Components, design and effectiveness of digital physical rehabilitation interventions for older people: A systematic review.

BACKGROUND: With the rapid advancement in digital technologies, the use of digital health applications is increasing day by day. Although a large number of digital applications have been developed for rehabilitation of older people, there has been no review of the evidence for effectiveness of these interventions. METHODS: The aim of our study was to review the evidence of digital rehabilitation interventions on outcomes including pain, function and quality of life in older people. We focused on digital interventions that are designed to improve and restore physical functioning. We searched six electronic bibliographic databases and included randomised controlled trials. Cochrane risk of bias tool and Cochrane's Grading of Recommendations, Assessment, Development and Evaluation approach was used to evaluate the risk of bias and grade the evidence. RESULTS: Eight trials were included. The short-term effects of digital rehabilitation interventions on physical activity, quality of life, vertigo symptoms and falls are uncertain. Quality of trials was rated as very low to moderate evidence. CONCLUSION: More research is needed to estimate effectiveness of these interventions.

A hand exercise mobile app for people with rheumatoid arthritis in Turkey: design, development and usability study.

To design and develop a smartphone application for a structured hand exercise programme for patients with rheumatoid arthritis (RA) in Turkey and to test its usability. We followed a two-stage process: (1) Design and Development and (2) Usability testing. In stage 1, we used a qualitative user-centered design approach. We conducted a focus group (8 therapists and people with RA) to discuss the content, features and design to produce a prototype of the application. In a second focus group session, the participants tested the prototype, provided feedback and further revisions were made. In stage 2, 17 participants with RA used the app for 4 to 6 weeks. The System Usability Scale and the adapted Usability, Satisfaction and Ease to Use Questionnaires were used to measure usability, ease of use. Semi-structured interviews were conducted to explore user experiences with the application with 17 participants. In stage 1, the following themes were identified from the focus groups (a) login techniques (b) self-monitoring (c) exercises, (d) exercise diary, (e) information, (f) behavioral change and encouragement (g) exercise adherence. In stage 2, 3 themes were determined from interviews: (a) learning and accuracy, (b) ease of use, (c) motivation and adherence. USE and SUS scores indicated that users reported a high level of usability, satisfaction and ease of use. A mobile app for hand exercise for people with RA was developed using a mixed-method and iterative design. Participants perceived the mobile app as easy to use with high levels of satisfaction.

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.

Cross-cultural adaptation, reliability and validity of the Turkish version of the Chronic Venous Disease Quality of Life Questionnaire (CIVIQ-20).

BACKGROUND: Chronic venous disease (CVD) is a well-defined and known disorder which impact on related-health quality of life (QoL). The Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ) is a disease-specific instrument to measure the impact of chronic venous insufficiency on patients' lives. The purpose of this study is to cross-culturally adapted the Chronic Venous Disease Quality of Life Questionnaire (CIVIQ-20) for Turkish-speaking patients and determine the psychometric properties of reliability, validity and factor structure in a Turkish population with CVD. METHODS: The CIVIQ-20 was translated into Turkish and culturally adapted using a double forward-backward protocol according to established guidelines. Individuals (n = 140) with venous diseases completed the CIVIQ-20, Venous Insufficiency Epidemiological and Economic Study (VEINES-QoL/Sym) and Nottingham Health Profile (NHP) questionnaires at baseline and 1 month later. RESULTS: Cronbach's α value was 0.93. Test-retest reliability was determined as moderate (ICC2:1 = 0.80). There was a significant correlation between CIVIQ-Tk and Nottingham and VEINES-QoL total scores (Nottingham 1: r = 0.770; p < 0.00, Nottingham 2: r = 0.7000; p < 0) (VEINES-QoL: r = -0.574; p < 0.00, VEINES-QoL 2: -0.592, p: 0.00). The measurement error were calculated from SEM and MDC90. The SEM was 2.63 and the MDC90 was 5.79. Exploratory factor analysis demonstrated a three factor structure that explained 56.32 % of total variance. CONCLUSION: The CVIQ-20 Turkish is a reliable and valid instrument for Turkish speaking patients with chronic venous insufficiency.

Effectiveness of Client-Centered Occupational Therapy in Patients With Rheumatoid Arthritis: Exploratory Randomized Controlled Trial.

OBJECTIVES: This study aims to examine the effectiveness of client-centered occupational therapy in patients with rheumatoid arthritis (RA). PATIENTS AND METHODS: The study included 40 patients (2 males, 38 females; range 39 to 60 years) with RA. Patients were divided into two groups as intervention group (n=20) and control group (n=20) by random sampling method. Each group was given 10 sessions of physical therapy program. In addition, the intervention group received client-centered occupational therapy. Patients were evaluated with Turkish versions of Short-Form McGill Pain Questionnaire, Health Assessment Questionnaire, The Arthritis Impact Measurement Scales 2, RA Quality of Life Questionnaire, and Canadian Occupational Performance Measurement. RESULTS: Pain, activity limitation, and participation restriction scores decreased significantly more in the intervention group compared to the control group. Also, quality of life increased significantly in the intervention group (p<0.05). CONCLUSION: Our findings suggest that occupational therapy intervention reduces activity limitation and participation restrictions in patients with RA. Therefore, such interventions may be generalized for this patient group.

Development and reliability of a Turkish version of the Short Form-Joint Protection Behavior Assessment (JPBA-S).

STUDY DESIGN: Clinical measurement. PURPOSE: To adapt the original JPBA-S to a Turkish version (TUR-JPBA-S) and to investigate its reliability in assessing patients with rheumatoid arthritis (RA). METHODS: Twenty-two participants with RA and 21 healthy people were videotaped while performing tasks listed in the TUR-JPBA-S. Two raters scored the video recordings for to evaluate inter-rater reliability. One rater re-analyzed the recordings at a different time point for intra-rater reliability. Participants with RA were asked to perform the same tasks after three to four weeks which was also recorded to evaluate test-retest reliability. RESULTS: Internal consistency (Cronbach's α value) was found to be high (0.89) for participants with RA. Our results demonstrate excellent intra-rater (ICC: 0.99, SEM 1.2) inter-rater (ICC: 0.99, SEM 1.7) reliability, apart from excellent test-retest reliability (ICC: 0.96). CONCLUSION: The TUR-JPBA-S is a valid and reliable instrument for assessing JP behavior in patients with RA in Turkey. LEVEL OF EVIDENCE: Level 2.

Activity performance problems of patients with cardiac diseases and their impact on quality of life.

[Purpose] To describe the functional consequences of patients with cardiac diseases and analyze associations between activity limitations and quality of life. [Subjects and Methods] Seventy subjects (mean age: 60.1±12.0 years) were being treated by Physical Medicine and Rehabilitation and Cardiology Departments were included in the study. Activity limitations and participation restrictions as perceived by the individual were measured by the Canadian Occupational Performance Measure (COPM). The Nottingham Extended Activities of Daily Living (NEADL) Scale was used to describe limitations in daily living activities. To detect the impact of activity limitations on quality of life the Nottingham Health Profile (NHP) was used. [Results] The subjects described 46 different types of problematic activities. The five most identified problems were walking (45.7%), climbing up the stairs (41.4%), bathing (30%), dressing (28.6%) and outings (27.1%). The associations between COPM performance score with all subgroups of NEADL and NHP; total, energy, physical abilities subgroups, were statistically significant. [Conclusion] Our results showed that patients with cardiac diseases reported problems with a wide range of activities, and that also quality of life may be affected by activities of daily living. COPM can be provided as a patient-focused outcome measure, and it may be a useful tool for identifying those problems.

Cross-cultural adaptation, reliability and validity of the Turkish version of the Upper Limb Functional Index (ULFI).

STUDY DESIGN: Clinical measurement. BACKGROUND: The Upper Limb Functional Index (ULFI) is a patient reported outcome (PRO) measure with sound clinimetric properties and clinical viability for determination of upper limb function. PURPOSE-METHODS: The aims of this study were to cross-culturally adapt the ULFI for Turkish-speaking patients (ULFI-Tk) and investigate the reliability and validity in patients with upper limb problems. Patients (n=l02, age 49.1±16.6) with upper limb disorders were consecutively recruited. All participants completed the ULFI-Tk and the Disability of Arm, Shoulder and Hand Turkish-version (DASH-Tk) criterion at baseline and day-three. RESULTS: The ULFI-Tk demonstrated good internal consistency (α=0.87), moderate criterion validity (DASH-Tk:r=0.68;p<0.05), moderate reliability (ICC2:1=0.72,CI=0.58-0.80) and strong error measurement (SEM=2.94;MDC90=5.35). Exploratory factor analysis demonstrated a dual factor structure that explained 31.2% of total variance. CONCLUSIONS: The ULFI-Tk is a reliable and valid PRO that could be used to assess upper limb musculoskeletal disorders in Turkish speaking patients LEVEL OF EVIDENCE: Class 2.

Cross-cultural adaptation, reliability and validity of the Turkish version of the spine functional index.

BACKGROUND: The Spine Functional Index (SFI) is a patient reported outcome measure with sound clinimetric properties and clinical viability for the determination of whole-spine impairment. To date, no validated Turkish version is available. The purpose of this study is to cross-culturally adapted the SFI for Turkish-speaking patients (SFI-Tk) and determine the psychometric properties of reliability, validity and factor structure in a Turkish population with spine musculoskeletal disorders. METHODS: The SFI English version was culturally adapted and translated into Turkish using a double forward and backward method according to established guidelines. Patients (n = 285, cervical = l29, lumbar = 151, cervical and lumbar region = 5, 73% female, age 45 ± 1) with spine musculoskeletal disorders completed the SFI-Tk at baseline and after a seven day period for test-retest reliability. For criterion validity the Turkish version of the Functional Rating Index (FRI) was used plus the Neck Disability Index (NDI) for cervical patients and the Oswestry Disability Index (ODI) for back patients. Additional psychometric properties were determined for internal consistency (Chronbach's α), criterion validity and factor structure. RESULTS: There was a high degree of internal consistency (α = 0.85, item range 0.80-0.88) and test-retest reliability (r = 0.93, item range = 0.75-0.95). The factor analysis demonstrated a one-factor solution explaining 24.2% of total variance. Criterion validity with the ODI was high (r = 0.71, p < 0.001) while the FRI and NDI were fair (r = 0.52 and r = 0.58, respectively). The SFI-Tk showed no missing responses with the 'half-mark' option used in 11.75% of total responses by 77.9% of participants. Measurement error from SEM and MDC90 were respectively 2.96% and 7.12%. CONCLUSIONS: The SFI-Tk demonstrated a one-factor solution and is a reliable and valid instrument. The SFI-Tk consists of simple and easily understood wording and may be used to assess spine region musculoskeletal disorders in Turkish speaking patients.

Cross-cultural adaptation, reliability and validity of the Turkish version of the Lower Limb Functional Index.

PURPOSE: This study aims to adapt culturally a Turkish version of the Lower Limb Functional Index (LLFI) and to determine its validity, reliability, internal consistency, measurement sensitivity and factor structure in lower limb problems. METHOD: The LLFI was translated into Turkish and cross-culturally adapted with a double forward-backward protocol that determined face and content validity. Individuals (n = 120) with lower limb musculoskeletal disorders completed the LLFI and Short Form-36 questionnaires and the Timed Up and Go physical test. The psychometric properties were evaluated for the all participants from patient-reported outcome measures made at baseline and repeated at day 3 to determine criterion between scores (Pearson's r), internal consistency (Cronbachs α) and test-retest reliability (intraclass correlation coefficient - ICC2.1). Error was determined using standard error of the measurement (SEM) and minimal detectable change at the 90% level (MDC90), while factor structure was determined using exploratory factor analysis with maximum likelihood extraction and Varimax rotation. RESULTS: The psychometric characteristics showed strong criterion validity (r = 0.74-0.76), high internal consistency (α = 0.82) and high test-retest reability (ICC2.1 = 0.97). The SEM of 3.2% gave an MDC90 = 5.8%. The factor structure was uni-dimensional. CONCLUSIONS: Turkish version of LLFI was found to be valid and reliable for the measurement of lower limb function in a Turkish population. Implications for Rehabilitation Lower extremity musculoskeletal disorders are common and greatly impact activities among the affected individuals pertaining to daily living, work, leisure and quality of life. Patient-reported outcome (PRO) measures have advantages as they are practical, cost-effective and clinically convenient for use in patient-centered care. The Lower Limb Functional Index is a recently validated PRO measure shown to have strong clinimetric properties.

[The relationship between scapular dyskinesia, pain, range of motion, and flexibility in patients with neck and shoulder problems]. / Boyun ve omuz agrili olgularda skapular diskinezi, agri, eklem hareket açikligi ve esneklik arasindaki iliski.

OBJECTIVES: To investigate the relationship between scapular dyskinesia, pain, and flexibility in patients with neck, shoulder, or both injuries. METHODS: A total of 160 patients who came to Baskent University Hospital, Department of Physical Medicine and Rehabilitation with pathology and pain in the neck and shoulder regions were included to our study. Patients were divided into three groups; Neck group, shoulder group and neck+shoulder group. Visual Analog Scale (VAS) for pain intensity, goniometer for range of motion, and tape measurement for evaluation of flexibility was used. Lateral Scapular Slide Test (LSST) and Scapular Retraction Test (SRT) vs Skapular Assisstance Test (SAT) were used for evaluation of scapular dyskinesia. RESULTS: SRT (r=0.617, p=0.000) and SAT (r=0.565, p=0.000) positivity was found to be correlated with dominant and non-dominant sides in patients with neck pathology. Pain at night and during rest were found to correlate with pain during activity in patients with neck+shoulder pathology (r=0.572, p=0.002). No significant correlation was found between pain intensity and scapular dyskinesia in all groups. LSST values were found under 1.5 cm and therefore, scapular mobilization was considered as normal (LSST1=0.76±0.74; LSST2=0.68±0.81; LSST3=0.75±0.75). CONCLUSION: In addition to joint limitations and flexibility, scapular dyskinesia should also be evaluated in order to solve problems related to pain in patients with neck, shoulder and neck+shoulder pathology. In future studies, the classification of groups according to pathology may help to understand the impact of scapular dyskinesia on the pathology of shoulder and neck pain.

The Effect of Balance Training by Tetraks Interactive Balance System on Balance and Fall Risk in Parkinson's Patients: A Report of Four Cases.

This pilot study aimed to investigate the effect of balance training by Tetraks Interactive Balance System (TIBS) on balance and fall risk in patients with mild to moderate Parkinson's disease. Four patients with Parkinson's disease between the ages of 56 and 70 years (61.25±6.70) were applied balance training for 3 weeks by TIBS. Sociodemographic features and physical properties of the subjects were recorded. Their motor performance was evaluated by the Unified Parkinson's Disease Rating Scale (UPDRS), balance was measured using the Berg Balance Scale (BBS), Functional Reach Test (FRT), Timed Up and Go Test (TUG), and the Standing on One Leg Balance Test (SOL) and, their fall risks were evaluated by TIBS. Evaluations were performed twice, before and after treatment. Following training, Parkinson's patients showed improvements in UPDRS, TUG, BBS, FRT, SOL and fall risk. Balance training by TIBS has positive effects on balance and decreases fall risk in Parkinson's disease patients.

Effects of two different quadriceps strengthening exercise approaches on cardiovascular fitness in healthy female subjects: a single blind randomized study.

OBJECTIVE: There are limited number of documents showing the relations between cardiovascular fitness and muscle strength. This study aimed to determine the effects of two different quadriceps strengthening exercise approaches on cardiovascular fitness in healthy female subjects. METHODS: Forty female university students participated in this study on a voluntary basis. The participants were randomly assigned to do either isokinetic exercise (IE) or progressive resistive exercise (PRE) in two different groups. Both training schemes were performed three times a week for a period of two weeks. The subjects were given a maximum symptom limited exercise test on a treadmill before and after (each) training period. RESULTS: Total exercise duration increased and Borg scale level decreased significantly after training in the two groups (p < 0.05). Maximal systolic blood pressure, recovery heart rate, and recovery diastolic blood pressure decreased significantly in the IE Group (p < 0.05). Resting and recovery systolic blood pressure decreased significantly in the PRE Group (p < 0.05). Compared to PRE group, improvement for Borg Scale level, recovery heart rate and recovery diastolic blood pressure were more obvious in IE Group (p < 0.05). CONCLUSIONS: This study demonstrated that both quadriceps strengthening methods have displayed improvements in cardiovascular fitness. Further research with larger sample groups may need to be carried out.