Efficacy of EMG-biofeedback in knee osteoarthritis.

This study was designed to investigate the additive effect of EMG-biofeedback in rehabilitation of knee osteoarthritis. Forty patients, aged 45-70, with the diagnosis of knee osteoarthritis according to American College of Rheumatology (ACR) criteria were taken into the study. The patients were randomly assigned in two groups. One group (n = 20) received strengthening exercise program with EMG-biofeedback while the other group (n = 20) had the same exercise program without biofeedback for 3 weeks. The clinical outcome was assessed on the basis of pain with visual analog scale (VAS), function with Western Ontario McMaster Osteoarthritis Index (WOMAC) and quality of life with Nottingham Health Profile (NHP). Quadriceps strength was measured with Cybex isokinetic dynamometer, isokinetically at the angular velocities of 60 and 180 degrees /s and isometric strength at 65 degrees of knee flexion. Pain, WOMAC scores and muscle strength improved in both groups but there was no statistically significant differences between two groups (p > 0.05). In both groups physical mobility, pain scores of NHP improved significantly (p < 0.001) while in EMG-biofeedback group energy and sleep scores also improved after treatment (p < 0.05). As reported in the literature, in our study, strengthening exercises improved pain, function, muscle strength and quality of life in patients with knee osteoarthritis. But it seems that there is no significant additive effect of EMG-biofeedback to regular strengthening exercise program in these patients.

Easy Volumeter in Detection of Breast Cancer-Related Lymphedema: A Validity Study.

Aim and Hypothesis: The standard volumeter is heavy and fragile, and using the same volumeter for different patients can result in hygiene problems. These disadvantages point to the need for the development of a new model of volumeter. The new volumeter put forward in this study is lighter, smaller, sturdier, and easier to clean, while also having its own scale. In this study, the validity of this newly designed volumeter is investigated. Materials and Methods: In the first step, the volume of standard cylinders was measured thrice using a standard volumeter and an easy-measurement volumeter, after which a total of 30 arm volumes of 15 volunteers were measured. In the final stage, the arms of 28 patients with breast cancer-related lymphedema were measured once with both volumeters and the mean results were compared. Results: There was a high degree of consistency between the measured volumes of cylinders of known volume when measured with a standard volumeter and the "Easy volumeter." The measured mean volumes with the two volumeters were assessed with paired sample t-test, resulting in a significance (p value) of 0.927, indicating no difference between the measurements of the two volumeters. The variance of measurement of the devices was assessed with a Levene's test, and the significance (p value) was obtained as 0.981. Based on this result, the null hypothesis cannot be rejected, meaning that there is no difference in the variances of measurements of the two volumeters. Likewise, a paired sample t-test was used to evaluate the differences between the mean measurements of the healthy volunteers group, and no difference was detected between the mean arm volumes measured with each volumeter (significance=0.105). The measurements between the two volumeters were also consistent in the lymphedema patient group (involved arm significance = 0.842 and normal arm significance = 0.075). Conclusion: Our study revealed the validity of the newly designed "Easy Volumeter" for the measurement of arm volumes, indicating its appropriateness for use in daily practice.

Is Continuous Passive Motion Effective in Patients with Lymphedema? A Randomized Controlled Trial.

BACKGROUND: In this randomized controlled study, we aimed to evaluate the effect of shoulder flexion exercise using continuous passive motion (CPM) on lymphedema during the treatment of breast cancer-related lymphedema (BCRL). METHODS: Thirty patients with BCRL were enrolled and completed the study. Fourteen patients were treated with complete decongestive therapy (CDT) and CPM in the intervention group, and 16 patients were treated with CDT alone (control group) for 15 sessions. The main outcome measures were included; the shoulder range of motion (ROM) assessed with a goniometer, limb volume difference measured using the water immersion method, function with the Disabilities of the Arm, Shoulder and Hand (DASH), and the quality of life using the Functional Assessment of Cancer Therapy for Breast Cancer (FACT-B4). Lymphedema volume measures were taken at baseline, on days 1, 2, 3, 4, 5, 10, and 15; and shoulder ROM, FACT-B4, and DASH were taken at baseline and on day 15. RESULTS: All subjects were similar at baseline. After treatment significant improvement was found in ROM, volumetric differences, DASH, and FACT-B4 scores in both groups. No significant differences were observed in the volumetric differences, ROM, and the DASH, and FACT-B4 scores between the groups, except for the FACT-B4 physical well-being subscores, which were better in intervention group. CONCLUSION: Our study results showed that CPM did not contribute to the reduction of BCRL.

Quantitative calcaneal ultrasonometry: normative data and age-related changes for stiffness index in the Turkish population.

The aim of this cross-sectional study was to define the normative data for stiffness index in a large sample of Turkish population and to clarify sex differences as well as age-related changes. A total of 10,435 subjects (aged 18-89 yr) were screened with calcaneal ultrasound and were requested to complete a detailed questionnaire listing all important risk factors, diseases, and treatments affecting bone metabolism. To be included in the study, subjects had to be free of any disease and any medical treatment known to affect bone metabolism. A total of 8,156 subjects (1,389 males and 6,767 females) were included in the study. Normative data was expressed using two statistical models including mean and 95th percentile, and regression analysis. The mean value of stiffness index in females peaked in the third decade, whereas in males it peaked in the age group of 18-29 yr. The stiffness index of females decreased by 24.26%. The total age-related decrease was 17.8% for stiffness index in the males. Stiffness index in males was a function of age (negatively) and body mass index (positively). Stiffness index in females was a function of age (negatively) and weight (positively). The results of this study could be useful as a guide for comparing the data of individual studies and may serve as reference normative data for the Turkish population.

[The relationship between objective and subjective evaluation criteria in lumbar spinal stenosis]. / Lomber spinal stenozda objektif ve subjektif degerlendirme ölçütleri arasindaki iliski.

OBJECTIVES: We evaluated the relationship between functional objective and patient-based subjective assessments and quality of life in patients with lumbar spinal stenosis (LSS). METHODS: Thirty patients (25 females, 5 males; mean age 62+/-9 years; range 41-78 years) were prospectively studied. All were diagnosed as having LSS by clinical and radiological evaluations. Pain was assessed by a visual analog scale. The patients were evaluated by the two-staged treadmill exercise tolerance (TET) test, SF-36 health status survey, and Oswestry Disability Index (ODI). The relationships between the TET test, which is an objective functional assessment, and patient-based assessments (SF-36 and ODI), pain and age were investigated. RESULTS: There were significant differences between the functional grades of the patients at the speed of 1.9 km/hour with respect to ODI scores, the physical component scale of SF-36, age, and the preferred speed of the patients (p<0.05). These differences emerged from the fourth functional stage (p<0.01). Oswestry disability scores and the physical component scores of SF-36 worsened in parallel with the stages of the TET test. The preferred speed of the patients at the TET test was positively correlated with the physical component scores of SF-36 and negatively correlated with Oswestry disability scores (p<0.05). There was a negative correlation between the physical component scores of SF-36 and Oswestry disability scores (p<0.05). CONCLUSION: The TET test used to determine the functional capacity seems to be correlated well with subjective patient-based assessments. This objective tool, when combined with subjective assessments, may be helpful in the evaluation and treatment of patients with LSS.

Gastrointestinal side effect profile due to the use of alendronate in the treatment of osteoporosis.

The aim of our study was to evaluate the upper gastrointestinal (GI) tract side effect profile in 759 female patients that had taken alendronate (10 mg/day), for at least 6 months, for the treatment of osteoporosis, in relation to the safety of alendronate and the compliance of patients to its absorption rules. This study was a multicentered retrospective, clinical, non- placebo controlled, study of 759 female subjects carried out at 26 centres in 6 different regions of Turkey. The mean age of our patients was 62.6 +/- 8.6, with 51.2%in the age range 60 to 69 years. 158 patients (20.8%) were considered to have upper GI tract complaints with nausea as the most often encountered symptom. Of the subjects with upper GI tract complaints, 20% reported discontinued drug use, and 30% reported the requirement of an additional drug in order to abolish their complaints. Approximately 537 (71%) of the patients stated they had been given written information about the administration of the drug, and at least 93 patients (12%) and 73 patients (18.4%) acknowledged non compliance with the safety and absorption rules, respectively. In our study, no significant difference was found between the adherence to the safety measures and upper GI tract complaints (p > 0.05), but that upper GI tract complaints were higher in patients taking additional medication to alendronate (p < 0.05).

Effects of muscle strengthening versus aerobic exercise program in fibromyalgia.

The purpose of this study was to compare the effects of aerobic training with a muscle-strengthening program in patients with fibromyalgia. Thirty women with fibromyalgia were randomized to either an aerobic exercise (AE) program or a strengthening exercise (SE) program for 8 weeks. Outcome measures included the intensity of fibromyalgia-related symptoms, tender point count, fitness (6-min walk distance), hospital anxiety and depression (HAD) scale, and short-form health survey (SF-36). There were significant improvements in both groups regarding pain, sleep, fatigue, tender point count, and fitness after treatment. HAD-depression scores improved significantly in both groups while no significant change occurred in HAD-anxiety scores. Bodily pain subscale of SF-36 and physical component summary improved significantly in the AE group, whereas seven subscales of SF-36, physical component summary, and mental component summary improved significantly in the SE group. When the groups were compared after treatment, there were no significant differences in pain, sleep, fatigue, tender point count, fitness, HAD scores, and SF-36 scores. AE and SE are similarly effective at improving symptoms, tender point count, fitness, depression, and quality of life in fibromyalgia.