Validation and reliability study of the Turkish version of the Neuroquality of Life (Neuro-QoL)-Stigma Scale for neurological disorders

Background/aim: Stigma can be defined as a negative perception of chronically ill patients by their relatives or by society, or a similar self-perception by the patients themselves. We aimed to validate the Turkish version of the Neuroquality of Life (Neuro-QoL)-Stigma Scale for neurologic diseases. Materials and methods: Forms were filled out by a total of 152 randomized patients under regular follow-up in the outpatient clinic (29 polyneuropathy, 25 epilepsy, 23 stroke, 24 tension-type headache, 28 multiple sclerosis, 27 Parkinson disease). The forms consisted of the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), WHOQOL-BREF quality of life scale, the Multidimensional Scale of Perceived Social Support (MSPSS), the General Self-Efficacy (GSE) scale, and the Neuro-QoL-Stigma scale. Results: The internal consistency of the Neuro-QoL-Stigma scale showed Cronbach's α coefficients of 0.95 for all groups. The mean scores of the stigma scales were 33.42 ± 13.91 (min­max: 24­87). There were strong negative correlations between high stigma scores and GSE-T, MSPSS-T, and WHOQOL-BREF, and a positive correlation with the BDI and BAI. Conclusion: The Turkish version of Neuro-QoL-Stigma has satisfactory content validity and high internal consistency. Neuro-QoL-Stigma is suitable for understanding stigmatization in different neurological disorders in the Turkish population. The scale is available for use at http://www.healthmeasures.net/explore-measurement-systems/neuro-qol.

Efficacy of therapeutic ultrasound in treatment of adhesive capsulitis: A prospective double blind placebo-controlled randomized trial.

BACKGROUND: In treatment of adhesive capsulitis, deep heating agents have been shown to have positive effects on pain and function. OBJECTIVE: To evaluate if addition of ultrasound used in treatment of adhesive capsulitis will provide additional benefits. METHODS: Thirty patients with adhesive capsulitis were included in a prospective, double-blind, randomized controlled trial. Hotpack, TENS (Transcutaneus Electrical Nerve Stimulation), exercise and active ultrasound therapies were applied to the first group (n= 15), whereas sham ultrasound was applied to the second group (n= 15) in addition to hotpack, TENS and exercise. The patients were evaluated using joint range of motion, UCLA shoulder scale and Shoulder Disability Questionnaire scales at baseline and at 6th and 24th weeks post-treatment. RESULTS: When pain and the clinical and functional parameters were compared in both groups, significant improvement was found compared to baseline (p< 0.001). At week 24, no difference was found in terms of pain at rest, but all other parameters were improved compared to week 6. When the groups were compared, no difference was found in any comparison between 6th and 24th week (p> 0.05). CONCLUSION: Adding ultrasound treatment to a combination of physical therapy modalities did not provide any additional benefits for the treatment of adhesive capsulitis.

The association of endoplasmic reticulum aminopeptidase-1 (ERAP-1) with Familial Mediterranean Fever (FMF).

BACKGROUND: The ERAP1 gene cleaves the receptors and reduces their ability to transmit chemical signals to the cell that affect the process of inflammation and, secondly, it cleaves many types of proteins into small peptides that are recognized by the immune system. OBJECTIVE: ERAP-1 gene mutations may create a sensitivity for Familial Mediterranean Fever (FMF). METHOD: We included 15 FMF patients with the M694 (+) mutation in the study in order to exclude patients without pyrin gene mutations and create a homogeneous study group. Fifteen patients with ulcerative colitis formed the control group. RESULTS: There wasn't any case without ERAP-1 gene mutations. At least one mutation at exon 3 or exon 10 was found in all cases in both groups. There were 14 ERAP-1 gene mutations at exon 10 and 11 at exon 3 in patients with FMF. Interestingly, if there were ERAP-1 gene mutations at exon 3, a p.Arg127 Pro (c.380 G>C) mutation always existed for three FMF patients with polymorphic mutations at this exon. There were 11 ERAP-1 gene mutations at exon 10 and 12 gene mutations at exon 3 in patients with ulcerative colitis. Exon 3 mutations were usually single p.Arg127 Pro (c.380 G>C) mutations for 12 patients with ulcerative colitis as seen in the patients with FMF. The single mutation was always p.Ser453 Ser (c.1359T>C) for patients with ulcerative colitis at exon 10. CONCLUSION: There are more ERAP-1 mutations in the FMF group in comparison to the ulcerative colitis group. So, there may be a strong susceptibility to ERAP-1 gene mutations in FMF patients according to our results. However, further studies with larger study and control groups are needed.

The efficacy of physical therapy and physical therapy plus calcitonin in the treatment of lumbar spinal stenosis.

PURPOSE: The aim of our study was to compare the efficacy of physical therapy alone and in combination with calcitonin in patients with neurogenic claudication (NC). MATERIALS AND METHODS: In this single blind, and randomized study, patients with lumbar spinal canal stenosis who were diagnosed by clinical findings and MRI and having NC were included. Patients were observed for 8 weeks and evaluated before and after treatment. Patients were randomized between the salmon calcitonin 200 U/day + physical therapy (n = 23) (Group 1) and paracetamol 1,500 mg/day + physical therapy (n = 22) (Group 2) treatment groups. Both groups received the same physical therapy (interferential current + hot pack + short wave diathermy) and exercise protocol. The association of various clinical and functional parameters was assessed statistically by using paired and unpaired t test, chi square test and McNemar's test. p < 0.05 indicated statistical significant. RESULTS: Mean age of the patients in Group 1 was 57.6 +/- 11.2 and in Group 2 54.5 +/- 10.6 years. Before treatment, there were no significant differences between groups with respect to age, body mass index, spinal axial diameter, Visual Analogue Scale (VAS), spinal mobility, functional status and walking distance (p > 0.05). After 8 weeks of treatment, both groups benefited significantly with respect to VAS, functional status and walking distance (p < 0.001). There was no statistically significant difference between groups (p > 0.05). CONCLUSION: In 45 patients with lumbar spinal stenosis who received 8 weeks of treatment, concomitant use of calcitonin with physical therapy and exercise did not have any benefical effect on the patient's pain, functional status, lumbar mobility and walking distance.

Reliability and validity of the Turkish version of the Nottingham Extended Activities of Daily Living Scale.

BACKGROUND AND AIMS: The aim of this study was to develop a Turkish version of the Nottingham Extended Activities of Daily Living Scale (NEADLS) and to assess its reliability and validity. METHODS: Sixty healthy volunteers over 67 years old were included in the study. After translation, the Turkish version of the scale was filled in by each participant over a period of 2 weeks. Reliability was assessed by internal consistency, test-retest intraclass correlation coefficient (ICC) and Spearman's correlation. Converging validity was determined correlating the scale with the Modified Barthel Index (MBI). RESULTS: The mean age of participants was 77+/-5.67 years. In the reliability studies, internal consistency within the subsections and items of the NEADLS was good and very good, with Cronbach's alpha values ranging between 0.84-0.93 and 0.74-0.97 respectively. The Cronbach's alpha for the total NEADLS score was also determined as 0.97. Test-retest intraclass correlation coefficients, determined as 0.97 in total score, ranged from 0.84-0.97 between items. The converging validity study for the NEADLS total score was correlated with the MBI and the r value was found statistically significant (r=0.84, p<0.0001). CONCLUSIONS: The Turkish version of the NEADLS is a reliable and valid scale and can be used in activities of daily living assessment of Turkish elderly persons.

Efficacy of salmon calcitonin in complex regional pain syndrome (type 1) in addition to physical therapy.

The aim of the study was to assess the efficacy of salmon calcitonin, which was suggested as effective in the treatment of complex regional pain syndrome type 1 (CRPS 1). Patients who had suffered trauma to their upper extremities and developed CRPS 1 were included into this randomised, controlled single-blind study. The diagnosis was made according to the clinical examination and scintigraphy. The evaluation parameters were: pain [visual analogue scale (VAS)], the angle of dorsiflexion (DF) and palmar flexion (PF) of the wrist, distance between the fingertip and distal palmar crease (FT-DPC), allodynia, hyperalgesia and trophic changes. One group received paracetamol 1500 m/day and the other group salmon calcitonin 200 IU/day for 2 months. All of the patients participated in a physical therapy and exercise programme. A total of 35 patients were divided into two groups, who were found to be similar for age, body mass index, period of trauma, period of rest in a plaster splint or bandage, the duration of symptoms, VAS, DF and PF angle, FT-DPC, presence of allodynia, hyperalgesia and trophic changes (p>0.05). The control examination showed similar results for allodynia, hyperalgesia and trophic changes, whereas remarkable improvement was observed in the rest of the parameters within groups. On the other hand, between the two groups there was no significant difference in any of the parameters (p>0.05) This randomised, single-blind study showed that all of the patients with acute CRPS 1 in their upper extremities after trauma, who were treated with either paracetamol or calcitonin along with physical therapy, recovered in all parameters significantly, but without any difference between groups. We can conclude that calcitonin does not make any favourable contribution in the treatment of patients with acute CRPS 1; physical therapy combined with only a simple analgesic is an efficient means of therapy.

A prospective randomised controlled clinical trial comparing the efficacy of different molecular weight hyaluronan solutions in the treatment of knee osteoarthritis.

Viscosupplementation consists of injecting exagenous hyaluronan (HA) into the synovial joints to restore the normal rheological environment which deteriorates severely in osteoarthritic (OA) joints. Efficacy might be related to the rheological properties and molecular weight (MW) of the hyaluronan preparations. This prospective, controlled, double-blind, randomised clinical trial was aimed at comparing the elastoviscous properties of a high molecular weight viscosupplement, hylan G-F 20, with that of a lower molecular weight hyaluronan product in order to determine the relationship of elastoviscosity to efficacy, alongside placebo, in the treatment of patients with knee OA. The results were analysed as a "completers" analysis with 59 patients. Primary outcome measures included the Western Ontario and Mc Master Universities' Osteoarthritis Index (WOMAC) for pain, stiffness and function scores, and patient and physician global assessments (0-100 scale). For patient (PGA) and physician global assessments (PhGA), the 0-100 scale was used, with 100 being the worst. Follow-up assessments were made at intervals of 1, 3 and 6 months after the first injection. Local adverse events, such as transient pain at the injection site or warm knee lasting for one night, were recorded in two patients (3%). In all groups, the WOMAC pain score exhibited a significant difference from the baseline value; neither treatment group was significantly different from the placebo group, but total pain score was significantly better than baseline for both of the HA groups at the end of 6 months (p < 0.05). Improvement in WOMAC physical function score favoured both sodium hyaluronate and hylan G-F 20 after the first month, and remained significant until the end of 6 months (p < 0.01). In the placebo group, the physical function scores became worse after the end of the 1st month; the scores at the end of 6 months were no different from those at the beginning. The WOMAC stiffness scores of both of the hyaluronic acid groups improved with the first injection, and remained significantly better than the placebo group until the end of the survey (p < 0.001). All groups expressed improvement with PGA scores after the first injection. At the end of 6 months all three groups were similar, but the treatment groups were significantly better than the placebo group (p < 0.05), and all were significantly better than at the beginning (p < 0.05). The PhGA scores were similar in all groups until after the third injection. The second group was slightly better in the controls at 1 and 3 months, but all the groups were similar at the end of 6 months. Although the placebo group seemed worse, it was not statistically significant. Compared with lower molecular weight HA, the higher molecular weight HA might be more efficacious in treating knee OA, but heterogeneity of previous studies limited definitive conclusions. Patients treated by injection of either of two hyaluronan preparations showed clinical improvement for pain, though no different from the placebo group; WOMAC stiffness scores were better than placebo in the HA groups, whereas PGA scores showed improvement in all groups but HA groups were better than placebo. PhGA scores were worse in the placebo group, but not to a statistically-significant extent. The HA groups did not differ in terms of clinical efficacy.

Ultrasound imaging in the diagnosis of carpal tunnel syndrome and its relevance to clinical evaluation.

UNLABELLED: In ultrasound evaluation, median nerve can be measured quantitatively with a high reproducibility. In this study we looked for the diagnostic role of ultrasound in the carpal tunnel syndrome and its correlation with some clinical tests as Phalen and Tinnel sign. METHODS: Twenty-four patients with signs and positive EMG results of CTS along with 14 age and sex matched healthy subjects were evaluated with ultrasound. The flattening ratios, cross-sectional areas of the nerve were calculated. The ultrasonographic results of the patient and control groups were compared with t-test. The correlations between clinical tests were investigated. RESULTS: Mean cross-sectional area of the median nerve in the carpal tunnel was 10.29 +/- 3.39 mm(2) proximally, 15.28 +/- 6.16 mm(2) in the middle, 13.78 +/- 4.76 mm(2) distally. Mean flattening ratio in the carpal tunnel was 2.20 +/- 0.36 proximally, 2.61 +/- 0.54 in the middle, 3.07-0.69 distally. In the control group the cross-sectional areas were as follows: 6.46 +/- 0.72 mm(2) proximally, 6.94 +/- 0.72 mm(2) in the middle, 6.65 +/- 0.64 were mm(2) distally; mean flattening ratios were 1.76 +/- 0.18 proximally, 2.00 +/- 0.21 in the middle, 2.36 +/- 0.23 distally. At all of the levels the cross-sectional areas were significantly different between the two groups (p < 0.001). The sonographic signs were found correlated with both Phalen test (r = 0.80, p < 0.001), and Tinnel sign (r = 0.70, p < 0.001). The sensitivity and specificity of ultrasound was 89% and 100%, respectively. CONCLUSION: The combination of typical clinical symptoms and at least one pathologically increased sonographic measurement of median nerve is highly predictable for diagnosis of carpal tunnel syndrome.

Diagnosing tuberculous spondylitis: patients with back pain referred to a rheumatology outpatient department.

The onset of tuberculous spondylitis is insidious in nature, with various clinical presentations, slow development of radiographic abnormalities, and nonspecific constitutional symptoms. This lack of specific symptoms causes delays in diagnosis. Magnetic resonance imaging demonstrates osteitis, intraosseous abscesses, paravertebral and epidural soft tissue extensions and abscesses, discitis, multilevel involvement of spinal cord or nerve root compression, and scoliosis. We present six patients with tuberculous spondylitis referred to our outpatient department with back pain resistant to medical therapy. All of them were women aged from 25 to 58 years (mean 44.6). The diagnosis of tuberculous spondylitis was based on clinical presentation, radiographic and/or MRI evidence of focal destructive vertebral lesions (with paravertebral mass), and positive bacteriological findings of Mycobacterium tuberculosis. The combined antituberculous chemotherapy consisted of 1.0 g/day streptomycin for 1 month, 25 mg/kg ethambutol or 25 mg/kg pyrazinamide, 600 mg/day rifampicin, and 300 mg/day isoniazid. The duration of therapy was 12 months. All the patients recovered without any sequelae. The mean follow-up period was 28 months (range 12-48). Magnetic resonance imaging is considered the main imaging modality for patients with suspected tuberculous spondylitis; it must be included in differential diagnosis of back pain and, if it is diagnosed in early stages, antituberculous chemotherapy enables satisfactory outcome.

Subcutaneous cholesterol nodules: a case report.

Subcutaneous nodules are important in the diagnosis of some rheumatic and systemic diseases. Subcutaneous cholesterol nodule is a rare occurrence and does not accompany any inflammatory disease. It is generally mistaken for a gouty tophus. We report a case with numerous cholesterol nodules and discuss the clinical presentation and diagnostic procedure.

[Tuberculous osteitis of the tarsal bones: a case report]. / Tarsal kemiklerde tüberküloz osteitis: olgu sunumu.

A thirty-year old woman presented with complaints of pain, swelling in her right ankle, and difficulty in walking that had a history of six months. The range of motion of the joint was limited. She did not get any benefit from various non-steroidal anti-inflammatory drugs. She had undergone surgery three years ago for pain in her right hip, difficulty in walking, and a swelling in the right inguinal area. She had an elevated erythrocyte sedimentation rate. Foot radiographs showed degeneration of the navicular and cuneiform bones. Hyperintensity in the same area on magnetic resonance scans was interpreted in favor of a chronic infection. Arthrotomy of the calcaneocuboid joint and the 3rd, 4th, and 5th tarsometatarsal joints was performed, with curettage of the cuboid and lateral cuneiform bones. Tissue samples were obtained from the synovium, joint capsule, and bone, among which Mycobacterium tuberculosis was recovered only in bone cultures. The patient manifested rapid improvement with antituberculous therapy. This case demonstrates the need to obtain cultures from the bone as well as those from the synovial fluid or tissues to identify tuberculosis of a very rare site of involvement.