The Diagnostic Role of Adding the Hoffman Reflex for L5 Radiculopathy in the Electrodiagnostic Laboratory: A Cross-sectional Study.

OBJECTIVES: To investigate changes in the H-reflex in patients with monoradiculopathies involving L5 or S1 levels by stimulating the sciatic nerve and recording simultaneously from the tibialis anterior (TA), peroneus longus (PL), and soleus (S) muscles. METHODS: Patients with unilateral radicular back pain with L5 or S1 root compression on MRI, participated in this cross-sectional study. The H-reflex over the TA, PL, and S muscles was simultaneously recorded by sciatic nerve stimulation. The H-reflex latency was compared with that of the contralateral extremity. RESULTS: Fifty-eight patients (29 patients L5; 29 patients S1 radiculopathy) were included in the study. There were significant delays in the latency of the H-reflex over TA (30.95±2.31-29.21±1.4) and PL (31.05±2.85-29.02±1.99) muscles on the affected side in patients with L5 radiculopathy. However, the latency of the S H-reflex was similar on both sides. In contrast, in patients with S1 radiculopathy, there was a significant delay in the latency of soleus H reflex (32.76±3.45-29.9±3.19), while the significant delay was not detected in the TA and PL muscles. However, the cutoff values for the H-reflex latency of all muscles were not found to have clinical significance. CONCLUSIONS: The study presents that the H-reflex study, recorded from the TA, PL, and S muscles by sciatic nerve stimulation, is of interest but has minimal contribution to radiculopathy diagnosis in conventional electrodiagnostic tests.

Musculoskeletal symptoms and relationship with laboratory findings in patients with COVID-19.

AIM: To investigate the frequency of fatigue and musculoskeletal symptoms and their correlation with laboratory data in patients with COVID-19. METHODS: This study included 80 patients hospitalised and treated for COVID-19 in the infectious diseases clinic between March 2020 and May 2020. Data analysis was performed retrospectively from the hospital medical charts. Demographic data, clinical symptoms, and laboratory findings were noted. Clinical symptoms and correlations with laboratory results were assessed. Besides, an analysis of patients with and without chronic disease was performed for clinical symptoms and laboratory findings. RESULTS: The frequencies of myalgia and fatigue were 46.1% and 50%, respectively. In the laboratory data, there was a significant increase in creatinine kinase (CK) level and lymphocyte count in the patients with myalgia symptoms (P < .05). There were no other significant results in the laboratory data. Of the patients with chronic disease, it has been shown that hemoglobin levels were significantly decreased (P < .05), while D-dimer was markedly increased (P < .05). CONCLUSION: The laboratory findings of COVID-19-related myalgia suggested that patients might have a risk of progressive muscle injury. Therefore, these patients should also be followed up in terms of the myopathic process.

Total Knee Arthroplasty due to Knee Osteoarthritis: Risk Factors for Persistent Postsurgical Pain.

OBJECTIVE: The aim of this study was to identify whether different patient characteristics and clinical factors can be risk factors in patients with persistent postsurgical pain (PPSP) after total knee arthroplasty (TKA). METHODS: Patients who underwent TKA due to knee osteoarthritis were divided into two groups: those who experienced no or mild PPSP (Numerical Rating Scale [NRS] ≤ 3) (group 1, n = 91) and those who experienced moderate to severe PPSP (NRS > 3) (group 2, n = 183). Information on the characteristics of patients, comorbid diseases and pre-surgical NRS scores were obtained retrospectively from hospital charts. The follow-up time; pre-surgical and last control time walking distance; and ratings on the NRS, Pain DETECT Questionnaire (PDQ) and patient satisfaction scales were recorded from the standard questionnaire presented to patients during the telephone interview. RESULTS: The mean follow-up time was 22.8 ± 12.3 months. The rate of moderate to severe PPSP among patients amounted to 66.7% after TKA. No neuropathic pain was found in Group 1. In Group 2, 22.9% of patients experienced neuropathic pain, the results for 18% of patients were uncertain, and 59% of patients did not experience neuropathic pain. Group 2 had worse scores on the patient satisfaction scale following the last control time compared with Group 1. Being widowed, having a low education level, being a housewife, having employment that requires physical effort, pre-surgical pain intensity at rest and pre-surgical restricted walking distance are risk factors for Group 2. CONCLUSIONS: PPSP and the neuropathic component in PPSP after TKA are not underestimated for pain management and patient satisfaction. Subgroups of patients, particularly widowers, having a primary school education level or under, housewives, people with jobs that require physical effort, individuals with intense pre-surgical pain during rest and those suffering from pre-surgical restricted walking distance, are at higher risk of developing PPSP following TKA.

Utility of shear wave elastography for diagnosing carpal tunnel syndrome with psoriatic arthritis.

BACKGROUND: Carpal tunnel syndrome (CTS) is a type of peripheral entrapment neuropathy and common for the patients with psoriatic arthritis (PsA). Shear wave elastography (SWE) is a new ultrasonography technique that can be used for diagnosing CTS, but not studied in PsA patients. AIMS: The aim of this study to measure the stiffness of median nerve and hand muscles by quantitative SWE to identify whether SWE can be used for diagnosing CTS in patients with PsA or not. METHODS: To diagnose CTS, all patients had electrodiagnostic study. The stiffness values of the median nerve, abductor pollicis brevis, and abductor digiti minimi were determined using SWE. Muscle stiffness ratio was also calculated. RESULTS: Consideration is given to 48 patients with PsA (93 wrists) and 29 healthy volunteers (57 wrists). Median nerve stiffness was found to be significantly higher, and abductor pollicis brevis' stiffness and muscle stiffness ratio were significantly lower in PsA patients' wrists compared to control group (p = 0.002, p < 0.001, p = 0.001, respectively) and in CTS wrists compared to others (p < 0.001, p < 0.001, p = 0.001, respectively). Receiver operating characteristic analysis identified 28.2 kPA as the median nerve stiffness cut-off point for differentiating CTS in PsA patients (p = 0.001). CONCLUSIONS: We found that SWE has a good diagnostic value for CTS with PsA patients; hence, we can conclude that SWE could diagnose CTS in PsA patients.

Carpal Tunnel Syndrome in Patients with Psoriatic Arthritis: Ultrasonography and Magnetic Resonance Imaging Findings.

Objective: The aim of the present study is to assess carpal tunnel syndrome's (CTS's) ultrasonography (US) and magnetic resonance imaging (MRI) findings in patients with psoriatic arthritis (PsA) and compare them with healthy controls. Methods: Thirty-nine PsA and twenty-eight healthy volunteers were examined in this study. Demographic and clinical features were recorded. CTS-6, a diagnostic algorithm, was used to estimate the probability of CTS. Electrodiagnostic study (EDS) was applied to all wrists included in the report, where the diagnosis of CTS was made by EDS. The cross-sectional area (CSA) of the median nerve was measured at pisiform bone level by US and MRI. Results: Regarding to the demographic characteristics, no statistically significant difference was found between the groups. Twelve of 39 (30.76%) PsA patients had CTS, whereas CTS was not detected in the control group (p=0.001). US and MRI showed increased median nerve CSA in PsA patients compared to healthy controls (p=0.005, p<0.001; respectively). Also, US and MRI showed increased median nerve CSA in CTS patients compared to others (p=0.002, p<0.001; respectively). The Pearson correlation coefficient between MRI and US measurements of the CSA was 0.85 (p<0.001). Conclusion: CTS frequency in PsA patients is found higher than healthy controls. The relationship between CTS diagnosed by EDS and CSA measured by both US and MRI was observed in PsA patients.

Diagnostic Dilemma: Which Clinical Tests Are Most Accurate for Diagnosing Supraspinatus Muscle Tears and Tendinosis When Compared to Magnetic Resonance Imaging?

BACKGROUND:  The study aims to investigate the diagnostic accuracy of five clinical shoulder tests in the diagnosis of supraspinatus tears and tendinosis when compared to magnetic resonance imaging (MRI). METHODS:  A total of 116 shoulders of 106 consecutive patients who experienced shoulder pain were assessed for this cross-sectional diagnostic accuracy study. Patients were assessed with the most commonly used clinical shoulder tests, including the Jobe test (empty can), Neer test, drop arm test, Hawkins test, and full can test to identify supraspinatus tears and tendinosis. MRI examinations were performed on a 1.5 Tesla MRI system, and images were assessed by a blinded radiologist. The primary outcomes were to determine the sensitivity, specificity, and accuracy of the five clinical tests and to establish their correlation with MRI for supraspinatus tears and tendinosis. RESULTS: The Hawkins test had a higher sensitivity and accuracy when diagnosing tears (sensitivity 89.66% [95% CI, 78.83-96.11] and accuracy 56.03% [95% CI, 46.51-65.23], respectively) and higher sensitivity in tendinosis (79.07% [95% CI, 63.96-89.96]). The drop arm test had a lower sensitivity but higher specificity in both tendinosis and tears (sensitivity 0% [95% CI, 0-8.22] and 12.07% [95% CI, 4.99-23.29], respectively, and specificity 87.67% [95% CI, 77.88-94.21] and 96.5% [95% CI, 88.09-99.58], respectively). The Neer test had a higher positive predictive value (PPV) of 37.21% in diagnosing tendinosis. When compared to the Hawkins test, the combination of the clinical tests had no statistically significant contribution to sensitivity and diagnostic accuracy. CONCLUSION: The Hawkins test had higher accuracy in diagnosing tears and was the most sensitive in diagnosing supraspinatus tendinosis and tears when compared to the MRI findings. The Neer test may also be another reliable tool for the diagnosis of tendinosis due to its higher PPV.

Effect of swallowing rehabilitation using traditional therapy, kinesiology taping and neuromuscular electrical stimulation on dysphagia in post-stroke patients: A randomized clinical trial.

OBJECTIVE: We aimed to evaluate the functional recovery of stroke patients with orophyaryngeal dysphagia after treatment with traditional swallowing therapy (TST), neuromuscular electrical stimulation (NMES), and kinesiology taping (KT), by using clinical swallowing assessments and objective fiberoptic endoscopic evaluation of swallowing (FEES). METHODS: A total of 37 patients were randomized in three groups: those who received TST and NMES as Group 1 (n:12), those who received both TST and KT as Group 2 (n:13), and those who received TST, NMES, and KT together as Group 3 (n:12). Patients were evaluated before treatment, after treatment, and three months after treatment onset with bedside water-swallow test, Eating Assessment Tool (EAT-10), Functional Oral Intake Scale (FOIS), penetration-aspiration scale (PAS), and National Institute of Health-Swallow Safety Scale (NIH-SSS). FOIS, PAS, and NIS-SSS were completed according to results of fiberoptic endoscopic evaluation of swallowing (FEES). RESULTS: A statistically significant decrease was observed in bedside water-swallow test, EAT-10, PAS, and NIH-SSS scores in all treatment groups 5 weeks and 3 months after treatment onset compared to pre-treatment scores (p < 0.05). There was a statistically significant increase in FOIS scores 5 weeks and 3 months after treatment compared to pretreatment scores in all treatment groups (p < 0.05). When the pre-treatment, 3-week, and 5-month swallow scale scores of all groups were compared, there was no significant different difference in terms of bedside water-swallow test, EAT-10, FOIS, PAS, or NIH-SSS scores (p > 0.05). CONCLUSION: According to the results of our study, KT is a new option in the treatment of stroke-related dysphagia, is an effective treatment approach and its efficacy is maintained throughout long-term follow-up.

Assessment of pain, care burden, depression level, sleep quality, fatigue and quality of life in the mothers of children with cerebral palsy.

The aim of this study were to evaluate pain, care burden, depression level, sleep quality, fatigue and quality of life (QoL) among a group of mothers of children with cerebral palsy (CP) and to compare their results with a group of healthy controls. The study involved 101 mothers who had children with CP and 67 mothers who had a healthy child as the control group. Pain, care burden, depression level, sleep quality, fatigue and QoL of all the participants were evaluated by the numerical rating scale, the Zarit care burden scale (ZCBS), the beck depression inventory (BDI), the Pittsburgh sleep quality index (PSQI), the checklist individual strength (CIS) and the short form-36 (SF-36), respectively. Numerical rating scale value was 3.57 ± 2.96 in the patient group. When the two groups were compared, the CP group showed higher scores for ZCBS, BDI, PSQI, total CIS and SF-36 subscales of general health and vitality whereas the scores for role physical, role emotional, mental health and mental component summary were found to be lower in the patients, compared to the control group. Reducing caregiving burden of the mothers' by other family members and increasing psychosocial supports may help improve the mother's health status.

A placebo-controlled, multicenter, randomized, double-blind, flexible-dose, two-way crossover study to evaluate the efficacy and safety of sildenafil in men with traumatic spinal cord injury and erectile dysfunction.

BACKGROUND/OBJECTIVE: To show the efficacy, safety, and tolerability of sildenafil in men with erectile dysfunction (ED) associated with complete or incomplete spinal cord injury (SCI) and to assess its effects on quality of life (QoL) using the Life-Satisfaction Check List. METHODS: This was a placebo-controlled, multicenter, randomized, double-blind, flexible-dose, 2-way crossover study with a 2-week washout period between each phase. Patients with ED attributable to SCI (Sexual Health Inventory-Male score < or =21) received 50 to 100 mg sildenafil (n = 24) or placebo (n = 26). RESULTS: Compared with placebo, sildenafil produced higher levels of successful sexual stimulation, intercourse success, satisfaction with sexual life and sexual relationship, erectile function, overall sexual satisfaction, and an improved Erectile Dysfunction Inventory of Treatment Satisfaction score, with no clinically relevant effects on vital signs. Sildenafil seemed more effective in patients with incomplete SCI than in those with complete SCI, producing significant improvements, compared with placebo, in a number of measures only in patients with incomplete SCI. All patients who expressed a preference selected sildenafil over placebo, although the drug had no effect on patient QoL. Sildenafil was well tolerated, with a profile comparable to that of placebo. CONCLUSIONS: Compared with placebo, treatment with oral sildenafil safely and effectively improved erectile function in patients with ED attributable to SCI, especially in those with incomplete injury, and was the agent of choice in those who expressed a preference.

CT measurement of trunk muscle areas in patients with chronic low back pain.

PURPOSE: The objective of this study was to determine the cross-sectional area changes of the paraspinal, isolated multifidus, quadratus lumborum, psoas, and the gluteus maximus muscles with CT in patients with chronic low back pain. MATERIALS AND METHODS: In this study, we evaluated 36 patients with chronic low back pain and 34 healthy volunteers. The mean age of the patients was 43.2 +/- 6.9 years (range, 30- 58 years) and the mean age of control group was 44.4 +/- 6.9 years (range, 31-61 years). We defined pain that lasts more then one year as chronic pain. Female patients were selected for standardization. All patients were housewives. None of the patients or controls engaged in physical activity other than routine housework. We used a visual analog scale and the Oswestry Pain Questionnaire for clinical evaluation. We made CT cross-sections of the paraspinal muscles at the upper and lower endplates of L4, and of the gluteus maximus at the head of the interfoveal level. RESULTS: In the patient group the multifidus, psoas, and quadratus lumborum cross-sectional areas were smaller than in the control group, and the P values were P = 0.002, P = 0.042, and P = 0.047, respectively, at the L4 endplate. At the L4 endplate level, cross-sectional areas of the multifidus and paravertebral muscles in the patient group were smaller than in the control group, and the difference was statistically significant (P = 0.001, P = 0.010, respectively). We did not find any significant difference between the patient and the control groups in gluteus maximus cross-sectional area. CONCLUSION: Chronic low back pain caused atrophy of the paraspinal, isolated multifidus, quadratus lumborum, psoas, and the gluteus maximus muscles to varying degrees, which was most prominent in the multifidus. Atrophy was noted in all of the studied muscles, except the gluteus maximus. The reliability of CT in measuring the cross-sectional areas of the back muscles was acceptable.

Complex regional pain syndrome in stroke patients.

The objective of this study was to investigate the incidence, and the factors influencing the development, of complex regional pain syndrome-I in the upper extremity in hemiplegic patients within the first 28 weeks following a stroke. We followed up 82 stroke patients. All patients were evaluated at weeks 2, 6, 14 and 28 after suffering a stroke. Outcomes were assessed using passive range of motion of shoulder, presence of subluxation, Ashworth score, Motricity index arm score, Brunnstrom stages and depression score. The incidence of complex regional pain syndrome-I was 48.8% in the first 28 weeks. Significant correlation was found between complex regional pain syndrome-I and the presence of subluxation, Ashworth score, Motricity index arm score, Brunnstrom stage and depression score (r=0.259, P=0.019; r=0.271, P=0.014; r=-0.393, P<0.001; r=-0.385, P<0.001; r=0.293, P=0.008, respectively). In this study, there was a relationship between complex regional pain syndrome-I and subluxation, loss of range of motion, spasticity of shoulder muscles and muscle strength. In order to prevent the development of complex regional pain syndrome-I, exercises directed at increasing the range of motion for the glenohumeral joint, strengthening shoulder muscles and reduction of spasticity will establish the integrity of the shoulder joint.

Transient Sensory Recovery in Stroke Patients After Pulsed Radiofrequency Electrical Stimulation on Dorsal Root Ganglia: A Case Series.

INTRODUCTION: The integrity of the somatosensory system is important for motor recovery and neuroplasticity after strokes. Peripheral stimulation or central stimulation in patients with central nervous system lesions can be an effective modality in improving function and in facilitating neuroplasticity. CASE REPORT: We present 2 hemiplegic cases with sensory motor deficit and the result of the pulsed radiofrequency (PRF) electrical stimulation to the dorsal root ganglia. After PRF electrical stimulation, significant improvement was achieved in the examination of patients with superficial and deep sensation. However, during the follow-up visits were observed that the effect of PRF electrical stimulation disappeared. CONCLUSIONS: We believe that these preliminary results could be used in the development of future prospective cohort studies and randomized controlled trials that focus on the effect of PRF electrical stimulation on dorsal root ganglia to treat sensory deficits in poststroke patients.

Efficacy of Pulsed Radiofrequency Therapy to Dorsal Root Ganglion Adding to TENS and Exercise for Persistent Pain after Total Knee Arthroplasty.

The majority of patients achieve substantial pain relief and improved function after total knee arthroplasty (TKA), but a proportion continues to experience life-disturbing persistent postsurgical pain (PPSP) in the months and years after surgery. This study aimed to assess the efficacy of transcutaneous electrical nerve stimulation (TENS), exercise, and pulsed radiofrequency (PRF) treatment on pain severity, neuropathic pain, knee flexion range of motion (ROM), functional status, and patient satisfaction in patients with PPSP after TKA. This is a retrospective study of prospectively collected data. Patients who were identified retrospectively from hospital charts were divided into two groups: group 1 (n = 17) received TENS and exercise treatment and group 2 (n = 22) received TENS, exercise, and PRF application to the dorsal root ganglion (DRG). The following procedure-related parameters were collected from the special registry form: visual analog scale (VAS), Douleur Neuropathique 4 (DN4) questionnaire, knee flexion ROM, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and patient satisfaction scale scores. The mean follow-up was 253.8 ± 109 days. When the two groups were compared, a significant difference of at least 50% improvement in the VAS (activity) and a significant reduction in the DN4 scores following the last control examination were found in group 2. There was a significant reduction in total WOMAC scores in group 1 compared with group 2 for the four study periods. Higher scores for the patient satisfaction scale were found in group 1 compared with group 2 following the last control examination. Adding PRF to TENS and exercise therapy is useful in reducing the degree of pain and the neuropathic component of PPSP in patients with PPSP.

Comparison of the effects of two antidepressants on exercise performance of the female patients with fibromyalgia.

OBJECTIVE: To compare the effects of two antidepressants on exercise performance of the female patients with fibromyalgia. METHODS: Fifteen patients with fibromyalgia participated in this randomized, double-blind crossover study composed of two trials separated by a 2-week washout phase. The pharmacy randomly assigned patients to two groups: (a) placebo (glucose) in the morning and 25 mg amitriptyline at bedtime or (b) 20 mg fluoxetine in the morning and placebo at bedtime. The VO(2max) and Wingate anaerobic test were evaluated. Within 24 h after 15-day medication, the tests were repeated. RESULTS: Peak power and fatigue index increased, and VO(2max) and VT did not change with both fluoxetine and amitriptyline. Mean power significantly increased after fluoxetine but not after amitriptyline. CONCLUSION: Both amitriptyline administration and fluoxetine administration in patients with fibromyalgia have beneficial effects on anaerobic performance. These effects may be important in life quality of the female patients with fibromyalgia.

Physical disability, psychological status, and health-related quality of life in older hemodialysis patients and age-matched controls.

We aimed at comparing the elderly adults and normal subjects with regard to their disability, psychological status, and quality of life (QOL). One hundred and twenty-five dialysis patients and 61 controls were recruited in the study. Depression and anxiety symptoms of the patients were evaluated with the Psychological Symptom Screening List (SCL 90-R). For evaluating the disability, the Rivermead mobility index (RMI) was utilized. For evaluating the QOL, we used the short form-36 (SF-36) scale. The Rivermead mobility index of the patients (9.6 +/- 3.4) was found. When compared with controls, dialysis patients had higher levels of disability (p = 0.0001). Depression and anxiety symptom scores of these patients were also significantly higher than that of the controls (p < 0.05). There was a correlation between the disability and depression symptom scores (r: 0.171, p = 0.037). Both physical and mental capacity scores of the dialysis patients were lower than those of the controls (p < 0.05 and p < 0.05) QOL scores for elderly hemodialysis patients were found to be lower. Their disability was higher, making them dependable on others during their daily lives. Specific exercise programs should be developed for these patients. Even the smallest effort in this regard will result in improvements in physical functioning while bringing them significant benefits.

The association between bone mineral density, quality of life, quality of sleep and fatigue.

OBJECTIVES: This study was undertaken to examine quality of life (QoL), the quality of sleep and fatigue level in postmenopausal women with osteoporosis (OP) but without fractures, to assess the associations between these parameters and to compare the results with those for subjects who have osteopenia or normal bone mineral density (BMD). METHODS: In this study, 113 postmenopausal osteoporosis (PMO) subjects without fractures, 172 subjects with osteopenia and 102 subjects with normal BMD were included. The severity of pain, QoL, quality of sleep and fatigue were assessed using the visual analogue scale (VAS), the QoL Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41), the Pittsburgh Sleep Quality Index (PSQI) and the Checklist of Individual Strength (CIS) questionnaire. RESULTS: No statistically significant differences between the three groups were found in terms of VAS and QUALEFFO-41 total scores (p > 0.05). On the other hand, PSQI and CIS total scores were significantly different in the PMO and osteopenia groups (P = 0.015 and 0.007, respectively) compared to the group with normal BMD. CONCLUSIONS: During the follow-up and treatment of women with PMO or osteopenia, QoL, quality of sleep and fatigue should be assessed and incorporated into treatment decisions, even in the absence of fractures.

Pulsed radiofrequency applied to the dorsal root ganglia for treatment of post-stroke complex regional pain syndrome: A case series.

STUDY OBJECTIVE: Complex regional pain syndrome is a painful and disabling syndrome where the patient presents with neuropathic pain, edema, or vasomotor or pseudomotor abnormalities that are often refractory to treatment. Complex regional pain syndrome type 1 may occurs in stroke patients. Radiofrequency is a therapeutic modality that has been used for years for diseases associated with neuropathic pain. DESIGN: Case series report. SETTING: Selcuk University Hospital. PATIENTS: A 69-year-old woman and a 48-year-old women who suffered post-stroke complex regional pain syndrome type 1. INTERVENTIONS: Pulsed radiofrequency current application to the cervical dorsal root ganglia. MEASUREMENTS: Pain reduction. MAIN RESULTS: The patients had complete resolution of their symptoms, which was maintained at 10 and 5 months of follow-up. CONCLUSIONS: These cases illustrates that pulsed radiofrequency applied to cervical dorsal root ganglia might play a significant role in multi-modal approach of complex regional pain syndrome type 1 management after stroke. Further randomized, controlled studies are needed to support this argument.

A twelve week exercise program improves the psychological status, quality of life and work capacity in hemodialysis patients.

BACKGROUND: Patients with chronic renal failure (CRF) are restricted in physical, emotional and social dimensions of life due to their treatment and their comorbid medical conditions. We aimed to evaluate the effects of a 12-week exercise program on the functional capacity, functional mobility, walking capacity, quality of life and depression in patients with renal failure on hemodialysis (HD). METHODS: Twenty patients with renal failure on HD were included and 14 of them completed the study. The patients went through a 12-week exercise program of 90 min/day, 3 days a week. Exercise and walking capacity, functional mobility, psychological status and quality of life were evaluated pre- and post-training. RESULTS: Following the exercise, peak oxygen consumption, exercise duration and peak workload improved significantly (respectively, p=0.006, p=0.002 and p=0.002). There were significant improvements in the sit-to-stand-to-sit test and the 6- min walk test (p<0.001 and p=0.002). There was a significant reduction in the depression score (p<0.001). Both physical component scale (PCS) and mental component scale (MCS) of the Kidney Disease Quality of Life Short-Form 36 (SF-36) questionnaire showed significant increases (respectively, p=0.002 and p=0.004). CONCLUSION: The application of an appropriate exercise program would improve psychological status and quality of life, as well as work capacity in long-term maintenance HD patients.