Nurses' roles, interventions, and implications for management of rheumatic diseases.

Nurses have become integral members of multidisciplinary teams in managing rheumatic diseases, departing from their traditional patient care roles. This article provides a comprehensive review of nurses' roles, interventions, and impacts in several rheumatic diseases, including rheumatoid arthritis, osteoarthritis, spondyloarthritis, gout, systemic lupus erythematosus, and polymyalgia rheumatica. It has been demonstrated that care under nursing supervision is effective and safe, with benefits including disease management, quality of life, and treatment adherence. In addition, nurses play a crucial role in promoting health, educating patients, and administering biological disease-modifying anti-rheumatic drugs. The COVID-19 pandemic has highlighted the significance of telehealth services and nurses' role in delivering remote care. However, nursing education and training challenges persist, particularly in standardization and access to postgraduate education. Efforts to enhance the role of nurses in rheumatology care are necessary to optimize patient outcomes and meet the evolving needs of individuals with rheumatic diseases. Collaboration across healthcare institutions, professional groups, and educational facilities is necessary for promoting the continual growth and advancement of rheumatology nurse practice. By equipping nurses with the requisite knowledge, expertise, and resources to deliver top-notch care, we can enhance the well-being of individuals with rheumatic diseases and foster improved overall health outcomes.

Uncovering the link between inflammatory rheumatic diseases and male reproductive health: a perspective on male infertility and sexual dysfunction.

Inflammatory rheumatic diseases (IRDs) refer to a range of persistent disorders that have a major influence on several physiological systems. Although there is much evidence connecting IRDs to sexual dysfunction and fertility problems, research specifically focusing on male infertility in relation to these diseases is sparse. This review addresses the complicated connection between IRDs and male infertility, emphasising the physiological, psychological, and pharmacological aspects that influence reproductive health outcomes in men with rheumatic conditions. We explore the effects of IRDs and their treatments on many facets of male reproductive well-being, encompassing sexual functionality, semen characteristics, and hormonal balance. Additionally, we present a comprehensive analysis of the present knowledge on the impact of several categories of anti-rheumatic drugs on male reproductive function. Although there is an increasing awareness of the need of addressing reproductive concerns in individuals IRDs, there is a noticeable lack of research especially dedicated to male infertility. Moving forward, more comprehensive research is needed to determine the prevalence, risk factors, and mechanisms driving reproductive difficulties in males with IRDs. We can better assist the reproductive health requirements of male IRD patients by expanding our understanding of male infertility in the setting of rheumatic disorders and implementing holistic methods to care.

Pain types and risk factors in post-COVID-19.

Objectives: This study aims to accurately evaluate pain lasting longer than three months and falls under the category of chronic pain and to determine the risk factors to follow up and treat properly and to develop appropriate diagnostic and treatment algorithms. Patients and methods: Between March 2021 and December 2021, a total of 437 patients (162 males, 275 females; mean age: 44±14.6 years; range, 12 to 82 years) who were referred to the participating centers due to pain complaints and were diagnosed with post-COVID-19 condition according to the criteria defined by the World Health Organization (WHO) were included in the study. The patients were divided into three groups as nociceptive pain, neuropathic pain, and central sensitization, based on the physician's clinical evaluation and the Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) and Central Sensitization Inventory scores. Results: The most common diagnosis was nociceptive pain followed by central sensitization. Patients with nociceptive pain had less pain. It was found that not exercising regularly, having a chronic disease and being a woman were risk factors for central sensitization, having thyroid disease before COVID-19, and defining the current pain as very severe were risk factors for neuropathic pain. Conclusion: In the evaluation of post-COVID-19 pain, neuropathic pain and central sensitization should be also considered in addition to nociceptive pain and the severity of pain, systemic diseases and physical activity should be questioned.

Association between swallowing muscle mass and dysphagia in older adults: A case-control study.

BACKGROUND: Swallowing function is formed by the synergistic, coordinated, and complex movements of approximately 30 muscles. However, There is no study on which one(s) of these muscles can predict the possibility of dyspfagia. OBJECTIVES: The purpose of this study was to investigate whether there is a relation between dysphagia and ultrasonographic measurements of swallowing muscles mass, and to determine which muscle mass would predict the possibility of dysphagia. METHODS: This prospective and controlled study was performed on 87 older people (aged >65 years). Clinical (Eating assessment tool-10 and The Gugging Swallowing Screen test), endoscopic, electrophysiological (dysphagia limit and swallowing intervals), and ultrasonographic (masseter [MM], genioglossus [GGM], geniohyoid [GHM], myohyoid [MH] and anterior digastric muscles [ADM]) evaluations were performed on all patients. The relationship between ultrasound measurements and demographic/swallowing characteristics and presence of dysphagia were investigated. RESULTS: The muscle mass measurement which was associated with dysphagia was contracted masseter muscle. In terms of diagnostic performance, the sensitivity was the highest in GHM (92.3%) and the specificity was the highest in contracted MM thickness (90.3%). The probability of dysphagia increases from 54% to 80-89% with a decrease in contracted MM thickness, and the probability of dysphagia increased from 48% to 72% with a decrease in contracted GGM thickness. In addition, the highest AUC level was detected in contracted MM and contracted GGM muscles. Moreover, it was determined that the risk of dysphagia increased from 9.6 to 14.1 times with one unit decrease in muscle thickness in contracted MM muscles, and the risk of dysphagia increased 9.1 times with one unit decrease in contracted GGM muscles. CONCLUSION: Decreased swallowing muscle mass in older adults are independent risk factors for dysphagia. Especially the decrease in the thickness of the contracted MM increases the possibility of dysphagia at high rate.

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.

Effectiveness of kinesiotape and sham kinesiotape application in children with cerebral palsy with dysphagia: A randomized controlled study.

Objectives: This study aimed to investigate the short- and long-term effects of kinesiotaping (KT) on dysphagia in children with cerebral palsy (CP). Patients and methods: One hundred one CP patients (59 males, 42 females; mean age: 49.3±18.8 years; range, 2 to 6 years) with dysphagia referred between October 2017 and January 2020 were enrolled in the randomized controlled study. Children who met the study criteria were randomly assigned to the kinesiotape group (n=54) or the sham group (n=47). Specific swallowing evaluations were performed on all patients before the therapy. The KT or sham application protocole combined with conventional rehabilitaion therapy was conducted for six weeks. Evaluation parameters were repeated at 6 and 18 weeks. The evaluated parameters were compared within and between groups. Results: Drooling, weak tongue movement, chewing difficulty, coughing/choking and retching/vomiting during/after feeding, functional oral intake score, and meal time were found to be significantly improved at six weeks in the kinesiotape group compared to the sham group, and the clinical improvements were present at 18 weeks (p<0.05). There was no statistically significant difference in any parameter in the sham group at 6 and 18 weeks compared to the pretreatment (p>0.05). Conclusion: The addition of KT to a home exercise program is an effective method for dysphagia in CP.

Comparison of the Effects of Isokinetic, Isometric, and Isotonic Exercises on Knee Osteoarthritis Using Ultrasound.

INTRODUCTION: This study aims to investigate the effects of different types of exercise on pain, functional capacity, muscle strength measured by an isokinetic dynamometer, and femoral cartilage (FC) thickness measured using ultrasound in patients with knee osteoarthritis (KOA). METHODS: Sixty patients were randomized to isokinetic, isometric, and isotonic exercise groups, and exercise programs were completed five days a week over three weeks. The FC thickness for each knee was evaluated in medial, intercondylar, and lateral areas using ultrasound, and muscle strength was assessed by an isokinetic dynamometer. Activity levels were also measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). At three weeks from baseline, follow-up clinical measurements of knee muscle strength and FC thickness were performed. RESULTS: A significant decrease was observed in all three groups in post-treatment visual analog scale (VAS) pain scores. In terms of evaluation of WOMAC scores, no significant difference was observed between the groups. In the isokinetic group, a significant increase was detected in extensor and flexor muscle strength measurements at the angular velocities of 60º/s and 180º/s. In the isotonic group, a statistically significant increase was detected in peak torque values of extensor and flexor muscles at 60º/s in the left knee only. Regarding FC thickness, a significant increase was found in the intercondylar area and the lateral condyle measurements of the left knee in the isokinetic group and the intercondylar area measurements of the right knee in the isometric group. In the isokinetic group, a statistically significant decrease was detected in the medial condyle of the right knee. It was observed that isokinetic exercise ended up with a significant increase in FC thickness in the intercondylar area and the lateral condyle of the left knee and a significant decrease in the medial condyle of the right knee. CONCLUSION: Isokinetic exercise is functionally superior to isometric and isotonic exercise, providing more significant improvements in muscle strength measurements and FC thickness. Further research is needed to determine the interactions among therapeutic exercises in patients with KOA that impact knee cartilage quantities.

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.

Neuropathic Pain and Its Relationship with Clinical Findings in Patients with Fibromyalgia.

Introduction: Fibromyalgia syndrome (FMS) is a clinical condition characterised by chronic generalised body pain, fatigue and presence of tender points. In this study, we hypothesized that FMS could be a type of neuropathic pain and investigated the relationship between neuropathic pain and sleep disturbance and depression. We also investigated the association between these clinical conditions and disease severity. Methods: Seventy-six patients who had FMS diagnosis according to 2010 ACR criteria were included in the study. Patients were evaluated by Fibromyalgia Impact Questionnaire (FIQ), Hamilton Depression Rating Scale (HAM-D), Pittsburgh Sleep Quality Index (PSQI), Douleur Neuropathique 4 Questions (DN4) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS). Results: Patients had neuropathic pain in 92.1% of patients with LANSS and 82.9% of patients with DN4. According to the Pittsburg Sleep Quality Scale, 90.8% of patients had poor sleep quality. According to HAM-D, 82.9% of the patients had depression. The mean FIQ values of the patients were calculated as 63.16±10.73. There was a positive correlation between DN4 values and FIQ, PSQI, HAM-D and LANSS. There was a positive correlation between LANSS values and FIQ and PSQI values. Conclusion: In this study we found the frequency of neuropathic pain high in FMS. We also found a positive association between neuropathic pain scales and depression, sleep disturbance, and fibromyalgia impact score. Pain, functionality and psychosocial characteristics should be assessed extensively to understand fibromyalgia completely. Abnormal pain process and secondary clinical conditions should be considered together.

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.

Use of lower extremity orthoses in patients with cerebral palsy and related factors.

BACKGROUND: The purpose of this study was to investigate the frequency of using lower extremity orthosis prescribed for patients with cerebral palsy (CP) and to determine the factors associated with orthosis use. STUDY DESIGN: The study had a retrospective and descriptive design. METHODS: One hundred and twenty-nine patients with CP who were prescribed orthoses were included in this study. The sociodemographic data and orthosis use status of patients were questioned with telephone calls. Motor functions were evaluated with Gross Motor Function Classification System (GMFCS). Spasticity was evaluated with the modified Ashworth scale, and range of motion was evaluated by goniometry. The study had a retrospective and descriptive design and included 129 patients with CP (53 females and 76 males) who were prescribed orthosis. The sociodemographic data and orthosis use status of patients were questioned with telephone calls. Motor functions were evaluated with Gross Motor Function Classification System (GMFCS). Spasticity was evaluated with the modified Ashworth scale, and range of motion was evaluated by goniometry. RESULTS: A total of 53 patients who were included in the study were female, and 76 were male. The most commonly used orthosis was Ankle-Foot Orthosis. The number of patients who used orthosis every day was 45 (34.8%). The most common reason for not using orthosis was difficulty in wearing it. The mean age was significantly lower in the group that used orthosis regularly (P < 0.05). Spasticity and range of motion limitations were low in the group that used orthosis regularly at significant levels (P < 0.05). A significant relation was detected in logistic regression analysis between age and orthosis use (P < 0.05). CONCLUSION: Regular orthosis use is at quite low levels in patients with CP. The decision for prescribing orthosis should be made with a rehabilitation team, with the patient included before orthosis is prescribed. Problems related to orthosis use should be addressed at regular intervals after prescribing orthosis.

Assessment of foot posture and related factors in patients with knee osteoarthritis.

OBJECTIVES: The aim of this study was to compare foot posture between patient and control groups, and to identify factors associated with foot posture abnormality in knee osteoarthritis (OA). PATIENTS AND METHODS: This case-control study included a total of 115 patients (26 males, 89 females; mean age: 54.4±9.3 years; range, 29 to 73 years) with OA and 77 healthy controls (20 males, 57 females; mean age: 52.1±8.1 years; range, 32 to 69 years) between May 2019 and July 2019. The participants were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale (VAS), and the Beighton criteria. Radiological assessments were performed using the Kellgren-Lawrence grading, condylar plateau angle, and medial tibiofemoral joint width. The Foot Posture Index-6 (FPI-6) was used for foot posture analysis and three groups were formed as supinated, neutral, and pronated postures. RESULTS: Foot posture was significantly different between the patient and control groups (p<0.05). Of the patients with knee OA, significant differences were found in the VAS, WOMAC-pain, WOMAC-physical function, and WOMAC-total (p<0.05) among the foot postures. No significant difference was found among the foot posture groups in terms of the radiological parameters and WOMAC-stiffness (p>0.05). Hypermobility and WOMAC-total scores were significantly associated with foot posture abnormality (p<0.05). CONCLUSION: Joint hypermobility and foot posture are the factors which may influence the clinical characteristics of knee OA. Foot posture and joint hypermobility should be taken into consideration during the examination and management of patients with knee OA.

Assessment of the responsiveness of four scales in geriatric patients with chronic neck pain.

The purpose of this study was to evaluate the responsiveness of Copenhagen Neck Functional Disability Scale (CNFDS), Neck Disability Index (NDI), Neck Bournemouth Questionnaire (NBQ), Neck Pain and Disability Scale (NPDS) in geriatric patients with non-specific chronic neck pain. A total of 52 geriatric patients with non-specific chronic neck pain were included in the present study. All participants were included in a physical therapy and rehabilitation program for five sessions per week that lasted 3 weeks. All participants were evaluated before and after the treatment. Pain and disability were assessed with the Visual Analog Scale-pain (VAS-pain), VAS-disability, muscle spasm, CNFDS, NDI, NBQ, NPDS scales. Additionally, patient satisfaction scores were questioned both before and after the treatment. Following the 3-week physical therapy and rehabilitation program, significant improvements were detected in the VAS-pain, VAS-disability, muscle spasm, CNFDS, NDI, NBQ, and NPDS scores (p < 0.05). Responsiveness values were found to be as follows: CNFDS [effect size (ES) = 0.78; standardized response mean (SRM) = 0.90], NDI (ES = 0.66; SRM = 1.18), NBQ (ES = 0.82; SRM = 0.97) and NPDS (ES = 0.87; SRM = 0.98). Our study demonstrated that CNFDS, NDI, NBQ, and NPDS are responsive scales in determining treatment-related changes in geriatric patients with non-specific neck pain. These results also suggest that all of these four scales can be used in the assessment of treatment induced changes in geriatric patients with chronic neck pain.

The effect of Pulmonary Rehabilitation Programme on work productivity and clinical parameters in patients with ankylosing spondylitis.

OBJECTIVE: The objective of the present study was to investigate the effect of the Pulmonary Rehabilitation Programme on work productivity, disease activity, functional status, quality of life, respiratory function tests (RFTs), physical capacity and depression in ankylosing spondylitis (AS) patients. METHOD: Twenty-five patients diagnosed with AS were included in this study. The disease severity was evaluated with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional status was evaluated with Bath Ankylosing Spondylitis Functional Index (BASFI), quality of life was evaluated with AS-Related Quality of Life Scale (ASQOL), physical capacity was evaluated with the 6-min walking test (6MWT), depression level was evaluated with Beck Depression Scale (BDS) and work productivity was evaluated with Spondyloartropathy Work Productivity and Activity Impairment (WPAI-SpA) Survey. Finally, RFT was evaluated with spirometry measurement. The patients were included in the Pulmonary Rehabilitation Programme for 8 weeks. RESULTS: A total of 30% of the patients who were included in this study were unemployed, 35% of them were on and below the hunger limit, 25% were on and below the poverty line, and 40% were on the normal income line. No significant changes were detected in the RFTs after the exercise programme in AS patients (P > .05), but significant improvements were detected in the BASDAI, BASFI, WPAI, 6MWT, ASQOL and BDS (P < .001). CONCLUSION: Pulmonary Rehabilitation Programme was found to be an effective method of improving work productivity in AS patients. Also, the Pulmonary Rehabilitation Programme has positive effects on disease activity, functional status, physical capacity, depression level, and quality of life.

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).

Efficacy of high intensity laser therapy in knee osteoarthritis: a double-blind controlled randomized study.

OBJECTIVE: The aim of this study is to investigate the effectiveness of high intensity laser therapy on pain, functionality, flexion range of motion (FROM), and ultrasonographic cartilage measurement in patients with knee osteoarthritis. METHODS: This study was designed as a double-blind randomized placebo-controlled study. Forty patients diagnosed with knee osteoarthritis according to the American College of Rheumatology criteria were included in the study. After obtaining written informed consent, patients were randomized into high intensity laser therapy (HILT) + exercise therapy (ET), and placebo laser (PL) + ET groups. Each patient was treated five sessions per week for 2 weeks. The outcomes measured were pain level and functional disability using the visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively. The femoral cartilage thickness measurement was made ultrasonographically, and FROM was measured with goniometry. RESULTS: Statistically significant improvements were detected in VAS, WOMAC scores, femoral cartilage thickness, and FROM at the end of the treatment (in week 2) compared to the pre-treatment period in both groups (p < 0.05). There were significant decreases in the VAS and WOMAC scores of both groups in the 6th week compared to the pre-treatment period, and the results of the FROM and femur cartilage thickness measurements were increased at statistically significant levels (p < 0.05). The VAS and WOMAC scores were significantly lower in the 6th week in HILT + ET group compared to the PL + ET group (p < 0.05). Similarly, statistically significant increases were detected in the FROM and femur cartilage thickness measurements in HILT + ET group (p < 0.05). CONCLUSION: HILT + ET combination was more effective in KOA than the PL + ET combination. Key Points • HILT is an effective modality on pain, functional status and FROM in patients with KOA. • HILT is a modality that increases femoral cartilage thickness in patients with KOA.

Assessment of responsiveness of four hand-related scales in stroke patients.

Self-reporting scales are commonly utilized in determining appropriate treatment strategies and follow-up in hand-related disorders. Responsiveness is described as the ability of a scale to detect clinically significant changes. We aimed to evaluate responsiveness of Michigan Hand Outcomes Questionnaire (MHQ), Duruöz Hand Index (DHI), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and ABILHAND questionnaire in stroke patients. Fifty-one stroke patients were assessed in this descriptive study. Participants received conventional stroke rehabilitation program consisting of 30 sessions. Brunnstrom stages of the stroke patients were recorded before and after treatment. MHQ, DHI, DASH, ABILHAND questionnaire and patient satisfaction scores were filled in by participants before and after the conventional rehabilitation program. Significant improvements were found in MHQ, DHI, DASH, ABILHAND, patient satisfaction scores and Brunnstrom motor recovery stages after the rehabilitation program (p < 0.001). Responsiveness values of the scales were calculated as MHQ (effect size (ES) = - 0.74; standardized response mean (SRM) = - 1.25), DHI (ES = 0.64; SRM = 1.22), DASH (ES = 0.71; SRM = 1.01), and ABILHAND (ES = - 0.55; SRM = - 1.22). Our study revealed that MHQ, DHI, DASH and ABILHAND are responsive scales in detecting treatment-related changes in stroke patients. MHQ, DHI, DASH and ABILHAND can be used in the evaluation of treatment responses in stroke patients.

Kinesiophobia Levels in Fibromyalgia Syndrome and the Relationship Between Pain, Disease Activity, Depression.

OBJECTIVES: This study aims to compare kinesiophobia levels between patients with fibromyalgia syndrome (FMS) and healthy volunteers and to investigate the factors associated with kinesiophobia in FMS. PATIENTS AND METHODS: This case-control study included 88 female patients with FMS (mean age 41.61 years; range 21 to 61 years) and 67 female healthy volunteers (mean age 41.34 years; range 19 to 59 years). The participants' age, body mass index (BMI), and educational status were recorded. Patients were evaluated using a visual analog scale for pain, the Fibromyalgia Impact Questionnaire (FIQ) for disease activity, the Hamilton Depression Scale (HAM-D) for depression level, and the Tampa Scale for Kinesiophobia (TSK) for kinesiophobia. Additionally, the patients' serum 25-hydroxyvitamin D levels were measured. RESULTS: No significant differences were found between the patient and control groups in terms of age, BMI, and educational status (p>0.05). The mean TSK scores were 42.0±7.6 in the patient group and 37.2±8.8 in the control group. TSK score was significantly higher in the patient group (p<0.001). BMI levels, FIQ scores, and vitamin D concentrations were significantly associated with TSK scores according to the linear regression analysis (p<0.05). However, age, symptom duration, and HAM-D scores were not found to be associated with TSK scores (p>0.05). CONCLUSION: Kinesiophobia scores were significantly higher in patients with FMS. Physicians should focus on kinesiophobia when evaluating patients with FMS and inform patients about the importance and treatment strategies of kinesiophobia.