Postacute Rehabilitation Impact on Functional Recovery Outcome and Quality of Life in Stroke Survivors: Six Month Follow-Up.

Background and Objectives: This study aimed to examine the impact of postacute rehabilitation duration on the outcome of the functional recovery and patients' quality of life after the stroke. Materials and Methods: One hundred patients (52 females, 48 males, mean age: 66.5 ± 7.3; range 53 to 79 years) who experienced a stroke (50 with ischemic stroke (IS) and 50 with intracranial hemorrhage (ICH)) took part in the study. Patients (treated with postacute rehabilitation measures for six months) were examined after one, three, and six months of postacute rehabilitation. Functional independence was measured using the functional independence measure (FIM) test, while the EQ-5D-3L questionnaire was used to assess the quality of life. Results: Patients with ICH had a slightly lower FIM score (FIM motor = 29.8 ± 11.8; FIM cognitive = 14.4 ± 4.6) on admission compared to patients with IS (FIM motor = 41.8 ± 18.8; FIM cognitive = 18.7 ± 6.3), but, after six months of postacute rehabilitation, patients with ICH reached an approximate level of functional independence (FIM motor = 53.8 ± 14.4; FIM cognitive = 25.8 ± 4.7), as did patients with IS (FIM motor = 67.6 ± 16.4; FIM cognitive = 29.2 ± 4.0). The motor and cognitive FIM, as well as quality of life, was statistically significantly increased at all four measurement points (p < 0.001). Furthermore, there is a statistically significant connection between functional independence and quality of life at all tested times. Conclusion: Patients achieved the highest degree of functional independence after six months. Furthermore, our findings point out that inpatient rehabilitation as well as outpatient rehabilitation are effective in functionality and quality of life improvement after a stroke; thus, both should be emphasized and regularly implemented.

Reliability, Validity and Temporal Stability of the Serbian Version of the Boston Carpal Tunnel Questionnaire.

Background and Objectives: The aim of this study was to validate the Serbian version of the Boston Carpal Tunnel Questionnaire (BCTQ) and to evaluate temporal stability for the purpose of its implementation in the evaluation of Serbian patients with carpal tunnel syndrome (CTS). Materials and Methods: For the validation of the Serbian version of the BCTQ (BCTQSR), we tested 69 individuals with diagnosed CTS that were referred for a conservative treatment at the Institute for Rehabilitation. Neurophysiological tests were used for the electrophysiological grading (EG) of CTS severity in the study sample. The final version of the BCTQSR was given to the tested participants from the study on two occasions: test and retest, with a five-day period between the two measurements. Results: The mean value for the symptom severity subscale (SSS) of the BCTQSR was 3.01 ± 0.94; for the functional status subscale (FSS) of the BCTQSR it was 2.85 ± 1.00. Cronbach's α for the SSS was 0.91 and 0.93 for the FSS. The intraclass correlation coefficients (ICCs) concerning the test−retest were significant (p < 0.001) and were 0.949 for the SSS and 0.959 for the FSS. Those with a higher EG grade had higher values of the SSS and FSS but without a statistical significance (p = 0.103 and p = 0.053, respectively). The intercorrelation of the BCTQSR subscales (SSS and FSS) on the test was significant (p < 0.001) with a correlation coefficient equal to 0.777. Conclusion: The Serbian version of the BCTQ (BCTQSR) was successfully culturally adopted. The BCTQSR was a valid and reliable instrument for the measurement of symptom severity and functional status in adults with CTS. Therefore, it can be used in clinical practice for patients with CTS.

The Effects of Continued Rehabilitation After Primary Knee Replacement.

INTRODUCTION: Tasks of rehabilitation after arthroplasty are to provide painless joint movements, to improve the range of motion, to establish a scheme of walking, to achieve independence in activities of daily living. THE AIM: of the study is to determine the effects of continued rehabilitation on the range of the knee motion and reducing the swelling after total knee replacement. METHODS: The study was conducted from 2011 to 2013 and included 140 patients of both sexes, aged 45 to 85 with implanted endoprosthesis based on primary osteoarthritis. They were divided into two groups, experimental, which after early rehabilitation continued ongoing rehabilitation for a period of three weeks, while the control group after completion of early rehabilitation began rehabilitation two months from the surgery for a period of three weeks. The range of motion in the knee joint and the extent of the knee joint in the medium of patella were measured in both groups during the admission and discharge from rehabilitation. In the experimental group, control measurements were carried out three months after surgery. RESULTS: In both groups, there was a significant reduction of the swelling at the discharge in relation to the admission while in the experimental group there was no change on the control of the joint swelling after three months in relation to the release from rehabilitation. In the experimental group, the range of motion of flexion and extension was improved at the discharge in relation to the admission as well as the flexion during the control while the range of motion of extension wasn't significantly changing during the control examination. In the control group, the extension and flexion were significantly improved at the discharge compared to the admission. Comparing both groups, the results showed that there was a significant improvement in flexion movements in the experimental group during rehabilitation in comparison to the control group, while the range of motion of the extension was not significantly different in these two groups. Comparing the range of motion of the experimental group on the control examination and the control group at discharge, it is demonstrated significant improvement in flexion and extension in the experimental group. CONCLUSION: Results of monitoring the reduction of the swelling and the return of the range of motion confirm the advantage of continuous rehabilitation.

Electrodiagnostic evaluation of patients with carpal tunnel syndrome regarding the presence of subjective and physical findings.

The aim of our study was to evaluate the changes of median nerve conduction velocities by electrodiagnostic procedure in carpal tunnel syndrome (CTS) patients with and without present subjective and physical findings. We have evaluated 116 patients that were diagnosis with CTS. Subjective findings: weakness, numbness and night pain were analyzed. Further physical findings were evaluated: Tinels sign, muscles hypotrophy and weakness according to muscle manual test (MMT). Duration of complaints was evaluated as well. Electroneurographic findings included: estimation of median nerve motor terminal latency (mMTL), sensory velocity (mSV) and motor velocity (mMV). Significantly longer complaints were present in patients who experienced night pain (p=0.015) and those with muscles weakness on MMT (p=0.016). Statistically significant increase for mMTL values was noticed for patients with Tinels sign (p=0.045), present muscles hypotrophy (p=0.001) and weakness on MMT (p=0.001). There is significant decrease for mMV in group with present Tinels sign (p=0.048), muscle hypotrophy (p=0.003) and weakness on MMT (p=0.002), and for mSV in group with present muscle hypotrophy (p=0.008) and group with weakness on MMT (p=0.019). Multivariate logistic regressional analysis shown that only for hypotrophy, mMTL variable presents significant independent contributor (p=0.009). For the diagnosis confirmation and treatment planning along with elecroneurography it is necessary to evaluate patients with CTS clinically, since different clinical manifestations are correlating in different degree with electroneurographic findings.

Evidence-based position paper on Physical and Rehabilitation Medicine practice for people with amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease that affects both upper and lower motor neurons and is fatal in its course. This evidence-based position paper represents the official position of the UEMS PRM Section. The aim of the paper is to define the role of the physical and rehabilitation medicine (PRM) physician and PRM professional practice for people with ALS. A systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. The systematic literature review is reported together with thirty-two recommendations resulting from the Delphi procedure. The responsibility of the PRM physician is functional assessment of persons with ALS and delivering the optimal and most effective PRM program of care. The rehabilitation program of patients with ALS should be delivered and monitored by the multiprofessional team, with the PRM physician as principal coordinator.

Factors associated with poor self-reported function and quality of life in patients with end-stage knee or hip osteoarthritis immediately prior to total joint arthroplasty.

INTRODUCTION: The aim was to evaluate patients' perception of function and physical and mental dimensions of health-related quality of life (HRQoL) in patients with end-stage knee or hip osteoarthritis (OA) immediately prior to surgery and to identify the factors associated with the outcomes. MATERIAL AND METHODS: The study included 200 patients with end-stage OA (100 knee OA and 100 hip OA patients). Self-reported physical function was assessed using the Oxford Knee Score or Oxford Hip Score. Physical and mental dimensions of HRQoL were assessed using the physical and mental component summary scores of the 36-Item Short-Form Health Survey. Multivariate linear regression analysis was used to identify the sociodemographic, clinical and psychological factors associated with self-reported function and physical and mental dimensions of HRQoL. RESULTS: End-stage knee or hip OA patients had poor function and physical dimension of HRQoL, while the mental dimension of HRQoL was not impaired. In knee OA, pain, flexion range of motion (ROM), catastrophizing, and anxiety were significantly associated with self-reported function (explained 56% of the variance), whereas catastrophizing explained 10% of the variance of the physical dimension of HRQoL. In hip OA, flexion ROM, catastrophizing and being employed were significantly associated with self-reported function (explained 44% of the variance), whereas catastrophizing and flexion ROM explained 34% of the variance of the physical dimension of HRQoL. CONCLUSIONS: Many investigated factors were associated with poor self-reported function and HRQoL in knee and hip OA. However, the most important factors for both knee and hip OA were catastrophizing and flexion ROM.

Evidence based position paper on Physical and Rehabilitation Medicine practice for people with muscular dystrophies.

Muscular dystrophies present a group of inherited degenerative disorder that are characterized by progressive muscular weakness. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section. The aim of the paper is to evaluate the role of the physical and rehabilitation medicine (PRM) physician and PRM practice for people with muscular dystrophies. A systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. The systematic literature review is reported together with thirty-three recommendations resulting from the Delphi procedure. The role of the PRM physician is to assess the functional status of persons with muscular dystrophy and to plan, monitor and lead PRM program in an interdisciplinary setting within a multiprofessional team.

A 12-week exercise program improves functional status in postmenopausal osteoporotic women: randomized controlled study.

BACKGROUND: Beside the importance of implementing physical activity in treatment of patients with osteoporosis, the multicomponent exercise program and assessment of its functional outcomes performed by five performance-based measures, have not been explored yet. AIM: The present study evaluated the effect of the 12 weeks exercise program on functional outcomes of postmenopausal patients with densitometric diagnosed osteoporosis. DESIGN: The study was designed as randomized control study. SETTING: Female outpatients with diagnosed postmenopausal osteoporosis were included in the study. POPULATION: The study included women from urban area. METHODS: Patients were randomized in two groups: exercise group (EG) and control group (CG). Patients in the exercise group (N.=47) participated in a 12 weeks exercise program, which consisted of resistance training, balance exercise and aerobic exercise, while patients from control group (N.=49) had not participated in any exercise program during the intervention period. Functional outcomes determined by Time Up and Go Test (TUG), Sit To Stand test (STS) and One Leg Stance Test (OLST) were evaluated at baseline and 4 and 12 weeks after treatment, while Fall Efficacy Scale (FES-I) and Knowledge About Osteoporosis Questionnaire (OKAT-S) were assessed at baseline and after 12 weeks, respectively. RESULTS: There were noticed statistically significant improvement in all observed measurements in EG after 4 and 12 weeks, respectively. Comparison between groups showed statistically significant difference in EG compared to CG in all functional outcomes in observed periods (P<0.001 for all). OLST significantly changed only in EG, not in CG, in both experimental periods. After 4 weeks, in CG there were no statistically significant changes in any of the monitored parameters, while after 12 weeks improvements were detected with TUG, STS, FES-I and OKAT-S. CONCLUSIONS: Twelve weeks exercise program, as an effective, inexpensive and easily performed method, improved functional status in postmenopausal osteoporotic women. CLINICAL REHABILITATION IMPACT: In the present study we found that supervised exercise program in postmenopausal osteoporotic female patients significantly improved their muscle strength and balance and decreased fear of falling. Thus, it is proposed to be a part of clinical protocol for osteoporosis treatment.

Effects of 12-Week Exercise Program on Enzyme Activity of Serum Matrix Metalloproteinase-9 and Tissue Inhibitor of Metalloproteinase-1 in Female Patients with Postmenopausal Osteoporosis: A Randomized Control Study.

BACKGROUND: Osteoporosis is a disease characterized by decreased bone density and destruction of bone microarchitecture. Indicators for altered bone homeostasis are changes in the serum level of matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs). The purpose of the current study was to evaluate the effect of a 12-week exercise program on enzyme activity of serum MMP-9 and TIMP-1 in postmenopausal osteoporotic patients. Materials and methods. Participants were randomized in two groups: exercise (EG) (N = 37) and control (CG) (N = 37) and control (CG) (. RESULTS: Significant differences between pretreatment and posttreatment enzyme activities of serum MMP-9 (p=0.009), TIMP-1 (p=0.009), TIMP-1 (p=0.009), TIMP-1 (. CONCLUSION: Our results suggest that a 12-week exercise program has an influence on enzyme activity of serum MMP-9, revealing a possible role of MMPs in initiating training-specific adaptation. Although measurements of circulating MMP-9 and TIMP-1 allowed us to detect effects of exercise, as of today, they have no real role in the diagnosis of osteoporosis and/or follow-up of osteoporotic patient's response to treatment. MMP-9 might be used as an important prognostic marker for the evaluation of patient's response to exercise. Larger-randomized controlled studies need to be performed to expand this area of knowledge. This trial is registered with trial registration number: NCT03816449).

Morphogenetic Variability as Potential Biomarker of Functional Outcome After Ischemic Stroke.

The aim of our study was to evaluate the role of morphogenetic variability in functional outcome of patients with ischemic stroke. The prospective study included 140 patients with acute ischemic stroke, all of whom were tested upon: admission; discharge; one month post-discharge; and three months post-discharge. The age was analyzed, as well. The Functional Independence Measure (FIM) test and the Barthel Index (BI) were used for the evaluation of functional outcomes for the eligible participants. We analyzed the presence of 19 homozygous recessive characteristics (HRC) in the studied individuals. There was a significant change in FIM values at discharge (p = 0.033) and in BI values upon admission (p = 0.012) with regards to the presence of different HRCs. Age significantly negatively correlated for the FIM score and BI values at discharge for the group with 5 HRCs (p < 0.05), while for BI only, negative significant correlation was noticed for the group with 5 HRCs at three months post-discharge (p < 0.05), and for the group with 3 HRCs at one month post-discharge (p < 0.05) and three months post-discharge (p < 0.05). Morphogenetic variability might be one among potentially numerous factors that could have an impact on the response to defined treatment protocols for neurologically-impaired individuals who suffered an ischemic stroke.

The approach of physiatrists to low back pain across Europe.

BACKGROUND: Low back pain (LBP) is the most common type of musculoskeletal pain, thus it is one of the most commonly encountered conditions in Physical and Rehabilitation Medicine. The physicians who are primarily responsible for the nonsurgical management of LBP are physiatrists. OBJECTIVE: The present study aimed to investigate the approaches of physiatrists to low back pain across Europe. Preferences, tendencies, and priorities in the diagnosis, management, and treatment of LBP, as well as the epidemiological data pertaining to LBP in PRM practice were evaluated in this Europe-wide study. METHODS: The study was conducted under the control of the European Society of Physical and Rehabilitation Medicine (ESPRM) Musculoskeletal Disorders Research Committee. A total of 576 physiatrists from most European countries participated in the survey. RESULTS: The results show that physiatrists frequently deal with patients with LBP in their daily practice. Most patients are not referred to other departments and are treated with various conservative methods. Less than one-fifth of patients are primarily referred for surgery. The physiatrists believe that a clear diagnosis to account for cases of low back pain is rarely established. The most common diagnosis is discopathy. History and physical examination remain the most valuable clinical evaluation tools for low back pain according to physiatrists. Less than half the patients require a magnetic resonance imaging. Non-steroidal anti-inflammatory drugs are the most commonly prescribed drugs for low back pain. Exercise, back care information, and physical therapy are the preferred conservative treatments. More than half of the physiatrists offer interventional treatments to patients with low back pain. CONCLUSION: The present study is a preliminary report that presents the attitudes of European physiatrists in the management of low back pain. Further researches are warranted to standardize the conservative management of LBP.

Morphogenetic Variability and Hypertension in Ischemic Stroke Patients-Preliminary Study.

In this study, we evaluated and compared the morphogenetic variability and the degree of recessive homozygosity in patients with manifested ischemic stroke compared to healthy controls. We have evaluated 120 patients with manifested ischemic stroke, of which 64 did not have hypertension and 56 have hypertension. For comparison, we additionally tested 194 healthy individuals without manifested ischemic stroke (controls). For the estimation of the degree of recessive homozygosity, we have performed the homozygously recessive characteristics (HRC) test and tested 19 HRCs. There was a significant difference in the individual variations of 19 HRCs between the controls and patients with manifested ischemic stroke (∑χ² = 60.162, p < 0.01). The mean values of the tested HRCs significantly differed between the controls and group with manifested ischemic stroke (Controls − 5.71 ± 1.61, Ischemic stroke group − 6.25 ± 1.54, p = 0.012). For the tested individuals with hypertension, the mean values of HRCs did not significantly differ between the controls and those that had manifested ischemic stroke (Controls − 5.28 ± 1.75, Ischemic stroke group − 5.64 ± 1.48, p = 0.435). We found a significant difference in the frequencies of HRCs between those with and without hypertension for controls (p < 0.003) and for those with manifested ischemic stroke (p < 0.001). There are increased degrees of recessive homozygosity along with decreased variability in patients with manifested ischemic stroke compared to controls.

The effectiveness of group Otago exercise program on physical function in nursing home residents older than 65years: A randomized controlled trial.

AIM: To examine whether the 6-months group-based Otago exercise program is more effective than usual care on physical function and functional independence in nursing home residents older than 65 years. METHODS: An observer-blind randomized controlled study included 77 independently walking, cognitively unimpaired residents aged 78.4±7.6years, of which 66.2% were female. Physical function was assessed at baseline, after 3 and 6months of the Otago exercise program by three performance tests: Berg Balance Scale (BBS), Timed Up and Go (TUG) and Chair Rising Test (CRT), and functional independence by the motor Functional Independence Measure (mFIM). RESULTS: Significant within participant effects of time in EG for BBS, TUG and CRT (p<0.001) and for mFIM (p=0.010) were found. Between participant effects of groups on BBS, TUG, CRT and mFIM values were not significant. Changes in values of performed three tests regarding physical function were significantly different in EG and CG (p<0.001), as well as for functional independence test (mFIM) (p=0.019). In EG the values got better, while in CG values worsened. Effect sizes of change in the EG were higher for BBS, TUG and CRT compared to mFIM. CONCLUSION: The Otago exercise program was shown as effective in improving balance, functional mobility, lower limbs muscle strength and functional independence, indicating that it could help in slowing of disability progression.

Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice for people with respiratory conditions. The European PRM position (UEMS PRM Section).

Chronic respiratory conditions are among the top causes of death and disability. The aim of the paper was to improve Physical and Rehabilitation Medicine (PRM) physicians' professional practice for people with chronic respiratory conditions in order to promote their functioning and to reduce activity limitations and/or participation restrictions. A systematic review of the literature and a Consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. The systematic literature review is reported together with twenty-three recommendations resulting from the Delphi procedure. The professional role of PRM physicians having expertise in the rehabilitation of chronic respiratory conditions is to lead pulmonary rehabilitation programs in multiprofessional teams, working in collaboration with other disciplines in a variety of settings to improve functioning of people with chronic respiratory conditions. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians for people with respiratory conditions.

Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice for people with cardiovascular conditions. The European PRM position (UEMS PRM Section).

Cardiovascular conditions are significant causes of mortality and morbidity leading to substantial disability. The aim of the paper is to improve Physical and Rehabilitation Medicine (PRM) physicians' professional practice for people with cardiovascular conditions in order to promote their functioning and to reduce activity limitations and/or participation restrictions. A systematic review of the literature and a Consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. The systematic literature review is reported together with thirty recommendations resulting from the Delphi procedure. The professional role of PRM physicians having expertise in the rehabilitation of cardiovascular conditions is to lead cardiac rehabilitation programs in multiprofessional teams, working in collaboration with other disciplines in a variety of settings to improve functioning of people with cardiovascular conditions. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians in persons with cardiovascular conditions.

Botulinum toxin type A in combination with standard urotherapy for children with dysfunctional voiding.

PURPOSE: We investigated the role of botulinum toxin type A and urotherapy in the treatment of children with dysfunctional voiding. MATERIALS AND METHODS: Nine female children with dysfunctional voiding refractory to standard urotherapy and alpha1-adrenergic blocking agents were included in the prospective clinical study. Botulinum toxin type A in a dose of 500 units was injected transperineally into the external urinary sphincter. Bladder rehabilitation was introduced 2 weeks after botulinum toxin type A treatment. Uroflow studies with ultrasound residual urine volumes were obtained before and 6 months after treatment. All children were tested before and 6 months after treatment using the empirically designed International Reflux Study in Children modified questionnaire. RESULTS: After treatment the mean +/- SD voided volume increased from 180 +/- 73 to 228 +/- 94 ml (p <0.05) while post-void residual urine volume decreased from 52 +/- 40 to 19 +/- 18 ml (p <0.05). Significant differences in other uroflowmetry parameters were not found. However, significant symptom score improvement was detected 6 months after treatment, being decreased by 7 vs 20 (p <0.01). No systemic side effects occurred following botulinum toxin type A injection. CONCLUSIONS: Our study demonstrates that the voiding mechanism in children with dysfunctional voiding refractory to standard therapy can be significantly improved and maintained at least 6 months after combined botulinum toxin type A injection and bladder rehabilitation.

Ibuprofen plus paracetamol versus ibuprofen in acute low back pain: a randomized open label multicenter clinical study.

OBJECTIVE: to estimate whether combination of ibuprofen and paracetamol is more effective than ibuprofen in monotherapy, in the treatment of acute low back pain. METHODS: 80 adult patients with acute low back pain were randomized into two subgroups. In the first subgroup, 40 patients were treated with ibuprofen 400mg three times a day (TID), whilst patients in the second subgroup (n=40) were treated with a fixed-dose combination tablet of ibuprofen 200mg plus paracetamol 325mg TID, for three consecutive days. Patients were followed for another 7 days. Efficacy and tolerability of both treatment options was assessed. RESULTS: A statistically significant decrease in pain intensity, assessed using a visual analogue scale (p<0.001), as well as the 5-point Likert scale, was noticed in both subgroups of patients. However, intensity of pain on Day 4 was significantly lower in patients treated with combined therapy (t=2.05, p=0.045). Considerable improvement in mobility of the lumbar spine was noticed in both subgroup of patients (p<0.001), but at the end of the follow up period, finger-to-floor distance was lower in patients on combined therapy (4.7cm vs. 8.3cm, t=2.27, p=0.03). Improvement of functional ability on Day 4 and Day 10 was significant, regardless of treatment (p<0.001). One patient on combined therapy and two patients on ibuprofen monotherapy reported minor gastric intolerability. CONCLUSION: compared to ibuprofen monotherapy, combination of ibuprofen and paracetamol may provide faster and longer analgesia in patients with acute low back pain, with equally favorable effect on mobility and functional ability and similar tolerability.

Relationship between fear of falling and functional status in nursing home residents aged older than 65 years.

AIM: The present study investigated the relationship between fear of falling and functional status, and sociodemographic and health-related factors in nursing home residents aged older than 65 years. METHODS: The cross-sectional study involved 100 participants who were residents of a nursing home and aged older than 65 years. Fear of falling was assessed using the Falls Efficacy Scale. Functional status was assessed by four performance-based measures. Balance was assessed by the Berg Balance Scale, mobility by the Timed Up and Go test, lower limbs muscle strength by the Chair Rising Test and participants' functional ability by the motor Functional Independence Measure. RESULTS: There was a significant negative correlation between the Falls Efficacy Scale and Berg Balance Scale (P < 0.001), and motor Functional Independence Measure (P < 0.001) scores; and a positive correlation with the Timed Up and Go test (P < 0.001) and Chair Rising Test (P < 0.001) values. Falls Efficacy Scale score increase is associated with age, being a widower/widow and the number of falls in the previous year. Higher fear of falling is associated with an increase in the number of falls in the previous year and with a decrease in Berg Balance Scale score. CONCLUSIONS: The study found a significant associations between Falls Efficacy Scale score and all of the examined parameters of functional status, the number of falls in the previous year, age and marital status of widower/widow. The major finding was that poor balance and an increase in the number of falls in the previous year are independent factors significantly associated with the fear of falling. Geriatr Gerontol Int 2017; 17: 1470-1476.

Clinoptilolite for Treatment of Dyslipidemia: Preliminary Efficacy Study.

OBJECTIVES: A tribomechanically activated clinoptilolite (natural aluminosilicate mineral) has been used to increase growth in meat-producing animals, as an adjuvant in cancer therapy, and a heavy metal remover in humans. Because of its unique cation exchanging and chelating properties, we hypothesized that clinoptilolite may be beneficial for the treatment of dyslipidemia in the manner similar to bile acid sequestrants. Thus, specific aims of this pilot study were to orally administer clinoptilolite in different doses and granule size combinations to determine magnitude and time profile of changes in blood lipids. DESIGN: A phase I/IIa prospective, open-label, uncontrolled, dose/granule size-ranging study (treatment phase 8 weeks, follow-up 6 weeks). Blood lipids were examined every 2 weeks. SETTINGS: Outpatient clinic of a university-affiliated hospital. SUBJECTS: Forty-one subjects (all white, mean age 57.6 ± 6.8 years, 17 women) with blood lipids above the normative limits divided into three groups. INTERVENTION: A tribomechanically activated clinoptilolite was administered in three dose/grind combinations: 6 g/day of fine grind (6gF), 6 g/day of coarse grind (6gC), and 9 g/day of coarse grind (9gC). OUTCOME MEASURES: Blood concentrations of total cholesterol (TC), low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc), and triglycerides (TG). RESULTS: For the 3 groups combined, all lipid fractions significantly improved after 8 weeks of treatment (20-25%, p < 0.001), which reversed to baseline after 6 weeks of clinoptilolite withdrawal. Early (week 2) and the most pronounced decrease in TC and LDLc was observed in the 6gF group (19% and 23% in week 8, respectively), with no difference in HDLc and TG between the three dose/grind groups. No side effects were reported. CONCLUSIONS: These pilot results suggest that oral administration of clinoptilolite may improve lipid profile in individuals with dyslipidemia, which warrants further investigations.

Are Interferential Electrical Stimulation and Diaphragmatic Breathing Exercises Beneficial in Children With Bladder and Bowel Dysfunction?

OBJECTIVE: To evaluate the effects of interferential current (IC) stimulation and diaphragmatic breathing exercises (DBEs) in children with bladder and bowel dysfunction. PATIENTS AND METHODS: Seventy-nine children with dysfunctional voiding and chronic constipation who were failures of primary care interventions were included in the prospective clinical study. All the children were checked for their medical history regarding lower urinary tract symptoms and bowel habits. Physical examination, including abdominal and anorectal digital examination, was performed. Children kept a bladder and bowel diary, and underwent urinalyses and urine culture, ultrasound examination of bladder and kidneys, and uroflowmetry with pelvic floor electromyography. Eligible children were divided into 3 groups (A, B, and C). All groups were assigned education and behavioral modifications. Additionally, group A underwent DBEs and IC stimulation, whereas group B received only DBEs. The treatment was conducted for 2 weeks in the clinic in all 3 groups,. The behavioral modifications and DBEs were continued at home for 1 month. Clinical manifestations, uroflowmetry parameters, and postvoided residual urine were analyzed before and after 6 weeks of therapy. RESULTS: After the treatment, significant improvement in defecation frequency and fecal incontinence was noticed only in group A (P < .001 and P < .05, respectively). These children demonstrated significant improvement in lower urinary tract symptoms and postvoided residual urine (P < .001 and P < .05, respectively). Bell-shaped uroflowmetry curve was observed in 73.3% of group A patients (P < .001). CONCLUSION: IC stimulation and DBEs are beneficial in chronically constipated dysfunctional voiders. Further trials are needed to define the long-term effects of this program.