Determinants of social participation in people with disability.

PURPOSE: In this study, it is aimed to determine personal wellbeing and social participation levels across different physical disability types and levels of mobility. METHODS: A sample of 85 individuals with physical disabilities, excluding those with mental disabilities were included. Sociodemographics, mobility of the participants, cause, duration of disability were recorded. Personal Wellbeing Index-Adult (PWI-A) scale was used for the assessment of wellbeing and Keele Assessment of Participation (KAP) for social participation. RESULTS: Female, single, unemployed subjects and individuals with neurologic disability showed significantly higher median KAP-scores(p = 0.009, p = 0.050, p<0.001, p = 0.050, respectively).The median KAP-score of the independently mobile group was significantly lower compared to the other two groups (p = 0.001). The factors affecting KAP were determined as employment, mobility level and personal wellbeing (p = 0.002, p = 0.024, p = 0.050, respectively). CONCLUSION: Mobility level, employment and personal wellbeing are the determinants of social participation in people with disabilities. Neurological disability, female gender, being single, unemployment and mobility limitations are factors that reduce social participation.

Can Early Fatigue in Leg Muscles After Exercise Cause Postural Instability in Women With Fibromyalgia?

OBJECTIVES: This study aimed to investigate the effects of exercise-induced lower limb muscle fatigue on postural stability in female patients with fibromyalgia (FMS). METHOD: This study included 19 female patients diagnosed with FMS according to the 2010 American College of Rheumatology criteria and 19 age-matched healthy controls. Muscle fatigue was induced by chair sit-to-stand (STS) repetitions in all participants. Postural stability was evaluated before and immediately after muscle fatigue test (MFT) in standard bipedal and tandem stances with eyes open (EO) and eyes closed (EC), and in single leg stance with EO using a foot pressure platform. RESULTS: The mean number of STS repetitions on MFT was lower in FMS patients (p<0.001). Before MFT, plantar center of pressure (CoP) excursions was greater in FMS patients versus controls in all postures tested except in EO bipedal stance (all p<0.01). Postural sway increased post-MFT in both FMS and control groups in all stances (all p<0.001). Post-MFT increase in postural sway was greater in the FMS group versus controls (all p<0.05). CONCLUSION: Lower limb muscle fatigue occurs earlier in FMS patients than in healthy individuals and exacerbates postural stability problems. This indicates the importance of planning tailored exercise programs for these patients.

Pectoralis muscle area measured at T4 level is closely associated with adverse COVID-19 outcomes in hospitalized patients.

OBJECTIVES: Skeletal muscle area (SMA) at T4 level on chest computed tomography (CT) is a newly available method that can be used as a surrogate sarcopenia marker. The objective of this study is to evaluate association of SMA with adverse COVID-19 outcomes in hospitalized patients. METHODS: Hospitalized COVID-19 patients were prospectively recorded in a database containing age, gender, date of admission, date of outcome (discharge, mortality, presence of intensive care unit (ICU) stay, additional coding information (comorbidities, superimposed conditions). Admission CT-scans were retrospectively evaluated for segmentation (bilateral pectoralis major/minor, erector spinae, levator scapulae, rhomboideus minor and major and transversospinalis muscles) and SMA calculation using 3-D slicer software. RESULTS: 167 cases were evaluated (68 male, 72 female, 140 survived, 27 dead). Muscle area was lower in patients with ICU stay (p=0.023, p=0.018, p=0.008) and mortality outcome (p=0.004, p=0.007, p=0.002) for pectoralis, back and SMA. In multivariate Cox-regression analysis, hazard ratio (HR) value for the pectoralis muscle area value below 2800 mm2 was found to be 3.138(95% CI: 1.171-8.413) for mortality and 2.361(95% CI: 1.012-5.505) for ICU. CONCLUSIONS: Pectoralis muscle area measured at T4 level with 3-D slicer was closely associated with adverse outcomes (mortality, ICU stay) in hospitalized COVID-19 patients. Since early treatment methods for COVID-19 are being evaluated, this method may be a useful adjunct to clinical decision making in regard to prioritization.

Validity, reliability and minimal detectable change of Mini-BESTest Turkish version in neurological disorders.

AIMS: It is aimed to investigate the psychometric properties of Mini-BESTestTR in Turkish patients with neurological disorders. METHODS: A total of 61 people between the ages of 42 and 80, who were patients with Parkinson's disease, stroke or multiple sclerosis for more than 1 year, were included in the study. For inter-rater reliability, two independent researchers applied the scale two times within 5 days for test-retest reliability. The relationship of mini-BESTestTR with Berg Balance Scale (BBS) to assess concurrent validity, and Timed Get up and Go (TUG), Functional Reach Test (FRT) and Functional Ambulation Classification (FAC) for convergent validity was investigated. RESULTS: The scores of the two evaluators were within the range of agreement (mean = - 0.278 ± 1.484, p > 0.05), and the Mini-BESTestTR had excellent inter-rater reliability [ICC (95% CI) = 0.989 (0.981-0.993)] and test-retest reliability [ICC (95% CI) = 0.998 (0.996-0.999)]. Mini-BESTestTR had a strong correlation with BBS (r = 0.853, p < 0.001) and TUG (r = - 0.856, p < 0.001), had a moderate correlation with FAC (r = 0.696, p < 0.001) and FRT (r = 0.650, p < 0.001). CONCLUSIONS: Mini-BESTestTR showed significant correlations with other balance assessment measures, and concurrent and convergent validity of Mini-BESTestTR was demonstrated when administered to a sample of patients with chronic stroke, Parkinson's disease and multiple sclerosis.

Pain, Anxiety, and Quality of Life of COVID-19 Survivors with Myofascial Pain Syndrome: A cross sectional study.

BACKGROUND: People who have survived COVID-19 may develop chronic pain. AIMS: To investigate the difference in pain level, anxiety, functional status, and quality of life in COVID-19 survivors with myofascial pain syndrome (MPS) in the trapezius muscle compared with MPS patients without COVID-19. DESIGN: Cross-sectional observational study. SETTINGS: Physical medicine and rehabilitation outpatient clinics of a single tertiary-care hospital. PARTICIPANTS/SUBJECTS: Eighty patients (40 patients with MPS and 40 patients with MPS + COVID) who were diagnosed with chronic MPS in the trapezius muscle were evaluated. METHODS: Pain level of the patients was evaluated using the visual analogue scale (VAS), the functional status with the Neck Pain and Disability scale, the psychosocial effects of the pain with the Beck Anxiety Inventory, and the quality of life with the Nottingham Health Profile tests, and the two groups (MPS and MPS + COVID) were compared. RESULTS: A significant difference was observed between the groups in terms of pain, anxiety, and disability (p < .001). MPS + COVID group showed significantly greater pain intensity on VAS and higher mean total scores on Nottingham Health Profile, Beck Anxiety Inventory, all Nottingham Health Profile subdomains (pain, emotional reactions, sleep, social isolation, physical mobility, energy) compared with the MPS group (p < .001). CONCLUSIONS: After recovering from COVID-19, patients with MPS showed increased pain, anxiety, disability, and decreased quality of life.

Multimorbidities and quality of life in adult cerebral palsy over 40 years.

AIM: This study aimed to describe the most common combinations of comorbidities and their relationship to quality of life in a sample of adults over 40 years of age with cerebral palsy. METHODS: Patients who are 40 years or older and admitted to the hospital in the last 5 years and were diagnosed with cerebral palsy were included. Demographic data and comorbidities were both questioned through the Patient Information Management System and confirmed by asking the individual about their diseases. The patients' quality of life was evaluated with the EQ-5D-3L Telephone interview version. Principal component analysis was used to determine comorbidity combinations for multiple morbidity. RESULTS: Comorbidity was found in 72.1% of the participants and multimorbidity was found in 47.5%. The 5 most common comorbidities were musculoskeletal diseases (34.4%), psychiatric diseases (21.3%), essential hypertension (21.3%), osteoporosis (18%) and hyperlipidemia (18%). As a result of principal component analysis, a total of five components are formed and this most common comorbidity combinations in the sample explained 66.78% of the total variance. CONCLUSIONS: New combinations of comorbidities have been demonstrated that may perhaps serve as a starting point for identifying new association of pathways. Future efforts are needed to identify modifiable factors for early intervention and prevention of chronic health problems in this population.

Pedobarographic Measurements of Rheumatoid Feet Compared with Clinical Parameters.

Objective: This study aimed to investigate the relationship between plantar pressure pedobarographic measurements and disease activity, radiological abnormalities, and foot indexes in patients with rheumatoid arthritis (RA). Methods: Sociodemographics, foot symptoms, anatomical distribution, pain intensity and duration, and podiatry services access data were collected. Disease activity scale of 28 joints (DAS28) was used for the disease activity, and Health Assessment Questionnaire (HAQ) was used for the functional status. Foot function index (FFI) was used to measure the impact of foot pathology on its function. The Modified Larsen scoring was used to assess radiological abnormalities. Pedobarographic measurements were used to analyze foot loading characteristics. Results: A total of 104 feet of 52 patients with RA was evaluated. DAS28 scores did not correlate with the plantar pressure values (p>0.05). A significant correlation was found between HAQ scores and right medial midfoot loading pressure (r=0.355; p<0.01). FFI scores were positively correlated with right lateral midfoot loading pressure (r=0.302; p<0.05). No relationship was found between Manchester Foot Pain and Disability Index and plantar loading characteristics. The radiological scores were correlated with left lateral hindfoot plantar pressure (r=0.286; p<0.05). Conclusions: Pedobarographic measurements can be considered as a follow-up evaluation tool for the evaluation of all foot parts (forefoot, midfoot, and hindfoot). Rheumatoid feet investigation showed that foot involvement is independent of the disease duration, whereas midfoot plantar pressures are associated with the body mass index. Additionally, DAS28 may fall short as a marker of disease activity because it neglects foot problems.

Quality of Life, Participation, and Functional Status in Cerebral Palsy: A 13-year Follow-up Study.

Objective: This study aimed to investigate the current status and changes in motor and functional status, participation, and quality of life of individuals with cerebral palsy (CP) during the 13-year follow-up. Methods: Data from the database were retrospectively analyzed, including comorbidities, mobility status, orthotic usage, and information about the rehabilitation program and follow-up. The EuroQol 5-Dimension 3-Level (EQ-5D-3L) was used to measure the health-related quality of life. Results: Of our participants, 38.4% could independently walk 13-years ago, which increased to 51.2% presently. The orthotic usage decreased from 48.7% to 25.6%, and the rate of continuing rehabilitation decreased from 100% to 58.9%. The mean EQ-5D-3L score was 0.36±0.42, and the mean EQ-visual analog scale score was 68±24.01. Conclusions: Individuals with CP and their caregivers should be aware that CP is a lifelong disease and their continuity in rehabilitation programs should be encouraged. Independence in daily life activities should be aimed and participation in social life should be ensured.

The Effect of Yoga Asana "Vrksasana (Tree Pose)" on Balance in Patients With Postmenopausal Osteoporosis: A Randomized Controlled Trial.

OBJECTIVE: In this study, the effect of the add-on effect of the Tree Pose (Vrksasana) on the balance of patients with postmenopausal osteoporosis was investigated. DESIGN: Thirty-two patients with postmenopausal osteoporosis were randomly assigned to conservative exercise group (30 mins/d for 12 wks) or Tree Pose-added exercise group (30-min conventional exercise + 2-min Tree Pose/d for 12 wks) by Microsoft Excel randomization option. The balance of the patients was evaluated with Berg Balance Scale, Timed Up and Go Test, single-leg standing test, tandem walk test, tandem stance test, and Korebalance static&dynamic balance tests at baseline, sixth week, and third month of the exercise program. RESULTS: There was no statistically significant difference on baseline data between groups. There was a statistically significant difference between the two groups in the sixth-week measurement of single-leg stance (P < 0.05). In the Berg Balance Scale, static balance test, dynamic balance test, and tandem walk test, a statistically significant difference was found among baseline, sixth-week, and 12th week measurements in both the exercise group and the Tree Pose-added exercise group. CONCLUSIONS: Gains in the static and dynamic balance of postmenopausal osteoporotic patients can be obtained by adding "Vrksasana" to conventional exercises.

Psoas muscle index is related to hip fracture in osteoporosis: a cross-sectional MRI study.

OBJECTIVE: The aim of this study was to investigate the properties of psoas muscle in osteoporotic patients in lumbar magnetic resonance imaging (MRI) scan and their relationship with hip fracture. MATERIALS AND METHODS: One hundred seventy-seven patients with osteoporosis (63.69 ± 9.677, 105 female) who had received lumbar spine MRI and dual-energy X-ray absorptiometry (DXA) examinations were retrospectively included. Thickness (PMT), cross-sectional areas (CSA), and index (PMI) values were measured for psoas muscle at L3 level and psoas muscle characteristics were compared between hip fracture and control groups. RESULTS: PMT, CSA, and PMI values were statistically significantly different between hip fracture and control groups (respectively p < .001, p < .05, p < .01). The results showed that there was a significant association between being sarcopenic and having hip fracture (χ2 (1, n = 117) = 4.57, p < .05, phi = .20). CONCLUSION: PMT, CSA, and PMI might be associated with hip fracture in osteoporotic patients. However, this association is independent of bone mineral density (BMD). Psoas muscle features including PMT, CSA, and PMI should be used as significant predictors of falls and fractures in osteoporotic patients.

Anthropometric and Body Composition Measurements Related to Osteoporosis in Geriatric Population.

Objective: This study aimed to evaluate different anthropometric and body composition measurements, including weight, body mass index (BMI), body fat percentage (fat%), skeletal muscle index (SMI), a body shape index (ABSI), waist circumference (WC), and hip circumference (HC), in relation to bone mineral density. Methods: This is a cross-sectional study of a total of 482 patients who consulted the geriatric outpatient clinic between 2018 and 2019. Patients were evaluated with dual-energy X-ray absorptiometry. Anthropometric measurements (HC, WC, weight, BMI, and ABSI), as well as body composition analysis (fat% and SMI) by bioimpedance analysis system, were performed. The patients were evaluated with the rapid Assessment of Physical Activity Index in terms of aerobic exercise habits. Results: There was a significant correlation between lumbar spine (LS) T-score and SMI (r=0.36, p=0.000) and between LS T-score and weight (r=0.21, p=0.000), BMI (r=0.10, p=0.045) and WC (r=0.15, p=0.001). There was a statistically significant correlation between femur neck (FN) T-score and fat% (r=0.15, p=0.001), SMI (r=0.15, p=0.010), weight (r=0.22, p=0.000), BMI (r=0.20, p=0.000), WC (r=0.14, p=0.003), and HC (r=0.17, p=0.001). There was no statistically significant correlation between physical activity and LS T-score (n=353, r=0.08, p=0.16) and FN T-score (n=360, r=0.03, p=0.53). In multiple regression analysis, SMI contributes most in predicting FN and LS T-scores. Conclusions: Anthropometric measurements should be carefully selected in the geriatric population. Among the measurements, the strongest relationship was found between LS T-score and SMI.

Alexithymia in ankylosing spondylitis.

OBJECTIVES: This study aims to determine the effect of ankylosing spondylitis (AS) on alexithymia. PATIENTS AND METHODS: In this study, a total of 55 AS patients (30 males, 25 females; mean age: 40±8 years; range, 21 to 57 years) who were under follow-up and 55 age- and sex-matched healthy volunteers (31 males, 24 females; mean age: 38.9±8.5 years; range, 21 to 53 years) were included between March 2016 and August 2016. Toronto Alexithymia Scale (TAS), and Beck Depression Inventory (BDI) were performed to assess both patient and control groups. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), and Ankylosing Spondylitis Quality of Life (ASQoL) were performed to assess AS patients. RESULTS: The mean diagnosis time in the patient group was 5.18±4.32 (range, 1 to 18) years. Compared to the control group, depression scores were higher in the patient group and the alexithymic characteristics were significantly higher in the patient group (p<0.05). There was a positive correlation between complaint duration and BASMI, BASFI, and ASQoL scores (p<0.01). In our study, alexithymia rate was significantly higher in women (p<0.05). CONCLUSION: As in all inflammatory chronic diseases, depression and anxiety are commonly seen in AS patients. Alexithymia of these patients should be considered carefully.

How Did the Lockdown Imposed Due to COVID-19 Affect Patients With Cerebral Palsy?

BACKGROUND: The novel coronavirus infection (SARS-CoV-2) caused disruption of the treatment and follow-up evaluations of children with cerebral palsy. AIM: The change in mobility, pain, functional status, and spasticity was investigated who were followed in a pediatric rehabilitation unit after the lockdown. METHODS: One hundred ten children were evaluated. Pain, severity of spasticity, botulinum toxin administration dates, and continuity of home exercises were recorded. The functional status was evaluated with the Functional Independence Measure for Children (WeeFIM). RESULTS: The WeeFIM self-care and mobility subscale scores and total scores were significantly worse. Only 5 of the participants had pain in the previous evaluations; in the last evaluation, 29 had pain complaints. The pain and spasticity severity of the participants whose botulinum toxin administration was delayed were significantly increased. CONCLUSIONS: The children with cerebral palsy should be followed with telemedicine at short intervals, and when necessary, in the hospital.

Rehabilitation in paraneoplastic stiff-person syndrome - Case Report.

We aimed to share our rehabilitation experience in a patient diagnosed with paraneoplastic Stiff-person syndrome(SPS). A 45-year-old female patient was admitted to neurology with the complaint of widespread painful contractions. EMG was evaluated in favor of SPS. Amphiphysin-antibody was +++ in CSF. Patients' treatment was arranged and transferred to rehabilitation inpatient-clinic. The patient was included in the rehabilitation program of range of motion, stretching, strengthening, posture&walking exercises, balance&coordination exercises, 5 days/week for 3 months. The patient was screened for breast cancer, diagnosed with invasive breast carcinoma and underwent mastectomy. With the rehabilitation, the patient was mobilized first in the parallel-bar then with tripod-cane in the following months. Significant improvements were found in functional status and quality of life with control of spasticity and mobilization. Although the primary treatment of paraneoplastic SPS is cancer treatment, significant gains have been achieved with rehabilitation. It is necessary to raise awareness of the importance of rehabilitation to physicians who diagnose the disease.

The effect of therapeutic instrumental music performance method on upper extremity functions in adolescent cerebral palsy.

The aim of the study is to investigate the improvement of upper extremity functions with piano training of adolescent cerebral palsy. Nine adolescent cerebral palsy patients admitted to the Pediatric Disability Clinic between 2018 and 2020 and 9 healthy adolescent volunteers as control group were included. Therapeutic Instrumental Music Performance method was applied 2 days a week, 3 months in 40-min sessions. Before/after intervention, MACS, Box Block Test, Nine-Hole Peg Test, Jamar hand dynamometer and key pressing force of fingers were evaluated with Cubase MIDI program. Five of our patients included in the study were spastic hemiplegic and 4 were spastic diplegic cerebral palsy. All measurements made after intervention were found to be statistically significant compared to the measurements made before piano training (p < 0.05). The fingers that improved the most in the key pressing force of the fingers were found as the right hand 4th, left hand the 4th and 5th fingers (p < 0.01). A significant strong negative relationship was detected between the Box Block Test and the Nine-Hole Peg Test (p < 0.001). With therapeutic instrumental music performance method, functional gains can be achieved in the grip strength, strengths of the fingers, gross and fine motor skills of adolescent cerebral palsy patients. Further studies are needed to establish a piano training protocol in neurological music therapy.

Clinical presentations of pain in patients with COVID-19 infection.

BACKGROUND: Pain can be considered an early sign of COVID-19 infection. There are no studies that specifically investigate the frequency, characteristics, and presentation patterns of pain in COVID-19 infection. AIMS: Our aim is to evaluate the frequency, localization, and severity of pain among the presenting signs and symptoms in patients with COVID-19. METHODS: Patients with the diagnosis of COVID-19 who were admitted to our hospital between March and June 2020 were retrospectively analyzed. Patients' general symptoms at the first admission to the hospital, presence of pain at admission, localization, severity, and persistence of pain were queried by phone call. RESULTS: A total of 210 inpatients diagnosed with COVID-19 were recruited from the hospitals database. Complaints of the patients were 76.6% fatigue, 69.3% pain, 62% fever, 45.3% cough, 43.5% loss of taste and/or smell, 25% diarrhea, and 0.5% skin lesions respectively. Pain was the chief complaint in of 46.61% of the patients. Pain complaints had started on average 2.2 (± 2.8) days before admission. Among 133 patients reporting pain, the distribution of site was 92 (69.2%) myalgia/arthralgia; 67 (50.4%) headache; 58 (43.6%) back pain; 44 (33.1%) low back pain; 33 (25.0%) chest pain; 28 (21.1%) sore throat; and 18 (13.6%) abdominal pain. CONCLUSIONS: The most common pain symptoms were myalgia/arthralgia and headache (69.17% and 50.37%) and found to be much higher than previously reported. Pain is one of the most common complaints of admission to the hospital in patients with COVID-19. Patients who apply to health institutions with pain complaints should be evaluated and questioned in suspicion of COVID-19 infection.

Assessment of adult patients with cerebral palsy.

OBJECTIVES: The aim of this study was to evaluate health problems, accommodation, and mobility of adult patients with cerebral palsy (CP). PATIENTS AND METHODS: Between September 2018 and September 2019, a total of 70 adult CP patients (37 males, 33 females; mean age 29.4±10.2 years; range, 19 to 68 years) who were admitted to our clinic were included. Accommodation, education status, mental state, comorbidities, spasticity, contracture, deformity, and mobility of the patients were evaluated. RESULTS: Of the patients, 24.3% were diplegic, 21.4% were hemiplegic, 32.9% were tetraplegic, 15.7% were dyskinetic, and 5.7% had mixed form of CP. Among the patient, 38.6% had normal mental ability and 21.4% had severe mental retardation. A total of 92.9% of the patients were living with their family, 85.7% were unemployed, 10% were illiterate, and 21.4% had no health problems. Speech disorder was the most common health issue in 52.9% of the patients. Other health concerns included sensory problems, epilepsy, bladder/intestinal problems, nutritional problems, and respiratory and skin problems. The ratio of pain was 31.4%. Mild deformity was present in 54.3% of the patients, 43.7% were wheelchair-dependent, and 25.7% were Gross Motor Function Classification System (GMFCS) Level V. CONCLUSION: Recognition and understanding health problems and living conditions of adult patients with CP would be useful both in determining the treatment goals of pediatric CP patients and in improving the quality of life of adult CP patients.

Validity of the Korebalance® Balance System in Patients with Postmenopausal Osteoporosis.

OBJECTIVE: Balance is impaired in postmenopausal osteoporosis. Balance can be assessed with several tests and balance assessment systems. In our study, we investigated validity of Korebalance Balance System (KBS). METHOD: 52 postmenopausal osteoporotic patient evaluated with balance tests (Berg Balance Scale (BBS) and Time Up&Go Test (TUG)) and Korebalance Balance System. KBS is a balance evaluation and exercise system. The higher the score, the greater the deterioration in the balance. Static and dynamic balance evaluation results are recorded as score values. KBS, BBS and TUG compared with demographic and clinic parameters (age, 25OHvitD, menopausal age, fall history in last year, fracture history). RESULTS: According to Pearson r correlation analysis, Korebalance Dynamic Test (KDT) and BBS had moderately negative correlation (r=-.38, p<.01), KDT and TUG had moderately positive correlation (r=-.42, p<.01). According to Spearman rho correlation analysis, Korebalance Static Test (KST) and BBS had moderately negative correlation (r=-.30, p<.05). Age and KST (r=.33, p<.05), age and KDT (r=.31, p<.05) had moderately positive correlation. No significant correlation was found with other parameters. In discriminant validity, there was no correlation between other nonfunctional demographic and clinical parameters. CONCLUSION: Korebalance Balance System was found to be a convenient assessment tool with moderate convergent validity compared with BBS and TUG and has an excellent intraclass correlation.

Bilateral and atypical localized elastofibroma dorsi in a patient with shoulder and back pain: A case report.

A 61-year-old woman presented with localized back pain at the left inferomedial border of the scapula and left shoulder pain. On physical examination, a soft tissue mass was detected on the left scapula. Magnetic resonance imaging showed a mass at the left suprascapular region and another mass in the left infrascapular region. A Tru-Cut biopsy of the lesion at the left suprascapular region was obtained due to atypical localization. Pathological examination was consistent with an elastofibroma. During wire-marking, another mass was detected at the right infrascapular region. Three mass lesions were excised on consecutive operations. During follow-up, the patient reported reduced shoulder and back pain.