The frequency of sarcopenia in haemophilia patients: Effects on musculoskeletal health and functional performance.

INTRODUCTION: In patients with haemophilia A, chronic arthropathy develops over time as a result of recurrent joint bleeds, which leads to restricted mobility and disability in the affected joints. There are limited studies in the literature evaluating sarcopenia in patients with haemophilia. The present study aims to determine the prevalence of sarcopenia in severe haemophilia-A patients and to evaluate musculoskeletal health and functional performance. METHODS: Thirty haemophilia-A patients and 26 adult male volunteers were enrolled in the study. For detection of sarcopenia, the appendicular skeletal muscle mass (ASM) obtained by bioelectrical impedance analysis (BIA) was divided by height squared (m2 ) to obtain the appendicular skeletal muscle mass index (ASMI) value. The thighs of both lower extremities were measured using the Modified Sonographic Tight Adjustment Ratio (STAR) method, which was obtained by adding the bilateral rectus femoris and vastus intermedius muscle thicknesses measured by ultrasound. Hand and quadriceps muscle strength (MS) were measured with a dynamometer. Physical performance was determined using the walking speed (WS), timed up-and-go test (TUGT), 5-repetition sit-to-stand test (5RSTS), and 6-min walk test (6MWT). Haemophilia Joint Health Score (HJHS) and Haemophilia Early Arthropathy Detection-Ultrasonography (HEAD-US) were also used to assess the musculoskeletal system. RESULTS: According to the modified STAR values calculated based on body mass index, sarcopenia was present in 15 (50%) of 30 patients. However, based on the ASMI-BIA values, sarcopenia was present in only two (6.6%) patients. A weak correlation was found between ASMI and HJHS, HEAD-US, WS, TUGT, and hand MS (left), while a moderate correlation was found with knee MS (right), knee MS (left), and 5RSTS. A strong correlation was found between the modified STAR score and HEAD-US, HJHS, knee MS (left), 5RSTS, TUGT, and WS, while a moderate correlation was found with hand MS (left), hand MS (right), and knee MS (right). CONCLUSION: This study showed muscle loss, joint mobility restrictions, and decreased functional capacity in haemophilia patients and demonstrated the presence of sarcopenia in these patients. The STAR measurement method showed stronger relationships with MS and functional performance values than ASMI measurements in terms of evaluating sarcopenia.

Psychiatric symptoms in ankylosing spondylitis: their relationship with disease activity, functional capacity, pain and fatigue.

OBJECTIVES: The aim of this study is to evaluate psychiatric symptoms in patients with ankylosing spondylitis (AS) and to investigate the relationship of the disease activity, functional capacity, pain, and fatigue with psychiatric symptoms. METHODS: Eighty AS patients and 80 healthy controls were included in the study. Spinal pain by visual analog scale (pain VAS-rest), disease activity by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional capacity by Bath Ankylosing Spondylitis Functional Index (BASFI), and fatigue by Multidimensional Assessment of Fatigue (MAF) were assessed in patients. Psychiatric symptoms were measured using the Symptom Checklist-90-R (SCL-90 R), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Pittsburgh Sleep Quality Index (PSQI) and Rosenberg Self-Esteem Scale (RSES). RESULTS: SCL-90-R total and all subscale scores (except interpersonal sensitivity and psychoticism) and BDI scores were significantly higher in the AS group compared to control group. PSQI total and all subscale scores were significantly higher in the AS group. State anxiety scale score was significantly higher and RSES score was significantly lower in the AS group. Psychiatric symptoms (except Rosenberg Self-Esteem score) were significantly correlated with BASDAI, BASFI, pain VAS rest, and MAF scores. CONCLUSION: Psychiatric symptoms are often seen in patients with AS. Disease activity, functional capacity, pain and fatigue were correlated with psychiatric symptoms but self-esteem was not. Therefore, psychiatric symptoms should be taken into consideration in the management of AS.

The relationship between prosthesis use, phantom pain and psychiatric symptoms in male traumatic limb amputees.

OBJECTIVES: The purpose of this study was to identify psychiatric symptoms by comparing male patients with traumatic leg amputations (LAs) with healthy controls and to determine the association between these psychiatric symptoms and phantom pain and prosthesis use characteristics. METHODS: One hundred four volunteers, 51 LA patients (group 1) and 53 healthy controls (group 2) were included. Demographic data including age, height, weight, time since amputation, duration of prosthesis use, and Satisfaction with Prosthesis Questionnaire scores were recorded. Phantom pain was measured a visual analog scale (VAS). Psychiatric symptoms were measured using the Symptom Checklist-90-R, Beck Depression Inventory, Pittsburgh Sleep Quality Index, Rosenberg Self-Esteem Scale, and State-Trait Anxiety Inventory. Correlations were determined between time since amputation, duration of prosthesis use and satisfaction with prosthesis questionnaire scores and psychiatric scale scores. RESULTS: Amputee patients had higher phobic anxiety, state anxiety, trait anxiety and sleep disturbance scores (p<0.05) than the controls. No difference was determined in terms of psychiatric symptoms between the phantom pain and no phantom pain groups (p>0.05). There were significant negative correlations between time since amputation, duration of prosthesis use, duration of daily prosthesis use, and satisfaction with prosthesis questionnaire scores and psychiatric symptoms. CONCLUSIONS: Apart from anxiety (state, trait or phobic) and disturbed sleep, other psychiatric symptoms in amputee patients undergoing lengthy prosthetic rehabilitation may not differ from those of healthy controls. The presence and severity of phantom pain appear to be unrelated to general psychiatric symptomatology. Length of time since amputation, length of prosthesis use, daily length of prosthesis use and prosthesis satisfaction are negatively correlated with general psychiatric symptoms. These characteristics must be borne in mind in psychiatric and prosthetic rehabilitation.

A randomized placebo-controlled clinical trial of phonophoresis for the treatment of chronic neck pain.

The aim of this trial was to investigate and compare the effects of phonophoresis (PP), placebo PP and exercise therapies on pain, disability, sleep quality, and depression in the patients with chronic neck pain (CNP). This is a randomized, single-blind, placebo-controlled study. A total of 61 patients with definite CNP were included in this study. The patients were randomized into three groups. Group 1 (n = 21) received PP with capsaicin treatment and exercises. Group 2 (n = 20) received placebo PP with capsaicin and exercises. Group 3 (n = 20) was given only exercises. All of the programs were performed 3 days a week, for 6 weeks. The pain (visual analog scale), disability (the neck pain disability index), depression (Beck Depression Inventory scores), and sleep quality (Pittsburgh Sleep Quality Index) of all participants were evaluated. Measurements were taken before and after treatment. All of the groups showed statistically significant improvements in pain, disability, sleep quality, and depression. While there was no difference between groups regarding depression and sleep quality, intergroup comparison showed significant differences in pain and disability among three groups. These differences were statistically significant in group 1 and 2 compared to group 3, and also in group 1 compared to group 2. We observed that PP treatment was effective in the treatment for patients with CNP. A combination of PP with exercises can be used to obtain optimal clinical results.

Functional capacity, strength, and quality of life in children and youth with familial Mediterranean fever.

PURPOSE: To examine functional capacity and muscle strength in children and youth with familial Mediterranean fever (FMF) as compared with controls, and to assess whether these factors influence quality of life (QOL) in FMF. METHODS: A total of 100 subjects with FMF and 55 control subjects (8-18 years old) without known health issues were enrolled in the study. The 6-Minute Walk Test (6MWT) was used to evaluate functional capacity. Quadriceps strength was measured with a hand-held dynamometer. Quality of life was evaluated with the Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0). RESULTS: Significant differences were found between subjects with FMF and controls in the 6MWT and strength test. PedsQL scores of subjects with FMF were significantly lower than the scores of the controls. The 6MWT and quadriceps strength were weakly correlated with the PedsQL. CONCLUSION: Subjects with FMF displayed lower functional capacity and QOL than peers who are healthy. Decreased functional capacity was correlated with decreased QOL in those with FMF.

Frequency of idiopathic intracranial hypertension with ultrasound in patients with fibromyalgia: Relation with function, central sensitization, and neuropathic pain.

OBJECTIVE: The purpose of this study was to evaluate the prevalence of idiopathic intracranial hypertension (IIH) in fibromyalgia (FMS) patients by utilizing ultrasound to measure the optic nerve sheath diameter (ONSD), a marker of elevated intracranial pressure and also to investigate the relationship with function, fatigue, quality of life (QOL), central sensitization (CS) and neuropathic pain. METHODS: The study encompassed 80 female FMS patients and 75 healthy controls. Ultrasound was employed to measure the average ONSD in both groups. Conditions potentially elevating intracranial pressure were ruled out following neurological assessments. Pain (via visual analog scale, VAS), function (revised Fibromyalgia Impact Questionnaire, r-FIQ), QOL (Short Form-36, SF-36), fatigue (fatigue severity scale, FACIT), CS (Central Sensitization Scale), and neuropathic pain (Douleur Neuropathique-4) were evaluated. RESULTS: The average ONSD was significantly higher in the patient group than the control group. Patients with ONSD >5.5 mm consistent with IIH were categorized as Group 1 (n = 54, 67.5%), while those with a diameter of 5.5 mm and below-formed Group 2. VAS pain (p = .033) and FIQ-R scores (p = .033) were significantly higher in Group 1 than Group 2. Headache was found more common in Group 1. CONCLUSION: This study unveils a substantial occurrence (67.5%) of IIH in FMS patients, suggesting shared pathophysiological mechanisms contributing to symptoms like fatigue, headache, and cognitive dysfunction. Additionally, these findings implicate heightened functional impairment, CS, headache, and fatigue in FMS patients with IIH.

Does fear of activity predict exercise capacity in patients with coronary artery disease in both sexes? A cross-sectional multicenter study.

Objectives: This study aimed to identify whether fear of activity predicts exercise capacity in patients with coronary artery disease (CAD) and whether there is a difference between sexes regarding this relationship. Patients and methods: One hundred ninety-seven patients (145 males, 52 females; mean age: 56.3±10.8 years; range, 22 to 80 years) with a diagnosis of CAD or cardiac event in the previous one to 60 months were enrolled in this cross-sectional multicenter study between November 2015 and February 2017. Demographic and clinical features were recorded. Fear of activity was assessed by the fear of activity scale in patients with CAD (FactCAD). A 6-min walk test was used to assess exercise capacity. Results: Female participants were older, less educated, and less employed (p=0.045, p=0.048, and p<0.001, respectively) than males. Prevalence of myocardial infarction was higher in males. Comorbidities were higher in females. Multiple linear regression predicted 6-min walk distance (6MWD) based on FactCAD, sex, and education level with an r-squared of 0.321 (p<0.001). Fear of activity had an effect on walking distance in males (each additional score of FactCAD predicts a decrease of 1.3 m in 6MWD), together with disease duration, presence of chronic pulmonary disease, and low back pain, whereas fear of activity was not a predicting factor on walking distance in females. Age, education, and presence of angina predicted 6MWD in females. Conclusion: This study emphasizes that fear of activity is one of the predictors of 6MWD in males with CAD, and its assessment is recommended as a possible barrier to rehabilitation.

Effects of glucosamine sulfate and exercise therapy on serum leptin levels in patients with knee osteoarthritis: preliminary results of randomized controlled clinical trial.

Osteoarthritis (OA) is a slow, chronic disease characterized by the focal deterioration and abrasion of articular cartilage. Leptin may play an important role in the pathophysiology of OA. Exercise and glucosamine sulfate therapy is one of the most commonly used in patients with knee OA. The goals of the present study are performed to investigate whether 12-week strength training program and glucosamine sulfate have an effect on serum leptin levels in knee OA and the relationship between leptin, clinical parameters, and radiographic severity of knee OA. Thirty-seven women with the diagnosis of knee OA were enrolled in the study. Patients were randomized into two groups. Group I (n = 19) received an exercise program, while group II (n = 18) received glucosamine sulfate (1,500 mg/day) in addition to the exercise therapy. Both groups were treated for 12 weeks. Leptin level was assessed at baseline and after 12 weeks. The concentration of leptin was measured by ELISA. The patients were evaluated regarding pain, disability, functional performance, and muscle strength. Both groups showed significant improvements in leptin levels, pain, disability, muscle strength, and functional performance with no statistically significant difference between the groups after the therapy. At basal time, plasma leptin levels were significantly correlated with body mass index and duration of disease, but no significant correlation was found with patient age, pain, disability, functional performance, muscle strength, and radiographic severity of knee OA. The results of this preliminary study revealed that exercise alone was adequate to prevent structural changes relieving the symptoms of OA. We also found that exercise alone could affect serum plasma levels of the leptin, important mediators of cartilage metabolism. Decreases in serum leptin may be one mechanism by which cartilage metabolism affects physical function and symptoms in OA patients.

Is phonophoresis effective in the treatment of chronic low back pain? A single-blind randomized controlled trial.

The aim of this trial is to investigate and compare the effects of phonophoresis (PP) and ultrasound (US) therapy on pain, disability, trunk muscle strength, walking performance, spinal mobility, quality of life (QOL), and depression in the patients with chronic low back pain (CLBP). A total of 60 patients with definite CLBP were included in this study. The patients were randomized into three groups. Group 1 (n = 20) was accepted as the control group and was given only exercises. Group 2 (n = 20) received US treatment and exercises. Group 3 (n = 20) received PP and exercises. All of the programs were performed 3 days a week, for 6 weeks. The pain (visual analog scale, VAS), disability (Oswestry Disability Questionnaire, ODQ and pain disability index, PDI), walking performance (6 min walking test, 6MWT), depression (Beck Depression Inventory scores, BDI), and QOL (Short Form 36, SF-36) of all participants were evaluated. The trunk muscle strength was measured with a handheld dynamometer. All of the groups showed statistically significant improvements in pain, disability, muscle strength, endurance, 6MWT, mobility, QOL, and depression. The intergroup comparison showed significant differences in VAS pain, 6MWT, and EMS, among three groups. These differences were statistically significant in groups 2 and 3 compared with the group 1. The intergroup comparison showed significant difference in pain, physical function, and energy subgroups of SF-36. The differences were statistically in group 3 compared with group 1 and 2. We observed that US and PP treatments were effective in the treatment of patients with CLBP but PP was not found to be superior over ultrasound therapy.

Effectiveness of microwave diathermy on pain, functional capacity, muscle strength, quality of life, and depression in patients with subacromial impingement syndrome: a randomized placebo-controlled clinical study.

The aim of this clinical trial was to evaluate the effectiveness of therapeutic MD on pain, functional capacity, muscle strength, quality of life, and depression in patients with subacromial impingement syndrome (SIS). A total of 40 inpatient subjects with definite SIS were included in this study. These patients were sequentially randomized into 2 groups. Group 1 (n = 20) received therapeutic MD. Group 2 (n = 20) was served as control group and received sham MD. Superficial heat and exercise program were given to both groups. Both of the programs were performed 5 times weekly for 3 weeks. Patients were assessed before treatment (BT), after treatment (AT), and at a 1-month follow-up (F). Outcome measures included visual analogue scale, goniometry, Shoulder Pain and Disability Index, Shoulder Disability Questionnaire, shoulder isokinetic muscle testing, handgrip strength, Short Form 36, and Beck Depression Index. The patients with SIS in each group had significant improvements in pain, shoulder ROM, disability, shoulder muscles and grip strength, quality of life, and depression AT and F when compared with their initial status (P < 0.05). There was no statistically significant difference between the groups according to all the parameters regarding the change scores between AT-BT test and F-BT test (P > 0.05). A 2,450-MHz MD regimen showed no beneficial effects in patients with SIS, so the superficial heat and exercise program, as it is efficient, may be preferable for the treatment of SIS, alone.

Effects of therapeutic ultrasound and electrical stimulation program on pain, trunk muscle strength, disability, walking performance, quality of life, and depression in patients with low back pain: a randomized-controlled trial.

The aim of this trial is to investigate and compare the effects of electrical stimulation (ES) program and ultrasound (US) therapy on pain, disability, trunk muscle strength, walking performance, spinal mobility, quality of life (QOL), and depression in the patients with chronic low back pain (CLBP). A total of 59 patients with definite CLBP were enrolled in this study. These patients were randomized into three groups. Group 1 (n = 20) was given an ES program and exercises. Group 2 (n = 19) was given an US treatment and exercises. Group 3 (n = 20) was accepted as the control group and was given only exercises. All of the programs were performed 3 days a week, for 6 weeks. The patients were evaluated according to pain, disability, walking performance, endurance, mobility, QOL, depression. The trunk muscle strength was measured with a hand-held dynamometer. All of the groups showed stastically significant improvements in pain, disability, muscle strength, endurance, walking performance, mobility, sub-scores of SF 36, and depression when compared with their initial status. The intergroup comparison showed significant difference in physical function, energy and social function sub-groups of SF-36, VAS pain, extensor muscle strength, between three groups. This difference was statistically significant in the groups 1 and 2 compared to the control group. There was also no significant difference between the groups 1 and 2. We observed that US treatment and ES treatment were effective in improving pain, isometric extensor muscle strength, and QOL in patients with CLBP.

Effects of a home-based exercise program on quality of life, fatigue, and depression in patients with ankylosing spondylitis.

The aim of this trial was to investigate the effects of a 12-week home-based exercise program (HEP) on quality of life (QOL) and fatigue in patients with Ankylosing Spondylitis (AS). Forty-three patients with AS were included in this study. Group 1 was given a HEP; Group 2 served as the control group. The functional capacity (Bath Ankylosing Spondylitis Functional Index), disease activity (Bath Ankylosing Spondylitis Disease Assessment Index), fatigue (Multidimensional Assessment of Fatigue Scale), depression (Beck Depression Inventory scores), and QOL (Short Form 36) of all participants were evaluated. There were significant improvements for all the parameters in two groups after the treatment. The improvements for all the parameters were better in the exercise group than in the control group. Home-based exercise programs are very effective in improving QOL and reducing fatigue. Because of these advantages, HEP should be advised for the management program in AS in addition to medical treatments.

Effects of electrical stimulation program on trunk muscle strength, functional capacity, quality of life, and depression in the patients with low back pain: a randomized controlled trial.

The aim of this clinical trial was to evaluate the effects of electrical stimulation (ES) program on trunk muscle strength, functional performance, quality of life (QOL) in the patients with chronic low back pain (CLBP). A total of 41 patients with definite CLBP were included in this study. These patients were randomized into two groups. Group 1 (n = 21) was given an ES program and exercises. Group 2 (n = 20) was accepted as the control group and given only exercises. Both the programs were performed 3 days a week, for 8 weeks in the out-patient department. The patients were evaluated according to pain, disability, functional performance, endurance, quality of life, depression. The muscle strengths were measured with a hand-held dynamometer. There were significant improvements for all the parameters in two groups after the treatment. Except depression and social function, the improvements for all the parameters were better in the ES group than in the control group. We observed that ES program was very effective in improving QOL, functional performance and isometric strength. In conclusion, we can say that ES therapy provides comfortable life functions by improving muscle strength, functional performance and QOL.

Effects of global postural reeducation exercise and anti-TNF treatments on disease activity, function, fatigue, mobility, sleep quality and depression in patients with active Ankylosing spondylitis: A prospective follow-up study.

OBJECTIVE: The purpose of this study was to investigate the effects of combination therapy with global postural reeducation exercise (GPR) and anti-TNF treatments on clinical parameters in patients with active Ankylosing spondylitis (AS). MATERIALS AND METHOD: Sixty patients with active AS were distributed into three groups. Group 1 was given anti-TNF therapy plus GPR program. Group 2 was given anti-TNF and conventional exercise therapy. Group 3 was accepted as the control group. Patients were assessed according to pain, disease activity (Bath Ankylosing Spondylitis Disease Activity Index), functionality (Bath Ankylosing Spondylitis Functional Index and walking performance), mobility (lumbar Schöber, chest expansion, hand-finger to floor distance), fatigue (Multidimensional Assessment Questionnaire), sleep quality (Pittsburgh sleep quality index), and depression. RESULTS: The parameters were significantly improved in both groups receiving exercise and anti-TNF therapy compared to the control group after treatment. The anti-TNF plus GPR exercise therapy resulted in greater improvements than the anti-TNF plus conventional exercise therapy in pain, walking performance, and mobility. CONCLUSIONS: Anti-TNF therapy and exercise were efficient in both groups on improving all clinic parameters. However, the improvements in pain, function, and mobility were greater in the active AS patients with GPR exercise method. Therefore, motivated patients should be encouraged to perform this method.

Effects of quadriceps electrical stimulation program on clinical parameters in the patients with knee osteoarthritis.

The aim of this study was to evaluate the effects of electrical stimulation program on pain, disability, and quadriceps strength in the patients with knee osteoarthritis. Fifty women diagnosed as knee osteoarthritis were randomized into two groups as electrical stimulation and biofeedback-assisted isometric exercises. Both of the programs were performed 5 days a week, for a duration of 4 weeks. Outcome measures for pain were visual analogue scale pain score and Western Ontario McMaster osteoarthritis index (WOMAC) pain score. Disability and stiffness were assessed with WOMAC physical function and stiffness score. One repetition maximum (RM) and 10 RM were used for measuring quadriceps strength. In addition, 50 m walking time and 10 steps stairs climbing up-down time were evaluated. Both groups showed significant improvements in pain, physical function, and stiffness scores after the therapy. There were statistically significant improvements in 50 m walking time and 10 steps stairs climbing up-down time and 1 RM and 10 RM values indicating the improvement in muscle strength. In addition, there were no significant differences between the groups after the therapy. We conclude that electrical stimulation treatment was as effective as exercise in knee osteoarthritis and electrical stimulation treatment can be suggested especially for the patients who have difficulty in or contraindications to perform an exercise program.

Cultural adaptation of the Michigan Hand Outcomes Questionnaire in patients with Carpal Tunnel Syndrome: A Turkish version study.

OBJECTIVE: Cultural adaptations of the questionnaires are important for easy use. We aimed to assess the reliability and validity of the Turkish Version of the Michigan Hand Outcomes Questionnaire in patients with Carpal Tunnel Syndrome. METHODS: To assess test-retest reliability, the Turkish "Michigan Hand Outcomes Questionnaire" and "Disabilities of Arm, Shoulder and Hand" questionnaires were answered by patients and controls and were repeated a week later. For testing internal consistency, the Cronbach's alpha test was used. For testing validity, correlations between the subscales of the "Michigan Hand Outcomes Questionnaire" and "Disabilities of Arm, Shoulder and Hand" questionnaire were measured in patient groups. One hundred patients with idiopathic Carpal Tunnel Syndrome and 50 healthy participants were included in the study. RESULTS: In test-retest reliability, intraclass correlations of the subscales of the "Michigan Hand Outcomes Questionnaire" were high. Cronbach's alphas were found to be high in all subscales. There was no significant correlation between asthetics and pain scales. We found significant differences between patients and controls regarding all subscales of the "Michigan Hand Outcomes Questionnaire". Correlations between subscales of the "Michigan Hand Outcomes Questionnaire" and "Disabilities of Arm, Shoulder and Hand" questionnaire were significant. We found no difference between one-hand effected and two-hand effected patients, in terms of the "Michigan Hand Outcomes Questionnaire", "Disabilities of Arm, Shoulder and Hand" questionnaire Function/Symptom and Work average scores. CONCLUSION: This study showed that the Turkish version of the "Michigan Hand Outcomes Questionnaire" is reliable and valid and can be used in Turkish patients with Carpal Tunnel Syndrome because it is comprehensible and practicable.

How effective is a modified exercise program on its own or with back school in chronic low back pain? A randomized-controlled clinical trial.

BACKGROUND AND OBJECTIVES: The aim of this trial is to search effectiveness of specifically adapted exercise programs on its own and with low back school on pain, disability, trunk and quadriceps muscle strength, walking performance, spinal mobility, quality of life (QOL), and depression in the patients with chronic low back pain (CLBP). MATERIAL AND METHOD: A total of 121 patients with definite CLBP were included in this study. The patients were randomized into two groups. Group 1 (n=60) was given exercises only and accepted as the control group. Group 2 (n=61) received back school program and exercises. The exercise treatment was performed 3 days a week, for 3 months. The pain (visual analog scale, VAS), disability (Oswestry Disability Questionnaire, ODQ), walking performance (6 minute walking test, 6MWT), depression (Beck Depression Inventory scores, BDI), and QOL (Short Form 36, SF-36) of all participants were evaluated. The trunk and knee muscle strength were measured with a handheld dynamometer. Patients were assessed at baseline (BT), at the end of treatment (AT), and at the six month follow-up (F). RESULTS: Statistically significant improvements were found between groups regarding all of the clinical parameters over time. Pain, disability, muscle strength, endurance, 6MWT, mobility, QOL, and depression of both groups also showed improvements AT. These improvements persisted at 6-months follow-ups (P < 0.05). There were statistically significant differences between the groups for pain, disability, muscle strength, endurance, 6MWT, QOL, and depression regarding the change scores between AT-BT test and F-BT test (P < 0.05). Group 2 improved more than group 1 except for mobility. CONCLUSION: Exercise programs can be modified and used successfully in CLBP and this effect can be increased with addition of back school further. LEVEL OF EVIDENCE: Diagnostic study Level-I-I (prospective study).

Coping with Stress and Body Image in Patients with Ankylosing Spondylitis.

INTRODUCTION: The aim of this study was to determine coping with stress and body image in patients with ankylosing spondylitis (AS) and to investigate the correlation between these two characteristics together and also between them and disease activity/functional capacity. METHOD: Fourty healthy controls and 40 patients with AS who were diagnosed on the basis of Modified New York Criteria were included in the study. The exclusion criteria were another medical disease or comorbid psychiatric disorder. All participants were administered the Coping Orientations to Problems Experienced (COPE) questionnaire in order to evaluate attitudes to coping with stress and the Multidimensional Body-Self Relations Questionnaire (MBSRQ) to evaluate body image. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) were used to evaluate AS patients' disease activities and functional capacities. RESULTS: There was no difference between the two groups in terms of COPE scores. The MBSRQ 'health evaluation' subscale scores were lower and the 'fitness orientation' scores higher in the AS group. The COPE active coping subscale had a weak, positive correlation with MBSRQ total score and a weak, negative correlation with BASFI score. MBRSQ total score had a moderate, negative correlation with BASFI score, and a weak, negative correlation with BASDAI score. CONCLUSION: The attitudes to coping with stress in AS patients with no accompanying medical disease or psychiatric disorder may not differ from that in healthy controls. Negative health evaluation and fitness orientation must be characteristics considered in psychotherapeutic interventions applied to these patients. In addition, psychotherapeutic interventions directed toward coping with stress and body image may be especially useful in active stages of the disease and in patients with limited functional capacity.

Spondyloarthritis Research Consortium of Canada (SPARCC) enthesitis index in Turkish patients with ankylosing spondylitis: relationship with disease activity and quality of life.

AIM: The aim of this study was to investigate the relationship between Spondyloarthritis Research Consortium of Canada (SPARCC) enthesitis index and disease activity and health-related quality of life in patients with ankylosing spondylitis (AS). METHODS: Eighty-six AS patients not receiving antitumour necrosis factor (TNF) therapy were included in the study. Spinal pain by visual analogue scale (pain VAS rest and activity), disease activity by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional capacity by Bath Ankylosing Spondylitis Functional Index (BASFI), enthesitis severity by SPARCC index, quality of life by Short Form-36 (SF-36), and Bath Ankylosing Spondylitis Metrology Index (BASMI) were assessed in patients. In the laboratory evaluations, the erythrocyte sedimentation rates and serum C-reactive protein levels of the patients were determined. RESULTS: All participants were aged between 18 and 65 years, with a mean age of 36.9 ± 11.13 years. The most frequent region of enthesitis was Achilles tendon insertion into calcaneum (55.8%). Pain VAS rest and activity, BASFI and all parameters of SF-36 were significantly different in AS patients with and without enthesitis. SPARCC index was significantly correlated with pain VAS activity (P < 0.05), pain VAS rest, BASDAI, BASFI and all parameters of SF-36 (P < 0.001). There were no correlations between SPARCC index and BASMI, disease duration and laboratory parameters (P > 0.05). CONCLUSION: The clinical assessment of enthesitis in AS is an important outcome measure, and enthesitis indexes such as SPARCC enthesitis index can be valuable tools in the evaluation of disease activity in AS patients not receiving anti-TNF therapy.