The Immediate Effect of Hanging Exercise and Muscle Cylinder Exercise on the Angle of Trunk Rotation in Adolescent Idiopathic Scoliosis.

(1) Background: Semi-hanging and muscle cylinder exercises have been defined as scoliosis-specific corrective exercises. The aim of this study was to evaluate the immediate effect of muscle cylinder and semi-hanging exercises on the angle of trunk rotation in patients with adolescent idiopathic scoliosis (AIS). (2) Methods: Twenty-seven patients with AIS with a mean age of 18.6 years were retrospectively analyzed. The angle of trunk rotation (ATR) values were measured before and after performing semi-hanging and standing muscle cylinder exercises. Both exercises were performed for three to five respiratory cycles. The semi-hanging exercise was performed first, followed by the muscle cylinder exercise, in this order, in all participants. For statistical analysis, the Wilcoxon signed-rank test was used to analyze ATR changes after the exercises, and the Kruskal-Wallis test was used to compare ATR changes according to the main curve location. (3) Results: The thoracic, thoracolumbar and lumbar maximum ATR values were significantly increased after the semi-hanging exercise (p < 0.001) and decreased after the muscle cylinder exercise (p < 0.001). The ATR change was greater in the lumbar region than in the thoracic and thoracolumbar regions. (4) Conclusion: The results of this study of a small group of patients emphasized that one of the scoliosis-specific corrective exercises, the standing muscle cylinder exercise, improved ATR, while the other, the semi-hanging exercise, worsened ATR in patients with AIS. It is recommended that each scoliosis-specific corrective exercise be evaluated and redesigned to maximize the three-dimensional corrective effect, considering the biomechanics of the spine and the pathomechanics of scoliosis.

Respiratory function and respiratory muscle strength in adolescent idiopathic scoliosis.

PURPOSE: It was aimed to analyze the relationship of the respiratory functions, respiratory muscle strength, magnitude of the curvature, angle of trunk rotation (ATR) and brace-wearing duration in patients with adolescent idiopathic scoliosis (AIS). METHODS: Sixty patients with AIS (43 females), with maximum Cobb angles between 20° and 66° were included in the study. ATR values were measured with a scoliometer. Respiratory function parameters (forced vital capacity [FVC], forced expiratory volume in one second [FEV1], FEV1/FVC ratio, peak expiratory flow [PEF]) and respiratory muscle strengths (maximum inspiratory pressure [MIP] and maximum expiratory pressure [MEP]) were measured by combined spirometry. RESULTS: There was a negative significant correlation between maximum Cobb angle and ATR with respiratory function parameters except for PEF and FEV1/FVC (r = -0.258-0.441; p = <0.001-0.047). There was a moderate negative correlation between ATR with MIP (cmH2O) (r = -0.377; p = 0.003) and MEP (cmH2O) (r = -0.362; p = 0.005). On the other hand, no correlation was found between brace-wearing duration with respiratory functions, maximum Cobb angle and brace-wearing duration with respiratory muscle results. CONCLUSION: The results of this study showed that, respiratory functions were normal or mildly affected, and respiratory muscle strengths were weak in AIS. Increased Cobb angle and ATR negatively affected respiratory function; increased ATR was associated with decreased inspiratory and expiratory muscle strength. It is extremely important to carefully evaluate the respiratory system and to know the variables that affect respiratory functions and respiratory muscle strength in achieving optimum recovery in the holistic treatment of individuals with scoliosis.

Results of Gensingen Bracing in Patients With Adolescent Idiopathic Scoliosis: Retrospective Cross-Sectional Feasibility Study.

BACKGROUND: Bracing is an essential part of scoliosis treatment. The standard of brace treatment for patients with scoliosis today is still very variable in terms of brace quality and outcome. The Gensingen brace is a further developed Chêneau brace derivative with individual design, which can be adapted through computer-aided design. OBJECTIVE: This study aims to generate a template to obtain a database for prospective multicenter studies study to analyze the results of high-corrective asymmetric Gensingen brace treatment for patients with adolescent idiopathic scoliosis (AIS). METHODS: A template for the database was created, which contains the patients' basic data (age, menarcheal status, Risser Sign, curve pattern, and daily brace wearing time), the Cobb angles of curvature, and the cosmetically relevant angles of trunk rotation (ATR). A retrospective review of medical records of patients with AIS, who met the Scoliosis Research Society's inclusion criteria for brace studies, was performed to test the feasibility of the template. Template items were filled in by the researchers. RESULTS: Out of 115 patients between 2014 and 2018, the complete data of 33 patients followed up at least 3 months after complete Gensingen brace weaning could be analyzed. The mean age was 12 years, the mean Cobb angle was 33.6°, and the mean Risser value was 0.7 at the beginning of the treatment. The mean improvement in the Cobb angle on in-brace x-ray imaging was -26.1० (80% of in-brace correction). The Cobb angle of the major curvature changed as follows: curve stabilization was achieved in 7 (21.2%) cases, and curve improvement was achieved in 26 (78.8%) cases. None of the patients showed a curve progression. The Cobb angle was significantly reduced in the brace at the end of treatment and at follow-up evaluation (P<.001). ATR improved significantly for thoracic (P<.001) and lumbar curves (P<.001). CONCLUSIONS: The database proved to be informative in the assessment of radiological and clinical outcome parameters. The example data set we have generated can be a helpful tool for professionals who work in clinics but do not store regular patient data. Especially with regard to different patient collectives worldwide, different results may be achieved with the same standards of care. In addition, the results of this study suggest that above-average correction effects with a full-time brace application lead to significant improvements in the Cobb angle after brace treatment has been completed.

Effects of rigid and kinesio taping on plantar pressure distribution in patients with Lisfranc fracture sequelae.

BACKGROUND: Patients with Lisfranc fractures may regain functional status after anatomical fixation, but they may experience sequelae such as flatfoot deformity and pain associated with foot pressure distribution during weight-bearing. RESEARCH QUESTION: What is the impact of Lisfranc fracture sequelae on both the injured and uninjured sides, and how does the antipronation taping affect plantar pressure distribution parameters? METHODS: Twenty-six patients who underwent anatomical fixation for Lisfranc fracture, displaying pronation on the injured side based on the Foot Posture Index-6 test, as well as 15 healthy subjects, participated in this study. Plantar pressure distribution measurements were conducted during barefoot walking for the healthy subjects. In the patient group, measurements were taken under two antipronation taping conditions (kinesio and rigid taping), as well as during barefoot walking. RESULTS: Participants who received anatomical fixation after Lisfranc fracture exhibited significant alterations in plantar pressure distribution parameters on both the injured and uninjured sides, as compared to the control group. After the application of Kinesio Taping to the injured side, there was no significant change observed in the plantar pressure distribution values (p > 0.05). The analysis of the rigid taping on the injured side revealed statistically worse values in peak pressure of the hindfoot (p = 0.027) and maximum force of the midfoot and toes (p = 0.005 and p = 0.013, respectively) compared to the injured barefoot condition. SIGNIFICANCE: Lisfranc fracture sequelae affected plantar pressure distribution on both injured and uninjured sides. Anti-pronation taping (kinesio and rigit), commonly used for foot conditions, did not lead to foot pressure distribution becoming more similar to that of the control group.

The effect of spinal range of motion on functional balance, quality of life, and perception of appearance in adolescent idiopathic scoliosis after posterior spinal fusion surgery.

OBJECTIVE: Spinal fusion, which is widely used in the surgical treatment of adolescent idiopathic scoliosis (AIS), limits the movements of the vertebral column. In this study, it was aimed to investigate the relationship between spinal mobility in the postoperative period with functional balance, quality of life, and perception of appearance in individuals with AIS. METHODS: Thirty patients with AIS who underwent posterior spinal fusion surgery 1 to 3 years ago were included in the study. A universal goniometer was used to measure a spinal range of motion (ROM), functional reach test for functional balance, Scoliosis Research Society-30 (SRS-30) for quality of life, and Spinal Appearance Questionnaire (SAQ) for perception of appearance. RESULTS: Surgical fusion length was significantly correlated with movements in the sagittal and transverse planes (r = - 0.383-[- 0.608]; p = < 0.001-0.037). Except for spinal left rotation, there was a significant positive correlation between functional balance level and ROM results (r = 0.374-0.523; p = 0.003-0.42). The SRS-30 total score correlated significantly with all other ROM measures except for rotations (r = 0.434-0.574; p = 0.00-0.016). SAQ total data correlated significantly with all ROM measurements (r = - 0.553-[- 0.395]; p = 0.002-0.031). CONCLUSIONS: In AIS, limitation of movement in the coronal, sagittal, and transverse planes is observed after fusion surgery. Spinal ROM is affected by the level of fusion performed at surgery. Postoperative spinal limitation of motion adversely affected functional balance, quality of life, and perception of appearance. We believe that comprehensive rehabilitation approaches that improve postoperative range of motion and increase functionality are important for optimal postoperative recovery.

Spatiotemporal Gait Parameters and Gait Asymmetry in Patients With Lumbar Disc Herniation, Treated With Microdiscectomy: A Prospective, Observational Study.

OBJECTIVE: The aim of this study was to emphasize on the interaction of spatial and temporal gait parameters and analyse the gait asymmetry in the patients with lumbar disc herniation (LDH) before and after microdiscectomy. METHODS: This was a prospective, observational study conducted on 59 cases of LDH planned for lumbar microdiscectomy, and healthy control group with 54 participants for analysis was performed prior to surgery and 15 days after surgery. The spatiotemporal gait parameters were measured using a "Win-Track" gait analysis platform system. All the participants walked barefoot for 10 times with their normal walking speed in the same day. The 3 flawless walking data were recorded and the arithmetic means were computed. The gait symmetry index was used to calculate the walking asymmetry. The pain intensity of the patients was recorded shortly before performing the analysis by a visual analogue scale. RESULTS: In the postoperative assessment LDH patients had significantly shorter temporal parameters, longer spatial parameters, faster walking speed, and more cadence than the preoperative assessment (p < 0.05). There were improvements in the asymmetry values of the postoperative gait parameters compared to the preoperative values, but these differences were not significant (p > 0.05). In addition, there was a significant difference in all parameters in terms of gait asymmetry between the postoperative assessment and the healthy controls (p < 0.05). CONCLUSION: These results can guide the patient-specific evaluating and implementation of gait rehabilitation programs, and design protocols before or after surgery in the LDH patients.

Translation, reliability and validity of the Turkish version of Scoliosis Japanese Questionnaire-27 in adolescent idiopathic scoliosis.

PURPOSE: Disease-specific scales which evaluate QoL are needed to evaluate treatment outcomes, and to compare the effects of different treatments. The outcome measures evaluating quality of life in adolescent idiopathic scoliosis are limited. The purpose of this study was to examine the validity and reliability of the Turkish version of the Scoliosis Japanese Questionnaire-27 (SJ-27) in adolescent idiopathic scoliosis. METHODS: The SJ-27 questionnaire was translated into Turkish and 61 female patients filled out the translated version (TRv.SJ-27) twice to measure the test-retest reliability of the scale. Internal reliability of the questionnaire was estimated using Cronbach's α coefficient. The intraclass correlation coefficient was analysed for each item. Discriminant validity and convergent validity were determined by correlations with Cobb angle, ATR and the SRS-22r scale. RESULTS: The mean Cobb angle was 25.8° and the ATR angle was 8.8°. Cronbach's α value was estimated as 0.935. The test-retest correlation coefficient for the item-total score was 0.877 (p = 0.000). Validity analysis showed a significantly positive correlation between the TRv.SJ-27 total score and Cobb and ATR angles, and a significantly negative relationship was found between the TRv.SJ-27 and SRS-22r scores. CONCLUSIONS: It would be useful to use different outcome measures to assess the scoliosis-specific quality of life in clinical practice and research. The findings suggest that the Turkish version of Scoliosis Japanese Questionnaire-27 is a valid and reliable measure to assess Turkish patients with AIS.

The effect of mirror therapy in patients with frozen shoulder.

Introduction: This study was designed to compare mirror therapy and visual feedback with the control group in adhesive capsulitis patients. Methods: Thirty-six patients, divided into three groups as mirror therapy, visual feedback and control for 15 sessions of treatment. Evaluations were made before treatment, at 6th and 10th weeks. Bilateral glenohumeral exercise was performed at the end of each session with the affected extremity behind the mirror in the mirror group, with both upper extremities in front of the mirror in the visual feedback group, and without the mirror in the control group. Results: There were statistically significant differences between the mirror therapy and visual feedback in terms of pain severity change, and the visual feedback was superior to the change in pain severity compared to the control. Visual feedback showed significant improvement in mean change from baseline to week 10 in shoulder pain and disability index scores compared to control (p = 0.012). There was no significant difference between the groups in terms of modified constant score, proprioception and shoulder range of motion. Conclusion: It was determined that the exercises performed by seeing the affected extremity in the mirror were more effective than mirror therapy and control group.

A new device for assessment and training the human balance and coordination: Marmara Balance and Education System (MarBES).

BACKGROUND: Balance and coordination are important for performing activities of daily living. Balance and coordination assessment and training are used by physiotherapists in many different rehabilitation areas. Marmara Balance and Education System (MarBES) is a device developed to evaluate and improve balance and coordination. AIMS: To examine the test-retest reliability of the MarBES device. METHODS: Double-leg and single-leg (eyes open-closed) tests were applied to healthy young adult participants for balance testing on the MarBES device. Weight data is estimated from pressure sensors located in 4 different corners and a score is calculated with computer software for the individual's center of gravity (center of pressure X, Y) and the amount of deviation from the center for each axis. Weight transfer to the target surface was measured for assessment of the participants' coordination performance. Participants rested for 10 min and all measurements were repeated by the same evaluator. The obtained data were recorded and the reliability of the measurements was evaluated with Spearman's rho correlation analysis. RESULTS: A total of 40 healthy young individuals (28 female) with a mean age of 21 years were included. The balance assessments with MarBES showed moderate to good reliability (ICC: 0.535-0.903). The coordination assessment results showed moderate to good reliability (ICC: 0.575-0.712). CONCLUSIONS: Objective evaluation of balance and coordination parameters is very important in rehabilitation. Results of the study showed that the MarBES device developed by the researchers is a reliable method for the evaluation of balance and coordination in healthy young individuals.

The Effectiveness of the Schroth Best Practice Program and Chêneau-Type Brace Treatment in Adolescent Idiopathic Scoliosis: Long-Term Follow-Up Evaluation Results.

BACKGROUND: Although the number of studies showing the efficacy of conservative treatment in adolescent idiopathic scoliosis has increased, studies with long-term follow-up are very limited. The aim of this study was to present the long-term effects of a conservative management method including exercise and brace in adolescent idiopathic scoliosis patients. METHODS: This retrospective cohort study included patients with idiopathic scoliosis who presented at our department and were followed up for at least 2 years after completing the treatment. The main outcome measurements were the Cobb angle and angle of trunk rotation (ATR). RESULTS: The cohort participants were 90.4% female, with a mean age of 11 years and the maximum Cobb angle was mean 32.1°. The mean post-treatment follow-up period was 27.8 months (range 24-71 months). The improvements after treatment in mean maximum Cobb angle (p < 0.001) and ATR (p = 0.001) were statistically significant. At the end of treatment, the maximum Cobb angle was improved in 88.1% of the patients and worsened in 11.9% compared to baseline. In the long-term follow-up evaluations, 83.3% of the curvatures remained stable. CONCLUSIONS: The results of this study showed that moderate idiopathic scoliosis in growing adolescents can be successfully halted with appropriate conservative treatment and that long-term improvement is largely maintained.

Effects of Pilates exercises on idiopathic scoliosis: a scoping review of the literature.

PURPOSE: Scoliosis is a deformity involving changes in three planes. These changes include lateral curvature in the frontal plane, changes in physiological thoracic kyphosis and lumbar lordosis angles in the sagittal plane, and rotation of the vertebrae in the transverse plane. The aim of this scoping review was to review and summarize the available literature to determine whether Pilates exercises are an effective treatment for scoliosis. METHODS: The Cochrane Library (reviews, protocols, trials), PubMed, Web of Science, Ovid, Scopus, PEDro, Medline, CINAHL (EBSCO), ProQuest, and Google Scholar electronic databases were used to search for published articles from inception to February 2022. All the searches included English language studies. Keywords were determined as "scoliosis and Pilates" or "idiopathic scoliosis and Pilates", "curve and Pilates", "spinal deformity and Pilates." RESULTS: Seven studies were included; one study was a meta-analysis study, three studies compared Pilates and Schroth exercises, and three applied Pilates exercises in combined therapy. The studies included in this review used outcome measurements of Cobb angle, ATR, chest expansion, SRS-22r, posture assessment, weight distribution, and psychological factors such as depression. CONCLUSIONS: The results of this review suggest that the level of evidence regarding the effect of Pilates exercises on scoliosis-related deformity is very limited. Pilates exercises can be applied to reduce asymmetrical posture in individuals with mild scoliosis with reduced growth potential and progression risk.

Adaptation, reliability, and validation of the Turkish version of the Bad Sobernheim Stress Questionnaire-Deformity in patients with adolescent idiopathic scoliosis.

BACKGROUND: There is a limited number of disease-specific outcome measurement scales in Turkish, which can be used for individuals with adolescent idiopathic scoliosis (AIS). The aim of this study was to translate, adapt, and evaluate the validity and reliability of the Turkish version of the Bad Sobernheim Stress Questionnaire-Deformity (TRv.BSSQD) questionnaire in Turkish patients with AIS. OBJECTIVES: After the translation and back-translation process, the TRv.BSSQD and Scoliosis Research Society-22 questionnaires were completed in face-to-face interviews with 49 patients with AIS. The TRv.BSSQD questionnaire was readministered to the same patients 2 weeks later to assess test-retest reliability. RESULTS: The Cronbach alpha value calculated for internal reliability was 0.806. The intraclass correlation coefficient values of the items of the TRv.BSSQD ranged from 0.809 ( P < 0.001) (question 8) to 0.955 ( P < 0.001) (question 7). The test-retest correlation coefficient for the item-total score was 0.960 ( P < 0.001). Validity analysis showed a significantly positive correlation between the TRv.BSSQD total score and pain, self-image, and mental subgroup and the total scores of the SRS-22r scale ( P < 0.05). CONCLUSIONS: This patient-reported outcome instrument, the TRv.BSSQD, showed good internal consistency, good reliability with test-retest analysis, and construct validity, suggesting that it is an appropriate assessment instrument for Turkish patients with AIS.

Comparison of the effectiveness of proprioceptive neuromuscular facilitation exercises and shoulder mobilization patients with Subacromial Impingement Syndrome: A randomized clinical trial.

INTRODUCTION: The aim of this study was to compare the effectiveness of Proprioceptive Neuromuscular Facilitation (PNF) exercises and shoulder mobilization (SM) in addition to conventional physiotherapy on pain, range of motion (ROM), functionality, and muscle strength in patients with Subacromial Impingement Syndrome (SIS). METHODS: Forty-four patients were randomly allocated into three groups as conventional physiotherapy (control group; n = 14), conventional physiotherapy + PNF exercises (PNF group; n = 15), and conventional physiotherapy + SM techniques (SM group; n = 15). Pain, ROM, muscle strength, and functionality were evaluated by using VAS (Visual Analog Scale), goniometer, push-pull dynamometer, Constant-Murley score and DASH (Disabilities of the Arm, Shoulder and Hand) score. Patients were received 20 sessions (4 weeks) of treatment. Assessments were performed at baseline, and weeks two, four, and sixteen. RESULTS: After treatment, significant improvements in outcome measurements were observed in all groups (all p < 0.05). PNF or SM groups were not superior to each other in terms of improving pain and functionality. SM group was superior to PNF group for improving shoulder flexion ROM at week 4 (p = 0.009). The improvements in shoulder extension muscle strength were greater in PNF group at weeks 2 and 16 compared with other groups (p = 0.030, 0.035). CONCLUSION: PNF or SM, in addition to conventional physiotherapy, might help to improve pain and functionality more in patients with SIS. It is recommended to add SM or PNF to conventional treatment to maintain the ROM increase gained with SIS treatment after treatment, and to apply this treatment for 4 weeks for muscle strength increase.

The reliability of the augmented Lehnert-Schroth and Rigo classification in scoliosis management.

BACKGROUND: In pattern-specific scoliosis exercises and bracing, the corrective treatment plan differs according to different curve patterns. There are a limited number of studies investigating the reliability of the commonly used classifications systems. OBJECTIVE: To test the reliability of the augmented Lehnert-Schroth (ALS) classification and the Rigo classification. METHODS: X-rays and posterior photographs of 45 patients with scoliosis were sent by the first author to three clinicians twice at 1-week intervals. The clinicians classified images according to the ALS and Rigo classifications, and the data were analysed using SPSS V-16. Intraclass correlation coefficients (ICCs) and standard error measurement (SEM) were calculated to evaluate the inter- and intra-observer reliability. RESULTS: The inter-observer ICC values were 0.552 (ALS), 0.452 (Rigo) for X-ray images and 0.494 (ALS), 0.518 (Rigo) for the photographs. The average intra-observer ICC value was 0.720 (ALS), 0.581 (Rigo) for the X-ray images and 0.726 (ALS) and 0.467 (Rigo) for the photographs. CONCLUSIONS: The results of our study indicate moderate inter-observer reliability for X-ray images using the ALS classification and clinical photographs using the Rigo classification. Intra-observer reliability was moderate to good for X-ray images and clinical photographs using the ALS classification and poor to moderate for X-ray and clinical photographs using the Rigo classification. CLINICAL IMPLICATIONS: Pattern classifications assist in creating a plan and indication of correction in specific scoliosis physiotherapy and pattern-specific brace applications and surgical treatment. More sub-types are needed to address the individual patterns of curvature. The optimisation of curve classification will likely reduce failures in diagnosis and treatment.

Brace treatment for patients with scoliosis: State of the art.

BACKGROUND: Physiotherapy, brace applications or surgery are the treatment options utilised to manage patients with scoliosis. Many different brace applications are used, and the success rates of orthoses vary. OBJECTIVES: Brace applications can have detrimental impacts on the patient leading to physical discomfort, psychological discomfort, and in some instance the use of braces may even be painful. Therefore, future developments in this field should be aimed at improving the success rate and reducing physical distress experienced by the patient while using brace applications. The purpose of this article is to provide recommendations with respect to the most appropriate bracing approach in general. METHOD: A narrative review of the scientific literature was carried out to substantiate the statements made in this article. RESULTS: The most important braces provided for the treatment of patients with scoliosis and the treatment results that can be achieved are presented and discussed, taking into account the most recent systematic reviews. A wide range of success rates have been found for the different brace applications. CONCLUSION: Given that brace application may impact the patient leading to physical discomfort and psychological distress, good quality management in brace application for patients with scoliosis is needed to ensure the best possible outcome and the least stressful management. CLINICAL IMPLICATIONS: Safety in brace application for patients with scoliosis needs improvement. The use of standardised and reliable computer aided design (CAD) libraries and appropriate patient information based on published guidelines is suggested.

Effect of Chêneau style braces on vertebral wedging amongst individuals with adolescent idiopathic scoliosis.

BACKGROUND: It is generally accepted that braces can stop curve progression but little evidence exists regarding structural improvement in the spine using spinal bracing. Our study aimed to investigate the possible structural improvements of vertebral wedging with high correction bracing. OBJECTIVES: The aim of our study was to assess whether spinal brace treatment may influence vertebral wedging in adolescent idiopathic scoliosis (AIS). METHOD: We reviewed our database according to the following inclusion criteria: girls with a diagnosis of AIS, Risser 0-2, age 10-14 years with Cobb angles greater than 35°. Our study cohort consisted of 27 patients fulfilling the inclusion criteria with an average brace wearing time of 16.6 h per day and Cobb angles between 36° and 79°. The target value for our study was the apical vertebra wedging, measured twice before brace treatment commenced and twice after the average follow-up period of 20.5 months of treatment. RESULTS: The average apex wedging noted before brace wearing started was 9.8° (median: 9) and after a period of 20.5 months of brace wearing, it had reduced to an average of 5.8° (median: 4.9), (p < 0.001). This would indicate a structural correction of 44%. CONCLUSIONS: Our study supports the hypothesis that spinal high correction braces improve the degree of vertebral wedging in skeletally immature girls with AIS. CLINICAL IMPLICATIONS: Structural corrections of the apical vertebra seem possible when high correction asymmetric braces are used in the treatment of patients with AIS.

Guidelines for the conservative treatment of spinal deformities - Questionnaire for a Delphi consensus.

BACKGROUND: Spinal deformity is the oldest disease known to humankind. Many types of treatment methods, including both conservative and surgical, are in use. OBJECTIVE: We aimed to validate a published guideline protocol based on the conservative treatment of spinal deformities. METHOD: A modified Delphi technique was used with a questionnaire sent out to professionals worldwide regarding the conservative treatment of spinal deformities. RESULTS: Our study was completed after two rounds. A strong level of agreement of 80% and more (consensus cut-off point) was achieved in most questions in the first round. Some statements were below this margin, and they were sent to the participants via email in the second round for re-evaluation. Consensus was achieved in almost all of the statements in the second round. Only two items did not reach the cut-off point but were close to this value. CONCLUSION: This proposed Guideline Protocol was approved by the participants using the Delphi method and can be used as a valid tool for the conservative treatment of spinal deformities. CLINICAL IMPLICATIONS: A conservative treatment guideline in spinal deformity management, will provide consistency in treatment and will facilitate comparability with surgery. It will be useful in determining the cost-effectiveness of treatment and in choosing the right patient for the right method of treatment. This guideline might help in this context, and may also create a systematic method for clinicians to use as a reference in both research and clinical practice.

Pedobarographic, Clinic, and Radiologic Evaluation after Surgically Treated Lisfranc Injury.

INTRODUCTION: Lisfranc injuries are rare, often missed, and may cause permanent structural deterioration of tarsometatarsal joint, despite optimal management. Consequently, a Lisfranc injury may lead to disruption of the biomechanics of the normal foot during walking and may alter the plantar pressure distribution, which is essential for proper gait mechanics. Therefore, the main purpose of the study was to specify the dynamic plantar pressure, radiographic and clinical features, after surgically managed Lisfranc injuries. METHODS: This study was carried out over a period of 10 years and included 62 patients who were surgically treated for Lisfranc injury, with mean 57-month follow-up. Radiological (intermetatarsal, Kite's, first metatarsophalangeal, Meary's, Hibbs' and calcaneal pitch angles, and medial cuneiform-fifth metatarsal distance), pedobarographical, and clinical results with the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score assessments for both feet were assessed. RESULTS: In the radiological assessment, the mean first intermetatarsal (p = 0.006) and Meary's angle (p = 0.000) were decreased on the injured feet compared to the uninjured feet on the anteroposterior and lateral radiographs. In the pedobarographic assessment, the injured feet midfoot contact time increased (p = 0.03), and maximum force (p = 0.001), total peak pressure (p = 0.008), and contact area (p = 0.017) decreased, compared to the uninjured feet. The mean AOFAS score was 75/100 at the final follow-up visit. There was seen to be reduced both contact surface area and time of the midfoot. CONCLUSION: Despite surgical management of Lisfranc injuries, the injured foot does not regain functional, radiological, or pedobarographical levels as compared to the uninjured foot for ≥ 57 months.

Translation, reliability, agreement and validity of the Turkish version of Cumulated Ambulation Score in patients with hip fracture.

OBJECTIVES: This study aims to translate and investigate the inter- rater reliability, agreement and validity of the Turkish version of the Cumulated Ambulation Score (CAS-TR) in patients with hip fracture. PATIENTS AND METHODS: This study included patients with a hip fracture of the femoral neck between July 2019 and March 2020 at the Dr. Lütfi Kirdar Kartal Training and Education Hospital, Department of Orthopedics and Traumatology, Istanbul. The CAS manual and score-sheet were translated into Turkish. An orthopedician and a physiotherapist independently administered the CAS-TR to 36 patients (12 males, 24 females; mean age 78.7 years; range, 65 to 90 years) at postoperative days one, two, three and 30. Weighted Cohen's kappa coefficient was used to measure inter-rater reliability. Turkish version of modified Barthel Index was used for analysis of validity. RESULTS: The majority of the patients had type III fracture (72.2%) according to Garden's classification. The kappa value was ≥0.90 for days one-three, the total and 30th day score of CAS-TR. The observed agreement ranged between 91.6% and 100% for all assessments. Validity analysis showed a significantly positive correlation between day two and day 30 CAS-TR and Barthel scores. CONCLUSION: We found almost perfect reliability, high percentage agreement and acceptable convergent validity of the CAS-TR. We recommend the CAS to be used as an easily applicable instrument to assess basic mobility status in Turkish patients with hip fracture. Orthopedic and geriatric patients and patients undergoing any type of surgery can be assessed with CAS for early evaluation of mobility status.