Validity and reliability of selective control of upper extremity scale (SCUES) in patients with chronic stroke.

PURPOSE: The aim of this study is to investigate the validity and reliability of the Selective Control of Upper Extremity Scale (SCUES) in patients with stroke. MATERIALS AND METHODS: Forty-two patients with stroke aged 18-75 years, were included in the study. Patients were video-recorded while SCUES was administered. The videos were scored to determine the intrarater and inter-rater reliability. Fugl Meyer Assessment of Upper Extremity (FMA-UE), Box and Block test (BBT) and Brunnstrom Stages of Motor Recovery were measured to evaluate validity of SCUES. Spearman correlation analysis was used to assess the validity of SCUES. Intraclass correlation coefficient (ICC), Kappa (κ) and weighted Kappa (κw) were calculated to determine intrarater and inter-rater reliability. RESULTS: There were significant positive high correlations between SCUES and FMA-UE and BBT and Brunnstrom upper extremity proximal and distal values (rho = 0.944, p = 0.01; rho = 0,875, p = 0.01; rho = 0.84, p = 0.01, rho = 0.82, p = 0.01; respectively) showing validity of SCUES. The ICC value of inter-rater reliability of SCUES was 0,99 (%95 CI: 0,989-0,997, p = 0,001) showing excellent reliability. κ and κ w values for inter-rater and intrarater reliability of individual SCUES items were above 0.7 indicating excellent reliability. ICC of SCUES and FMA-UE indicated excellent intrarater reliability (ICC = 0,99; %95 CI: 0,989-0,997, p = 0,001; ICC = 0.943; %95 CI: 0.9-0.97, p = 0,0001, consecutively). CONCLUSIONS: SCUES showed similar validity and reliability with FMA-UE and SCUES can be used in the evaluation of upper extremity selective motor control in patients with stroke.

The Selective Control of Upper Extremity Scale (SCUES) stands out from existing outcome assessment tools for upper extremity motor control in stroke patients by enabling the evaluation of various quantifiers of selective motor function.SCUES assesses not only the accompanying movements of the trunk or additional joints beyond the targeted joint but also the presence of mirror movements, along with assessing the limited dynamic range of motion.SCUES appears valid and reliable in patients with stroke, indicating its potential use in evaluating upper extremity selective motor control and assessing the outcomes of interventions aimed at enhancing selective motor control.

The effects of spasticity on glucose metabolism and soft tissue body composition in patients with spinal cord injury.

Objectives: The aim of this study was to assess the effects of spasticity on glucose metabolism and percentage of fat-free mass (FFM%) in patients with spinal cord injury (SCI). Patients and methods: A total of 33 patients (22 males, 11 females; mean age: 38.6±12.5 years; range, 20 to 64 years) with SCI defined by the American Spinal Injury Association Impairment Scale Grades A to D were included between September 2014 and May 2018. We assessed spasticity with the Modified Ashworth Scale (MAS) and evaluated spasms with the Penn Spasm Frequency Scale (PSFS). We assessed the glucose metabolism by calculating the Matsuda and HOMA-IR index, and measured FFM% by dual-energy X-ray absorptiometry. Results: Fourteen patients had motor complete, and 19 had motor incomplete SCI. The neurological injury levels of the patients were C4-T12. There was a positive correlation between hip adductor muscle MAS and trunk, android, and gynoid FFM% and between hip extensor muscle MAS and android FFM% in patients with motor complete SCI. Hip extensor and knee flexor muscle MAS showed a negative correlation with the HOMA-IR. Hip adductor and extensor muscle MAS, as well as knee flexor and extensor muscle MAS, had a positive correlation with the Matsuda index in these patients. There was a positive correlation between knee extensor muscle MAS and gynoid FFM% and between PSFS and arms, trunk, gynoid, and total FFM% in patients with motor incomplete SCI. There was a negative correlation between hip adductor and extensor muscle MAS, PSFS, and level of fasting glucose in these patients. Conclusion: This study supports the notion that spasticity has positive effects on the FFM% and glucose metabolism in patients with motor complete and incomplete SCI.

Comparison of the effects of duloxetine and pregabalin on pain and associated factors in patients with knee osteoarthritis.

OBJECTIVES: This study aimed to investigate the effects of duloxetine and pregabalin primarily on pain and functional status in patients with knee osteoarthritis and secondarily on quality of life, depression, anxiety, and sleep disturbance. METHODS: A total of 66 patients with knee osteoarthritis were randomized to use duloxetine or pregabalin. Patients were evaluated by Visual Analog Scale, Neuropathic Pain Diagnostic Questionnaire, Western Ontario and McMaster University Osteoarthritis Index, Short Form-36, Beck Depression Inventory, Beck Anxiety Inventory, and Pittsburg Sleep Quality Index before the treatment and after 4 and 12 weeks of treatment. RESULTS: Improvements occurred in Visual Analog Scale, Neuropathic Pain Diagnostic Questionnaire, Western Ontario and McMaster University Osteoarthritis Index, Short Form-36 (with an exception of the mental health subgroup scores in duloxetine-treated group), Beck Depression Inventory, and Beck Anxiety Inventory scores in both groups from 4 weeks after baseline. Pittsburg Sleep Quality Index total scores and SF-36 mental health subgroup scores started to improve on the 4th and 12th weeks in pregabalin- and duloxetine-treated groups, respectively. CONCLUSION: Osteoarthritis pain, a complex outcome with nociceptive and neuropathic components, leads to central sensitization in a chronic phase. Using centrally acting drugs in the control of pain and associated symptoms would increase the probability of treatment success.

Comparison of the effects of duloxetine and pregabalin on pain and associated factors in patients with knee osteoarthritis

SUMMARY OBJECTIVES: This study aimed to investigate the effects of duloxetine and pregabalin primarily on pain and functional status in patients with knee osteoarthritis and secondarily on quality of life, depression, anxiety, and sleep disturbance. METHODS: A total of 66 patients with knee osteoarthritis were randomized to use duloxetine or pregabalin. Patients were evaluated by Visual Analog Scale, Neuropathic Pain Diagnostic Questionnaire, Western Ontario and McMaster University Osteoarthritis Index, Short Form-36, Beck Depression Inventory, Beck Anxiety Inventory, and Pittsburg Sleep Quality Index before the treatment and after 4 and 12 weeks of treatment. RESULTS: Improvements occurred in Visual Analog Scale, Neuropathic Pain Diagnostic Questionnaire, Western Ontario and McMaster University Osteoarthritis Index, Short Form-36 (with an exception of the mental health subgroup scores in duloxetine-treated group), Beck Depression Inventory, and Beck Anxiety Inventory scores in both groups from 4 weeks after baseline. Pittsburg Sleep Quality Index total scores and SF-36 mental health subgroup scores started to improve on the 4th and 12th weeks in pregabalin- and duloxetine-treated groups, respectively. CONCLUSION: Osteoarthritis pain, a complex outcome with nociceptive and neuropathic components, leads to central sensitization in a chronic phase. Using centrally acting drugs in the control of pain and associated symptoms would increase the probability of treatment success.

Poor Accuracy of Clinical Diagnosis in Pes Anserine Tendinitis Bursitis Syndrome.

OBJECTIVES: To investigate the characteristics of the patients who are clinically diagnosed with pes anserine tendinitis bursitis syndrome (PATBS), and to determine the sensitivity and specificity of clinical diagnose based on magnetic resonance imaging (MRI). METHODS: Included in this cross-sectional clinical study were 156 patients who were evaluated based on the clinical presence or absence of PATBS. All patients underwent Q-angle measurement, knee osteoarthritis (OA) grading according to the Kellgren-Lawrence classification, and medial joint space measurement, and their cartilage thickness, and any periarticular and intraarticular knee pathologies were recorded from an assessment of knee MRIs. RESULTS: Of the total, 64 cases (41%) were diagnosed clinically with PATBS and 92 (59%) were not. There was no difference in the Q angles of the two groups (p > 0.05), while the medial joint spaces were significantly lower in the PATBS patients (p < 0.05). There were no significant differences between the two groups in an MRI assessment of meniscus and ligament lesions, chondromalacia patella, cyst, bursitis, effusion and synovial pathologies (p > 0.05). The sensitivity and specificity of the PATBS clinical diagnoses relative to the MRI findings were determined as 41.2% and 59.5%, respectively. CONCLUSION: The medial joint space was found to be significantly lower in patients with PATBS, while there was no difference in any other knee pathologies between the two groups. The sensitivity and specificity of a PATBS clinical diagnosis were found to be low, and so it was concluded that clinical PATBS diagnoses may be inaccurate, particularly in the presence of such invasive therapies as injection, and that diagnoses based on imaging methods would be more accurate.

Evaluation of the physical and emotional effects of the COVID-19 pandemic on patients with fibromyalgia and chronic low back pain: A multicenter cross-sectional controlled study.

Objectives: This study aimed to investigate the physical and emotional effects of the coronavirus disease 2019 pandemic in patients with fibromyalgia syndrome (FMS) and chronic low back pain (CLBP) patients. Patients and methods: The cross-sectional controlled study was performed with 1,360 participants (332 males, 1,028 females; mean age: 42.3±12.5 years; range, 18 to 65 years) between September 2020 and February 2021. The participants were evaluated in three groups: the FMS group (n=465), the CLBP group (n=455), and the healthy control group (n=440). Physical activity, pain levels, and general health status before and during the pandemic were evaluated in all participants. Stress levels were analyzed with the perceived stress scale (PSS) in all groups, and disease activity was analyzed with the fibromyalgia impact questionnaire (FIQ) in patients with FMS. Results: Patients with FMS had worsened general health status and pain levels during the pandemic compared to the other groups (p<0.01). The FMS group showed significantly higher PSS scores than those in other groups (p<0.01). There was a weak-positive correlation between FIQ and PSS parameters in patients with FMS (p<0.05, r=0.385). Conclusion: The general health status, pain, and stress levels of the patients with FMS and CLBP tended to worsen during the pandemic. This high-stress level appeared to affect disease activity in patients with FMS.

Rehabilitation status of children with cerebral palsy and anxiety of their caregivers during the COVID-19 pandemic.

OBJECTIVE: The purpose of the study is to explore the rehabilitation status of children with cerebral palsy (CP) and anxiety level of their caregivers during the Coronavirus disease-2019 (COVID-19) pandemic. METHODS: Caregivers of children with CP who were being followed up in our outpatient CP clinic were contacted between May 28 and June 26, 2020. Two hundred and six caregivers who voluntarily agreed to participate were administered the State-Trait Anxiety Inventory and were questioned about the rehabilitation status of their children. Demographic data, other health problems, Gross Motor Function Classification System, and Manual Ability Classification System levels of children were recorded from their files. RESULTS: All children were at home with their families during the pandemic. Their mean age was 9.58±3.84 years. One hundred and ninety-nine children were going to the rehabilitation center before the pandemic, only three children went to the rehabilitation center twice a week during the pandemic period. The anxiety level of all the caregivers was found to be high. Trait anxiety of the caregivers who did not perform home exercise to their children were found to be statistically significantly higher than those who performed exercise (p<0.05). CONCLUSION: Rehabilitation strategies should focus on reducing anxiety level in caregivers of children with CP and effective homecare therapy techniques should be acquired by the caregivers.

Spasticity-induced Pectoralis minor syndrome: a case-report.

Background: Pectoralis minor syndrome (PMS) develops when the neurovascular bundle compression occurs at the retropectoralis minor space. It may occur due to repetitive overhead activities, traumatic incident, structural causes, myofascial pain syndrome in the pectoralis minor muscle, as well as spasticity of the pectoralis minor muscle. In patients with hemiplegia, adductor muscles along with pectoralis minor muscle spasticity may be present in the upper extremity.Objective: We report a 19-year-old male patient with spastic hemiparesis who was diagnosed with PMS due to spasticity of the pectoralis minor muscle.Method: Diagnosis of PMS was confirmed by Ultrasound-guided 4 cc 1% lidocaine injection to the right pectoralis minor muscle and Ultrasound-guided onabotulinum toxin A injection was performed. Stretching exercises to the pectoral muscles were also added to the rehabilitation program.Result: Complaints of the patient were controlled by botulinum toxin injections at 3-month intervals.Conclusion: It should be kept in mind that spasticity in the upper extremity may develop in the pectoralis minor muscle, and may cause pressure on the neurovascular structures. Ultrasound-guided botulinum toxin injections can be a safe and effective treatment for PMS in a patent with post stroke spastic hemiparesis.

The transitional vertebra and sacroiliac joint dysfunction association.

PURPOSE: The purpose of this study was to investigate whether transitional vertebrae contribute to the development of sacroiliac joint dysfunction. The prevalence of transitional vertebrae in patients with lumbar pain was determined during this process, and the prevalence of sacroiliac dysfunction was compared between patients with low back pain and healthy volunteers. METHODS: 700 subjects, 500 with low back pain and 200 healthy volunteers were included in this study. Five tests were applied to all participants to determine sacroiliac joint dysfunction. Positivity in three tests was regarded as dysfunction. Lateral lumbosacral and Ferguson angle X-rays were taken from the group with low back pain. The patient was evaluated a specialist radiologist in terms of presence or absence of transitional vertebrae, and if identified, what type. RESULTS: Transitional vertebrae were determined in 26% (n = 130) of the patients with low back pain. Type 1a was determined in 20%, type 1b in 10%, type 2a in 26.9%, type 2b in 30.8%, type 3a in 0.8%, type 3b in 4.6% and type 4 in 6.9%. The prevalence of sacroiliac joint dysfunction in the low back pain group (15.4%) and the prevalence of sacroiliac joint dysfunction in cases of transitional vertebra (28.5%) were significantly higher compared to the control groups (p < 0.05). CONCLUSION: Sacroiliac joint dysfunction must be considered when investigating the etiology of low back pain. Particular sensitivity must be exhibited on this subject in patients with transitional vertebrae.

The relationship between joint hypermobility and subacromial impingement syndrome and adhesive capsulitis of the shoulder.

OBJECTIVE: Joint hypermobility (JH) is a clinical condition in which the joints move beyond the expected physiological range of motion. JH can be accompanied by many musculoskeletal complaints. One of the common causes of musculoskeletal pain is shoulder pain. The aim of this study was to investigate the relationship between subacromial impingement syndrome (SAIS), shoulder adhesive capsulitis (AC), and JH in patients with shoulder pain. METHODS: Patients aged between 18 and 70 years who presented at the physical medicine and rehabilitation outpatient clinic and who were diagnosed with SAIS or AC in a clinical and physical examination were included in the study. Patients in the same age group without musculoskeletal system pain were included in a control group. All of the cases were assessed for hypermobility using the Beighton score for generalized joint hypermobility (GJH), and the revised 1998 Brighton criteria for benign joint hypermobility syndrome (BJHS). RESULTS: Of the 124 cases included in the study, 71 (57.3%) were female and 53 (42.7%) were male. There was no case of GJH in the AC group. There were 2 (4.50%) cases in the SAIS group and 3 (7.5%) in the control group. BJHS was found in 4 (10%) cases in the AC group, 6 (13.63%) in the SAIS group, and 2 (5%) cases in the control group. There was no statistically significant difference between groups in terms of JH (p>0.05). The Beighton scores of the AC group were statistically lower those of the control group (p<0.05). CONCLUSION: The results of this study indicated no significant difference between the SAIS group, the AC group, and the control group in terms of GJH and BJHS. The fact that Beighton scores were lower in the AC group than in the control group suggests that the probability of developing AC in those with JH may be lower.

Effect of bone mineral density on lumbar discs in young adults: A case-control study.

Bone mineral density (BMD) might be a risk factor for lumbar disc herniation (LDH) in young adults, but there is not enough data concerning this effect. Several studies have been performed on elderly and osteoporotic patients. Thus, we aimed to investigate the effect of BMD on the etiopathogenesis of LDH in young adults.One hundred patients (mean age: 38.45 ±â€Š8.92 years; 50 men and 50 women) were enrolled this case-control study and classified into 2 groups, as follows. The case group (G-I) included 50 patients with symptomatic LDH who were hospitalized in the Physical Medicine and Rehabilitation Clinic, and the control group (G-II) included 50 patients with lower back pain but no finding of LDH detected using magnetic resonance imaging. Patients in the G-II were recruited among those admitted to the outpatient clinic at the time of the study, and whose age and sex were matched to those of the study group. Women in menopause were excluded from the study. BMD analysis by dual energy x-ray absorptiometry was performed in both groups.The mean values of the femur neck and lumbar spine BMD were 1.02 ±â€Š0.13 and 1.19 ±â€Š0.14 g/cm, respectively. There was no statistically significant relationship between BMD and LDH in this population.This result may mean that in a normal range, BMD does not exert a compressive load on the lumbar discs in young adults and therefore may not lead to LDH by this mechanism and the load.

Reliability and cross-cultural adaptation of the Turkish version of the Spinal Cord Injury Spasticity Evaluation Tool.

The Spinal Cord Injury Spasticity Evaluation Tool is a 7-day recall self-reported questionnaire that assesses the problematic and useful effects of spasticity on daily life in patients with spinal cord injury (SCI). We aimed to determine the reliability and cross-cultural validation of the Turkish translation of the Spinal Cord Injury Spasticity Evaluation Tool (SCI-SETT). After translation and back translation of the Spinal Cord Injury Spasticity Evaluation Tool, 66 patients between the ages of 18 and 88 years with SCI, American Spinal Injury Association impairment scale grades from A to D with spasticity, and at least 6 months after injury were assessed. Participants rated the SCI-SETT at the same time period of the day, 1 week apart, and test-retest agreement was investigated. Also, the Penn Spasm Frequency Scale, self-assessment of spasticity severity, self-assessment of spasticity impact, Functional Independence Measure motor subscale, and 36-Item Short Form Health Survey were assessed for the evaluation of the convergent validity. There were 45 participants with tetraplegia and 21 patients with paraplegia. The test-retest reliability for the SCI-SETT was good. The intraclass correlation coefficient was 0.80 at 95% confidence interval. There were no significant correlations between the SCI-SETT scores and Functional Independence Measure motor subscale and Penn Spasm Frequency Scale scores. There was a significant correlation between the SCI-SETT scores and vitality scores of the 36-Item Short Form Health Survey. The SCI-SETT showed statistically significant correlations with other measures including self-assessed spasticity severity and self-assessed spasticity impact (P<0.05). The SCI-SETT is a reliable self-rating tool for assessing spasticity in patients with SCI in the Turkish population.

A rare cause of non-discogenic sciatica; musculus gemellus inferior: A case report.

Herein, we report a 51-year-old female with complaint of right sciatica. According to physical examination, the etiology was suspected as piriformis syndrome. Therefore, piriformis injection was administered and piriformis stretching exercises were recommended.However the complains did not resolve. Magnetic resonance imaging showed hyperintensity of the right inferior musculus gemellus. One of the main causes of extra-spinal sciatica is piriformis syndrome. However, other pelvic muscles anatomically near the sciatic nerve are often overlooked. Magnetic resonance imaging is useful in the differential diagnosis from intractable piriformis syndrome, particularly in cases resistant to treatment.

Reliability of the Spinal Cord Assessment Tool for Spastic Reflexes.

OBJECTIVE: To assess the reliability of the Spinal Cord Assessment Tool for Spastic Reflexes (SCATS). DESIGN: Observational reliability study of the SCATS. SETTING: Inpatient rehabilitation unit at an education and research hospital. PARTICIPANTS: Subjects (N=47) between the ages of 18 and 88 years with spinal cord injury (SCI) and with American Spinal Injury Association Impairment Scale grades from A to D with spasticity, who were at least 6 months postinjury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Interrater and test-retest reliability of the SCATS. RESULTS: The SCATS had substantial to almost perfect interrater agreement (κ=.669-1.000) between the 2 physiatrists. Test-retest agreement of the SCATS was also substantial to almost perfect (κ=.614-1.000) as well. There was a significant correlation between the SCATS clonus scores and the Modified Ashworth scores of the hip, knee, and ankle. No correlation was found between SCATS extensor spasm scores and Modified Ashworth scores. The SCATS flexor spasm scores were only correlated significantly with the ankle plantar flexor Modified Ashworth scores (P<.05). CONCLUSIONS: The SCATS is a reliable tool for assessing spasm activity and spastic hypertonia in patients with SCI.