Exercise capacity, lung and respiratory muscle function in substance use disorders

BACKGROUND

Substance use disorder (SUD) causes conditions such as cognitive and behavioral disorders, anxiety, depression, and social isolation it also causes acute airway inflammation by affecting airway bronchial dynamics. The current study aimed to investigate the lung function, respiratory muscle strength, and exercise capacity in patients with SUD.

METHODS

One hundred-eighty three patients with SUD, a total of 119 healthy controls, 54 of whom were cigarette smokers and 65 of whom were non-smokers were included in the study. Spirometric tests, respiratory muscle strength (MIP and MEP), and the 6-Minute Walk Test (6-MWT) were assessed. The III National Health and Nutrition Examination Survey were used to evaluate respiratory symptoms in patients with SUD and cigarette smokers.

RESULTS

86.3% of the SUD patients included in the study were using heroin, 9.2% were cannabis, and 5.5% were spice. The most common symptom in both SUD patients and cigarette smokers was shortness of breath, wheezing, and sputum production. After post-hoc tests, the FVC (p = 0.002), FVC (%predicted) (p < 0.0001), FEV1 (p = 0.002), FEV1 (%predicted) (p < 0.0001), FEV1/FVC (%) (p < 0.0001), PEF (p < 0.0001) and FEF%25-75 (p < 0.0001) lung function parameters were significantly lower in SUD patients than non-smokers. In addition, it was found that MIP (p < 0.0001), MIP (%predicted) (p < 0.0001), MEP (p < 0.0001), and MEP (%predicted) (p < 0.0001) values of SUD patients were significantly lower than non-smokers.

CONCLUSION

The study findings indicate that substance use has an effect on lung functions and the most commonly reported symptoms are shortness of breath, wheezing, and sputum production. In addition, respiratory muscle strength and exercise capacity were decreased in SUD patients compared to non-smokers.

The Shanghai Elbow Dysfunction Score: Psychometric Properties, Reliability and Validity Study of the Turkish Version

The Shanghai Elbow Dysfunction Score (SHEDS) is a self-reported assessment of post-traumatic elbow stiffness that measures elbow-related symptoms and elbow motion capacities. This study aimed to (1) translate and cross-culturally adapt the SHEDS into Turkish and (2) investigate the psychometric properties of the Turkish version in patients with post-traumatic elbow stiffness. The psychometric properties of the Turkish version of the SHEDS (SHEDS-T) were tested in 108 patients (72 male; mean age, 43.2 ± 11.2 years) with post-traumatic elbow stiffness. Cronbach's alpha was used to assess internal consistency. The intraclass correlation coefficients were used to estimate test-retest. Construct validity was analyzed with the Turkish version of the Disabilities Arm, Shoulder and Hand (DASH), the Mayo Elbow Performance Score (MEPS), and the Short Form-12 (PCS-12 and MCS-12). The SHEDS-T showed sufficient internal consistency (Cronbach's α coefficient = 0.83) and test-retest reliability (ICC = .96). The correlation coefficients between the SHEDS-T, the DASH, and the MEPS were .75 and .54, respectively (p < .001). There was a moderate correlation between the SHEDS-T and PCS-12 (r = .65, p = .01) and a weak positive correlation between the SHEDS and the MCS-12 (r = .40, p = .03). The SHEDS-T has sufficient reliability and validity to measure elbow-related symptoms and elbow motion capacities for Turkish-speaking individuals with post-traumatic elbow stiffness.

A multi-dimensional assessment of internet gaming disorder in children and adolescents: A case-control study

BACKGROUND

Internet gaming disorder (IGD) leads to social disturbances and isolation, neglect of daily responsibilities, behavioral disorders, and physical impairments.

OBJECTIVE

This study aimed to investigate the effect of IGD on spine biomechanics, range of motion in the neck and low back, and lung functions and respiratory muscle strength in children and adolescents.

METHODS

Sixty-four children and adolescents with IGD (Group I) and 41 healthy controls (Group II) were included in the study. The outcomes were assessed with the Visual Analogue Scale (VAS), Internet Addiction Scale, active range of motion (AROM) in the neck and lumbar spine, posture and spinal alignment, lung function tests, and respiratory muscle strength.

RESULTS

There is a significant difference in pain intensity at rest, during activity, and daily sitting time between groups (p < 0.05). Craniovertebral angle, shoulder asymmetry, thoracic kyphosis angle, cervical extension and rotation, and right lumbar rotation significantly decreased in Group I than in Group II (p < 0.05). Besides, the PEF, FEF 25-75%, and respiratory muscle strength were lower in Group I than in Group II (p < 0.05). With a multiple linear regression model, MEP, FEV1, and weekly time spent playing online games were significant predictors of internet addiction intensity (R2 = 0.28; p = 0.02, p = 0.01, and p < 0.001, respectively).

CONCLUSION

Postural misalignment and increased sedentary time cause physical health deterioration and negatively affect lung functions in children and adolescents with IGD. Consequently, considering both psychological and physical health is necessary to assess the problematic nature of internet gaming. A comprehensive assessment and multidisciplinary team approach is essential to managing the IGD.

Reliability and Validity of the Turkish Version of the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Joint Scale

BACKGROUND

The American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP) scale is one of the most widely used outcome measures to evaluate hallux pathologies. This study aimed to translate the AOFAS Hallux MTP-IP scale into Turkish and investigate its psychometric properties.

METHODS

The psychometric properties of the Turkish version of the AOFAS Hallux MTP-IP (AOFAS Hallux MTP-IP-T) scale were tested in 66 patients with hallux pathologies (52 women; mean age, 47.64 ± 12.75 years). Cronbach's alpha was used to assess internal consistency. The intraclass correlation coefficient (ICC) was used to estimate test-retest. Construct validity was analyzed with the Turkish version of the Manchester-Oxford Foot Questionnaire (MOXFQ), Visual Analogue Scale (VAS), and 12-item Short-Form Health Survey(SF-12).

RESULTS

The AOFAS Hallux MTP-IP-T scale had adequate internal consistency (α = 0.71) and test-retest reliability (ICC2,1 = 0.93 for pain, ICC2,1 = 0.97 for function, and ICC2,1 = 0.97 for total score). The AOFAS Hallux MTP-IP-T total score has a moderate to strong correlation with VAS-activity and MOXFQ (ρ = -0.77, P = .001; ρ = -0.69, P = .001, respectively). The weakest correlation was found between the AOFAS Hallux MTP-IP-T and the SF-12 mental component scale (ρ = 0.31, P = .01).

CONCLUSION

AOFAS Hallux MTP-IP-T has sufficient reliability and validity to evaluate Turkish-speaking individuals with a variety of forefoot pathologies including the hallux.

LEVELS OF EVIDENCE

Level II.

The Validity and Reliability of the Turkish Version of Self-Perceived Barriers for Physical Activity Questionnaire

Identifying the barriers to physical activity (PA) is important for comprehensive management strategies to decrease physical inactivity. This study aimed to translate and cross-culturally adapt the Self-Perceived Barriers for Physical Activity Scale (SPBPA) into Turkish and investigate its psychometric properties. One-hundred fifty-two young and middle-aged adults (mean age of 33.3 ± 12.66 years) were included. Within a 5-to-15-day period after the first assessment, the participants completed the Turkish version of SPBPA (SPBPA-T) to evaluate test-retest reliability. Cronbach's alpha (α) was used to assess internal consistency. The correlation between the SPBPA-T and Physical Activity Barriers Questionnaire (PABQ) and Short Form-12 (SF-12) was determined to check the validity. The SPBPA-T had a strong internal consistency (α = .83) and test-retest reliability (ICC_2,1 = .90). There was a strong correlation between PABQ and SPBPA-T (r = 0.709; p < .0001), indicating strong construct validity. The convergent validity of SPBPA-T was confirmed with the mental component of SF-12 (r = -.228; p < .0001). There was no floor or ceiling effect. The questionnaire had a 1.083 SEM value and its MDC was 3.00 points. The SPBPA-T is semantically and linguistically adequate and has strong internal validity and test-retest reliability to determine the self-perceived barriers to PA among Turkish-speaking young adults.

The Reliability and Validity of the Turkish Version of Smartphone Impact Scale

The Smartphone Impact Scale (SIS) was originally developed in English to determine the cognitive, affective, social, and behavioral impacts of smartphones. This study aimed to translate and cross-culturally adapt the SIS instrument into Turkish and investigate its psychometric properties. Two hundred and sixty-four young and middle-aged adults (186 females) with a mean age of 36.24 years (SD = 14.93; range, 18-65 years) were included. For cross-cultural adaptation, two bi-lingual translators used the back-translation procedure. Within a 5-to-7-day period after the first assessment, the participants completed the Turkish version of SIS (SIS-T) to evaluate test-retest reliability. Cronbach's alpha (α) was used to assess internal consistency. The correlation between the Turkish version of the Smartphone Addiction Scale (SAS-T) and the Nottingham Health Profile was determined to check the validity. The SIS-T had a high-level internal consistency (α = 0.86) and test-retest reliability (ICC2,1 = 0.56 to 0.89 for subscales). The SIS-T subscales were correlated with the SAS-T (r = 0.31 to 0.66, p < 0.01), indicating a good concurrent validity. The results show that the SIS-T is semantically and linguistically adequate to determine smartphones' cognitive, affective, social, and behavioral impacts on young and middle-aged adults. Good internal validity and test-retest reliability of the SIS-T were defined to evaluate the impacts of smartphones among Turkish-speaking young and middle-aged adults.

The efficacy of graded motor imagery in post-traumatic stiffness of elbow: a randomized controlled trial

BACKGROUND

Physiotherapy improves the movement range after the onset of post-traumatic elbow stiffness and reduces the pain, which is a factor limiting elbow range of motion. However, no results have been reported for motor-cognitive intervention programs in post-traumatic elbow stiffness management. The objective was to investigate the efficacy of graded motor imagery (GMI) in post-traumatic elbow stiffness.

METHODS

Fifty patients with post-traumatic elbow stiffness (18 female; mean age, 41.9 ± 10.9 years) were divided into 2 groups. The GMI group (n = 25) received a program consisting of left-right discrimination, motor imagery, and mirror therapy (twice a week for 6 weeks); the structured exercise (SE) group (n = 25) received a program consisting of range-of-motion, stretching, and strengthening exercises (twice a week for 6 weeks). Both groups received a 6-week home exercise program. The primary outcome was the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. The secondary outcomes were the active range of motion (AROM), visual analog scale (VAS), Tampa Scale for Kinesiophobia (TSK), muscle strength of elbow flexors and extensors, grip strength, left-right discrimination, and Global Rating of Change. Patients were assessed at baseline, at the end of treatment (12 sessions), and a 6-week follow-up.

RESULTS

The results indicated that both GMI and SE interventions significantly improved outcomes (P < .05). After a 6-week intervention, the DASH score was significantly improved with a medium effect size in the GMI group compared with the SE group, and improvement continued at the 6-week follow-up (F_1,45 = 3.10, P = .01). The results with a medium to large effect size were also significant for elbow flexion AROM (P = .02), elbow extension AROM (P = .03), VAS-activity (P = .001), TSK (P = .01), and muscle strength of elbow flexors and elbow extensors (P = .03) in favor of the GMI group.

CONCLUSION

The GMI is an effective motor-cognitive intervention program that might be applied to the rehabilitation of post-traumatic elbow stiffness to improve function, elbow AROM, pain, fear of movement-related pain, and muscle strength.

The investigation of foot structure within children who have attention-deficit hyperactivity disorder: a case-controlled study

The impairments in motor performance could be related to the foot structure in children with attention-deficit/hyperactivity disorder (ADHD) while considering the close relationship between foot structure and lower extremity alignment. This study aimed to investigate the foot structure and its relationships between disease severity, physical activity and psychiatric traits in children with ADHD. Children with ADHD (n = 50; mean age: 12.02 ± 1.83 years) and typically developing peers (n = 30; mean age: 12.86 ± 2.56 years) were included. The static footprint analysis was collected by using digital images. The ImageJ program was used to calculate Clarke's angle, Staheli arch index (SAI) and Chippaux-Smirak index (CSI). The Turgay DSM-IV disruptive behavior disorders rating scale (T-DSM-IV-S), physical activity questionnaire for older children (PQ-C), children's depression inventory and state-trait anxiety inventory for children were all used to assess symptoms of ADHD, physical activity, depression, stress and anxiety, respectively. Approximately 52-53% of children with ADHD had mild to severe flatfoot, while only 8-13% of typically developing peers had flatfoot based on SAI and CSI (P = 0.01). Significant correlation was found between Clarke's angle and PQ-C (r = 0.21, P = 0.04). Besides, T-DSM-IV-S was significantly correlated with SAI (r = 0.24, P = 0.01) and CSI (r = 0.25, P = 0.01) in children with ADHD. Children with ADHD had a significantly greater tendency of flatfoot compared to typically developing peers. Besides, the deterioration of the foot structure of children with ADHD was associated with disease severity.

The effectiveness of Kinesio taping on playing-related pain, function and muscle strength in violin players: A randomized controlled clinical trial

OBJECTIVES

This study aimed to investigate the effectiveness of Kinesio taping (KT) on playing-related pain, upper extremity and hand function, grip and pinch strength in violin players.

DESIGN

Randomized controlled trial.

SETTING

Faculty of health sciences.

PARTICIPANTS

One hundred seventeen participants who were professional violinists for at least two years (82 women; mean age, 22.76 ± 3.87 years) were randomized to receive either therapeutic tape application (KT group), a sham tape application (placebo group), or no application (control group) for one week.

OUTCOME MEASURES

The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) in one week. The secondary outcomes were the Visual Analogue Scale (VAS), the Purdue Pegboard Test, grip and pinch strength. Outcome measures were performed at baseline, immediately after the intervention, and one week later (follow-up). Participants were asked to play the "Violin Concerto No.2, Op.35 (Rieding, Oskar)"; pre-and post-performance pain and grip and pinch strength were assessed.

RESULTS

The overall group-by-time interaction was not significant for DASH, but the improvement in the mean VAS-playing was slightly better in the KT group than in others (p < 0.05). The mean post-performance VAS-playing remained similar in the KT group while slightly increasing in the other groups (p < 0.05). In addition, a decrease in the mean post-performance grip strength of the left hand was significantly lower in the KT group than in the other groups (p < 0.05).

CONCLUSIONS

Violin players receiving an application of KT represented minor improvements in playing-related pain, and post-performance pain intensity and grip strength of the left hand slightly remained after 1 week kT application. The possible post-performance effect of the tape on the pain intensity and grip strength must also be considered because KT can be used during the performance.

The Investigation of Falls and Balance from the Perspective of Activities of Daily Living in Patients with COPD

The aim of this study was (1) to compare the activities of daily living (ADLs), perceived falling risk and balance in chronic obstructive pulmonary disease (COPD) patients with or without falling history and (2) to investigate the relationship between ADLs and balance. Fourteen patients with COPD with a history of falling whose mean falling frequency was 2.64 ± 0.74 times in the last 12-months (fallers) and 14 age and sex-matched patients with COPD with no history of falling (non-fallers) were included. The outcome measures were the London Chest Activity of Daily Living (LCADL) scale, Activities-Specific Balance Confidence (ABC) scale, Berg Balance Scale (BBS), 6-minute walking test, and quadriceps-femoris strength. Fallers reported increased dyspnoea perception in ADLs, decreased balance confidence, and disturbed balance compared with non-fallers (p < 0.05). A strong correlation was found between the LCADL scale item score (dressing the upper body) and the BBS total score (rho = -0.81, p = 0.001) in fallers. The LCADL scale item score (going out socially) was significantly correlated with the total score of the ABC scale (rho = -0.61, p = 0.001). Moderate correlations were found between the LCADL scale item scores (dressing the upper body, washing hair, and walking up stairs) and the BBS total score (p < 0.003). This study demonstrated that increased severity of dyspnoea perception during ADLs is associated with impaired balance and poor balance confidence, regardless of functional capacity and peripheral muscle strength in patients with COPD. The balance confidence was low in functional mobility-based activities in patients with COPD with a history of falling.

Musculoskeletal pain and its relation to individual and work-related factors: a cross-sectional study among Turkish office workers who work using computers

Objective. Office workers are commonly exposed to work-related musculoskeletal pain. This study investigated the individual and work-related risk factors linked to musculoskeletal pain and pain-related disability among Turkish office workers who work using computers. Methods. One-hundred and fifty office workers were included. Data were collected using an online survey with a combination of the Nordic musculoskeletal questionnaire, Oswestry disability index (ODI), neck disability index (NDI) and disabilities of the arm, shoulder, and hand questionnaire short-form (Q-DASH). The participants were divided into four subgroups: no pain (n = 26), lower back pain (n = 37), neck pain (n = 49) and upper-extremity pain (n = 38). Results. There were differences between subgroups in terms of the condition that feet touch the floor and the condition that the keyboard, mouse and wrist are in a straight line (p = 0.013 and p = 0.025, respectively). Working years was correlated with the ODI score (ρ = 0.802, p = 0.041). There was also a significant correlation between the NDI score and working hours (ρ = 0.415, p = 0.003), while Q-DASH was correlated with body mass index and working years (ρ = 0.406, p = 0.014, and ρ = 0.327, p = 0.043, respectively). Conclusions. Pain-related disability was associated with various risk factors such as physical inactivity, body mass index, working hours, working years and workplace ergonomics in the office workers.

Chest Wall Mobility: Identification of Underlying Predictors

OBJECTIVE

The purpose of this study was to identify factors contributing to normal mobility or hypermobility of the chest wall.

METHODS

Seventy-eight young adults were divided into 2 groups: patients with normal mobility (group 1, n = 40) and hypermobility of the chest wall (group 2, n = 38). The mean mobility of the chest wall in groups 1 and 2 was 9.9 and 6.1 cm, respectively. The mean age of groups 1 and 2 was 22.2 and 21.5 years, respectively. The Brief Symptom Inventory, State-Trait Anxiety Inventory, Beck Depression Inventory, and the Perceived Stress Scale were used to evaluate the psychometric properties. Quality of life was assessed using 12-Item Short Form Health Survey. Smoking status was determined via self-report of current smoking status. Chest wall mobility was measured using thoracic and axillary cirtometry. Pulmonary functions were evaluated using a Spirobank II device. Subsequently, forced vital capacity (FVC), forced expiratory volume in 1 second, peak expiratory flow, and forced expiratory flow 25% to 75% were verified. Carefusion Micro RPM and the 6-minute walk test were used to evaluate maximal respiratory pressures and functional capacity, respectively.

RESULTS

With backward linear regression models, FVC and obsessive-compulsive traits were significant predictors of chest wall mobility (R² = 0.27; P < .001 and P = .01, respectively). In logistic regression models, FVC, maximum inspiratory pressure, and obsessive-compulsive traits were significant predictors of normal mobility/hypermobility of the chest wall (R² = 0.42; P < .001, P = .01, and P = .03, respectively).

CONCLUSION

Forced vital capacity, maximum inspiratory pressure, and obsessive-compulsive traits are significant predictors of chest wall mobility and normal mobility or hypermobility of the chest wall.

THU0609-HPR RESPONSIVENESS OF THE DISABILITIES OF THE ARM, SHOULDER AND HAND (DASH) AND THE UPPER EXTREMITY FUNCTIONAL INDEX (UEFI) IN PATIENTS WITH POSTTRAUMATIC ELBOW STIFFNESS

Background:

There are many patient-rated outcome measures to assess the subjective component of function in musculoskeletal disorders of elbow. The first step of functional assessment is to select the instrument, which is sufficiently responsive. Although the disabilities of the arm, shoulder and hand (DASH) and the upper extremity functional index (UEFI) are widely used in reporting outcomes in upper extremity function, the responsiveness of these two scales has not been investigated in elbow disorders.

Objectives:

This study aimed to compare and report the responsiveness of the DASH and the UEFI in patients with posttraumatic elbow stiffness.

Methods:

Fifty-seven patients with posttraumatic elbow stiffness (32 women; mean age, 44.54 ± 6.51 years) were included. All patients completed the DASH and UEFI at baseline and after a six-week intervention, which was a structured exercise program. Patients who improved (much improved and slightly improved) and those who unimproved were defined using a 5-point global rating chance scale (GROC). Responsiveness was assessed using effect size and standardized response mean (SRM). ES has observed the mean change scores divided by the standard deviation of the initial score. SRM was calculated for the improved group and the unimproved group, dividing the mean change scores by the standard deviation of mean change scores. Similar to effect size, SRM values and ES values of 0.20, 0.50 and 0.80 were considered small, moderate or large, respectively.

Results:

Forty-eight patients (84.21%) were classified improved and 9 patients (15.79%) were classified unimproved according to the GROC. Effect sizes and SRMs were large (greater than 1.00) for participants who were “much improved” or “slightly improved” on the GROC for both the DASH and UEFI. For groups of participants who improved on the GROC, effect sizes and SRMS were ranged from 1.87 to 2.09 and 2.13 to 2.56 for the DASH, and 1.59 to 2.16 and 1.65 to 2.29 for the UEFI, respectively (Table 1).

Table 1.

Mean baseline scores, change scores, effect size and standardized response mean for improved and unimproved patients

Global Rating of ChangeImproved(n=48)Unimproved(n=9)Much Improved(n=27)Slightly Improved(n=21)No Change(n=9)Mean (SD)Mean (SD)Mean (SD)The disabilities of the arm, shoulder and handBaseline43.41 (14.22)42.66 (13.41)44.21 (7.24)After 6-week13.65 (11.60)17.51 (8.91)39.72 (6.81)Change-29.75 (11.61)-25.14 (11.77)-4.48 (3.26)ES2.091.870.61SRM2.562.131.37The upper extremity functional indexBaseline42.00 (10.15)42.76 (15.75)39.75 (9.85)After 6-week64.00 (10.53)67.47 (11.47)47.00 (5.39)Change22.00 (9.60)24.71 (14.96)7.25 (6.47)ES2.161.560.73SRM2.291.651.12

Abbreviations: ES, Effect Size; SD, Standard Deviation; SRM, Standardised Response Mean.

Conclusion:

These findings showed that for patients receiving physiotherapy for the management of elbow stiffness, both the DASH and the UEFI are similarly responsive to change in symptoms and disability and similarly able to discriminate between patients who improved or unimproved.

References:

[1]Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG). American journal of industrial medicine. 1996;29(6):602-8.

[2]Stratford PW, Binkley JM, Stratford DM. Development and initial validation of the upper extremity functional index. Physiotherapy Canada. 2001;53(4):259-67.

[3]Smith MV, Calfee RP, Baumgarten KM, Brophy RH, Wright RW. Upper extremity-specific measures of disability and outcomes in orthopaedic surgery. The Journal of bone and joint surgery American volume. 2012;94(3):277-85.

Characters from table content including title and footnotes:783

Disclosure of Interests:

None declared

FRI0617-HPR GRADED MOTOR IMAGERY IN POSTTRAUMATIC STIFFNESS OF THE ELBOW: A PILOT STUDY

Background:

Elbow fracture is treated either conservatively or surgically followed by a period of immobilization with casting or splinting. A splint used to immobilize upper limbs for many weeks results in changes in both the peripheral musculature and the central nervous system. It is well known that common complaints after upper limb fractures include weakness, pain, and stiffness; therefore, pain management is important in the early stages of the rehabilitation of upper limb fractures.

Objectives:

This pilot study aimed to investigate the efficacy of graded motor imaginary (GMI) on pain, range of motion (ROM), and function in patients with posttraumatic stiff elbow.

Methods:

Fourteen patients with posttraumatic stiff elbow (6 women, mean age: 45.42 ± 11.26 years, mean body mass index: 24.29 ± 3.38 kg\m2and mean duration of immobilization: 4.75 ± 1.03 weeks) were randomly allocated to either GMI or control groups. The GMI group received GMI treatment in addition to a structured exercise program, and the control group received a structured exercise program (two days per week for six weeks) (Figure 1). The assessments included pain at rest and during activity using the visual analog scale (VAS), elbow active ROM with a digital goniometer (Baseline Evaluation Instrument, Fabrication Enterprises, Inc., White Plains, NY), and upper extremity functional status using the Disability of the Arm, Shoulder and Hand Questionnaire (DASH). The assessments were performed at baseline and after the 6-week intervention.

Figure 1.

Graded motor imagery performed with mirror box

Results:

After the 6-week intervention, there was a significant increase in elbow flexion-extension ROM and supination-pronation ROM, and improvement in DASH score in both groups (p<0.05). However, improvement in VAS-rest and VAS-activity was significantly higher in the GMI group than the control group (p=0.03 and p=0.01, respectively).

Conclusion:

A conservative treatment program consisting of GMI treatment in addition to a structured exercise program applied twice a week for 6 weeks, has been found more effective in decreasing pain in the posttraumatic stiff elbow. It could be concluded that GMI is an effective treatment method for elbow fracture in patients with predominant elbow pain.

References:

[1] Harris JE, Hebert A. Utilization of motor imagery in upper limb rehabilitation: a systematic scoping review. Clin Rehab. 2015:29(11):1092-1107.

[2] Opie GM, Evans A, Ridding MC, Semmler JG. Short-term immobilization influences use-dependent cortical plasticity and fine motor performance. Neuroscience. 2016:330:247-256.

[3] Birinci T, Razak Ozdincler A, Altun S, Kural C. A structured exercise programme combined with proprioceptive neuromuscular facilitation stretching or static stretching in posttraumatic stiffness of the elbow: a randomized controlled trial. Clin Rehab. 2019:33(2):241-252.

Acknowledgments:

The present work was supported by the Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa (Project No: TDK-2019-33997).

Disclosure of Interests:

None declared

AB1310-HPR EFFECTS OF INSTRUMENT-ASSISTED SOFT TISSUE MOBILIZATION ON FROZEN SHOULDER: A RANDOMIZED CONTROLLED TRIAL

Background:

Frozen shoulder has a greater incidence, more severe course, and resistance to treatment in patients. Management is based on the underlying cause of pain and stiffness. Joint mobilization has been reported to improve joint range of motion in frozen shoulder. However, there is no information regarding the effect of instrument-assisted soft tissue mobilization (IASTM) in frozen shoulder. We proposed that there would be no significant difference between the two manual physical therapy techniques with relatively similar treatment effects in the frozen shoulder.

Objectives:

The aim of this randomized controlled study was to compare the effectiveness of IASTM and joint mobilization in the treatment of patients with frozen shoulder.

Methods:

Thirty patients with phase II frozen shoulder (mean age 50,9 years, age range 39–65 years) were randomly assigned to one of the two treatment groups: Group I received joint mobilization combined with manual stretching exercise and Group II received IASTM with manual stretching exercise (two days per week for six weeks) (Figure 1). The pain level was evaluated with a visual analogue scale (VAS) and the active range of motion (ROM) was measured with a universal goniometer. The Disabilities of the Arm, Shoulder and Hand score and the Constant-Murley score were used for functional assessment. The assessments were performed at baseline and after the 6-week intervention.

Figure 1.

Instrument-Assisted Soft Tissue Mobilization

Results:

Both groups had a significant decrease in pain according to VAS and a significant increase in ROM and function level (p<0.05). After the 6-week intervention, improvement of shoulder abduction ROM in Group I was found significantly higher than Group II (p=0.01), on the other hand, Constant-Murley score in Group II was found significantly higher compared to Group I (p=0,001).

Conclusion:

Our results supported the hypothesis that either joint mobilization or IASTM, performed in addition to stretching exercise, provided similar improvements in pain levels in patients with the frozen shoulder.

References:

[1]Kelley MJ, Shaffer MA, Kuhn JE, Michener LA, Seitz AL, Uhl TL, et al. Shoulder Pain and Mobility Deficits: Adhesive Capsulitis, J Orthop Sports Phys Ther, 2013:43:1-31.

[2]Celik D, Kaya Mutlu E.Does AddingMobilization toStretchingImprove Outcomes for People with Frozen Shoulder? A Randomized Controlled Clinical Trial, Clin Rehab, 2016: 30(8): 786-794.

[3]Iked N, Otsuka S, Kawanishi Y, Kawakami Y. Effects of Instrument-Assisted Soft Tissue Mobilization on Musculoskeletal Properties, Med Sci Sports Exerc, 2019:51(10): 2166-2172.

Disclosure of Interests:

None declared

The Reliability and Validity of the Turkish Version of the Survey of Activities and Fear of Falling in the Elderly

BACKGROUND AND PURPOSE

The Survey of Activities and Fear of Falling in the Elderly (SAFE) was originally developed in English to determine the level of fear of falling and its interactions with activities of daily living. The purpose of this study was to translate and cross-culturally adapt the SAFE instrument into Turkish and investigate its psychometric properties.

PARTICIPANTS

One hundred eleven older adults (72 females) with a mean age of 69 years (SD = 7.22; range, 60-87) were included.

METHODS

For cross-cultural adaptation, 2 bilingual translators used the back-translation procedure. Within a 5- to 7-day period after the first assessment, the participants completed the Turkish version of the SAFE (SAFE-T) to evaluate test-retest reliability. Cronbach's α was used to assess internal consistency. The correlation with the Turkish version of the Falls Efficacy Scale-International (FES-T) was determined to check the validity.

RESULTS

The SAFE-T had excellent internal consistency (α = 0.96) and test-retest reliability (intraclass correlation coefficient [ICC2,1] = 0.96 for activity level, ICC2,1 = 0.95 for fear of falling, and ICC2,1 = 0.86 for activity restriction subscales). The SAFE-T activity level and SAFE-T activity restriction subscales were moderately correlated with the FES-I (ρ = -0.51, P < .001; ρ = 0.55, P < .001, respectively). A strong positive correlation was found between the SAFE-T fear of falling subscale and the FES-I (ρ = 0.75, P < .001), indicating good concurrent validity.

CONCLUSIONS

The results show that the SAFE-T is semantically and linguistically adequate to assess the fear of falling in adults older than 60 years. Excellent internal validity and test-retest reliability of the SAFE-T were defined to evaluate the fear of falling among Turkish speaking older adults.

The effectiveness of trigger point treatment in rotator cuff pathology: A randomized controlled double-blind study

BACKGROUND

Studies have emphasized the importance of the presence of myofascial trigger points (MTrPs) in patients with rotator cuff pathologies and the high frequency of MTrPs in rotator cuff muscles.

OBJECTIVE

Evaluate the effectiveness of the treatment of active MTrPs in patients with rotator cuff pathologies.

METHODS

Fifty-three patients with rotator cuff tear were randomized into two groups. All patients received the same standard conservative treatment twice a week for 6 weeks. Patients in Group 1 additionally received ischemic compression (IC) of MTrPs. Pain, range of motion (ROM), function, and anxiety and depression were assessed. MTrPs in rotator cuff muscles were assessed manually, and the number of MTrPs on the shoulder complex was counted.

RESULTS

There were no significant differences between the groups in terms of changes in resting/activity/night pain, ROM, function, or anxiety and depression (p> 0.05). Pain scores improved only in Group 1. However, the total number of MTrPs was significantly decreased in Group 1 (p= 0.001).

CONCLUSION

A six-week course of IC helps treat active MTrPs. A standard conservative treatment program reduced pain and increased function; the addition of MTrP treatment did not improve clinical outcomes in patients with rotator cuff pathologies.

A structured exercise programme combined with proprioceptive neuromuscular facilitation stretching or static stretching in posttraumatic stiffness of the elbow: a randomized controlled trial

Objectives:

To compare the different stretching techniques, proprioceptive neuromuscular facilitation (PNF) stretching and static stretching, in patients with elbow stiffness after a treated elbow fracture.

Design:

Randomized-controlled, single-blind study.

Setting:

Department of physiotherapy and rehabilitation.

Subjects:

Forty patients with posttraumatic elbow stiffness (24 women; mean age, 41.34 ± 7.57 years).

Intervention:

PNF stretching group ( n = 20), hold-relax PNF stretching combined with a structured exercise programme (two days per week for six weeks); static stretching group ( n = 20), static stretching combined with a structured exercise programme (two days per week for six weeks).

Main measures:

The primary outcome is the Disabilities of the Arm, Shoulder and Hand (DASH). The secondary outcomes are active range of motion (AROM), visual analogue scale (VAS), Tampa Scale for Kinesiophobia, Short Form-12 and Global Rating of Change. Participants were assessed at baseline, after a six-week intervention period and one-month later (follow-up).

Results:

After treatment, improvement in the mean DASH score was slightly better in the PNF stretching group (8.66 ± 6.15) compared with the static stretching group (19.25 ± 10.30) ( p = 0.03). The overall group-by-time interaction for the 2 × 3 mixed-model analysis of covariance (ANCOVA) was also significant for elbow flexion AROM (mean change for PNF stretching group; static stretching group; 41.10, 34.42, p = 0.04), VAS-rest (–1.31, –1.08, p = 0.03) and VAS-activity (–3.78, –3.47, p = 0.01) in favour of PNF stretching group. The other outcomes did not differ significantly between the two groups.

Conclusion:

The study demonstrated that the structured exercise programme combined with PNF stretching might be effective in patients with posttraumatic elbow stiffness with regard to improving function, elbow flexion AROM, pain at rest and during activity.

Relationship between the mobility of medial longitudinal arch and postural control

OBJECTIVE

The aim of this study was to analyze the relationship between the medial longitudinal arch mobility and static and dynamic balance.

METHODS

A total of 50 subjects (25 female, and 25 male; Mean age: 22.2 ± 1.3 years; BMI: 22.8 ± 3.8 kg/m²) were included in this study. The relative arch deformity (RAD) was calculated with both 10% and 90% weight bearing (WB). Static balance was evaluated with Single Leg Stance Test and dynamic balance with TechnoBody PK 200WL computerized balance device. Subjects were evaluated for goniometric measurements of lower extremity joints, leg dominance and leg-length discrepancy.

RESULTS

Bipedal dynamic balance was correlated with both feet length at 10% WB and 90% WB. There was a correlation between the dynamic balance on dominant foot and RAD value on the aspect of Medium Speed (r = -0.32, p = 0.02), Perimeter Length (r = -0.32, p = 0.02) and Anterior-Posterior Sway (r = 0.36, p = 0.01). Static balance was unaffected by RAD value when the visual system was eliminated.

CONCLUSION

Our results suggest that decrease of arch mobility on the dominant foot is associated with posterior sway by causing knee or hip strategy and preventing ankle strategy even in small perturbations. The rate of deviation from the equilibrium point and the degree of total swaying increase when arch mobility decreases.

Applications of Platelet-Rich Plasma in Lymphedema

Platelet-rich plasma (PRP) is an autologous concentrated preparation of human platelets contained in a small volume of plasma that is characterized by hemostatic and tissue-repairing effects. Being enriched by various kinds of growth factors, and their tissue-repairing effects have made them the focus of attention for use in tissue regeneration. PRP has been safely used and documented in many different fields, including orthopedics, sports injuries, dental and periodontal surgery, and cosmetic, plastic, cardiovascular, general, and maxillofacial surgery. The current evidence obtained from in vitro and animal studies pointed out that PRP may potentially be used to regenerate injured lymphatic vessels to treat or prevent lymphedema. Therefore, we have reviewed existing literature on the clinical uses of PRP in lymphedema and inquired whether there is enough evidence to support the use of PRP in clinical practice as a treatment option. In contrast to in vitro and animal models, there is no clinical trial regarding the use of PRP in lymphedema treatment. Only two animal studies matched to our research yielded positive and promising results in terms of the potential role of PRP in future for lymphedema therapies. In the light of these findings, it is clear that this is an important issue that should be studied in greater depth to clarify the efficacy of PRP in the management of lymphedema.