Efficacy of local oxygen-ozone therapy for the treatment of digital ulcer refractory to medical therapy in systemic sclerosis: A randomized controlled study.

BACKGROUND: This study aimed to investigate the efficacy of local oxygen-ozone therapy in systemic sclerosis (SSc) patients with digital ulcers (DUs) who were resistant to medical therapy and had impairment in activities of daily living. METHODS: Participants' demographic data, and clinical parameters were recorded. Twenty-five SSc patients with DUs were randomized to the ozone group (I) (n = 13) to receive medical treatment plus local oxygen-ozone therapy and the control group (II) (n = 12) to receive medical treatment only. Hand functions were assessed using the Health Assessment Questionnaire (HAQ) and the Modified Hand Mobility in Scleroderma (HAMISm) test. Clinical parameters, HAQ, and mHAMIS scores were re-evaluated in participants 4 weeks after the initiation of treatment. RESULTS: Demographic and clinical characteristics of the two groups showed no significant differences. At 4 weeks after the initial treatment, the efficacy rate was significantly higher in the ozone group than that in the control group (92% versus 42% P = 0.010). Clinical parameters, HAQ, and HAMISm scores were significantly improved in the treatment group compared to those in the control group (P < 0.05). CONCLUSION: Local oxygen-ozone therapy was effective in the treatment of SSc patients with resistant DUs and improved clinical parameters and functional disability.

Effectiveness of conventional versus virtual reality-based vestibular rehabilitation exercises in elderly patients with dizziness: a randomized controlled study with 6-month follow-up.

OBJECTIVES: To investigate the effect of vestibular rehabilitation exercises supported with virtual reality containing real-life environments on dizziness, static and dynamic balance, functional mobility, fear of falling, anxiety, and depression in elderly patients with dizziness. METHODS: In this prospective randomized controlled study, 32-patients aged 65-years and older who applied to the otorhinolaryngology clinic with dizziness complaint randomly assigned to 2 groups. In Group 1 (n=16), vestibular rehabilitation program, supported with virtual reality, and in Group 2 (n=16), conventional vestibular rehabilitation program was applied 30-min a day, 5 sessions per week, 15 sessions in total for 3 weeks. Subjects were evaluated with The Vertigo Symptom Scale (VSS), Dizziness Handicap Inventory (DHI), Berg Balance Test (BBT) and Timed Up & Go Test (TUG), Falls Efficacy Scale-International (FES-I), Postural Stability Test (PST), Geriatric Depression Scale (GDS), Hamilton Anxiety Scale (HAS) at baseline, at the end of the treatment and 6-months after the treatment. RESULTS: Statistically significant improvements were seen in the DHI emotional subscale and TUG in Group 1 compared to Group 2 at the end of the treatment in elderly with dizziness (p<0.05). Also, there were significant improvements in the VSS, all DHI subgroups, and total scores, BBT, HAS in Group 1 compared to Group 2 at the 6-months after the treatment (p<0.05). CONCLUSION: The application of vestibular rehabilitation in a virtual reality environment can lead to additional improvements especially in dizziness symptoms, disability, balance, and mobility in the elderly with chronic dizziness.

Effects of different types of exercises on pain, quality of life, depression, and body composition in women with fibromyalgia: A three-arm, parallel-group, randomized trial.

Objectives: This study aims to compare the efficacy of three different exercise types on pain, health-related quality of life (HRQoL), depression, and body composition in women with fibromyalgia (FM). Patients and methods: Between June 2019 and December 2019, a total of 41 women with FM (mean age: 46.7+9.4 years; range, 24 to 62 years) were randomly allocated into Group 1 (n=13, supervised aerobic plus stretching), Group 2 (n=13, supervised resistance plus stretching), and Group 3 (n=15, home-based stretching). All exercises were performed three times per week for 12 weeks and were individualized by measuring the maximal oxygen consumption (VO2max) for aerobic exercise and one-repetition maximum (1-RM) test for resistance exercise. The main measures were pain intensity assessed by the Visual Analog Scale (VAS), severity by the Fibromyalgia Impact Questionnaire (FIQ), symptoms of depression by the Beck Depression Inventory, HRQoL by the Short-Form Health Questionnaire (SF-36), and body composition by bioelectrical impedance analysis. Results: The mean VAS difference (95% confidence interval [CI]): -2.61 (-1.94, -3.29); -2.61 (-1.82, -3.42); -1.07 (-0.49, -1.64) for Group 1, Group 2, and Group 3, respectively (p<0.001); however, there was no significant difference between the combined exercise groups. The FIQ scores decreased significantly in all exercise groups after training (p<0.05). At 12 weeks, 21 (80.8%) patients from combined groups and six (40%) patients from the stretching alone group achieved a minimal clinically significant difference defined as a 14% change in baseline FIQ scores (p=0.008). Other outcome parameters did not differ significantly among the groups. Conclusion: Supervised aerobics/muscle strengthening combined with stretching exercises reduced pain, and FM severity more than a home stretching exercise alone.

Cognitive function and cardiorespiratory fitness affect gait speed in type-2 diabetic patients without neuropathy.

AIM: To identify physical, cognitive, and metabolic factors affecting gait speed in patients with type-2 diabetes mellitus (T2DM) without neuropathy. METHODS: This cross-sectional study enrolled 71 diabetic patients without neuropathy (mean age 55.87±7.74 years, 85.9% women). Neuropathy status was assessed with Douleur Neuropathique 4. We used a cut-off point for gait speed of 1 m/s to classify the participants into two groups: slow walkers (SW) and average and brisk walkers (ABW). The groups were compared in terms of age, sex, body mass index (BMI), hemoglobin A1c (HbA1c), fasting glucose, systolic blood pressure, maximal aerobic capacity (VO2 max), percentage of muscle mass, percentage of lower extremity muscle mass, Mini-Mental State Examination (MMSE) score, and years of education. RESULTS: Compared with the ABW group, the SW group had significantly lower VO2 max (14.49±2.95 vs 16.25±2.94 mL/kg/min) and MMSE score (25.01±3.21 vs 27.35±1.97), fewer years of education, and these patients were more frequently women (P<0.05). In the multivariate regression models, the combination of VO2 max, sex, and MMSE score explained only 23.5% of gait speed (P<0.001). MMSE score and VO2max independently determined gait speed after adjustment for age, BMI, HbA1c, fasting glucose, systolic blood pressure, percent of muscle mass, percent of lower extremity muscle mass, and years of education. CONCLUSION: In diabetic patients without neuropathy, physical impairment and disability could be prevented by an improvement in aerobic capacity and cognitive function.

Role of rehabilitation in a COVID-19 survivor with intensive care unit-acquired weakness: A case report.

Intensive care unit-acquired weakness (ICU-AW) is a catastrophic and debilitating clinical condition that causes generalized weakness and predisposes to adverse short- and long-term outcomes. Novel coronavirus disease-2019 (COVID-19) has been a global pandemic since November 2019. Each additional ICU admission for COVID-19 stresses intensive care unit (ICU) and hospital capacity. Accurately designed, timely rehabilitation procedures may reduce the patient burden of ICUs and hospitals. In this article, we describe a COVID-19 survivor who developed acute respiratory distress syndrome (ARDS) and ICU-AW. Early pulmonary rehabilitation in the ICU and long-term rehabilitation maintenance after the ICU and hospital discharge resulted in a positive outcome.

Effectiveness of whole-body vibration or biofeedback postural training as an add-on to vestibular exercises rehabilitation therapy in chronic unilateral vestibular weakness: A randomized controlled study.

BACKGROUND: The efforts to achieve better functional results in vestibular rehabilitation have been continued by using different visual and somatosensory stimuli for a long time. Whole-body vibration (WBV) is a mechanical vertical stimulation that provides high frequency vibration stimulus to the proprioceptive receptors. Biofeedback provides continuous information to the subject regarding postural changes. These techniques may aid to improve vestibular rehabilitation. OBJECTIVE: We aimed to investigate the effect of adding WBV or biofeedback postural training (BPT) to standard rehabilitation exercises in patients with chronic unilateral vestibular weakness. METHODS: Ninety patients were randomized into three groups. Group 1 had WBV and Group 2 BPT in addition to the standard rehabilitation exercises. Group 3 only carried out the home-based exercises and served as the control. Outcome measures such as static posturography, Berg Balance Scale, Timed Up-and-Go test, Visual Analog Scale, and Dizziness Handicap Inventory (DHI) were used for comparison. RESULTS: Statistically significant gains were achieved in all groups with all parameters at the end of treatment when compared to baseline (p < 0.05). The patients in Group 1 (WBV), however, were significantly better than those in Groups 2 and 3 at the static posturographic stability score, Berg Balance Scale, and DHI (p < 0.05). CONCLUSION: Adding WBV to a rehabilitation program may be an effective strategy to improve postural stability and achieve better physical, functional and emotional outcomes.

Interval Versus Continuous Aerobic Exercise Training in Overweight and Obese Patients With Chronic Obstructive Pulmonary Disease: A RANDOMIZED CONTROLLED STUDY.

PURPOSE: The aim of this study was to compare the efficacy of the supervised pulmonary rehabilitation programs consisting of either an interval or continuous aerobic exercise program, with a home-based exercise program in patients with chronic obstructive pulmonary disease (COPD) who were overweight or obese. METHODS: In this randomized controlled study, 72 overweight and obese patients diagnosed as having COPD were randomly assigned to 3 groups. Group 1 received an interval-type (IT) aerobic exercise program, group 2 received a continuous-type (CT) aerobic exercise program (both groups performed home exercises as well) and group 3 was only given a home-based exercise (HE) program. For the evaluation of patients, anthropometric measures, cardiopulmonary exercise testing (CPX), 6-min walk test (6MWT), modified-Borg dyspnea and leg fatigue scores, St George's Respiratory Questionnaire, and Hospital Anxiety and Depression Scale were used. RESULTS: Both IT and CT groups showed significant improvement on CPX parameters, 6MWT distances, mental health, and health-related quality of life (HRQoL) compared with the HE group in overweight and obese patients with COPD (P < .001). Moreover, the IT group demonstrated a significant decrease in the modified-Borg dyspnea and leg fatigue during the CPX compared with both CT and HE groups (P < .001). Furthermore, the Borg dyspnea and leg fatigue during training were lower in the IT group than in the CT group (P < .05). CONCLUSIONS: An interval or continuous aerobic exercise program added onto a home-based exercise program improved exercise capacity and HRQoL, and reduced anxiety and depression levels in overweight and obese patients with COPD.

The Correlations Between Disease Specific Quality of Life, Short Form-36 and Clinical Variables in Patients With Ankylosing Spondylitis.

OBJECTIVES: This study aims to assess the correlations between disease specific quality of life (QoL), general health status and clinical variables in patients with ankylosing spondylitis (AS), and also to determine a cutoff value for the disease specific QoL questionnaire. PATIENTS AND METHODS: A total of 124 patients (80 males, 44 females; mean age 40.6±11.1 years; range, 20 to 65 years) who fulfilled the modified New York criteria for AS were included in this cross-sectional study. All patients received a comprehensive rheumatologic assessment including disease specific instruments for disease activity, functional status, spinal mobility and QoL. Furthermore, short form-36 (SF-36) was used to determine general health status. Pain levels of the patients were assessed with visual analog scale (VAS). Pearson's analysis was used to assess correlation among variables, with moderate, strong, or very strong correlations if the value was between 0.40-0.69, 0.70-0.89, and 0.90-0.99, respectively. To determine a cutoff value for the ankylosing spondylitis quality of life (ASQoL) score, the area under the receiver operating characteristic curve (AUC) was computed according to clinical parameters which have the strongest correlations with ASQoL. RESULTS: The mean ASQoL score was 8.8±4.9. There was a significantly positive correlation between ASQoL and disease activity, functional status, spinal mobility and pain VAS whereas there was a significantly negative correlation between ASQoL and the SF-36 subscale scores except for mental health and emotional role (p<0.001). The strongest positive correlation was found between ASQoL and the Bath Ankylosing Spondylitis Disease Activity Index (r=0.721, p<0.001) whereas the strongest negative correlation was found between ASQoL and the first question of SF-36 (r=-0.844, p<0.001). A cutoff value of eight in ASQoL showed good discriminative properties for impaired QoL where sensitivity and specificity were simultaneously maximized according to disease activity (AUC=0.84 [95% confidence interval (CI): 0.770-0.908, p<0.001]) and the patients' global health status (AUC=0.85 [95% CI: 0.782-0.923, p<0.001]) in patients with AS. CONCLUSION: There was a strong correlation between ASQoL and disease activity as well as the patients' global health status in patients with AS. A cutoff value of eight in ASQoL could be used with good discriminative properties for impaired QoL in AS.

Prevalence of Rheumatoid Arthritis and Spondyloarthritis in Turkey: A Nationwide Study.

OBJECTIVES: This study aims to estimate the prevalence of rheumatoid arthritis (RA) and spondyloarthritis (SpA) in Turkey using the same telephone questionnaire developed for screening RA and SpA in France and used in Serbia and Lithuania. MATERIAL AND METHODS: The study was performed in two steps. In step I, the French questionnaire was translated into Turkish and validated through a group of 200 patients (80 males, 120 females; mean age 44.0±13.1 years; range 19 to 75 years) followed up at the rheumatology departments of University Hospitals in Antalya and Ankara. In step II, the validated Turkish questionnaire was administered face-to-face to randomly selected 4,012 subjects (1,670 males, 2,342 females; mean age 41.5±16.8 years; range 16 to 97 years) by trained general practitioners across the country, in 25 prov- inces for case detection. The subjects who were suspected of having RA or SpA in accordance with the questionnaire were invited to the nearest university hospital for rheumatologic examination in order to confirm the diagnosis. RESULTS: In step II, a total of 25 subjects (2 males, 23 females) were diagnosed as RA. The standardized RA prevalence for the general population of Turkey was calculated as 0.56% (95% confidence interval [CI]; 0.33-0.79), 0.10% (95% CI; -0.05-0.25) for males and 0.89% (95% CI; 0.51-1.27) for females. A total of 18 subjects (3 males, 15 females) were diagnosed as SpA. The standardized SpA prevalence for the general population of Turkey was 0.46% (95% CI; 0.25-0.67), 0.17% (95% CI; -0.03-0.37) for males and 0.65% (95% CI; 0.32-0.98) for females. The prevalence of RA was highest in the Northern region (2.00%) and the prevalence of SpA was highest in the Central region (1.49%). CONCLUSION: The prevalences of RA and SpA in Turkey are close to each other and there are significant inter-regional variations in prevalences of both RA and SpA.

A case with rheumatod arthritis and atraumatic odontoid fracture: disappearence of bony landmarks.

We aim to draw attention to occult, atraumatic fractures of the odontoid process in patients with rheumatoid arthritis (RA) and to underline difficulties encountered during clinical and radiological diagnosis. A forty-seven years old man with RA for 4 years had occipital pain for 1 year without any history of trauma. Later, he developed weakness in the upper extremities, but he did not realize weakness in the lower extremities due to deformities. Contrast magnetic resonance imaging revealed a linear fracture of odontiod process and myelopathy. Cervical computed tomography scan revealed an old fracture border with separated and almost disappeared remnant of the tip of the odontoid without free particles in the cord. It was impossible to evaluate atlantoaxial and vertical subluxations with craniometric measurements due to destruction of the tip of odontoid. Following occipitocervical fusion and decompression and a rehabilitation program, his muscle strength improved; however, functional myelopathy stage did not change. Atraumatic fractures of the odontoid process may be more common than reported and may cause compression of the spinal cord or brain stem. Surgery is the treatment of choice but functional recovery is limited once neuronal damage has occurred. Erosion of the critical landmarks makes it difficult to diagnose and follow up atlantoaxial subluxation and/or vertical subluxation, therefore clinicians should consider radiographical follow-ups during the course of the disease.

Efficacy of moderate-intensity walking provided feedback by ECE PEDO on abdominal fat in overweight and obese women: A randomized, exercise study.

OBJECTIVES: The aim of this study was to investigate the effectiveness of walking with Equipment for Clever Exercise (ECE PEDO) compared to supervised, moderate-intensity, aerobic, treadmill walking exercise in overweight and obese women. PATIENTS AND METHODS: Between September 2014 and January 2015, 28 women with overweight and obesity were assigned to two groups: supervised treadmill walking (Group 1, n=14) or walking with ECE PEDO (Group 2, n=14). The target heart rate (HR) corresponding to values of 50 to 70% VO2max were determined by submaximal treadmill test. Group 1 was instructed walking at their target HR on treadmill. The number of steps in a min corresponding to the target HR was calculated by a criterion pedometer and Group 2 was instructed walking in this step range recorded to the ECE PEDO giving audible feedback. Before and after a 12-week exercise program, all participants were evaluated by Body Mass Index (BMI) and waist circumference (WC). Ultrasonographic visceral fat thickness (VFT) and ergospirometric VO2max. RESULTS: The VFT decreased in both walking groups in association with reduced WC and weight loss and also significant increases in the VO2max after exercise intervention (p<0.05). The VFT decreased only in women by walking with ECE PEDO compared to the other group (p<0.05). CONCLUSION: Our study results showed that both moderate-intensity exercise provided by a novel pedometer and supervised treadmill walking showed significant improvements in abdominal obesity and VO2max.

Cadence Feedback With ECE PEDO to Monitor Physical Activity Intensity: A Pilot Study.

The purpose of this study was to examine the monitoring capabilities of the equipment for clever exercise pedometer (ECE PEDO) that provides audible feedback when the person exceeds the upper and lower limits of the target step numbers per minute and to compare step counts with Yamax SW-200 (YX200) as the criterion pedometer.A total of 30 adult volunteers (15 males and 15 females) were classified as normal weight (n = 10), overweight (n = 10), and obese (n = 10). After the submaximal exercise test on a treadmill, the moderate intensity for walking was determined by using YX200 pedometer and then the number of steps taken in a minute was measured. Lower and upper limits of steps per minute (cadence) were recorded in ECE PEDO providing audible feedback when the person's walking speed gets out of the limits. Volunteers walked for 30 minutes in the individual step count range by attaching the ECE PEDO and YX200 pedometer on both sides of the waist belt in the same session. Step counts of the volunteers were recorded. Wilcoxon, Spearman correlation, and Bland-Altman analyses were performed to show the relationship and agreement between the results of 2 devices.Subjects took an average of 3511 ±â€Š426 and 3493 ±â€Š399 steps during 30 minutes with ECE PEDO and criterion pedometer, respectively. About 3500 steps taken by ECE PEDO reflected that this pedometer has capability of identifying steps per minute to meet moderate intensity of physical activity. There was a strong correlation between step counts of both devices (P < 0.001, r = 0.96). Correlations across all three BMI categories and both sex remained consistently high ranging from 0.92 to 0.95. There was a high level of agreement between the ECE PEDO and YX200 pedometer in the Bland-Altman analysis.Although both devices showed a strong similarity in counting steps, the ECE PEDO provides monitoring of intensity such that a person can walk in a specified time with a desired speed.

Effect of mud compress therapy on cartilage destruction detected by CTX-II in patients with knee osteoarthritis.

BACKGROUND/OBJECTIVE: The aim of this study is to investigate the effect of mud compress (MC) therapy compared to hot pack (HP) therapy on cartilage destruction and subchondral bone alterations detected by urine levels of C telopeptide fragment of collagen type-II (uCTX-II) in patients with knee osteoarthritis (OA). METHODS: Fifty-nine patients between 49-74 years of age with bilateral knee OA divided into 2 groups. Twenty-five patients (16 females, 9 males) and 34 patients (22 females, 13 males) were given HP versus local natural organic and mineral-rich MC therapy respectively for 2 weeks as a total of 12 sessions. uCTX-II, Visual Analog Scale (VAS), 15 m walking time, Western Ontario and McMaster Universities multifunctional (WOMAC) index were measured at baseline, after-treatment and 3 months after treatment. RESULTS: uCTX-II level did not show any difference between the two groups, however it decreased significantly in MC and HP groups 3 months after treatment (p< 0.017). WOMAC stiffness sore was significantly lower in MC group 3 months after treatment (p< 0.05). Both MC and HP therapies lowered VAS, WOMAC total and subscores significantly up to 3 months (p< 0.017). CONCLUSIONS: HP and MC therapies for OA of knee are not superior to one another with respect to the level of uCTX-II. MC may probably decrease the ongoing cartilage destruction and related subchonral bone interactions earlier compared to HP treatment in patients with knee OA as evidenced by decreased uCTX-II levels after-treatment.

Arterial and intraocular pressure changes after a single-session hot-water immersion.

BACKGROUND/AIMS: The aim of this study is to investigate the effect of head-out hot-water immersion on the intraocular pressure (IOP) of healthy subjects and investigate whether this intervention alters cardiovascular and microcirculatory responses. METHODs: 16 male and 18 female healthy young adults were immersed in 39 degrees C water up to shoulder level for 20 minutes. Blood pressure (BP), heart rate (HR) and IOP were measured pre-immersion, post-immersion and five minutes after immersion on the same day. Tono-Pen was used to measure IOP. Mean arterial blood pressure (MAP), systolic pressure rate product (S-PRP), diastolic pressure rate product (D-PRP), pulse pressure (PP), mean ocular perfusion pressure (mean-OPP), systolic ocular perfusion pressure (S-OPP) and diastolic ocular perfusion pressure (D-OPP) were calculated. RESULTS: Systolic BP (SBP), diastolic BP (DBP), MAP, IOP, S-OPP, D-OPP and mean-OPP decreased; HR increased five minutes after immersion in the pool and post-immersion out of the pool significantly, compared to pre-immersion data (p < 0.05). HR, S-PRP and D-PRP measured five minutes after immersion were significantly higher from post-immersion (p < 0.05). PP and S-OPP were significantly different five minutes after immersion compared to pre-immersion. There was no statistically significant correlation between IOP and SBP, DBP, MAP, S-PRP, D-PRP, PP, S-OPP, D-OPP, or mean-OPP (p > 0.05). CONCLUSIONS: Physiological hemodynamic response to single head-out hot-water immersion caused a statistically significant decrease in IOP. Preliminary results could help to clarify vascular reactions and IOP changes during hot-water immersion that might be potentially therapeutic in glaucoma patients.

Effect of 10-Week Supervised Moderate-Intensity Intermittent vs. Continuous Aerobic Exercise Programs on Vascular Adhesion Molecules in Patients with Heart Failure.

OBJECTIVE: Abnormal expression of cellular adhesion molecules may be related to endothelial dysfunction, a key feature in chronic heart failure. This study compares the effects of 10-wk supervised moderate-intensity continuous aerobic exercise (CAE) and intermittent aerobic exercise (IAE) programs on markers of endothelial damage, disease severity, functional and metabolic status, and quality-of-life in chronic heart failure patients. DESIGN: Fifty-seven patients between 41 and 81 yrs with New York Heart Association class II-III chronic heart failure and with a left ventricular ejection fraction of 35%-55% were randomized into three groups: nonexercising control, CAE, and IAE, which exercised three times a week for 10 wks. Endothelial damage was assessed by serum markers of vascular cell adhesion molecule-1, serum intercellular adhesion molecule-1, and nitric oxide; disease severity was measured by left ventricular ejection fraction and N-terminal probrain natriuretic peptide; metabolic status was evaluated by body composition analysis and lipid profile levels; functional status was evaluated by cardiorespiratory exercise stress test and 6-min walking distance; quality-of-life was assessed with Left Ventricular Dysfunction-36 and Short-Form 36 questionnaires at the baseline and at the end of the 10th week. RESULTS: Significant decreases in serum vascular cell adhesion molecule-1 or serum intercellular adhesion molecule-1 in IAE and CAE groups after training were found, respectively. Resting systolic and diastolic blood pressure, peak systolic and diastolic blood pressure, 6-min walking distance, and the mental health and vitality components of Short-Form 36 improved in the CAE group, whereas left ventricular ejection fraction and 6-min walking distance improved in the IAE group compared with the control group. CONCLUSIONS: Both moderate-intensity CAE and IAE programs significantly reduced serum markers of adhesion molecules and prevented the change in VO2 in patients with chronic heart failure.

Efficacy of low level laser therapy and intramuscular electrical stimulation on myofascial pain syndrome.

BACKGROUND: Myofascial pain syndrome (MPS) which is an important cause of musculoskeletal pain has shown a dramatic increase in recent years. OBJECTIVES: We aimed to evaluate the efficacy of intramuscular electrical stimulation therapy (IMS) and low-level-lasertherapy (LLLT) in patients with MPS. METHODS: Patients were randomly divided into three groups. First group were treated with LLLT and stretching exercise. Second group were treated with IMS and stretching exercise. Third group were treated with only stretching exercise. The patients were evaluated through the pain intensity, pain threshold, cervical joint movement range and the neck disability index parameters. RESULTS: An improvement was found in all parameters for all groups, except for the pain threshold within the control group at the end of the treatment and one month after the treatment. It was found that pain score was significantly lower in Group 1 and 2 at one month after the treatment compared to Group 3. Similarly, it was found that pain threshold score was significantly higher in Group 2 at one month after the treatment compared to Group 3. CONCLUSIONS: In this study we observed that both LLLT and IMS treatments added on to stretching are effective in improving pain parameters in patients with MPS.

Turkish version of the painDETECT questionnaire in the assessment of neuropathic pain: a validity and reliability study.

OBJECTIVES: The aim of this study was to develop a Turkish version of the painDETECT questionnaire (PD-Q) and assess its reliability and validity. METHODS: Two hundred and forty patients who were diagnosed by expert pain physicians in daily clinical practice and classified as having either neuropathic, nociceptive, or mixed pain for at least 3 months were enrolled in this study. After the usual translation process, the Turkish version of the PD-Q was administered to each participant twice with an interval of 48 hours. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), Douleur Neuropathique en 4 questions (DN4) and a pain visual analog scale were assessed along with the PD-Q. Chronbach's α was calculated to evaluate internal consistency of the PD-Q. Intraclass correlation coefficient was calculated to examine test-retest reliability. Convergent validity was assessed by correlating the scale with LANSS and DN4. Discriminant statistics-sensitivity, specificity, Youden index, positive predictive value, negative predictive value-were also assessed. RESULTS: A total of 240 patients with chronic pain, 80 patients in each neuropathic, nociceptive, and mixed pain group, were included in this study. Mean age of the patients was 54.1 years, and majority of the patients were female (52.9%). Chronbach's α of the Turkish version of the PD-Q was 0.81. The test-retest reliability of the Turkish version of the PD-Q was determined as 0.98 for the total score and ranged from 0.86 to 0.99 for individual items. The Turkish version of the PD-Q was possitively and significantly corralated with LANSS (r 0.89, P < 0.001) and DN4 (r 0.82, P < 0.001). When the two cutoff values in the original version were used, sensitivity was found 77.5% for a cutoff value ≤19, and specificity was 82.5%. Sensitivity and specificity were 90% and 67.5%, respectively, for the other cutoff value ≤12. Scores ≤12 represents a negative predictive value = 87%, and scores 19≤ represents a positive predictive value = 82%. When mixed pain patients were included in the neuropathic pain group, discriminant values were reduced as expected. CONCLUSIONS: The Turkish version of the PD-Q is a reliable and valid scale to be used to determine neuropathic component of chronic pain in Turkish patients.

Comparison of the effectiveness of active and passive neuromuscular electrical stimulation of hemiplegic upper extremities: a randomized, controlled trial.

To compare the efficacy of electromyography (EMG)-triggered (active) neuromuscular electrical stimulation (NMES) and passive NMES in enhancing the upper extremity (UE) motor and functional recovery of subacute and chronic stage stroke patients. Thirty-one hemiplegic patients were randomly assigned to active NMES (n=11), passive NMES (n=10), and control (sham stimulation) (n=10) groups. Each treatment regimen was applied five times per week for 45 min for 3 weeks. All of the patients performed the same neurophysiologic exercise program for 45 min five times per week for 3 weeks. Patients were assessed by the UE component of the Fugl-Meyer Motor Assessment (UE-FMA), the self-care component of the Functional Independence Measure (self-care FIM), the Motor Activity Log (MAL), goniometric measurements of active wrist and metacarpophalangeal joint extension, surface EMG potentials, grip strength, and the modified Ashworth scale in a blinded manner. Data were obtained before and at the end of the treatment. Participants were similar in all clinical and demographic features (P>0.05). All groups were comparable with respect to UE-FMA, MAL, self-care FIM, wrist and finger flexor spasticity, active range of motion (ROM), grip strength, and surface EMG potentials before treatment (P>0.05). The active ROM, grip strength, FMA, FIM, surface EMG potentials, and MAL: amount of use were significantly improved in the EMG-triggered NMES group compared with the controls (P<0.05). The active wrist extension ROM and FMA scores were significantly improved in the passive NMES group compared with the controls (P<0.05). There were no statistically significant differences between active and passive NMES groups in any of the parameters evaluated at the end of the treatment (P>0.05). Both active and passive NMES as adjuvant therapy in the neurophysiologic exercise program effectively enhanced the UE motor and functional recovery of stroke survivors.

Ultrasonographic measurement of the distal femoral cartilage thickness in patients with unilateral transtibial amputation.

BACKGROUND: Lower limb amputation sometimes predisposes to degenerative secondary disorders. OBJECTIVES: To evaluate the distal femoral cartilage thicknesses of patients with unilateral transtibial amputations using ultrasound and to investigate the relationship between cartilage thickness and disease-related parameters. STUDY DESIGN: Cross-sectional study. METHODS: Twenty-four unilateral transtibial amputees (mean age: 46.4 ± 8.5 years, range: 28-60 years) were evaluated. Duration of prosthesis use (years) and daily walking time with prosthesis (hours) were recorded. Functional status was assessed by gate velocity (m/s), and 6-min walking distance (m) with prosthesis. Ultrasound was used to measure distal femoral cartilage thicknesses bilaterally at medial/lateral condyles and the intercondylar areas. The percentages of cartilage loss (of the amputee-side in comparison with the nonamputee-side) were calculated. RESULTS: Compared to the nonamputee-sides, distal femoral cartilage was significantly thinner at lateral condyles and the intercondylar areas on the amputee-sides (p < 0.05). Significant positive correlations were detected between the percentage of cartilage loss (at all three sites of measurement) and gate velocity, 6-min walking distance, and daily walking time with prosthesis (all p < 0.05). CONCLUSIONS: Future prospective controlled studies are warranted to determine the principles of optimum prosthetic use regarding its possible effects on the femoral cartilage of amputee patients. CLINICAL RELEVANCE: The correlations between the cartilage loss in the amputee extremity with faster gait and longer daily prosthetic use suggest that abnormal gait patterns might increase the loading on the amputated extremity.

Ultrasonographic evaluation of the femoral cartilage thickness after unilateral arthroscopic partial meniscectomy.

PURPOSE: To assess the distal femoral cartilage after unilateral arthroscopic partial meniscectomy and to explore the relationship between cartilage thickness and various disease-/surgery-related parameters. METHODS: Eighty-nine patients (42 M, 47 F) who had undergone arthroscopic partial meniscectomy surgery were evaluated. Ultrasonographic distal femoral cartilage thicknesses were measured with a 5-13-MHz linear probe (General Electric, Logiq P5) on mid-points of the lateral condyle, intercondylar notch and medial condyle of operated and non-operated knees by a physician blinded to patients' data. Demographic features, duration after surgery, type of meniscal tear and site of meniscectomy were recorded. RESULTS: Mean age of the patients was 51.8 ± 12.8 years (range 18-88). Mean body mass index was 29.4 ± 4.4 kg/m2 (range 18-38). Overall, in patients with degenerative meniscal tears, femoral cartilage thicknesses pertaining to all the three measured sites (lateral, intercondylar and medial) were found to be decreased in the operated knees when compared with those of the non-operated knees (p = 0.004, p = 0.003, p = 0.041, respectively), whereas in patients with non-degenerative tears, this decrease was significant only in the intercondylar area (p = 0.038). When patients were grouped according to the duration (months) after their surgery (≤36, 37-48 and ≥49), cartilage thickness was similar between both knees in the first group, decreased at the lateral condyle (p = 0.008) and intercondylar area (p = 0.049) in the second group and decreased at all three sites (lateral, intercondylar and medial) in the third group (p = 0.015, p = 0.005 and p = 0.008, respectively). CONCLUSION: These findings would be considered as unfavourable with respect to weight-bearing, and thus, conservative measures to support relevant joints would strongly be kept in mind during clinical practice. Lastly, ultrasonography may be a convenient alternative imaging method for the evaluation of short- and medium-term cartilage loss in patients with arthroscopic partial meniscectomy. LEVELS OF EVIDENCE: III.