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Altan L, Metin Ökmen B, Tuncer T, Sindel D, Fatih Çay H, Hepgüler S, Sarıkaya S, Ayhan F, Bal A, Bilgilisoy M, Çapkın E, Cerrahoğlu L, Çevik R, Dülgeroğlu D, Durmaz B, Duruöz T, Gürer G, Gürsoy S, Hizmetli S, Kaçar C, Kaptanoğlu E, Ecesoy H, Melikoğlu M, Nas K, Nur H, Özçakır Ş, Şahin N, Şahin Ö, Sarıdoğan M, Faruk Şendur Ö, Sezer İ, Taşçı Bozbaş G, Tıkız C, Uğurlu H. Correlation of clinical signs and magnetic resonance imaging findings in patients with lumbar spondylosis. Arch Rheumatol 2023; 38:512-520. [PMID: 38125064 PMCID: PMC10728734 DOI: 10.46497/archrheumatol.2023.9806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/23/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives The purpose of the study was to contribute further to this debated topic by investigating the correlation of magnetic resonance imaging (MRI) findings with the clinical picture in lumbar spondylosis patients. Patients and methods This multicenter retrospective study (as part of the epidemiological project of the TLAR-OASG [Turkish League Against Rheumatism-Osteoarthritis Study Group]) included 514 patients (101 males, 413 females; mean age: 63.6±10.8 years; range, 40 to 85 years) who were diagnosed as lumbar spondylosis by clinical examination and direct X-ray between December 2016 and June 2018. Demographic characteristics of patients, Visual Analog Scale for pain, presence of radiating pain, Roland-Morris disability questionnaire, straight leg raise test, deep tendon reflexes, neurogenic intermittent claudication symptoms, any decrease of muscle strength, and abnormality of sensation were recorded. Lumbar MRI findings of the patients were recorded as positive or negative in terms of disc herniation, intervertebral disc degeneration, root compression, osteophytes, spinal stenosis. Statistical analysis was done to assess the correlation between the clinical symptoms, physical examination, and MRI findings. Results Correlation analysis of the MRI results and the clinical findings showed a significant correlation between straight leg raise test and root compression (p<0.001, r=0.328) and a significant correlation between neurogenic intermittent claudication and spinal stenosis (p<0.001, r=0.376). Roland-Morris disability questionnaire had a significant correlation with all MRI findings (p<0.05, r<0.200). Conclusion The results of this study corroborate the notion that diligent patient history and physical examination are more valuable than MRI findings, even though a higher incidence of abnormal MRI findings have been obtained in patients with disability and dermatomal radiating pain.
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Affiliation(s)
- Lale Altan
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Uludağ University School of Medicine, Bursa, Türkiye
| | - Burcu Metin Ökmen
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Türkiye
| | - Tiraje Tuncer
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Akdeniz University Faculty of Medicine, Antalya, Türkiye
| | - Dilşad Sindel
- Department of Physical Medicine and Rehabilitation, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye
| | - Hasan Fatih Çay
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Türkiye
| | - Simin Hepgüler
- Department of Physical Medicine and Rehabilitation, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Selda Sarıkaya
- Department of Physical Medicine and Rehabilitation, Bülent Ecevit University Faculty of Medicine, Zonguldak, Türkiye
| | - Figen Ayhan
- Department of Physical Medicine and Rehabilitation, Atılım University Medical School, Ankara, Türkiye
| | - Ajda Bal
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Türkiye
| | - Meral Bilgilisoy
- Department of Physical Medicine and Rehabilitation, Health Science University, Antalya Training and Research Hospital, Antalya, Türkiye
| | - Erhan Çapkın
- Department of Physical Medicine and Rehabilitation, Karadeniz Technical University Faculty of Medicine, Trabzon, Türkiye
| | - Lale Cerrahoğlu
- Department of Physical Medicine and Rehabilitation, Celal Bayar University Faculty of Medicine, Manisa, Türkiye
| | - Remzi Çevik
- Department of Physical Medicine and Rehabilitation, Dicle University Faculty of Medicine, Diyarbakır, Türkiye
| | - Deniz Dülgeroğlu
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Türkiye
| | - Berrin Durmaz
- Department of Physical Medicine and Rehabilitation, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Tuncay Duruöz
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Marmara University Faculty of Medicine, Istanbul, Türkiye
| | - Gülcan Gürer
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Adnan Menderes University Faculty of Medicine, Aydın, Türkiye
| | - Savaş Gürsoy
- Department of Physical Medicine and Rehabilitation, Gaziantep University Faculty of Medicine, Gaziantep, Türkiye
| | - Sami Hizmetli
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Cumhuriyet University Faculty of Medicine, Sivas, Türkiye
| | - Cahit Kaçar
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Akdeniz University Faculty of Medicine, Antalya, Türkiye
| | - Ece Kaptanoğlu
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Başkent University Faculty of Medicine, Zübeyde Hanım Hospital, Izmir, Türkiye
| | - Hilal Ecesoy
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Karamanoğlu Mehmetbey University Faculty of Medicine, Konya, Türkiye
| | - Meltem Melikoğlu
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Kemal Nas
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology and Immunology, Sakarya University Faculty of Medicine, Sakarya, Türkiye
| | - Hakan Nur
- Department of Physical Medicine and Rehabilitation, Akdeniz University Faculty of Medicine, Antalya, Türkiye
| | - Şüheda Özçakır
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Uludağ University School of Medicine, Bursa, Türkiye
| | - Nilay Şahin
- Department of Physical Medicine and Rehabilitation, Balıkesir University Faculty of Medicine, Balıkesir, Türkiye
| | - Özlem Şahin
- Department of Physical Medicine and Rehabilitation, Cumhuriyet University Faculty of Medicine, Sivas, Türkiye
| | - Merih Sarıdoğan
- Department of Physical Medicine and Rehabilitation, Istanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Tıp Fakültesi, Istanbul, Türkiye
| | - Ömer Faruk Şendur
- Department of Physical Medicine and Rehabilitation and Algology, Medicana International Hospital, Izmir, Türkiye
| | - İlhan Sezer
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Akdeniz University Faculty of Medicine, Antalya, Türkiye
| | - Gülnur Taşçı Bozbaş
- Department of Physical Medicine and Rehabilitation, Adnan Menderes University Faculty of Medicine, Aydın, Türkiye
| | - Canan Tıkız
- Department of Physical Medicine and Rehabilitation, Celal Bayar University Faculty of Medicine, Manisa, Türkiye
| | - Hatice Uğurlu
- Department of Physical Medicine and Rehabilitation, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Türkiye
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Duruöz MT, Erdem Gürsoy D, Tuncer T, Altan L, Ayhan F, Bal A, Bilgilisoy M, Cerrahoğlu L, Çapkın E, Çay HF, Çevik R, Durmaz B, Dülgeroğlu D, Gürer G, Gürsoy S, Hepgüler S, Hizmetli S, Kaçar C, Kaptanoğlu E, Kaya T, Ecesoy H, Alkan Melikoğlu M, Nas K, Nur H, Özçakır Ş, Sarıdoğan M, Sarıkaya S, Sezer İ, Sindel D, Şahin N, Şahin Ö, Faruk Şendur Ö, Taşçı Bozbaş G, Tıkız C, Uğurlu H. The clinical, functional, and radiological features of hand osteoarthritis: TLAR-osteoarthritis multi-center cohort study. Arch Rheumatol 2022; 37:375-382. [PMID: 36589604 PMCID: PMC9791555 DOI: 10.46497/archrheumatol.2022.9234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/24/2021] [Indexed: 01/03/2023] Open
Abstract
Objectives This study aims to evaluate the clinical, functional, and radiological features of hand osteoarthritis (OA) and to examine their relationships in different geographic samples of the Turkish population. Patients and methods Between April 2017 and January 2019, a total of 520 patients (49 males, 471 females; mean age: 63.6±9.8 years) with hand OA were included in the study from 26 centers across Turkey by the Turkish League Against Rheumatism (TLAR). The demographic characteristics, grip strengths with Jamar dynamometer, duration of hand pain (month), the severity of hand pain (Visual Analog Scale [VAS]), and morning stiffness were evaluated. The functional disability was evaluated with Duruöz Hand Index (DHI). The Kellgren-Lawrence (KL) OA scoring system was used to assess the radiological stage of hand OA. Results The DHI had significant correlations with VAS-pain (r=0.367, p<0.001), duration of pain (r=0.143, p=0.001) and bilateral handgrip strengths (r=-0.228, p=0.001; r=-0.303, p<0.001). Although DHI scores were similar between the groups in terms of the presence of hand deformity (p=0.125) or Heberden's nodes (p=0.640), the mean DHI scores were significantly higher in patients with Bouchard's nodes (p=0.015). The total number of nodes had no significant correlations with the VAS-pain and DHI score (p>0.05). The differences between the groups of radiological hand OA grades in terms of age (p=0.007), VAS-pain (p<0.001), duration of pain (p<0.001), and DHI (p<0.001) were significant. There were no significant differences between radiological hand OA grades according to the duration of the stiffness, grip strength, and BMI (p>0.05 for all). Conclusion In our population, the patients with hand OA had pain, functional disability, and weak grip strength. The functional impairment was significantly correlated with the severity of the pain, and the functional status was worse in high radiological hand OA grades.
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Affiliation(s)
- Mehmet Tuncay Duruöz
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Didem Erdem Gürsoy
- Department of Physical Medicine and Rehabilitation, Rheumatology Clinic, Prof. Dr. Cemil Taşcoğlu City Hospital, Istanbul, Turkey
| | - Tiraje Tuncer
- Department of Physical Medicine and Rehabilitation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Lale Altan
- Department of Physical Medicine and Rehabilitation, Uludağ University School of Medicine, Bursa, Turkey
| | - Figen Ayhan
- Department of Physical Medicine and Rehabilitation, Atılım University School of Medicine, Ankara, Turkey
| | - Ajda Bal
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Meral Bilgilisoy
- Department of Physical Medicine and Rehabilitation, Antalya Training and Research Hospital, Antalya, Turkey
| | - Lale Cerrahoğlu
- Department of Physical Medicine and Rehabilitation, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Erhan Çapkın
- Department of Physical Medicine and Rehabilitation, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Hasan Fatih Çay
- Department of Physical Medicine and Rehabilitation, Antalya Training and Research Hospital, Antalya, Turkey
| | - Remzi Çevik
- Department of Physical Medicine and Rehabilitation, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Berrin Durmaz
- Department of Physical Medicine and Rehabilitation, Ege University School of Medicine, Izmir, Turkey
| | - Deniz Dülgeroğlu
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Gülcan Gürer
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Savaş Gürsoy
- Department of Physical Medicine and Rehabilitation, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Simin Hepgüler
- Department of Physical Medicine and Rehabilitation, Ege University School of Medicine, Izmir, Turkey
| | - Sami Hizmetli
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Cahit Kaçar
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Ece Kaptanoğlu
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Başkent University Zübeyde Hanım Application and Research Center, Izmir, Turkey
| | - Taciser Kaya
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Izmir Faculty of Medicine, Izmir, Turkey
| | - Hilal Ecesoy
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Karamanoğlu Mehmetbey University School of Medicine, Karaman, Turkey
| | - Meltem Alkan Melikoğlu
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Kemal Nas
- Department of Physical Medicine and Rehabilitation, Sakarya University School of Medicine, Sakarya, Turkey
| | - Hakan Nur
- Department of Physical Medicine and Rehabilitation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Şüheda Özçakır
- Department of Physical Medicine and Rehabilitation, Uludağ University School of Medicine, Bursa, Turkey
| | - Merih Sarıdoğan
- Department of Physical Medicine and Rehabilitation, Istanbul University Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Selda Sarıkaya
- Department of Physical Medicine and Rehabilitation, Bülent Ecevit University School of Medicine, Zonguldak, Turkey
| | - İlhan Sezer
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Dilşad Sindel
- Department of Physical Medicine and Rehabilitation, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Nilay Şahin
- Department of Physical Medicine and Rehabilitation, Balıkesir University, Balıkesir, Turkey
| | - Özlem Şahin
- Department of Physical Medicine and Rehabilitation, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Ömer Faruk Şendur
- Department of Physical Medicine and Rehabilitation, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Gülnur Taşçı Bozbaş
- Department of Physical Medicine and Rehabilitation, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Canan Tıkız
- Department of Physical Medicine and Rehabilitation, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Hatice Uğurlu
- Department of Physical Medicine and Rehabilitation, Necmettin Erbakan University School of Medicine, Konya, Turkey
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Umay E, Eyigor S, Bahat G, Halil M, Giray E, Unsal P, Unlu Z, Tikiz C, Vural M, Cincin AT, Bengisu S, Gurcay E, Keseroglu K, Aydeniz B, Karaca EC, Karaca B, Yalcin A, Ozsurekci C, Seyidoglu D, Yilmaz O, Alicura S, Tokgoz S, Selcuk B, Sen EI, Karahan AY, Yaliman A, Ozkok S, Ilhan B, Oytun MG, Ozturk ZA, Akin S, Yavuz B, Akaltun MS, Sari A, Inanir M, Bilgilisoy M, Çaliskan Z, Saylam G, Ozer T, Eren Y, Bicakli DH, Keskin D, Ulger Z, Demirhan A, Calik Y, Saka B, Yigman ZA, Ozturk EA. Best Practice Recommendations for Geriatric Dysphagia Management with 5 Ws and 1H. Ann Geriatr Med Res 2022; 26:94-124. [PMID: 35527033 PMCID: PMC9271401 DOI: 10.4235/agmr.21.0145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 04/26/2022] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ebru Umay
- Department of Physical Medicine and Rehabilitation, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
- Corresponding Author Ebru Umay, MD Department of Physical Medicine and Rehabilitation, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara 06200, Turkey E-mail:
| | - Sibel Eyigor
- Department of Physical Medicine and Rehabilitation, Ege University, Izmir, Turkey
| | - Gulistan Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Meltem Halil
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Esra Giray
- Department of Physical Medicine and Rehabilitation, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
| | - Pelin Unsal
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Zeliha Unlu
- Department of Physical Medicine and Rehabilitation, Celal Bayar University, Manisa, Turkey
| | - Canan Tikiz
- Department of Physical Medicine and Rehabilitation, Celal Bayar University, Manisa, Turkey
| | - Meltem Vural
- Department of Physical Medicine and Rehabilitation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Asli Tufan Cincin
- Department of Internal Medicine, Marmara University, Istanbul, Turkey
| | - Serkan Bengisu
- Department of Speech and Language Therapy, Uskudar University, Istanbul, Turkey
| | - Eda Gurcay
- Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Kemal Keseroglu
- Department of Otolaryngology, Head and Neck Surgery, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Banu Aydeniz
- Department of Physical Medicine and Rehabilitation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Elif Celik Karaca
- Ministry of Health Eskisehir Provincial Health Directorate, Eskisehir, Turkey
| | - Burak Karaca
- Ministry of Health Inonu Public Health Center, Eskisehir, Turkey
| | - Ahmet Yalcin
- Division of Geriatrics, Department of Internal Medicine, Ankara University, Ankara, Turkey
| | - Cemile Ozsurekci
- Department of Physical Medicine and Rehabilitation, Trabzon Kanuni Training and Research Hospital, University of Health Sciences Turkey, Trabzon, Turkey
| | | | - Ozlem Yilmaz
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Sibel Alicura
- Department of Otolaryngology, Head and Neck Surgery, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Serhat Tokgoz
- Department of General Surgery, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Barin Selcuk
- Department of Physical Medicine, Goztepe Medicalpark Hospital, Bahcesehir University, Istanbul, Turkey
| | - Ekin Ilke Sen
- Department of Physical Medicine and Rehabilitation, Istanbul University, Istanbul, Turkey
| | - Ali Yavuz Karahan
- Department of Physical Medicine and Rehabilitation, Usak University, Usak, Turkey
| | - Ayse Yaliman
- Department of Physical Medicine and Rehabilitation, Istanbul University, Istanbul, Turkey
| | - Serdar Ozkok
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Birkan Ilhan
- Department of Internal Medicine, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Merve Guner Oytun
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | | | - Sibel Akin
- Department Internal Medicine, Erciyes University, Kayseri, Turkey
| | - Betul Yavuz
- Department of Physical Medicine and Rehabilitation, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Mazlum Serdar Akaltun
- Department of Physical Medicine and Rehabilitation, Gaziantep University, Gaziantep, Turkey
| | - Aylin Sari
- Istanbul Erenkoy Physical Medicine and Rehabilitation Hospital, Istanbul, Turkey
| | - Murat Inanir
- Department of Physical Medicine and Rehabilitation, Kocaeli University, Kocaeli, Turkey
| | - Meral Bilgilisoy
- Department of Physical Medicine and Rehabilitation, Antalya Training and Research Hospital, Antalya, Turkey
| | - Zuhal Çaliskan
- Department of Gastroenterology, Umraniye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Guleser Saylam
- Department of Otolaryngology, Head and Neck Surgery, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Tugce Ozer
- Department of Otolaryngology, Head and Neck Surgery, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Yasemin Eren
- Department of Neurology, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | | | - Dilek Keskin
- Department of Physical Medicine and Rehabilitation, Kirikkale University, Kirikkale, Turkey
| | - Zekeriya Ulger
- Department of Internal Medicine, Kirikkale University, Kirikkale, Turkey
| | - Aylin Demirhan
- Aylin Demirhan Physical Medicine and Rehabilitation Clinic, Izmir, Turkey
| | - Yalkin Calik
- Department of Physical Medicine and Rehabilitation, Bolu Izzet Baysal Training and Research Hospital, Bolu Turkey
| | - Bulent Saka
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Zeynep Aykin Yigman
- Department of Physical Medicine and Rehabilitation, Polatli City Hospital, Ministry of Health, Ankara, Turkey
| | - Erhan Arif Ozturk
- Department of Physical Medicine and Rehabilitation, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
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