The caregiver burden of informal caregivers for stroke patients with and without dysphagia: A multi-center, cross-sectional study in Türkiye

Objectives

The aim of this study was to investigate the caregiver burden (CB) of informal caregivers for stroke survivors with and without dysphagia and to assess the relationship between the CB levels of informal caregivers for stroke survivors with dysphagia, patients' swallowing-related quality of life (QoL), and patients' stroke-specific QoL.

Patients and methods

This multi-center, prospective, cross-sectional study included a total of 120 stroke patients (76 males, 44 females; mean age: 61.1±12.3 years; range, 19 to 86 years) between October 2019 and 2020. Of the patients, 57 had dysphagia and 63 had no dysphagia. The Functional Oral Intake Scale (FOIS) was used to classify the degree of functional dietary limitation caused by each patient's swallowing impairment. Patients and caregivers completed the Eating Assessment Tool (EAT-10), Swallowing Quality of Life (SWQoL) questionnaire, Stroke Impact Scale (SIS), and the Zarit Caregiver Burden Interview (ZBI).

Results

The CB levels were higher in those caring for stroke patients with dysphagia than in those caring for stroke patients without dysphagia. Caregiver burden was found to be associated with patients' swallowing-related QoL and stroke-related QoL. Significant predictors of high CB scores (F=2.55, R2=0.59; p=0.007) were being an employed caregiver (B=17.48, p=0.003), being a caregiver with high school (B=-19.6, p=0.03), and secondary school (B=-16.28, p=0.02) educational status, being son, daughter (B=30.63, p=0.007) or other relative of the patient (B=20.06, p=0.01), lower FOIS stage (B=-3.14, p=0.011), lower SWQoL (B=0.52, p=0.009) and lower SIS (B=-0.37, p=0.04) scores.

Conclusion

Caregivers of stroke patients with dysphagia suffer from a higher CB than those without dysphagia. In stroke patients with dysphagia, swallowing-related QoL is associated with the QoL levels of stroke patients and the CB levels of their caregivers. Employment status, educational status of caregiver, caregiver's relativity to the patient, FOIS stage, swallowing and stroke related QoL of the patients are factors related to burden levels of caregivers of stroke patients with dysphagia. These results may help health professionals to understand dysphagia as an essential source of CB and consider it, while planning treatments.

Familial Mediterranean fever: perspective on female fertility and disease course in pregnancy from a multicenter nationwide network

The aim of this study was to analyze the pregnancy process, especially the Familial Mediterranean fever (FMF) disease course and attack types during pregnancy, and to examine the relationship between disease-related factors and female infertility in FMF patients. The study, which was planned in a multicenter national network, included 643 female patients. 435 female patients who had regular sexual intercourse were questioned in terms of infertility. Pregnancy and delivery history, FMF disease severity and course during pregnancy were evaluated. The relationship between demographic and clinical findings, disease severity, genetic analysis results and infertility was investigated. 401 patients had at least 1 pregnancy and 34 patients were diagnosed with infertility. 154 patients had an attack during pregnancy. 61.6% of them reported that attacks during pregnancy were similar to those when they were not pregnant. The most common attack symptoms were fever, fatigue and abdominal pain-peritonitis (96%, 87%, and 83%, respectively) in the pregnancy period. The disease-onset age, disease activity score, gene mutation analyses, and regular colchicine use (> 90%) were similar between the fertile and infertile groups, while the frequency of previous appendectomy and alcohol consumption rates were higher in individuals with infertility. Our results indicated no significant change in the frequency and severity of attacks during pregnancy. The low rate of infertility (7.8%) in our patients was noted. It has been suggested that the risk of FMF-related infertility may not be as high as thought in patients who are followed up regularly and received colchicine.

Pilates-based therapeutic exercise for pregnancy-related low back and pelvic pain: A prospective, randomized, controlled trial

Objectives

In this study, we aimed to clarify the impact of a Pilates-based therapeutic exercise on disability, pain, mood, and sleep quality in patients with pregnancy-related lumbopelvic pain (LPP).

Patients and methods

In the single-blinded randomized controlled study conducted between January 2018 and June 2018, 34 pregnant women (mean age: 29.7±6.2 years; range, 18 to 40 years) in the second trimester (week 14-24) with LPP were randomly assigned to a control group and a Pilates group. All patients underwent usual prenatal care. In addition, the selected Pilates exercise was carried out twice a week for 60-min per session for 12 weeks in the Pilates group. The control group was not prescribed an exercise regimen; however, they were not discouraged from exercising. The primary outcome was disability; secondary outcomes were LPP, mood, and sleep quality. Disability [Roland-Morris Disability Questionnaire (RMDQ)], LPP [Visual Analog Scale (VAS)], mood [Hospital Anxiety and Depression Scale, Anxiety (HADS-A) and Depression (HADS-D) subscales], and sleep quality [Pittsburgh Sleep Quality Index (PSQI)] were measured before and after 12 weeks. Adverse effects and adherence were recorded to determine exercise safety and compliance. The intention-to-treat analysis was applied.

Results

The between-group effect sizes were moderate for the RMDQ and VAS scales (d=0.4 and d=0.7, respectively) and small for the HADS-A and HADS-D scales (both d=0.2). The intention-to-treat analysis demonstrated that there was a statistically significant difference in disability, pain, and mood in favor of the Pilates group (p0.05).

Conclusion

Adding Pilates to usual prenatal care should be considered a promising treatment option for pregnancy-related LPP.

The effectiveness of hippotherapy simulation exercises for muscle strength, disease activity and quality of life in sedentary adults with ankylosing spondylitis

INTRODUCTION/OBJECTIVE

Newly created systems called hippotherapy simulators (HS) mimic the primitive movements of a live horse. As they are new systems, research examining their usefulness has been well received. The aim of this study is to research the effects of HS on disease activity, quality of life and muscle strength in patients with ankylosing spondylitis (AS).

METHODS

In a prospective, assessor-blinded, block-randomized trial, 48 AS patients were randomly assigned in a 1:1 ratio to receive either HS or conventional home (CH) exercise therapy. All Participants received 48 sessions, that is 4 sessions a week for 12 consecutive weeks. The primary outcome measures included the quadriceps muscle strength, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI) and Ankylosing Spondylitis Quality of Life Scale (ASQoL).

RESULTS

Both groups demonstrated significant improvement in BASDAI, BASFI, BASMI, ASQoL and muscle strength scores compared to the baseline (p < 0.05). BASDAI, BASFI and BASMI scores decreased significantly in the HS group compared to the CH group at week 12 (p=.005, p=.003, p=.045, respectively), but there was no significant difference between the groups in terms of ASQoL and muscle strength scores at week 12 (p=.245, p=.212, respectively).

CONCLUSIONS

The results of this clinical trial of HS exercises for AS patients indicate a positive effect on disease activity, quality of life and muscle strength. Therefore, horse-riding simulator exercises can be used as an alternative method for the management of individuals with AS.

Effects of hippotherapy simulation exercise vs. conventional home exercises on muscle strength and balance in people with multiple sclerosis: A randomized controlled trial

OBJECTIVE

To determine the efficacy of hippotherapy simulation exercise on the improvement of muscle strength, balance, spasticity, and quality of life in individuals with multiple sclerosis (MS).

DESIGN

Randomized controlled trial.

SETTING

Outpatient clinic at the rehabilitation clinic of University of Usak, Turkey PARTICIPANTS: Individuals with MS (n = 40) participated in this randomized clinical study.

INTERVENTIONS

Patients in both groups received 36 treatment sessions, 3 times per week for 12 consecutive weeks. Subjects in the study group performed hippotherapy simulation exercise via a hippotherapy simulator device. The control group received conventional home exercises.

MAIN OUTCOME MEASURES

The primary outcome measures included the Monitoring My Multiple Sclerosis (MMMS) Scale, the Berg Balance Scale (BBS), and the Timed Up and Go (TUG) test; quadriceps muscle strength was measured with a dynamometer.

RESULTS

At the level of physical activity, post-intervention MMMS measures showed significant differences in both cases. TUG was significantly lower, and muscle strength and BBS were significantly higher in both post-interventions. No outcome measure showed a significant difference between the groups at both post-intervention and follow-up.

CONCLUSIONS

The results of this study in the field of hippotherapy simulation exercise for people with MS indicate a positive effect on health conditions, balance, mobility skills, and muscle strength. Further studies are necessary to confirm these preliminary results.

Familial Mediterranean fever: Health-related quality of life and associated variables in a national cohort

Objectives

This study aims to evaluate the effectivity of Familial Mediterranean Fever Quality of Life (FMF-QoL) Scale for the measurement of QoL in patients with FMF and to perform correlations between related clinical variables in Turkish patients.

Patients and methods

This multicenter prospective study performed between December 2017 and November 2018 included 974 FMF patients (334 males, 640 females; median age: 35; range, 26 to 45 years). Sociodemographic characteristics and clinical features were recorded. All participants were asked to complete the FMF-QoL Scale, Short Form-36 (SF-36), Hospital Anxiety and Depression Scale (HADS), Health Assessment Questionnaire (HAQ), and Functional Assessment of Chronic Illness Therapy (FACIT) Scale.

Results

The median FMF-QoL Scale score was 26. Higher FMF-QoL Scale scores were shown to be related to female sex, illiteracy or primary education, monthly low-income (US$<300), smoking, late-onset FMF (>20 years), a higher number of attacks per month (>1/month), and severe disease. FMF-QoL Scale scores were correlated negatively with subscales of SF-36, and positively with HADS-anxiety and HADS-depression scores, HAQ and FACIT.

Conclusion

Female sex, smoking, lower educational status, more severe disease, fatigue, and functional impairment were associated with poor QoL. FMF-QoL Scale was noted as a valid and simple patient-reported outcome instrument and correlated with the SF-36 scale.

Evaluation of mandibular condyle trabecular structure in patients with rheumatoid arthritis using fractal analysis

OBJECTIVES

The aim of this study was to compare the fractal dimension (FD) of trabecular structure of the mandibular condyles in patients with rheumatoid arthritis (RA) to patients without RA. Correlations between condylar FD and bone mineral density T-scores in the femoral neck and lumbar spine were also examined.

STUDY DESIGN

The RA study group patients were divided into 3 categories (33 normal, 33 osteopenic, and 34 osteoporotic) according to T-scores. The control group without RA was sex- and age-matched with the study group. FD was calculated from panoramic radiographs and compared between the study and control groups. The relationships between FD values and femoral neck and L1-L4 lumbar spine T-scores were investigated for study and control groups. Significance was established at P < .05.

RESULTS

The mean FD values of the entire study group and of each category in the study group were significantly lower than those of the control group (P < .001). There were no significant differences in FD values among the 3 RA categories (P > .05). No significant correlations appeared between FD and femoral neck or lumbar spine T-scores (P ≥ .063).

CONCLUSIONS

Fractal analysis of the condyles on panoramic radiographs can distinguish RA from healthy condyles, even if the patients with RA have normal bone mineral density T-scores.

Epileptic seizures in cerebral venous sinus thrombosis: Subgroup analysis of VENOST study

PURPOSE

The aim of this study is to evaluate the presence and prognostic impact of early seizures in cerebral venous sinus thrombosis patients (CVST).

METHOD

VENOST is a retrospective and prospective national multicenter observational study. CVST patients with or without epileptic seizures (ES) were analyzed and compared in terms of demographic and imaging data, causative factors, clinical variables, and prognosis in a total of 1126 patients.

RESULTS

The mean age of the patients in the ES group was 39.73 ± 12.64 and 40.17 ± 14.02 years in the non-ES group (p > 0.05). Epileptic seizures were more common (76.6 %) in females (p < 0.001). Early ES occurred in 269 of 1126 patients (23.9 %). Epileptic seizures mainly presented in the acute phase (71.4 %) of the disease (p < 0.001). Majority of these (60.5 %) were in the first 24 h of the CVST. The most common neurological signs were focal neurologic deficits (29.9 %) and altered consciousness (31.4 %) in the ES group. Superior sagittal sinus (SSS) and cortical veins (CV) involvement were the most common sites of thrombosis and the mostly related etiology were found puerperium in seizure group (30.3 % vs 13.9 %). Patients with seizures had worse outcome in the first month of the disease (p < 0.001) but these did not have any influence thereafter.

CONCLUSIONS

In this largest CVST cohort (VENOST) reported female sex, presence of focal neurological deficits and altered consciousness, thrombosis of the SSS and CVs, hemorrhagic infarction were risk factors for ES occurrence in patients with CVST.

Correction to: Role of low-level laser therapy added to facial expression exercises in patients with idiopathic facial (Bell's) palsy

The published version contains a mistake in Figure 1. Below is the correct figure.

Superb Microvascular Imaging of the Median Nerve in Carpal Tunnel Syndrome: An Electrodiagnostic and Ultrasonographic Study

OBJECTIVE

To evaluate intraneural blood flow of the median nerve using superb microvascular imaging (SMI) and power Doppler ultrasonography (PDUS), and to examine their correlation with electroneuromyography in patients with carpal tunnel syndrome (CTS).

METHODS

A cross-sectional survey was used, and the study was conducted in the research unit of a training and research hospital. Patients diagnosed with CTS according to electroneuromyography studies were included in the study. Ultrasound measurements were taken using an Aplio-500 (Toshiba Medical System Corporation, Tokyo, Japan) device and a linear multifrequency 14-MHz probe. The cross-sectional area of the median nerve at the carpal tunnel level was measured by the direct tracing method using electronic calipers. The power Doppler ultrasonography and superb microvascular imaging scores were recorded by grading the vascularity between 0 and 3.

RESULTS

Evaluation was made of a total of 113 hands of 80 patients (18 men, 62 women) with a mean age of 34.67 ± 12.82 years. The mean duration of symptoms was 12.34 ± 6.66 months. When the patients were grouped as mild, moderate, and severe CTS, there was a statistically significant difference between the SMI and PDUS grades (P < .05). As the severity of CTS increased, an increase in SMI and PDUS scores was observed. There was a strong correlation between SMI scores and motor distal latency (r = .71/P = .026), amplitude of sensory action potential (r = -.77/P = .029), and sensory neurotransmission rate (r = .77/P = .029).

CONCLUSION

SMI seems to be more sensitive than PDUS for evaluating the vascularity of the median nerve in patients with CTS, and SMI grading is correlated with the ENMG results.

Behçet’s disease as a causative factor of cerebral venous sinus thrombosis: subgroup analysis of data from the VENOST study

Objective

This study was performed to determine the rate of cerebral venous sinus thrombosis (CVST) among cases of Behçet’s disease (BD) included in a multicentre study of cerebral venous sinus thrombosis (VENOST).

Methods

VENOST was a retrospective and prospective national multicentre observational study that included 1144 patients with CVST. The patients were classified according to aetiologic factors, time of CVST symptom onset, sinus involvement, treatment approach and prognosis.

Results

BD was shown to be a causative factor of CVST in 108 (9.4%) of 1144 patients. The mean age of patients in the BD group was 35.27 years and 68.5% were men, whereas in the non-BD CVST group, the mean age was 40.57 years and 28.3% were men (P < 0.001). Among the aetiologic factors for patients aged 18–36 years, BD was predominant for men, and puerperium was predominant for women. The onset of symptoms in the BD group was consistent with the subacute form. The transverse sinuses were the most common sites of thrombosis, followed by the superior sagittal sinuses. The most common symptom was headache (96.2%), followed by visual field defects (38%).

Conclusions

BD was found in 9.4% of patients in our VENOST series. Patients with BD were younger and showed a male predominance. The functional outcome of CVST in patients with BD was good; only 12% of patients presenting with cranial nerve involvement and altered consciousness at the beginning had a poor outcome (modified Rankin Score ⩾2).

The Turkish adaptation and psychometric properties of the Geriatric Anxiety Scale

The purpose of the present study is to translate and adapt the Geriatric Anxiety Scale (GAS), a 30-item self-report measure of anxiety among older adults, into Turkish and examine its basic psychometric properties. We tested the translated GAS in a sample of community-dwelling older adults in Konya, Turkey (N=100; Mage=71.4 years, SD=6.5; range=65-88) without a history of mental disorder and sufficient cognitive abilities. To assess the convergent validity, Turkish versions of the Beck Anxiety Inventory (BAI) and Geriatric Depression Scale (GDS) were administered. The mean GAS total score was 13.33 (SD=11.86). Due to low item-total correlations (<0.30), two items (items 2 and 3) were removed from the Turkish version of the GAS. The internal reliability (Cronbach's alpha) was excellent for the total score (0.91) and acceptable for the subscales (somatic = 0.71; cognitive = 0.85; affective = 0.84). Regarding the convergent validity, the GAS total score was significantly and positively correlated with the total scores of the BAI (r=0.87, P<0.05) and GDS (r=0.57, P<0.05), with large effect sizes. Implications: The newly translated Turkish version of the GAS has promising utility in an older adult Turkish sample. Future studies of this measure are warranted.

The Turkish adaptation and psychometric properties of the Geriatric Anxiety Scale

The purpose of the present study is to translate and adapt the Geriatric Anxiety Scale (GAS), a 30-item self-report measure of anxiety among older adults, into Turkish and examine its basic psychometric properties. We tested the translated GAS in a sample of community-dwelling older adults in Konya, Turkey (N=100; Mage=71.4 years, SD=6.5; range=65-88) without a history of mental disorder and sufficient cognitive abilities. To assess the convergent validity, Turkish versions of the Beck Anxiety Inventory (BAI) and Geriatric Depression Scale (GDS) were administered. The mean GAS total score was 13.33 (SD=11.86). Due to low item-total correlations (<0.30), two items (items 2 and 3) were removed from the Turkish version of the GAS. The internal reliability (Cronbach's alpha) was excellent for the total score (0.91) and acceptable for the subscales (somatic = 0.71; cognitive = 0.85; affective = 0.84). Regarding the convergent validity, the GAS total score was significantly and positively correlated with the total scores of the BAI (r=0.87, P<0.05) and GDS (r=0.57, P<0.05), with large effect sizes.

IMPLICATIONS

The newly translated Turkish version of the GAS has promising utility in an older adult Turkish sample. Future studies of this measure are warranted.

Effectiveness of physical therapy and exercise on pain and functional status in patients with chronic low back pain: a randomized-controlled trial

OBJECTIVES

This study aims to investigate the effect of physical therapy modalities on pain and functional status in patients with non-specific low back pain.

PATIENTS AND METHODS

Between February 2011 and August 2013, a total of 104 patients (38 males, 66 females; mean age 49.3±12.5 years; range 34 to 62 years) with non-specific chronic low back pain for more than 12 weeks without any neurological deficit were included in this randomized-controlled study. The patients were divided into two groups: physical therapy group (n=52) and control group (n=52). Both groups were given exercise and medical treatment; physiotherapy modalities were also applied in the physical therapy group. The patients were assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Istanbul Low Back Pain Disability Index (ILBP) before treatment and at two weeks, three months, and one year after treatment.

RESULTS

A total of 100 patients completed one-year follow-up. In both groups, the VAS, ODI, and ILBP significantly improved after treatment (p<0.01), compared to before treatment values. There were statistically significant differences in the VAS, ODI, and ILBP scores at three months and one year after treatment between the physical therapy group and control group (p<0.05).

CONCLUSION

Multidisciplinary approaches including physical therapy should be implemented to provide long-term improvement in pain and functional status in the treatment of non-specific chronic low back pain.

Diagnostic Performance of Superb Microvascular Imaging and Other Sonographic Modalities in the Assessment of Lateral Epicondylosis

OBJECTIVES

The aim of this study was to compare the diagnostic performance of different sonographic modalities for diagnosing lateral epicondylosis.

METHODS

A total of 50 symptomatic and 50 asymptomatic common extensor tendons in 44 patients with lateral epicondylosis, and 25 healthy participants were prospectively examined by B-mode sonography, color Doppler imaging, power Doppler imaging, Superb Microvascular Imaging (SMI; Toshiba Medical Systems Corporation, Tokyo, Japan), and strain elastography. We evaluated blood flow in common extensor tendons by using a grading system with color Doppler imaging, power Doppler imaging, and SMI. The diagnostic performance of the modalities was compared.

RESULTS

When a cutoff value of hypoechogenicity was used for the mean strain ratio, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy rates were 92.0%, 94%.0, 93.9%, 92.2%, and 93.0%, respectively. When a cutoff point of grade 1 was used, the sensitivity, specificity, PPV, NPV, and accuracy rates were 26.0%, 10.0%, 10.0%, 57.5%, and 63.0, for color Doppler imaging; 40.0%, 10.0%, 10.0%, 62.5%, and 70.0% for power Doppler imaging; and 84.0%, 94.0%, 93.0%, 85.5%, and 89.0% for SMI. When a cutoff value of 3.94 was used for the mean strain ratio, the sensitivity, specificity, PPV, NPV, and accuracy rates were 78.0%, 92.0%, 90.7%, 80.7%, and 85.0%, respectively. A statistically significant correlation was detected between SMI, strain elastography, and visual analog scale scores (P < .001).

CONCLUSIONS

The combination of SMI and B-mode sonography was found to have excellent diagnostic performance for lateral epicondylosis. Neovascularzation in patients' tendons with lateral epicondylosis was identified much better with SMI compared to color or power Doppler imaging.

Efficacy of paraffin wax bath for carpal tunnel syndrome: a randomized comparative study

Carpal tunnel syndrome (CTS) is the most frequently diagnosed neuropathy of upper extremity entrapment neuropathies. We aimed to investigate the effectiveness of paraffin therapy in patients with CTS. Seventy patients diagnosed with mild or moderate CTS were randomly divided into two groups as splint treatment (during the night and day time as much as possible for 3 weeks) alone and splint (during the night and day time as much as possible for 3 weeks) + paraffin treatment (five consecutive days a week for 3 weeks). Clinical and electrophysiological assessments were performed before and 3 weeks after treatment. The patients were assessed by using visual analog scale (VAS) for pain, electroneuromyography (ENMG), and Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ). The significant improvement was found in VAS scores in both groups when compared with pretreatment values (p < 0.05). There was no significant improvement in functional capacity score (p > 0.05), whereas a significant improvement was noted in the BCTQ symptom severity scale score in the splint group (p < 0.05). Significant improvements were demonstrated in both scorers in the combined treatment group. Similarly, significant improvements were found in the combined treatment group in terms of motor and sensory distal latency, sensory amplitude, and median sensory nerve velocity (p < 0.05). There was no significant change in electrophysiologic parameters in the splint group (p > 0.05), and the difference in these parameters between the groups was statistically significant (p < 0.05). In conclusion, using splinting alone in patients with CTS is an effective treatment for reducing symptoms in the early stages. Paraffin treatment with splint increases the recovery in functional and electrophysiological parameters.

Common Mistakes in the Dual-Energy X-ray Absorptiometry (DXA) in Turkey. A Retrospective Descriptive Multicenter Study

BACKGROUND

Osteoporosis is a widespread metabolic bone disease representing a global public health problem currently affecting more than two hundred million people worldwide. The World Health Organization states that dual-energy X-ray absorptiometry (DXA) is the best densitometric technique for assessing bone mineral density (BMD). DXA provides an accurate diagnosis of osteoporosis, a good estimation of fracture risk, and is a useful tool for monitoring patients undergoing treatment. Common mistakes in BMD testing can be divided into four principal categories: 1) indication errors, 2) lack of quality control and calibration, 3) analysis and interpretation errors, and 4) inappropriate acquisition techniques. The aim of this retrospective multicenter descriptive study is to identify the common errors in the application of the DXA technique in Turkey.

METHODS

All DXA scans performed during the observation period were included in the study if the measurements of both, the lumbar spine and proximal femur were recorded. Forearm measurement, total body measurements, and measurements performed on children were excluded. Each examination was surveyed by 30 consultants from 20 different centers each informed and trained in the principles of and the standards for DXA scanning before the study.

RESULTS

A total of 3,212 DXA scan results from 20 different centers in 15 different Turkish cities were collected. The percentage of the discovered erroneous measurements varied from 10.5% to 65.5% in the lumbar spine and from 21.3% to 74.2% in the proximal femur. The overall error rate was found to be 31.8% (n = 1021) for the lumbar spine and 49.0% (n = 1576) for the proximal femur.

CONCLUSION

In Turkey, DXA measurements of BMD have been in use for over 20 years, and examination processes continue to improve. There is no educational standard for operator training, and a lack of knowledge can lead to significant errors in the acquisition, analysis, and interpretation.

Comparison among pain, depression, and quality of life in cases with failed back surgery syndrome and non-specific chronic back pain

[Purpose] The aim of this study is to compare patients with failed back surgery syndrome (FBSS) with those with non-specific chronic back pain (NSCBP) in terms of pain, depression, and quality of life levels to explain the effects of surgery experience on low-back pain. [Subjects and Methods] A total of 50 patients with FBSS and 51 patients with NSCBP who consecutively applied to the outpatient clinic from September 2012 to April 2013 were included in the study. Patients completed questionnaires on demographics, body mass index, education level, work history, and pain duration (in months). Lumbar pain at rest, during movement, and at night were measured with a visual analogue scale (VAS). The Short Form 36 scale was used for evaluating quality of life, and the Beck Depression Inventory (BDI) was used for assessing depression. [Results] VAS scores reporting pain at rest and at night and BDI scores were significantly higher in the FBSS group than in the NSCBP group. Role limitations due to physical functioning, which is one of the measures of quality of life, were significantly higher in the FBSS group than in the NSCBP group. [Conclusion] These assessments show that surgery experience in patients with ongoing low-back pain makes their pain and depression worse.

Role of low-level laser therapy added to facial expression exercises in patients with idiopathic facial (Bell's) palsy

The aim of the present study was to investigate the efficacy of low-level laser therapy in conjunction with conventional facial exercise treatment on functional outcomes during the early recovery period in patients with facial paralysis. Forty-six patients (mean age 41 ± 9.7 years; 40 women and 6 men) were randomized into two groups. Patients in the first group received low-level laser treatment as well as facial exercise treatment, while patients in the second group participated in facial exercise intervention alone. Laser treatment was administered at a wavelength of 830 nm, output power of 100 Mw, and frequency of 1 KHz using a gallium-aluminum-arsenide (GaAIAs, infrared laser) diode laser. A mean energy density of 10 J/cm² was administered to eight points of the affected side of the face three times per week, for a total of 6 weeks. The rate of facial improvement was evaluated using the facial disability index (FDI) before, 3 weeks after, and 6 weeks after treatment. Friedman analysis of variance was performed to compare the data from the parameters repeatedly measured in the inner-group analysis. Bonferroni correction was performed to compare between groups as a post hoc test if the variance analysis test result was significant. To detect the group differences, the Bonferroni Student t test was used. The Mann-Whitney U test was used to compare numeric data between the groups. In the exercise group, although no significant difference in FDI scores was noted between the start of treatment and week 3 (p < 0.05), significant improvement was observed at week 6 (p < 0.001). In the laser group, significant improvement in FDI scores relative to baseline was observed at 3 and 6 weeks (p < 0.001). Improvements in FDI scores were significantly greater at weeks 3 and 6 in the laser group than those in the exercise group (p < 0.05). Our findings indicate that combined treatment with low-level laser therapy (LLLT) and exercise therapy is associated with significant improvements in FDI when compared with exercise therapy alone.

Extracorporeal shock wave therapy versus corticosteroid injection in the treatment of trigger finger: a randomized controlled study

The purpose of this study was to compare the efficacies of extracorporeal shock wave therapy and corticosteroid injection for the management of trigger finger. In this prospective randomized clinical trial, 40 patients with actively correctable trigger fingers were randomly assigned to extracorporeal shock wave therapy (1000 impulses and 2.1 bar) or injection groups. The effectiveness of the treatment was assessed using cure rates, a visual analogue scale, the frequency of triggering, the severity of triggering, the functional impact of triggering, and the Quick-Disabilities of the Arm, Shoulder, and Hand questionnaire at 1, 3, and 6 months after treatment. An intention-to- treat analysis was used in this study. Both groups demonstrated statistically significant improvements in all outcome measures after treatment. The intention-to-treat analyses showed no between-group differences for cure rates, pain, and functional status at follow-up. We conclude that extracorporeal shock wave therapy could be a non-invasive option for treating trigger finger, especially for those patients who wish to avoid steroid injections.

LEVEL OF EVIDENCE

Level II.

The Effectiveness of Exergames in Patients with Ankylosing Spondylitis: A Randomized Controlled Trial

BACKGROUND

Exergames are a well-known type of game based on a virtual avatar's body movements. This hightech approach promotes an active lifestyle.

OBJECTIVES

The aim of this randomized controlled trial was to evaluate the effects of exergames on pain, disease activity, functional capacity and quality of life in patients with ankylosing spondylitis (AS).

MATERIAL AND METHODS

The study involved 60 patients, who were randomized into either the exergame group (EG) or the control group (CG). The EG patients engaged in exergaming, and CG patients did not engage in any exercises. The exergaming sessions were performed five times a week for eight weeks (40 sessions in total). The patients were assessed before and after the eight-week program on a visual analog scale (VAS), the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Quality of Life (ASQOL) questionnaire.

RESULTS

A statistically significant improvement was observed in VAS, BASFI, BASDAI and ASQoL scores in the EG group after completion of the exercise program (p < 0.05).

CONCLUSIONS

This study is a first step in investigating the possibilities of using an exergame platform to help patients with spondyloarthropathies to adopt a more physically active lifestyle. The results of this study suggest that exergames increase physical activity and decrease the pain scores in AS patients and also could, therefore, be feasible and safe.

Comparison of effectiveness of different exercise programs in treatment of failed back surgery syndrome: A randomized controlled trial

BACKGROUND

Failed back surgery syndrome (FBSS) is a condition characterized by persistent pain following back surgeries.

OBJECTIVE

To determine the effects of different exercises programs in FBSS.

METHODS

A Single-blind, randomized, controlled trial designed. One hundred participants with failed back surgery syndrome were randomly assigned to three different exercises groups (Isokinetic, Dynamic lumbar stabilization (DLS), and home exercises (HE) groups) and a control group. Patients were evaluated before and after 8-week exercise program and follow-ups at the 3rd and 6th months after the exercise program. Finger-floor distance and lumbar Schober for lumbar mobility, visual analog scale (VAS) for pain, modified Oswestry disability index, Beck depression inventory, fear-avoidance attitudes survey, and progressive-isoinertial weight lifting test were used as follow-up parameters. Lumbar muscle strength was assessed with the isokinetic dynamometer.

RESULTS

VAS levels were decreased from 67.7 to 22.8 in isokinetic and from 68.7 to 25.0 in DLS and from 64.6 to 47.1 in HE groups at the end of the program (p< 0.05). Also, all of other follow-up parameters of the isokinetic and DLS exercise groups viewed significant improvements compared to the control group.

CONCLUSIONS

According to our results either isokinetic or DLS exercises are more effective in FBSS patients.

Recovery features in ulnar neuropathy at the elbow

[Purpose] This study evaluated the effect of age, sex, and entrapment localization on recovery time in patients treated conservatively for ulnar neuropathy at the elbow. [Subjects] Thirty-five patients (16 women and 15 men) who were diagnosed with ulnar neuropathy at the elbow using short segment conduction studies were evaluated retrospectively. [Methods] Definition of recovey was made based on patient satisfaction. The absence of symptoms was considered as the marker of recovery. Patients who recovered within 0–4 weeks were in Group 1, and patients who recovered within 4 weeks to 6 months were in Group 2. The differences between Group 1 and Group 2 in terms of age, sex and entrapment localization were investigated. [Results] Entrapment was most frequent in the retroepicondylar groove (54.3%). No significant difference was found in terms of age and entrapment localizations between Groups 1 and 2. There was a statistically significant difference between the groups for the male sex. [Conclusion] In ulnar neuropathy at the elbow, age and entrapment localization do not affect recovery time. However, male sex appears to be associated with longer recovery time.

Impact of exercises administered to stroke patients with balance trainer on rehabilitation results: a randomized controlled study

OBJECTIVE

The objective of this study was to determine the efficacy of the exercises administered to stroke patients with the balance trainer (BALANCE-trainer, art.nr. 07001-001(TM)) on balance, level of independence and ambulation parameters.

MATERIAL AND METHOD

Fifty patients with hemiplegia were randomized into either study group or control group. Patients in the control group received 30 sessions of conventional rehabilitation program and patients in the study group were trained with balance trainer in addition to conventional rehabilitation program. Balance level and postural control were evaluated with Berg Balance Scale (BBS) and Timed-Up and Go Test (TUG). Their functional statuses were evaluated using Functional Independence Measure (FIM). Evaluations were repeated following the six-week rehabilitation program.

RESULTS

Of the 50 participants, 19 were women (38%) and 31 were men (62%). The mean age was 57.1 ± 9.2 years. The time that elapsed after stroke was 87.3 ± 26.3 days. Statistically significant improvements were noted in BBS, TUG and FIM in intra-group evaluations for both groups. Statistically significant improvements were documented in BBS and TUG levels for inter-group evaluation (respectively p =0.038, p =0.025), while the difference in FIM levels was not statistically significant (p >0.05).

CONCLUSION

Positive impact of balance trainer on balance and postural control was demonstrated in stroke patients in the current study. Hippokratia 2015; 19 (2):125-130.

An important cause of pes planus: the posterior tibial tendon dysfunction

Posterior tibial tendon dysfunction (PTTD) is an important cause of acquired pes planus that frequently observed in adults. Factors that play a role in the development of PTTD such as age-related tendon degeneration, inflammatory arthritis, hypertension, diabetes mellitus, obesity, peritendinous injections and more rarely acute traumatic rupture of the tendon. PTT is the primary dynamic stabilizer of medial arch of the foot. Plantar flexion and inversion of the foot occurs with contraction of tibialis posterior tendon, and arch of the foot becomes elaveted while midtarsal joints are locked and midfoot-hindfoot sets as rigid. Thus, during the walk gastrocnemius muscle works more efficiently. If the PTT does not work in the order, other foot ligaments and joint capsule would be increasingly weak and than pes planus occurs. We present a 10-year-old female patient diagnosed as PTTD and conservative treatment with review of the current literature.

Familial Mediterranean Fever

Familial Mediterranean Fever is an autosomal recessive inherited disease with a course of autoinflammation, which is characterized by the episodes of fever and serositis. It affects the populations from Mediterranean basin. Genetic mutation of the disease is on MEFV gene located on short arm of Chromosome 16. The disease is diagnosed based on clinical evaluation. Amyloidosis is the most important complication. The only agent that decreases the development of amyloidosis and the frequency and severity of the episodes is colchicine, which has been used for about 40 years. In this review, we aimed to discuss especially the most recent advances about Familial Mediterranean Fever which is commonly seen in our population.

Neutrophil-to-lymphocyte ratio is involved in the severity of ankylosing spondylitis

OBJECTIVE

Ankylosing spondylitis (AS) is a progressive chronic inflammatory disease mainly characterized by axial skeleton and sacroiliac joint involvement. We aimed to investigate the relation between neutrophil-to-lymphocyte ratio (NLR) and disease severity of AS and to explore its availability in clinical practice.

METHODS

A total of 102 AS patients and 60 individuals who were age- and gender-compatible with the control group were included into the study. Patients were divided into 2 groups according to Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores. Patients with BASDAI scores < 4 were considered to be having mild disease activity, whereas those with scores ≥ 4 were considered to be displaying severe disease activity. Hemogram test during the diagnosis, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) and other laboratory values of the control group were recorded.

RESULTS

NLR was observed to be higher in AS patients compared to the controls (2.47 ± 1.33 and 1.72 ± 0.47; respectively; p<0.0001). NLR was observed to be significantly higher in severe AS disease activity compared to the mild AS disease activity (2.72 ± 1.41, 2.20 ± 1.19; respectively; p = 0.001). NLR had statistical significant differences between mild disease activity compared to the controls (2.20 ± 1.19 and 1.72 ± 0.47, respectively; p = 0.263). There was a positive correlation between NLR and BASDAI (r = 0.193, p = 0.041). The performance of NLR evaluating the disease severity by Roc analysis had sensitivity of 69%, specificity of 54% (cut-off value 1.91), and AUC of 0.652 (95% Cl, 0.549-0.755) (p = 0.006).

CONCLUSIONS

NLR may be a simple and inexpensive marker to indicate disease activity in patients with AS in daily clinical practice (Tab. 3, Fig. 3, Ref. 25).

Effects of rehabilitation services on anxiety, depression, care-giving burden and perceived social support of stroke caregivers

BACKGROUND

Few data are available on the specific care giving-related problems of stroke patient's caregivers and factors that influence the burden of these caregivers.

AIM

To study the influences of the active rehabilitation process on anxiety, depression, care burden and perceived social support level of stroke patients caregivers.

DESIGN

A prospective clinical trial.

SETTING

Patients and caregivers entering a rehabilitation program at a university hospital in Turkey.

POPULATIONS

Ninety patients with a first episode of stroke and 90 caregivers responsible for their care were recruited for our study.

METHODS

Patients and caregivers were assessed before and after the active rehabilitation process. The functional disability level of the patients was assessed by Functional Independence Measure (FIM). The Beck Anxiety Scale (BAS) and the Beck Depression Scale (BDS) were used for anxiety and depression assessment, the Zarit Care Burden Scale (ZCBS) for care burden assessment and the Multi-Dimensional Scale of Perceived Social Support (MDSPSS) for perceived social support assessment.

RESULTS

A statistically significant rise is observed in the special person sub-assessment of MDSPSS in both female and male caregivers. Also, a significant decrease in care burden, anxiety and depression levels of caregivers was noted after the rehabilitation program (p < 0.05).

CONCLUSION

Caregivers accept the rehabilitation period as important social support in addition to the support provided by family and friends. Also, our positive results were associated with an improvement in the patients' functional level and an increase in the acquisition of knowledge and skill required of caregivers in order to provide care during rehabilitation.

CLINICAL REHABILITATION IMPACT

The rehabilitation team should be aware of the fact that the perceived care burden may be greater due to the lack of knowledge concerning available resources and due to the inability to cope with stress effectively.

Nurse’s knowledge of neuropathic pain

The aim of our study was to determine the levels of information and awareness of the nurses who work on neuropathic pain in the departments of physical medicine and rehabilitation, neurology and neurosurgery. A total of 60 nurses (20 per each department) who work in the physical medicine and rehabilitation, neurology and neurosurgery departments of Beyhekim State Hospital of Konya in Turkey took part in the study. The level of information and awareness of the nurses on neuropathic pain were assessed via a questionnaire prepared by specialists in the light of recent literature. The questionnaire was composed of 30 questions including the definition, symptoms, treatment and management of neuropathic pain. None of 60 nurses participating in the study were given any previous in-service training on neuropathic pain. According to the assessments, 80% of nurses (48) were found not to have sufficient knowledge about definition of neuropathic pain; 83.3% (50) about diseases causing neuropathic pain; 83.3% (50) about symptoms of neuropathic pain; and 90% (54) about management of neuropathic pain. The findings obtained from the nurses of these three departments showed no statistically significant relation. Our findings indicated that the knowledge of participants’ about neuropathic pain who work in these three departments seriously lack of information. Informing nurses about neuropathic pain during in-service training will be an important step towards improving the quality of services provided.