have assessed the effectiveness of kinesiotaping (KT) method.

OBJECTIVE

This study aimed to show the effectiveness of KT compared with ESWT in the management of plantar fasciitis.

METHODS

A total of 84 patients with plantar fasciitis were enrolled from a single center and randomized into KT and ESWT treatment groups in a 1:1 ratio (i.e., 42 patients in each group); only one foot was considered for each patient. Both KT and ESWT were applied once a week for 6 weeks. Patients' pain, functional status and quality of life were evaluated with the visual analog scale (VAS), Foot Function Index (FFI) and the Short-Form-36 (SF-36) health survey, respectively. Patients' fat pat and plantar fascia thickness were measured using ultrasonography. All evaluations were performed before and immediately after the 6-week intervention.

RESULTS

In the KT group, six patients were lost to follow-up; therefore, the final analysis only included 36 patients. After the intervention, there was a statistically significant improvement in the VAS and SF-36 scores of both groups (P = 0.001), but the FFI score improvement was statistically significant only in the KT group (P = 0.001). In both groups, the mean thickness of plantar fascia decreased after treatment and the mean thickness of the fat pat increased; however, the change was not statistically significant (P = 0.935 and P = 0.832, respectively).

CONCLUSION

Both KT and ESWT treatments improved pain levels and quality of life in patients with plantar fasciitis, but KT also improved functionality. Multicentered studies with larger sample size and longer follow-ups are required to further validate these findings.

Effects of diaphragm thickness on rehabilitation outcomes in post-ICU patients with spinal cord and brain injury

BACKGROUND

Intensive care unit (ICU) complications affect outcomes but it remains unknown if the diaphragm thickness affects rehabilitation outcomes after ICU. We conducted a pilot study to evaluate the effect of diaphragm thickness on rehabilitation outcomes of post-ICU patients with spinal cord injury (SCI) and traumatic brain injury (TBI) and to evaluate factors that may be associated with diaphragm atrophy.

MATERIALS AND METHODS

Fifty-one patients (26 SCI, 25 TBI) who admitted to the rehabilitation clinic from the ICU included in this study. All demographic data were recorded. All participants underwent diaphragmatic ultrasonography evaluation before and after 12 weeks of neurologic rehabilitation program. The diaphragm thickness and outcome parameters were compared in all patient groups and in each patient subgroups. Evaluation parameters of patients before and after treatment were compared in patient subgroups.

RESULTS

Diaphragm atrophy was found in 14 patients (64%) in TBI group and 12 patients (46%) in SCI group. The diaphragm thickness negatively correlated with the ICU length of stay and positively correlated with the before/after rehabilitation functional scores and the change in functional independence measure scores (p < 0.05). According to the regression analysis; the change in functional independence measure scores was found to be affected by the diaphragm thickness (p < 0.05).

CONCLUSIONS

The diaphragm thickness may be an effective factor on the rehabilitation process.

Reliability and validity of the pediatric feeding and swallowing disorders family impact scale for Turkish children with cerebral palsy by endoscopic evaluation

Umay E, Gündoğdu İ, Öztürk EA. Reliability and validity of the pediatric feeding and swallowing disorders family impact scale for Turkish children with cerebral palsy by endoscopic evaluation. Turk J Pediatr 2019; 61: 741-748. The caregivers of children with cerebral palsy (CP) have high mood disorders and stress levels. This study was aimed to conduct validity and reliability of Turkish version of The Pediatric Feeding and Swallowing Disorders Family Impact Scale (PFSDFIS) by using an objective method. This study was performed in our physical medicine and rehabilitation (PMR) clinic between July 2016 and July 2018. This study was performed with 251 children with CP who had complaint of swallowing and/or feeding problems, and their primer caregivers. Cronbach`s alpha and corrected item-total correlations were used to assess internal consistency. Test and retest reliability studies were also conducted. The construct validity was assessed using the dysphagia level defined with flexible fiberoptic endoscopic evaluation of swallowing and Impact on Family Scale (IFS). Total score of T-PFSDFIS was correlated to the dysphagia level by using FEES. Results showed, Cronbach's alpha value of the scale to be 0.821. Corrected item-to-total correlations ranged from 0.729 to 0.911. Test-retest reliability coefficients was calculated with intra-class correlation coefficient (ICC), the total score was 0.989. A negative significant good level correlation was found between the dysphagia level by using endoscopic evaluation and the T- PFSDFIS total score as well as between total scores of IFS and T-PFSDFIS. In subgroup analysis; the lowest value was in normal swallowing and significantly different from all dysphagia levels. In conclusion; this scale is effective in reflecting the influence of caregivers on the severity of dysphagia measured objectively and T-PFSDFIS is a valid and reliable scale for Turkish children with CP.

The Turkish League Against Rheumatism Recommendations for the Management of Hand Osteoarthritis Under Guidance of the Current Literature and 2018 European League Against Rheumatism Recommendations

Objectives

This study aims to explore the accordance to the 2018 European League Against Rheumatism (EULAR) recommendations for the management of hand osteoarthritis (OA) among the Turkish League Against Rheumatism (TLAR) expert panel and composition of TLAR recommendations for the management of hand OA under guidance of the current literature.

Materials and methods

The TLAR convener designated an expert panel of 10 physicians experienced in hand OA for this process. The 2018 EULAR recommendations for the management of hand OA and the systematic review of the literature were sent to the expert panel via e-mails. The e-mail process which included Delphi round surveys was completed. The EULAR standard operational procedure Appraisal of Guidelines for Research and Evaluation II was followed. The level of agreement was calculated for each item and presented as mean, standard deviations, minimum and maximum and comparisons of 2018 EULAR recommendations were performed.

Results

Five overarching principles and 10 recommendations were discussed. Revisions were held for the sixth, seventh, and ninth recommendations with lowest level of agreements. These recommendations were revised in accordance with suggestions from the experts and re-voted. The revised forms were approved despite the lack of statistically significant difference between these forms (p=0.400, p=0.451, p=0.496, respectively). Except for the ninth recommendation about surgery (p=0.008), no significant difference in level of agreements was observed between the EULAR and TLAR hand OA recommendations. The 11th recommendation about paraffin bath was added.

Conclusion

The optimal treatment of hand OA consists of personalized non-pharmacological (self-management, exercise, splint), pharmacological (topical non-steroidal anti-inflammatory drugs as the first choice), and interventional procedures (only for refractory cases) based on shared decision between the patient and physician. TLAR hand OA recommendations were created mainly based on the most recent literature and the last EULAR hand OA management recommendations, which are widely approved among the TLAR experts.

The comparison of efficacy of single intraarticular steroid injection versus the combination of genicular nerve block and intraarticular steroid injection in patients with knee osteoarthritis: a randomised study

OBJECTIVES

The aim of this study is to evaluate the efficacy of genicular nerve block (GNB) and intraarticular corticosteroid injection (IACSI) in patients with knee osteoarthritis (OA).

METHODS

Forty patients with Kellgren-Lawrence grade 2-4 knee OA were included for the study. Patients were divided into two groups randomly as IACS and IACS + GNB groups. All patients were evaluated with ultrasound for cartilage thickness, patellar tendon thickness, quadriceps tendon thickness and quadriceps muscle cross-sectional area (QMA). Pain intensity of the patients was evaluated with visual analogue scale and the Leeds Assessment of Neuropathic Symptoms and Signs pain scale. Functional status of the patients was evaluated with Western Ontario and Mc Master Universities Osteoarthritis Index. Quality of life of the patients was assessed with Nottingham Health Profile (NHP). All assessments were measured and compared at baseline, 1st month and 3rd month after treatment.

RESULTS

All evaluation parameters were significantly improved in IACSI and IACSI + GNB groups. However, the improvement was better in IACSI + GNB group compared to those in IACSI group in terms of all evaluation parameters except QMA (0.10 ± 0.18 and 0.11 ± 0.22, respectively) and NHP scores in 1st month evaluation (- 3.11 ± 6.99 and - 3.54 ± 1.74, respectively).

CONCLUSIONS

When combined with IACSI, GNB yields better analgesic effect and improves function in patients with knee OA compared to only IACSI.

What happens to muscles in fibromyalgia syndrome

BACKGROUND

The main somatic symptoms of fibromyalgia syndrome (FMS) are chronic musculoskeletal pain, stiffness, and fatigue, all of which are related to the muscle system and its functioning.

AIMS

The aim of this study was to evaluate whether the asymptomatic upper and lower extremity muscles evaluated using ultrasonography (US) were different from healthy controls in both newly diagnosed and established FMS and to assess whether muscle measurements were related to fatigue and disease severity, as well as quality of life.

METHODS

This study was conducted on 152 subjects (102 patients and 50 healthy controls) as a cross-sectional controlled trial. Real-time imaging of cross-sectional thickness (CST) (for deltoid, biceps brachii, triceps brachii, forearm flexor, tibialis anterior, and gastrocnemius medialis), and cross-sectional areas (CSAs) (quadriceps femoris (QF)) measurements were performed using US. Fatigue and disease severity as well as quality of life scales were given to all participants.

RESULTS

In both patient groups, decreased QF muscle CSA was significantly correlated with increased fatigue severity and decreased overall quality of life and energy levels. Moreover, in patients with established disease, there was a significant correlation between the decrease in QF muscle CSA and increased social isolation and between the decrease in biceps brachii muscle CST and increased fatigue severity.

CONCLUSIONS

Whether in newly diagnosed or established disease, muscle measurement values and quality of life parameters were significantly decreased in patients with FMS compared with healthy controls.

Acupuncture plus night splint for quality of life and disability in patients with carpal tunnel syndrome: a randomized controlled trial

Background

Carpal tunnel syndrome (CTS) is a common condition caused by pressure on a nerve in the wrist. This study aimed to evaluate the effects of acupuncture plus night splinting on quality of life, function and pain in patients with CTS.

Methods

This research is a prospective randomized, single-center trial. Acupuncture and night splinting was applied two times a week for five weeks, while the control group received night splinting only. Outcomes measured were Quality of life (Nottingham Health Profile, NHP), function (Boston Carpal Tunnel Questionnaire) and pain (visual analogue scale, VAS).

Results

At the end of the treatment, the acupuncture plus splinting group showed more reduction in the pain level than the splinting group (p = 0.007). The change in the pain subscale of the NHP was significantly reduced in the acupuncture plus night splinting group than the night splinting group (p = 0.001). The change in sleep and physical activity subscale of the NHP score failed to show significant differences between the two groups. The functional scores also failed to show the signficant differences between the two groups.

Conclusion

The effect of acupuncture plus night splinting may show significant reduction on pain but failed to show significant differences on the other outcomes compared to the night splinting group. Further studies with larger sample size may confirm the findings.

Effect of Primary Hypertension on Treatment Outcomes of Patients with Postmenopausal Osteoporosis: A 5 Year Follow Up Retrospective Study

AIM

To investigate the efficacy of primary hypertension (HTN) on the treatment prognosis of patients with postmenopausal osteoporosis (PMOP).

METHODS

45 patients who were diagnosed as PMOP with lumbar and/or femur neck bone mineral density screening (BMD) but have no history of PMOP treatment including calcium and vitamin D, have comorbid primary HTN and treated with a vasodilator antihypertensive drug at least a year were included to the study. Control group was constituted with 44 patients with PMOP at same age but have no comorbidity. Demographic features including age, height, weight, occupation, educational level menarche and menopause age, clothing style, daily intake of calcium, smoking and/or alcohol consumption, daily physical activity level, personal history of fragility fracture or in mother and duration of primary HTN diagnosis were recorded. Biochemical parameters were also recorded. Patients were treated with bisphosphonate, calcium and vitamin D and same parameters were evaluated at the end of first and fifth year.

RESULTS

Demographic and disease characteristics were not different between groups before treatment (p > 0.05). In group analysis, there was significant improvement in lumbar and femur neck T scores of PMOP + HT and PMOP groups after 1 and 5 years of treatment compared to baseline (p < 0.05) Lumbar and femur neck T score variations between the baseline, first and fifth years of treatment were not significantly different in PMOP + HT and PMOP groups (p < 0.05).

CONCLUSIONS

Although the results vary between populations, primary HTN does not have an impact on the prognosis of PMOP treatment in Turkish population.

Timing of rehabilitation in children with obstetric upper trunk brachial plexus palsy

OBJECTIVES

The initiation timing of rehabilitation in children with obstetric brachial plexus palsy is controversial. The aim of the present study is to evaluate the effectiveness of rehabilitation timing to the functional outcomes of patients with obstetric upper trunk brachial plexus palsy.

MATERIAL AND METHODS

Twenty-nine patients, who did not previously received any rehabilitation programme but attended our outpatient clinic, were included for the study. The electrophysiological findings, obstetric characteristics, and demographic features of the patients were recorded. The range of motion (ROM) of shoulders, elbows, and wrists and the strength of the muscles associated with these joints were evaluated. Modified Mallet Scale (MMS) was used for functional evaluation. A 4-week rehabilitation programme was performed twice at 2-month intervals. Patients were divided into three groups according to their ages as follows: 1-3 years old (group 1), 3-5 years old (group 2), and 5-7 years old (group 3). The ROMs, muscle strengths, and MMS scores of the patients were all evaluated.

RESULTS

Two out of 29 patients were female (6.9%) and 27 were male (93.1%). All 29 patients had right upper extremity palsy (100%). The MMS scores, ROMs, and muscle strength of the upper extremities had improved in all the groups following the standardized rehabilitation programme.

CONCLUSIONS

A rehabilitation programme is the best choice of treatment before surgical procedures in patients with mild to moderate obstetric upper trunk brachial plexus palsy regardless of age and the initiation time.

The effect of premorbid features on post-stroke rehabilitation outcome

Background: A wide variety of factors influence stroke prognosis, including age, stroke severity, stroke mechanism, infarct location, comorbid conditions, clinical findings, and related complications. The aim of this study was to detect the prognostic determinants in patients with acute stroke for guiding rehabilitation. Methods: Patients with ischemic acute stroke were included in the study. Patients' age, sex, education level, and marital status, premorbid personality traits, comorbidities such as current smoking status and alcohol consumption, regular exercise habits, and sleeping disorder were recorded. Motor assessment and daily activity skills were evaluated according to the Brunnstrom staging and Functional Independence Measure (FIM), respectively. Results: A total of 85 patients were studied. All patients' motor and functional stages were significantly improved with the rehabilitation. The improvements in the upper extremity motor levels were less in whom over 76 years and smokers, in patients who had 4 and more comorbidities and sleep disorders. The functional improvement was less in whom over 76 years and men, and in patients who had 4 and more comorbidities and sleep disorders. Conclusion: The significant post-stroke predictor of insufficiency in functioning was having 4 or more risk factors.

The effect of swallowing rehabilitation on quality of life of the dysphagic patients with cortical ischemic stroke

Background: Swallowing and swallowing-related quality of life studies following stroke were almost always performed by including both patients with brainstem and cortical involvement. It was aimed in this study to show the presence of dysphagia in patients with only cortical ischemic stroke and to investigate the interaction between dysphagia and quality of life as well as to evaluate the effect of a rehabilitation program in the acute phase. Methods: Seventy-two patients with cortical stroke (between 0 and 30 days) and dysphagia were included. Swallowing function of patients was assessed by dysphagia screen questionnaire and fiberoptic endoscopic assessment. Also, functional impairment and swallowing quality of life were assessed. The swallowing rehabilitation program for 4 weeks was given to all patients. Results: All patients demonstrated disorders related to oral phase (n = 69, 95.8%), pharyngeal phase (n = 4, 5.6%) or both phases. The swallowing function, swallowing quality of life and functional impairment were improved at the end of therapy. Conclusion: Swallowing quality of life is severely affected in cortical hemispheric stroke patients and can be improved with an early rehabilitation program.

Rheumatoid Arthritis: Are psychological factors effective in disease flare?

OBJECTIVE

Rheumatoid arthritis (RA) is clinically an undulant disease, and reasons for flare or remission vary. We aimed to identify factors potentially associated with disease flare and remission.

MATERIAL AND METHODS

Two hundred and seventy-four patients with RA who were admitted to our center between January 2010 and January 2016 were included. Disease activity was evaluated using disease activity score 28 (DAS 28); functional status was evaluated using the modified Health Assessment Questionnaire (m-HAQ), a questionnaire that comprises flare or remission domains such as psychological stress and mood status, physical trauma, nutrition regimen, infection, antibiotic use, and seasonal weather changes. Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were used to identify if patients had a mood disorder. Four subscales of Arthritis Impact Measurement Scale-2 (AIMS-2) (level of tension, mood, general perception of health, and satisfaction with health) were used to determine patient quality of life.

RESULTS

Of the 274 patients, 261 were female (95.3%) and 13 were male (4.7%); the mean age was 52.10±9.41 years. According to patients' perception, the most frequent reasons for joint symptoms were psychological stress/mood disorder (86.1%), followed by infection (49.6%) and trauma (46.4%). The most frequent factors for remission of symptoms were antibiotic use (42.7%), cold weather (34.3%), and hot weather (19%).

CONCLUSION

Psychological stress and mood status are independent factors for relapse periods in patients with RA. These should be considered particularly in patients who are resistant to different treatment regimens and in whom any other reason for disease flare is not obvious.

Efficacy of extracorporeal shockwave therapy and low-intensity pulsed ultrasound in a rat knee osteoarthritis model: A randomized controlled trial

OBJECTIVE

This study aims to assess the efficacy of extracorporeal shockwave therapy (ESWT) and low-intensity pulsed ultrasound (LIPUS) on osteoarthritic rat knees.

MATERIAL AND METHODS

Twenty-four rats were divided into 3 groups: group 1-control (n=8), group 2-LIPUS (n=8) and group 3-ESWT (n=8). Cartilage degeneration was provided using mono-iodo-asetate (MIA). One milligram of MIA was delivered to the right knees in group 1 and both knees in group 2 and 3. A 0.09% saline solution was delivered to the left knees in group 1 for control. Twenty-four hours after the delivery, ESWT was applied once on the right knees in the group 2 rats to the medial tibia plateu with a 1 Hz frequency and 800 impulses. LIPUS was applied to the right knees in the group 2 rats to the medial tibia plateu with a 3 mHz frequency and 40 mW/cm2 intensity for 20 minutes over a period of 15 days. Pain scores were measured with a knee bend test. Bone mineral density measurements and scintigraphic bone scans were performed. Histopathological examination was done using a modified Mankin scale.

RESULTS

There was no difference among the right knee subchondral bone osteoblastic activities (p>0.05). The left knee osteoblastic activities in the LIPUS and extracorporeal shockwave therapy (ESWT) groups were higher than those in the control group (p<0.05), but there was no difference between the LIPUS and ESWT groups. There was no difference among the groups for both knee subchondral bone BMD values (p>0.05). The modified Mankin scores of both the right and left knees of the ESWT and LIPUS groups were lower than those of the control group (p<0.05), but there was no difference between the ESWT and LIPUS groups. The pain scores of both knees of the ESWT and LIPUS groups at day 7 were higher than those of the control group (p<0.05), but there was no difference between the ESWT and LIPUS groups. There was no difference among the pain scores of the right knees at day 14 (p<0.05).

CONCLUSION

ESWT and LIPUS have systemic proliferative and regenerative effects on cartilage and tissue.

The effects of balneotherapy on blood pressure and pulse in osteoarthritis patients with hypertension

BACKGROUND

Balneotherapy is a treatment modality that uses the physical and chemical effects of water, including thermomineral, acratothermal, and acratopegal waters. Although balneotherapy is an ancient treatment method that has a limited use within current treatment modalities, it is still widely popular with the public. Studies usually have reported that balneotherapy is associated with an increased risk of complications, especially in patients with hypertension (HT).

OBJECTIVE

The research team intended this study to evaluate the effects of balneotherapy on peripheral, arterial blood pressure and pulse in osteoarthritis (OA) patients with HT, compared to normotensive patients.

METHODS/DESIGN

For the current study, the research team examined the medical records of 5814 patients who were hospitalized and treated for OA at the team's institution between 2008 and 2010. This examination involved a review of the evaluation form that a nurse had obtained when those patients entered the hospital.

SETTING

This study was done at a balneotherapy hospital.

PARTICIPANTS

Participants were 2090 individuals, including 1036 (49.6%) with primary (essential) HT and 1054 (50.4%) normotensives, with OA of the lumbosacral region, knee, hand, and foot.

INTERVENTION

All participants received balneotherapy at the same time every day (10:00-10:30 AM) for 20 min/d, 5 d/wk, for a total duration of 15 d. Following balneotherapy, all participants performed an exercise program consisting of range of motion (ROM) and stretching exercises.

PRIMARY OUTCOME MEASURES

Measurements of pulse and systolic and diastolic blood pressures were recorded before treatment and after 15 sessions of balneotherapy. Within-group and between-group comparisons of results of pulse and systolic and diastolic blood pressure measurements were performed.

RESULTS

The study found a significant reduction after treatment in systolic and diastolic blood pressures in both normotensive and HT participants. Moreover, the reduction in diastolic blood pressure was noted to be greater in the HT group (P = .046).

CONCLUSION

Balneotherapy may be suggested as an alternative treatment in OA patients with HT.

Importance of cutaneous silent period in fibromyalgia and its relationship with disease characteristics, psychological disorders and quality of life of patients

INTRODUCTION

Cutaneous silent period (CSP) is an inhibitory spinal protective reflex and its afferents consist of A-delta nerve fibers. We aimed to evaluate patients with fibromyalgia (FM) and healthy controls to determine any differences between the groups in terms of CSP duration and latency, and if present, to determine whether there is any relationship with disease characteristics, psychological disorders and quality of life.

MATERIALS AND METHODS

Thirty-two patients with FM and 32 healthy volunteers were included in the study. The patient and control groups were compared in terms of CSP latency and duration in both upper and lower extremities. Disease characteristics, psychological disorders and quality of life of patients were assessed using the Fibromyalgia Impact Questionnaire (FIQ) and Short Form-36 (SF-36). Patients with CSP measurements equal to or lower than those of the control group were compared with those with higher values than controls in terms of disease characteristics, psychological status and quality of life.

RESULTS

Significantly prolonged CSP latencies in both upper and lower extremities were determined in patients compared to controls. We found that prolongation of CSP latency in the lower extremity is associated with disease severity and functional disability.

CONCLUSIONS

CSP latencies in both upper and lower extremities in patients with FM are longer than in healthy volunteers. Moreover, prolongation of CSP latency in the lower extremity is associated with disease severity and physical functional disability.

The relationship between bisphosphonate use and demographic characteristics of male osteoporosis patients

INTRODUCTION

This study aimed to investigate a number of demographic characteristics in males with osteoporosis (OP) treated with bisphosphonate and determine whether any of these measures could act as an effective indicator of medication persistence and compliance.

MATERIAL AND METHOD

Among the patients with OP who applied to our clinic and were prescribed weekly oral bisphosphonate treatment, 89 patients over 50 years of age were included in this study. The demographic characteristics of these patients were evaluated. The number of medications used by the patients over the past 1 and 3 years were counted, and the persistence and compliance with bisphosphonate treatment was estimated. The patients were divided into two groups: fully compliant and noncompliant subjects. The two groups of patients were compared separately for 1 and 3 years while considering their demographic characteristics.

RESULTS

The mean age of the 89 patients included in the study was 62.43 ± 9.41 years. Comparisons among the studied demographic characteristics during the 1-year period of medication use indicated that the educational status of the fully compliant patients was higher. During the 3-year period of medication use, educational status was the only demographic characteristic that was determined to be significantly lower in the noncompliant patients than in the fully compliant group.

CONCLUSION

Although deficiencies in medication persistence and compliance during osteoporosis treatment can lead to serious health and social problems in both genders, the causes of these deficiencies have not been thoroughly clarified. We suggest that the educational status of the patient may contribute to these deficiencies.

Botulinum toxin injection of the subscapularis muscle

Patients with hemiplegia frequently suffer from pain and have a limited range of motion (ROM) of the shoulder. The common pattern of shoulder movement in a patient with spastic hemiplegia is primarily adduction and internal rotation. Spasticity of the subscapularis muscle limits the abduction, external rotation and flexion of the shoulder. Injection of botulinum toxin or application of phenol can reduce the spasticity of the subscapularis muscle and various techniques to inject this muscle have been reported. We injected five patients with hemiplegia with botulinum toxin using our previously reported inferior approach, which is easy, safe and effective. We observed a reduction in pain and spasticity and improvement in the ROM of the shoulder for all patients.

Neurolytic phenol blockade of the obturator nerve for severe adductor spasticity

BACKGROUND

In this study, we present the 3-month follow-up results of a retrospective analysis of obturator nerve (ON) phenol neurolysis performed between 2000 and 2007 in patients with adductor spasticity.

METHODS

The study was performed by retrospective investigation of the clinical follow-up results of 80 ON phenol treatments in 62 patients. Neurolysis using 5-10 ml 6% phenol was applied with the guidance of fluoroscopy and a peripheral nerve stimulator. Pain, spasticity and hygiene were evaluated and the hip abduction range of motion (ROM) was measured at the end of the first week and in the first, second and third months following the intervention.

RESULTS

The visual analogue scale scores decreased significantly in the first week, first month and the second month, but reached their initial values in the third month. A drastic increase in the ROM values was shown in hip abduction in the first week, first month and second month. An increase in the Ashworth Scale values was observed in the second and third months, but they did not reach their initial values. The hygiene score decreased drastically in the first week and the first and second months, but worsened in the third month. The success rate in nerve localization during ON neurolysis was 100%.

CONCLUSION

ON phenol blockade with fluoroscopy and peripheral nerve stimulator guidance in patients with adductor spasticity led to a decrease in spasticity and pain with an increase in the ROM of the hip and better hygiene with an efficacy lasting for about 3 months.