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

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

Effects of Single-Task Versus Dual-Task Training on Balance Performance in Elderly Patients With Knee Osteoarthritis.

OBJECTIVES: This study aims to compare the effects of single-task and dual-task training on balance performance in elderly patients with knee osteoarthritis (OA). PATIENTS AND METHODS: Fifty elderly osteoarthritic patients with balance impairment (16 males, 34 females; mean age 72.9±5.5 years; range 65 to 84 years) were included in this study. Patients were randomly assigned to single-task balance training (group 1) or dual-task balance training (group 2) groups. Balance activities were given to both groups for three times a week for four weeks. Patients in group 2 also performed cognitive tasks simultaneously with these exercises. Patients were evaluated with Berg balance scale (BBS), kinesthetic ability trainer static and dynamic scores, timed up and go (TUG) test and walking speed (WS) for single and dual tasks, number of stopping and activities-specific balance confidence (ABC) scale at baseline and at the end of four weeks. RESULTS: At the end of the therapy, there were statistically significant improvements in BBS, KAT 2000 static and dynamic scores, TUG test and WS for single and dual tasks, number of stopping and ABC scale in both groups (p<0.05). But there was no statistical difference in any parameter between the groups (p>0.05). CONCLUSION: Both single- and dual-task trainings are effective in improving balance performance under single- and dual-task conditions in elderly patients with knee OA. Dual-task training is not superior to single-task training for balance improvement in elderly osteoarthritic patients.

Validity and Reliability of Turkish Version of the Identification Pain Questionnaire in the Assessment of Neuropathic Pain.

Objectives: This study aims to assess the validity and reliability of a Turkish version of the identification (ID) pain (ID pain-T) questionnaire in Turkish patients. Patients and methods: The Turkish version of ID pain questionnaire was obtained after translation from English into Turkish. The study included 194 patients of which 100 (34 males, 66 females; mean age 59.8±14.3 years; range, 28 to 88 years) were diagnosed as neuropathic pain (NP) and 94 (31 males, 63 females; mean age 47.2±16.5 years; range, 20 to 78 years) were diagnosed as non-neuropathic pain. Patients with mixed-type pain, cancer pain, headaches, substance abuse, severe depression or fibromyalgia syndrome were excluded. Results: The reliability and consistency of ID pain-T questionnaire were acceptable, with a Cronbach's alpha coefficient of 0.701. Statistical analysis of the ID pain-T questionnaire calculated an optimal cut-off score of ≥2 for determining NP with a sensitivity of 77.2% and a specificity of 85%. Further, with an excellent value of 0.92 for area under the curve, a good diagnostic value was indicated. Conclusion: The Turkish version of ID pain questionnaire assessed in the present study is a valid and reliable self-administered questionnaire to identify NP in Turkish patients.

The effectiveness of Kinesio taping on pain and clinical features in chronic non-specific low back pain: A randomized controlled clinical trial.

OBJECTIVES: This study aims to investigate the effectiveness of Kinesio taping (KT) and sham KT on pain, lumbar range of motion (ROM) and disability in chronic non-specific low back pain. PATIENTS AND METHODS: This is a randomized, placebo controlled study. Sixty patients (22 males, 38 females; mean age 21.5±1.7 years, range, 19 to 25 years) with chronic low back pain were randomized into either intervention or placebo groups. Group 1 (n=30) was treated with KT and group 2 (n=30) was treated with sham taping six times by intervals of three days. Patients were evaluated according to pain, modified Schober's test value, hand-ground distance and lumbar ROM and disability at baseline and at the end of the first and sixth months of intervention. Pain was assessed by using Visual Analog Scale (VAS), while ROM was assessed by modified Schober's test value, hand-ground distance and lumbar lateral flexion ROM. Disability was assessed with Oswestry Disability Index (ODI). RESULTS: Statistically significant improvements for all parameters were found for both groups after one month of intervention (p<0.05). These effects were sustained after six months of follow-up for modified Schober's test, hand-ground distance and ODI. There were statistically significant differences between the groups for all outcome measures at the first month of intervention (p<0.05). However, at sixth-month follow-up, only modified Schober's test, hand-ground distance and ODI values were significantly different between groups (p<0.05) except VAS (p>0.05). CONCLUSION: Kinesio taping provided significant improvements in pain, ROM and disability at short term. These positive effects were sustained for ROM and disability at long term but not for pain.

Gait analysis in adults with severe hip dysplasia before and after total hip arthroplasty.

Anatomical reconstruction of high riding hips by total hip arthroplasty (THA) and subtrochanteric shortening osteotomy aims to normalise gait pattern and improve functional hip scores. We present the medium-term clinical results of a group of patients with high riding dislocated hips in whom a cementless THA and subtrochanteric shortening osteotomy had been performed. We compared them with their preoperative status, with patients who had undergone a cementless THA for primary osteoarthritis, and also with a group of healthy gender and age-matched controls. Prospective computerized, three-dimensional gait analyses were performed in 8 female patients with uni-/ or bilateral severe developmental dysplasia of the hip (Group I). Gait analysis was performed preoperatively and at a mean of 12.5 months postoperatively. A group of 8 individuals who received cementless hip replacement for primary osteoarthritis (Group II), and a control group of 8 able-bodied individuals (Group III) were recruited for comparison. Patients in Group I improved and approached the values of Group II. However both were behind Group III. Limb length discrepancy was reduced from a mean of 4.3 cm (range, 1 - 8 cm) to a mean of 0.8 cm (range, 0 - 2 cm) at the latest follow-up. Pain was reliably relieved and activities of daily living were improved in patients with high riding developmental dysplasia of the hip, but they were still behind the normal population average. Nevertheless, the results can be as satisfactory as those in patients who undergo a THA for primary osteoarthritis.

A placebo-controlled, multicenter, randomized, double-blind, flexible-dose, two-way crossover study to evaluate the efficacy and safety of sildenafil in men with traumatic spinal cord injury and erectile dysfunction.

BACKGROUND/OBJECTIVE: To show the efficacy, safety, and tolerability of sildenafil in men with erectile dysfunction (ED) associated with complete or incomplete spinal cord injury (SCI) and to assess its effects on quality of life (QoL) using the Life-Satisfaction Check List. METHODS: This was a placebo-controlled, multicenter, randomized, double-blind, flexible-dose, 2-way crossover study with a 2-week washout period between each phase. Patients with ED attributable to SCI (Sexual Health Inventory-Male score < or =21) received 50 to 100 mg sildenafil (n = 24) or placebo (n = 26). RESULTS: Compared with placebo, sildenafil produced higher levels of successful sexual stimulation, intercourse success, satisfaction with sexual life and sexual relationship, erectile function, overall sexual satisfaction, and an improved Erectile Dysfunction Inventory of Treatment Satisfaction score, with no clinically relevant effects on vital signs. Sildenafil seemed more effective in patients with incomplete SCI than in those with complete SCI, producing significant improvements, compared with placebo, in a number of measures only in patients with incomplete SCI. All patients who expressed a preference selected sildenafil over placebo, although the drug had no effect on patient QoL. Sildenafil was well tolerated, with a profile comparable to that of placebo. CONCLUSIONS: Compared with placebo, treatment with oral sildenafil safely and effectively improved erectile function in patients with ED attributable to SCI, especially in those with incomplete injury, and was the agent of choice in those who expressed a preference.

Immediate effects of silicone insoles on gait pattern in patients with flexible flatfoot.

BACKGROUND: Flatfoot in which a normal arch fails to develop is a common deformity in both children and adults. A frequently-used treatment is an over-the-counter insole to normalize foot mechanics and relieve pain. This study was designed to evaluate the effects of over-the-counter silicone insoles on the gait patterns of patients with flexible flatfoot. METHODS: Thirty-four adults (24 women and nine men, average age 43.7 +/- 9.7 years) with bilateral symptomatic flatfoot deformities were included in the study. Flatfoot was diagnosed by a lateral talometatarsal angle of more than 4 degrees and a talocalcaneal angle of more than 30 degrees. Three-dimensional gait analysis and video recordings were done at a single session. All patients walked at self-selected speeds over a 10-meter walkway with and without insoles. Time-distance parameters and kinematic and kinetic characteristics of gait in the sagittal plane were evaluated by a quantitative gait analysis system. RESULTS: Mean lateral talometatarsal and talocalcaneal angles were 6.3 +/- 2.5 degrees and 56.1 +/- 8.6 degrees, respectively. There was no difference in gait parameters with or without the insoles. CONCLUSIONS: Over-the-counter insoles have no beneficial effect in normalizing forces acting on the foot and on the entire lower extremity in adults with flexible flatfoot.

Neuromuscular electric stimulation effect on lower-extremity motor recovery and gait kinematics of patients with stroke: a randomized controlled trial.

OBJECTIVE: To evaluate the effects of neuromuscular electric stimulation (NMES) of the tibialis anterior muscle on motor recovery and gait kinematics of patients with stroke. DESIGN: Randomized, controlled, assessor-blinded trial. SETTING: Rehabilitation ward and gait laboratory of a university hospital. PARTICIPANTS: A total of 25 consecutive inpatients with stroke (mean age, 55y), all within 6 months poststroke and without volitional ankle dorsiflexion. INTERVENTION: Both the NMES group (n=12) and the control group (n=13) participated in a conventional stroke rehabilitation program, 5 days a week for 4 weeks. The NMES group also received 10 minutes of NMES to the tibialis anterior muscle of the paretic limb. MAIN OUTCOME MEASURES: Brunnstrom stages of motor recovery and kinematic characteristics of gait. RESULTS: Brunnstrom stages improved significantly in both groups (P<.05). In total, 58% of the NMES group and 61% of the control group gained voluntary ankle dorsiflexion. Between-group difference of percentage change was not significant (P>.05). Gait kinematics was improved in both groups, but the difference between groups was not significant. CONCLUSIONS: NMES of the tibialis anterior muscle combined with a conventional stroke rehabilitation program was not superior to a conventional stroke rehabilitation program alone, in terms of lower-extremity motor recovery and gait kinematics.

Exercise and cognitive-behavioural treatment in fibromyalgia syndrome.

Fibromyalgia syndrome is a nonarticular rheumatic disorder characterised by diffuse musculoskeletal pain, stiffness, fatigue, disturbed sleep and tender points. The pathophysiology is not well understood and treatment remains a challenge. Although pharmacological therapy is still the primary treatment choice, a long-term effective intervention has not been demonstrated yet. Thus, besides pharmacotherapy, other multimodal interventions are often used. Exercise and cognitive-behavioural treatments which exist in the multimodal approach and encompass largely self-managed strategy, are reviewed in this article. Although, there is a great number of exercise studies, the large diversity of outcome measures and measurement instruments that have been used in studies, varying intensity and types of exercises, small sample sizes, high attrition rates, large variability in baseline function, symptom severity and psychosocial status limit to come to a conclusion about the efficacy of exercise in the treatment of fibromyalgia syndrome. There are also inconclusive results about the efficacy of cognitive-behavioural treatment because of limited number of studies with small sample sizes of patients with fibromyalgia syndrome. However, the results of the trials overall demonstrate the beneficial effects of both different types of exercise and cognitive-behavioural treatment, on the other hand, there is still a need for larger, more systematic and randomised controlled trials to evaluate the effectiveness.

Effects of intra-articular hylan G-F 20 injections on clinical and biomechanical characteristics of the knee in osteoarthritis.

The objectives of this study were to investigate the effects of Hylan G-F 20 (Synvisc; Genzyme Biosurgery, Ridgefield, New Jersey, USA) injections on clinical and biomechanical gait characteristics of patients with knee osteoarthritis. The design was a before-after trial, set in the gait laboratory of the rehabilitation unit of a university hospital. Twelve patients participated with an average age (+/-SD) of 63.2+/-4.4 years, and Kellgren and Lawrence grade II or III knee osteoarthritis. The main outcome measures were the Western Ontario McMaster Universities Osteoarthritis Index, and time-distance, kinematic and kinetic parameters of gait. The intervention used was a single course of three bilateral intra-articular injections of 2 ml Hylan G-F 20. One week after the treatment, the pain subscore and total score of WOMAC decreased from 9.2+/-2.7 to 4.8+/-3.1 and from 42.1+/-15.2 to 37.9+/-13.5, respectively. There was improvement in sagittal plane excursions of the knee (from 40.2+/-8.1 to 43.3+/-8.5), in extensor and adductor moments (from 0.26+/-0.2 to 0.14+/-0.1 and from 0.45+/-0.1 to 0.41+/-0.1, respectively), and in scaled vertical forces (from 85.8+/-4.5 to 88.4+/-5.4). All these differences were statistically significant. In conclusion, intra-articular Hylan G-F 20 injections not only decrease pain in patients with knee osteoarthritis, but can alter the natural history of the disease by decreasing excessive loads in the knees.

Detecting of Mycoplasma genitalium in male patients with urethritis symptoms in Turkey by polymerase chain reaction.

OBJECTIVE: The aim of this study was to investigate the incidence of Mycoplasma genitalium in the urine samples of 63 male patients who had urethritis symptoms. Along with Neisseria gonorrhoeae (N. gonorrhoeae) and Chlamydia trachomatis (C. trachomatis). We also investigated Mycoplasma hominis (M. hominis) and Ureaplasma urealyticum (U. urealyticum), both of which are known to cause urethritis. METHODS: Microorganisms were investigated in urine samples of the patients with polymerase chain reaction. The study was conducted between September 2003 - February 2004 at the Department of Microbiology and Clinical Microbiology Ankara University School of Medicine, Ankara, Turkey. RESULTS: A total of 63 urine samples were analyzed and 6 (9.52%) patients had N. gonorrhoeae, 4 (6.34%) had C. trachomatis, while 4 (6.34%) urines were positive in terms of M. genitalium. Nevertheless, 3 (4.76%) patients had U. urealyticum and 2 (3.17%) patients had M. hominis. One urine sample was positive in terms of both N. gonorrhoeae and U. urealyticum, and another urine sample was positive in terms of both M. hominis and U. urealyticum. The results were compared with the control group and found no statistically significant difference. CONCLUSION: Mycoplasma species are found in normal flora of urogenital system and also as an agent of urogenital infection. In our study, we found low microorganism rates when compared with Europe and America. This difference may be due to the conservative sexual behavior in Turkey.

Energy expenditure of the paraplegic gait: comparison between different walking aids and normal subjects.

The aim of this study was to investigate the energy expenditure of walking with different aids in patients with spinal cord injury (SCI) and to compare the results with normal able-bodied control subjects. The tests were performed on a 20 m indoor path in a comprehensive rehabilitation clinic of a university hospital. Nine male patients with incomplete SCI at various levels from C6 to L2 and nine age- and gender-matched normal able-bodied subjects were enrolled in the study. Two different walking aids were evaluated: walker and crutch. The main outcome parameters--walking velocity, oxygen uptake and oxygen cost--were measured during ambulation with the two different walking aids. There was a statistically significant difference between controls and SCI patients in terms of walking velocity (P<0.001), and oxygen cost (crutches P<0.01; walker P<0.001). SCI patients walked more slowly and less efficiently. When we compared SCI patients' walking with the two different aids, a statistically significant difference was observed in velocity and oxygen cost (P<0.05) in favour of crutches. We concluded that energy expenditure studies are useful tools for giving objective measures to patients at the time of discharge and to encourage them to use efficient assistive devices in their daily activities.

Effects of ankle-foot orthoses on hemiparetic gait.

OBJECTIVE: Ankle-foot orthoses (AFOs) are widely used to provide optimal ambulation in people with hemiplegia. In this study we evaluated the mechanical effects of metallic and plastic AFOs on severely hemiparetic stroke patients. METHODS: Twelve hemiparetic patients were analysed on a Vicon 370 Motion Analysis System. Spatiotemporal, kinematic and kinetic parameters were measured. RESULTS: The two types of orthoses generally had similar positive effects on hemiplegic gait parameters, increasing cadence, walking speed, single and double step length, ankle dorsiflexion angle at heel strike and swing. The metallic AFO was better at increasing the ankle dorsiflexion angle than the plastic AFO. CONCLUSION: Hemiplegic gait was improved by both orthoses. However, metallic AFOs provided better stabilization of the ankle, allowing improved heel strike and push-off.

Effect of an arm sling on gait pattern in patients with hemiplegia.

OBJECTIVE: To investigate the effect of an arm sling on gait patterns of patients with hemiplegia. DESIGN: Crossover design of 3-dimensional gait analysis and concomitant video recordings performed during a single session. SETTING: Rehabilitation ward gait laboratory of a university hospital. PARTICIPANTS: Thirty-one patients (20 men, 11 women) with hemiplegia with an average age of 53.1+/-9.7 years and 31 age-, sex-, height-, and weight-matched able-bodied persons. INTERVENTIONS: All patients with hemiplegia and able-bodied controls walked at self-selected speed over a 10-m walkway, either with or without an arm sling. MAIN OUTCOME MEASURES: Time-distance, kinematic, and kinetic parameters of gait. RESULTS: The able-bodied group did not show any difference in gait parameters while using the sling. However, in patients with hemiplegia wearing a sling, walking speed and stance period of the paretic side increased, double support time of the paretic side decreased, excursion of the center of gravity (COG) decreased, and weight bearing of the paretic side increased. CONCLUSIONS: An arm sling improved gait, especially during gait training sessions of patients with hemiplegia who have impaired body image and excessive motion of the COG.

Prevalence of carpal tunnel syndrome in patients with fibromyalgia.

This study was planned to investigate the prevalence of carpal tunnel syndrome (CTS) in patients with fibromyalgia (FM) and the normal population. Paresthesia in the hands, sensory and motor deficits, and atrophy of the thenar muscles of 50 patients with FM and 50 matched control subjects were evaluated. Tinel's and Phalen's signs and bilateral electrophysiological studies of the median nerves were performed. The differences between the groups in terms of paresthesia (13 FM patients, two control subjects, P<0.01) and sensory deficits (four FM patients, 0 control subjects, P<0.05) were statistically significant. In the FM and the control groups, a total of five (10%) and two (4%) cases of CTS were documented electrophysiologically, respectively. However, the difference between the groups in CTS prevalence was not statistically significant ( P>0.05). In conclusion, paresthesias are a common symptom and associated condition of FM patients. Together with sensory deficits in the hands, they should remind the physician of the possibility of undiagnosed CTS.

Kinetic and kinematic characteristics of gait in patients with medial knee arthrosis.

We compared the mechanics of gait in 13 patients with early medial arthrosis (OA) of the knee and 13 normal controls, by measuring gait events, kinematic and kinetic parameters. In the OA group, walking velocity, cadence and stride length were reduced and stride time and double support time accordingly increased on both sides, the overall stance phase was prolonged in the OA group, but the stance phase and swing phase peak flexion were reduced. The varus in the stance phase and the valgus in the swing phase were increased. The extensor moment in the loading response was increased and the flexor moment at late stance reduced in the OA group. Patients with OA had a greater valgus (abductor) and internal rotation moment during the stance phase. The times to second vertical force peak (VFP) were similar in the two groups. Values of VFP1 and VFP2 were lower in the OA group. Our findings indicate that computerized gait analysis can be used to reveal various mechanical abnormalities accompanying arthrosis of the knee joint at an early stage. Some of these abnormalities may have etiologic implications, but others may represent secondary changes developed in part as a compensatory mechanism in knee OA.