Environmental characteristics of older people attending physical medicine and rehabilitation outpatient clinics.

OBJECTIVE: A residential environment refers to the physical and social characteristics in a neighbourhood. The physical characteristics include interior housing qualities, exterior neighbourhood characteristics, and the accessibility of essential facilities and services outside the neighbourhood. Older adults especially may be vulnerable to the negative impacts of the residential environment. The aim of this study is to elucidate the problems ageing people face in their neighbourhoods, buildings and public areas. METHODS: The study group consisted of a total of 1,001 people over the age of 65 who were admitted to physical medicine and rehabilitation clinics in Turkey and consented to participate. A questionnaire covering demographic, social and environmental information was used. RESULTS: Of the study group, 58.6% was living in an apartment building, but only 23.6% of these buildings had an elevator, and the stairs were inconvenient in 46.7% of the buildings. Only 49% of the elderly people went for a walk regularly. The most frequent complaint about the hospitals, community health centres and other public areas was the inappropriate restroom conditions. Eighty-six percent of the study group were not members of an organization, a foundation or a group, and 73.6% did not have personal hobbies. CONCLUSIONS: The layouts of buildings and surroundings are inappropriate for older people, and the opportunities for them to participate in social activities are limited. Health and social programmes and governmental and local policies for older people are needed, and public awareness about this issue should be raised.

Laser Acupuncture Treatment Improves Pain and Functional Status in Patients with Subacromial Impingement Syndrome: A Randomized, Double-Blind, Sham-Controlled Study.

Objective: The present study aims to determine the effect of laser acupuncture in patients with subacromial impingement syndrome (SAIS). Design: Randomized, double-blind, sham-controlled study. Setting: Physical medicine and rehabilitation outpatient clinic. Subjects: A total 73 patients with SAIS were randomly assigned into a treatment group (n = 36) and a control group (n = 37). Methods: The treatment group received laser acupuncture, and the control group received sham laser acupuncture. Eleven acupuncture points (GB 21, LI 4, LI 11, LI 14, LI 15, LI 16, SI 9, SI 10, SI 11, TE 14, and TE 15) were irradiated using a gallium-aluminium-arsenide continuous wave diode-laser, with a wavelength of 850 nm and a power output of 100 mV. The laser acupuncture treatment at each acupuncture point was administered at 4 joules/cm 2 (total dose = 40 joules). All patients were also treated with a hot pack. The patients were assessed at baseline and after 15 sessions of laser treatment. Pain severity and doctor's and patient's global assessments were measured via visual analog scale (VAS). Range of motion (ROM) and functional status were measured using a digital inclinometer and the Shoulder Pain Disability Index, respectively. Results: Statistically significant improvements were observed in all parameters in the treatment group. All parameters of pain and functional status in the treatment group were significantly better than those in the control group at week 3. Conclusions: To the best of our knowledge, this is the first study that investigates the effect of laser acupuncture in SAIS. The positive results of the present study should lead to further laser acupuncture studies with combinations of different acupuncture points, at different wavelengths, and with long-term follow-up periods.

New Approach in Fibromyalgia Exercise Program: A Preliminary Study Regarding the Effectiveness of Balance Training.

OBJECTIVES: To determine the effectiveness of balance exercises on the functional level and quality of life (QOL) of patients with fibromyalgia syndrome (FMS) and to investigate the circumstances associated with balance disorders in FMS. DESIGN: Randomized controlled trial. SETTING: Physical medicine and rehabilitation clinic. PARTICIPANTS: Patients (N=57) (age range, 18-65y) with FMS were randomly assigned into 2 groups. INTERVENTIONS: Group 1 was given flexibility and balance exercises for 6 weeks, whereas group 2 received only a flexibility program as the control group. MAIN OUTCOME MEASURES: Functional balance was measured by the Berg Balance Scale (BBS), and dynamic and static balance were evaluated by a kinesthetic ability trainer (KAT) device. Fall risk was assessed with the Hendrich II fall risk model. The Nottingham Health Profile, Fibromyalgia Impact Questionnaire (FIQ), and Beck Depression Inventory (BDI) were used to determine QOL and functional and depression levels, respectively. Assessments were performed at baseline and after the 6-week program. RESULTS: In group 1, statistically significant improvements were observed in all parameters (P<.05), but no improvement was seen in group 2 (P>.05). When comparing the 2 groups, there were significant differences in group 1 concerning the KAT static balance test (P=.017) and FIQ measurements (P=.005). In the correlation analysis, the BDI was correlated with the BBS (r=-.434) and Hendrich II results (r=.357), whereas body mass index (BMI) was correlated with the KAT static balance measurements (r=.433), BBS (r=-.285), and fall frequency (r=.328). CONCLUSIONS: A 6-week balance training program had a beneficial effect on the static balance and functional levels of patients with FMS. We also observed that depression deterioration was related to balance deficit and fall risk. Higher BMI was associated with balance deficit and fall frequency.

Correlations among enthesitis, clinical, radiographic and quality of life parameters in patients with ankylosing spondylitis.

OBJECTIVES: To investigate the relationship between enthesitis and disease activity, functional status, fatigue, joint mobility, radiological damage, laboratory parameter and quality of life in patients with ankylosing spondylitis (AS). METHODS: A total of 421 patients with AS (323 male and 98 female) who were included in the Turkish League Against Rheumatism Registry were enrolled in the study. The Bath AS Disease Activity Index (BASDAI), fatigue, the Bath AS Functional Index (BASFI), the Bath AS Metrology Index (BASMI), the Maastricht AS Enthesitis Score (MASES), AS quality of life (ASQoL), the Bath AS Radiology Index (BASRI) and erythrocyte sedimentation rate (ESR) were evaluated. RESULTS: Enthesitis was detected in 27.3% of patients. There were positive correlations between MASES and BASDAI, BASFI and fatigue (p < 0.05). MASES was not correlated with BASRI, BASMI, ASQoL and ESR. The mean MASES score was 1.1 ± 2.4. The most frequent regions of enthesopathies were right iliac crest, spinous process of L5 and proximal to the insertion of left achilles tendon, respectively. CONCLUSIONS: Enthesitis was found to be associated with higher disease activity, higher fatigue, worse functional status and lower disease duration. As enthesitis was correlated with BASDAI, we conclude that enthesitis can reflect the disease activity in patients with AS.

Comparison of the Effectiveness of TENS and Low-Level Laser Therapy Applied to the Sciatic Nerve Region in Chronic Lumbar Radiculopathy.

Introduction: This study was carried out to assess and compare the efficacies of transcutaneous electrical nerve stimulation (TENS) and low-level laser therapy (LLLT) applied to sciatic Valleix points to reduce sciatica in patients with chronic lumbar radiculopathy. Methods: The study population consisted of 164 patients with chronic radicular pain caused by LDH. The remaining 75 patients were studied in three groups. TENS and hotpack were applied to the lower back region of all patients. In addition, group 1 (n=24), group 2 (n=25), and group 3 (n=26) received LLLT (4 J/cm2 for each point), TENS, and sham LLLT, respectively, on sciatic Valleix points five days a week, for three weeks (15 sessions). Outcomes were assessed at the beginning of the treatment, after completion of 3 weeks of treatment, and after three months (follow-up). Results: Post-treatment assessments indicated that all parameters investigated within the scope of the study improved in all three groups, except for the VAS leg pain (VASLP) score in group 3. Post-treatment VASLP and DN4 scores of group 1 were significantly superior to those of group 2 (P˂0.001). Follow-up assessments revealed an improvement only in the VASLP score and in group 1. The VASLP, DN-4, and ODI scores of groups 1 and 2 were significantly superior to those of group 3. There was no significant difference between the groups in the PSQI score and lumbar ROM value. Conclusion: Both LLLT and TENS were found to be effective in treating the sciatic nerve associated with lumbar disk herniation with radiculopathy. LLLT was found to be more effective than TENS in reducing leg and neuropathic pains. Follow-up assessments revealed that the only lasting effect of the treatments, which continued into the third month, was the improvement in leg pain.

Pain types and risk factors in post-COVID-19.

Objectives: This study aims to accurately evaluate pain lasting longer than three months and falls under the category of chronic pain and to determine the risk factors to follow up and treat properly and to develop appropriate diagnostic and treatment algorithms. Patients and methods: Between March 2021 and December 2021, a total of 437 patients (162 males, 275 females; mean age: 44±14.6 years; range, 12 to 82 years) who were referred to the participating centers due to pain complaints and were diagnosed with post-COVID-19 condition according to the criteria defined by the World Health Organization (WHO) were included in the study. The patients were divided into three groups as nociceptive pain, neuropathic pain, and central sensitization, based on the physician's clinical evaluation and the Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) and Central Sensitization Inventory scores. Results: The most common diagnosis was nociceptive pain followed by central sensitization. Patients with nociceptive pain had less pain. It was found that not exercising regularly, having a chronic disease and being a woman were risk factors for central sensitization, having thyroid disease before COVID-19, and defining the current pain as very severe were risk factors for neuropathic pain. Conclusion: In the evaluation of post-COVID-19 pain, neuropathic pain and central sensitization should be also considered in addition to nociceptive pain and the severity of pain, systemic diseases and physical activity should be questioned.

Musculoskeletal involvement: COVID-19 and post COVID 19.

The worldwide pandemic of coronavirus disease 2019 (COVID-19) was known to predominantly affect the lungs, but it was realized that COVID-19 had a large variety of clinical involvement. Cardiovascular, gastrointestinal, neurological, and musculoskeletal systems are involved by direct or indirect mechanisms with various manifestations. The musculoskeletal involvement can manifest during COVID-19 infection, due to medications used for the treatment of COVID-19, and in the post/long COVID-19 syndrome. The major symptoms are fatigue, myalgia/arthralgia, back pain, low back pain, and chest pain. During the last two years, musculoskeletal involvement increased, but no clear consensus was obtained about the pathogenesis. However, there is valuable data that supports the hypothesis of angiotensinconverting enzyme 2, inflammation, hypoxia, and muscle catabolism. Additionally, medications that were used for treatment also have musculoskeletal adverse effects, such as corticosteroid-induced myopathy and osteoporosis. Therefore, while deciding the drugs, priorities and benefits should be taken into consideration. Symptoms that begin three months from the onset of the COVID-19 infection, continue for at least two months, and cannot be explained by another diagnosis is accepted as post/long COVID-19 syndrome. Prior symptoms may persist and fluctuate, or new symptoms may manifest. In addition, there must be at least one symptom of infection. Most common musculoskeletal symptoms are myalgia, arthralgia, fatigue, back pain, muscle weakness, sarcopenia, impaired exercise capacity, and physical performance. In addition, the female sex, obesity, elderly patients, hospitalization, prolonged immobility, having mechanical ventilation, not having vaccination, and comorbid disorders can be accepted as clinical predictors for post/long COVID-19 syndrome. Musculoskeletal pain is also a major problem and tends to be in chronic form. There is no consensus on the mechanism, but inflammation and angiotensin-converting enzyme 2 seem to play an important role. Localized and generalized pain may occur after COVID-19, and general pain is at least as common as localized pain. An accurate diagnosis allows physicians to initiate pain management and proper rehabilitation programs.

Comparison of kinesio taping, trigger point injection, and neural therapy in the treatment of acute myofascial pain syndrome: A randomized controlled study.

OBJECTIVES: Myofascial pain syndrome (MPS) is a regional painful soft-tissue disorder, characterized by trigger points (TrPs) and taut bands in the muscles. In this study, we aimed to compare the effectiveness of kinesio taping (KT), TrPs injection, and neural therapy (NT) on pain and disability in acute MPS. METHODS: 104 patients with MPS in the cervical region were allocated into three groups. Group 1 (n=35) were treated with KT, Group 2 (n=35) received local anesthetic (LA) (lidocaine of 0.5%) TrPs injection, and Group 3 (n=34) received NT with the same LA solution. Patients were assessed by means of pain, pressure pain threshold (PPT), and disability. Pain severity was measured by Visual Analog Scale. The neck pain disability scale was used for assessing disability. PPT was measured by using an algometer. Measurements were taken before and after treatment of 3rd and 7th days. RESULTS: There were improvements on pain and disability in all groups at the end of treatments at 3rd day and during follow-up period (p<0.001) and no differences were found between the groups. There was significant difference in PPT values in TrPs injection and NT groups in comparisons between all time periods, however, the change, depending on time in the KT group, was not statistically significant. CONCLUSION: The results of this study show that all these three treatment methods found to be effective on pain relief and disability in acute MPS. In terms of PPT, injection treatments seem to be superior than KT.

Why do manuscripts submitted to the Turkish Journal of Physical Medicine and Rehabilitation get rejected?

Objectives: The study aimed to examine the reasons for the rejection of manuscripts, considering the increased rejection rates of our journal of up to 73% in 2022, and help authors realize what the editors and referees are paying attention to while assessing the manuscript. Materials and methods: In this retrospective study, original articles, case reports, systematic reviews, and meta-analyses submitted and rejected to the Turkish Journal of Physical Medicine Rehabilitation were searched between January 1, 2016, and June 30, 2022. After reviewing the referee's evaluations and editorial opinions for all rejected articles, the reasons for rejection were classified under three main headings: journal, manuscript, and ethical issues. The manuscript issues were detailed under 11 subheadings. Results: A total of 1,293 rejected submissions were reviewed. Of these, 35% were rejected at the editorial stage, while 65% were rejected after peer review. Thirty-three submissions were rejected for ethical reasons, 168 were out of the journal's field of interest, and 1,092 (84%) submissions were rejected for reasons related to the manuscript. The three most common reasons for rejection were protocol/methodology errors (44%), lack of contribution to the literature (41%), and lack of adequate discussion (40%). Conclusion: Before starting the studies, supporting the hypotheses with the current literature review, planning with the right protocol, and interpreting the findings in the discussion will facilitate the acceptance of the manuscripts to our journal.

The utility of faces pain scale in a chronic musculoskeletal pain model.

OBJECTIVES: The main aim of this study was to investigate the clinical utility and sensitivity to change of faces pain scale (FPS) in patients with shoulder pain, chosen as a chronic pain model. The secondary aim was to determine the association of FPS with psychologic status and quality of life of these patients. METHODS: Thirty Turkish patients with chronic shoulder pain were included in the study. Pain intensity was evaluated by visual analog scale (VAS), which is a commonly used pain scale besides FPS. Depression and quality of life were screened by Beck Depression Inventory (BDI) and Short Form-36 (SF-36). All assessments were done before and after the physical therapy. RESULTS: There was a statistically significant decrease in pain severity after the treatment as indicated by FPS and VAS (P=0.000). The standardized response mean (SRM) value of FPS of 2.35 was accepted as a good responsiveness. The FPS showed a strong correlation with VAS (r=0.62 and 0.73) both before and after the treatment. Also, moderate to strong correlations were detected between the FPS and physical functioning (PF), physical role (PR), bodily pain (BP), emotional role (ER), general health (GH), mental health (MH) subscales of SF-36 (r=-0.58-0.80), and BDI scores (r=0.39) before the treatment. However, there were moderate and weak correlations with FPS and PR and social functioning (SF) subscales of SF-36 only after the treatment (r=-0.52 and r=-0.39). CONCLUSIONS: FPS is a satisfactory tool to assess pain in patients with chronic pain conditions and demonstrates sensitivity to detect changes after the treatment.

Evaluation of the physical and emotional effects of the COVID-19 pandemic on patients with fibromyalgia and chronic low back pain: A multicenter cross-sectional controlled study.

Objectives: This study aimed to investigate the physical and emotional effects of the coronavirus disease 2019 pandemic in patients with fibromyalgia syndrome (FMS) and chronic low back pain (CLBP) patients. Patients and methods: The cross-sectional controlled study was performed with 1,360 participants (332 males, 1,028 females; mean age: 42.3±12.5 years; range, 18 to 65 years) between September 2020 and February 2021. The participants were evaluated in three groups: the FMS group (n=465), the CLBP group (n=455), and the healthy control group (n=440). Physical activity, pain levels, and general health status before and during the pandemic were evaluated in all participants. Stress levels were analyzed with the perceived stress scale (PSS) in all groups, and disease activity was analyzed with the fibromyalgia impact questionnaire (FIQ) in patients with FMS. Results: Patients with FMS had worsened general health status and pain levels during the pandemic compared to the other groups (p<0.01). The FMS group showed significantly higher PSS scores than those in other groups (p<0.01). There was a weak-positive correlation between FIQ and PSS parameters in patients with FMS (p<0.05, r=0.385). Conclusion: The general health status, pain, and stress levels of the patients with FMS and CLBP tended to worsen during the pandemic. This high-stress level appeared to affect disease activity in patients with FMS.

Comparison the efficacy of phonophoresis and ultrasound therapy in myofascial pain syndrome.

The aim of this study is to compare the effect of phonophoresis, ultrasound and placebo ultrasound therapies in the treatment of myofascial pain syndrome (MPS). This is a randomized, double-blind placebo controlled study. Sixty patients (48 women, 12 men, mean age 37.9 ± 12.2 years) with MPS were included in this study. Patients were allocated into three groups. Group 1(n = 20) was received diclofenac phonophoresis, group 2(n = 20) was received ultrasound and group 3(n = 20) was received placebo ultrasound therapies over trigger points, 10 min a day for 15 session during 3 weeks (1 MHz-1,5 watt/cm²). Additionally, all patients were given neck exercise program including isotonic, isometric and stretching. Patients were assessed by means of pain, range of motion (ROM) of neck, number of trigger points (NTP), algometric measurement and disability. Pain severity was measured by visual analog scale (VAS) and Likert scale. The neck pain disability index (NPDI) was used for assessing disability. Measurements were taken before and after treatment. After treatment, there were statistically significant improvements in pain severity, NTP, pressure pain threshold (PPT), ROM and NPDI scores both in phonophoresis and in ultrasound therapy groups (P < 0.05). Statistically significant increase in cervical lateral flexion and rotation was observed in the placebo US group. While there was no statistically significant improvement in the cervical flexion-extension joint movement, pain levels, number of trigger points and NPDI score, pressure pain threshold (P > 0.05), also there were no significant differences in all parameters between group 1 and 2 (P = 0.05). Both diclofenac phonophoresis and ultrasound therapy were effective in the treatment of patients with MPS. Phonophoresis was not found to be superior over ultrasound therapy.

Comparison of efficacy of different treatment methods in the treatment of idiopathic tinnitus.

OBJECTIVES: This study aims to detect whether any differences were present between betahistine dihydrochloride, transcutaneal electrical nerve stimulation and pure tone masking-tinnitus retraining therapy (TRT) methods in the effects on quality of life and treatment of the symptoms of the patients. PATIENTS AND METHODS: A total of 91 patients (42 females, 49 males; mean age 49.3±8.3 years; range 30 to 70 years) who admitted to the Otorhinolaryngology Clinic of the Ufuk University between June 2009 and June 2010 with a complaint of subjective tinnitus and who had no hearing loss were included in the study. In this study, the effects of these three treatment methods on healing and quality of life in patients suffering from bilateral subjective tinnitus were comparatively evaluated using Tinnitus Handicap Inventory Score (THIS), visual analog scale (VAS) and audiological parameters. The evaluations were made immediately before the treatment, immediately after the treatment and three weeks after the treatment. Kolmogorov-Smirnov analysis was used to test the normal distribution of the data and Wilcoxon signed rank test was used to show the differences between the different treatment methods before the treatment, immediately after the treatment and three weeks after the treatment. Mann-Whitney U and Kruskal-Wallis H tests were used to show the inter-group differences. RESULTS: In the inter-group analyzes, success rate of the pure tone masking-TRT was much higher when compared to the other treatment methods. In the evaluations performed at the end of the three-month period, it was seen that the efficacy of the treatment was continuing. CONCLUSION: According to these results, pure tone masking-TRT was found to be the best treatment method when compared to other methods and it was concluded that this treatment may be considered as the first choice in patients with idiopathic tinnitus.

Prevalence, etiology, and biopsychosocial risk factors of cervicogenic dizziness in patients with neck pain: A multi-center, cross-sectional study.

OBJECTIVES: This study aims to investigate the prevalence, etiology, and risk factors of cervicogenic dizziness in patients with neck pain. PATIENTS AND METHODS: Between June 2016 and April 2018, a total of 2,361 patients (526 males, 1,835 females; mean age: 45.0±13.3 years; range, 18 to 75 years) who presented with the complaint of neck pain lasting for at least one month were included in this prospective, cross-sectional study. Data including concomitant dizziness, severity, and quality of life (QoL) impact of vertigo (via Numeric Dizziness Scale [NDS]), QoL (via Dizziness Handicap Inventory [DHI]), mobility (via Timed Up-and-Go [TUG] test), balance performance [via Berg Balance Scale [BBS]), and emotional status (via Hospital Anxiety- Depression Scale [HADS]) were recorded. RESULTS: Dizziness was evident in 40.1% of the patients. Myofascial pain syndrome (MPS) was the most common etiology for neck pain (58.5%) and accompanied with cervicogenic dizziness in 59.7% of the patients. Female versus male sex (odds ratio [OR]: 1.641, 95% CI: 1.241 to 2.171, p=0.001), housewifery versus other occupations (OR: 1.285, 95% CI: 1.006 to 1.642, p=0.045), and lower versus higher education (OR: 1.649-2.564, p<0.001) significantly predicted the increased risk of dizziness in neck pain patients. Patient with dizziness due to MPS had lower dizziness severity scores (p=0.034) and milder impact of dizziness on QoL (p=0.005), lower DHI scores (p=0.004), shorter time to complete the TUG test (p=0.001) and higher BBS scores (p=0.001). CONCLUSION: Our findings suggest a significant impact of biopsychosocial factors on the likelihood and severity of dizziness and association of dizziness due to MPS with better clinical status.

Cost-effectiveness analysis of chronic mechanical back pain treatment modalities.

OBJECTIVES: This study aims to evaluate and compare the cost-effectiveness of inpatient physical therapy, outpatient physical therapy applications, and back school education in low back pain (LBP) treatment. PATIENTS AND METHODS: Between March 2011 and September 2011, a total of 105 patients (43 males, 62 females; mean age 44.8±12.7 years; range, 27 to 58 years) who were treated for chronic LBP were included in this prospective study. Of the patients, 34 received inpatient physical therapy consisting of electrotherapy, superficial-deep heat application, and basic back exercise program, 35 received the same treatment in the outpatient setting, and 36 received back school education. Each patient was evaluated five times during the study using pain intensity Visual Analog Scale (VAS), spinal mobility measurements (inclinometer), general evaluation (VAS), functional disability measurement (Roland-Morris Disability Questionnaire [RMDQ]), and quality of life (Short Form-36 [SF-36]). All expenses and costs for treatment of LBP were estimated. RESULTS: At the end of six months of follow-up, all study groups had a statistically significant improvement in all variables. Improvements in spinal mobility, RMDQ, and SF-36 scores were significantly higher in the inpatient physical therapy group (p<0.001). Direct and total costs were the highest in the inpatient treatment group and were the lowest in the back school education group (p<0.001). No statistically significant differences were observed in terms of additional cost of one-unit improvement in these variables among the study groups. CONCLUSION: Our study results suggest that all three treatment modalities are effective in chronic LBP. In patients with LBP-related impairment in functional status and quality of life, inpatient physical therapy and rehabilitation should be preferred.

The effects of pulsed electromagnetic fields in the treatment of knee osteoarthritis: a randomized, placebo-controlled trial.

In this study, we planned to investigate the effects of pulse electromagnetic field (PEMF) on pain relief and functional capacity of patients with knee osteoarthritis (OA). Fifty-five patients with knee OA were included in a randomized, placebo-controlled study. At the end of the therapy, there was statistically significant improvement in pain scores in both groups (P < 0.05). However, no significant difference was observed within the groups (P > 0.05). We observed statistically significant improvement in some of the subgroups of Lequesne index. These are morning stiffness and activities of daily living activities compared to placebo group. However, we could not observe statistically significant differences in total of the scale between two groups (P > 0.05). Applying between-group analysis, we were unable to demonstrate a beneficial symptomatic effect of PEMF in the treatment of knee OA in all patients. Further studies using different types of magnetic devices, treatment protocols and patient populations are warranted to confirm the general efficacy of PEMF therapy in OA and other conditions.

Adaptation and validation of Turkish version of the Knee Outcome Survey-Activities for Daily Living Scale.

The Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS), originally developed in English, is a valid and reliable self-reported instrument used for patients with various painful knee conditions. We adapted the KOS-ADLS to Turkish and tested its reliability and validity. We enrolled 142 patients with knee pain in the study. The patients were randomized into two groups: Group 1 (n = 75) completed the questionnaire twice a week for assessing test-retest reliability and Group 2 (n = 67) answered the questionnaire and performed additional tests for assessing validity. The intraclass correlation coefficient ranged from 0.98 to 0.99 with high internal consistency (Cronbach's alpha, 0.89). Validity-related tests included pain measurement with a visual analog scale and functional tests, including time measurements for the get-up-and-go and ascending/descending stairs tests. The visual analog scale score correlated with total score (r = 0.56), function total score (r = 0.53), and symptom total score (r = 0.45). The ascending/descending stairs test correlated with total score (r = 0.47), function total score (r = 0.49), and symptom total score (r = 0.31). The get-up-and-go test weakly correlated with all three scores. The Turkish version of the KOS-ADLS is reliable and valid in evaluating the functional limitations of patients with knee pain.

The Turkish Society of Physical Medicine and Rehabilitation (TSPMR) guideline recommendations for the management of fibromyalgia syndrome.

In the present study, we aimed to establish a national guideline including recommendations of the Turkish Society of Physical Medicine and Rehabilitation (TSPMR) for the management of Fibromyalgia (FM) syndrome. This guideline was built mainly in accordance with the 2017 revised European League Against Rheumatism (EULAR) guideline recommendations for the management of FM. A total of 46 physical medicine and rehabilitation specialists were included. A systematic literature search was carried out in PubMed, Scopus, Cochrane, and Turkish Medical Index between 2000 and 2018. Evidence levels of the publications were evaluated, and the levels of recommendation were graded on the basis of relevant levels of evidence, The Assessment of Level of Agreement with opinions by task force members was established using the electronic Delphi technique. Recommendations were assessed by two Delphi rounds and 7 of 10 points were deemed necessary for agreement. The treatment recommendations were classified as non-pharmacological therapies (6 main items), pharmacological treatments (10 items), and complementary therapies (5 items). These were recommended in the light of evidence, depending on the clinical and general condition of each patient. This is the first national TSPMR guideline recommendations for the management of FM in Turkey. We believe our effort would be helpful for the physicians who are interested in the treatment of FM.

Prevalence of Rheumatoid Arthritis and Spondyloarthritis in Turkey: A Nationwide Study.

OBJECTIVES: This study aims to estimate the prevalence of rheumatoid arthritis (RA) and spondyloarthritis (SpA) in Turkey using the same telephone questionnaire developed for screening RA and SpA in France and used in Serbia and Lithuania. MATERIAL AND METHODS: The study was performed in two steps. In step I, the French questionnaire was translated into Turkish and validated through a group of 200 patients (80 males, 120 females; mean age 44.0±13.1 years; range 19 to 75 years) followed up at the rheumatology departments of University Hospitals in Antalya and Ankara. In step II, the validated Turkish questionnaire was administered face-to-face to randomly selected 4,012 subjects (1,670 males, 2,342 females; mean age 41.5±16.8 years; range 16 to 97 years) by trained general practitioners across the country, in 25 prov- inces for case detection. The subjects who were suspected of having RA or SpA in accordance with the questionnaire were invited to the nearest university hospital for rheumatologic examination in order to confirm the diagnosis. RESULTS: In step II, a total of 25 subjects (2 males, 23 females) were diagnosed as RA. The standardized RA prevalence for the general population of Turkey was calculated as 0.56% (95% confidence interval [CI]; 0.33-0.79), 0.10% (95% CI; -0.05-0.25) for males and 0.89% (95% CI; 0.51-1.27) for females. A total of 18 subjects (3 males, 15 females) were diagnosed as SpA. The standardized SpA prevalence for the general population of Turkey was 0.46% (95% CI; 0.25-0.67), 0.17% (95% CI; -0.03-0.37) for males and 0.65% (95% CI; 0.32-0.98) for females. The prevalence of RA was highest in the Northern region (2.00%) and the prevalence of SpA was highest in the Central region (1.49%). CONCLUSION: The prevalences of RA and SpA in Turkey are close to each other and there are significant inter-regional variations in prevalences of both RA and SpA.