Efficacy of platelet-rich plasma in the treatment of hemiplegic shoulder pain.

OBJECTIVE: The aim of this study was to examine the effects of platelet-rich plasma (PRP) on pain and functional outcomes in patients with hemiplegic shoulder pain. We compared the effects of PRP against saline solution by designing a double blind, randomized, prospective study. DESIGN: Forty-four patients with hemiplegia were included in this study. All patients received a total of 3 injections, 1 week apart. The first group received PRP injections while the second group received placebo injections. After 3 months of follow-up, 40 patients completed the trial. Primary outcome measure was movement-induced pain score (VAS), and secondary outcome measures were spontaneous pain score, shoulder passive range of motion (ROM), functional independence measure score, and the amount of paracetamol used. All subjects were evaluated at baseline, 1 week, 1 month, and 3 months after the completion of the last injection. RESULTS: Both groups showed an improvement in spontaneous and movement-related pain scores and shoulder passive ROM values on 1st and 3rd month visits (p < 0.05). No significance difference was detected between groups (p > 0.05). Similarly, FIM scores improved significantly in both groups (p < 0.05) but no difference was found between groups. Paracetamol use did not differ significantly between groups. CONCLUSION: The PRP injections were found not to be superior to placebo. Improvements in both groups can be attributed to the use of rehabilitation techniques and exercises in all patients. There is still need for further research to show whether PRP is a treatment option in the course of hemiplegic shoulder pain. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03931824.

Efficacy of platelet-rich plasma injections in patients with adhesive capsulitis of the shoulder.

PURPOSE: The goal of this study is to investigate whether platelet-rich plasma (PRP) injections are effective in the management of adhesive capsulitis of the shoulder (AC). A triple-blind, randomized controlled trial was designed and conducted in a medical school hospital. METHODS: 32 adult patients with adhesive capsulitis (21 female, 11 male with a mean age of 57, ranging from 23 to 70) were included in this study. Patients had to have shoulder pain and restrictions in movements (at least 25% when compared to the other side, and at least in two directions) for three months minimum and nine months maximum. Patients were randomized to two groups, and one group took PRP injections for three times every two weeks, while the other group took saline injections in same frequency and volume. A standardized exercise program was also applied to all patients. Patients were evaluated with Shoulder Pain and Disability Index (SPADI), Visual Analogue Scales for pain and disability, ranges of movements, and use of analgesics in before, after, and third month after the initiation of the therapy. RESULTS: Baseline comparisons between groups showed no differences. SPADI and ranges of motion in all directions showed significant improvements with therapy, and the group which took PRP injections showed better improvements when compared to the control group (p < 0.05). Visual Analogue Scale was found to be better for the PRP group after therapy and third month, and not for the control group (0.4 ± 1.06 and 0.17 ± 0.72 vs. 2.5 ± 2.6 and 2 ± 2.2, respectively, p < 0.05). Use of analgesics was not found to be significant for both groups (p > 0.05). CONCLUSION: PRP injections were found to be effective in both pain and disability, and showed improvements in a restricted shoulder due to adhesive capsulitis. These findings might point out PRP as a therapeutic option in the management of adhesive capsulitis.

Bladder wall thickness and ultrasound estimated bladder weight in healthy adults with portative ultrasound device.

BACKGROUND: The aim of this study was to investigate bladder wall thickness (BWT) and ultrasound estimated bladder weight (UEBW) values in healthy population with a portative ultrasound device and their relationship with demographic parameters. MATERIALS AND METHODS: The study was carried out in Neurorehabilitation Clinic of Ege University Hospital. Ninety-five subjects (48 women and 47 men) aged between 18 and 56 were included in the study. BWT and UEBW were determined non-invasively with a portative ultrasound device; Bladder Scan BVM 6500 (Verathon Inc., WA, USA) at a frequency of 3.7 MHz at functional bladder capacity. These values were compared by gender, and their relation was assessed with age, body mass index (BMI) and parity. RESULTS: Mean BWT was 2.0 ± 0.4 mm and UEBW was 44.6 ± 8.3 g at a mean volume of 338.0 ± 82.1 ml. Although higher results were obtained in men at higher bladder volumes, the results did not differ significantly by gender. Correlation analyses revealed statistically significant correlation between UEBW and age (r = 0.32). BWT was negatively correlated with volume (r = -0.50) and bladder surface area (r = -0.57). Also, statistically significant correlations were observed between UEBW and volume (r = 0.36), bladder surface area (r = 0.48) and BWT (r = 0.25). CONCLUSION: Determined values of BWT and UEBW in healthy population are estimated with portative ultrasound devices, which are future promising, for their convenient, easy, non-invasive, time-efficient hand-held use for screening.

Reliability and Validity of the Turkish Version of the Multiple Sclerosis Knowledge Questionnaire.

Introduction: Multiple Sclerosis Knowledge Questionnaire (MSKQ) is a self-administered inventory assessing patients' knowledge about Multiple Sclerosis. In this study, we aimed to test the reliability and validity of MSKQ in Turkish patients. Methods: Patients with Multiple Sclerosis who attended an education seminar in our university hospital were enrolled in the study. Results: Fifty-eight patients completed and returned the questionnaire twice, before and after the seminar. Mean number of items that were answered correctly in the first round was 12.8 (5.2), which increased to 18.7 (3.2) in the second round after the seminar. This increase was found to be significant (p<0.01). Conclusion: Questions regarding general characteristics of the disease were found to be answered correctly more often than those questions regarding diagnostic and treatment options. This finding indicates that patients may be more interested in the general characteristics of the disease and in the factors that may have started the disease process. Higher number of incorrect answers regarding diagnostic and treatment strategies may be caused by a lack of interest on the part of the patient who may perceive these subjects to be too complex or who may choose to leave decision-making to healthcare professionals. Also, physicians may be unable to inform patients in these areas because of a lack of time or resources. New molecules developed for the treatment of Multiple Sclerosis makes it even more difficult for patients to follow and form their own opinions about the treatment process. These results show us that patient education is essential and our patients need more educational resources, especially regarding treatment options. The significant increase in the number of correct answers after the education seminar supports the need for broader patient education (p<0.01). Turkish version of MSKQ is a reliable and valid measure for assessing patients' level of knowledge.

Reference data for ulnar nerve short segment conduction studies at the elbow.

INTRODUCTION: The aim of this study was to generate reference data for ulnar nerve short segment conduction studies (SSCSs) at 2-cm intervals. METHODS: Ulnar nerve SSCS data were collected from dominant and non-dominant arms of 200 healthy volunteers. The effects of age, gender, weight, height, and body mass index (BMI) on SSCSs were also investigated. RESULTS: High percentile values for short segment latency changes varied from 0.4 to 0.7 ms. Ulnar nerve conductions were slower in the segments 2 cm below and above the elbow compared with the other segments. The amplitude was found not to decrease by >15% in subsequent short segments. There were no significant effects of age and gender on the SSCS parameters. Conductions over the short segments tended to be faster as BMI increased. CONCLUSIONS: Reference values should be determined separately over each 2-cm segment, and the effect of BMI should be considered when interpreting SSCSs.

Effects of Short Wave Diathermy Added on Dextrose Prolotherapy Injections in Osteoarthritis of the Knee.

Objective: To show the effects of short wave diathermy (SWD) added on prolotherapy injections in osteoarthritis (OA) of the knee on pain, physical functioning, and quality of life. Design: This is a single-blinded randomized controlled study. Setting: Physical Medicine and Rehabilitation Department of a university hospital. Subjects: Sixty-three patients with OA of the knee with Kellgren-Lawrence class 2 or 3 were included in the study. Methods: Patients were randomized into two groups, first being dextrose prolotherapy+SWD and the second being dextrose prolotherapy with sham SWD. Patients were injected with dextrose prolotherapy solutions in the beginning, third, and sixth week of the study, for a total of three times, and took 20 min of SWD after injection (true or sham). Outcome measures: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analogue Scale (VAS) for pain, and Short Form Health Survey (SF-36) were applied before, after (sixth week), and at the third month of treatment. Results: Both groups showed improvements in VAS, WOMAC, and SF-36 scores (p < 0.05). Between-group analyses showed no significant differences (p > 0.05). Conclusions: This study shows that prolotherapy is effective for pain, functionality, and quality of life in patients with OA of the knee. The effects of additional SWD require more evidence. More studies of higher quality are required to make a statement.

Reliability and validity of the Turkish version of the intermittent self-catheterization questionnaire in patients with spinal cord injury.

PURPOSE: To evaluate the validity and reliability of the Turkish version of the Intermittent Self-Catheterization Questionnaire (ISC-Q) in patients with spinal cord injury (SCI). This questionnaire evaluates four problems related to the use of ISC, which are ease of use, convenience, discreetness and psychological well-being. METHODS: A total of 60 SCI (40 males, 20 females) patients were included in the study. Reliability was assessed using Cronbach's α and intraclass correlation coefficient (ICC) methods, and the validity was assessed using the correlations between the ISC-Q scores and the scores for the King's health questionnaire (KHQ). RESULTS: The mean age of the study sample was 37.07 ± 12.6 years. Of patients, 56.6% were completely injured. Both the internal consistency (Cronbach's alpha coefficient 0.899-0.947) and the test-retest reliability (intraclass correlation coefficient 0.899-0.947) of the ISC-Q were found to be high in patients with SCI. In the validity analysis, significant positive correlation was identified between convenience, psychological well-being, and total score domains and most subgroups of the KHQ, and also significant negative correlation was found between the discreetness of the domain and the impact of urinary incontinence, role limitation, physical limitation, social limitation and emotional status domains of the KHQ. CONCLUSION: The Turkish version of the ISC-Q can be considered a reliable and valid tool for the evaluation of quality of life related to catheterization in patients with SCI.

Updated approach for the management of osteoporosis in Turkey: a consensus report.

As a result of the current demographics, increased projections of osteoporosis (OP) and prevalence of the disease in Turkey, a panel of multidisciplinary experts developed a thorough review to assist clinicians in identifying OP and associated fracture risk patients, diagnosing the disease with the appropriate available diagnostic methods, classifying the disease, and initiating appropriate treatment. The panel expects to increase the awareness of this prevalent disease, decrease consequences of OP with corresponding cost savings and, ultimately, decrease the overall burden of OP and related fractures in Turkey. BACKGROUND: OP is not officially accepted as a chronic disease in Turkey despite the high prevalence and predicted increase in the following years. However, there are areas where the country is performing well, such as having a country-specific fracture risk assessment model, DXA access, and the uptake of FRAX. Additional efforts are required to decrease the existing treatment gap estimating 75-90% of patients do not receive pharmacological intervention for secondary prevention, and the diagnosis rate is around 25%. METHODS: A selected panel of Turkish experts in fields related to osteoporosis was provided with a series of relevant questions to address prior to the multi-day conference. Within this conference, each narrative was discussed and edited by the entire group, through numerous drafts and rounds of discussion until a consensus was achieved. Represented in the panel were a number of societies including The Turkish Osteoporosis Society, The Society of Endocrinology and Metabolism of Turkey (SEMT), and The Turkish Society of Physical Medicine and Rehabilitation. RESULTS: Standardized general guidelines to identify OP and related fractures and at-risk population in Turkey, which will enable clinicians to accurately and effectively diagnose the disease, treat the appropriate patients with available pharmacological and non-pharmacological treatments and decrease the burden of the disease. CONCLUSIONS: This manuscript provides a review of the current state of OP and related fractures in Turkey. Moreover, this manuscript reviews current international guidelines and national studies and proposes a number of helpful country-specific classifications that can be used by healthcare providers caring for the at-risk population. Additionally, the panel proposes practical recommendations that should be implemented nationally in order to decrease the burden of OP and related fractures and effectively preventing the burden in future generations.

Escobar (multiple pterygium) syndrome: Multidisciplinary approach to a very rare syndrome.

Escobar (multiple pterygium) syndrome is progressive and a very rare syndrome. It is generally characterized by multiple pterygia that are found in the cervical, antecubital and popliteal regions. In this report, we present the treatment management of a 14-year-old case with late stage Escobar syndrome who was admitted due to multiple pterygia and bilateral knee contractures. The treatment of this case was conducted in collaboration with the department of orthopedics and the department of physical therapy. The treatment of the case was done in three stages: soft tissue procedures, femoral recurvatum osteotomy and triple arthrodesis, respectively. In addition to all these, the patient did intensive physical therapy for one year. As a result of the operations and physical therapy, adequate muscle strength was obtained.

The psychometric properties of the Turkish Stroke and Aphasia Quality Of Life Scale-39.

The Stroke and Aphasia Quality Of Life Scale (SAQOL-39) is a widely used instrument in assessing the quality of life in aphasic patients. Our purpose was to translate the SAQOL-39 into the Turkish language (SAQOL-39/TR) and assess its reliability and validity in patients who had aphasia. SAQOL-39/TR was obtained using the 'translation-backward translation' method and administered to 40 patients with aphasia. The reliability studies were performed by means of internal consistency and test-retest reliability. The validation studies were carried out by means of construct validity using within-scale analyses and analyses against the external criteria. Correlation analysis was performed between scales and the Ege Aphasia Test, the Barthel index, the 12-item General Health Questionnaire and the Brunnstrom recovery stages (BRS) of the arm, hand, and lower extremity. In the results, the scores of the SAQOL-39 were not different between groups. Cronbach's α variables were good for all domains (0.80, 0.88, 0.89, 0.82, and 0.83). Test-retest reliability was also high (0.96, 0.97, 0.91, 0.70, and 0.96). There were significant correlations with coefficients ranging from 0.36 to 0.60 among the domains of scale and other measures. Moderate-high correlations were also seen with BRS-arm, BRS-hand, and BRS-lower extremity (r, 0.27-0.58). It was found that all domains were highly related with all domains of Ege aphasia test, except praxia (P<0.001). This study showed that the SAQOL-39/TR has acceptable validity and reliability in assessing the quality of life. However, similar results of the scale in patients with dysarthria suggest that the SAQOL-39 may not be specific to only aphasic patients.

Validity and reliability of a new test for Turkish-speaking aphasic patients: Ege Aphasia Test.

Due to the fact that the phonetic, morphological and syntactic structures of the Turkish language differ significantly from other European languages, the translated forms of the currently available aphasia assessment batteries are not adequate for Turkish-speaking aphasic patients. The aim of this study was to assess the validity and reliability of the Ege Aphasia Test that we have developed. The test, which includes the 8 subtests of praxia, spontaneous language, auditory and verbal comprehension, repetition, naming, reading, writing and calculating, was applied into 100 aphasic patients, 40 dysarthric patients and 40 healthy subjects. All test-retest intra-class correlation coefficients were found to be excellent (ICC = 0.99). The Cronbach's coefficients ranged from 0.71 to 0.91. All the subtests showed significantly greater scores in aphasic patients (p < 0.05). Significant correlations were found between the subtests and corrected total score (p < 0.05). Finally, the Ege Aphasia Test has an acceptable validity and reliability. It seems to be a promising battery for evaluation of aphasia in the Turkish language, which is spoken mainly in Turkey and in the surrounding regions. We believe that this study will pioneer the development of aphasia rehabilitation in these countries and contribute to future studies.