The effects of COVID-19 on Physical Medicine and Rehabilitation in Turkey in the first month of pandemic.

OBJECTIVES: The outbreak of novel coronavirus-2019 (COVID-19) has affected Turkey very seriously, as well as all around the world. Many urgent and radical measures were taken due to the high contagious risk and mortality rate of the outbreak. It is noteworthy that isolation recommendations and the provision of health services for pandemic have a negative impact on Physical Medicine and Rehabilitation (PMR) services. In this study, we aimed to evaluate the effects of COVID-19 on the PMR services and physiatrists immediately after the first month of pandemic in Turkey. PATIENTS AND METHODS: An online survey consisting of 45 items was sent to the members of the Turkish Society of Physical Medicine and Rehabilitation. The main goal of the survey was to evaluate the changes in the provided service of PMR and conditions of physiatrists one month after the first reported COVID-19 case in Turkey. RESULTS: A total of 606 PMR specialists and residents responded to the survey. The mean number of the patients visited the outpatient clinics was 148.2±128.5 per week before the pandemic, it significantly decreased to 23.4±33.1 per week after the first month of the reported first COVID-19 case. Similarly, the mean number of the patients of inpatient service significantly decreased from 21.7±39.3 per week to 2.5±10.0 per week after the first month of the pandemic. Most of the residents (69%) reported that their training was seriously affected due to pandemic. From the economic aspect, 69.2% of the participants who were working at private hospitals reported a decrease in their monthly salary, and 21% of them were sent to an unpaid vacation. A total of 21.9% of private-practice institutions paused their services. During the first month, 46.9% of the participants were assigned to the different services such as COVID-19 inpatient service, emergency or COVID-19 outpatient clinics. According to the Republic of Turkey, Ministry of Health guideline and algorithm, 15.7% of the physicians were in the category of healthcare workers with suspected COVID-19. CONCLUSION: The COVID-19 pandemic affected seriously both the services and the PMR physicians as early as the first month. This effect is expected to become worse, when the duration of pandemic prolongs. Proper arrangements and measures should be planned to ameliorate the negative effects of the pandemic on the patients and PMR physicians.

Prevalence of adolescent idiopathic scoliosis in Turkey: an epidemiological study.

BACKGROUND CONTEXT: Studies have shown that adolescent idiopathic scoliosis (AIS) prevalence varies between 0.35% and 5.2% and it is generally accepted as an average of 2%-3% in children under age 16. There are a few narrow-scope studies based on school screening performed on the epidemiology of AIS in Turkey. Prevalence rates reported by these studies are lower than reported in neighboring countries. Of note, they were conducted in single cities, generally based on small sample size, and are different from each other in terms of methodology and age groups. The present study was conducted based on a large population in 85 schools of 40 provinces in Turkey. PURPOSE: The aim of this study was to determine the prevalence of AIS in Turkey. Secondary outcomes were to determine age, gender, curve distribution, using standard tests, and radiological verification. STUDY DESIGN: A cross-sectional epidemiological study. PATIENT SAMPLE: The sample size was calculated to estimate the prevalence of AIS in children aged 10-15 years in Turkey. OUTCOME MEASURES: Adams' forward bending test, angle of trunk rotation measurement, and posture analysis were used to screen. Students who had an angle of trunk rotation greater than or equal to five (≧5°) with scoliometer measurement or who had a positive forward bending test were referred to the mobile X-ray unit located in the school-yard on screening day. Their diagnosis was confirmed using Cobb angles of greater than or equal to 10 (≧10°). METHODS: Medical personnel, mobile radiological tools, and logistical support needed during fieldwork were provided by the Directorate General for Health Research, Ministry of Health Republic of Turkey. Spine and posture were examined in upright standing position. Examiners looked for shoulder asymmetries, scapular prominence, unequal waist, and lower limb length discrepancy. Potential scoliosis diagnosis was verified with onsite radiographic examination. Cases with a Cobb angle of ≧10° detected in any region were accepted as scoliosis. The direction and location of scoliosis were determined according to the Scoliosis Research Society terminology criteria. RESULTS: A total of 16,045 students were reached whose informed consent forms were signed by their parents. The prevalence of AIS was found to be 2.3% (female, 3.1%; male, 1.5%). Radiological confirmation rate was 98.8%; 256 (69.3%) of 369 adolescents with scoliosis had a single curvature and 108 (29.3%) had a double curvature. The most common single curve type was a lumbar curve. In all, 90.5% of cases with AIS had a mild (range of 10°-19°) Cobb angle. CONCLUSIONS: The prevalence of AIS was 2.3% in Turkey. This prevalence rate was considerably higher than the values in previous regional studies conducted in Turkey; however, it was close to generally accepted averages in the literature. One of the strongest aspects of the study was that radiologic confirmation of each suspected case was made during the screening.

Hypermobility Frequency in School Children: Relationship With Idiopathic Scoliosis, Age, Sex and Musculoskeletal Problems.

Objectives: This study aims to assess the prevalence of generalized joint hypermobility (GJH) in school children in relation to scoliosis and to identify musculoskeletal problems. Patients and methods: This cross-sectional study included 822 school children (413 males, 409 females; mean age 12.2±1.3 years; range, 10 and 15 years). Demographic characteristics of all children were recorded. The presence of GJH was assessed by the Beighton score (≥4 was considered joint hypermobility). Scoliosis screening consisted of forward bend test (FBT) and measurement of angle of trunk rotation (ATR). Positive FBT or ATR ≥5° was referred to a portable X-ray device. The presence of musculoskeletal complaints was determined by a questionnaire. Results: Children's Body Mass Index (BMI) was 19.6±4.1. GJH was diagnosed in 151 subjects (18.4%). No significant association was detected between sex and hypermobility. Joint hypermobility was inversely correlated with age and BMI. Scoliosis was found in 43 subjects (5.2%) and all of them except one girl had mild scoliosis. The most common scoliosis pattern was a single left thoracolumbar curve. Seventy-three subjects (8.9%) had Cobb angle under 10°, with a potential for progression. Among subjects having GJH, the most common clinical finding was pes planus (34.3%) and the most common clinical symptom was ankle sprain (31.3%). Conclusion: Similar to that found in children from many countries, GJH is a common clinical condition in Turkish children. GJH should be assessed in the differential diagnosis of adolescents with musculoskeletal complaints for effective treatment and reducing morbidity. GJH should be considered in adolescents with scoliosis, which may be an important aspect in treatment.

Causal attributions and alexithymia in female patients with fibromyalgia or chronic low back pain.

AIMS: Our general objective was to assess the psychological symptoms and the types of causal attributions linked to the symptoms among women chronic pain. METHODS: 70 fibromyalgia (FM) patients, 56 chronic low back pain (CLBP) patients and 72 healthy controls were assessed within a general hospital setting, using the Toronto Alexithymia Scale, Brief Symptom Inventory and Symptom Interpretation Questionnaire. Three-way analysis of variance and chi-square tests were used for inter-group comparisons, followed by multivariate correlation, covariate analysis and linear regression. RESULTS: Alexithymia, somatization, depression, anxiety and hostility scores were significantly higher in FM patients relative to CLBP patients and healthy controls (P < 0.05). Alexithymia was linked to psychological attributions in FM patients and to somatic attributions in CLBP patients. Psychological attributions, the number of symptoms and difficulty in describing emotions were related to increased anxiety in FM patients. Depression, anxiety and somatization were significantly increased in subjects with high alexithymia scores in the FM group. There was no difference between groups regarding causal attributions. CONCLUSIONS: Causal attributions do not seem to have distinctive features between functional somatic syndromes like FM and CLBP, though differences might exist between groups as to the effects of coexisting psychological distress symptoms like anxiety and depression.

The value of calcaneal bone mass measurement using a dual X-ray laser Calscan device in risk screening for osteoporosis.

OBJECTIVE: To evaluate how bone mineral density in the calcaneus measured by a dual energy X-ray laser (DXL) correlates with bone mineral density in the spine and hip in Turkish women over 40 years of age and to determine whether calcaneal dual energy X-ray laser variables are associated with clinical risk factors to the same extent as axial bone mineral density measurements obtained using dual energy x-ray absorbtiometry (DXA). MATERIALS AND METHODS: A total of 2,884 Turkish women, aged 40-90 years, living in Ankara were randomly selected. Calcaneal bone mineral density was evaluated using a dual energy X-ray laser Calscan device. Subjects exhibiting a calcaneal dual energy X-ray laser T- score < or = -2.5 received a referral for DXA of the spine and hip. Besides dual energy X-ray laser measurements, all subjects were questioned about their medical history and the most relevant risk factors for osteoporosis. RESULTS: Using a T-score threshold of -2.5, which is recommended by the World Health Organization (WHO), dual energy X-ray laser calcaneal measurements showed that 13% of the subjects had osteoporosis, while another 56% had osteopenia. The mean calcaneal dual energy X-ray laser T-score of postmenopausal subjects who were smokers with a positive history of fracture, hormone replacement therapy (HRT), covered dressing style, lower educational level, no regular exercise habits, and low tea consumption was significantly lower than that obtained for the other group (p<0.05). A significant correlation was observed between the calcaneal dual energy X-ray laser T-score and age (r= -0.465, p=0.001), body mass index (BMI) (r=0.223, p=0.001), number of live births (r= -0.229, p=0.001), breast feeding time (r= -0.064, p=0.001), and age at menarche (r= -0.050, p=0.008). The correlations between calcaneal DXL and DXA T-scores (r=0.340, p=0.001) and calcaneal DXL and DXA Z-scores (r=0.360, p=0.001) at the spine, and calcaneal DXL and DXA T- scores (r=0.28, p=0.001) and calcaneal DXL and DXA Z-scores (r=0.33, p=0.001) at the femoral neck were statistically significant. CONCLUSION: Bone mineral density measurements in the calcaneus using a dual energy X-ray laser are valuable for screening Turkish women over 40 years of age for the risk of osteoporosis.

The value of calcaneal bone mass measurement using a dual X-ray laser calscan device in risk screening for osteoporosis

OBJECTIVE: To evaluate how bone mineral density in the calcaneus measured by a dual energy X-ray laser (DXL) correlates with bone mineral density in the spine and hip in Turkish women over 40 years of age and to determine whether calcaneal dual energy X-ray laser variables are associated with clinical risk factors to the same extent as axial bone mineral density measurements obtained using dual energy x-ray absorbtiometry (DXA). MATERIALS AND METHODS: A total of 2,884 Turkish women, aged 40-90 years, living in Ankara were randomly selected. Calcaneal bone mineral density was evaluated using a dual energy X-ray laser Calscan device. Subjects exhibiting a calcaneal dual energy X-ray laser T- score <-2.5 received a referral for DXA of the spine and hip. Besides dual energy X-ray laser measurements, all subjects were questioned about their medical history and the most relevant risk factors for osteoporosis. RESULTS: Using a T-score threshold of -2.5, which is recommended by the World Health Organization (WHO), dual energy X-ray laser calcaneal measurements showed that 13 percent of the subjects had osteoporosis, while another 56 percent had osteopenia. The mean calcaneal dual energy X-ray laser T-score of postmenopausal subjects who were smokers with a positive history of fracture, hormone replacement therapy (HRT), covered dressing style, lower educational level, no regular exercise habits, and low tea consumption was significantly lower than that obtained for the other group (p<0.05). A significant correlation was observed between the calcaneal dual energy X-ray laser T-score and age (r=-0.465, p=0.001), body mass index (BMI) (r=0.223, p=0.001), number of live births (r=-0.229, p=0.001), breast feeding time (r=-0.064, p=0.001), and age at menarche (r=-0.050, p=0.008). The correlations between calcaneal DXL and DXA T-scores (r=0.340, p=0.001) and calcaneal DXL and DXA Z-scores (r=0.360, p=0.001) at the spine, and calcaneal DXL and DXA T- ...