Relationship between spinal mobility measures and quality of life in patients with ankylosing spondylitis.

The aim of this study was to assess spinal mobility status and Quality of life (QoL) of patients with ankylosing spondylitis (AS) and determine the relationship between spinal mobility and measures of clinical condition including QoL. A total of 74 patients with AS were included in this study. Disease specific instruments Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) were applied, and mobility testing: occiput-wall distance and chest expansion. QoL was assessed by the Short Form-36 (SF-36). The mean age was 48.5 years; there were significant correlations between BASMI score and age (P < 0.001), disease duration (P < 0.001), symptoms duration (P < 0.001) and BASFI (P < 0.001). BASMI was negatively correlated with SF-36 physical function subscale (P < 0.001) and general health subscale (P = 0.029). In multivariate regression analysis, BASFI score (P < 0.001) was independently associated factor with physical function domain of SF-36. This study showed that in AS spinal mobility measures are associated with physical function, general health, emotional role and mental health domains of QoL.

The efficacy of two protocols for inducing motor cortex plasticity in healthy humans--TMS study.

Stimulation-induced plasticity represents an experimental model of motor cortex reorganization. It can be produced in awaked humans by combining the non-invasive electrical stimulation of somatosensory afferents via mixed peripheral nerves with the transcranial magnetic stimulation (TMS) of the motor cortex. Animal experiments indicate that an application of two converging inputs from various sources in a tightly coupled manner, following the so called Hebbian rule of learning, leads to an increase in motor cortical excitability. The aim of our study was to compare the effects of two plasticity-inducing protocols by quantifying the motor cortex changes using TMS. Plasticity was induced by combining peripheral nerve stimulation with TMS (paired associative stimulation - PAS) and by peripheral motor point stimulation of two adjacent hand muscles (dual associative stimulation - DAS). The protocols were randomly applied in 12 right-handed healthy volunteers. The amplitudes of TMS-induced motor-evoked potentials (MEPs) in the right abductor pollicis brevis muscle were recorded before, immediately after PAS or DAS stimulation, and 10, 20 and 30 min later. Both protocols led to significant and lasting changes in MEP amplitudes, however, a significantly larger increase in MEPs was observed after PAS than DAS. The results indicate that afferent input can differently affect cortical motor circuits and produce variable motor output. Thus, the efficacy of LTP-like mechanisms, presumably involved in Hebbian-like plasticity in humans, varies with the types/origin of the converging inputs. Our findings may be relevant when designing therapeutic interventions for improving motor function after neurological injury or disease.

Dose-response relationship between the H-reflex and continuous intrathecal baclofen administration for management of spasticity.

OBJECTIVE: To determine the relationship between the H-reflex (H/M ratio) and continuous intrathecal baclofen (CITB) dose after pump implantation for control of spastic hypertonia. METHODS: Soleus H-reflexes were serially recorded in 34 subjects (19 men, mean age 32 years, mean follow-up 1.7 years) during simple continuous mode of CITB delivery. Different fitting methods were explored to determine which function best described changes in H/M ratio with increasing CITB dose. We then calculated effective CITB doses yielding H/M ratios equal to 75, 50, and 25% (ED75, ED50, ED25) of the baseline recorded before the implant in 22 subjects. RESULTS: We found a significant dose-response relationship between the soleus H/M ratio and CITB dose. A two-decay exponential function was the best fit on each side for pooled data, but a general linear model when controlling for subject. The mean ED75, ED50, ED25 were 30, 70, and 110 mcg/day. Logistical regression predicted with high probability that the H/M ratio should be less than 30% at CITB doses above 150 mcg/day. CONCLUSIONS: H/M ratio is strongly dependent on CITB dose. It sharply decreases up to 150 mcg/day of CITB followed by a plateau. SIGNIFICANCE: Establishing the relationship between the H/M ratio and CITB dose may be useful for dose titration and early identification of an ITB system malfunction.

Structured exercise program improves functional capacity and delays relapse in euthyroid patients with Graves' disease.

PURPOSE: To evaluate short- and long-term effects of structured exercise program in euthyroid patients with Graves' disease. METHODS: The study employed a retrospective case-control design. The exercise group (n = 62) underwent 3 weeks of structured exercise program consisting of daily walking, strengthening, and stretching exercises while the control group (n = 62) participated in leisure activities. Thyroid profile, aerobic capacity, and perceived fatigue were evaluated on in-patient admission and discharge. Time to discontinuation of anti-thyroid medication after discharge and time to relapse of symptoms were determined. RESULTS: The exercise group increased estimated peak oxygen consumption (significant group-by-time ANOVA interaction, P < 0.001), decreased serum thyroxin (P = 0.038), increased serum thyrotropin (P = 0.071), and reported less fatigue (Fisher's exact test, p < 0.001) from admission to discharge. The anti-thyroid medication was withdrawn within 6 months of discharge in significantly greater proportion of subjects in the exercise than control group (84% vs. 18%). Conversely, the rate of relapse within 12 months of medication withdrawal was smaller in the exercise (29%) than control group (72%). CONCLUSIONS: The results suggest that structured exercise program may normalize thyroid profile, improve aerobic capacity, and reduce fatigue on the short-term basis as well as reduce the need for anti-thyroid medication on the long-term basis.

Assessment of functional disability and quality of life in patients with ankylosing spondylitis.

INTRODUCTION: Ankylosing spondylitis is a chronic progressive autoimmune inflammatory disorder involving mainly the axial skeleton and larger peripheral joints that progressively limits spinal mobility and may lead to irreversible structural changes and consequently to impaired physical function and reduced quality of life. OBJECTIVE: The aim of this study was to assess functional disability and quality of life of patients with ankylosing spondylitis and determine the correlation between functional disability and quality of life. METHODS: The study enrolled 74 patients with ankylosing spondylitis (16 females and 58 males). The demographic data of the patients were collected. Functional disability was assessed with the Bath Ankylosing Functional Index (BASFI). Quality of life was assessed by the Short-Form 36 (SF-36) and the European Quality of Life Questionnaire (EuroQoL/EQ-5D). RESULTS: In our study, the mean age was 48.5 +/-10.3 years. BASFI was negatively correlated with the SF-36 physical function subscale (p < 0.001), physical role (p = 0.002), bodily pain (p = 0.003), general health (p < 0.001), vitality (p = 0.012) and mental health (p = 0.010) subscale. There was a significantly inverse correlation between the BASFI score and the rating scale of EQ-5D (p = 0.001). In the regression model, the BASFI score (p = 0.000) showed an independent association with the physical function domain of SF-36. CONCLUSION: In conclusion, the BASFI index was associated with physical function, physical role, bodily pain, general health, vitality and mental health domains of SF-36 and also with the rating scale of EQ-5D.

[Assessment of health-related quality of life of patients with chronic arthritis].

The assessment of the quality of life as a subjective measure of therapeutic intervention outcome appears to be increasingly adopted by different fields of medicine. In contrast to conventional indicators of condition, which are recognized as objective outcomes, the health-related quality of life (HRQoL) focuses on the patient himself. HRQoL has been determined as the perception of the individual of his or her situation in the current culture and value system; it includes wishes, expectations and emotional responses of the individual related to his or her health. Chronic arthritis leads to irreversible structural changes in joints and consequently to impaired physical function and reduced HRQoL. Today there are validated disease specific ("target") questionnaires to assess HRQoL in patients with rheumatoid arthritis and ankylosing spondylitis, but not yet in patients with psoriatic arthritis. A disease specific questionnaire makes easier approach to patients suffering from a specific rheumatic condition; it enables the comparison of HRQoL among patients suffering from the different types of chronic arthritis. The most frequently used questionnaire in the assessment of the HRQoL of patients suffering from chronic arthritis is the generic MOS 36-Item Short-Form Health Survey (SF-36) which is considered as the "gold standard". It is a generic questionnaire for the assessment of HRQoL in patients with chronic arthritis. To our knowledge, there are only a few studies focused on the HRQoL of patients suffering from chronic arthritis in Serbia and Montenegro.

[Beneficial effects of spa treatment on functional status and quality of life of patients with rheumatoid arthritis].

INTRODUCTION: Rheumatoid arthritis (RA) is a chronic constantly deteriorating disease of unpredictable clinical course, with exacerbations, remissions and damaged joints. It leads to the loss of self-sufficiency, independence in performing many daily activities, decrease of working ability and invalidity. Beside physical factors, which are regarded as most responsible for the poorer quality of life of RA patients, psychological changes are also significant, such as the feeling of helplessness, hopelessness and depression. The goal of the treatment of patients with RA is to decrease illness symptoms, slow down the development of illness progression, improvement of physical functioning and provision of expert help to the RA patients to adapt to life. OBJECTIVE: The aim of the study was to assess the influence of spa therapy on the functional condition and life quality of RA patients. METHODS: The study involved 69 patients with RA (51 female and 18 male, on average aged 55.2 +/- 11.4 years, with illness duration 12.5 +/- 7.5 years), and were a part of a cohort from Norway, suffering of inflammatory rheumatism. All the patients came for four-week rehabilitation at the Institute for Physical Medicine, Rehabilitation and Rheumatology "Dr. Simo Milosevic" in Igalo, Montenegro. The RA patients underwent treatment with mud compresses, mud, mineral and pearl baths, as well as with underwater shower massage (balneotherapy) kinesitherapy and certain forms of electrotherapy with analgesic effects. The evaluation was done on admission and after completed physical therapy when we assessed RA patients' functional condition and quality of life. The functional condition was determined using the Modified Health Assessment Questionnaire (MHAQ), and the quality of life using the Medical Outcomes Study Short Form 36-item Questionnaire (SF-36), which encompassed eight life domains. RESULTS: After completion of 28-dayspa therapy, RA patients showed a significant improvement in functional condition. Their quality of life was significantly improved in all dimensions of SF-36 Questionnaire (p < 0.01), and the functional status (MHAQ score) was also significantly better (p < 0.01). CONCLUSION: Balneotherapy, together with climatic factors in Igalo, leads to a significant improvement of functional status and quality of life in patients suffering from RA.

[Early rehabilitation after traumatic brain injury and cerebrovascular accident--functional tests database].

INTRODUCTION: This paper deals with implementation of functional tests used in early rehabilitation into medical record databases. A pilot-testing of certain measurement instruments was performed to establish if they can be used in short intervals as variables for traumatic brain injury patients and those with stroke in intensive care units. The steering group gave critera for inclusion/exclusion. MATERIAL AND METHODS: We followed up four groups of 15 patients. On admission, their Glasgow Coma Score (GCS) was 5-8, 9-12, 13-15. Patients with isolated traumatic brain injury (TBI) were examined using Disability Rating Score (DRS); patients with GCS 13-15 underwent Galveston Orientation and Amnesia Test (GOAT); stroke patients were tested using Motricity Index and the Canadian Stroke Scale. All test were performed for five days in a row. RESULTS: In the first group, DRS results were identical in all cases. Differences were found in patients with GCS higher than eight, while GOAT was positive in four patients that required neuropsychological testing. In stroke patients, Motricity Index was more discriminative than the Canadian Stroke Scale. CONCLUSION: In accordande with our results, the steering group accepted DRS as the variable for patients with GCS 9-12 and 13-15, GOAT for patients with GCS 13-15 and Motricity Index for stroke patients.

[Functional outcome evaluation after total hip arthroplasty].

INTRODUCTION: Total hip arthroplasty improves the hip functional status and quality of life of operated patients. The surgery outcome is determined by several numerical methods. The aim of this study was to evaluate the hip functional status 1 and 5 years after total hip arthroplasty using a modified Harris hip score. MATERIAL AND METHODS: 75 patients with 78 primary total hip arthroplasties were included in the study. All patients underwent clinical evaluation 1 and 5 years after operation using our modified Harris hip score. From the original score 2 questions, that evaluated the range of motion (5 points) and deformity (4 points), were excluded, and 2 questions that assessed the hip function were added: rising from a chair after an hour of sitting (5 points) and bathing (4 points). Also, we added one question regarding patient's satisfaction after surgery. RESULTS: I and 5 years after the surgery, very good hip functional status was verified in 77% and 82.4% of patients respectively (excellent and good total Harris hip score). 92% of patients were satisfied with the outcome 1 and 5 years after the operation. CONCLUSION: Our modified Harris hip score can be used for long-term evaluation of patients after total hip arthroplasty.

[Prognostic value of classical electrodiagnosis in patients with peripheral facial nerve paralysis].

INTRODUCTION: Electrodiagnostic tests are performed in order to obtain information on the severity of lesions and the possibility of functional recovery. Classic electrodiagnostics implies excitability testing by faradic and galvanic currents, and chronaximetry. This method has been pushed out by new diagnostic procedures, although it is a reliable method that can give data about the severity of lesions and precise data about the maximal possible function recovery and the time it takes. The aim of this study was to investigate the correlation between the results of classic electrodiagnosis and functional recovery in patients with facial paralysis. MATERIAL AND METHODS: The prospective study included 50 ambulatory patients treated at the Department of Physical Medicine and Rehabilitation. After the use of diagnostic procedures (otorhinolaryngological, neurological, radiological), all patients underwent physical therapy. Two weeks after the onset of paralysis, classic electrodiagnostics was performed. We compared the prognosed and achieved recovery in two ways: for each muscle separately and for gross function (the House-Brackmann scale). RESULTS: 32 patients (64%) had only changes in excitability, 7 patients (14%) showed partial electrodegenerative reactions, 4 patients (8%) had electrodegenerative reactions and preserved reactions to faradic currents, 4 patients (8%) showed electrodegenerative reactions and inexcitability to faradic currents, and 3 patients (6%) had disruption of conductivity. Comparison of prognosed and achieved marks for the frontal, orbicularis oris and mental muscle showed a highly significant agreement in 94%, 80% and 86% of patients, respectively. There is also a highly significant agreement between prognosed and achieved recovery, described according to the House-Brackmann scale. DISCUSSION: In this study, classic electrodiagnostics showed a highly significant correlation between the predicted and the achieved outcome. Correlation was more significant when the "marking method for individual muscles" was used. The authors think that the classic test, unjustly pushed out in favor of new methods, (electroneurography - ENG, nerve excitability test - NET), certainly has advantages (insignificant intertrial and side-to-side variations as well as the possibility to test each muscle separately). CONCLUSION: The classic electrodiagnostics is a century old technology that offers useful information on nerve lesions. In our opinion, it should be part of the physiatric examination of patients with peripheral facial nerve paralysis.