Test-retest reliability, convergent validity and cross-cultural adaptation of Turkish version of the Hand10 questionnaire.

BACKGROUND: The Hand10 Questionnaire is composed of 10 short, easy to understand and illustrated questions and was developed to measure upper extremity disorders. Thanks to these features, unlike other questionnaires that assess upper extremity disorders, it can be used in the elderly and children as well as adults. The aim of this study was to cross-culturally adapt the Hand10 into Turkish and to test its reliability and validity. METHODS: Translation and back-translation of the Hand10 were performed according to Beaton guidelines. Patients completed the Disabilities of the Arm, Shoulder and Hand Questionnaire once and the final version of the Hand10 Questionnaire twice, with 7-days interval. Test-retest reliability and internal consistency were determined using Intraclass Correlation Coefficient analysis and Cronbach's alpha, respectively. Convergent validity of Hand10 was determined with Disabilities of the Arm, Shoulder and Hand Questionnaire using Pearson Correlation Coefficient analysis. RESULTS: One hundred patients participated in the study. Cronbach's alpha value was 0.919, indicating an excellent internal consistency. Intraclass Correlation Coefficient value for test-retest reliability were found to be 0.890 that indicates a high reliability. Hand10 showed very good correlation with Disabilities of the Arm, Shoulder and Hand Questionnaire (r: 0.669). CONCLUSIONS: The Turkish version of the Hand10 met set criteria of reliability and validity. As a result of this study, we determined that Hand10 is a useful instrument to measure upper extremity disorders in Turkish-speaking patients. It is recommended to be used in clinical settings and researches.

Mobilization with movement and kinesio taping in knee arthritis-evaluation and outcomes.

INTRODUCTION: The aim of this study was to investigate the acute effects of Mulligan mobilization with movement (MwM) and taping on function and pain intensity in patients with osteoarthritis (OA). MATERIALS AND METHODS: Female patients aged between 40 and 70 years with knee OA participated in the study. The patients were divided into three groups and each group received different interventions. Group 1 received MwM and taping according to Mulligan's concept. Group 2 received MwM and placebo taping with no recovery effect and group 3 received placebo taping. Functional tests including lifting, picking up, sit and stand-up, socket tests in addition to climbing up and down stairs, ten metres walk, and timed up and go (TUG) tests were performed before and after intervention. Pain during the test performances were assessed by a visual analog scale. RESULTS: Performance in all tests improved significantly in the MwM + taping group, while only sit and stand-up, ten metres walk, and TUG test performances improved in the MwM + placebo taping group (p < 0.05). Pain intensity during the tests was also significantly better after intervention in those two groups (p < 0.05). Comparison between the groups showed that the pain intensity during all tests was less and functional test scores were better in sit and stand-up, ten metres walk, and walking down stairs in the MwM + taping group than the MwM + placebo taping group. CONCLUSIONS: MwM accompanied by taping improves pain during functional activities as well as the performance. MwM without taping may also improve pain intensity; however, it may be inadequate in increasing the performance.

Hand functions in systemic lupus erythematosus: a comparative study with rheumatoid arthritis patients and healthy subjects

Background/aim: Systemic lupus erythematosus (SLE) frequently affects the small joints of the hand and may result in difficulty in activities of daily living. There are very few studies evaluating the problems encountered in the hands in patients with SLE. The aim of this study is to evaluate hand functions in patients with SLE and compare them with rheumatoid arthritis (RA) patients and healthy subjects. Materials and methods: A total 46 female patients meeting the SLE classification criteria were recruited. Similarly, 51 female RA patients and 46 healthy female subjects served as the control groups. To assess the upper extremity disability level, the Disability Arm Shoulder and Hand Questionnaire (DASH) was used. Some functional performances such as hand grip and pinch strength were evaluated using a dynamometer and the Nine Hole Peg Test (NHPT), respectively. Results: Hand functions were found to be impaired in both SLE and RA patients when compared to healthy controls. In addition, patients with SLE showed better performance in the NHPT, hand grip, and pinch strength than RA patients (P < 0.05). However, the patient-reported disability level was similar in both patient groups (P > 0.05). Conclusion: Similar to patients with RA, hand functions are significantly impaired in patients with SLE in daily activities.

Relationship between kinesiophobia and pain, quality of life, functional status, disease activity, mobility, and depression in patients with ankylosing spondylitis

Background/aim: Our aim was to investigate the association of kinesiophobia with pain, quality of life, clinical measures, and depression in patients with ankylosing spondylitis (AS). Materials and methods: Patients with AS (n: 163) were enrolled in the study. Kinesiophobia was evaluated with the Tampa Scale of Kinesiophobia (TSK), pain with a visual analog scale (VAS), mobility with Bath Ankylosing Spondylitis Metrology Index (BASMI), disease activity with the Bath AS Disease Activity Index (BASDAI), functional status with the Bath AS Functional Index (BASFI), depression level with Beck's Depression Inventory (BDI), and quality of life with the AS Quality of Life Questionnaire (ASQoL). Besides correlation analysis, outcome measures were compared between patients with (TSK ? 37) and without (TSK < 37) kinesiophobia. Results: Kinesiophobia was found to be common with a percentage of 66.6%. TSK scores were correlated with VAS, BASFI, ASQoL, and BDI scores (r = 0.259, r = 0.294, r = 0.392, and r = 0.398, respectively; P < 0.05 for each). There were no correlations between TSK and the BASDAI and BASMI scores (r = 0.142, r = 0.198, respectively; P > 0.05). Patients with kinesiophobia had more pain and poorer BASFI, ASQoL, and BDI scores than patients without kinesiophobia (P < 0.05).Conclusion: Our study is the first study that investigated the relationship between kinesiophobia and other clinical measures in AS patients. Pain and psychological status have an impact on fear of movement and thus functional status and quality of life.

Translation, cross-cultural adaptation and validation of the Turkish version of the Lower Extremity Functional Scale on patients with knee injuries.

INTRODUCTION: The Lower Extremity Functional Scale is a widely used questionnaire to evaluate the functional impairment in lower extremities. To date, the Lower Extremity Functional Scale has not been translated into Turkish. The aim of this study is to translate and culturally adapt the Lower Extremity Functional Scale into a Turkish version, and evaluate the psychometric properties of this version in patients with knee injuries. MATERIALS AND METHODS: The translation of the English version of the Lower Extremity Functional Scale into a Turkish version was performed using standard guidelines. Validity and reliability of Turkish version were tested in 134 patients with knee injuries. Association level between other outcomes measures (Kujala Patellofemoral Score, the Western Ontario and McMaster Universities Osteoarthritis Index, Lysholm Knee Scoring Scale and a Visual Analog Scale) and Turkish version of the Lower Extremity Functional Scale was analyzed to assess validation. Participants completed the questionnaire at baseline and after 2 days to test reliability. RESULTS: The Turkish version of the Lower Extremity Functional Scale was showed a high degree of internal consistency (Cronbach α = 0.93). ICCs were 0.96 and no floor or ceiling effects. The Lower Extremity Functional Scale had a high level of association with the Kujala Patellofemoral Score (r = 0.82), Lysholm Knee Scoring Scale (r = 0.80) and the Western Ontario and McMaster Universities Osteoarthritis Index scores (r = 0.69) (all, p < 0.05). CONCLUSION: The Turkish version of the Lower Extremity Functional Scale is a valid and reliable questionnaire that can be used to evaluate functional status in Turkish speaking patients with different knee disorders. LEVEL OF EVIDENCE: III.

Aerobic exercise improves oxidant-antioxidant balance in patients with rheumatoid arthritis.

[Purpose] Although oxidative stress is known to be present in rheumatoid arthritis (RA), the effects of exercise on oxidative parameters are unknown. The aim of this study was to investigate the effects of acute aerobic exercise on serum oxidant and antioxidant levels in patients with RA. [Subjects and Methods] Sixteen patients with RA and 10 age-matched healthy volunteers participated in this study. All participants wore polar telemeters and walked on a treadmill for 30 minutes at a speed eliciting 60-75% of maximal heart rates. Blood samples were obtained before, immediately and 24 hours after exercise and malondialdehyde (MDA) and total sulfhydrile group (RSH) levels were measured. [Results] Both groups had similar heart rates during the test but the treadmill speed of the RA patients was significantly lower than that of the healthy volunteers. Serum MDA levels were lower than in both groups immediately after exercise, with greater decrements in the RA patients than controls. MDA levels returned to baseline 24 hours after the exercise only in the controls; they remained low in the RA patients. There was a slight increase in serum RSH levels after exercise compared to baseline in both groups. [Conclusion] Moderate intensity treadmill exercise did not have any adverse effect on the oxidant-antioxidant balance. The results suggest that such an exercise may be safely added to the rehabilitation program of RA for additional antioxidant effects. Morever, this antioxidant environment is maintained longer in RA patients.

Wide-Awake Hand Surgery Experience in Patients 10 to 18 Years of Age.

Purpose: We investigated the frequency of wide-awake local anesthesia no tourniquet (WALANT) use for hand surgery in the a 10- to 18-year-old age group and patients' experiences. Methods: Patients aged 10-18 years who had hand surgery in June 2016 to March 2020 were identified. The frequency of patients who agreed to have surgery under WALANT was calculated (%). Patients who received WALANT over the previous year were interviewed for their surgical experiences. Results: A total of 69 patients were identified, and 46 of them received WALANT. The mean age was 14.5 ± 2 years, and 22 of them were boys. Sixteen patients were called for a surgical experience assessment via questionnaire. They reported pain less than 1/10 during anesthesia injection and surgery. Ten patients (62%) found their operation easy, and 14 (87.5%) would prefer WALANT again. Conclusions: This study showed that most patients in the 10-18 years age group accepted WALANT, and their surgical experiences were positive. For its advantages, WALANT should be considered in hand surgery for compliant patients in this age group. Type of study/level of evidence: Therapeutic III.

Getting Better Results in Flexor Tendon Surgery and Therapy.

Recently, better outcomes have been reported when up-to-date developments in flexor tendon surgery and therapy were followed. Slightly tensioned multistrand repairs, judicious venting of pulleys, and early active motion are widely accepted principles. In addition to these principles, tailoring of the repair according to intraoperative active movement with wide awake local anesthesia no tourniquet (WALANT) surgical setting is recommended for better results. We aimed to describe our up-to-date approach to flexor tendon surgery and therapy with the help of visual communication tools of this age. The ideal primary repair of flexor tendons, the management of delayed presentation flexor tendon injuries, the key steps to achieve better results with flexor tendon therapy, and the tele-rehabilitation experience during COVID-19 pandemic will be highlighted. Zone 2 flexor tendon injuries are the most demanding part and will be focused on.

Evaluating Stack Splint Use for Mallet Finger.

Background: Stack splint is commonly used for mallet finger treatment but patients had a tendency to frequently remove it because of skin complications. We hypothesized that a comprehensively instructed splinting regime would increase patients' compliance and lead to favorable outcomes with fewer skin complications. The aims of this study were to assess the patients' compliance and to evaluate outcomes with that particular splinting regime. Methods: Forty-six consecutive patients were enrolled in this prospective study. They were instructed to wear the Stack splint for 24 hours a day every day in the first six weeks and remove it once a day for 10 minutes to vent. They were told to support distal interphalangeal joint volarly both while wearing the splint and when it was removed. Free movement of proximal interphalangeal joint within the splint was checked after each application. Following whole-day regime for 6 weeks, night splinting continued for 2 more weeks. Range of motion, skin complications, patients' compliance and satisfaction were assessed at last follow-up. Results: There were 26 patients with a mean age of 39.8 and mean follow-up period of 6.7 months. No skin complications or proximal interphalangeal joint stiffness were reported. However, nine patients declared that they wore the splint ≤ 4 weeks, the compliance rate to our regime was 65.4% (17/26). In the 17 fully compliant patients, mean distal interphalangeal joint extension lag was 12.4 and nine of them (52.9%) were satisfied with the outcome. Conclusions: Our both hypotheses failed; comprehensive instructions for the splinting regime did not improve patients' compliance satisfactorily, nor did it lead to favorable outcomes. Although Stack splint has practical points, we no longer use it.

Cortical motor areas show different reorganizational changes in adult patients with brachial plexus birth injury (BPBI).

INTRODUCTION: Brachial plexus birth injury (BPBI) may cause permanent disability. It is recently thought to result from the (mal)adaptive reorganizational central nervous system problems. METHODS: In this study, adult patients with BPBI and age-matched healthy controls were compared for the cortical activity during action observation by functional magnetic resonance imaging (fMRI). RESULTS: The cortical activity in patients was significantly weaker than in the control group (p < .05). Areas of difference were middle temporal gyrus, premotor area, and inferior parietal lobule. The signal change in these areas was significantly lower in the patient group (p < .05). CONCLUSIONS: This study showed that the cortical activity in the associative motor regions was weaker in the patients while no primary region showed any difference. The results were concluded that there is a diversity in the neuroplastic changes between primary and associative motor areas. Clinically, neurorehabilitative interventions should be planned based on this diversity.

Translation, validation and cross-cultural adaptation of the mouth handicap in systemic sclerosis questionnaire into the Turkish language.

AIM: The aim of this study was to translate and adapt the Mouth Handicap in Systemic Sclerosis (MHISS) Questionnaire into the Turkish language and evaluate its validity and reliability in Turkish systemic sclerosis (SSc) patients. METHOD: The MHISS was translated according to Beaton guidelines. Patients being diagnosed with SSc, being between 18-65 years old and receiving no treatment between test-retest assessments were included to study. Test-retest reliability was evaluated, comparing the results of two administrations, with Spearman's correlation. Internal consistency was assessed by Cronbach's α. Validity of the questionnaire was assessed by comparison with mouth opening, total scores of Disabilities of Arm, Shoulder and Hand Questionnaire (DASH) and Health Assessment Questionnaire (HAQ). Construct validity was tested by factor analysis. RESULTS: Forty-five SSc patients were included in the study. The Turkish version of the MHISS (MHISS-T) met set criteria of reliability and validity. Internal consistency (Cronbach's α = 0.863) and test-retest reliability were excellent (r = .88). The correlations between MHISS-T and inter-incisor distance, MHISS-T and HAQ and MHISS-T and DASH were negatively and statistically significant (r = -0.739, P < .001), very good and statistically significant (r = .664, P < .001), good and statistically significant (r = .570, P < .001), respectively. Regarding factor analysis, MHISS-T has three subscales. CONCLUSION: Our results demonstrated that the Turkish version of the MHISS-T has excellent test-retest reliability and very good validity. As a result of this study we determined that MHISS-T is a valid and reliable instrument to measure mouth disabilities in Turkish-speaking SSc patients.

Validity of the Patient-Rated Wrist Evaluation questionnaire in rheumatoid arthritis.

BACKGROUND: The Patient-Rated Wrist Evaluation (PRWE) is a patient-reported questionnaire focusing on symptoms and function in wrist pathologies. It consists of 15 questions regarding pain and functional activities of the wrist. Rheumatoid arthritis (RA) is a multi-systemic disease characterized by inflammation of the wrist and hand joints in almost all patients. This study aims to test the validity of PRWE in patients with RA. METHOD: Seventy-five patients with RA from a single outpatient clinic participated in the study. Patients filled out the Michigan Hand Outcomes Questionnaire (MHOQ) and grip strength of both hands were measured. Patients filled out the PRWE questionnaire consecutively once for the dominant and once for the non-dominant hand. Correlations between PRWE and MHOQ and grip strength scores were analyzed by Spearman's correlation method. RESULTS: Our results demonstrated that there was a very strong correlation between the PRWE and the MHOQ and a moderate correlation between the PRWE and grip strength (P < .001). PRWE also showed negative and fair correlation with grip strength of both hands (P < .001). CONCLUSIONS: The Patient-Rated Wrist Evaluation is a valid tool for evaluating wrist involvement in patients with RA. PRWE may be preferred in the busy clinical setting since it has simple and short questions. Additionally, it may provide a sensitive follow-up tool for patients separately using its subscales of pain and function.

The presence and influence of posterior capsule tightness on different shoulder problems.

BACKGROUND: In the literature it has been shown that posterior capsule flexibility is a precursor to shoulder problems. However, no study thus far has shown the influence of the flexibility of posterior capsule in different shoulder pathologies. OBJECTIVE: This study set about to compare the role of posterior capsule tightness in different shoulder problems. METHODS: One-hundred-twenty-five patients diagnosed with shoulder subacromial impingement syndrome (n= 52), partial rotator cuff tear (n= 31) or frozen shoulder (n= 42) and 30 asymptomatic peers participated in the study. Horizontal adduction was assessed in side-lying position for posterior capsule tightness. Pain was measured via the visual analogue scale and shoulder range of motion and active total elevation was assessed with goniometer. Hand behind the back (HBB) test was assessed the active internal rotation by measuring the distance between T5 and the thumb. RESULTS: It was found that the affected side of the posterior capsules of the patients with subacromial impingement syndrome (p< 0.001), partial rotator cuff tear (p< 0.001) and frozen shoulder (p< 0.001) was stiffer than their healthy side. There were significant differences among groups in the level of tightness in the posterior capsule between the affected and the healthy sides (p< 0.001). All range of motion of the shoulder including HBB test and the posterior capsule tightness of the affected side are found to be correlated (p< 0.05). CONCLUSIONS: This study emphasized that the posterior capsule's susceptibility to tightness is most evident in frozen shoulder among different shoulder problems.