Effects of perceptive rehabilitation and mobilization methods on symptoms and disability in patients with fibromyalgia: A preliminary randomized control trial.

BACKGROUND: Currently, there is no definitive cure for fibromyalgia. Instead, treatments focus of reducing symptoms and disability. AIMS: This randomized controlled study aimed to evaluate the effectiveness of perceptive rehabilitation and soft tissue and joint mobilization on the severity of symptoms and disability in fibromyalgia compared with a control group. METHODS: A total of 55 fibromyalgia patients were randomized into three groups: perceptive rehabilitation, mobilization, and control. The impact of fibromyalgia was evaluated using the Revised Fibromyalgia Impact Questionnaire (FIQR; primary outcome). Pain intensity, fatigue severity, depression, and sleep quality were secondary outcome measures. Data were collected at baseline (T0), the end of treatment (8 weeks; T1), and the end of 3 months (T2). RESULTS: Statistically significant differences were found in between-groups comparisons at T1 for primary and secondary outcome measurements (p < .05), except for sleep quality. Both the perceptive rehabilitation and mobilization groups had statistically significant differences at T1 over the control group (p < .05). Between-group pairwise comparisons showed statistically significant differences between the perceptive and control groups for all outcome measures at T1 (p < .05). Similarly, statistically significant differences existed between the mobilization and control groups for all outcome measures at T1 (p < .05), except the FIQR overall impact scores. All other variables except depression were statistically similar between groups at T2. CONCLUSION: This study shows that perceptive rehabilitation and mobilization therapy are similarly effective in improving fibromyalgia symptoms and disability, but the effects disappear within 3 months. Further research is needed to understand how the improvements could be maintained longer. TRIAL REGISTRATION: Clinical Trial Registration number, ClinicalTrials.gov Identifier: NCT03705910.

Lower extremity proprioceptive sensation in patients with early stage knee osteoarthritis: A comparative study.

BACKGROUND: Knee OA causes pain and proprioceptive impairment. The body acts as a closed kinetic chain, and deformation on the knee cannot only affect the knee joint but also can affect the other joints. OBJECTIVE: To assess the proprioception of lower extremity in early stage knee osteoarthritis compared with without knee osteoarthritis individuals. METHODS: The study sample consisted of 26 adults with early stage knee osteoarthritis and 26 subjects without knee osteoarthritis individuals. Western Ontario and McMaster Universities Osteoarthritis Index was used for clinical disease severity. Visual Analogue Scale was used for pain severity. Proprioception (position and motion sense) was measured by isokinetic dynamometer. RESULTS: Western Ontario and McMaster Universities Osteoarthritis Index total score was 10.9 ±â€¯5. Visual Analogue Scale scores during activity were found to be significantly higher than the scores at rest and night for both sides. Hip flexion and internal rotation joint position sense were significantly different between two groups (all p's < 0.05). Hip abduction, knee flexion, ankle and subtalar position sense, as well as hip and knee motion sense were similar between groups (all p's > 0.05). Ankle dorsiflexion and eversion motion sense were significantly different between two groups (all p's < 0.05). CONCLUSIONS: This study demonstrated that the hip flexion and internal rotation position sense and ankle/subtalar joints motion sense may be affected on early stage of knee osteoarthritis. Investigation of the mechanism of proprioception for joints and also focusing on the longitudinal relationship between proprioception, knee OA disease and symptoms is recommended for future studies.

A randomized trial of trigger point dry needling versus sham needling for chronic tension-type headache.

BACKGROUND: In this randomized, double-blind, parallel-group trial, we aimed to explore the effectiveness of trigger point dry needling in patients with chronic tension-type headache in reducing headache frequency, intensity and duration, and improvement of health-related quality of life. METHODS: The 168 patients in 2 neurology clinics with chronic tension-type headache. The participants were randomly assigned to one of two treatment groups for dry needling or sham dry needling, delivered in 3 sessions a week for 2 weeks. The 160 patients fulfilled the study requirements. The dry needling was applied in active trigger points located in the musculature of the head and the neck. The patients received dry needling using sterile stainless-steel acupuncture needles of 0.25 × 40 mm and 0.25 × 25 mm dimensions. The sham dry needling procedure was applied into the adipose tissue located at any area where an active trigger point was absent. The primary outcome measurement was the headache intensity. Secondary outcomes were frequency and duration of headache, and quality of life, assessed by the Short Form-36. All outcomes were measured at baseline, at the end of 2-week, and 1-month follow-up period. RESULTS: In the dry needling group, intensity, frequency and duration of headache, and the scores of Short Form-36 subscales were significantly improved after treatment (P < .05). In the dry needling group, all the effect sizes for headache variables were large. CONCLUSIONS: The results of this clinical trial suggest that trigger point dry needling in patients with chronic tension-type headache is effective and safe in reducing headache intensity, frequency and duration, and increasing health-related quality of life. TRIAL REGISTRATION: Clinical Trials NCT03500861.

Effectiveness of the muscle energy technique on respiratory muscle strength and endurance in patients with fibromyalgia.

BACKGROUND: Fibromyalgia is characterized by a chronic and common musculoskeletal system pain that affects cervical mobility and inspiration. This may cause changes in thoracic mechanics. OBJECTIVE: To investigate the effectiveness of the muscle energy technique applied to cervical accessory respiratory muscles on respiratory muscle strength and endurance in patients with fibromyalgia. METHODS: The participants were 37 women diagnosed with fibromyalgia. They were assessed for their respiratory muscle strength, respiratory muscle endurance, pain and fatigue severity, flexibility and disability. The muscle energy technique was applied to the scalene, upper trapezius, and sternocleidomastoid muscles after a superficial heat application. The treatment was continued for 3 weeks with 3 sessions per week. RESULTS: After the treatment, expiratory muscle strength and respiratory muscle endurance increased significantly. Severity of pain and fatigue and disability were reduced, cervical flexibility increased significantly (p< 0.05). The effect size was r⩾ 0.4 for all the variables. CONCLUSION: The muscle energy technique applied to cervical accessory respiratory muscles in patients with fibromyalgia who had complaints in the neck and back region positively increased respiratory muscle strength and endurance, cervical flexibility, and decrease pain intensity, fatigue and disability. It is recommended that subsequent randomized studies are carried out with a placebo control group.

The reliability and validity of the Turkish version of Fullerton Advanced Balance (FAB-T) scale.

PURPOSE: The aim of this study was to evaluate the reliability and validity of the Turkish version of the FAB(FAB-T) scale in the older Turkish adults. METHODS: The reliability and validity of the scale was tested on 200 community-dwelling older adults. FAB-T scale was scored by different physiotherapists on different days to evaluate inter-rater and intrarater reliability. The Berg Balance Scale (BBS) was used for the evaluation of convergent validity, and the content validity of the FAB-T scale was investigated. RESULTS: The FAB-T scale showed very high inter- and intra-rater reliability. For inter-rater agreement, on the individual test items and total score ICC values were 0.92 (95 %CI; 0.90-0.94) and 0.96 (95% CI; 0.95-0.97) respectively. The intra-rater agreement, on the individual test items and total score ICC values were 0.93 (95 %CI; 0.91- 0.95) and 0.96 (95% CI; 0.95- 0.97) respectively. There was a good agreement between the FAB-T and BBS scales. A high correlation was found between the BBS and FAB-T scales [rho = 0.70 (%95 CI; 0.62-0.76)] indicating good convergent validity. Considering the content validity of the FAB-T scale, no floor (floor score: 0%) or ceiling (ceiling score: 6.5%) effect was detected. CONCLUSION: The FAB-T scale was successfully translated from the original English version (FAB) and demonstrated strong psychometric features. It was found that the FAB-T scale has very high inter-rater and intra-rater reliability. Considering the convergent validity, the scale has high correlation with the BBS. The FAB-T has no floor and ceiling effect.

The Upper Extremity Functional Index (UEFI): cross-cultural adaptation, reliability, and validity of the Turkish version.

BACKGROUND: Turkish version of the Upper Extremity Functional Index (UEFI) may help to assess shoulder function in patients with shoulder impingement syndrome (SAIS). OBJECTIVE: To translate and cross-culturally adapted UEFI into Turkish and to assess its acceptability, reliability, validity in patients with SAIS. METHODS: This study conducted with 93 SAIS participants. UEFI, the short version of the Disability of the Arm, Shoulder and Hand scale (Quick DASH), the Shoulder Pain and Disability Index, and the Short Form-36 Health Survey (SF-36) were administered. Acceptability was assessed in terms of refusal rate, rates of missing responses, and administration time. Test-retest reliability was assessed with intra class correlation coefficient (ICC), internal consistency was assessed with Cronbach's alpha coefficient. Validity was assessed by floor and ceiling effects, skew of distributions and Pearson's correlation coefficients. RESULTS: Cronbach's alpha coefficients for the UEFI at Time 1 and Time 2 were as follows: α = 0.89 and α = 0.89. Average measure ICC was 0.80. The UEFI score demonstrated strong negative correlations with SPADI total score and Quick DASH score. There was not a significant correlation between the UEFI and mental health subscale score derived from SF-36. CONCLUSIONS: The Turkish version of UEFI is acceptable, valid, and reliable.

Nutritional status of children with cerebral palsy in Turkey.

PURPOSE: The aim of this study was to assess the nutritional status, and provide information regarding anthropometric measurements of cerebral-palsied children living in the city of Ankara, Turkey. METHOD: A total of 447 children with cerebral palsy (CP) were participated in this cross-sectional study. Participants were assessed for functional motor impairment by the gross motor function classification system (GMFCS). Assesment of nutritional status was based on the triceps skinfold thickness (TSF), arm fat area (AFA) estimates derived from TSF and mid-upper arm circumference measurements. TSF and AFA Z-scores were computed using reference data. RESULTS: Cerebral-palsied children had lower TSF and AFA Z-scores compared to reference data from healthy children. The prevalence of underweight and overweight among boys was 8.3 and 9.5%, respectively, whereas it was 19.0 and 0.5% for girls. Underweight was more prevalent in the low functioning children than in moderate functioning children. CONCLUSIONS: The findings of this study indicate that cerebral-palsied children face nutritional challenges. Underweight is more prevalent than overweight among cerebral-palsied children. To optimize the outcomes of rehabilitation and prevention efforts, an understanding of the heterogeneity of nutritional status among children with CP is required.

Pain prevalence and its impact on the quality of life in a sample of Turkish children with cerebral palsy.

PURPOSE: To investigate the measurement properties of the Pain Evaluation Scale (PES), to estimate the prevalence of pain based on the PES data, and to evaluate the impact of pain on the quality of life (QoL) in a sample of Turkish children with CP. METHOD: A total of 346 children with CP participated in a cross-sectional study. The Gross Motor Function Classification System (GMFCS), PES, Wong-Baker FACES Pain Rating Scale, and the Child Health Questionnaire (CHQ-PF50) were used as the assessment tools. RESULTS: The Cronbach's alpha coefficient was 0.90 for the PES. The PES score was moderately correlated with the bodily pain subscale score, and very weekly with the mental health subscale score of the CHQ-PF50. For the threshold value of 2 on the PES, sensitivity and specificity were 91.1% and 100%, respectively. Overall, apparent prevalence and true prevalence of pain were 69.1% and 75.9%, respectively. There was a significant negative effect of pain on the QoL of subjects. The pain also negatively affected parent's personal time and caused limitations in family activities. CONCLUSIONS: The PES is valid and reliable pain assessment tool for children with CP. Pain is a frequent health problem and has severe consequences both on the cerebral palsied children's QoL and their family.

The influence of gender roles on health seeking behaviour during pregnancy in Turkey.

OBJECTIVES: To explore the impact of gender roles in relation to health seeking behaviour during pregnancy and childbirth. METHODS: The study was conducted in neighbourhoods with low antenatal care rates in three provinces of Turkey. The study population consisted of pregnant women who never got or discontinued antenatal care and their peers, families and community leaders. Sixteen focus group discussions and 125 in-depth interviews were conducted with a total of 239 participants. RESULTS: Pregnancy and childbirth are interwoven strongly with gender roles. Since the patriarchal system acknowledges women through the means of childbirth, women are expected to have many children. Hence women experience pregnancy as a burden and are not motivated to seek antenatal care. During pregnancy, only 'serious' conditions are considered as legitimate reasons for accessing care. However, the decision regarding whether a pregnant woman is seriously sick or not belongs to the responsibilities of elder women, which delays service use. CONCLUSIONS: Providing information regarding the value of antenatal care also to elder women is essential in increasing the demand to the services. Incorporating gender perspectives into daily health practice and maintaining access to high quality reproductive care services are vital in reducing the gender based barriers to care.

Perceived barriers to physical activity in university students.

Many studies which were published in other countries identified certain benefits and barriers to physical activity among young people. But there is no data about the subject pertaining to Turkish adolescents. This study tries to rectify this with a study of Turkish university students. Undergraduate university students (n = 303) were recruited to the study. Current exercise habits and perceived barriers to physical activity were assessed in the sample. Using a Likert Type scale, participants responded an instrument with 12 items representing barriers to physical activity. Mean scores were computed. External barriers were more important than internal barriers. "Lack of time due to busy lesson schedule", "My parents give academic success priority over exercise. "and "lack of time due to responsibilities related to the family and social environment "were most cited items for physical activity barriers. There is a need for future research, which will be carried out with larger sample groups to develop national standardized instrument. It will be helpful for accurately identify perceived barriers and then recommend changes to enhance physical activity among young people. Key PointsThe purpose of this study was to analyze perceived barriers to physical activity in the university students.The results showed that not having enough time was the most important barrier for not participating in physical activity among our samples.This study with relatively small sample must be considered as pilot study for related studies in the future.

Predictors of job satisfaction among physiotherapists in Turkey.

The aim of this study was to investigate the level of job satisfaction among physiotherapists, and to identify the best predictors of job satisfaction. A self-administrated questionnaire survey was conducted in September 2003. Data were collected from 198 physiotherapists in 13 health care settings (five university hospitals, seven government hospitals, and one municipality hospital) located in Ankara, Turkey. Respondents were asked to complete a 31-item job satisfaction questionnaire. The response rate was 79.8%. The percentage of satisfied physiotherapists was 45.5%. There were no significant satisfaction differences between genders or between age groups. There was a positive relationship between the global satisfaction and domain scores (all ps<0.01). Logistic regression analysis showed that the most important predictors of job satisfaction were: (1) Leadership (OR=1.03, 95% CI 1.01 to 1.06), (2) Interpersonal relationships (OR=1.03, 95% CI 1.00 to 1.05), (3) Advancement (OR=1.02, 95% CI 1.00 to 1.05), and (4) Salary (OR=1.02, 95% CI 1.00 to 1.04). Specific job satisfaction dimensions indicate that highest dissatisfaction levels occur in the area of salary and advancement. Areas of dissatisfaction are signals for change.

A comparison study of quality of life in women with fibromyalgia and myofascial pain syndrome.

PURPOSE: To compare the quality of life scores of fibromyalgia patients with myofascial pain syndrome patients. METHOD: Thirty-three fibromyalgia patients, 33 myofascial pain syndrome patients, and 33 age-matched controls completed Beck Depression Inventory and Short Form-36 questionnaires. RESULTS: Compared with myofascial pain syndrome patients, fibromyalgia patients reported significantly more often fatigue, numbness, tingling, gastrointestinal discomfort, and poor sleep. The mean scores on VAS and on Beck Depression Inventory were significantly higher in fibromyalgia patients than myofascial pain syndrome patients. Patients with fibromyalgia had significantly poorer health than the patients with myofascial pain syndrome in pain, general health, vitality, and role emotional subscales. CONCLUSIONS: The quality of life profile of fibromyalgia patients is quite different from those in the myosfascial pain syndrome group. Myofascial pain syndrome impacted mostly on physical health whereas fibromyalgia impacted on both physical and mental health.

An evaluation of quality of life of mothers of children with cerebral palsy.

PURPOSE: To evaluate the quality of life of mothers with children suffering from cerebral palsy compared with those who have children with minor health problems. METHOD: Forty mothers with a child suffering from cerebral palsy and 44 mothers with a child suffering from minor health problems participated in a comparative study. The Turkish version of the Medical Outcomes 36-Item Short Form Health Survey (SF-36) was used to assess a mother's quality of life. The severity of a child's motor disability was assessed using the Gross Motor Function Classification System (GMFCS). RESULTS: With the exception of the SF-36 physical functioning subscale, the mean scores on the SF-36 subscales were significantly lower in mothers of children with CP than those of the comparison group. The quality of life scores of mothers were significantly correlated with the severity of a child's motor disability (except physical functioning subscale). Significant correlations were found between GMFCS and the role physical; vitality; role emotional; and mental health subscales of the SF-36. CONCLUSIONS: The quality of life profile of mothers of children with cerebral palsy is different from those who have a child with minor health problems. Different coping strategies and psychosocial programmes must be designed and implemented to decrease the burden of care.