Reliability of the Modified Ashworth Scale and Modified Tardieu Scale in patients with spinal cord injuries.

STUDY DESIGN: Psychometrics study. OBJECTIVES: To assess the reliability of the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) in patients with spinal cord injuries (SCIs). SETTING: Inpatient rehabilitation clinics at two state hospitals. METHODS: The study included 65 participants aged between 18 and 88 years with SCI with spasticity. All participants were at least 6 months after injury and had an American Spinal Injury Association Impairment Scale grade of A-D. The MAS and MTS scores were collected from the right hip adductor and hip extensor muscles, right knee extensor and knee flexor muscles and right plantar flexor muscles. Each participant was assessed twice by two experienced physiatrists 1 week apart. The raters were blinded to each other's scores. RESULTS: Inter-rater and test-retest agreement for the MAS scores (κ=0.531-0.774) was moderate to substantial. Inter-rater and test-retest agreement for the MTS X scores (κ=0.692-0.917) was substantial to almost perfect. Inter-rater reliability and test-retest reliability of the MTS R2-R1 was excellent (intra-class correlation coefficient (ICC) 0.874-0.973, confidence interval (CI): 0.79-0.98) for all muscles tested. Inter-rater reliability of the MTS R2 for the hip adductor and knee extensor muscles was poor (ICC 0.248, CI: -0.00 to 0.47 and ICC 0.094, CI: -0.16 to 0.34, respectively). The test-retest reliability of the MTS R2 was also poor for the knee extensor muscles (ICC 0.318, CI: -0.06 to 0.53). CONCLUSION: MAS has adequate reliability for determining lower-extremity spasticity in patients with SCI. The demonstration of excellent inter-rater reliability and test-retest reliability of the MTS R2-R1 suggests its utility as a complementary tool for informing treatment decisions in patients with SCI.

Sacroiliitis or insufficiency fracture?

Sacral stress fracture and sacroiliitis are two conditions that present with pain. Sacral stress fractures are a rare cause of lumbar and hip pain. Sacral insufficiency fractures are a type of sacral stress fractures. Sacroiliitis represents inflammation of the sacroiliac joints. Coexistence of sacroiliitis and sacral insufficiency fracture (SIF) has not been reported before. Case 1: A 39-year-old woman reporting inflammatory back pain. Imaging revealed bilateral chronic sacroiliitis and bilateral SIF. Case 2: A 31-year-old woman presenting with left hip and inguinal pain. Imaging revealed left sacroiliitis and ipsilateral SIF. Calcium and vitamin D supplementation together with nonsteroidal anti-inflammatory drug (NSAID) treatment were given. Sulfasalazine was added to the treatment of the second patient who developed peripheral arthritis during follow-ups. Early diagnosis is best made with magnetic resonance imaging (MRI) since roentgenograms may be negative initially. Furthermore, MRI findings of both entities share common features leading to a diagnostic dilemma. Interpretation of radiological findings assisted by detailed history and clinical findings is crucial for diagnosis and treatment.

What do patients really know about cardiopulmonary rehabilitation: a cross-sectional survey study.

BACKGROUND: Although it is known that cardiopulmonary rehabilitation (CPR) reduces mortality and morbidity, it is not widely implemented as is in Turkey. One factor might be lack of demand since the levels of knowledge and awareness among patients who are eligible for CPR seem to be insufficient. AIM: It is aimed to investigate the level of awareness and knowledge of CPR among patients with cardiopulmonary problems. DESIGN: Cross-sectional survey study. SETTING: Outpatient. METHODS: Knowledge regarding CPR was assessed by questionnaires given to 690 patients recruited in seven university hospitals and six training and research hospitals in which either comprehensive or limited CPR services are available. POPULATION: Patients who have cardiopulmonary problems RESULTS: Of the patients, 34.7% were given information on CPR by healthcare staff, and 25.3% reported that their source of information was physicians. Although 49.9% of the patients knew that they needed to exercise for their cardiac/pulmonary problems, only 23.4% and 32.1% of those were aware that fast walking and climbing stairs, respectively, would not pose a risk to their cardiac/pulmonary health. The majority of the patients believed that activities of daily living, which comprise the most important component of exercise-based CPR, were harmful for their cardiopulmonary health. We found that 31.1% of the patients exercised regularly. During their stay at the hospital, certain kinds of exercises were suggested to 62.7% of the patients, and 34.7% of these patients performed various exercises. Of the patients who were given detailed information on cardiopulmonary rehabilitation, 69% stated that they would be willing to participate in a similar program. CONCLUSION: Although nearly half of the patients stated that they needed CR, it was observed that the ratio of patients who had true knowledge of CPR was low among patients. It is imperative to furnish patients with information on CPR, both in the field of PMR and throughout Turkey, and to put more effort into running those services effectively. Furthermore, we should make an effort to increase the level of liaison between patients and physicians and other healthcare professionals who participate in the treatment of cardiac/pulmonary patients.

The effect of cardiac rehabilitation on quality of life, anxiety and depression in patients with congestive heart failure. A randomized controlled trial, short-term results.

AIM: One of the major treatment goals in congestive heart failure (CHF) is to preserve the functional level of the patient and to improve psychosocial factors. For these purposes, exercise training is recommended for the management of CHF. With this background, the aim of this study is to investigate the effects of aerobic exercise on quality of life, depression and anxiety levels in a Turkish patient population with CHF. METHODS: Sixty patients with CHF in stage II-III according to NYHA were included. Patients were randomly assigned either to a cardiac rehabilitation group or to a control group. Twenty-seven patients were allocated to a weekly aerobic walking program on treadmill, thrice a week for 8 weeks, and 26 patients did not receive any exercise training. Both groups were assessed by an ergospirometric exercise test, Hacettepe Quality of Life Questionnaire (HQoL), Beck Depression Inventory (BDI), Spielberger Trait Anxiety Inventory (STAI) at baseline and at the end. RESULTS: Forty-four patients (treatment group: 23) completed the study. In the treatment group, significant increases in peak oxygen consumption, exercise time and metabolic equivalents (MET) levels were attained (P=0.001, P=0.001, P=0.003, respectively). Significant decreases in BDI (P=0.004) and STAI subgroups (P=0.049, P=0.023, respectively) were observed, whereas there was no change in HQoL scores. In the control group, there was no difference between baseline and 8th week evaluation in all parameters. CONCLUSIONS: Patients with CHF tolerated aerobic exercise programs well. This resulted with improvement in both physical and psychologic wellbeing, but not in quality of life in the short term.