The effects of inspiratory muscle training on cardiorespiratory functions in juvenile idiopathic arthritis: A randomized controlled trial

INTRODUCTION

Although inspiratory muscle training (IMT) has proven effective in adult rheumatic diseases, its impact on juvenile idiopathic arthritis (JIA) remains unexplored. The present study aimed to investigate the effects of IMT in children with JIA.

METHODS

Thirty-three children (13-18 years) with JIA were divided into two groups as exercise (n = 17) and control (n = 16). The exercise group performed IMT at home daily for 8 weeks. The initial IMT load was set as 60% of maximal inspiratory pressure (PImax ) and increased by %10 of the initial load every 2 weeks. The control group received no additional intervention. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1 ), FVC/FEV1 , PImax , and maximal expiratory pressure (PEmax ) were evaluated. Peak oxygen consumption (VO2max ), metabolic equivalents (METs), and maximal heart rate were measured with cardiopulmonary exercise test. Functional capacity and quality of life were assessed with 6-min walk distance and Pediatric Quality of Life Inventory 3.0 Arthritis Module. All participants were evaluated at baseline and post-treatment.

RESULTS

FVC ( ↑ 0.20 (95% CI: 0.07/0.32) liters), FEV1 ( ↑ 0.14 (95% CI: 0.02/0.25) liters), PImax (↑19.11 (95% CI: 9.52/28.71) cmH2 O), PEmax (↑12.41 (95% CI: 3.09/21.72) cmH2 O), VO2peak (↑158.29 (95% CI: 63.85/252.73) ml/min), and METs (↑0.92 (95% CI: 0.34/1.49) [ml/kg/min]) significantly improved only in the exercise group (p < .05). The difference over time in FVC, FEV1 , PImax , VO2peak , and METs were significantly higher in exercise group compared to control group (p < .05).

CONCLUSIONS

IMT seems to be an effective option for improving respiratory functions and aerobic exercise capacity in JIA.

Investigating performance-based hand functions in patients with systemic sclerosis

OBJECTIVE

Systemic sclerosis (SSc) is a connective tissue disorder characterized by collagen deposits in various organs. Skin involvement is one of the most common symptoms and along with vascular damage, may deteriorate hand functions. However, the status of hand functions has generally been investigated using patient-reported measures in patients with SSc. The aim of the present study was to investigate performance-based hand functions in patients with SSc using the Sollerman Hand Function Test (SHFT).

METHODS

A total of 39 patients with SSc (33 females) were included in the study. Twenty-four patients were classified as limited cutaneous SSc (lcSSc), while 15 patients were classified as diffuse cutaneous SSc (dcSSc). Hand-related physical characteristics were evaluated using the Modified Hand Mobility in Scleroderma Test, grip strength, and pinch strengths. The Duruoz Hand Index (Cochin Hand Functional Disability Scale), Disability of Arm, Shoulder, and Hand Questionnaire, Health Assessment Questionnaire, and Scleroderma Health Assessment Questionnaire were used as patient-reported measures. Performance-based hand functions were evaluated using SHFT.

RESULTS

No significant differences were observed between lcSSc and dcSSc subtypes regarding performance-based and patient-reported hand functions (p > 0.05). SHFT scores significantly correlated with hand-related physical characteristics and patient-reported hand functions (p < 0.05). The highest correlation was determined between SHFT and the Duruoz Hand Index (rho: -0.652, p < 0.001).

CONCLUSION

According to our results, performance-based hand functions seem not to be affected by disease subtype. Performance-based hand functions may partially be captured by the patient-reported outcomes, especially the Duruoz Hand Index, in patients with SSc.

Effect of cervical stabilization exercises on cervical position error in patients with axial spondyloarthritis: a randomized controlled pilot study

OBJECTIVE

To investigate the effect of cervical stabilization exercises on cervical position error in patients with axial spondyloarthritis (axSpA).

MATERIALS AND METHODS

Thirty-nine patients with axSpA were randomly allocated to two groups as exercise group (n = 20, 11 males) and control group (n = 19, 12 males). The exercise group performed a progressive home-based cervical stabilization exercise program, while the control group did not receive any exercise intervention. To control exercise adherence and progression, text messages and video instructions were delivered via a freeware and cross-platform messaging service on a weekly basis. All patients were evaluated regarding physical characteristics, disease activity (Bath Ankylosing Spondylitis Disease Activity Index), functional status (Bath Ankylosing Spondylitis Functional Index), and spinal mobility (Bath Ankylosing Spondylitis Metrology Index). Cervical position error was evaluated in flexion, extension, rotation, and lateral flexion directions. All evaluations were performed at baseline and after 6 weeks.

RESULTS

Baseline physical and disease-related characteristics were similar between the groups (p > 0.05). After 6 weeks, significant improvements were observed in cervical position error in all directions in the exercise group (p < 0.05), whereas no improvements were detected in the control group (p > 0.05).

CONCLUSION

A 6-week home-based cervical stabilization exercise program seems to be beneficial for improving impaired cervical proprioception in patients with axSpA.

The Effects of 2 Different Soft Tissue Mobilization Techniques on Delayed Onset Muscle Soreness in Male Recreational Athletes: A Single-Blinded Randomized Controlled Trial

CONTEXT

Soft tissue mobilization is frequently employed for delayed onset muscle soreness (DOMS) management. Foam roller and percussive massage are 2 popular soft tissue mobilization methods preferred by various professionals. However, their effects on DOMS symptoms are controversial and there are no studies comparing these 2 methods. The aim of the present study was to compare the acute effects of soft tissue mobilization with a foam roller or a percussive massage device on DOMS in young male recreational athletes.

DESIGN

A parallel, single-blinded, randomized controlled trial.

METHODS

Thirty-six participants (median [interquartile range 25/75]; age: 20.0 [19.3/21.0] y) were randomly allocated to percussive massage group (n = 12), foam roller group (n = 12), and control group (n = 12). First, a fatigue protocol targeting quadriceps femoris was performed. Then, participants received soft tissue mobilization with foam roller/percussive massage or rested for 10 minutes according to their groups. Pain and fatigue were evaluated by a visual analog scale, and the skin surface temperature of over the quadriceps femoris was measured with thermal camera imaging. Evaluations were performed at baseline, following fatigue protocol, at 24th hour, and at 48th hour. Changes from the baseline at 24th and 48th hours were compared between groups.

RESULTS

No significant between-group differences were observed at the assessments performed at 24th or 48th hour regarding the changes from baseline in pain (P value for 24th hour = .905, P value for 48th hour = .733), fatigue (P value for 24th hour = .895, P value for 48th hour = .606), or skin surface temperature measurements (P values for 24th hour = between .300 and .925, P values for 48th hour = between .311 and .750).

CONCLUSIONS

Soft tissue mobilizations applied with foam roller or percussive massage device do not seem to be superior to passive resting in alleviating DOMS symptoms in recreational athletes.

Systemic Sclerosis Quality of Life Questionnaire (SScQoL): translation into Turkish and assessing its psychometric properties

BACKGROUND

Systemic sclerosis (SSc) is a chronic autoimmune disease that affects the connective tissues and leads to physical, emotional, and social challenges for patients. Evaluating health-related quality of life (HRQoL) with a disease-specific tool may be preferable for improving patient care and treatment outcomes. The aim of this study was to translate the Systemic Sclerosis Quality of Life Questionnaire (SScQoL) into Turkish and to investigate its psychometric properties.

METHODS

Eighty-six patients with SSc (mean age 51.8 ± 11.7 years, 80 females) participated in the study. Convergent validity was explored by correlation analyses between Turkish SScQoL and Short-Form 36 (SF-36), European Quality of Life Survey-5 Dimensions (EQ-5D), EQ-5D Visual Analog Scale (EQ-VAS), and Scleroderma Health Assessment Questionnaire (SHAQ). Cronbach's alpha was calculated to test internal consistency. Turkish SScQoL was readministered after 7-14 days to fifty-eight patients for determining test re-test reliability. Intraclass correlation coefficients in 95% confidence interval (ICCs [95%CI]) were calculated to examine the agreement between two assessments. Values greater than 15% and an absolute skewness value < 1 were recognized as the presence of a floor or ceiling effect.

RESULTS

SScQoL correlated significantly with SF-36 subdomains (r = -0.347 to -0.618, p < 0.01), EQ-5D (r = -0.535, p < 0.01), EQ-VAS (r = -0.636, p < 0.01), and SHAQ global score (r = 0.521, p < 0.01). SScQoL demonstrated excellent internal consistency (Cronbach's alpha = 0.917), and good to excellent test-retest reliability (ICC [95%CI] = 0.85 [0.76-0.91]). No floor/ceiling effects were observed.

CONCLUSION

The Turkish version of SScQoL seems to have adequate psychometric properties and can be used to evaluate HRQoL in clinical and research settings. Key points • Turkish version of SScQoL is a valid and reliable tool for measuring health-related quality of life of patients with systemic sclerosis. • SScQoL is the only diseases-specific quality of life measurement for systemic sclerosis available in Turkish. • Patients with limited and diffuse SSc seem to be similar in terms of self-reported health-related quality of life.

Breathlessness Beliefs and Related Factors in Male Patients with Chronic Obstructive Pulmonary Disease

OBJECTIVE

Dyspnea may be a debilitating factor for people with pulmonary problems as it may cause fear of movement. The aim of the present study was to determine the related factors with breathlessness beliefs, in other words, dyspnea-related fear of movement, in patients with chronic obstructive pulmonary disease.

MATERIAL AND METHODS

Male patients with chronic obstructive pulmonary disease were included in the study. Breathlessness beliefs (Breathlessness Belief Questionnaire), perceived dyspnea severity (modified Medical Research Council Dyspnea Scale and modified Borg Scale), pulmonary function tests (forced vital capacity, forced expiration volume in 1 second, and peak expiratory flow), emotional status (Hospital Anxiety and Depression Scale), fatigue (Fatigue Impact Scale and Fatigue Severity Scale), physical activity level (International Physical Activity Questionnaire-Short Form), disease-related quality of life (St. George Respiratory Questionnaire), and generic quality of life (Short-Form 36) were evaluated.

RESULTS

A total of 70 patients were included. Significant correlations were detected between breathlessness beliefs and perceived dyspnea severity, pulmonary function tests, emotional status, fatigue, physical activity level, disease-related quality of life, and generic quality of life (P < .001). No correlations were detected between physical characteristics and dyspnea-related fear of movement (P > .05).

CONCLUSION

Dyspnea-related fear of movement was found to be strongly related to perceived dyspnea severity, pulmonary function tests, emotional status, fatigue, physical activity level, and quality of life; thus, including breathlessness beliefs assessment into clinical examination may help clinicians to understand their patients' needs comprehensively.

Assessing dyspnea-related kinesiophobia in patients with systemic sclerosis (SSc): validity and reliability of Turkish Breathlessness Beliefs Questionnaire for SSc

INTRODUCTION/OBJECTIVE

The respiratory system is often affected by systemic sclerosis (SSc), a connective tissue disease characterized by fibrosis, vasculopathy, and inflammation. As a result, especially exertional dyspnea may occur in SSc patients. Evaluation of attitudes towards dyspnea is important in terms of preventing negative consequences such as kinesiophobia. However, no validated tool is available for assessing dyspnea-related kinesiophobia for patients with SSc. The aim of the present study was to perform the Turkish validation of the Breathlessness Beliefs Questionnaire for SSc (BBQ-SSc), which was adapted from the Tampa Kinesiophobia Scale, and to investigate its relationships with physical and clinical characteristics.

METHOD

Fifty patients with SSc (47 females) were included in the study. The patients were evaluated regarding pulmonary function tests, respiratory muscle strength, patient-reported dyspnea, quality of life related to respiratory problems, mood, and fatigue. The patients were re-evaluated 1 week later for the test-retest reliability of the BBQ-SSc.

RESULTS

Internal consistency (Cronbach's alpha: 0.862) and test-retest validity (ICC: 0.831; 95% CI: 0.702-0.907) of the 12-item Turkish BBQ-SSc were found to be good. Principal component analysis confirmed the two-dimensional structure of the questionnaire. The scores of the questionnaire were associated with duration of illness, patient-reported dyspnea, quality of life related to respiratory problems, mood, and fatigue (p < 0.05).

CONCLUSIONS

According to our results, the 12-item Turkish BBQ-SSc is a reliable and valid tool to assess dyspnea-related kinesiophobia in SSc patients. Key Points • There are no structured tools available for assessing dyspnea-related kinesiophobia in patients with systemic sclerosis (SSc) • The 12-item Turkish Breathlessness Beliefs Questionnaire for SSc (BBQ-SSc) is a reliable and valid tool to assess dyspnea-related kinesiophobia in SSc patients.

Assessing fatigue and related factors in adolescents with familial Mediterranean fever (FMF): psychometric properties of the PedsQL Multidimensional Fatigue Scale

BACKGROUND

Fatigue is a common problem in pediatric rheumatic diseases and is associated with poor quality of life. However, no validated methods are available to measure fatigue in adolescents with familial Mediterranean fever (FMF). The aim of the study was to establish validity and reliability for the child self-report PedsQL Multidimensional Fatigue Scale (PedsQL-MFS) and to investigate the effects of physical characteristics, diseaserelated characteristics, sleep quality/duration, and the amount of physical activity on fatigue in adolescents with FMF.

METHODS

Seventy-one adolescents with FMF (13-18 years) were included. Children were examined regarding physical- and disease-related characteristics and completed patient-reported outcome measures (PROMs) regarding sleep quality/duration, physical activity levels, and fatigue. PedsQL-MFS was re-completed within the following 7-14 days.

RESULTS

PedsQL-MFS demonstrated excellent test-retest reliability (ICC in 95% CI: 0.877-0.958) and internal consistency (Cronbach`s α: 0.928). All items contributed to the total score (item-total correlation > 0.3). PedsQLMFS scores were significantly correlated to fatigue (r: -0.666, p < 0.001), physical activity (r: 0.373, p < 0.001), sleep quality (rs: 0.678, p < 0.001), and sleep duration (r: 0.473, p < 0.001). Being female, having attacks in the last six months, a sleep duration of less than seven hours, and engaging in less physical activity resulted in higher fatigue.

CONCLUSIONS

PedsQL-MFS seems to be feasible for assessing fatigue in adolescents with FMF. Sex, recent attacks, sleep, and physical activity should be taken into consideration in the fatigue management of patients with FMF.

Investigating Wrist Joint Position Sense and Hand Functions in Children With Polyarticular Juvenile Idiopathic Arthritis With Wrist Involvement

Comparing the wrist joint position sense and hand functions between children with juvenile idiopathic arthritis (JIA) and healthy controls, and determining possible relationships between these parameters in children with JIA were the aims of this study. Twenty children with polyarticular JIA with wrist involvement (JIAWrist+), 20 children with other subtypes of JIA without wrist involvement (JIAWrist-), and 20 healthy controls were included. Wrist joint position sense was evaluated by measuring joint repositioning error. Hand functions were assessed by using the Purdue Pegboard test, hand grip strength, pinch strength, and Duruoz Hand Index. Joint position sense and hand functions were diminished in the JIAWrist+ group compared with healthy control group (P < .05). Few moderate relationships were detected between hand functions and wrist joint position sense (P < .05). Improving proprioceptive acuity by appropriate training methods may have a role in enhancing hand functions.

AB1258 THE PREDICTED VERSUS MEASURED RESPIRATORY PRESSURES, PULMONARY FUNCTIONS, CARDIOPULMONARY FITNESS PARAMETERS IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS

Background

Although musculoskeletal system-related symptoms are the most common problems in children with Juvenile Idiopathic Arthritis (JIA), cardiac and pulmonary manifestations are observed in more than half of these children. However, the available research on the extent of cardiorespiratory involvement is very limited [1].

Objectives

The aim of this study was to compare the predicted respiratory pressures, pulmonary functions, cardiopulmonary exercise test (CPET) values to objectively measured ones in children with JIA.

Methods

Twenty-two children with JIA (mean age: 15.5±2.3, 14 male) who were under biological agents for at least three months were included in the study. Maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and pulmonary functions were measured by using a portable automated testing device (Cosmed Pony FX Desktop Spirometer, USA). Cardiorespiratory fitness parameters were measured with the Quark CPET Treadmill System (COSMED, Rome, Italy). The values calculated by the softwares of the Cosmed Pony FX Desktop Spirometer and Quark CPET Treadmill System according to the healthy children’s normative data were used as predictive values.

Results

Within-group analyses demonstrated statistically significant differences between all measured and predicted parameters (p<0.05), (Table 1), except for MIP and forced vital capacity/forced expiratory volume values.

Table 1.

The comparison of predicted versus measured respiratory pressures, pulmonary functions, cardiopulmonary fitness parameters

MeasuredPredictedp(Mean±SD)(Mean±SD)FVC (l)3.82±0.924.20±1.04<0.001*FEV1(l)3.31±0.803.59±0.860.004*FEV1/FVC (%)86.13±7.7483.91±0.410.179MIP (cmH2O)101.90±37.45104.31±21.920.686MEP (cmH2O)95.13±47.84134.36±30.22<0.001*VO2max(ml/kg/min)2109.83±732.953159.94±745.87<0.001*METs (ml/kg/min)9.71±2.18014.88±2.39<0.001*HR (bpm)187.88±20.28205.0±2.370.02*VO2/HR (ratio)11.2015.42±3.75<0.001*

*:p<0.05, Student’s t-test, FVC: Forced vital capacity, FEV1: Forced expiratory volume, FEV1/FVC: Forced expiration volume/forced vital capacity, VO2max: Maximum oxygen consumption, ml: milliliters, kg: kilograms, min: minute, METs: Metabolic equivalent HR: Heart rate, bpm: beats per minute, VO2/HR: Oxygen consumption/heart rate.

Conclusion

The present study’s findings indicate that the respiratory pressures, pulmonary functions, and cardiopulmonary fitness parameters of the children with JIA are diminished compared to predicted values.

References

[1]Alkady EA, Helmy HA, Mohamed-Hussein AA (2012) Assessment of cardiac and pulmonary function in children with juvenile idiopathic arthritis. Rheumatol Int 32(1):39-46. https://doi.org/10.1007/s00296-010-1548-5

Disclosure of Interests

None declared

POS1536-HPR THE RELATIONSHIP BETWEEN POSTURAL CHANGES AND TRUNK MUSCLE ENDURANCE IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS

Background

Body posture is defined as relative biomechanical alignment of body’s head, trunk, and extremities as well as position of the body in the space. Body posture might be altered due to different musculoskeletal pathologies. Juvenile Idiopathic Arthritis (JIA) is a chronic inflammatory disease characterized by musculoskeletal problems including bone and muscle geometry alterations which may lead a deteriorated posture. However, it is not known whether trunk muscle endurance is associated with body posture in children with JIA.

Objectives

To investigate the relationship between postural changes and trunk muscle endurance in children with JIA.

Methods

Thirty-four children (eighteen female, sixteen male) were included in the study. Postural changes were assessed by a three-dimensional evaluation system (PosturePrint System, Biotonix, Canada). The system provides Posture Index (PI) score which is a composite score from three postural regions including head, ribcage, and pelvis. Higher PI scores indicate a more deteriorated posture. Biering–Sørensen Test (BST), Flexor Endurance Test (FET), Lateral Endurance Test (LET) were used to assess trunk muscle endurance, and Static Scapular Endurance Test (SSET) were used to assess scapular muscle endurance. Spearman Rank Correlation test was employed to determine the possible relationships.

Results

Enthesitis related arthritis was the most common JIA subtype in the study (38.2%) followed by oligoarthritis (26.5%), polyarthritis (20.6%), and systemic arthritis (14.7%). Significant negative correlations were detected between SSET and PI-head score (rho= -0.467, p=0.005), SSET and PI-ribcage score (rho= -0.381, p=0.026); FET and PI-head score (rho= -0.469, p=0.005); LET and PI-head score (rho= -0.441, p=0.009).

Table 1.

Demographics, muscle endurance and Posture Index scores of children

VariableMedian (IQR 25th/75th)Age (years)12.0 (10.0/14.0)Height (cm)145.50 (140.00/158.25)Weight (kg)42.75 (33.00/49.50)Body mass index (kg/m2)19.17 (16.09/21.42)Biering– Sørensen Test (sec)49.70 (28.42/80-78)Flexor Endurance Test (sec)38.91 (30.59/60.19)Lateral Endurance Test (sec)32.52 (19.99/59.68)Static Scapular Endurance Test (sec)23.19 (15.93/44.74)Posture Index-Head (score)7.0 (5.0/8.0)Posture Index-Ribcage (score)5.0 (4.0/6.0)Posture Index-Pelvis (score)6.0 (3.0/8.0)

IQR: Interquartile range

Conclusion

These results indicated that postural displacements of head and ribcage are linked with decreased trunk and scapular muscle endurance in children with JIA. Exercise and physical activity programs targeting muscle endurance may result improvements in posture in these children.

Disclosure of Interests

None declared

POS1535-HPR THE RELATIONSHIP BETWEEN SCAPULAR STABILIZATION AND HAND FUNCTIONS IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS

Background

Distal stabilization is an essential component for high quality proximal movement. In this regard, scapular stabilization is important for upper extremity and hand functions. Moreover, scapular stabilization might have a role as a support point for hand functions in patients with joint problems. However, the relationships between scapular stabilization and hand functions were not investigated in children with juvenile idiopathic arthritis (JIA).

Objectives

To investigate the relationship between scapular stabilization and hand function in children with JIA with wrist arthritis history (JIAWrist+), and children with JIA without wrist arthritis history (JIAWrist-).

Methods

A total of forty children (20 children for each group) were included in the study. Scapular stabilization was measured by using scapular muscle endurance test. General functional status, subjective hand functions, and objective hand functions were assessed by using Childhood Health Assessment Questionnaire (CHAQ), Duruoz Hand Index, and Purdue Pegboard Test, respectively.

Results

JIAWrist+ patients reported poorer hand functions compared to JIAWrist- patients. No significant differences were detected for other parameters. Scapular muscle endurance was moderately related to CHAQ Disability Index score, Purdue Pegboard Test (single hand score and assembly score) in JIAWrist+ patients, while there was only a significant relationship between scapular muscle endurance and Purdue Pegboard Test both hand score in JIAWrist- patients.

Table 1.

Comparison of the Groups and Relationships between Scapular Muscle Endurance and Hand Functions

JIAWrist+ (n:20)JIAWrist- (n:20)Median (IQR 25/75)Median (IQR 25/75)p*Age (years)14.0 (10.5/16.0)12.5 (11.0/14.5)0.512Scapular Muscle Endurance (sec)21.9 (10.7/35.8)22.5 (15.8/50.8)0.383CHAQ Discomfort Index (score)20.0 (7.5/48.2)27.5 (10.0/50.0)0.489CHAQ Health Status Index (score)45.0 (30.0/75.0)45.0 (30.0/57.5)0.558CHAQ Disability Index (score)0.8 (0.1/1.0)0.3 (0.0/0.7)0.104Duruöz Hand Index (score)5.5 (2.5/13.5)0.5 (0.0/4.0)0.006Purdue Pegboard Test Single Hand (score)15.2 (13.5/15.5)15.2 (14.5/16.2)0.981Purdue Pegboard Test Both Hands (score)11 (9.8/12.0)11.0 (10.3/12.3)1.000Purdue Pegboard Test Assembly (score)26.5 (23.0/28.5)26.0 (23.5/29.0)0.779Relationships between Scapular Muscle Endurance and Hand FunctionsCHAQ Discomfort Index (score)rho: -0.086, p: 0.718rho: -0.174, p: 0.464CHAQ Health Status Index (score)rho: 0.090, p: 0.706rho: 0.005, p: 0.982CHAQ Disability Index (score)rho: -0.560, p: 0.010rho: -0.219, p: 0.353Duruöz Hand Index (score)rho: -0.442, p: 0.051rho: -0.158, p: 0.506Purdue Pegboard Test Single Hand (score)rho: 0.503, p: 0.024rho: 0.313, p: 0.179Purdue Pegboard Test Both Hands (score)rho: 0.400, p: 0.081rho: 0.459, p: 0.042Purdue Pegboard Test Assembly (score)rho: 0.594, p: 0.006rho: 0.218, p: 0.355

*Mann-Whitney-U Test, p<0.05, CHAQ: Childhood Health Assessment Questionnarie, JIAWrist+: children with JIA with wrist arthritis history; JIAWrist-: children with JIA without wrist arthritis history, rho: Spearman’s Rank Correlatio

Conclusion

According to our results, scapular endurance was found more related to hand functions in wrist involved JIA patients. It seems that scapular stabilization contributes to hand functions differently related to joint involvement in JIA patients. It might be a beneficial strategy to work on scapular muscles in JIA patients with wrist involvement and poor hand functions.

Disclosure of Interests

None declared

POS1533-HPR COMPARISON OF HAND FUNCTIONS AND FUNCTIONAL STATUS IN PATIENTS WITH LIMITED CUTANEOUS SYSTEMIC SCLEROSIS AND DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS

Background

Systemic Sclerosis (SSc) is an autoimmune connective tissue disorder which is characterised by the fibrotic changes in the skin effecting especially fingers and hands. Regarding skin manifestations, SSc is classified into two different subtypes as limited cutaneous SSc (lcSSc) and diffuse cutaneous SSc (dcSSc).

Objectives

The aim of the present study was to compare hand functions and functional status in patients with lcSSc and dcSSc.

Methods

Twenty-three patients with lcSSc and thirteen patients with dcSSc were included in the study. Modified Hand Mobility in Scleroderma Test (mHAMIS), modified Rodnan skin score (mRSS), grip and pinch strengths were measured to evaluate hand-related physical characteristics. Duruoz Hand Index, Disability of Arm, Shoulder and Hand Questionnaire (DASH), Health Assessment Questionnaire (HAQ), and Scleroderma Health Assessment Questionnaire (SHAQ) were used as the outcomes.

Results

While differences were detected in mRSS scores between disease subtypes (p<0.05), hand functions and functional status were comparable between groups (p>0.05).

Table 1.

Comparison of the groups

lcSSc Group Median (IQR 25/75) (n= 23)dcSSc Group Median (IQR 25/75) (n=13)p*mHAMIS (score 0-4)0 (0/1)0 (0/0)0.745mRSS Fingers (score 0-3)2 (1.5/3)3 (2/3)0.100mRSS Hands (score 0-3)1 (0.5/2)2 (2/3)0.020*mRSS Forearms (score 0-3)0 (0/1)2 (1/2)0.013*mRSS Upper Arms (score 0-3)0 (0/0)1 (0/1)0.003*mRSS Total (0-51)8 (5/13)27 (18/29)0.006*Hand Grip Strength (kg)19.7 (11.2/24.6)20.9 (14.4/24.8)0.649Tip to Tip Pinch Strength (kg)3 (2.2/3.9)3.3 (2.4/2.9)0.721Three Jaw Pinch Strength (kg)2.4 (1.7/3.2)2.8 (2/3.5)0.226Lateral Pinch Strength (kg)3.8 (3.4/5.1)4 (3.2/5.3)0.948Duruoz Hand Index (score 0-90)5 (0/17)6 (0/15)0.770DASH (score 30-150)62 (47/84)61 (53/77)0.770HAQ (score 0-3)0.3 (0.1/0.9)0.3 (0.8/0.9)1.000SHAQ-Raynaud’s Phenomenon (score 0-3)0.8 (0/1.4)1.3 (0.3/1.5)0.363SHAQ-Digital Ulcers (score 0-3)0 (0/0.6)0.3 (0/1.7)0.136SHAQ-Gastrointestinal (score 0-3)0 (0/1.5)0.7 (0.1/1.4)0.466SHAQ-Pulmonary (score 0-3)0.5 (0/1.5)1 (0.2/1.5)0.534SHAQ-Patient Global Assessment (score 0-3)1.1 (0.1/2)1.4 (0.8/2.2)0.345

p<0.05, *: Mann-Whitney U test, IQR 25/75: Interquartile range between the 25th and 75th percentiles, n: number, mHAMIS: modified Hand Mobility in Scleroderma Test, mRSS: modified Rodnan skin score, DASH: Disability of Arm, Shoulder, and Hand Questionnaire, HAQ: Health Assessment Questionnaire, SHAQ: Scleroderma Health Assessment Questionnaire, lcSSc: limited cutaneous Systemic Sclerosis, dcSSc: diffuse cutaneous Systemic Sclerosis

Conclusion

According to our results, even though, patients with dcSSc present higher skin thickening compared to patients with lcSSc, hand functions and functional status seem to be similar between SSc subtypes.

Disclosure of Interests

None declared

AB1257 INVESTIGATING THE ASSOCIATIONS BETWEEN THE MAXIMAL RESPIRATORY PRESSURES AND CARDIORESPIRATORY FITNESS PARAMETERS IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS

Background

The most prominent symptom of juvenile idiopathic arthritis (JIA) is joint involvement; however, the effect of the disease is not limited to the joints. Evidence suggests that cardiopulmonary fitness is affected in children with JIA compared to their healthy peers [1].

Objectives

This study aimed to investigate the associations between the maximal respiratory pressures and cardiorespiratory fitness parameters.

Methods

Seventeen children with JIA (mean age: 15.4±2.2 years, 11 male) who have been using biological agents for at least three months were included in the study. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were evaluated with a portable device (Cosmed Pony FX Desktop Spirometer, USA). The Quark Cardiopulmonary Exercise Test Treadmill System (COSMED, Rome, Italy) was employed to analyze cardiorespiratory fitness parameters by using expired gas collection and analysis.

Results

Significant moderate correlations were detected between MIP and maximum oxygen consumption (VO2max) values (r=0.519, p=0.033) and MEP and VO2max values (r=0.507, p=0.038), (Table 1). No other significant correlations were observed between maximal respiratory pressures and other parameters.

Table 1.

The associations between maximal respiratory pressures and cardiorespiratory fitness parameters

n:17MIP (cmH2O) (r)pMEP (cmH2O) (r)PVO2max(ml/kg/min)0.5190.033*0.5070.038*METs (ml/kg/min)0.2760.2830.2980.246HR (bpm)0.2850.2680.1840.479VO2/HR0.4560.0660.4790.052PETCO2max(mmHg)0.4160.0970.3580.158PETO2max(mmHg)-0.2840.269-0.1580.544

*:p<0.05, Pearson Correlation Coefficients, VO2max: Maximum oxygen consumption, ml: milliliters, kg: kilograms, min: minute, METs: Metabolic equivalent HR: Heart rate, bpm: beats per minute, VO2/HR: Oxygen consumption/heart rate, PETCO2: Tidal partial pressure for carbon dioxide, PETO2: Tidal partial pressure for oxygen.

Conclusion

The results of the study suggest that maximal respiratory pressures are associated with maximal oxygen consumption. Evaluating maximal respiratory pressures might be helpful when prescribing exercise programs for JIA patients with diminished cardiorespiratory fitness.

References

[1]Richardson AE, Warrier K, Vyas H (2016). Respiratory complications of the rheumatological diseases in childhood. Arch Dis Child 101(8):752-758. https://doi.org/10.1136/archdischild-2014-306049

Disclosure of Interests

None declared

POS1479-HPR INVESTIGATING THE RELIABILITY OF THE SOLLERMAN HAND FUNCTION TEST AND THE ASSOCIATIONS WITH DISEASE- AND HAND-RELATED PARAMETERS IN PATIENTS WITH SYSTEMIC SCLEROSIS

Background

Although the hand involvement is one of the first manifestations in the disease course of Systemic Sclerosis (SSc), hand functions are generally inquired by using patient-reported tools. Sollerman Hand Function Test (SHFT) is developed to evaluate the performance-based hand functions.

Objectives

The aim of this study was to investigate the reliability of the SHFT and the associations with disease- and hand-related parameters in patients with SSc.

Methods

Thirty-six patients (30 females) were included in the study. SHFT includes 20 different hand functions which are scored between 0 (unable to perform) and 4 (performed within 20 seconds with normal quality) (1). In the present study, item 12 ‘put on Tubigrip stocking on the other hand’ was not evaluated, thus, the SHFT was scored over a total score of 76. Inter-rater reliability was investigated by comparing the scores of two different investigators, and test-retest reliability was investigated by assessing the scores obtained at 2-hour intervals. Modified Hand Mobility in Scleroderma Test (mHAMIS), modified Rodnan skin score (mRSS), grip and pinch strengths were measured to evaluate hand-related physical characteristics. Duruoz Hand Index, Disability of Arm, Shoulder and Hand Questionnaire (DASH), Health Assessment Questionnaire (HAQ), and Scleroderma Health Assessment Questionnaire (SHAQ) were used as patient-reported outcomes.

Table 1.

Associations between the Sollerman Hand Function Test scores and disease- and hand-related parameters

n= 36Median (IQR 25/75)rhopmHAMIS (score 0-4)0 (0/0)-0.3660.072mRSS-Fingers (score 0-3)2.5 (2/3)-0.0700.684mRSS-Hands (score 0-3)1.5 (1/2)-0.0560.747mRSS-Forearms (score 0-3)1 (0/2)-0.0320.855mRSS-Upper Arms (score 0-3)0 (0/1)0.0080.962mRSS-Total (0-51)10 (6/27.5)-0.1580.356Hand Grip Strength (kg)19.9 (12.0/24.9)0.612<0.001*Tip to Tip Pinch Strength (kg)3.1 (2.3/3.9)0.5170.001*Three Jaw Pinch Strength (kg)2.7 (1.9/3.4)0.554<0.001*Lateral Pinch Strength (kg)3.9 (3.3/5.3)0.4610.005*Duruoz Hand Index (score 0-90)5.5 (0/17)-0.751<0.001*DASH (score 30-150)61.5 (47/84)-0.645<0.001*HAQ (score 0-3)0.3 (0.1/0.9)-0.632<0.001*SHAQ-Raynaud’s Phenomenon (score 0-3)0.9 (0.1/1.4)-0.2460.161SHAQ-Digital Ulcers (score 0-3)0.1 (0/1.2)-0.3720.030*SHAQ-Gastrointestinal (score 0-3)0.2 (0/1.5)-0.1770.315SHAQ-Pulmonary (score 0-3)0.6 (0.1/1.5)-0.2700.123SHAQ-Patient Global Assessment (score 0-3)1.4 (0.1/2.1)-0.5470.001*

p<0.05, rho: Spearman correlation coefficient, mHAMIS: modified Hand Mobility in Scleroderma Test, mRSS: modified Rodnan skin score, lcSSc: limited cutaneous Systemic Sclerosis, dcSSc: diffuse cutaneous Systemic Sclerosis, DASH: Disability of Arm, Shoulder, and Hand Questionnaire; HAQ: Health Assessment Questionnaire; SHAQ: Scleroderma Health Assessment Questionnaire

Results

SHFT demonstrated excellent inter-rater reliability (75 (72/76) vs. 75 (72/76), ICC: 0.987) and moderate test-retest reliability (75 (72/76) vs. 76 (75/76), ICC: 0.645). SHFT scores correlated significantly with grip and pinch strengths, Duruoz Hand Index scores, HAQ scores, SHAQ-Patient Global Assessment scores, and SHAQ-Digital Ulcer Scores (p<0.05). No significant correlations were observed between other parameters and SHFT (p>0.05). The hardest task was determined as ‘do up buttons’ which cannot be completed within 20 seconds by the half of the patients. All the patients completed ‘put key into Yale lock, turn 90o’, ‘lift iron over edge 5 cm in height’, and ‘lift telephone receiver, put to ear’ tasks within 20 seconds with normal quality.

Conclusion

The results of the present study suggest that SHFT is a reliable tool to evaluate hand functions in patients with SSc.

References

[1]Sollerman C, Ejeskär A. Sollerman hand function test. A standardised method and its use in tetraplegic patients. Scand J Plast Reconstr Surg Hand Surg 1995; 29: 167-176.

Disclosure of Interests

None declared

POS1534-HPR WRIST JOINT POSITION SENSE AND MANUAL DEXTERITY IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS

Background

Joint position sense is a marker of proprioception and is defined as being aware of the body position and individual body parts in the space. Position sense in the wrist joint is especially important for the manual dexterity. A possible damage due to arthritis may lead a decrease in joint position sense. However, the status of joint position sense was not investigated in children with juvenile idiopathic arthritis (JIA).

Objectives

To compare the wrist position sense and a motor performance test related to manual dexterity among children with JIA with wrist arthritis history (JIAWrist+), children with JIA without wrist arthritis history (JIAWrist-), and healthy controls.

Methods

A total of sixty children (20 children for each group) were included in the study. Wrist joint position sense was evaluated by measuring joint re-position error. The wrist was passively placed in a pre-determined position (30o for flexion, 30o for extension, 10o for radial deviation, and 15o for ulnar deviation). Then passively was returned to baseline position. The patient was asked to reposition their wrist into the target degree actively. The absolute error in degrees between each position and reposition was calculated. Manual dexterity was evaluated by using Purdue Pegboard Test. The test was repeated three times and the average number of the correctly placed pines was used in the analysis.

Results

Joint position sense (in all directions except radial deviation) and manual dexterity (except assembly) was found negatively affected in JIAWrist+ patients compared to healthy controls. No differences (except radial deviation) were observed between JIAWrist- patients and healthy controls.

Table 1.

Comparison of the groups

JIAWrist+ (n:20)JIAWrist- (n:20)Healthy Controls (n:20)Physical CharacteristicsMedian (IQR 25/75)Median (IQR 25/75)Median (IQR 25/75)p*Age (years)14.0 (10.5/16.0)12.5 (11.0/14.5)12.0 (10.0/13.0)0.131Body-Mass Index (kg/m2)20.1 (18.8/22.6)18.9 (15.7/23.9)18.6 (16.8/21.9)0.477Disease Related DataMedian (IQR 25/75)Median (IQR 25/75)Median (IQR 25/75)p**Disease Duration (months)27.5 (10.5/64.0)31.5 (11.0/63.0)NA0.903Gendern (%)n (%)n (%)p***Female19 (95%)10 (50%)13 (65%)0.007Male1 (5%)10 (50%)7 (35%)Joint Re-position ErrorMedian (IQR 25/75)Median (IQR 25/75)Median (IQR 25/75)p*Flexion (o)5.2 (3.3/6.7)2.7 (2.0/4.0)2.0 (1.3/2,7)p<0.001 p1: 0.061 p2< 0.001 p3: 0.148Extension (o)3.8 (2.2/6.0)3.5 (2.8/4.5)1.8 (1.3/4.0)p: 0.038 p1: 1.000 p2: 0.045 p3: 0.171Radial Deviation (o)2.8 (2.0/5.2)3.3 (1.8/4.7)2.0 (1.3/2.7)p: 0.022 p1: 1.000 p2: 0.051 p3: 0.048Ulnar Deviation (o)3.5 (2.5/4.3)2.3 (1.5/3.0)1.7 (1.2/2.7)p: 0.003 p1: 0.084 p2: 0.003 p3: 0.805Flexion (o)5.2 (3.3/6.7)2.7 (2.0/4.0)2.0 (1.3/2,7)p<0.001 p1: 0.061 p2< 0.001 p3: 0.148Manual DexterityMedian (IQR 25/75)Median (IQR 25/75)Median (IQR 25/75)p*Purdue Pegboard Test Single Hand (score)15.2 (13.5/15.5)15.2 (14.5/16.2)16.2 (15.0/18.0)p: 0.022 p1: 0.981 p2: 0.019 p3: 0.244Purdue Pegboard Test Both Hands (score)11.0 (9.8/12.0)11.0 (10.3/12.3)12.5 (11.7/13.2)p: 0.006 p1: 1.000 p2: 0.007 p3: 0.051Purdue Pegboard Test Assembly (score)26.5 (23.0/28.5)26.0 (23.5/29.0)28.0 (25.5/30.0)p: 0.243

*Kruskal-Wallis Analysis, **Mann-Whitney-U Test, ***Chi-Square Test, p<0.05. JIAWrist+: children with JIA with wrist arthritis history; JIAWrist-: children with JIA without wrist arthritis history, NA: not applicable, p1: JIAWrist+ vs. JIAWrist-; p2: JIAWrist+ vs. healthy controls; p3: JIAWrist- vs. healthy controls.

Conclusion

Joint position sense and related manual dexterity is diminished in JIA patients with wrist involvement. The results of this study suggested that children with wrist arthritis should be followed with special attention focusing on manual abilities. Hand therapy programs might help improving joint position sense acuity.

Disclosure of Interests

None declared

Comparison of Anaerobic Exercise Capacity in Children With Familial Mediterranean Fever and Healthy Controls

BACKGROUND/OBJECTIVE

Anaerobic exercise capacity is an important component of performing daily activities during childhood. However, diminished anaerobic exercise capacity has been reported in children with chronic conditions. Therefore, the aim of this study was to compare anaerobic exercise capacities between children with familial Mediterranean fever (FMF) and healthy peers.

METHODS

Twenty-one children with FMF (FMF group) and 21 physically matched healthy controls (control group) were included. Peak power, peak power/kg, average power, and average power were evaluated using the Wingate Anaerobic Test.

RESULTS

The peak power (FMF group: 254.8 W [IQR 25/75: 216.4/293.0 W] vs control group: 333.7 W [IQR 25/75: 241.3/570.5 W], p = 0.009), peak power/kg (FMF group: 6.3 W/kg [IQR 25/75: 5.2/7.0 W/kg] vs control group: 7.0 W/kg [IQR 25/75: 6.1/8.6 W/kg], p = 0.046), average power (FMF group: 186.0 W [IQR 25/75: 164.3/211.2 W] vs control group: 231.8 W [IQR 25/75: 181.8/338.1 W], p = 0.006), and average power/kg (FMF group: 4.5 W/kg [IQR 25/75: 3.8/5.0 W/kg] vs control group: 5.1 W/kg [IQR 25/75: 4.2/5.9 W/kg], p = 0.040) were found significantly higher in the control group compared with FMF group.

CONCLUSIONS

Children with FMF seems to have diminished anaerobic exercise capacity compared with their healthy peers.

Investigating the lower extremity-related anaerobic exercise capacity and functional status in adult patients with familial Mediterranean fever

OBJECTIVES

No studies examined the lower extremity-related anaerobic exercise capacity or functional status in adult patients with FMF.

METHODS

Twenty-four patients with FMF (12 males) and 24 age-sex-matched healthy controls (13 males) were included in the study. Lower extremity-related anaerobic exercise capacity was assessed by using Wingate Anaerobic Test. Lower extremity-related functional status was examined by using 9-Step Stair Climb Test, 10-Repetition Chair Stand Test, and Six-Minute Walking Distance. Muscle strength of hip flexors, hip extensors, knee flexors, and knee extensors were evaluated by using a hand-held dynamometer.

RESULTS

Patients with FMF had significantly poorer results in all anaerobic exercise capacity parameters and functional status assessments (P < 0.05), except muscle strength measurements (P > 0.05). Both average and peak anaerobic exercise capacities correlated significantly with all muscle strength measurements, 9-Step Stair Climb Test, 10-Repetition Chair Stand Test times, and Six-Minute Walk Distances (P < 0.05) in patients with FMF.

CONCLUSION

Lower extremity-related anaerobic exercise capacity and functional status seem to be diminished in adult patients with FMF. Evaluating these parameters may be beneficial for planning more appropriate and individualized treatment regimens such as patient education and exercise counselling for patients with FMF.

Is the international physical activity questionnaire (IPAQ) a valid assessment tool for measuring physical activity of patients with axial spondyloartritis?

BACKGROUND

Determining the level of physical activity (PA) is an essential part of patient evaluation in axial spondylarthritis (axSpA). Subjective and objective methods are both frequently used methods for evaluating PA. Although subjective methods are cost-effective and easy to use, their accuracy for measuring PA is still questionable.

OBJECTIVE

To investigate the concurrent criterion validity of a self-reported questionnaire (IPAQ-Short Form) when compared to an accelerometer (Actigraph wGT3X-BT) for measuring PA level in patients with axSpA.

DESIGN

Cross-sectional design.

METHODS

Fifty-eight patients with axSpA with a median age of 39.0 (IQR 25/75: 30.0/46.0) years were included in the study. An accelerometer (Actigraph wGT3X-BT) was attached to the waist of patients at their first visits and was removed at their second visits, seven days later. Patients were asked to complete the International Physical Activity Questionnaire Short Form (IPAQ) at their second visits.

RESULTS

No significant correlations were determined between IPAQ and accelerometer (p > 0.05), except for the moderate PA (rho: 0.367, p < 0.05), and total PA (rho: 0.330, p < 0.05). It was also observed that IPAQ was underestimating energy expenditure for all types of PA.

CONCLUSION

IPAQ might not be a valid tool for measuring PA level in patients with axSpA. Disease-specific subjective methods for determining the PA should be developed and validated for those patients.

AB0669 DEPRESSION AND ANXIETY MIGHT NOT BE INCREASED DURING COVID-19 PANDEMIC IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS

Background:

Anxiety and depression are most common psychiatric disorders in chronic inflammatory rheumatic condition as well as axial spondyloarthritis (axSpA) (1). The prevalence of depression has been reported as 11-64% depending on the criteria used. Also self-reported depression and anxiety were found to be associated with disease activity and function in axSpA (1,2). It is observed that mental health is affected among healthy subjects during the COVID-19 pandemic, but this condition has not been systematically reviewed in axSpA patients.

Objectives:

We aimed to compare frequency of self-reported depression and anxiety before and during the Covid-19 pandemic in patients with axSpA.

Methods:

Seventy-six axSpA patients who were evaluated for the presence of depression and anxiety by using Hospital Anxiety and Depression scale (HADs) before pandemic were included in this study. All participants were classified according to the ASAS axSpA classification criteria. Patients were contacted by phone to participate and complete the HADS questionnaire. Demographic and disease related characteristics including BASDAI, BASFI and Patient Acceptable Symptom State (PASS) were recorded during interview. The HADs cut off value was taken as >7 in both groups to define the presence of anxiety or depression. Before and during pandemic period anxiety and depression scores were statistically compared.

Results:

The demographic and disease related characteristics of axSpA patients with and without anxiety/depression were summarized in Table 1. The frequency of anxiety (43.4% vs %43.4; p>0.05) and depression (46.1% vs 44.7%; p>0.05) were found to be similar before and during pandemic period. Patients with anxiety (HADs>7) and depression (HADs>7) had higher BASDAI and BASFI scores and much less PASS positivity (Table 1). Although the frequency of depression was similar between before and during the pandemic period, symptom severity in depression was slightly increased during the pandemic (Figure 1).

Table 1.

Patients’ demographics and characteristics according to the presence of anxiety and depression

VariablesPresence of depressionn:35Absence of depressionn:41PPresence of anxiety n:33Absence of anxiety n:43PAge (years) mean ± SD41.8±11.244.1±9.3>0.0542.0±10.943.6±10.0>0.05Male n(%)21(60.0)26(63.4)>0.0518(54.5)29(67.4)>0.05Education time (years) mean ± SD9.6±4.811.0±4.2>0.059.7±5.010.6±4.1>0.05Current smoker n(%)18(51.4)15(36.6)>0.0515(45.5)18(41.9)>0.05Alcohol consumption n(%)12(34.3)12(29.3)>0.0510(30.3)14(32.6)>0.05Current BMI kg/m2 mean ± SD26.0±4.826.8±4.5>0.0526.4±5.026.5±4.3>0.05Sleep time (hours) mean ± SD7.6±1.77.6±1.3>0.057.5±1.67.7±1.4>0.05Current BASDAI mean ± SD2.5±1.61.4±1.6<0.052.7±1.81.3±1.3<0.001Current BASFI mean ± SD2.4±2.11.1±1.3<0.052.4±2.01.2±1.4<0.05PASS positivity n(%)16(45.7)29(70.7)<0.0514(42.4)31(72.1)<0.05

Current depression and anxiety scores were correlated with disease activity (HADs Depression vs BASDAI r:0.530, p<0.001; HADs Anxiety vs BASDAI r:0.500, p<0.001) and function (HADs-Depression vs BASFI r:0.519, p<0.001; HADs-Anxiety vs BASFI r:0.391, p<0.001). These relationships were also observed in the pre-pandemic period (HADs-Depression vs BASFI r:0.326, p<0.05; HADs-Anxiety vs BASDAI r:0.342, p<0.05).

Conclusion:

Depression and anxiety symptoms seems to be comparable before and after the COVID-19 pandemic. Regardless of this period, the presence of both depression and anxiety are associated with disease activity, function and less patient acceptable symptom state.

References:

[1]Zhao S, Thong D, Miller N, et al. The prevalence of depression in axial spondyloarthritis and its association with disease activity: a systematic review and meta-analysis. Arthritis Res Ther. 2018;20:140.

[2]Barişan E, Bayir D, Solmaz D. Aksiyel spondiloartrit hastalarinda anksiyete düzeyinin çeşitli ölçeklerle değerlendirilmesi ve anksiyete ile ilişkili faktörler. Dokuz Eylül Üniversitesi Tip Fakültesi Dergisi. 2019; 129-137.

Figure 1.

Disclosure of Interests:

None declared

AB0862-HPR THE RELATIONSHIP BETWEEN ANAEROBIC EXERCISE CAPACITY AND LOWER EXTREMITY FUNCTIONALITY IN PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER

Background:

Familial Mediterranean fever (FMF) is an auto-inflammatory disease commonly affects people from Mediterranean basin. It is characterized by acute self-limiting inflammatory attacks of serous membranes. The disease is commonly associated with musculoskeletal symptoms of lower extremities such as arthritis, exercise induced leg pain, as well as protracted febrile myalgia. The term of anaerobic exercise capacity describes the ability of performing quick and explosive tasks such as stair climbing and brisk walking. It is well known that anaerobic exercise capacity is closely related to functional status.

Objectives:

To assess the relationship between anaerobic exercise capacity and lower extremity functionality in patients with FMF.

Methods:

Twenty-eight FMF patients (57% female) were included in the study. Median age was 33.5 (IQR 25/75: 23.3/44.3) years, median body mass index was 24.3 (IQR 25/75: 21.0/27.8) kg/m2, median time since symptom onset was 20.0 (IQR 25/75: 11.5/24.5) years, median time since diagnosis was 10.0 (IQR 25/75: 3.75/17.5) years, and median colchicine dosage was 1.5 (IQR 25/75: 1.0/1.5) mg/day. Anaerobic exercise capacity was measured with Wingate Anaerobic Test by using a cycle ergometer. Peak power (watt/kg) and average power (watt/kg) were calculated. Stair climbing, standing from a chair, and walking were assessed by using 9-step stair climb test, 10-repetition chair stand test, and 6-minute walking distance, respectively. Spearman’s rank-order correlation test was used to analyse the relationships between anaerobic exercise capacity and lower extremity functional tests.

Results:

The results of the anaerobic exercise capacity and lower extremity functional test scores of patients with FMF were summarized in table 1. Moderate relationships were found between both peak and average anaerobic exercise capacities and lower extremity functional status tests (Table 1, p<0.05). Six-minute walking distance has the strongest association with both peak (rho: .672, p<0.001) and average (rho: .689, p<0.001) anaerobic exercise capacity.

Table 1.

Anaerobic exercise capacity scores and lower extremity functionality as well as the relationships between anaerobic capacity and functional tests in patient with familial Mediterranean fever.

CharacteristicsMedian (IQR 25/75)(n:28)The correlation results, rho, p valuesPeak Power(watt/kg)Average Power (watt/kg)9-step stair climb test (seconds)5.7 (5.1/6.4)-.590*-.648*p:0.001p: 0.00110-repetition chair stand test (seconds)16.6 (13.7/18.7)-.493*-.476*p:0.008p:0.0106-minute walking distance (meters)594.1 (551.1/643.3).672*.689*p<0.001p<0.001Peak power (watt/kg)5.8 (4.1/7.9)Average power (watt/kg)4.6 (3.1/5.9)

IQR 25/75: Interquartile range between 25th and 75th percentiles; kg: kilograms, *Spearman’s rank-order correlation test, p<0.05.

Conclusion:

According to our results, anaerobic exercise capacity is related to lower extremity functional status in patients with FMF. Improving anaerobic capacity by using optimal rehabilitation programs including speed and agility exercises may help to improve anaerobic exercise capacity, and consequently lower extremity functionality in those patients.

Disclosure of Interests:

None declared

Comparison of physical activity levels among different sub-types of axial spondyloarthritis patients and healthy controls

OBJECTIVES

The aim was to compare the physical activity levels among radiographic axial spondyloarthritis (axSpA) patients, non-radiographic axSpA patients, and healthy controls and investigating the possible relationships between physical activity level and clinical features.

METHODS

Thirty-four patients with radiographic axSpA (24 male), 33 patients with non-radiographic axSpA (23 male), and 35 age and sex-matched healthy controls (24 male) were included. The patients were assessed with Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, Ankylosing Spondylitis Quality of Life Questionnaire, Hospital Anxiety and Depression Scale, Tampa Scale of Kinesiophobia. Physical activity was measured by using an accelerometer (Actigraph wGT3X-BT).

RESULTS

Physical and disease-related characteristics were comparable between groups (p > .05). Radiographic axSpA patients showed lesser physical activity compared to non-radiographic axSpA patients and healthy controls (p < .05). No difference was detected between non-radiographic axSpA patients and healthy controls (p > .05). Physical activity levels were correlated with different clinical features for each sub-type of axSpA. Decreased spinal mobility is the most correlated disease characteristic with lower physical activity level for both sub-types.

CONCLUSION

It seems that disease sub-type in axSpA may alter the physical activity levels. Increasing physical activity levels might need different approaches for different sub-types of axSpA.

Yoga versus home exercise program in children with enthesitis related arthritis: A pilot study

PURPOSE

The aim was to compare the effects of yoga and home exercise program on lower extremity functional status, pain, and quality of life in children with enthesitis related arthritis (ERA).

METHODS

Twenty-one children with ERA were divided into two groups as yoga (n = 11) and home exercise (n = 10). Yoga group performed supervised yoga exercises twice a week for eight weeks. Home exercise group performed video-based exercises for the same period. Pain in rest and activity, lower extremity functional status, and quality of life were evaluated at baseline and following eight weeks.

RESULTS

The groups were similar at baseline (p > 0.05). All the parameters, except parent reported quality of life, significantly improved in yoga group (p < 0.05), where only stair climb test times significantly improved in home exercise group (p < 0.05).

CONCLUSIONS

Yoga seems promising for improving lower extremity functional status, pain, and quality of life as an exercise intervention in rehabilitation programs of children with ERA.

Cervical proprioception accuracy is impaired in patients with axial spondyloarthritis

BACKGROUND

Proprioception is the awareness of body parts and includes joint position sense, kinesthesia, and sense of force. Cervical spine is one of the major affected areas in axial spondyloarthritis (axSpA), and is an essential region for proprioceptive receptors.

OBJECTIVE

To investigate the cervical joint proprioceptive accuracy by using cervical joint positioning error (JPE) method in patients with axSpA and healthy controls.

DESIGN

Cross-sectional study.

METHODS

JPE was calculated for cervical motions in the directions of flexion, extension, rotations, and lateral flexions. Time since diagnosis, symptom duration, spinal mobility, functional status, quality of life, disease activity, and pain were evaluated in axSpA patients. Cervical JPE of axSpA patients was also compared according to radiographic status, biologic use, and existence of cervical syndesmophytes.

RESULTS

Eighty-two axSpA patients (52 males) and 71 healthy subjects (53 males) were evaluated. Cervical JPE was higher in patients with axSpA compared to healthy subjects (p < 0.001), except left lateral flexion (p = 0.10). Cervical proprioceptive accuracy for extension and left rotation was better in biologics+ subgroup compared to biologic- subgroup (p < 0.05). No other differences were detected related to radiographic status nor existence of cervical syndesmophytes (p > 0.05).

CONCLUSION

Cervical proprioception accuracy is impaired in patients with axSpA. It seems that controlling disease activity by using appropriate medication may have a positive effect on cervical proprioception accuracy.

Validity and reliability of the Turkish version of the Self-reported Foot and Ankle Score in patients with foot or ankle pain

OBJECTIVE

The aim of this study was to translate the Self-Reported Foot and Ankle Score (SEFAS) into Turkish and to determine the validity and reliability of the translated version in patients with foot or ankle pain.

METHODS

A total of 98 patients (65 females, 33 males, mean age=39 years, age range 18-65 years) who presented with foot or ankle pain for at least one week were included in the study. SEFAS was translated into Turkish (SEFAS-T) and then back-translated into English by two bilingual translators to ensure the accuracy of translation. To determine the validity of the translated version, SEFAS-T, The Foot and Ankle Outcome Score (FAOS), and the Short Form 36 (SF-36) were administered at the first assessment on the same day. SEFAS-T was repeated five days later (Spearman's rho). Intra-class correlation coefficients (ICCs) were used for assessment of the test re-test reliability, while the Cronbach's alpha coefficient was used to assess the internal consistency of the questionnaire Results: SEFAS-T showed good test-retest reliability (ICC: 0.887). Item 4 showed poor item-total correlation and inter-item correlations. When item 4 was excluded, the Cronbach's alpha value was found as 0.906. SEFAS-T total scores showed correlation with all the FAOS sub-scores (p<0.001) and all the SF-36 components (p≤0.001) except mental health (rho: 0.149, p: 0.143). The highest correlation was found between SEFAS-T Total Score and the Sports and Recreations subscale of FAOS (rho: 0.796, p<0.001).

CONCLUSION

SEFAS-T seems to be valid and reliable as a measure for foot or ankle pain in Turkish patients.

LEVEL OF EVIDENCE

Level II, Diagnostic study.

THU0607-HPR COMPARISON OF THE PATIENT REPORTED PHYSICAL ACTIVITY LEVEL ACCORDING TO KINESIOPHOBIA PRESENCE IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS

Background:

Many factors such as poor functional or emotional status might play a role in participating physical activity for people with rheumatic diseases. There is a lack for evidence regarding to the effect of kinesiophobia presence on the physical activity levels of axSpA patients.

Objectives:

The primary objective was to compare the patient reported physical activity levels in axSpA patients with kinesiophobia and those without. Evaluating disease related and physical characteristics, quality of life and emotional status according to presence of kinesiophobia were also aimed.

Methods:

One-hundred forty-eight consecutive axSpA patient were allocated to Kinesiophobia+ group (n: 90, 66% males) or Kinesiophobia- group (n: 58, 64% males). The presence of kinesiophobia was defined as having a score of >37 in Tampa Scale for Kinesiophobia. All patients were evaluated regarding to physical characteristics (age, body-mass index), functional status (Bath Ankylosing Spondylitis Functional Index), disease activity (Bath Ankylosing Spondylitis Disease Activity Index), spinal mobility (Bath Ankylosing Spondylitis Metrology Index), patient reported physical activity (International Physical Activity Questionnaire Short Form), emotional status (Hospital Anxiety and Depression Scale), and quality of life (Assessment of SpondyloArthritis International Society Health Index).

Results:

Physical characteristics and spinal mobility were similar in patients with and without kinesiophobia (p>0.05, Table). Disease activity, function, quality of life, depression and anxiety scores were poorer in Kinesiophobia+ group compared to Kinesiophobia- group (p<0.05, Table). Patient reported physical activity level was found to be lower in patients with kinesiophobia (p<0.05, Table).

Table.

Comparison of groups according to kinesiophobia presence

Kinesiophobia+ Group(n: 90)Median (IQR 25/75)Kinesiophobia- Group(n: 58)Median (IQR 25/75)p*Physical CharacteristicsAge (years)41.0 (37.0/52.0)44.0 (36.0/53.0)0.850Body-Mass Index (kg/m2)26.8 (24.6/30.1)26.0 (22.7/29.0)0.364Disease Related CharacteristicsBASDAI (score)2.7 (1.3/4.6)1.8 (0.6/3.5)0.036BASMI (score)3.3 (1.9/5.0)2.7 (1.6/3.5)0.114BASFI (score)2.5 (1.2/4.4)1.2 (0.5/2.7)0.003Patient Reported Physical Activity LevelIPAQ (MET/week)505.5 (169.0/1653.0)858.0 (330.0/2772.0)0.042Quality of LifeASAS-HI (score)7.0 (5.0/9.1)4.0 (2.0/7.9)0.001Emotional StatusHAD Anxiety (score)7.0 (4.0/9.0)5.0 (3.0/8.0)0.006HAD Depression (score)7.0 (4.0/10.0)3.0 (1.0/7.0)0.001Fear of MovementTAMPA (score)41.0 (39.0/44.0)34.0 (31.0/36.0)p<0.001

*Mann-Whitney U Test, IQR 25/75: Interquartile range 25/75, BASDAI: Bath Ankylosing Spondylitis Disease Activity Index, BASMI: Bath Ankylosing Spondylitis Metrology Index, BASFI: Bath Ankylosing Spondylitis Functional Index, IPAQ: International Physical Activity Questionnaire Short Form, HAD: Hospital Anxiety and Depression Scale, ASAS-HI: Assessment of SpondyloArthritis International Society Health Index, TAMPA: The Tampa Scale for Kinesiophobia, p<0.05.

Conclusion:

It seems that the presence of kinesiophobia may have a negative impact on patient reported physical activity level, and disease related parameters. However, it is also possible that kinesiophobia might occur as result of poor disease activity or disability. Strategies such as patient education should be included in axSpA management for preventing kinesiophobia development or improving kinesiophobia related consequences.

Disclosure of Interests:

None declared

THU0638-HPR PHYSICAL ACTIVITY LEVELS OF RADIOGRAPHIC AND NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS PATIENTS

Background:

It is known that cardiovascular disease risk is increased in chronic inflammatory diseases. Additionally, regular exercise is one of the main components of the management of patients with axial spondyloarthritis (axSpA). However, it was reported that axSpA patients do not meet recommended physical activity levels. It is still unknown, whether the disease subgroups of axSpA play a role in participating in physical activity.

Objectives:

To compare the physical activity levels among radiographic, non-radiographic axSpA patients, and healthy controls.

Methods:

Thirty-three patients with radiographic axSpA (23 [70%] male), 33 patients with non-radiographic axSpA (23 [70%] male) and 33 age and sex matched healthy controls (23 male [70%]) were included in the study. axSpA patients were assessed regarding to disease activity (Bath Ankylosing Spondylitis Disease Activity Index; BASDAI), functional status (Bath Ankylosing Spondylitis Functional Index; BASFI), spinal mobility (Bath Ankylosing Spondylitis Metrology Index; BASMI). Physical activity level of all subjects was measured by using an accelerometer (Actigraph wGT3X-BT) which was worn on the waist for seven consecutive days.

Results:

The groups were similar in terms of physical characteristics (age and body mass index) (p>0.05). Disease related characteristics (BASMI, BASFI, BASDAI) were comparable between radiographic and non-radiographic axSpA patients (p>0.05). Radiographic axSpA patients showed lesser physical activity compared to non-radiographic axSpA patients and healthy controls (p<0.05, Table 1). There is no difference between non-radiographic axSpA patients and healthy controls regarding the physical activity levels (p>0.05).

Table 1.

Comparison of Groups

Radiographic axSpA (n: 33)Median (IQR 25/75)Non-radiographic axSpA (n: 33)Median (IQR 25/75)Healthy Controls (n:33)Median (IQR 25/75)pPhysical CharacteristicsAge (years)41.0 (32.0/46.0)37.0 (32.0/40.0)33.0 (28.0/41.0)0.093*BMI (kg/m2)26.0 (22.9/29.6)26.3 (25.4/28.7)24.8 (22.3/26.9)0.064*Disease Related CharacteristicsBASMI (score)2.1 (1.5/3.9)1.5 (1.1/2.0)NA0.051**BASFI (score)2.4 (0.7/3.9)1.2 (0.6/2.9)NA0.267**BASDAI (score)3.6 (1.6/5.8)2.4 (1.4/5.4)NA0.519**Physical Activity LevelLight Physical Activity(min)2198.0 (1377.0/2658.0)2576.0#(1858.0/3690,0)2200.0 (1846.0/2762.0)0.015*Medium Physical Activity (min)188.0(109.0/304.0)264.0(216.0/446.0)363.0(267.0/491.0)##p<0.001*Vigorous Physical Activity (min)0.0(0.0/0.1)2.0(0.0/12.0)4.0(0.0/19.0)##0.009*Total Step Count (n)42481.0 (33651.0/57047.0)62872.0(53075.0/80160.0)#69710.0 (59943.0/85894.0)##p<0.001*

*Kruskal-Wallis Test, **Mann-Whitney U Test,#: difference between radiographic axSpA and non-radiographic axSpA,##: difference between radiographic axSpA and healthy controls, IQR 25/75: Interquartile range 25/75, BMI: Body Mass Index, BASMI: Bath Ankylosing Spondylitis Metrology Index, BASFI: Bath Ankylosing Spondylitis Functional Index, BASDAI: Bath Ankylosing Spondylitis Disease Activity Index, NA: Not Applicable, p<0.05.

Conclusion:

The results of the present study suggest that radiographic damage in axSpA may alter the physical activity levels. Every effort should be taken to increase physical activity levels in axSpA patients, especially in radiographic cases.

Acknowledgments:

This project was supported by Izmir Katip Celebi University Scientific Research Projects Coordinatorship.

Disclosure of Interests:

None declared

SAT0613-HPR EFFECT OF CERVICAL STABILIZATION EXERCISES ON CERVICAL POSITION ERROR IN PATIENTS WITH SPONDYLOARTHRITIS: A RANDOMIZED CONTROLLED TRIAL

Background:

Proprioception sense might be deteriorated due to joint related diseases. Different exercise programs were shown beneficial for improving proprioception sense. However, the effect of exercise on cervical position error was not investigated in patients with axial spondyloarthritis (axSpA).

Objectives:

To investigate the effect of cervical stabilization exercises on cervical position error in patients with axSpA.

Methods:

Thirty-nine patients with axSpA were randomly allocated into two groups as exercise group (n: 20, 11 males) and control group (n: 19, 12 males). All patients were evaluated regarding to physical characteristics (age, body-mass index), disease activity (Bath Ankylosing Spondylitis Disease Activity Index), functional status (Bath Ankylosing Spondylitis Functional Index), and spinal mobility (Bath Ankylosing Spondylitis Metrology Index). Cervical position error was evaluated in flexion, extension, rotation and lateral flexion directions and was calculated using a special formula (1). All evaluations were performed at baseline and after six weeks. Exercise group performed a progressive home-based cervical stabilization exercise program, while the control group did not receive any exercise intervention. Exercise adherence control and exercise progression was delivered by sending messages and video instructions via a freeware and cross-platform messaging service (WhatsApp Messenger) in a weekly basis.

Results:

Baseline physical and disease related characteristics were similar between groups (p>0.05, table 1). Exercise group showed significant improvements in all directions related to cervical proprioception following six weeks (p<0.05, Table 2), however, no improvements were observed in the control group (p>0.05, Table 2).

Table 1.

Comparison of the Groups at Baseline

Exercise Group (n: 20)Median (IQR 25/75)Control Group (n: 19)Median (IQR 25/75)p*Physical CharacteristicsAge (years)40.5 (36.0/52.5)44.0 (39.0/49.5)0.496Body-Mass Index (kg/m2)27.5 (24.5/30.2)26.8 (23.6/29.3)0.569Disease Related CharacteristicsBASDAI (score)2.0 (1.0/3.3)1.8 (1.3/2.5)0.687BASMI Total (score)2.9 (1.7/4.1)2.3 (1.8/3.1)0.127BASFI (score)1.8 (0.6/2.9)1.2 (1.0/2.2)0.496

*Mann-Whitney U Test, IQR 25/75: Interquartile range 25/75, BASDAI: Bath Ankylosing Spondylitis Disease Activity Index, BASMI: Bath Ankylosing Spondylitis Metrology Index, BASFI: Bath Ankylosing Spondylitis Functional Index, p<0.05.

Table 2.

In-Group Comparison of Cervical Position Sense Error

BeforeMedian (IQR 25/75)AfterMedian (IQR 25/75)p*Exercise Group (n: 20)Flexion(o)4.9 (2.2/7.0)2.8 (1.7/3.8)0.033Extension(o)4.5 (3.3/6.4)3.1 (1.8/4.8)0.040Right Rotation(o)5.2 (3.0/8.9)3.7 (1.9/4.7)0.006Left Rotation(o)4.3 (2.5/5.0)2.8 (2.2/3.3)0.017Right Lateral Flexion(o)4.9 (3.3/6.8)2.3 (1.8/3.7)0.009Left Lateral Flexion(o)4.3 (2.1/6.7)2.0 (1.5/3.4)0.010Control Group (n: 19)Flexion(o)6.3 (3.5/7.3)5.2 (3.8/7.0)0.856Extension(o)5.5 (4.5/7.3)4.1 (3.3/8.2)0.809Right Rotation(o)6.4 (4.3/9.0)5.5 (3.0/8.5)0.472Left Rotation(o)5.4 (3.5/7.9)5.0 (3.5/7.2)0.778Right Lateral Flexion(o)5.9 (3.6/8.4)4.3 (2.7/7.7)0.717Left Lateral Flexion(o)3.8 (2.4/5.6)4.9 (2.9/5.7)0.904

*Wilcoxon Signed Rank Test, IQR 25/75: Interquartile range 25/75,o: degree, p<0.05.

Conclusion:

A six-week cervical stabilization exercise program is beneficial for impaired cervical proprioception sense in patients with axSpA.

References:

[1]Dugailly P-M, De Santis R, Tits M, Sobczak S, Vigne A, Feipel V. Head repositioning accuracy in patients with neck pain and asymptomatic subjects: concurrent validity, influence of motion speed, motion direction and target distance. European Spine Journal. 2015;24:2885-2891.

Disclosure of Interests:

None declared

FRI0636-HPR COMPARING THE EFFECTS OF YOGA AND HOME EXERCISE PROGRAMS ON FUNCTIONAL STATUS IN CHILDREN WITH ENTHESITIS RELATED ARTHRITIS

Background:

Enthesitis-Related Arthritis (ERA), also referred as the juvenile ankylosing spondylitis, is a subtype of Juvenile Idiopathic Arthritis (JIA). However, ERA patients were reported as having higher pain levels, lower functional status and lower quality of life level compared to other JIA subtypes. Yoga is used as an exercise method in adult patients with rheumatic diseases and positive effects on physical and psychosocial symptoms were reported. However, no study was conducted related to yoga in pediatric population with rheumatic diseases.

Objectives:

The aim of this study was to investigate effects of performing yoga or home exercises on functional status in children with ERA.

Methods:

Twenty-one children with ERA were allocated into two groups as yoga group (n=11) and home exercise group (n=10). Yoga group performed yoga exercises supervised by a physiotherapist for twice a week, for eight weeks, while the home exercise group performed video-based home exercises for the same period. Pain in rest and activity (Numeric Rating Pain Scale), functional status (Six-Minute Walk Distance, Stair Climb Test), and quality of life (PedsQL Children and Parent Form) were evaluated at baseline and following eight weeks.

Results:

The groups were similar regarding to physical characteristics, pain, functional status, and quality of life at baseline (p>0.05, Table 1). While, all the parameters (except PEDSQL Parent Form) in yoga group significantly improved at the end of the study (p<0.05, Table 2), only stair climb test results significantly improved in home exercise group (p<0.05, Table 2).

Table 1.

Comparison of the groups at baseline

Yoga Group(n:11)Median (IQR 25/75)Home Exercise Group (n:10)Median (IQR 25/75)p*Physical parametersAge (year)15.0 (13.0/15.5)16.0 (14.0/17.0)0.099BMI (kg/m2)20.7 (18.3/23.1)21.2 (19.9/22.0)0.756PainRest pain (score)0 (0/5.0)1.0 (0/3.0)0.705Activity pain (score)4.0 (1.0/6.5)2.0 (0/7.0)0.387Functional StatusSix-minute walk distance (m)600.0 (552.5/664.5)626.0 (556.0/650.0)1.000Stair climb test (sec)7.6 (6.8/8.3)7.4 (7.0/8.0)1.000Quality of LifePedsQL Children (score)13.0 (10.0/23.5)12.5 (6.0/20.0)0.654PedsQL Parent (score)21.0 (8.5/31.5)26,0 (15.0/39.0)0.387

*: Mann-Whitney U test; IQR 25/75: Interquartile Range 25/75, PedsQL: Pediatric Quality of Life Inventory, p<0.05

Table 2.

Changes in the Groups

BeforeMedian(IQR 25/75)AfterMedian(IQR 25/75)p*Yoga GroupPainRest pain (score)0 (0/5.0)0 (0/2.5)0.039Activity pain (score)4.0 (1.0/6.5)0 (0/1.5)0.012Functional StatusSix-minute walk distance (m)600.0 (552.5/664.5)692.0 (595.0/705.5)0.011Stair climb test (sec)7.6 (6.8/8.3)6.2 (6.0/7.0)0.008Quality of LifePedsQL Children (score)13.0 (10.0/23.5)9.0 (4.0/17.0)0.021PedsQL Parent (score)21.0 (8.5/31.5)18.0 (8.0/22.0)0.169Home Exercise GroupPainRest pain (score)1.0 (0/3.0)0 (0/3.0)0.715Activity pain (score)2.0 (0/7.0)2.0 (0/7.0)0.892Functional StatusSix-minute walk distance (m)626.0 (556.0/650.0)601.5 (585.0/707.0)0.093Stair climb test (sec)7.4 (7.0/8.0)7.0 (6.5/7.8)0.028Quality of LifePedsQL Children (score)12.5 (6.0/20.0)8.5 (7.0/18.0)0.475PedsQL Parent (score)26.0 (15.0/39.0)22.5 (14.0/30.0)0.192

*: Wilcoxon Signed Rank Test, IQR 25/75: Interquartile Range 25/75, PedsQL: Pediatric Quality of Life Inventory, p<0.05

Conclusion:

Yoga seems promising for improving functional status in children with ERA compared to a home-based exercise program. Therefore, yoga can be implemented as an exercise intervention in rehabilitation programs in children with ERA.

Disclosure of Interests:

None declared

Are the alterations in body posture related to decreased trunk muscle endurance in healthy young adults?

BACKGROUND

Trunk muscle endurance exercises are commonly used for correcting the postural alterations. However, there is no study investigating the relationship between postural alignment and trunk muscle endurance in healthy young adults.

OBJECTIVE

The aim of this study was to examine whether the three-dimensional (3D) body posture is related to trunk muscle endurance in healthy young adults.

METHODS

Forty-two healthy young adults enrolled in this study. For 3D evaluation of the body posture, an internet-based postural assessment system was used. Alterations in posture (head, ribcage, and pelvis) were evaluated by using the Posture Index which represents the total score of postural displacements. The higher Posture Index scores indicate more severe displacements in the posture. Trunk muscle endurance measurements included side bridge, trunk flexors and trunk extensors endurance tests. Spearman's rho was used to evaluate the associations between measured parameters.

RESULTS

The median age of the participants were 22 (IQR: 21.0-23.0) years. The only significant correlation was detected between the side bridge endurance test and the total Posture Index score (rho =⁣-0.402, p= 0.008).

CONCLUSIONS

These results indicated that the alterations of the body posture was significantly related to lower lateral trunk muscle endurance scores. These findings support the importance of trunk muscles, especially lateral trunk musculature to have a better body posture.

The relationship between isometric trunk muscle endurance and physical activity related energy expenditure in healthy young adults

BACKGROUND

Despite the popularity of core stabilization, there is limited evidence as to the relationship between performance on tests of isometric trunk muscle endurance and physical activity levels in adults.

OBJECTIVE

To investigate the relationship between isometric trunk muscle endurance and physical activity related energy expenditure in healthy young adults.

METHODS

A total of 51 participants (24 female) participated in the study. Median age and body mass index were; 22 years (Min-max: 18-26 years) and 21.8 kg/m2 (Min-Max: 18.59-28.98 kg/m2), respectively. Participants completed the International Physical Activity Questionnaire. Isometric trunk muscle endurance was assessed with holding times of isometric trunk flexor, extensor, and lateral side bridge tests. Collected data were summarized based on median and interquartile ranges. The Spearman's correlation test was used to ascertain the relationship between isometric trunk muscle endurance and physical activity related energy expenditure.

RESULTS

There were no gender differences in holding times of the trunk flexor and trunk extensor endurance tests (p> 0.05). Males showed higher endurance scores for side bridge test than females (p< 0.001). No difference was found in physical activity related energy expenditure between males and females. No correlation was observed between isometric trunk muscle endurance and physical activity related energy expenditure for either females or males (p> 0.05).

CONCLUSIONS

According to our findings, trunk muscle endurance is not related to physical activity related energy expenditure in healthy young adults.

Cross-cultural adaptation and validation of the Turkish version of the pain catastrophizing scale among patients with ankylosing spondylitis

[Purpose] This study describes the cultural adaptation, validation, and reliability of the Turkish version of the Pain Catastrophizing Scale in patients with ankylosing spondylitis. [Methods] The validity of the Turkish version of the Pain Catastrophizing Scale was assessed by evaluating data quality (missing data and floor and ceiling effects), principal components analysis, internal consistency (Cronbach’s alpha), and construct validity (Spearman’s rho). Reproducibility analyses included standard measurement error, minimum detectable change, limits of agreement, and intraclass correlation coefficients. [Results] Sixty-four adult patients with ankylosing spondylitis with a mean age of 42.2 years completed the study. Factor analysis revealed that all questionnaire items could be grouped into two factors. Excellent internal consistency was found, with a Chronbach’s alpha value of 0.95. Reliability analyses showed an intraclass correlation coefficient (95% confidence interval) of 0.96 for the total score. There was a low correlation coefficient between the Turkish version of the Pain Catastrophizing Scale and body mass index, pain levels at rest and during activity, health-related quality of life, and fear and avoidance behaviors. [Conclusion] The results of this study indicate that the Turkish version of the Pain Catastrophizing Scale is a valid and reliable clinical and research tool for patients with ankylosing spondylitis.

Does correcting position and increasing sensorial input of the foot and ankle with Kinesio Taping improve balance in stroke patients?

BACKGROUND

We thought that the application of Kinesio Tape (KT) on the foot and ankle in stroke patients may improve the quality of somatosensory information and may activate ankle muscles which have an important role in postural control and that ultimately balance could be improved in stroke patients.

OBJECTIVE

The purpose of this study was to evaluate the effects of KT on balance in stroke patients.

METHODS

Nineteen stroke patients and 16 healthy controls were included in the study. The study group was evaluated with and without KT. Balance of the all subjects was evaluated Sensory Organization Tests (SOT) by using the Computerized Dynamic Posturography. Equilibrium, Strategy Analysis and Composite Equilibrium Scores were investigated in SOT.

RESULTS

Statistically significant differences were observed in all of the SOT parameters between stroke patients and healthy controls (p <  0.05). When the results with and without KT application were compared, the Equilibrium Scores in the conditions 3, 4, 6, Strategy Analysis Score in the conditions 2, 4, 6 and the Composite Equilibrium Score of the SOT were found to be improved in stroke patents (p <  0.05).

CONCLUSIONS

The results obtained from KT application are promising in improving balance in stroke patients.

A comparison of water-based and land-based core stability exercises in patients with lumbar disc herniation: a pilot study

PURPOSE

To determine and compare the effects of core stability exercise programs performed in two different environments in lumbar disc herniation (LDH) patients.

METHOD

Thirty-one patients who were diagnosed with LDH and were experiencing pain or functional disability for at least 3 months were randomly divided into two groups as land-based exercises or water specific therapy. Also, 15 age-sex-matched healthy individuals were recruited as healthy controls. Both groups underwent an 8-week (3 times/week) core stabilization exercise program. Primary outcomes were pain, trunk muscle static endurance and perceived disability level. The secondary outcome was health-related quality of life.

RESULTS

Level of static endurance of trunk muscles was found to be lower in the patients compared to the controls at baseline (p < 0.05). Both treatment groups showed significant improvements in all outcomes (p < 0.05) after 8-week intervention. When two treatment groups were compared, no differences were found in the amount of change after the intervention (p > 0.05). After the treatment, static endurance of trunk muscles of the LDH patients became similar to controls (p > 0.05).

CONCLUSION

According to these results, core stabilization exercise training performed on land or in water both could be beneficial in LDH patients and there is no difference between the environments.

IMPLICATIONS FOR REHABILITATION

An 8-week core stabilization program performed in water or on land decrease pain level and improve functional status in LDH patients. Both programs seem beneficial to increase health-related quality of life and static endurance of trunk muscles. Core stability exercises could be performed in water as well, no differences were found between methods due to environment.

Relationship between lower extremity isometric muscle strength and standing balance in patients with multiple sclerosis

BACKGROUND

Muscle strength and standing balance decrease in patients with Multiple Sclerosis (MS).

OBJECTIVE

The aim of the present study was to investigate the relationship between the lower extremity isometric muscle strength and standing balance in patients with MS.

METHODS

Forty-seven patients with MS and 10 healthy volunteers were included. Neurological disability level was assessed using Expanded Disability Status Scale (EDSS). Isometric strength of seven lower extremity muscles (hip flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor) was assessed using hand-held dynamometer. Duration of static one-leg standing balance was measured using digital chronometer.

RESULTS

Hip flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor isometric muscle strength, and duration of one-leg standing balance were decreased in patients with MS when compared with controls (p < 0.05). All assessed lower extremity isometric muscle strength and EDSS level was related duration of one-leg standing balance in patients with MS. All assessed lower extremity isometric muscle strength (except ankle dorsal flexor) was related with EDSS.

CONCLUSIONS

Hip flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor isometric muscle strength decreases in ambulatory MS patients. Lower extremity muscle weakness and neurological disability level are related with imbalance in MS population. Hip and knee region muscles weakness increases the neurological disability level. For the better balance and decrease neurological disability level whole lower extremity muscle strengthening should be included in rehabilitation programs.

Biomimetic Preparation of ha Precursors at 37°C in Urea- and Enzyme Urease-Containing Synthetic Body Fluids

An important inorganic phase of synthetic bone applications, calcium hydroxyapatite (HA, Ca10(PO4)6(OH)2), was prepared as a single-phase and sub-micron bioceramic powder. Carbonated HA precursors were synthesized from calcium nitrate tetrahydrate and diammonium hydrogen phosphate salts dissolved in “synthetic body fluid” (SBF) solutions, containing urea (H2NCONH2) and enzyme urease, under the biomimetic conditions of 37°C and pH 7.4, by using a novel chemical precipitation technique.