The Relationship Among Probable SARCopenia, Osteoporosis and SuprasPinatus Tendon Tears in Postmenopausal Women: The SARCOSP Study.

We aimed to investigate the relationship among probable sarcopenia, osteoporosis (OP) and supraspinatus tendon (SSP) tears in postmenopausal women. Postmenopausal women screened/followed for OP were recruited. Demographic data, comorbidities, exercise/smoking status, and handgrip strength values were recorded. Probable sarcopenia was diagnosed as handgrip strength values < 20 kg. Achilles and SSP thicknesses were measured using ultrasound. Among 1443 postmenopausal women, 268 (18.6%) subjects had SSP tears. Unilateral tears were on the dominant side in 146 (10.1%) and on the non-dominant side in 55 women (3.8%). In contrast to those without, women with SSP tears had older age, lower level of education, thinner SSP and lower grip strength (all p < 0.05). In addition, they had higher frequencies of hypertension, hyperlipidemia, DM, OP and probable sarcopenia, but lower exercise frequency (all p < 0.05). Binary logistic regression modeling revealed that age [odds ratio (OR): 1.046 (1.024-1.067 95% CI)], hypertension [OR: 1.560 (1.145-2.124 95% CI)], OP [OR: 1.371 (1.022-1.839 95% CI)] and probable sarcopenia [OR: 1.386 (1.031-1.861 95% CI)] were significant predictors for SSP tears (all p < 0.05). This study showed that age, presence of hypertension, probable sarcopenia and OP were related with SSP tears in postmenopausal women. To this end, although OP appeared to be related to SSP tears, SSP tear/thickness evaluation can be recommended for OP patients, especially those who have other risk factors such as older age, higher BMI, hypertension, and probable sarcopenia.

Additional contribution of phonophoresis and low-level laser therapy to exercise in the treatment of carpal tunnel syndrome: A clinical, electrophysiological, and ultrasonographic evaluation.

OBJECTIVES: Carpal Tunnel Syndrome (CTS) is the most common peripheral nerve compression syndrome. This study aims to evaluate the additive contribution of phonophoresis and low-level laser therapy (LLLT) to tendon and nerve gliding exercises electrophysiologically, ultrasonographically, and clinically in the treatment of moderate CTS. METHODS: The sample consisted of 45 patients with moderate CTS, randomized into three groups. Group 1 received phonophoresis and exercise, Group 2 received LLLT and exercise, and Group 3 received exercise alone. Participants were evaluated electrophysiologically, clinically, and ultrasonographically before treatment and at the 6th and 12th weeks after the treatment. RESULTS: An improvement was observed in clinical parameters (Boston Functional Status Scale, Boston Symptom Severity Scale, visual analog scale at rest, and visual analog scale during activity) for all groups at the 6th and 12th weeks after the treatment (p<0.05). An improvement was also noted in the ultrasonographic parameter (cross-sectional area) for all groups at the 12th week after the treatment (p=0.017). CONCLUSION: Phonophoresis and LLLT do not provide additional effects to exercise therapy. Exercise therapy alone may positively contribute to ultrasonographic and clinical outcomes in the treatment of moderate CTS.

Best Practice Recommendations for Dysphagia Management in Intensive Care Unit (ICU): A Delphi Study from Multidisciplinary Experts in Turkey.

There is no study about all aspects of oropharyngoesophageal (OPE) dysphagia from diagnosis to follow-up in a multidisciplinary manner in the world. In order to close this gap, we aimed to create a recommendation study that can be used in clinical practice, addressing all aspects of dysphagia in the ICU in detail with the opinion of experienced multidisciplinary experts. This recommendation paper was generated by a multidisciplinary team, using the seven-step process and a three-modified Delphi round via e-mail. Firstly, 15 open-ended questions were created, and then detailed recommendations including general principles, management, diagnosis, rehabilitation, and follow-up were created with the answers from these questions, Each recommendation item was voted on by the experts as overall consensus (strong recommendation), approaching consensus (weak recommendation), and divergent consensus (not recommended).In the first Delphi round, a questionnaire consisting of 413 items evaluated with a scale of 0-10 was prepared from the opinions and suggestions given to 15 open-ended questions. In the second Delphi round, 55.4% were accepted and revised suggestions were created. At the end of the third Delphi round, the revised suggestion form was approved again and the final proposals containing 133 items were created. This study includes comprehensive and detailed recommendations, including a broad perspective from diagnosis to treatment and follow-up, as detailed as possible, for management of dysphagia in patients with both oropharyngeal- and esophageal-dysphagia in ICU.

SARcopenia Assessment in Hypertension: The SARAH Study.

OBJECTIVES: The aims of the study were to investigate the relationship between sarcopenia and renin-angiotensin system-related disorders and to explore the effects of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on muscle mass/function and physical performance. DESIGN: This multicenter, cross-sectional study was performed using ISarcoPRM algorithm for the diagnosis of sarcopenia. RESULTS: Of the 2613 participants (mean age = 61.0 ± 9.5 yrs), 1775 (67.9%) were hypertensive. All sarcopenia-related parameters (except chair stand test in males) were worse in hypertensive group than in normotensive group (all P < 0.05). When clinical/potential confounders were adjusted, hypertension was found to be an independent predictor of sarcopenia in males (odds ratio = 2.403 [95% confidence interval = 1.514-3.813]) and females (odds ratio = 1.906 [95% confidence interval = 1.328-2.734], both P < 0.001). After adjusting for confounding factors, we found that all sarcopenia-related parameters (except grip strength and chair stand test in males) were independently/negatively related to hypertension (all P < 0.05). In females, angiotensin-converting enzyme inhibitors users had higher grip strength and chair stand test performance values but had lower anterior thigh muscle thickness and gait speed values, as compared with those using angiotensin II receptor blockers (all P < 0.05). CONCLUSIONS: Hypertension was associated with increased risk of sarcopenia at least 2 times. Among antihypertensives, while angiotensin-converting enzyme inhibitors had higher muscle function values, angiotensin II receptor blockers had higher muscle mass and physical performance values only in females.

The caregiver burden of informal caregivers for stroke patients with and without dysphagia: A multi-center, cross-sectional study in Türkiye.

Objectives: The aim of this study was to investigate the caregiver burden (CB) of informal caregivers for stroke survivors with and without dysphagia and to assess the relationship between the CB levels of informal caregivers for stroke survivors with dysphagia, patients' swallowing-related quality of life (QoL), and patients' stroke-specific QoL. Patients and methods: This multi-center, prospective, cross-sectional study included a total of 120 stroke patients (76 males, 44 females; mean age: 61.1±12.3 years; range, 19 to 86 years) between October 2019 and 2020. Of the patients, 57 had dysphagia and 63 had no dysphagia. The Functional Oral Intake Scale (FOIS) was used to classify the degree of functional dietary limitation caused by each patient's swallowing impairment. Patients and caregivers completed the Eating Assessment Tool (EAT-10), Swallowing Quality of Life (SWQoL) questionnaire, Stroke Impact Scale (SIS), and the Zarit Caregiver Burden Interview (ZBI). Results: The CB levels were higher in those caring for stroke patients with dysphagia than in those caring for stroke patients without dysphagia. Caregiver burden was found to be associated with patients' swallowing-related QoL and stroke-related QoL. Significant predictors of high CB scores (F=2.55, R2=0.59; p=0.007) were being an employed caregiver (B=17.48, p=0.003), being a caregiver with high school (B=-19.6, p=0.03), and secondary school (B=-16.28, p=0.02) educational status, being son, daughter (B=30.63, p=0.007) or other relative of the patient (B=20.06, p=0.01), lower FOIS stage (B=-3.14, p=0.011), lower SWQoL (B=0.52, p=0.009) and lower SIS (B=-0.37, p=0.04) scores. Conclusion: Caregivers of stroke patients with dysphagia suffer from a higher CB than those without dysphagia. In stroke patients with dysphagia, swallowing-related QoL is associated with the QoL levels of stroke patients and the CB levels of their caregivers. Employment status, educational status of caregiver, caregiver's relativity to the patient, FOIS stage, swallowing and stroke related QoL of the patients are factors related to burden levels of caregivers of stroke patients with dysphagia. These results may help health professionals to understand dysphagia as an essential source of CB and consider it, while planning treatments.

Pediatric dysphagia overview: best practice recommendation study by multidisciplinary experts.

BACKGROUND: Currently, there is no comprehensive and multidisciplinary recommendation study covering all aspects of pediatric dysphagia (PD). This study aimed to generate PD management recommendations with methods that can be used in clinical practice to fill this gap in our country and in the world, from the perspective of experienced multidisciplinary experts. METHODS: This recommendation paper was generated by a multidisciplinary team, using the seven-step process and a three-round modified Delphi survey via e-mail. First, ten open-ended questions were created, and then detailed recommendations including management, diagnosis, treatment, and follow-up were created with the answers from these questions. Each recommendation item was voted on by the experts as overall consensus (strong recommendation), approaching consensus (weak recommendation) and divergent consensus (not recommended). RESULTS: In the 1st Delphi round, a questionnaire of 414 items was prepared based on the experts' responses to ten open-ended questions. In the 2nd Delphi round, 59.2% of these items were accepted as pre-recommendation. In the 3rd Delphi round, 62.6% of 246 items were accepted for inclusion in the proposals. The final version recommendations consisted of 154 items. CONCLUSIONS: This study includes comprehensive and detailed answers for every problem that could be posed in clinical practice for the management of PD, and recommendations are for all pediatric patients with both oropharyngeal and esophageal dysphagia.

Best Practice Recommendations for Geriatric Dysphagia Management with 5 Ws and 1H.

BACKGROUND: Dysphagia is a geriatric syndrome. Changes in the whole body that occur with aging also affect swallowing functions and cause presbyphagia. This condition may progress to oropharyngeal and/or esophageal dysphagia in the presence of secondary causes that increase in incidence with aging. However, no study has been published that provides recommendations for use in clinical practice that addresses in detail all aspects of the management of dysphagia in geriatric individuals. This study aimed to answer almost all potential questions and problems in the management of geriatric dysphagia in clinical practice. METHODS: A multidisciplinary team created this recommendation guide using the seven-step and three-round modified Delphi method via e-mail. The study included 39 experts from 29 centers in 14 cities. RESULTS: Based on the 5W and 1H method, we developed 216 detailed recommendations for older adults from the perspective of different disciplines dealing with older people. CONCLUSION: This consensus-based recommendation is a useful guide to address practical clinical questions in the diagnosis, rehabilitation, and follow-up for the management of geriatric dysphagia and also contains detailed commentary on these issues.

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.

Best Practice Recommendations for Stroke Patients with Dysphagia: A Delphi-Based Consensus Study of Experts in Turkey-Part I: Management, Diagnosis, and Follow-up.

Dysphagia is one of the most common and important complications of stroke. It is an independent marker of poor outcome after acute stroke and may become chronic after the acute period and continues to affect all aspects of the patient's life. Patients with stroke may encounter any of the medical branches in the emergency room or outpatient clinic, and as in our country, there may not be specialists specific for dysphagia, such as speech-language pathologists (SLP), in every hospital. This study aimed to raise awareness and create a common opinion of medical specialists for stroke patients with dysphagia. This recommendation paper has been written by a multidisciplinary team and offers 45 recommendations for stroke patients with dysphagia. It was created using the eight-step Delphi round via e-mail. This study is mostly specific to Turkey. However, since it contains detailed recommendations from the perspective of various disciplines associated with stroke, this consensus-based recommendation paper is not only a useful guide to address clinical questions in practice for the clinical management of dysphagia in terms of management, diagnosis, and follow-up, but also includes detailed comments for these topics.

Best Practice Recommendations for Stroke Patients with Dysphagia: A Delphi-Based Consensus Study of Experts in Turkey-Part II: Rehabilitation.

Dysphagia is one of the most common and important complications of stroke. It is an independent marker of poor outcome following acute stroke and it continues to be effective for many years. This consensus-based guideline is not only a good address to clinical questions in practice for the clinical management of dysphagia including management, diagnosis, follow-up, and rehabilitation methods, but also includes detailed algorithms for these topics. The recommendation paper has been written by a multidisciplinary team and offers 117 recommendations for stroke patients with dysphagia. While focusing on management principles, diagnosis, and follow-up in the 1st part (45 items), rehabilitation details were evaluated in the 2nd part (72 items).

Which swallowing difficulty of food consistency is best predictor for oropharyngeal dysphagia risk in older person?

PURPOSE: The present study aimed to investigate which swallowing difficulty of food consistency in participants over 65 years of age who did not have any disease that might affect swallowing functions, and which symptoms were most likely related to oropharyngeal dysphagia (OD). METHODS: The cross-sectional and multicenter study was conducted at 12 hospitals including 883 participants aged ≥65 years who were fed orally and who were admitted to the physical medicine and rehabilitation outpatient clinics between September 2017 and December 2018. Demographic characteristics were recorded. Katz Daily Living Activities Index (KDLAI), swallowing-related quality of life scale (Swal-QoL) and 10-item Eating Assessment Tool (EAT-10) were used. The participants were asked the "yes" or "no" questions including swallowing difficulty of various types of food consistency with the face-to-face interview. RESULTS: Participants were divided into two groups as normal swallowing (EAT-10 < 3 group) (n = 639) and OD risk groups (EAT-10 ≥ 3 group) (n = 244) according to the EAT-10 scores. While there was no difference related to number of teeth and KDLAI scores between groups (p = 0.327 and p = 0.221, respectively), the significant difference was found between groups in terms of yes/no questions and Swal-QoL scores (p < 0.05). Receiver operating characteristic analysis revealed that eating difficulty of mixed content food provided maximum sensitivity (99%) and eating/drinking difficulty of thick liquid had maximum specificity (77%). The higher area under curve was in eating/drinking difficulty of thick liquid (0.891), and higher positive likelihood ratio (LR) was eating/drinking difficulty of thick liquid (4.26) as well as lower negative LR was eating difficulty of mixed content food (0.01). The higher diagnostic odds ratio was eating difficulty of mixed content food (367.0), and the higher posttest probability was eating/drinking difficulty of thick liquid (0.211). CONCLUSION: While eating difficulty of hard solid food is the most common symptom in healthy participants over 65 years of age, the eating difficulty of thick liquids is the highest predictive value related to oropharyngeal dysphagia risk. Also, the eating difficulty of mixed content food had the highest diagnostic ratio.

The GUSS test as a good indicator to evaluate dysphagia in healthy older people: a multicenter reliability and validity study.

PURPOSE: Dysphagia is known to be a disorder of the swallowing function, and is a growing health problem in aging populations. Swallowing screening tests have mostly been studied in comorbidities such as stroke associated with old age. There is no simple, quick and easy screening test to best determine the risk of oropharyngeal dysphagia in geriatric guidelines. We aimed to evaluate whether the Gugging Swallowing Screen (GUSS) test is an effective method for evaluating swallowing difficulty in healthy older people. METHODS: This cross-sectional and multicenter study was conducted at 13 hospitals between September 2017 and February 2019. The study included 1163 participants aged ≥65 years and who had no secondary dysphagia. Reliability was evaluated for data quality, scaling assumptions, acceptability, reliability, and validity as well as cutoff points, specificity and sensitivity. RESULTS: The age distribution of 773 (66.5%) patients was between 65 and 74 years and 347 (29.8%) of them were male and 767 (66%) patients were female. The average total GUSS score was 18.57 ± 1.41. The Cronbach's alpha was 0.968. There was a moderate statistically significant negative correlation between the total GUSS and 10-item Eating Assessment Tool scores as well as between the total GUSS score and quality of life. The cutoff point of the total GUSS score was 18.50, sensitivity was 95.5% and specificity was 94.4%. CONCLUSIONS: The GUSS test is a valid and reliable test to identify possible oropharyngeal dysphagia risk in healthy older people who had no secondary dysphagia. It is suitable as a screen test for clinical practice.

2017 update of the Turkish League Against Rheumatism (TLAR) evidence-based recommendations for the management of knee osteoarthritis.

In a Turkish League Against Rheumatism (TLAR) project, evidence-based recommendations for the management of knee osteoarthritis (OA) was developed for the first time in our country in 2012 (TLAR-2012). In accordance with developing medical knowledge and scientific evidence, recommendations were updated. The committee was composed of 22 physical medicine and rehabilitation specialists (4 have rheumatology subspeciality also) and an orthopaedic surgeon. Systematic literature search were applied on Pubmed, Embase, Cochrane and Turkish Medical Index for the dates between January the 1st 2012 and January the 29th of 2015. The articles were assessed for quality and classified according to hierarchy for the level of evidence, and the selected ones sent to committee members electronically. They were asked to develop new recommendations. In the meeting in 2015, the format of the recommendations was decided to be patient-based and considering the grade and the severity of the disease. By the discussion of the each item under the light of new evidences, the final recommendations were developed. Each item was voted electronically on a 10-cm visual analogue scale (VAS) and the strength of recommendation (SoR) was calculated. In the light of evidences, totally 11 titles of recommendations were developed; the first 7 were applicable to each patient in every stages of the disease, remaining were for defined specific clinical situations. The mean SoR value of the recommendations was between 7.44 and 9.93. TLAR-2012 recommendations were updated in a new format. We think that, present recommendations will be beneficial for the physicians who manage, as well as the patients who suffer from the disease.

Ultrasonographic evaluation of the flexor pollicis longus tendon in frequent mobile phone texters.

OBJECTIVE: The aim of this study was to assess flexor pollicis longus tendon by using ultrasound imaging in frequent mobile phone texters. SUBJECTS: In total, 149 subjects, aged 18-40 yrs, were recruited as frequent mobile phone texters (n = 71) and infrequent texters (n = 78). METHODS: Demographic data and estimate frequency of texting were noted. Thumb pain during activity, range of motion for thumb joints, grip and pinch strengths, and Quick Disabilities of arm, shoulder, and hand were evaluated. Standardized bilateral ultrasound evaluations were performed using a linear array probe, and tendon area measurements were done with axial imaging at midthenar region and midproximal phalangeal region with manual trace technique. RESULTS: The groups were similar except for the mean estimate number of messages/month (P = 0.001). Whereas grip and pinch strength values were significantly higher (frequent texter group, P = 0.001; infrequent texter group, grip strength P = 0.018; pinch strengths, P = 0.001) on the texting side in both groups, flexor pollicis longus tendons were larger (P = 0.001) and the activity pain was higher (P = 0.005) on the texting sides only in the frequent texter group. Flexor pollicis longus thickness significantly correlated with messages/month only in the frequent texter group (r = 0.592, P = 0.001). CONCLUSIONS: Flexor pollicis longus tendons seem to be thicker at the midthenar level in subjects who frequently use mobile phone texting. Because this increase in thickness parallels the number of messages per day, the authors believe that further studies are needed to elucidate whether such changes become problematic later on in life.

Femoral cartilage thickness measurements in healthy individuals: learning, practicing and publishing with TURK-MUSCULUS.

BACKGROUND AND OBJECTIVES: Measurement of the femoral cartilage thickness by using in-vivo musculoskeletal ultrasonography (MSUS) has been previously shown to be a valid and reliable method in previous studies; however, to our best notice, normative data has not been provided before in the healthy population.The aim of our study was to provide normative data regarding femoral cartilage thicknesses of healthy individuals with collaborative use of MSUS. METHODS: This is across-sectional study run at Physical and Rehabilitation Medicine Departments of 18 Secondary and Tertiary Centers in Turkey. 1544 healthy volunteers (aged between 25-40 years) were recruited within the collaboration of TURK-MUSCULUS (Turkish Musculoskeletal Ultrasonography Study Group). Subjects who had a body mass index value of less than 30 and who did not have signs and symptoms of any degenerative/inflammatory arthritis or other rheumatic diseases, history of knee trauma and previous knee surgery were enrolled. Ultrasonographic measurements were performed axially from the suprapatellar window by using linear probes while subjects' knees were in maximum flexion. Three (mid-point) measurements were taken from both knees (lateral condyle, intercondylar area, medial condyle). RESULTS: A total of 2876 knees (of 817 M, 621 F subjects) were taken into analysis after exclusion of inappropriate images. Mean cartilage thicknesses were significantly lower in females than males (all p< 0.001). Thickness values negatively correlated with age; negatively (females) and positively (males) correlated with smoking. Men who regularly exercised had thicker cartilage than who did not exercise (all p < 0.05). Increased age (in both sexes) and absence of exercise (males) were found to be risk factors for decreased cartilage thicknesses. CONCLUSION: Further data pertaining to other countries would be interesting to uncover whether ethnic differences also affect cartilage thickness. Collaborative use of MSUS seems to be promising in this regard.

Ultrasonographic measurement of the femoral cartilage thickness in hemiparetic patients after stroke.

The aim of the study was to evaluate the femoral cartilage thicknesses of hemiparetic patients after stroke using musculoskeletal ultrasonography and to determine whether there is any correlation between cartilage thicknesses and the clinical characteristics of the patients. Femoral cartilage thicknesses of both knees were measured in 87 (33 women, 54 men) hemiparetic patients. The mean age of the patients was 61.8 years (SD 11.1 years, range 32-87 years) and the mean duration of stroke was 12.3 months (SD 10.5 months, range 1-36 months). The outcome was measured in terms of motor recovery (Brunnstrom stages), spasticity (Modified Ashworth Scale), walking ability (Functional Ambulation Categories), and motor functioning (Functional Independence Measurement instrument). Ultrasonographic measurements were made axially from the suprapatellar window using linear probes while the patients' knees were held in maximum flexion. Three (midpoint) measurements were taken from both knees [lateral condyle (LFC), intercondylar area, and medial condyle (MFC)]. The mean cartilage thicknesses were found to be less on the paretic side (statistically significant only for LFC) when compared with the nonparetic side. Cartilage thickness values were found to be negatively correlated with the duration of immobilization (with paretic side LFC) and BMI (with both sides' MFC) and positively correlated with the Functional Independence Measurement motor score (with paretic side LFC) and the Functional Ambulation Categories scores (with both sides' LFC and MFC). Femoral cartilage is thinner on the paretic side in stroke patients. As the thickness values correlate with the duration of the disease and the ambulatory status of the patients, we suggest that early mobilization would be important in maintaining their cartilage integrity.

An idiopathic case of calcium pyrophosphate dihydrate crystal deposition disease with crowned dens syndrome in a young patient.

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is rare in patients under the age of 40 in the absence of metabolic or familial predisposition. A high incidence of involvement of the transverse ligament of the atlas in CPPD deposition disease was reported. However, involvement of the craniocervical junction is rarely symptomatic. We report a rare case in a young male with severe idiopathic CPPD crystal deposition disease, including crowned dens syndrome in the cervical spine.

Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniation measured by clinical evaluation and magnetic resonance imaging.

OBJECTIVE: This study measures and compares the outcome of traction, ultrasound, and low-power laser (LPL) therapies by using magnetic resonance imaging and clinical parameters in patients presenting with acute leg pain and low back pain caused by lumbar disc herniation (LDH). METHODS: A total of 60 patients were enrolled in this study and randomly assigned into 1 of 3 groups equally according to the therapies applied, either with traction, ultrasound, or LPL. Treatment consisted of 15 sessions over a period of 3 weeks. Magnetic resonance imaging examinations were done before and immediately after the treatment. Physical examination of the lumbar spine, severity of pain, functional disability by Roland Disability Questionnaire, and Modified Oswestry Disability Questionnaire were assessed at baseline, immediately after, and at 1 and 3 months after treatment. RESULTS: There were significant reductions in pain and disability scores between baseline and follow-up periods, but there was not a significant difference between the 3 treatment groups at any of the 4 interview times. There were significant reductions of size of the herniated mass on magnetic resonance imaging after treatment, but no differences between groups. CONCLUSIONS: This study showed that traction, ultrasound, and LPL therapies were all effective in the treatment of this group of patients with acute LDH. These results suggest that conservative measures such as traction, laser, and ultrasound treatments might have an important role in the treatment of acute LDH.

The role of phonophoresis in dyshpagia due to cervical osteophytes.

OBJECTIVE: Treatment of patients with anterior cervical osteophytes causing dysphagia includes conservative treatment with anti-inflammatory drugs, muscle relaxants, antibiotics, and an appropriate soft diet. Physical therapy with its advantages may be an alternative method in the treatment, which was not reported previously. CASE DESCRIPTION: Phonophoresis therapy is applied in nine patients with dysphagia due to cervical osteophytes. RESULTS: The symptom of dysphagia regressed in various degrees in all patients after phonophoresis therapy. CONCLUSIONS: Phonophoresis might be an alternative method for the non-steroidal anti-inflammatory drug (NSAID) treatment in patients with dysphagia due to cervical osteophytes.