An evaluation of bladder emptying methods and the effect of demographic and clinical factors on spontaneous voiding frequency in stroke patients.

In this study, the bladder emptying methods at different stages of the post-stroke period along with the effects of demographic and clinical parameters on spontaneous voiding frequency were investigated. The frequencies of bladder emptying methods at admission to the rehabilitation clinic, after neurourological and urodynamic assessment and at home after discharge were spontaneous voiding (SV) 51/99 (51.5 %), 62/99 (62.6 %), 73/99 (73.7 %), emptying without a urinary catheter + an external collector system (EWUC + ECS) 24/99 (24.2 %), 18/99 (18.2 %), 17/99 (17.2 %), intermittent catheterization (IC) 1/99 (1.0 %), 15/99 (15.2 %), 6/99 (6.1 %), indwelling urethral catheter (IUC) 23/99 (23.2 %), 4/99 (4.0 %) and 3/99 (3.0 %), respectively. Lower spontaneous voiding frequencies were observed in single-divorced and geriatric individuals (p < 0.05). The number of patients who modified the method at home was 2/62 for SV, 5/18 for EWUC + ECS, 9/15 for IC, and 2/4 for IUC. The majority of stroke patients were able to void spontaneously and the spontaneous voiding frequency increased at follow-up. The spontaneous voiding frequency was low in geriatric and single-divorced subgroups. The method in which the most changes occurred was IC.

The effects of baseline heart rate recovery normality and exercise training protocol on heart rate recovery in patients with heart failure.

OBJECTIVE: It is unclear which exercise training protocol yields superior heart rate recovery (HRR) improvement in heart failure (HF) patients. Whether baseline HRR normality plays a role in the improvement is unknown. We hypothesized that an exercise training protocol and baseline HRR normality would be factors in altering HRR in HF patients. METHODS: In this prospective, randomized, controlled and 3 group parallel study, 41 stable HF patients were randomly assigned to 3-times-weekly training sessions for 12 weeks, consisting of i) 30 minutes of interval training (IT) (n=17, 63.7±8.8 years old) versus ii) 30 minutes of continuous training (CT) (n=13, 59.6±6.8 years old) versus iii) no training (CON) (n=11, 60.6±9.9 years old). Each patient had cardiopulmonary exercise testing before and after the training program. Maximum heart rates attained during the test and heart rates at 1 and 2 min (HRR1 and HRR2) during the recovery phase were recorded. Paired samples t-test or Wilcoxon signed-rank test was used for comparisons before and after training. One-way ANOVA or Kruskal-Wallis variance analysis was used for comparisons among groups. RESULTS: HRR1 was unchanged after training. HRR2 improved in the IT group after training, and post-training HRR2 values were significantly faster in the IT group than in controls. Both HRR1 and HRR2 was significantly faster, irrespective of exercise protocol in patients with abnormal baseline values after training. CONCLUSION: HRR1 did not improve after training. HRR2 improved only in the IT group. Both HRRs in patients with abnormal baseline values improved after both exercise protocols. IT might be superior to CT in improving HRR2. Baseline HRR might play a role in its response to exercise.

Psychic predictors of outcomes of physical therapy.

BACKGROUND AND OBJECTIVES: To investigate the relations between alexithymia, temperament features, depression and anxiety levels and level of benefit from physical therapy. MATERIAL AND METHOD: Fifty-eight patients in a physical therapy program were included in this study. Toronto Alexithymia Scale (TAS), Temperament Evaluation of the Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A), Beck Depression Scale (BDS) and State-Trait Anxiety Inventory (STAI) were used before the treatment. Response to treatment parameters were as follows: pre-treatment, 10th session and 3rd month resting and activity pain was evaluated using the Visual Analogue Scale (VAS-R, VAS-A), patients' self global evaluation (PSGE), doctors' global patient evaluation (DGPE) and Nottingham Health Profile (NHP). RESULTS: At the end of treatment, significant recovery was obtained in VAS-R, VAS-A, PSGE, DGPE, NHP-pain, NHP-physical mobility and NHP-energy scores. No changes were found in NHP-sleep, NHP-social isolation and NHP-emotional reaction scores (p> 0.05). Except for the recovery percentage of TAS and NSP-energy, no relations between TAS and other parameters were detected (p< 0.05). Only the recovery percentage of the PSGE parameter revealed significant negative correlation with depressive, cyclothymic and anxious temperament means of TEMPS-A (p< 0.05). Other temperament features of TEMPS-A (hyperthymic, irritable) revealed no correlations. Significant negative correlations were found between BDS and PSGE, and VAS-A (p< 0.05). No correlations were found between BDS and other parameters, or between STAI scores and response parameters (p> 0.05). CONCLUSION: Although pain, life quality and doctor evaluation of the patients in the physical treatment program improved greatly after the treatment, no favorable results were obtained for patients who had high depressive, cyclothymic, anxious temperament and depression scores. It was detected that alexithymia and anxiety scores revealed no effect in this evaluation.

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.