The Impact of Lymphatic Drainage and Nerve Mobilization Techniques on Nerve Morphology in Mild-to-Moderate Carpal Tunnel Syndrome: A Randomized Controlled Trial.

OBJECTIVE: To investigate whether nerve mobilization related to nerve mobility or the removal of edema using lymphatic drainage affects the cross-sectional area of the nerve, hand function, and symptom severity in carpal tunnel syndrome. DESIGN: The study is a prospective randomized controlled trial. Data were analyzed between groups using ANOVA, Chi-squared test, and Kruskal-Wallis test. SETTING: Treatment lasted 4 weeks. Splint group wore the splint daily. Splint+manual lymphatic drainage received lymphatic drainage 5 days a week. Splint+nerve mobilization performed neuromobilization exercises as home exercises 5 days a week. Evaluations were conducted before and after 4 weeks of treatment. PARTICIPANTS: The study included 80 patients with mild-to-moderate carpal tunnel syndrome. INTERVENTIONS: The patients were randomly divided into three groups: splint (n = 27), splint+manual lymphatic drainage (n = 27), or the splint+nerve mobilization (n = 26). MAIN OUTCOME MEASURES: The main outcome measures were ultrasound assessments and the Boston Carpal Tunnel Questionnaire (Symptom Severity Scale and Boston Functional Status Scale). RESULTS: Compared to the other groups, the nerve cross-sectional area decreased at both the carpal tunnel (p = 0.003) and mid-forearm (p = 0.014) levels in the drainage group. Nerve mobilization did not result in a significant change in the nerve cross-sectional area. All groups showed significant improvements in both symptom severity and functional status scores (p < 0.001). CONCLUSION: The reduction of edema through lymphatic drainage contributes to a decrease in the cross-sectional area of the median nerve. Additionally, all three methods appear to positively impact the functional capacity of the hand and alleviate symptoms.

Comparing Relationships Between Pain Coping Levels and Pain, Functional Capacity, and Disability Among Patients with Fibromyalgia and Healthy Controls.

We compared the relationships between pain coping levels and pain, functional capacity, and disability among 48 patients with fibromyalgia and 48 healthy control participants. Specific characteristics of those diagnosed with fibromyalgia syndrome were documented. Participants were evaluated with the Visual Analog Scale (VAS), Pain Coping Scale (PCQ), Pain Disability Index (PDI), and Fibromyalgia Impact Questionnaire (FIQ). According to the 10 cm long VAS, fibromyalgia patients recorded pain intensity at 7 cm, significantly higher than in the control group (p < .001). All sub-scores of the PDI score were higher among patients with fibromyalgia compared to controls (p < .001). Scores on the PCQ score were higher for patients with fibromyalgia than controls on the sub-parameters of helplessness (p < .001) and medical remedies (p < .001). Functionality was lower among patients than controls (p < .001). Pain coping and pain-related disability (in areas of recreation, social activity, sexual behavior, total score) were significantly related in patients with fibromyalgia. These findings underscore the importance of comprehensive pain management and customized interventions for fibromyalgia patients to address their elevated pain intensity, reduced functionality, increased pain-related disability, and variable coping mechanisms compared to healthy controls. Understanding these correlations between pain coping strategies, functional status, and disability levels can help optimize treatment approaches and improve the quality of life for individuals living with fibromyalgia.

Comparing complex decongestive therapy in patients with lymphedema of different causes by measuring: extremity volume, quality of life, and functionality.

OBJECTIVE: This study aimed to investigate the effects of complex decongestive therapy (CDT) applied to the lower extremities of patients with lymphedema of different causes on the extremity volume, quality of life (QoL), and functionality. MATERIALS AND METHOD: The study included 90 patients, of whom 28 had primary lymphedema, 30 had secondary lymphedema, 18 had phlebolymphedema, and 14 had lipolymphedema. A total of 137 extremities were treated with CDT. The patients who received CDT for 5 days a week for 3 weeks (15 sessions in total) were included in the sample. Extremity volume was measured using a tape measure. The lymphedema QoL-Leg Questionnaire was used to evaluate QoL, and the lower extremity functional scale (LEFS) was administered to assess lower extremity functionality. RESULTS: The changes in QoL before and after treatment significantly differed in the primary lymphedema, phlebolymphedema, and lipolymphedema groups (p < 0.05). The post-treatment LEFS scores indicated a significant decrease in the phlebolymphedema and lipolymphedema groups compared to the pre-treatment scores (p < 0.05). CONCLUSIONS: The difference in appearance, which is one of the sub-parameters of QoL, significantly decreased in the comparisons performed between the groups, whereas the changes in the remaining parameters were not significant.

OBJETIVO: Investigar los efectos de la terapia descongestiva compleja (TDC) aplicada a las extremidades inferiores de pacientes con linfedema de diferentes causas sobre el volumen de la extremidad, la calidad de vida y la funcionalidad. MATERIALES Y MÉTODO: Se incluyeron en el estudio 90 pacientes, de los cuales 28 tenían linfedema primario, 30 linfedema secundario, 18 flebolinfedema y 14 lipolinfedema. Un total de 137 extremidades fueron tratadas con TDC. Se incluyeron en la muestra pacientes que recibieron TDC durante 5 días a la semana durante 3 semanas (15 sesiones en total). El volumen de las extremidades se midió con una cinta métrica. Se utilizó el Cuestionario de calidad de vida (QoL) de las piernas para el linfedema para evaluar la calidad de vida, y se administró la Escala funcional de las extremidades inferiores (LEFS) para evaluar la funcionalidad de estas. RESULTADOS: Los cambios en la calidad de vida antes y después del tratamiento difirieron significativamente en los grupos de linfedema primario, flebolinfedema y lipolinfedema (p < 0.05). Las puntuaciones LEFS posteriores al tratamiento indicaron una disminución significativa en los grupos de flebolinfedema y lipolinfedema en comparación con las puntuaciones previas al tratamiento (p < 0.05). CONCLUSIONES: La diferencia de apariencia, que es uno de los subparámetros de la calidad de vida, disminuyó significativamente en las comparaciones realizadas entre los grupos, mientras que los cambios en los demás parámetros no fueron significativos.

Effects of osteoarthritis grades on pain, function and quality of life.

BACKGROUND: Osteoarthritis (OA) is a pathology that frequently affects the geriatric population. OBJECTIVE: To investigate the extent to which pain, functionality, and quality of life change over the progression of OA grades. METHOD: The study included 161 patients with bilateral OA, whose disease stages ranged from 1 to 4 according to the Kellgren-Lawrence radiographic classification system. Pain was assessed using the Visual Analog Scale (VAS), functionality using the two-minute walk test and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, and quality of life using the Nottingham Health Profile (NHP). RESULTS: There were significant differences between the groups in terms of age, weight, and body mass index. The VAS, two-minute walk test, and WOMAC scores also significantly differed between the groups (p< 0.05). There was a significant difference between the groups in all domains of the NHP, except for energy (p< 0.05). The two-minute walk test score was negatively correlated with all the remaining evaluation parameters (p< 0.05). No correlation was found between the energy domain of the NHP and body mass index, the VAS score, the two-minute walk test distance, or the total WOMAC score (p> 0.05). CONCLUSION: After grade 1, the functional impacts of OA on patients increased by an average of four times. Pain was one of the most basic symptoms, the severity of which started to increase in grade 2. With the added effect of diminishing walking capacity over time, the reduction in the quality of life of the patients accelerated as the OA grade progressed.

Does manual lymphatic drainage improve upper extremity functionality in female patients diagnosed with rheumatoid arthritis? A randomized controlled study.

OBJECTIVE: To demonstrate the effect of manual lymphatic drainage (MLD) on upper extremity functionality in patients with rheumatoid arthritis (RA). MATERIALS AND METHODS: Thirty-nine female patients diagnosed with RA who were in remission were included in the study. The study group included 19 participants (mean age 50.63 ± 9.83 years), the control group included 20 participants (mean age 55.05 ± 5.89 years). The patients were randomized into two groups as home exercise program plus MLD and home exercise program alone. Both groups received treatment for 4 weeks. The primary outcome measure was pressure pain threshold (PPT). The patients were evaluated using the PPT, visual analog scale (VAS), hand-wrist joint range of motion examination, hand dynamometer and pinchmeter measurements, and the Rheumatoid Arthritis Quality of Life Scale before the interventention and at the end of the 4th week. RESULTS: The PPT evaluated at the thumbnail, wrist, and trapezius significantly increased in the study group after treatment (p < .001, p = .001, and p < .001, respectively). MLD was found to significantly increase the PPT at the thumbnail compared with home exercise program (p = .047). The VAS score significantly decreased in the study group (p = .011). The level of increase in radial deviation was statistically higher in the study group (p = .004). CONCLUSION: Manual lymphatic drainage had a positive effect on pain, PPT, and range of motion in RA patients in remission. MLD can be added to medical and other conservative treatments in RA patients.

Does Fear of Movement Affect Fatigue and Quality of Life in Lower Extremity Lymphedema?

Background: The aim of our study was to determine the causes of lower extremity kinesiophobia (whether it is biological or psychological) in individuals with lower limb lymphedema (LLL), and to compare the changes in fatigue and activities of daily living with healthy individuals. Methods: The study included 74 unilateral LLL patients (study group) and 74 individuals (control subjects). Causes of fear of movement were assessed with the Causes of Fear of Movement questionnaire; fatigue, with the Functional Assessment of Chronic Disease Treatment-Fatigue Questionnaire; and quality of life (QoL) with the Lymphedema Quality of Life Questionnaire-Leg. Results: One hundred forty-eight participants were included in the study, 74 of whom were in the study group and 74 in the control group. 63.5% of the lymphedema patients had primary lymphedema and 36.5% had secondary lymphedema. Fear of movement total score and QoL scores was higher in LLL group than control group. Total fear of movement score and biological subparameter score of fear of movement, fatigue, and some subparameters of QoL scores were found to be higher in primary LLL patients compared with secondary LLL. Conclusion: Fear of movement is common and QoL is impaired in patients with secondary LLL, more significant in primary LLL.

Turkish translation of the Prolapse and Incontinence Knowledge Questionnaire: validity and reliability.

INTRODUCTION AND HYPOTHESIS: To translate the Prolapse and Incontinence Knowledge Questionnaire (PIKQ) into Turkish and test its validity and reliability. METHODS: The study included 341 women. The translation of the PIKQ, which comprised of the urinary incontinence (PIKQ-UI) and pelvic organ prolapse (PIKQ-POP) sections, was performed in accordance with international recommendations. The Incontinence Quiz (IQ) and the Visual Analog Scale (VAS) were applied to assess the level of knowledge about POP and UI. Psychometric analyses consisted of assessing the following: (1) construct validity by confirmatory factor analysis, (2) criterion and known group validity, (3) internal consistency reliability by the KR-20 coefficient, and (4) test-retest reliability over 1 week with the intraclass correlation coefficient (ICC). RESULTS: All fit indices except the Standardized Root Mean Square Residual indicated acceptable fit for the final models. Criterion validity was supported by moderate correlations between the PIKQ-UI and the IQ (rho = 0.679, p < 0.001). There were positive and weak linear correlations between the PIKQ-UI and PIKQ-POP scores and their corresponding perceived knowledge scores (rho = 0.351, p = 0.013 and rho = 0.345, p = 0.014, respectively). The known group validity did not show differences indicating that participants did not have enough knowledge about UI and/or POP even when they had the condition or acquaintance with them (p = 0.852 and p = 0.185, respectively). Reliability was excellent as indicated by the ICCs of 0.91-0.90, and KR-20 of 0.67-0.75 indicated good internal consistency for the PIKQ-UI and PIKQ-POP, respectively. CONCLUSIONS: The Turkish version of the PIKQ is a valid and reliable instrument to assess the knowledge of UI and POP.

A comparison of the effects of exercises plus connective tissue massage to exercises alone in women with fibromyalgia syndrome: a randomized controlled trial.

This study aimed to compare the effectiveness of a 6-week combined exercise program with and without connective tissue massage (CTM) on pain, fatigue, sleep problem, health status, and quality of life in patients with fibromyalgia syndrome (FMS). Patients were randomly allocated into Exercise (n = 20) and Exercise + CTM (n = 20) groups. The exercise program with and without CTM was carried out 2 days a week for 6 weeks. Pain, fatigue, sleep problem with Visual Analog Scales, health status with Fibromyalgia Impact Questionnaire (FIQ), and quality of life with Short Form-36 were evaluated. After the program, pain, fatigue and sleep problem reduced, health status (except of the scores of FIQ-1 and FIQ-10), physical functioning, role limitations due to physical health, bodily pain, role limitations due to emotional health, vitality, and general health perceptions parameters related to quality of life improved in the Exercise group, (P < 0.05). In the Exercise + CTM group, pain, fatigue and sleep problem decreased, health status and quality of life improved (P < 0.05). Pain, fatigue, sleep problem, and role limitations due to physical health improved in the Exercise + CTM group in comparison to the Exercise group (P < 0.05). The study suggested that exercises with and without CTM might be effective for decreasing pain, fatigue and sleep problem whereas increasing health status and quality of life in patients with FMS. However, exercises with CTM might be superior in improving pain, fatigue, sleep problem, and role limitations due to physical health compared to exercise alone.