Investigation of health literacy level and its effect on quality of life in patients with spinal cord injury.

OBJECTIVES: To determine the health literacy (HL) level in patients with traumatic spinal cord injury (SCI) and evaluate the relationship between HL and the quality of life (QoL). STUDY DESIGN: Cross-sectional study. SETTING: Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Turkey. PARTICIPANTS: A total of 77 patients with traumatic SCI aged 15-65 years where the trauma had occurred at least a month ago before data collection and who were attending the rehabilitation program at the hospital as inpatients we included in the study. OUTCOME MEASURES: The European Health Literacy Questionnaire Turkish Adaptation (HLS-TR) was used for the evaluation of the HL level, and the Short Form-36 was used for the evaluation of the QoL. RESULTS: The HL level was inadequate in 32.5%, problematic-limited in 40.3%, sufficient in 19.5%, and excellent in 7.8% of the patients. The vitality and mental health subdimensions of the QoL were found to be statistically significantly better in participants with excellent, sufficient or problematic-limited HL compared to those with an inadequate level. CONCLUSIONS: According to our results, the HL level of the majority of patients with SCI who are hospitalized in our hospital is low, and there is a relationship between HL and QoL. In conclusion, steps need to be taken to increase the HL levels of patients to improve their QoL, taking into account the important effect of HL on the QoL.

Investigation of Sexual Function in Men with Spinal Cord Injury in a Rehabilitation Hospital in Turkey.

Background: Sexual function is one of the most important functions for males with spinal cord (SC) injuries, and there are wide ranges and conflicting results about sexual dysfunction and the frequency of education of these patients. Objectives: The aim of our retrospective study is to evaluate sexual function and to determine the level of sexual education provided by medical professionals in males with SC injury. Patients and Methods: Eighty-one inpatient males with SC injury were included in the study. "International Index of Erectile Function" and "International Spinal Cord Injury Male Sexual Function Basic Data Set" were used to evaluate sexual function. Results: The median age of the patients was 31 years old (range 20-63), and the median disease duration was 190 days (range 30-5475). Of 81 patients, 55.6% had C1-T10, 33.3% had T11-L2, and 11.1% had L3 and lower injury. Of the patients, 90.1% were never informed about the impact of SC injury on sexual function. The rates of normal psychogenic and reflex erection were 16 and 18.5%, respectively. Erectile dysfunction was severe in 66.7% and moderate in 16% of patients. Only 4.9% of patients had normal ejaculation and 7.4% had normal orgasmic function. Sexual desire was very high or high in 49.4% and moderate in 32.1%. Overall, sexual satisfaction was high or moderate in only 6.2% of patients. Conclusion: Sexual education rates of male SC injured persons are very low. Although most of the patients have normal sexual desire, erection, ejaculation, orgasmic function, and sexual satisfaction are severely damaged.

The inter-rater reliability of the Turkish version of Aphasia Rapid Test for stroke.

BACKGROUND: The Aphasia Rapid Test (ART) is a short bedside aphasia screening test developed originally in French for use with post-stroke patients in the acute phase of recovery. OBJECTIVES: The purpose of this study was to assess the inter-rater reliability of the Turkish version of the ART in stroke patients (ICTRP ID: NCT04386837). METHODS: The French ART was translated into Turkish. Inter-rater reliability was assessed in 30 post-stroke patients with aphasia by two independent speech-language pathologists blind to each other's ratings. RESULTS: 30 patients (18 men, 12 women; mean age 64.43 ± 16.60 years) were included within 10 days of stroke onset, as assessed by clinical examination and confirmed by CT and/or MRI. The mean (± SD) ART value was 16.26 (± 8.05) for rater 1 and 16.43 (±8.14) for rater 2. The inter-rater concordance coefficient was 0.997 (95% CI 0.994-0.999; p < .001). CONCLUSIONS: Findings indicate that the Turkish version of the original ART was successfully administered in Turkish-speaking patients.

Assessment of nocturnal polyuria in patients with spinal cord injury at three different mobilization phases: A multicenter cross-sectional study.

OBJECTIVE: To determine the prevalence of nocturnal polyuria (NP) in patients with spinal cord injury (SCI) during three different particular phases, and investigate the impact of injury level and injury type on the prevalence of NP. DESIGN: A cross-sectional study. SETTING: Neurogenic Bladder Study Group from six different rehabilitation centers across the country. PARTICIPANTS: 40 patients with SCI. OUTCOME MEASURES: Patients were divided into three groups according to mobilization phase; 1st group included patients confined to bed (n = 14), 2nd group included patients sitting on a wheelchair (n = 19) and 3rd group included patients standing with an assistive ambulation device (n = 7). NP was assessed by nocturnal polyuria index (NPi) and nocturnal urine production (NUP) indexes. RESULTS: No significant difference was found between the groups (P = 0.312 for NPi and P = 0.763 for NUP) in terms of the presence of NP according to their mobilization phase. The night and 24-hour urine volumes showed no significant difference between the groups (P = 0.907 and P = 0.395 respectively). The NPi and NUP values did not show a significant difference between male and female patients (P = 0.826, P = 0.364 respectively), patients with the injury level of ≥T6 and

Recurrent priapism in spinal cord injury: A case report.

Context: Recurrent priapism is characterized by repetitive episodes of erections which are unrelated to sexual interest or stimulation. It is extremely rare in patients with spinal cord injury (SCI). There are a number of conservative agents used in the treatment.Findings: We describe the case of a 20-year-old male with cervical-5 American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade A tetraplegia as a result of a diving accident 2 years ago. He declared that the recurrent penile erections occurred up to 15-20 times day and night every day and lasted up to 20 min each time unrelated to sexual interest or stimulation. He was prescribed baclofen 10 mg, twice daily. The frequency and duration of erections decreased to 3-5 times/day lasting for about 5 min each and the patient reported a high treatment satisfaction.Conclusion: The presentation of this case is to remind clinicians this rare but distressing condition of recurrent priapism seen in men with complete spinal cord lesions and to summarize the use of medications, most commonly baclofen, to alleviate the condition.

Post-stroke lower urinary system dysfunction and its relation with functional and mental status: a multicenter cross-sectional study.

BACKGROUND: Review of the literature clearly reveals that little is known about the association between functional and mental status, and Lower Urinary Tract Dysfunction (LUTD) in patients with stroke. OBJECTIVE: The aim of this study was to assess functional and mental status in stroke patients and to identify possible associations with the prevalence, severity and bother of LUTD. MATERIAL AND METHODS: This study was designed as a cross-sectional study and included 260 stroke patients enrolled from six different hospitals in Turkey. The patients were questioned using the Danish Prostatic Symptom Score (DAN-PSS) Questionnaire to evaluate LUTD, and evaluated using the Modified Barthel Index (MBI), Incontinence Quality of Life Questionnaire (I-QoL), and the Mini Mental State Examination (MMSE). RESULTS: At least one LUTD finding was reported in 243 (93.5%) patients; the most commonly encountered complaint in these patients was nocturia (75.8%). The mean MBI, MMSE, and I-QoL scores were found to be significantly lower in LUTD (+) patients compared to LUTD (-) patients (p = 0.000, p = 0.005, and p < 0.01, respectively). Similarly all parameters (MBI, MMSE, and I-QoL scores) assessed were found to be significantly lower for patients with urinary incontinence than those without incontinence (p = 0.000, p = 0.000, and p < 0.01, respectively). CONCLUSION: LUTD is a common problem in patients with stroke. LUTD is associated with poorer cognitive and functional status and the quality of life in these patients. We, therefore, suggest that bladder dysfunction should not be overlooked during rehabilitation of stroke patients.

The course of post-stroke bladder problems and their relation with functional and mental status and quality of life: A six-month, prospective, multicenter study.

OBJECTIVES: The aim of this study was to evaluate the frequency and course of post-stroke lower urinary tract dysfunction (LUTD) from early term up to a period of six months and to investigate the relation of LUTD with functional and mental status and quality of life (QoL) in stroke patients. PATIENTS AND METHODS: This prospective study included a total of 70 stroke patients (44 males, 26 females; mean age 62.7±7.0 years; range, 46 to 79 years) from five different centers across Turkey between June 2015 and January 2017. The patients were questioned using the Danish Prostatic Symptom Score (DAN-PSS) to evaluate LUTD and evaluated using the Modified Barthel Index (MBI), Incontinence QoL Questionnaire (I-QOL), and Mini-Mental State Examination (MMSE) at one, three, and six months. RESULTS: At least one symptom of LUTD was observed in 64 (91.4%), 58 (82.9%), and 56 (80%) of the patients according to the DAN-PSS at one, three, and six months, respectively. A statistically significant improvement was found in the DAN-PSS, MBI, MMSE, I-QOL total scores, avoidance and psychosocial subgroup scores at six months compared to the first month scores (p<0.05). There was a significant negative correlation between the DAN-PSS symptom score at one month and the MBI, MMSE, and QoL scores at six months. The DAN-PSS bother and total scores were found to be significantly and negatively correlated only with the subscales of the QoL questionnaire. CONCLUSION: Based on our study results, LUTD was very common and the prevalence of LUTD findings decreased constantly during six-month follow-up, showing an association with a poor cognitive and functional status and QoL in stroke patients with LUTD.

The regularity of orthosis use and the reasons for disuse in stroke patients.

This is a Retrospective descriptive study. Orthoses and walking aids are used frequently in stroke rehabilitation to facilitate ambulation. The aim was to describe the regularity of orthosis use and the reasons for disuse in stroke after discharge from inpatient rehabilitation. The study included 64 (43 men, 21 women) subacute stroke patients who had been discharged from our clinic in the last 6 months. Demographic and clinical findings, proposed orthoses and walking aids, frequency of usage for the proposed orthoses, reasons for disuse, and the ambulation levels were recorded. A total of 54 (84.4%) patients had an ankle-foot orthosis and 10 (15.6%) patients had a knee-ankle-foot orthosis. The orthosis frequency of use was every day in 38 (59.4%) patients and one to seven times a week in seven (10.9%) patients, whereas 19 (29.7%) did not use them. The reasons for orthosis disuse were finding them unnecessary in seven (27%) patients, usage difficulties in six (23%) patients, pressure sensation in five (19.2%) patients, the belief that they did not make life easier in five (19.2%) patients, lack of a suitable environment in one (3.8%) patient, orthosis wear in one (3.8%) patient, and systemic disease in one (3.8%) patient. Age, sex, residence, the disease duration, and recommended orthosis duration (how long the prescribed orthosis was used), recommended orthosis, range of motion limitation in the lower extremities, presence of spasticity, type of orthosis, and the ambulation level were not statistically significantly associated with the frequency of orthosis use (P>0.05). The only significant clinical factor for the frequency of orthosis use was the lower extremity Brunnstrom neurophysiological recovery stage (P<0.008). Orthosis use had been discontinued by 29% of the patients. The most common reasons reported for discontinuing orthosis use were that the patients found it unnecessary, usage difficulty, pressure sensation, not making life easier, lack of a suitable environment, and orthosis wear. The only significant clinical factor for the frequency of orthosis use was the lower extremity Brunnstrom neurophysiological recovery stage.

Demographic and clinical characteristics of persons with spinal cord injury in Turkey: One-year experience of a primary referral rehabilitation center.

OBJECTIVE: To define the demographic and clinical characteristics of persons with spinal cord injury, rehabilitated in a primary referral rehabilitation center in Turkey. DESIGN: Retrospective study. SETTING: Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey. METHODS: Medical records of all patients with spinal cord injury (acute-subacute-chronic) at a single academic referral center over the course of one year were reviewed. Variables of each patient were recorded, including: age, sex, etiology, length of rehabilitation stay, neurological level of injury, level of neurological impairment and severity of injury. RESULTS: Among 262 persons with spinal cord injury, 69.8% were male (male:female ratio is 2.31 : 1). Mean age was 38.3 ± 17.6 years. Falls were the most common cause of injury. The majority of falls were falls from a height (93.3%). More than 20% of falls from a height were related to occupational injury. The most common neurological level of injury was L1. Of all persons 46.2% had thoracic, 27.5% had lumbar and 26.3% had cervical lesions. The mean length of rehabilitation stay was 52.1 ± 25.5 days. Persons with motor complete injury and with a shorter (<12 months) time since injury had longer length of rehabilitation stay. CONCLUSION: The mean age of SCI population is increasing. Falls constitute the majority of etiologic factors and are more common in persons >60 years old. More than 20% of falls from a height are related to occupational injury. Male-female ratio is decreasing. Thoraco-lumbar injures are more common than cervical injuries.

The effects of the number of physical therapy sessions on pain, disability,and quality of life in patients with chronic low back pain

Background/aim: The aim of this study was to investigate and compare the effect of different physical therapy (PT) session numbers on pain, impairment. and quality of life in patients with chronic low back pain (LBP).Materials and methods: In this prospective, randomized-controlled, single-blind trial, a total of 60 patients with chronic LBP were divided into 2 groups with simple randomization within the scope of the study. A PT program of a total of 10 sessions was applied for patients in Group 10 (n = 30) and a total of 15 sessions for patients in Group 15 (n = 30). The main outcome measures were fingertip-to-floor distance (FFD), a visual analog scale (VAS), the modified Oswestry Disability Index (mODI), and the Nottingham Health Profile (NHP).Results: We found statistically significant differences in both groups between the before-treatment (BT) and after-treatment (AT) results in terms of all evaluation parameters. We detected significant differences between the 2 groups in terms of AT VAS, mODI, NHP Pain, and NHP Total; however, no significant differences were found in terms of FFD and the other NHP subdimension levels.Conclusion: We determined that 15 treatment sessions were more effective than 10 sessions on pain and disability in patients with chronic LBP.

Sleep disordered breathing in children with cerebral palsy.

OBJECTIVES: The purpose of this study was to investigate the frequency of Sleep Disordered Breathing (SDB) in children with Cerebral Palsy (CP), and determine whether a relationship between SDB and age, gender, weight status, type of CP, motor function level, and spasticity can be established. METHODS: The study included 94 children with CP and 94 healthy children with normal development, between the ages two and 18. SDB was assessed using the Sleep-Related Breathing Disorder (SRBD) scale of the Pediatric Sleep Questionnaire (PSQ). RESULTS: No statistically significant difference was found with respect to age and gender between the study and the control groups. It was found that 9.6% of the patients with CP had snoring, 12.8% had sleepiness, 37.2% had attention deficiency-hyperactivity, and 18.1% had SRBD. SRBD was statistically significantly higher in patients with CP compared with the control group. No significant relationship was detected between SRBD and age, gender, weight status, type of CP, motor function level, spasticity, and epilepsy. CONCLUSIONS: Our result confirm that SDB is more common in children with CP than typically developing children. Thus, SDB problems should be identified in routine clinical practice in patients with CP, by using the SRBD scale of the PSQ.

Blood mean platelet volume and platelet lymphocyte ratio as new predictors of hip osteoarthritis severity.

Osteoarthritis (OA) is a low grade systemic inflammatory disease in which many inflammatory mediators are known to be elevated in the peripheric blood. Blood platelet lymphocyte ratio (PLR) and mean platelet volume (MPV) are accepted as novel markers in many of the systemic inflammatory disorders, but have not been investigated in synovitis-free radiographic OA yet.The aim of this study was to evaluate the levels of blood PLR and MPV in radiographic hip OA. A total of 880 patients were evaluated retrospectively and after certain exclusion criteria, 237 of them who have primary hip OA were included. Age, sex, height, weight, body mass index, neutrophil, lymphocyte and platelet counts, erythrocyte sedimentation rate (ESR), PLR, and MPV levels were recorded, Kellgren-Lawrence (KL) grading of the hip joints were performed. Patients were then divided into 2 groups as KL grades 1 to 2 (mild-moderate) and KL grades 3 to 4 (severe) hip OA.Mean age, mean neutrophil, lymphocyte and platelet counts, mean MPV, mean PLR, and mean ESR were statistically significantly different between mild/moderate hip OA group and severe hip OA group. In univariate analysis, older age and higher MPV, PLR, and ESR were severely associated with severe hip OA. In multiple logistic regression analysis, MPV, PLR, and ESR emerged as independent predictors of severe hip OA.The results of the present study, for the first time in the literature, suggest blood PLR and MPV as novel inflammatory markers predicting the radiographic severity of hip OA in the daily practice.

Monitoring development of autonomic dysreflexia during urodynamic investigation in patients with spinal cord injury.

OBJECTIVES: We aimed to investigate whether autonomic dysreflexia (AD) develops during urodynamic investigation in patients with spinal cord injury (SCI) with neurological level below thoracic (T) 6 together with the frequency and related factors for AD development. STUDY DESIGN: Prospective study. METHODS: The systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) of 51 SCI patients with a neurological level below T6 were measured and recorded at the beginning and every two minutes during the filling phase of the urodynamic study. The changes between the SBP, DBP and HR values at the beginning and end of the filling phase were analyzed. RESULTS: Autonomic dysreflexia developed only in one of the 51 patients included into the study. The BP of this patient increased from 105/76 mmHg to 145/102 mmHg and the HR dropped from 88 beats/minute (bpm) to 69 bpm together with development of the AD symptoms. The patient was a 47-year-old male with a neurological level at T8. A significant difference was found between the mean SBP and the mean DBP values at the beginning and end of the filling phase. CONCLUSIONS: Although rare, AD can be seen during urodynamic investigation in patients with a neurological level below T6, especially when close to the T6 level. Therefore, we suggest that the patients with a neurological level below T6 and especially closer to T6 level should be followed-up in terms of development of AD. The clinicians should take into account the HR values in addition to the the SBP and DBP values at follow-ups.

The analysis of serum lipid levels in patients with spinal cord injury.

STUDY DESIGN: Retrospective study. OBJECTIVES: The purposes of this investigation were to evaluate the serum lipid profile among a broad sample of patients with spinal cord injury (SCI), examining the impact of disease duration, lesion level, lesion grade and functional activity level on serum lipid levels of patients with SCI. SETTING: Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Turkey. METHODS: Serum lipid profiles of 269 participants with SCI were analyzed and correlated to disease duration, lesion level, lesion grade and ambulation status. RESULTS: Total cholesterol (TC) was higher than normal in 21.2%, low density lipoprotein cholesterol in 24.4%, and triglycerides levels in 31% of the patients. The high density lipoprotein cholesterol (HDL-c) level was found to be lower than 40 mg/dl in 79.5% of the patients, TC/HDL-c ratio was 4.5 and above in 65.7% of the patients in our study. TC/HDL-c ratio was significantly higher in patients with SCI with a disease duration of 0-12 months than the group with a longer disease duration (P = 0.009). TC/HDL-c ratio was significantly higher in patients who could not be community ambulated than the patients who were community ambulated (P = 0.005). HDL-c levels in patients with motor complete SCI were significantly lower than patients with motor incomplete SCI (P = 0.028). CONCLUSION: Dyslipidemia is observed in a large number of patients with SCI. The risk of dyslipidemia was seen to have increased in motor complete SCI patients, in patients who can not be community ambulated and whose disease duration is between 0 to 12 months.

Speech and language therapy for aphasia following subacute stroke.

The aim of this study was to investigate the time window, duration and intensity of optimal speech and language therapy applied to aphasic patients with subacute stroke in our hospital. The study consisted of 33 patients being hospitalized for stroke rehabilitation in our hospital with first stroke but without previous history of speech and language therapy. Sixteen sessions of impairment-based speech and language therapy were applied to the patients, 30-60 minutes per day, 2 days a week, for 8 successive weeks. Aphasia assessment in stroke patients was performed with Gülhane Aphasia Test-2 before and after treatment. Compared with before treatment, fluency of speech, listening comprehension, reading comprehension, oral motor evaluation, automatic speech, repetition and naming were improved after treatment. This suggests that 16 seesions of speech and language therapy, 30-60 minutes per day, 2 days a week, for 8 successive weeks, are effective in the treatment of aphasic patients with subacute stroke.

The effectiveness of balneotherapy in chronic neck pain.

The aim of this study was to investigate the effectiveness of balneotherapy (BT), which is applied in addition to physical therapy (PT), in the treatment of chronic neck pain. Sixty patients with chronic neck pain were divided into study (n = 30) and control (n = 30) groups. All of the patients in both groups were treated with a 15-session standard PT program consisting of hot pack, ultrasound, and transcutaneous electrical stimulation. Patients in the study group were also treated with a 15-session BT program lasting 20 min/day in addition to the standard PT program. Visual analogue scale (VAS), modified neck disability index (mNDI), and Nottingham Health Profile (NHP) scores of all patients were evaluated at three different times as pretreatment, posttreatment, and posttreatment third week. There was no statistically significant difference between the clinical and demographic characteristics of the patients in different groups before treatment. Intragroup analysis revealed significant improvement in all parameters for both of the groups at all time intervals. Intergroup analysis uncovered the superiority of the study group. According to the results of this study, BT in combination with PT is superior to PT alone in reducing pain and disability and improving quality of life in patients with chronic neck pain.

Coexistence of Deep Vein Thrombosis, Heterotopic Ossification, and Complex Regional Pain Syndrome due to Hemorrhagic Stroke.

CASE: A patient who developed hemiplegia related to a hemorrhagic stroke and who had not been started on venous thromboembolism prophylaxis or a physical medicine and rehabilitation program was admitted to our clinic on the 4th month after the event. Our patient had pain, swelling, redness, increased temperature at the right lower extremity, range of motion limitation at the hip and knee, deep vein thrombosis (DVT) and complex regional pain syndrome (CRPS) at the same side lower extremity, and heterotopic ossification (HO) at the hip. CONCLUSIONS: Our case is presented to emphasize the HO that is not frequently seen after stroke, the importance of DVT prophylaxis in hemorrhagic stroke, and the association between DVT, HO, and CRPS.

Shifting to 4 × 1 intermittent catheterization without an early follow-up urodynamic study is possible in most patients with subacute spinal cord injury.

OBJECTIVES: We retrospectively evaluated the frequency of changing to 4/day intermittent catheterization (IC) in patients with subacute spinal cord injury (SCI) who had been initiated on IC 6 times a day and started oral anticholinergic treatment following urodynamic investigation for decreased maximum cystometric capacity and undergone a follow-up urodynamic study within 45 days. The goal of the study was to see if the second urodynamic study was necessary. METHODS: The frequency of shifting to 4/day IC was investigated retrospectively in 27 patients with subacute SCI who were prescribed 6/day IC. RESULTS: In 25 of 27 patients a bladder capacity of 400 ml or more was reached in urodynamic study carried out in the following 45 days and the patients were shifted to 4/day IC. There was a significant difference between the anticholinergic pre-treatment (293 ± 39 ml) and post-treatment (531 ± 81 ml) capacities (P < 0.001). The mean increase in bladder capacity in all patients was 237.6 ± 79.5 ml (83.5 ± 32.1%). CONCLUSION: Patients with subacute SCI who were prescribed 6/day IC and were given an oral anticholinergic drug can be shifted to 4/day IC after 45 days without performing an early control urodynamic study if the patients use the drug properly. However in the long-run, periodic follow-up urodynamic studies should be carried out at appropriate intervals, according to the patients' clinical findings.

The effectiveness of functional electrical stimulation for the treatment of shoulder subluxation and shoulder pain in hemiplegic patients: A randomized controlled trial.

PURPOSE: To investigate the effect of functional electrical stimulation (FES) for the treatment of shoulder subluxation and shoulder pain in hemiplegic patients. METHOD: A total of 50 hemiplegic patients with shoulder subluxation and shoulder pain were included in the study. The patients were randomly divided into the study and control groups. All patients were put on a rehabilitation program using conventional methods while the study group patients were additionally applied FES to supraspinatus and posterior deltoid muscles. The shoulder pain of all patients during resting, passive range of motion (PROM) and active range of motion (AROM) was measured with the visual analog scale (VAS) while the shoulder subluxation levels were evaluated with the classification developed by Van Langenberghe and by using the millimetric measurements on anteroposterior shoulder X-ray before and after the physical treatment and rehabilitation program and compared. RESULTS: Comparison of the resting AROM vs. PROM VAS value changes showed no significant difference between the groups. There was a significant difference between the two groups for the amount of change in shoulder subluxation in favor of the study group. CONCLUSIONS: The results of our study have shown that applying FES treatment to the supraspinatus and posterior deltoid muscles in addition to conventional treatment when treating the subluxation in hemiplegic patients is more beneficial than conventional treatment by itself.