Parent-patient Discrepancies in the Quality of Life Assessment of Early-onset Scoliosis: A Comparison Between 2 Questionnaires Completed on 2 Different Time Points - A Preliminary Report.

BACKGROUND: EOSQ-24 is a parent proxy questionnaire designed to assess the health-related quality of life (HRQoL) of early-onset scoliosis (EOS) patients during their childhood years. EOSQ-SELF, a novel self-reported questionnaire, assesses HRQoL in older children (>8 y) and adolescents. So far, the same group of EOS patients has not been evaluated with both EOSQ-24 and EOSQ-SELF. The aim of this study was to evaluate how the same pathology was reflected in the parent and patient at different time points by comparing the answers to the common questions between EOSQ-24 and EOSQ-SELF. METHODS: A group of otherwise healthy EOS patients whose parents filled out EOSQ-24 at the early phase of growth-friendly treatment was re-tested by the EOSQ-SELF questionnaire at the end of treatment. Both EOSQ-24 and EOSQ-SELF are validated in Turkish. Inclusion criteria were patients with EOS, independent ambulation, age of 8 years or older at EOSQ-SELF enrollment, literacy in Turkish, no apparent intellectual impairment, and a minimum of 24 months after graduation. The common questions between the 2 surveys with nearly identical phrasings were extracted. Common items from the 2 tests were compared with a Wilcoxon signed rank test. RESULTS: Twenty-one patients (15 females, 6 males) who previously filled out EOSQ-24 met the inclusion criteria. The mean age of the group was 10 (5 to 16) years at EOSQ-24 participation and 18 (13 to 24) at the final analysis. Fourteen questions were found common in 10 domains. The scores were significantly different in 5 questions of 4 domains. EOSQ-SELF had significantly less favorable scores in the pain/discomfort, pulmonary function, and fatigue/energy level domains. Scores in the parental burden/relationships domain were significantly higher (P<0.05). CONCLUSIONS: The self-reported group had a general trend of worse results. Parents and caregivers may not accurately perceive the problems of EOS patients. Our findings indicate a disconnect between caregivers and the patients, as both parties underreported the other side in some domains. These findings suggest the challenges faced by EOS patients are not adequately reflected on proxy questionnaires that assess the HRQoL of children. LEVEL OF EVIDENCE: Diagnostic Level I.

Translation and Cross-Cultural Adaptation of the Anterior Cruciate Ligament Donor Site Morbidity Questionnaire Into Turkish.

This study aimed to translate the ACL Donor Site Morbidity (ACL-DSM) questionnaire into Turkish and assess the reliability and validity of the Turkish version of the ACL-DSM questionnaire (ACL-DSM-Tr) among individuals following anterior cruciate ligament (ACL) reconstruction. The process involved forward and back-translation, cultural adaptation, and validation of the ACL-DSM-Tr questionnaire on ninety-nine patients (mean age 30.73 ± 8.55 years). Participants completed ACL-DSM-Tr, International Knee Documentary Committee (IKDC) subjective form, ACL Return to Sport (ACL-RSI), and Forgotten Joint Scale (FJS) questionnaires. The internal consistency, reliability, and validity of the ACL-DSM-Tr were analyzed. The ACL-DSM-Tr demonstrated a high internal consistency (Cronbach's alpha .755) and excellent test-retest reliability (Spearman correlation r = .811, p < .001; Cronbach's alpha .890). The ACL-DSM-Tr score exhibited a strong positive correlation with the IKDC score (r = .690, p < .001) and a moderate positive correlation with the FJS score (r = .535, p < .001). Despite a fair correlation between ACL-DSM-Tr and ACL- RSI subgroup scores, no significant correlation was observed with the ACL-RSI total score (p = .297). In conclusion, the ACL-DSM-Tr demonstrated internal consistency, reliability, and validity in patients with ACL reconstruction. This questionnaire has the potential to yield significant benefits in monitoring patient satisfaction and evaluating the level of comfort experienced at the donor site following ACL reconstruction.

Countermovement push-up test to assess the upper extremity force-time characteristics in swimmers during a macrocycle.

Although it is known that swimming training can improve upper extremity performance, the force-time characteristics of the upper extremity during different training periods are not well understood. The objective of this study was to measure changes in the force-time characteristics of the upper extremity of young swimmers during different training periods within a season. Seventeen young swimmers, comprising 5 males (age: 15.4 ± 0.54 years); 12 females (16.4 ± 2.6 years) participated in this study. They were tested at four experimental test time points: baseline (E1), post-general preparation (E2), post-specific preparation (E3), and taper season (E4). The countermovement push-up test was performed using a force plate to measure force time parameters. Differences in force, time, velocity and impulse parameters were evaluated between the different periods. The study found that vertical take off velocity significantly increased across the assessed periods (F = 11.79; p = .001; η2 = .424), with significant increases from E1 to E2 (p < .001) and from E3 to E4 (p = .016). Flight Time also significantly increased across the assessed periods (F = 11.79; p = .001; η2 = .424), with significant increases from E1 to E2 (p < .001), from E1 to E4(p = .001), and from E3 to E4 (p = .005). The Force Impulse significantly increased throughout the assessed periods (F = 5.84; p = .012; η2 = .267), with significant increases from E1 to E2, (p = .006), from E1 to E3 (p = .016), and from E1 to E4 (p = .003). As this study shows, periods of increased training intensity can affect athletic progression, even though training aims to improve strength, speed, and performance. While some practical aspects such as strength, flight time, and impulse parameters may change during a macrocycle, the countermovement push-up test can provide trainers with an alternative and convenient way to monitor anaerobic force, speed, and performance, as well as measure explosive force-time performance in the upper body.

Manual lymphatic drainage and Kinesio taping applications reduce early-stage lower extremity edema and pain following total knee arthroplasty.

BACKGROUND: Controlling early symptoms following total knee arthroplasty (TKA) is critical for long-term outcomes. OBJECTIVE: The purpose of this study was to compare the efficacy of manual lymphatic drainage (MLD) and Kinesio Taping®(KT) applications in terms of reducing lower extremity edema, pain, and improving function in the early postoperative period of TKA. METHODS: Forty-five female patients with unilateral TKA were allocated to an additional postoperative MLD treatment (n = 15) with exercises, additional Kinesio Taping® (n = 15) with exercises, or exercise-only (n = 15). Lower limb circumference, range of motion (ROM), pain level, and knee osteoarthritis outcome score (KOOS) were compared. RESULTS: Both MLD (p < .001; effect size range = 0.65-0.87) and the KT group (p = .001; effect size range = 0.74-0.78) had lower edema and pain levels (MLD group: p < .001; effect size = 0.84; KT group: p < .001; effect size = 0.78) compared to the control group on postoperative day 4. These beneficial effects continued only two weeks postoperatively, and no group differences were found by six weeks. CONCLUSION: Additional MLD or KT applications to standard exercises were both effective on early-stage lower extremity edema and pain levels. Clinicians might implement one of these applications to the standard rehabilitation programs to control pain and edema following TKA.

Postoperative bleeding adversely affects total knee arthroplasty outcomes in hemophilia.

BACKGROUND: Hemophilic arthropathy can result in severe degenerative arthritis and functional limitations in the knees of relatively young patients. Total knee arthroplasty (TKA) provides pain relief and gain of function in advanced-stage hemophilic arthropathy cases. However, little is known about the long-term effects of early major postoperative bleeding (MPOB) in people with hemophilia (PWH). The aim of this study was to evaluate the effects of early MPOB on the final functional outcome, complications, and implant survival of TKA in a single-center hemophilia cohort. METHOD: PWH who underwent TKA between 1998 and 2019 in a single center were reviewed. Demographic data, clinical data, and radiographic images were evaluated. Hospital for Special Surgery (HSS), Knee Society Score (KSS), and Knee Society Function Score (KSS-F) scores were used to determine function. Patients with early bleeding complications (wound dehiscence, ecchymosis, hemarthrosis, hematoma formation, prolonged or recurrent bleeding attacks) were defined as the bleeding group. Patients who did not experience these complications were assigned to the control group. The bleeding group was compared with controls. Survival of the primary arthroplasty was analyzed by Kaplan-Meier curves. RESULTS: Forty-five TKAs in 29 patients were included in the study. TKA led to an increase in the mean range of motion from 46.08° to 84.59° (P < 0.01). HSS scores increased from 48.33 preoperatively to 82.67 postoperatively (P < 0.01). There were improvements in both KSS and KSS-F scores from 34.22 and 53.3 preoperatively to 82.00 and 84.63 (P < 0.01), respectively. Ten patients (10 TKAs) (34%) experienced major bleeding during the postoperative period. Six of these patients had moderate hemophilia, and four had severe hemophilia. Three of these patients had hemarthroses (10.2%), one patient had a hematoma (3.4%), one patient had hemorrhagic bullae formation (3.4%), and five had excessive/prolonged bleeding from the wound (17%). The bleeding group (34%) had significantly worse HSS (63.78 vs 92.75, P < 0.001), KSS (61.78 vs 93.25, P < 0.001), and KSS-F (60.71 vs 96.25, P = 0.005) scores compared with controls. Preoperative and postoperative flexion contractures were positively correlated (+0.33, P = 0.003). One of the patients with postoperative hemarthrosis also had an accompanying transient common peroneal nerve palsy, and one patient (3.4%) had a periprosthetic fracture. Three knees (6.6%), two of whom were in the bleeding group, developed periprosthetic infections. Four knees (8.8%) in three patients underwent revision surgery, and two knees (4.4%) ended up in arthrodeses. Kaplan-Meier analysis revealed a mean survival duration of 17.04 years for the bleeding group and 22.15 years for the control group (P = 0.83). Survival rates were 80.0% for the bleeding group and 96.4% for the control group (P = 0.83). CONCLUSIONS: In this study, MPOB after TKA in PWH was common and led to significantly worse function. MPOB after TKA in PWH was associated with a higher rate of complications and lower survival rates, although the differences were not statistically significant. Efforts must be made to avoid MPOB after TKA in PWH.

Predictors of pain catastrophizing in women with systemic lupus erythematosus.

OBJECTIVE: The aim of this study was to identify predictive factors associated with pain catastrophizing in women with systemic lupus erythematosus (SLE). METHODS: A total of 104 volunteered women with a diagnosis of systemic lupus erythematosus participated in the study. Pain Catastrophizing Scale, Body Awareness Questionnaire, Tampa Scale of Kinesiophobia, and Beck Depression Inventory were used to assess patients. Correlations between pain catastrophizing (dependent variable) and independent variables (age, body mass index, disease activity, organ damage, depression, kinesiophobia, and body awareness) were analyzed with Pearson's rho correlation analysis. The multiple stepwise linear regression models with R2 were used to compare across the models and explain the total variance. The significance level of a p-value was considered significant if p≤0.05. RESULTS: There were no correlations between Pain Catastrophizing Scale and age, Beck Depression Inventory, disease activity, and organ damage (p>0.05). Pain Catastrophizing Scale was correlated with Tampa Scale of Kinesiophobia (r=0.585; p<0.001), Beck Depression Inventory (r=0.511; p<0.001), and Body Awareness Questionnaire (r=0.277; p<0.005). The regression analysis showed that the predictor factors of pain catastrophizing in women with systemic lupus erythematosus were TSK (B 0.411; p<0.001), Beck Depression Inventory (B 0.363; p<0.001), Body Awareness Questionnaire (B 0.273; p<0.001), and body mass index (B -0.169; p=0.02) (Nagelkerke R2=0.52). CONCLUSIONS: As a result, the most related factors on pain catastrophizing were kinesiophobia, depression, body awareness, and body mass index in women with systemic lupus erythematosus. We suggest assessing these parameters as predictive of pain catastrophizing throughout systemic lupus erythematosus management.

Predictors of pain catastrophizing in women with systemic lupus erythematosus

SUMMARY OBJECTIVE: The aim of this study was to identify predictive factors associated with pain catastrophizing in women with systemic lupus erythematosus (SLE). METHODS: A total of 104 volunteered women with a diagnosis of systemic lupus erythematosus participated in the study. Pain Catastrophizing Scale, Body Awareness Questionnaire, Tampa Scale of Kinesiophobia, and Beck Depression Inventory were used to assess patients. Correlations between pain catastrophizing (dependent variable) and independent variables (age, body mass index, disease activity, organ damage, depression, kinesiophobia, and body awareness) were analyzed with Pearson's rho correlation analysis. The multiple stepwise linear regression models with R2 were used to compare across the models and explain the total variance. The significance level of a p-value was considered significant if p≤0.05. RESULTS: There were no correlations between Pain Catastrophizing Scale and age, Beck Depression Inventory, disease activity, and organ damage (p>0.05). Pain Catastrophizing Scale was correlated with Tampa Scale of Kinesiophobia (r=0.585; p<0.001), Beck Depression Inventory (r=0.511; p<0.001), and Body Awareness Questionnaire (r=0.277; p<0.005). The regression analysis showed that the predictor factors of pain catastrophizing in women with systemic lupus erythematosus were TSK (B 0.411; p<0.001), Beck Depression Inventory (B 0.363; p<0.001), Body Awareness Questionnaire (B 0.273; p<0.001), and body mass index (B -0.169; p=0.02) (Nagelkerke R2=0.52). CONCLUSIONS: As a result, the most related factors on pain catastrophizing were kinesiophobia, depression, body awareness, and body mass index in women with systemic lupus erythematosus. We suggest assessing these parameters as predictive of pain catastrophizing throughout systemic lupus erythematosus management.

Supervised exercises have superior effects compared to home-based exercises for patients with knee osteoarthritis following platelet-rich plasma injection.

The purpose of the study was to compare the effectiveness of physiotherapist-supervised and home-based exercises after platelet-rich-plasma (PRP) injection in knee osteoarthritis (OA). Thirty women (mean age = 57.83 ± 7.26 years; mean weight = 72.13 ± 15.54 kg; mean height = 158.40 ± 4.49 cm; mean body mass index = 28.75 ± 6.18 kg/m2) were included. Patients randomized either supervised or home-basedexercise-group after PRP. Both groups performed 6-week (3 times/week) exercise. Pain, hip and knee muscle strength, and knee functions were assessed before and after exercise. The median improvement in the pain from baseline to 6th week was 3.80 (2.85-5.55) point in-supervised-exercise-group while it was 0.60 (-0.10-2.55) point in home-based-exercise-group (p = 0.002). The median improvement in knee function was 22.91 (13.02-30.20) in supervised-exercise-group overtime (p < 0.001). There was no improvement in knee function following home-based exercises (p = 1.000). The supervised-exercise-group revealed a significant improvement in hip (median difference = 32.00 (8.30-88.95), p = 0.011); quadriceps (median difference = 32.10 (21.65-60.05), p = 0.001) and hamstring (median difference = 27.90 (7.95-37.65), p = 0.022) strength overtime. The physiotherapist-supervised exercises after PRP had better effects on pain and knee function than the home-based exercises.

Effects of Pilates-Based Exercises on Functional Capacity and Mental Health in Individuals with Schizophrenia: A Pilot Study.

BACKGROUND: Although there is considerable evidence that exercise improves the physical and mental health of individuals with schizophrenia, the most useful exercise technique for this population is still the subject of research. PURPOSE: The aim of this study was to investigate the effects of Pilates exercises on functional capacity and mental health in individuals with schizophrenia. METHODS: Twenty-three participants were not randomly assigned to either Pilates exercise group (PEG) or nonspecific exercise group (NSEG). Ten participants from each group completed the study (87% response rate). The PEG participated in a 6-week Pilates exercise training twice per week, while the NSEG participated in a nonspecific activity program. 6-Minute Walk Distance (6-MWD) was assessed for functional capacity. Mental health was evaluated using Calgary Depression Scale for Schizophrenia (CDSS), and Brief Psychiatric Rating Scale (BPRS). RESULTS: 6-MWD significantly increased (p = .025), CDSS (p = .023) and BPRS (p = .012) scores significantly decreased in the PEG compared to baseline. Inter-group comparison showed that PEG had significantly better scores than NSEG in terms of the final 6-MWD (p = .005), CDSS (p = .008) and BPRS (p = .008). CONCLUSION: Results showed that Pilates may help improve the functional capacity and mental health of individuals with schizophrenia, but the small sample size and methodological limitations limit the interpretability of this study.

Factors associated with self-reported capacity to walk, jog and run in individuals with systemic lupus erythematosus.

OBJECTIVES: This study aims to explore how disease and health-related quality of life (HRQOL) factors are associated with self-reported physical capacity in walking, jogging and running in systemic lupus erythematosus (SLE). PATIENTS AND METHODS: This cross-sectional study is part of an ongoing cohort research project which started in 2014. A total of 198 patients (21 males, 177 females; mean age 51.5±16.1 years; range, 20 to 82 years) with SLE answered a question concerning physical capacity and the answers were categorized as low (can walk less than 2 km) and high (can jog and run at least 2 km) capacity. Additional measurements of disease activity (Systemic Lupus Activity Measure-Revised, SLAM-R), organ damage (Systemic Lupus International Collaborating Clinics-Damage Index, SLICC-DI), physical activity (International Physical Activity Questionnaire-Short Form, IPAQ-SF), exercise during the past year, Hospital Anxiety and Depression Scale (HADS), and HRQOL according to EuroQol five-dimension score and EuroQol visual analog scale (EQ-VAS) were included. The independent variables in the multiple logistic regression analysis were age, body mass index (BMI), disease duration, SLAM-R, SLICC-DI, IPAQ-SF category, sitting hours (IPAQ-SF), and exercise during the past year as well as HADS and EQ-VAS. RESULTS: Patients that reported low physical capacity (n=120) were older (p<0.001), had longer disease duration (p<0.001), had more organ damage (p<0.001), reported that they were less physically active (p=0.003), exercised less during the past year (p=0.001), reported more pain/discomfort and depressive symptom (p<0.001) and had lower overall HRQOL (p<0.001) and mobility and usual activities than those that reported high capacity (n=78). The regression analysis showed that age (median ≤49 vs >49) (Exp) (B): 4.52 (95% confidence interval [CI]: 2.05 to 9.98) (p<0.001), disease duration (median ≤17 vs >17) Exp (B): 2.53 (95% CI: 1.15 to 5.60) (p=0.02), SLICC-DI (median <1 vs ≥1) Exp (B): 3.60 (95% CI: 1.48 to 8.73) (p=0.005), and EQ-VAS (median <72 vs ≥72) Exp (B): 4.63 (95% CI: 2.13 to 10.05) (p<0.001) were significant factors associated with physical capacity (Nagelkerke R Squared=0.46). CONCLUSION: Patients with low physical capacity were less physically active, exercised less and had more pain and depressive symptoms than those that reported a high capacity. However, only age, disease duration, organ damage and overall HRQOL were indicators of low physical capacity. In order to increase physical capacity in the management of SLE, it is important to address overall HRQOL.

Immediate effects of thoracic manipulation on cervical joint position sense in individuals with mechanical neck pain: A randomized controlled trial.

BACKGROUND: Performing thoracic manipulations for neck pain can result in immediate improvements in neck function. OBJECTIVE: The aim of this study was to investigate the immediate effects of thoracic manipulation on cervical joint position sense and cervical range of motion in individuals with chronic mechanical neck pain. METHODS: Eighty male volunteers between 18-25 years and having chronic or recurrent neck or shoulder pain of at least 3 months duration with or without arm pain were randomized into two groups: Thoracic Manipulation Group (TMG:50) and Control Group (CG:30), with a pretest-posttest experimental design. The TMG was treated with thoracic extension manipulation while the CG received no intervention. Cervical joint position error and cervical range of motion of the individuals were assessed at baseline and 5 minutes later. RESULTS: There was no difference in demographic variables such as age (p= 0.764), Body Mass Index (p= 0.917) and Neck Pain Disability Scale (NPDS) scores (p= 0.436) at baseline outcomes between TMG and CGs. Joint position error outcomes between the two groups following intervention were similar in all directions at 30 and 50 degrees. Differences in range of motion following intervention in neck flexion (p< 0.001) and right rotation (p= 0.004) were higher in TMG compared to CG. CONCLUSIONS: A single session of thoracic manipulation seems to be inefficient on joint position sense in individuals with mild mechanical neck pain. However, thoracic manipulation might be an effective option to increase flexion and rotation of the cervical region as an adjunctive to treatment.

Correlation of force sense error test measured by a pressure biofeedback unit and EMG activity of quadriceps femoris in healthy individuals.

BACKGROUND: Our study developed a force sense error test (FSET) method for use on the quadriceps muscle, which could be employed in clinical practice to correlate the results of quadriceps muscle activity levels determined by surface electromyography (sEMG). METHODS: Twenty-four healthy individuals were included in the study. A pressure biofeedback unit (PBU) placed under the knee joint, was used for force sense error test (FSET) evaluation. First, a maximum contraction value was determined with the PBU. Next, 50% and 65% of the maximum contraction value were used for the analysis. Concurrently, norm values for the quadriceps muscle activity levels were determined by sEMG. Simultaneously, quadriceps muscle activity levels were recorded while testing the FSET using the PBU. Each measurement was repeated in triplicate, and the average constant errors observed by the PBU were recorded in mmHg. RESULTS: The FSET for both 50% and 65% of the normal mmHg value determined using the PBU positively correlated with activity change levels in the quadriceps muscle determined by sEMG (p < 0.05). CONCLUSIONS: The relationship between the FSET measured using PBU and changes in the level of activity in the quadriceps muscle showed that a PBU can be used in clinical practice for proprioceptive evaluation of the knee region.

Can Fear of Movement, Depression and Functional Performance be a Predictor of Physical Activity Level in Patients With Knee Osteoarthritis?

Objectives: This study aims to explore whether fear of movement, depression and functional performance are predictors of physical activity levels in patients with knee osteoarthritis (OA). Patients and methods: A total of 200 patients (80 males, 120 females; mean age 53.23±5.99 years; range, 40 to 65 years) with knee OA participated in this cross-sectional, correlational-design study. Oxford Knee Score (OKS) was used to evaluate physical function and pain through patient perspective. Six-Minute Walk Test (6-MWT) was used to evaluate functional performance. International Physical Activity Questionnaire-Short Form (IPAQ-SF) was used to assess subjective physical activity level. A 17-item of the self-reported Tampa Scale for Kinesiophobia (TSK) questionnaire was used to determine the fear of movement level. Beck Depression Inventory (BDI) was used as a self-reported measure for depression level. Spearman correlation analysis and the linear regression model with R-square (R2) were used to correlate and explain the total variance. Results: International Physical Activity Questionnaire-Short Form was significantly correlated to OKS (r=-0.550), 6-MWT (r=-0.561), TSK (r=-0.693) and BDI (r=-0.429) in patients with OA (p<0.001). Linear regression analysis revealed that OKS, 6-MWT test, TSK and BDI were independently associated with IPAQ-SF in predicting physical activity level in patients with knee OA (p≤0.001; R2=0.621). Conclusion: This study increases the understanding of the predictors of physical activity level related to fear of movement, depression and functional performance in patients with knee OA. Improving physical activity levels in OA population is necessary to implement early treatment strategies before the disease progresses and more costly solutions are needed.

Health-Related Quality of Life in Early-Onset Scoliosis Patients Treated Surgically: EOSQ Scores in Traditional Growing Rod Versus Magnetically Controlled Growing Rods.

STUDY DESIGN: Cross-sectional study. OBJECTIVE: To compare quality of life and caregiver burden in traditional growing rod (TGR) and magnetic controlled growing rods (MCGR) patients. SUMMARY OF BACKGROUND DATA: MCGR decrease surgical sessions associated with treatment of early onset scoliosis (EOS), hoping to minimize the burdens seen with repetitive invasive surgeries in TGR treatment. Although the clinical indications for these treatments have largely been agreed upon, there is a lack of understanding of their impact on patients' and families' quality of life. METHODS: Inclusion criteria: ≤10 years of age at index procedure, major curve ≥30°, no previous spine surgery, minimum 1-year postoperative follow-up. The previously validated 24-item early onset scoliosis questionnaire (EOSQ-24) was utilized to assess quality of life. Statistic methods were applied to compare domain scores between TGR and MCGR patients. RESULTS: Forty-four children with EOS were enrolled; 25 TGR and 19 MCGR. Groups were similar in sex and age at index surgery. Age at time of questionnaire and mean length of follow-up were significantly different; patients were older (14.0 vs. 8.8 yr) and had longer follow-up (101.3 vs. 34.3 mo) in TGR (P < 0.01). Deformity correction and complication rates were similar between groups. At the time of questionnaire, scores of economic burden and overall satisfaction in MCGR were significantly superior to those in TGR by univariate analysis. When controlled for duration of follow-up, some domain scores trended towards statistical significance, some remained stable, and others regressed to non-significance. CONCLUSION: Health related quality of life data reveal superior outcomes in overall satisfaction and financial burden domains in the MCGR group. However, the positive effects of MCGR decrease when controlled for length of follow up, indicating that the MCGR is not yet a magic fix-all, and that the TGR remains an option in the treatment of EOS. LEVEL OF EVIDENCE: 3.

Comparison of short-term effects of mobilization with movement and Kinesiotaping on pain, function and balance in patellofemoral pain.

OBJECTIVE: The aim of this study was to compare the short-term effects of Mobilization with movement (MWM) and Kinesiotaping (KT) on patients with patellofemoral pain (PFP) respect to pain, function and balance. METHODS: Thirty-five female patients diagnosed with unilateral PFP were assigned into 2 groups. The first group (n = 18) received two techniques of MWM intervention (Straight Leg-Raise with Traction and Tibial Gliding) while KT was applied to the other group (n = 17). Both groups received 4 sessions of treatment twice a week for a period of 2 weeks with a 6-week-home exercise program. Pain severity, knee range of motion, hamstring flexibility, and physical performance (10-step stair climbing test, timed up and go test), Kujala Patellofemoral Pain Scoring and Y-Balance test were assessed. These outcomes were evaluated before the treatment, 45 min after the initial treatment, at the end of the 4-session-treatment during 2-week period and 6 weeks later in both groups. RESULTS: Both treatment groups had statistically significant improvements on pain, function and balance (p < 0.05). Pain at rest (p = 0.008) and the hamstring muscle flexibility (p = 0.027) were demonstrated significant improvements in favor of MWM group. CONCLUSIONS: Our results demonstrated similar results for both treatment techniques in terms of pain, function and balance. The MWM technique with exercise had a short-term favorable effect on pain at rest and hamstring muscle flexibility than the KT technique with exercise in patients with PFP. LEVEL OF EVIDENCE: Level I, therapeutic study.

Do Pilates-based exercises following total knee arthroplasty improve postural control and quality of life?

PURPOSE: The aim of this prospective, randomized, controlled study was to investigate the effects of the addition of Pilates-based exercises to standard exercise programs performed after total knee arthroplasty on quality of life and balance. METHOD: Forty-six volunteers were divided into two groups. The control group (n = 17) was assigned a standard exercise program after discharge; the study group (n = 17) was assigned Pilates-based exercises along with the standard exercise program. We carried out clinical evaluations of all patients on the day of discharge and after the completion of the 6-week exercise program. We also recorded sociodemographic data, Berg Balance test scores, and Short Form-36 (SF-36) health-related quality of life measurements. RESULTS: When we compared the differences between pre- and post-treatment balance scores of the groups, we found a significant change in favor of the Pilates-based exercise group (13.64 ± 1.45; p < 0.01). The changes in the pre- and post-treatment SF-36 scores of the Pilates-based exercises group were found to be significant in terms of physical function (p = 0.001), physical role restriction (p = 0.01), and physical component score (p = 0.001). CONCLUSIONS: Pilates-based exercises performed along with standard exercise programs were more effective for improving balance and quality of life than standard exercise programs alone.

Development of Multidimensional Nil Hallux Valgus Scale: a reliability and validity study.

OBJECTIVE: The aim of this study was to develop a disease-specific multidimensional hallux valgus (HV) scale, as well as to establish the validity and reliability thereof. METHODS: The 14-item Multidimensional Nil Hallux Valgus Scale was developed. The scale has a score range of 0-60, with higher score indicating increased HV symptoms, complaints, and functional disorder. Among the patients referred to our clinic with HV diagnosis based on anterior-posterior non-weight-bearing radiography of the affected foot, 129 feet of 66 patients (63 bilateral, 3 unilateral) were included in the study. In clinical evaluations of these HV patients, American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal Interphalangeal Joints Scale (AOFAS-MTF-IF), Manchester Scale, and Short Form 36 Health Survey (SF-36) were used to test the validity and reliability of the new scale. RESULTS: From factor analyses, it was observed that the items clustered in 5 factors, which explained 73.2% of the variance. Floor and ceiling effects were observed to be within normal limits (floor effect: 3.1%; ceiling effect: 0.8%). The Cronbach's alpha level related with the overall internal consistency of the scale was estimated as 83.3%, and the Cronbach's alpha for the subheadings of the scale varied between 33.9% and 74.2%. High correlation was observed regarding test-retest reliability of the scale. CONCLUSION: This newly developed scale allows for the holistic evaluation of HV including the condition-specific parameters and is a valid and reliable scale that can be conveniently used by health care professionals.

Oxford Knee Score: cross-cultural adaptation and validation of the Turkish version in patients with osteoarthritis of the knee.

OBJECTIVE: The Oxford Knee Score (OKS) is a valid, short, self-administered, and site- specific outcome measure specifically developed for patients with knee arthroplasty. This study aimed to cross-culturally adapt and validate the OKS to be used in Turkish-speaking patients with osteoarthritis of the knee. METHODS: The OKS was translated and culturally adapted according to the guidelines in the literature. Ninety-one patients (mean age: 55.89±7.85 years) with knee osteoarthritis participated in the study. Patients completed the Turkish version of the Oxford Knee Score (OKS-TR), Short-Form 36 Health Survey (SF-36), and Western Ontario and McMaster Universities Index (WOMAC) questionnaires. Internal consistency was tested using Cronbach's α coefficient. Patients completed the OKS-TR questionnaire twice in 7 days to determine the reproducibility. Correlation between the total results of both tests was determined by Spearman's correlation coefficient and intraclass correlation coefficients (ICC). Validity was assessed by calculating Spearman's correlation coefficient between the OKS, WOMAC, and SF-36 scores. Floor and ceiling effects were analyzed. RESULTS: Internal consistency was high (Cronbach's α: 0.90). The reproducibility tested by 2 different methods showed no significant difference (p>0.05). The construct validity analyses showed a significant correlation between the OKS and the other scores (p<0.05). There was no floor or ceiling effect in total OKS score. CONCLUSION: The OKS-TR is a reliable and valid measure for the self-assessment of pain and function in Turkish-speaking patients with osteoarthritis of the knee.

Turkish version of the Anterior Cruciate Ligament Quality of Life questionnaire.

PURPOSE: To test the measurement properties of Turkish version of the Anterior Cruciate Ligament Quality of Life (ACL-QOL) questionnaire. METHODS: One hundred and nineteen patients with ACL reconstruction (ACL-R) completed internal consistency, agreement, construct validity, floor and ceiling effect analyses. Eighty out of 119 patients with ACL-R completed Turkish version of the ACL-QOL questionnaire twice for the test-retest reliability. A subgroup of thirty-nine patients undergoing physiotherapy were also asked to answer the ACL-QOL questionnaire, the Lysholm Knee Scale (LKS), Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) and the short form 36 (SF-36) at pre-operative, 16th week and 2 years post-operatively to assess responsiveness. RESULTS: The questionnaire had high internal consistency (Cronbach's α = 0.95). The paired t test showed no significant difference between the test-retest means. The intraclass correlation was excellent for reliability and agreement in five domains and overall score (ICC 0.95, 0.95, 0.97, 0.95, 0.96 and 0.95; p < 0.001). The standard error of measurement and the minimum detectable change (MDC95) were found to be 3.1 points and 8.7 points, respectively. The questionnaire showed a fair correlation (r = 0.23) with LKS and a poor correlation (r = 0.14) with KOS-ADLS; good and very good construct validity (r = 0.51, r = 0.62) with SF-36 physical component score and mental component score, respectively. No ceiling and floor effects were observed except the subdomain of 'work-related concerns' (22.9 %). A dramatic effect size was demonstrated at the 16th week (2.1) and 2 years (1.1) of follow-up. CONCLUSION: Turkish version of the ACL-QOL questionnaire is a reproducible and responsive instrument that can be used in clinical studies. LEVEL OF EVIDENCE: Diagnostic study, Level I.

The effect of progressive eccentric and concentric training on functional performance after autogenous hamstring anterior cruciate ligament reconstruction: a randomized controlled study.

OBJECTIVE: The aim of this study was to assess the functional results of an early onset progressive eccentric and concentric training in patients with autogen hamstring anterior cruciate ligament (ACL) reconstruction. METHODS: Thirty-three patients with autogenous hamstring ACL reconstruction were randomly divided into study (n=16, mean age; 33.87±8.19) and control (n=17, mean age; 32.64±8.21) groups and followed the same ACL rehabilitation program. Additionally, the study group followed a progressive eccentric and concentric training for 12 weeks on the Monitorized Functional Squat System (MFSS) beginning 3 weeks after surgery. The groups were compared according to the isokinetic strength of the knee extensors and flexors, functional performance (the vertical jump test, a single hop for distance test) and the Lysholm knee scale, the Anterior Cruciate Ligament-Quality of Life Questionnaire (ACL-QOL), before and 16 weeks after the surgery. RESULTS: The functional outcomes in terms of the vertical jump test (p=0.012), a single hop-for-distance test (p=0.027), the Lysholm knee scale (p=0.002) and the ACL-QOL questionnaire (p=0.000) demonstrated significantly greater improvement in the study group. No significant difference was reported between groups for isokinetic strength of the knee extensors and flexors (p>0.05). CONCLUSION: Adding progressive eccentric and concentric exercises to the standard rehabilitation protocol may improve the functional results after ACL reconstruction with autogen hamstring grafts.