An investigation of the factors that influence functional improvement in stroke rehabilitation

Background/aim: The purpose of this study was to determine effect of age, sex, affected extremity, disability severity, treatment type, cerebrovascular accident (CVA) etiology, number of treatment sessions, and CVA duration on the functional improvement of the stroke patients who participated in a physical medicine and rehabilitation program. Materials and methods: The research sample consisted of 322 stroke patients. Clinical and demographic features including age, sex, affected extremity, disability severity, treatment type, CVA etiology, number of treatment sessions, and CVA duration were recorded. Functional status was evaluated retrospectively by using the functional independence measure (FIM) at admission and discharge. Results: It was detected that discharge FIM score of the patients exhibited an increase of significance level (p < 0.05). It was found that age, number of treatment sessions, CVA duration and FIM admission score were determinative parameters in FIM gain level (p < 0.05) while sex, affected extremity, and CVA etiology were not effective in FIM gain level (p > 0.05). Conclusion: Results show that functional improvement after rehabilitation was better in the younger ages, shorter CVA durations and moderate functional disturbances. The findings obtained may be useful for stroke rehabilitation triage.

Extracorporal Shock Wave Therapy as a Delay Procedure to Improve Viability of Zone 4: An Experimental Study in a Rat TRAM Flap Model.

BACKGROUND: The purpose of this study was to test our hypothesis that preoperative application of radial extracorporeal shock wave therapy (rESWT) as a delay procedure would improve the survival of zone 4 of transverse rectus abdominis musculocutaneous (TRAM) flap and reduce the resulting necrotic area. METHODS: Twenty-four Wistar rats were randomized and divided into 3 experimental groups (n = 8 each). Caudally based TRAM flap model, with the right rectus abdominis muscle as the carrier and right inferior epigastric vessels as the vascular pedicle, was used in this study. In group 1 (control), after being raised, the TRAM flap was sutured back to its bed without any further intervention. In group 2, the TRAM flap was raised, and rESWT was administered immediately after the flap was sutured back to its bed. In group 3, rESWT was applied 7 days before the elevation of the flap, as a delay procedure. Seven days after the administration of rESWT, TRAM flap was raised and then sutured back to its bed. RESULTS: At postoperative day 5, the mean percentage of skin flap survival was 61.82 ± 12.22 for group 1, 77.65 ± 4.62 for group 2, and 79.89 ± 5.86 for group 3. Groups 2 and 3 revealed higher survival areas when compared with control group (P = 0.02). In rESWT applied groups 2 and 3, the increase in capillary density and dilatation of microvessels in the skin flap survival areas were obvious. Histologic analysis revealed significantly higher neovascularization and less inflammation in zone 4 of rESWT applied groups (P < 0.001 and P = 0.042, respectively). CONCLUSIONS: ESWT appears to be a cheap, practical, and promising option for improving the viability of zone 4 of TRAM flap and may also be used as a delay procedure in the clinical setting.

A rare case presentation of septic sacroiliitis caused by staphylococcus xylosus and complicated with abscess formation: A case report.

Septic sacroiliitis is one of the infectious causes of sacroiliitis and it is seen rarely. In current literature, cases of septic sacroiliitis caused by several microorganisms have been reported so far. This case report presents the first case of septic sacroiliitis caused by Staphylococcus xylosus and also complicated with an abscess formation.

Coronaphobia in patients with fibromyalgia.

Objectives: This study aims to evaluate the level of coronaphobia caused by the novel coronavirus disease 2019 (COVID-19) pandemic in patients with fibromyalgia syndrome (FMS) and to compare the results in patients without FMS. Patients and methods: Between August 2020 and October 2020, a total of 61 patients who were admitted to our outpatient clinic were included. The patients were divided into two groups as Group 1 (n=30; 2 males, 28 females; mean age: 43.2±9.3 years; range, 21 to 61 years) consisting of patients who were newly diagnosed or under follow-up for FMS and Group 2, the control group, (n=31; 4 males, 27 females; mean age: 49±10.7 years; range, 25 to 66 years) consisting patients who presented with any locomotor system complaint and were not diagnosed with FMS. Sociodemographic data of the patients and comorbidities were recorded. All the patients in both groups completed the COVID-19 Phobia Scale (C19P-S). Results: The C19P-S total score and psychological, psychosomatic, social, and economic subscale scores were statistically significantly higher in the FMS group than the control group (p<0.05). Conclusion: Our study results suggest that FMS patients have more concerns in this extraordinary global pandemic situation. Early detection of coronaphobia and timely psychological support are critical for individuals prone to psychological disorders, such as FMS.

Social media use in patients with fibromyalgia and its effect on symptom severity and sleep quality.

BACKGROUND: The aim of this study was to evaluate social media use in patients with fibromyalgia syndrome (FMS) and determine the effect of social media use on disease severity and sleep quality. MATERIALS AND METHODS: In total, 205 social media using patients with similar characteristics were included in the study. The study group consisted of 103 patients with FMS, and the control group consisted of 102 patients without FMS. The FMS symptom severity scale and diffuse pain index were used to determine the disease severity in FMS patients, the sleep disorder short form questionnaire (PROMIS) was used to evaluate sleep quality, and the Social Media Addiction Scale-Adult Form was used to evaluate social media addiction. A visual analog scale was applied to evaluate pain in both the patient and control groups, and social media usage times were recorded. RESULTS: We found that pain severity, sleep disturbance and social media addiction were higher in patients with FMS than in the control group, and there was no relationship between the rates of social media use in patients with FMS and the severity and prevalence of the disease. CONCLUSION: The use of social media is more frequent in patients with FMS, which can motivate healthcare professionals to evaluate social media habits in individuals with FMS.

Quantification of the effects of transcutaneous electrical nerve stimulation with functional magnetic resonance imaging: a double-blind randomized placebo-controlled study.

OBJECTIVE: To evaluate the effects of transcutaneous electric nerve stimulation (TENS) by using functional magnetic resonance imaging (fMRI) in patients with carpal tunnel syndrome (CTS). DESIGN: Randomized controlled trial. SETTINGS: University medical center and an outpatient imaging center. PARTICIPANTS: Female patients with CTS (n=20) were randomized into 2 groups receiving either TENS (n=10) or sham TENS (n=10). In both groups, an initial baseline fMRI session was performed via stimulating digits 2, 5, and 3 in turn, 1 scan run for each. TENS versus sham TENS treatment was given, and a repeat imaging was performed starting 20 minutes after the treatment as follows: second finger on the 20th minute, fifth finger on the 25th minute (ulnar nerve innervated control finger), and third finger on the 30th min. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Differences in fMRI activation between the 2 groups were evaluated. RESULTS: Our results demonstrated that 20 to 25 minutes after TENS treatment-but not in the sham TENS group-a significant fMRI signal decrease for digit 2 (post-TENS vs baseline) was observed in the secondary somatosensory regions, ipsilateral primary motor cortex (M1), contralateral supplementary motor cortex (SMA), contralateral parahippocampal gyrus, contralateral lingual gyrus, and bilateral superior temporal gyrus. Measurements on the 25th to 30th minutes for digit 5 were similar between the groups, with presence of activities in areas other than generally activated regions because of painful stimuli. Thirty to 35 minutes after TENS treatment, a significant fMRI signal decrease for digit 3 was detected in the contralateral M1 and contralateral SMA only in the TENS group. CONCLUSIONS: Our findings showed that TENS treatment significantly decreased the pain-related cortical activations caused by stimulation of the median nerve-innervated fingers up to 35 minutes after treatment.

Thickness, cross-sectional area, and stiffness of intrinsic foot muscles affect performance in single-leg stance balance tests in healthy sedentary young females.

The purpose of this study was to investigate the effect of thickness, cross-sectional area and stiffness of intrinsic foot muscles on performance in single-leg stance balance tasks in healthy sedentary young females. This study included a total of 40 healthy sedentary young females between the ages of 19 and 35 years. Single-leg stance balance assessments were carried out using Biodex Balance Systems (Biodex Medical Systems, Shirley, NY, USA). Performance in the single-leg stance balance tests was assessed using the overall stability index (OSI), mediolateral stability index (MLSI) and the anteroposterior stability index (APSI). Lower scores indicated better postural stability. Stiffness, thickness and cross-sectional area measurements of the abductor hallucis (AbH), flexor digitorum brevis (FDB) and flexor hallucis brevis (FHB) muscles were performed using an ultrasonography device. Larger AbH and FHB muscles were correlated with higher OSI, APSI, and MLSI (r = 0.31-0.46, p < 0.05), whereas larger FDB muscle was correlated with higher OSI and MLSI (r = 0.28-0.38, p < 0.05). Higher stiffness of the AbH and FHB muscles were correlated with lower OSI, APSI, and MLSI (r = -0.32 to 0.58, p < 0.05), but stiffness of the FDB muscle was not significantly correlated with OSI, APSI, and MLSI (r = 0.03-0.22, p Ëƒ 0.05). These results suggest that larger AbH, FDB and FHB muscles are related to reduced performance in single-leg stance balance tests, whereas higher AbH and FHB stiffness are related to better performance in single-leg stance balance tests in healthy sedentary young females.

Hand strenght and dexterity in interphalangeal hand osteoarthritis and effects of osteophyte formations.

BACKGROUND: Hand osteoarthritis (HOA) is a complex disorder with various subtypes characterized with predominance of different features. It is challenging to estimate the severity of hand disability in HOA, since contribution of different disease components to clinical burden is yet to be clarified. The aim of the study is to investigate hand functions in nonerosive interphalangeal hand osteoarthritis (HOA) without inflammatory features, and search for effects of osteophyte formations detected by radiography and ultrasound on functionality. METHODS: Thirty one HOA patients and 20 healthy subjects with similar age, gender, body mass index were included. Hand functions were evaluated by self-reported questionnaires and objective strength and dexterity measurements. A total of 459 interphalangeal joints were evaluated and scored by radiography and ultrasound for ostephyte formations. RESULTS: Strength and dexterity measurements were similar between groups. Self-reported functionality was hampered in HOA group but not statistically significant. Osteophyte scores obtained by ultrasound and radiography were significantly higher in HOA group. Osteophyte scores obtained by ultrasound were higher than the scores obtained by radiography. Ultrasound scores showed no correlation with any of the parameters while osteophytes scores obtained by radiography partially showed a significant negative correlation with assembly part of dexterity testing. CONCLUSIONS: No significant difference observed in hand strength and dexterity in nonerosive interphalangeal HOA patients withouth signs of inflammation when compared to healthy subjects. Osteophyte formations prominent enough to be deteceted by radiography may have a negative effect on hand dexterity.

Knee muscle and tendon stiffness in professional soccer players: a shear-wave elastography study.

BACKGROUND: It is well known that several risk factors such as fatigue, previous injury, muscle strength deficit or imbalance are related to a higher incidence of knee injuries in professional soccer players. Knee muscle and tendon stiffness may be another factor that is related to knee injuries in professional soccer players. Therefore, the aim of the present study was to investigate the differences between professional soccer players and healthy sedentary males in terms of the stiffness of patellar tendon (PT), quadriceps tendon (QT), and rectus femoris muscle (RF) and vastus medialis muscle (VM). METHODS: The study group was comprised of 17 professional male soccer players in age range of 24-37 years. The control group was comprised of 22 healthy sedentary males in an age range of 21-36 years. Shear-Wave Velocity (SWV) measurements of the selected muscles and tendons were performed using an ultrasonography device with a lineal probe. RESULTS: The professional soccer players had lower SWV of PT (P=0.024) and QT (P<0.001) in the dominant leg compared to the control group; however, SWV of PT (P=0.455) and QT (P=0.827) in the non-dominant leg were similar in both groups. SWV of RF was higher in both dominant and non-dominant legs in professional soccer players compared to the control group (P<0.05); however, SWV of VM was similar in both groups (P>0.05). CONCLUSIONS: Professional soccer players had lower PT and QT stiffness. On the other hand, they had higher RF stiffness compared to sedentary individuals. Furthermore, VM stiffness was similar in both groups.

Mechanical properties and morphologic features of intrinsic foot muscles and plantar fascia in individuals with hallux valgus.

BACKGROUND: The aim of the present study was to investigate the morphologic features and mechanical properties of plantar fascia (PF), flexor hallucis brevis (FHB), flexor digitorum brevis (FDB), and abductor hallucis (AbH) muscles in individuals with halluks valgus (HV) and to compare the results with individuals without HV. METHODS: A total of 30 participants (27 female, 3 male) between the ages of 19-58 years with HV deformity and 30 individuals without HV (27 female, 3 male) between the ages of 20-58 years were included in the study. AbH, PF, FHB, and FDB thickness, cross-sectional area and stiffness were measured with an ultrasonography device. For stiffness measurements, Shear Wave Velocity (SWV) of the assessed soft tissues was calculated using a customized software program. RESULTS: Mean and standard deviation of SWV of PF, AbH, FHB, FDB, and thickness of PF, AbH, FHB, FDB, and cross-sectional area of AbH, FHB, FDB in individuals with HV were 7.6 ± 1.0 m/sec, 2.8 ± 0.3 m/sec, 2.6 ± 0.4 m/sec, and 3.4 ± 0.2 m/sec, 3.3 ± 0.5 mm, 11.4 ± 2.2 mm, 16.5 ± 1.9 mm, 8.9 ± 1.8 mm, 2.4 ± 0.5 cm2, 2.7 ± 0.5 cm2, 1.9 ± 0.6 cm2, respectively. Mean and standard deviation of SWV of PF, AbH, FHB, FDB and thickness of PF, AbH, FHB, FDB, and cross-sectional area of AbH, FHB, FDB in controls groups were 7.6 ± 1.2 m/sec, 2.3 ± 0.3 m/sec, 2.3 ± 0.4 m/sec, and 3.4 ± 0.4 m/sec, 3.3 ± 0.5 mm, 9.7 ± 2.1 mm, 14.5 ± 1.4 mm, 9.7 ± 1.2 mm, 2.1 ± 0.3 cm2, 2.3 ± 0.4 cm2, 2.1 ± 0.4 cm2, respectively. Individuals with HV had lower AbH and FHB thickness, cross-sectional area and SWV, however FDB thickness and cross-sectional area were higher in individuals with HV compared to that of individuals without HV (p < 0.05). PF thickness (p = 0.273), SWV of PF (p = 0.979) and FDB (p = 0.295) were similar in both groups. CONCLUSION: Our results suggest that individuals with HV had lower AbH and FHB stiffness, however PF and FDB stiffness were similar in HV and control group. In addition, AbH and FHB thickness and cross-sectional area were lower in individuals with HV; however, FDB thickness and cross-sectional area were higher in individuals with HV compared to that of individuals without HV. LEVEL OF EVIDENCE: Level III, Diagnostic Study.

An investigation of the relationship between plantar pressure distribution and the morphologic and mechanic properties of the intrinsic foot muscles and plantar fascia.

BACKGROUND: The purpose of this study was to investigate the relationship between plantar pressure distribution and the stiffness, thickness, and cross-sectional area of the plantar fascia (PF) and abductor hallucis (AbH), flexor hallucis brevis (FHB), and flexor digitorum brevis (FDB) muscles. METHODS: The present study included a total of 41 healthy females between the ages of 20 and 34 years. Plantar pressure during static standing position was measured using a pedobarography system (MatScan, Tekscan, Inc., South Boston, Massachusetts, USA). Peak pressure, mean pressure, maximum force (Max-F), contact area (Con-A), pressure time integral, and force time integral (FTI) were measured. The thickness, cross-sectional area and stiffness of the intrinsic foot muscles and PF were measured using an ACUSON S3000 Ultrasound System and a 9L4 probe (4-9 MHz) (Siemens Medical Solution, Mountain View, CA, USA). Shear Wave Velocity (SWV) of the intrinsic foot muscles and PF was measured using a customized software program (Virtual Touch Imaging and Quantification; Siemens Medical Solution). RESULTS: Con-A had a moderate correlation with the thickness and cross-sectional area of PF, AbH, FHB, and FDB. A fair to moderate correlation was found between heel Max-F and the thickness and cross-sectional area of PF, AbH, FHB, and FDB. There is no significant correlation between the SWV of the assessed tissues and plantar pressure distribution parameters. Body mass and BMI had a fair to good correlation with Mean-P, Con-A, heel Max-F, midfoot Max-F, metatarsal Max-F, FTI, thickness, and cross-sectional area of the PF and assessed muscles SIGNIFICANCE: The results suggest that abnormal force, contact area, and higher body mass may cause hypertrophy of the PF and foot intrinsic muscles.

A comparison of the benefits of sonography and electrophysiologic measurements as predictors of symptom severity and functional status in patients with carpal tunnel syndrome.

OBJECTIVES: To clarify whether sonography or electrophysiologic testing is a better predictor of symptom severity and functional status in carpal tunnel syndrome (CTS) and to assess the diagnostic value of sonography in patients with idiopathic CTS. DESIGN: Cross-sectional. SETTING: University hospital physical medicine and rehabilitation clinic. PARTICIPANTS: Thirty-four hands with CTS and 38 normative hands were evaluated. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Boston Carpal Tunnel Questionnaire, which comprised symptom severity and functional status scale, was applied to CTS patients. Bilateral upper-extremity nerve conduction studies of median and ulnar nerves and sonographic imaging of the median nerve were performed in all participants. Sonographic evaluation was performed by a physician blinded to the physical and electrophysiologic findings of the subjects. RESULTS: Cross-sectional areas (CSAs) of the median nerve at the carpal tunnel entrance and proximal carpal tunnel were 12.5+/-2.6 and 10.6+/-2.6 versus 15.6+/-4.2 and 11.5+/-3.2 in CTS patients versus controls, respectively. Increased CSA of the median nerve at the carpal tunnel entrance (P<.002) and at the proximal carpal tunnel (P<.000) were detected in the hands with CTS. Flattening ratios did not differ in a statistically significant manner between the groups (P>.05). The best predictor of symptom severity was median nerve sensory distal latency and that of functional status was median nerve motor distal latency. The optimum cutoff value for median nerve CSA was 11.2mm(2) at the carpal tunnel entrance and 11.9mm(2) at the proximal carpal tunnel. Sensitivity, specificity, and positive and negative predictive values at the proximal carpal tunnel (88%, 66%, 71%, 80%, respectively) were higher than those at the carpal tunnel entrance (68%, 62%, 65%, 66%, respectively). CONCLUSIONS: The best predictors of symptom severity and functional status in idiopathic CTS seem to be the electrophysiologic assessments rather than sonographic measurements. On the other hand, sonography may be helpful in the diagnosis of idiopathic CTS.

Evaluation of the patient positioning during DXA measurements in daily clinical practice.

For prompt diagnosis of osteoporosis, properly instructed dual-energy X-ray absorptiometry (DXA) measurements are required. To get correct DXA results in addition to quality control procedures, proper positioning of specific body regions such as hip and spine should also be achieved. The aim of this study was to assess the accurateness of the patient positioning for hip and spine regions in daily clinical practice. Hip and spine scan images of 113 DXA reports were evaluated for whether or not the patient was positioned correctly. Out of 113 hip and spine DXA reports, 61 hips and 94 spines were found to have scan images with improper positions. The spine was not straight in 48.7% of the images. The 38.9% of the spinal images did not comprise both iliac crests, and 40.7% did not include T12 and L5 vertebrae. In hip DXA reports, 40.7% of the femoral shaft was deviated to one side. We found the ratio of invalid positions surprisingly very high. Although this may stem from local technical problems and may not reflect the overall quality of scans in other centers, such misinterpretations would definitely affect clinicians' decisions in an inappropriate way. We suggest that relevant inconveniences should be kept in mind both by the clinicians and the technical staff for better production and prompt estimation of DXA measurements.

Microvascular functions in patients with fibromyalgia syndrome: effects of physical exercise.

OBJECTIVES: This study aims to evaluate the current state of microvascular function and to investigate the effect of supervised aerobic exercise on microvascular control mechanisms and health outcomes in women with fibromyalgia syndrome (FMS). PATIENTS AND METHODS: Forty female patients (mean age 51±11 years) with a diagnosis of FMS according to the American College of Rheumatology criteria and 20 healthy female controls (mean age 52±9 years) were included in the study. Microvascular blood flow was measured using a laser Doppler flowmeter (LDF) at the volar skin site of the forearm. Pain severity and FMS were assessed using the visual analog scale (VAS) and Fibromyalgia Impact Questionnaire (FIQ), respectively, both at the beginnig and at the end of the study. Fibromyalgia was evaluated and a spectral analysis of LDF signals was carried out to assess the relative contribution of each control mechanisms. The local thermal hyperemia was used to test the microvascular functions. Moderate-intensity aerobic activity (energy expenditure 3.0 to 6.0 metabolic equivalent) was performed by treadmill walking for 30 min for five days each week for a month. RESULTS: The patients with FMS had lower VAS and FIQ scores at the end of the exercise period. There was a positive correlation between improved myogenic and neurogenic mechanisms and reduced FIQ scores. Cardiac signals were positively correlated with the FIQ scores at the end of the exercise period. Endothelial function was under the influence of pain, and baseline nitric oxide activity was found to be positively correlated with VAS. CONCLUSION: Our study results suggest that microvascular functions are impaired in FMS patients and moderate exercise training is effective to improve the FIQ/VAS scores and enhance vascular functions.

Social media use in patients with fibromyalgia and its effect on symptom severity and sleep quality

Abstract Background: The aim of this study was to evaluate social media use in patients with fibromyalgia syndrome (FMS) and determine the effect of social media use on disease severity and sleep quality. Materials and methods: In total, 205 social media using patients with similar characteristics were included in the study. The study group consisted of 103 patients with FMS, and the control group consisted of 102 patients without FMS. The FMS symptom severity scale and diffuse pain index were used to determine the disease severity in FMS patients, the sleep disorder short form questionnaire (PROMIS) was used to evaluate sleep quality, and the Social Media Addiction Scale-Adult Form was used to evaluate social media addiction. A visual analog scale was applied to evaluate pain in both the patient and control groups, and social media usage times were recorded. Results: We found that pain severity, sleep disturbance and social media addiction were higher in patients with FMS than in the control group, and there was no relationship between the rates of social media use in patients with FMS and the severity and prevalence of the disease. Conclusion: The use of social media is more frequent in patients with FMS, which can motivate healthcare professionals to evaluate social media habits in individuals with FMS.