THE EFFECT OF A 6-WEEK BALANCE EXERCISE PROGRAM ON BALANCE PARAMETERS IN FRAILTY SYNDROME: A RANDOMIZED CONTROLLED, DOUBLE-BLIND, PROSPECTIVE STUDY.

This study assessed the effectiveness of a six-week balance exercise program on balance parameters and fall frequency in geriatric patients with frailty syndrome. This randomized prospective study evaluated a total of 216 patients after referral to a physical medicine and rehabilitation outpatient clinic. Participants were divided into group 1 (flexibility exercises) and group 2 (balance exercises, including kinesthetic ability trainer [KAT] balance exercises, and flexibility exercises). Both groups performed exercises five days per week for six weeks. Balance assessments included the Berg Balance Scale and time-up-and-go test to evaluate dynamic and functional balance, while the one-leg stand test and KAT 4000 static balance test were done to evaluate static balance. Frailty was observed in 37 (17.12%) patients. Patients without frailty syndrome initially performed significantly better (p˂0.001). Group 2 demonstrated statistically significant improvements after six weeks (p˂0.05). Long-term exercise programs improve balance parameters and exercise performance in older adults with frailty.

Frailty prevalence and related factors in the older adult-FrailTURK Project.

Frailty is one of the geriatric syndromes and has an important relationship with mortality and morbidity. The aim of this study is to present the characteristics, prevalence, and related factors of frailty in older adults in our country. The study included 1126 individuals over 65 years of age from 13 centers. Frailty was evaluated using the Fried Frailty criteria, and patients were grouped as "frail," "pre-frail," and "non-frail." Nutritional status was assessed with "Mini Nutritional Test," psychological status with the "Center for Epidemiological Studies Depression Scale-CES-D," and additional diseases with the "Charlson Comorbidity index." Approximately 66.5 % of the participants were between 65 and 74 years of age and 65.7 % were women. Some 39.2 and 43.3 % of the participants were rated as frail and pre-frail, respectively. The multinomial logistic regression analysis was used to determine the factors associated with frailty. It was observed that age, female gender, low education level, being a housewife, living with the family, being sedentary, presence of an additional disease, using 4 or more drugs/day, avoiding to go outside, at least one visit to any emergency department within the past year, hospitalization within the past year, non-functional ambulation, and malnutrition increased the risk of frailty (p < 0.05). Establishing the factors associated with frailty is highly important for both clinical practice and national economy. This is the first study on this subject in our country and will provide guidance in determining treatment strategies.

Effect of aquatic exercise on ankylosing spondylitis: a randomized controlled trial.

Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease that affects mainly the axial skeleton and causes significant pain and disability. Aquatic (water-based) exercise may have a beneficial effect in various musculoskeletal conditions. The aim of this study was to compare the effectiveness of aquatic exercise interventions with land-based exercises (home-based exercise) in the treatment of AS. Patients with AS were randomly assigned to receive either home-based exercise or aquatic exercise treatment protocol. Home-based exercise program was demonstrated by a physiotherapist on one occasion and then, exercise manual booklet was given to all patients in this group. Aquatic exercise program consisted of 20 sessions, 5× per week for 4 weeks in a swimming pool at 32-33 °C. All the patients in both groups were assessed for pain, spinal mobility, disease activity, disability, and quality of life. Evaluations were performed before treatment (week 0) and after treatment (week 4 and week 12). The baseline and mean values of the percentage changes calculated for both groups were compared using independent sample t test. Paired t test was used for comparison of pre- and posttreatment values within groups. A total of 69 patients with AS were included in this study. We observed significant improvements for all parameters [pain score (VAS) visual analog scale, lumbar flexion/extension, modified Schober test, chest expansion, bath AS functional index, bath AS metrology index, bath AS disease activity index, and short form-36 (SF-36)] in both groups after treatment at week 4 and week 12 (p < 0.05). Comparison of the percentage changes of parameters both at week 4 and week 12 relative to pretreatment values showed that improvement in VAS (p < 0.001) and bodily pain (p < 0.001), general health (p < 0.001), vitality (p < 0.001), social functioning (p < 0.001), role limitations due to emotional problems (p < 0.001), and general mental health (p < 0.001) subparts of SF-36 were better in aquatic exercise group. It is concluded that a water-based exercises produced better improvement in pain score and quality of life of the patients with AS compared with home-based exercise.

Is there any requirement for celiac disease screening routinely in postmenapausal women with osteoporosis?

Screening studies indicate a prevalence of celiac disease (CD) of up to 1% in populations of European ancestry, yet the majority of cases remain undiagnosed. One of the common complication of CD is intestinal osteopathy or osteoporosis [bone mineral density (BMD) based diagnosis]. Available data regarding the prevalence of CD in the patients with osteoporosis are limited and controversial. The objective of this study was to perform serological testing to screen for CD among postmenopausal women with osteoporosis. We studied 192 postmenopausal women with low BMD with a mean age of 62.75 +/- 8.58 years. Among the patients, a total of 137 had osteoporosis and 55 had osteopenia. Venous blood samples were obtained for serological screening of CD and evaluation of bone metabolism. The serological screening protocol consisted of determining serum level of IgA antigliadin antibodies (AGA), IgG-AGA, IgA endomysial antibody (EMA), IgG-EMA. Subjects who were positive for both IgA-AGA and IgA-EMA were classified as having CD. Bone metabolism was evaluated by serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone, 25 (OH) vitamin D, osteocalcin, serum C-telopeptide cross-linked collagen type I levels. Of the 192 patients evaluated, only one (0.5%) was found to have positive for both IgA-AGA and IgA EMA tests and accepted as having CD. Prevelance of CD in postmenopausal women with low BMD (0.5%) did not differ from prevelance of CD in normal healthy population (0.3-1%). BMD values at proximal femur level were significantly lower in IgA-AGA (+) patients when compared to IgA-AGA (-) patients. However, the mean levels of bone metabolism markers were found similiar in both IgA-AGA (+) and (-) patients. In conclusion, the results of our study suggest that there is no need for routine screening of CD in postmenopausal women with osteoporosis.

Characteristics and medical management of patients with rheumatoid arthritis and ankylosing spondylitis.

Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic, progressive, systemic inflammatory rheumatic diseases that lead to serious disability. The objective of this study was to investigate the demographic and clinical characteristics of the patients with RA and AS who were treated in tertiary hospitals in Turkey and to analyze their current medical management. A total of 562 RA and 216 AS patients were evaluated. The mean age of RA patients was 52.1 +/- 12.6 years. The female to male ratio was 3.7:1. Of the RA patients, 72.2% had positive rheumatoid factor (RF), 62.9% had high C-reactive protein, and 75.2% had radiological erosion. The ratio of patients with Disease Activity Score (DAS) 28 >3.2 was 73.9% and of those with Health Assessment Questionnaire (HAQ) > or =1.5 was 20.9%. There was a statistically significant increase in RF positivity and HAQ scores in the group with higher DAS 28 score. Frequency of extraarticular manifestations was 22.4%. The ratio of the patients receiving disease modifying antirheumatic drugs (DMARD) was 93.1%, and 6.9% of the patients were using anti-tumor necrosis factor (TNF) blocking agents. In AS, the mean age of the patients was 38.1 +/- 10.6, and the female to male ratio was 1:2.5. The time elapsed between the first symptom and diagnosis was 4.3 years. The ratio of peripheral joint involvement was 29.4%. Major histocompatibility complex, class I, B 27 was investigated in 31.1% of patients and the rate of positivity was 91%. In 52.4% of the patients, Bath AS Disease Activity Index (BASDAI) was > or =4. The erythrocyte sedimentation rate, Bath AS Functional Index, and peripheral involvement were significantly higher in the group with BASDAI > or =4. Frequency of extraarticular involvement was 21.2% in AS patients. In the treatment schedule, 77.5% of AS patients were receiving sulphasalazine, 15% methotrexate, and 9.9% anti-TNF agents. Despite widespread use of DMARD, we observed high disease activity in more than half of the RA and AS patients. These results may be due to relatively insufficient usage of anti-TNF agents in our patients and therefore these results mostly reflect the traditional treatments. In conclusion, analysis of disease characteristics will inform us about the disease severity and activity in RA and AS patients and could help in selecting candidate patients for biological treatments.

The effect of gallium arsenide aluminum laser therapy in the management of cervical myofascial pain syndrome: a double blind, placebo-controlled study.

The efficacy of low-level laser therapy (LLLT) in myofascial pain syndrome (MPS) seems controversial. A prospective, double-blind, randomized controlled trial was conducted in patients with chronic MPS in the neck to evaluate the effects of low-level 830-nm gallium arsenide aluminum (Ga-As-Al) laser therapy. The study group consisted of 64 MPS patients. The patients were randomly assigned into two groups. In group 1 (n = 32), Ga-As-Al laser treatment was applied over three trigger points bilaterally for 2 min over each point once a day for 15 days during a period of 3 weeks. In group 2 (n = 32), the same treatment protocol was given, but the laser instrument was switched off during applications. All patients in both groups performed daily isometric exercise and stretching exercises for cervical region. Parameters were measured at baseline and after 4 weeks. All patients were evaluated with respect to pain (at rest, movement, and night) and assessed by visual analog scale, measurement of active range of motion using an inclinometer and a goniometer, and the neck disability index. In both groups, statistically significant improvements were detected in all outcome measures compared with baseline (p < 0.05). However, no significant differences were obtained between the two groups (p > 0.05). In conclusion, although the laser therapy has no superiority over placebo groups in this study, we cannot exclude the possibility of effectivity with another treatment regimen including different laser wavelengths and dosages (different intensity and density and/or treatment interval).

The innervation of patella: anatomical and clinical study.

As much interest has been focused on afferent innervation of knee than that of patella, there are few articles about patellar innervation. But in clinical practice anterior knee pain due to patellar disorders is a quite frequent problem. Our aim was to review the innervation pattern of patella and to give the topographic anatomy of the nerves. We dissected 30 knees of 15 formaldehyde-fixed cadavers. Two nerves from vastus medialis and lateralis were found to reach patellar edge. Apart from these, we were unable to find any other neural structures around patellae. Mean distances between the tuberosity of the tibia and medial and lateral nerve entry points were 90.1(range 74-102) and 96.3 mm (range 76-109), respectively. The angles between lines which join the entry points of nerves and vertical line to the center point of patella were measured in frontal plane. It was approximately 60 degrees medially and 40 degrees laterally. To confirm that these nerves are patellar pain afferents, we performed a local anesthesia test in 32 knees of 20 patients with patellofemoral pain. Clinically, there was a significant difference between the visual analogue scale (VAS) scores before and after local anesthetic injections (p<0.01). Previous studies have emphasized especially the medial innervation. We found that both superomedial and superolateral nerves were important for patellar innervation. We described precisely the entry points of these nerves to patella for selective denervation.

Doppler echocardiographic evaluation of ventricular function in patients with rheumatoid arthritis.

Cardiac involvement in rheumatoid arthritis (RA) has been reported previously. However, evaluation of ventricular function in this disease by the use of recently proposed Doppler echocardiographic methods has not been reported before. Thus, the aim of this study was to evaluate ventricular function by measurement of myocardial performance index (MPI) and transmitral flow propagation velocity (TFPV). Thirty-two patients with long-standing RA and 32 control subjects (mean ages 52 +/- 11 and 50 +/- 10 years, respectively) participated in this study. Systolic function was assessed by subjective evaluation of wall motion for both ventricles and by fractional shortening for the left ventricle (LV). LV diastolic function was evaluated by standard pulsed-wave Doppler echocardiography, MPI and TFPV. Right ventricular (RV) function was evaluated by MPI. No subject had signs or symptoms of clinically overt heart failure. Systolic function was normal in all subjects. Among the echocardiographic indices of LV diastolic function the peak E velocity, E velocity/A velocity ratio, isovolumetric relaxation time, MPI and TFPV in the RA group were significantly different from those of the controls ( P < 0.05). However, we did not observe a significant difference in RV echocardiographic indices between the two groups. Our results show that there is LV diastolic dysfunction in patients with long-standing RA. The lack of a history of cardiotoxic antirheumatic drug use among our patients suggests that this abnormality is due to RA itself.

Aortic valve aneurysm: a novel cardiac manifestation of rheumatoid arthritis?

This report describes a 51-year-old man with rheumatoid arthritis, coronary artery disease, left ventricular failure, and saccular aneurysm of the left coronary cusp of the aortic valve. Rheumatoid arthritis can involve the heart in several ways; however, aortic valve aneurysm in rheumatoid arthritis has not been reported before. Absence of vegetation, lack of a history of infective endocarditis, and the preservation of aortic valve function suggested that this saccular aneurysm was not a result of infective endocarditis. An intimal flap, which strongly suggests aortic dissection, was not observed. To our knowledge, this may be a novel cardiac manifestation of rheumatoid arthritis, and this is the first published report.

Do undereducated patients read and understand written education materials? A pilot study in Isparta, Turkey.

OBJECTIVES: The aim of our study is to evaluate the effect of written information in improving the knowledge of the undereducated nonsteroidal anti-inflammatory drug (NSAID) users about the side effects of NSAIDs and to investigate the compliance of patients with the written information materials. METHODS: Thirty patients received only verbal information, 38 patients received only written, and 40 patients received both verbal and written information. After seven or ten days a questionnaire was administered to the patients on the phone to assess the patients' knowledge. RESULTS: Sixty one (78.2%) patients read the leaflets. Higher number of correct answers was obtained with both verbal and written information. Written information better informed than verbal information alone (p=0.02). CONCLUSION: We conclude that the undereducated patients will read and understand written education materials especially when the materials are written simple and short.

Hormonal responses to exercise stress test in patients with fibromyalgia syndrome.

Twenty patients with fibromyalgia syndrome (FMS) and 20 matched healthy controls were subjected to an exercise stress test above their anaerobic threshold. Serum samples for the measurement of growth hormone (GH), insulin-like growth factor-1 (IGF-1), prolactin (PRL), adrenocorticotrophic hormone (ACTH) and cortisol were taken prior to and after the test at 30-min intervals. Compared to the controls, the patients with FMS displayed significantly lower basal GH levels and slightly, though significantly, higher prolactin levels. Following the exercise test there was a significant increase in the mean GH level in the patient group (P = 0.0474) and a significant decrease in the control group (P = 0.0286) 1 hour after the exercise. A slight decrease in ACTH levels in the control group was observed (P = 0.0002), but there was no significant change in FMS patients. Cortisol levels were significantly lower in both groups after the exercise (P = 0.0001). These results suggest the possibility of a perturbation in hormonal response to exercise in patients with FMS.