Coexistence of fibromyalgia and post-polio syndrome in persons with prior poliomyelitis in Turkey: the relations with symptoms, polio-related impairments, and quality of life.

PURPOSE: To investigate the prevalence of fibromyalgia(FM) and to show its relations with symptoms, polio-related impairments (PRI), and quality of life (QoL) in persons with prior paralytic poliomyelitis (PsPP) with and without post-polio syndrome (PPS). MATERIALS AND METHODS: The study included 74 PsPP under 60 years of age, 60 of whom met the criteria for PPS. Presence and severity of FM were assessed by the American College of Rheumatology (ACR) 1990, 2010, and 2016 criteria, and Fibromyalgia Severity Score. PPS symptoms, PRI, and QoL were evaluated using the Self-Reported Impairments in Persons with Late Effects of Polio Rating Scale, Fatigue Severity Scale, and Nottingham Health Profile. Frequency, comparison, and correlation analyses were performed. RESULTS: While 15% of PsPP with PPS met the criteria of ACR 1990, 32% of ACR 2010, and 35% of ACR 2016, none of those without PPS met any of the criteria for FM. Severity of PPS symptoms and PRI were significantly higher, and QoL was significantly lower in those with co-existing FM. FM severity was found to be significantly associated with severity of PPS symptoms, PRI and reduced QoL. CONCLUSIONS: FM frequently coexists in PsPP with PPS and may increase the burden of PPS.Implications for RehabilitationFibromyalgia (FM) is commonly seen in patients with post-polio syndrome (PPS).Co-existing FM may increase the burden of PPS, as it is associated with more severe symptoms, more polio-related impairments, and worse quality of life.Recognition, appropriate referral, and successful management of co-existing FM may allow for reduced symptoms or symptom severity and improved quality of life in persons with PPS.

Quantitative sensory test findings in cervical radicular pain and their relationship with the symptoms.

OBJECTIVES: This study aims to define and compare sensory phenotypes in cervical radiculopathy patients exhibiting neuropathic pain (NP) components with healthy volunteers using clinical examination and quantitative sensory test (QST) findings. Another aim of the study is to show whether symptomatic components of the pain detect questionnaire (PDQ) are correlated with the QST findings, which may help clinicians indicate patients with sensory abnormalities without the use of specialized tests. METHODS: Fifty-seven participants were included in the study, including patients with NP (n=20) and healthy volunteers (n=37). After obtaining the sociodemographic and clinical data of the participants, the PDQ was performed in patients with pain followed by QST analysis in all participants. RESULTS: Analyses between painful and non-painful extremities yielded no differences in all groups for QST (p>0.05). Sensory thresholds were found to be higher in the NP group compared to healthy volunteers, and the pain threshold test was found to be lower (p<0.05) in the intergroup analyses. The changes described were found in both painful and non-painful limbs. Pain with slight pressure was found to be correlated with the lower heat pain threshold values (R=-0.602, p=0.005). CONCLUSION: Patients with NP were found to have lower thresholds for pain and higher sensory thresholds when compared to healthy volunteers. Moreover, pain with pressure component in PDQ was found to be associated with hyperalgesia in QST.

Relationships of autonomic dysfunction with disease severity and neuropathic pain features in fibromyalgia: is it really a sympathetically maintained neuropathic pain?

Background: The pathophysiology of fibromyalgia (FM) involves many mechanisms including central nervous system sensitization theory, autonomic nervous system (ANS) dysfunction, and recently small fiber neuropathy. While the small fiber neuropathy itself can cause ANS dysfunction and neuropathic pain (NP), it is still unknown whether ANS problems have an association with severity of disease and NP in patients with FM. The aim of this study was to evaluate ANS dysfunction in FM patients and to explore possible associations of ANS dysfunction with disease severity and NP. Methods: Twenty-nine FM patients and 20 healthy controls were included in this cross-sectional study. Participants were tested using sympathetic skin responses (SSR) and R-R interval variation analyses for sympathetic and parasympathetic ANS dysfunction, respectively. Disease severity and somatic symptoms of patients with FM were evaluated using the ACR-2010 scales and Fibromyalgia Impact Questionnaire, and NP symptoms were evaluated using the Pain Detect Questionnaire and Douleur Neuropathique questionnaire. Results: FM patients were found to have ANS dysfunction characterized by increased sympathetic response and decreased parasympathetic response. SSR amplitudes were found to be correlated with a more severe disease. Although non-significant, NP severity tended to be associated with a decrease in sympathetic and parasympathetic activities. Conclusions: ANS dysfunction may play a role in the pathophysiology of FM. The trend of decreased ANS functions in FM patients exhibiting NP contradicts the notion that FM is a sympathetically maintained NP and may be explained with small fiber involvement.

Reflections of the sensory findings in the central nervous system in patients with neuropathic pain.

This study aimed to evaluate whether there was a difference in functional magnetic resonance imaging (fMRI) findings in patients who were found having hyperalgesia or hypoesthesia according to Quantitative Sensory Tests (QST). Forty participants were included in the study: 20 with neuropathic pain (NP) due to cervical disc pathology (NP group) and 20 healthy volunteers. After obtaining the socio-demographic and clinical data of the participants, the painDETECT questionnaire was administered, followed by QST analysis to show the presence of hypoesthesia and/or hyperalgesia, and fMRI examinations, which included sensory stimulation of both extremities. Sensory threshold tests were found to be higher in the NP group compared with the healthy volunteers, and the heat pain threshold was found to be lower in the tests showing pain thresholds in the intergroup analyses (p < 0.05). The changes described were found in both painful and non-painful limbs. In the hypoesthetic NP group, a lower somatosensory cortex activity was found in non-painful limbs compared with the healthy volunteers (p < 0.05). In the unilateral hyperalgesic NP group, a lower somatosensory cortex activity was found on the painful side, and if the hyperalgesia was widespread, lower blood oxygen-level-dependent activity was also found in the operculum and insular cortex (p < 0.05). The patients with different phenotypes of NP had different activities in the areas related to the processing of pain, and were more prominent in patients with widespread hyperalgesia. Studies with larger numbers of patients are required for a definite statement.

Evaluation of an upper limb robotic rehabilitation program on motor functions, quality of life, cognition, and emotional status in patients with stroke: a randomized controlled study.

OBJECTIVE: This study aims to find out whether including robotic therapy in addition to a conventional rehabilitation program affects the quality of life, motor function, cognition, and emotional status of hemiplegic patients. DESIGN: Thirty-seven stroke patients recruited between April 2016 and April 2019 were included in the study. The patients were randomized into 2 groups (Robotic rehabilitation group-RR n:17, Control group n:20), RR was arranged to be 30-45 min, 5 days per week for 4 weeks. All patients were assessed at the beginning of therapy and the end of 4th week with Brunnstrom stages of motor recovery, Fugl-Meyer Assessment (FMA), handgrip strength, Purdue peg test, Minnesota manual dexterity test, Modified Ashworth Scale (MAS), Functional Independence Measure (FIM), Stroke Specific Quality of Life Scale (SS-QOL), Nottingham Extended Activities of Daily Living (NEADL) Scale, Montreal Cognitive Assessment (MoCA) and Center for Epidemiological Studies Depression Scale (CES- D). RESULTS: Improvements in motor function scores, spasticity, general functioning, activities of daily living, cognitive assessment were better in the robotic group when compared to the control group but this difference was not statistically significant (p > 0.05). Improvement in the CES-D in the RR-group was better in comparison to the control group (p = 0.018). CONCLUSION: Improvements in motor functions were observed after the treatment in both groups. Although RR group improved better in numbers, none of the outcomes except the CES-D scale were significant. Robotic rehabilitation provides a favorable alternative bringing slight benefits, and also is advantageous in terms of work power and psychological recovery, making its addition to conventional neurological rehabilitation effective and useful in patient management after stroke. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04393480.

Effects of Yoga on Phase Angle and Quality of Life in Patients with Breast Cancer: A Randomized, Single-Blind, Controlled Trial.

INTRODUCTION: Phase angle (PA), a parameter that is obtained from body composition analysis, is an indicator of cellular health status. A lower PA in cancer patients can lead to a decrease in functional status and quality of life (QoL) and increased mortality. Studies have shown that physical activity increases PA. In this study, we aimed to examine the effects of Hatha yoga on PA, body composition, and QoL in patients with breast cancer. METHODS: Thirty-one patients were randomized into the yoga (group 1, n = 15) and the control group (group 2, n = 16). Hatha yoga was practiced twice a week for 10 weeks in the intervention group. The PA of the patients was assessed using a body analysis instrument, and QoL was evaluated with an EORTC QLQ questionnaire both before treatment and at week 10. RESULTS: Group 1 had significant improvements in the posttreatment EORTC QLQ functional and global scores (p < 0.05). In group 2, a significant improvement was observed in the EORTC QLQ symptom subscale (p = 0.035). PA values did not show any improvements in both groups (p > 0.05). Comparison of the 2 groups revealed no differences. CONCLUSION: Yoga may have beneficial effects on QoL in patients with breast cancer but does not have a significant effect on PA. There is a need for further studies to make a definitive statement.

Efficacy of platelet-rich plasma in the treatment of hemiplegic shoulder pain.

OBJECTIVE: The aim of this study was to examine the effects of platelet-rich plasma (PRP) on pain and functional outcomes in patients with hemiplegic shoulder pain. We compared the effects of PRP against saline solution by designing a double blind, randomized, prospective study. DESIGN: Forty-four patients with hemiplegia were included in this study. All patients received a total of 3 injections, 1 week apart. The first group received PRP injections while the second group received placebo injections. After 3 months of follow-up, 40 patients completed the trial. Primary outcome measure was movement-induced pain score (VAS), and secondary outcome measures were spontaneous pain score, shoulder passive range of motion (ROM), functional independence measure score, and the amount of paracetamol used. All subjects were evaluated at baseline, 1 week, 1 month, and 3 months after the completion of the last injection. RESULTS: Both groups showed an improvement in spontaneous and movement-related pain scores and shoulder passive ROM values on 1st and 3rd month visits (p < 0.05). No significance difference was detected between groups (p > 0.05). Similarly, FIM scores improved significantly in both groups (p < 0.05) but no difference was found between groups. Paracetamol use did not differ significantly between groups. CONCLUSION: The PRP injections were found not to be superior to placebo. Improvements in both groups can be attributed to the use of rehabilitation techniques and exercises in all patients. There is still need for further research to show whether PRP is a treatment option in the course of hemiplegic shoulder pain. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03931824.

Efficacy of platelet-rich plasma injections in patients with adhesive capsulitis of the shoulder.

PURPOSE: The goal of this study is to investigate whether platelet-rich plasma (PRP) injections are effective in the management of adhesive capsulitis of the shoulder (AC). A triple-blind, randomized controlled trial was designed and conducted in a medical school hospital. METHODS: 32 adult patients with adhesive capsulitis (21 female, 11 male with a mean age of 57, ranging from 23 to 70) were included in this study. Patients had to have shoulder pain and restrictions in movements (at least 25% when compared to the other side, and at least in two directions) for three months minimum and nine months maximum. Patients were randomized to two groups, and one group took PRP injections for three times every two weeks, while the other group took saline injections in same frequency and volume. A standardized exercise program was also applied to all patients. Patients were evaluated with Shoulder Pain and Disability Index (SPADI), Visual Analogue Scales for pain and disability, ranges of movements, and use of analgesics in before, after, and third month after the initiation of the therapy. RESULTS: Baseline comparisons between groups showed no differences. SPADI and ranges of motion in all directions showed significant improvements with therapy, and the group which took PRP injections showed better improvements when compared to the control group (p < 0.05). Visual Analogue Scale was found to be better for the PRP group after therapy and third month, and not for the control group (0.4 ± 1.06 and 0.17 ± 0.72 vs. 2.5 ± 2.6 and 2 ± 2.2, respectively, p < 0.05). Use of analgesics was not found to be significant for both groups (p > 0.05). CONCLUSION: PRP injections were found to be effective in both pain and disability, and showed improvements in a restricted shoulder due to adhesive capsulitis. These findings might point out PRP as a therapeutic option in the management of adhesive capsulitis.

Occupational therapy assessment and treatment approach in patients with subacute and chronic stroke: A single-blind, prospective, randomized clinical trial.

OBJECTIVES: The aim of this study was to examine the effects of occupational therapy (OT) combined with standard rehabilitation (SR) on the activities of daily living, quality of life, and psychological symptoms of hemiplegic patients. PATIENTS AND METHODS: Between August 2014 and February 2016, a total of 35 hemiplegic patients with post-diagnostic periods (19 males, 16 females; mean age 58.3 years; range 37 to 77 years) were included. The patients were randomized into two groups as OT+SR group (n=17) and SR only group (n=18). The study was completed by 16 patients in each group. The patients in the OT group were given 45-min SR five days a week plus 45-min OT three days a week over an eight-week period, while the patients in the SR group received SR only (of the same duration and frequency as the OT group). The patients were assessed at enrolment (pre-treatment), and again after eight weeks of treatment using the Pinch and Grip Strength and the Purdue Pegboard tests, Global Daily Living Activities Scale, Performance Assessment of Self-care Skills (PASS), Nottingham Extended Activities of Daily Living (NEADL) Scale, Quality of Life Short Form (SF-36) Questionnaire, and Hospital Anxiety and Depression Scale (HAD) for their psychological state. RESULTS: Significant improvements were observed in within-group scores for PASS, Pinch and Grip Strength Test, NEADL Scale, and Purdue Pegboard test (p<0.05). After treatment, a significant increase was found in the SF-36 physical function, general health and physical total in-group scores of the OT group, whereas a significant increase was observed only in the physical total scores of the SR group (p<0.05). There was no significant improvement in the HAD scores within both groups (p>0.05). Inter-group comparisons revealed a further significant improvement in PASS instrumental daily activity index-physical subscale and Purdue Pegboard Test scores of the OT group (p<0.05). However, there was no significant difference in PASS activity, self-care and instrumental daily activity cognitive subscale, SF-36, HAD and hand grip and pinch strength scores between the groups (p>0.05). CONCLUSION: Occupational therapy combined with SR applications has a beneficial impact on certain daily living activities and hand functions. Occupational therapy does not have any additional benefits on the quality of life, pinch and grip strength, and the psychological state.

Assessment of Muscle Strength and Volume Changes in Patients with Breast Cancer-Related Lymphedema.

INTRODUCTION: To determine whether complete decongestive therapy (CDT) used in breast cancer-related lymphedema affects muscle strength in the affected arm while assessing the efficacy of the therapy itself. MATERIAL AND METHODS: Seventy-four patients with breast cancer-related lymphedema were included in this study. The demographic and clinical history characteristics of the patients were taken. The patients were then evaluated with measurements of extremity volumes and handgrip strengths using a hand dynamometer before and after the CDT. Data were then assessed using relevant statistical methods. RESULTS: The mean CDT duration was 17.5 ± 8.93 days for the patients. Therapy resulted in significant improvement in the affected arm (p < 0.01). The difference between the arm with lymphedema and the other side was statistically significant, and this difference remained after the therapy (p < 0.01). The change in handgrip strength in the side with lymphedema was not found to be statistically significant after therapy (p > 0.05). Handgrip strength differences and volume differences before and after the treatment in the affected arm were not correlated (p > 0.05). CONCLUSION: Limbs affected with lymphedema were found to be weaker in handgrip strength and this weakness continued throughout the therapy. Strengthening exercises should be considered to be added into the treatment of patients undergoing CDT to gain better functional potential.

Evaluation of dysphagia in patients with sarcopenia in a rehabilitation setting: insights from the vicious cycle.

PURPOSE: Nutritional deficits are known to cause sarcopenia. There is also evidence that sarcopenia itself may cause dysphagia, and swallowing problems are among the reasons for patients to have nutritional deficits. This study aims to evaluate the prevalence of nutritional deficits and dysphagia in patients with or without sarcopenia. METHODS: 128 patients residing in a rehabilitation clinic are evaluated with EAT-10, MD Anderson Dysphagia Inventory, Functional Oral Intake Status scale, Mini Nutritional Assessment (MNA) and Beck Depression Index. All patients were then classified according to the latest sarcopenia classification proposed by the European Working Group on Sarcopenia in Older People in 2018. Muscle strength and mass were assessed using a hand dynamometer and measuring calf circumference, respectively. Walking velocity was assessed using the 4-m gait speed test. Patients belonging to sarcopenia, probable sarcopenia, and non-sarcopenia groups were then compared using relevant statistical methods to show whether there are differences in outcomes mentioned as well as demographical and clinical status. RESULTS: The presence of oropharyngeal dysphagia risk was only found between sarcopenic [85 (48-100)] and non-sarcopenic [91 (62-100)] individuals (p = 0.026) while other comparisons were insignificant. EAT-10 scores were found to be worse for probably sarcopenic [0 (0-13)] and sarcopenic [0 (0-35)] individuals compared to non-sarcopenics [0 (0-6)], and it was also shown sarcopenics were worse than probable sarcopenics (p = 0.001). While gait velocity only differed between individuals with sarcopenia and not sarcopenic ones, grip strength was deteriorated for both sarcopenic and probably sarcopenic individuals when compared to non-sarcopenics. MNA scores were still significantly worse for probable sarcopenics [10 (3-14)] and sarcopenics [9 (0-13)], when compared to non-sarcopenics [13 (3-14)] latter being even worse than the other two, respectively) (p = 0.0001). CONCLUSIONS: Dysphagia and nutritional impairments may be seen in the course of sarcopenia, and this also applies to the condition of probable sarcopenia.

Effects of Short Wave Diathermy Added on Dextrose Prolotherapy Injections in Osteoarthritis of the Knee.

Objective: To show the effects of short wave diathermy (SWD) added on prolotherapy injections in osteoarthritis (OA) of the knee on pain, physical functioning, and quality of life. Design: This is a single-blinded randomized controlled study. Setting: Physical Medicine and Rehabilitation Department of a university hospital. Subjects: Sixty-three patients with OA of the knee with Kellgren-Lawrence class 2 or 3 were included in the study. Methods: Patients were randomized into two groups, first being dextrose prolotherapy+SWD and the second being dextrose prolotherapy with sham SWD. Patients were injected with dextrose prolotherapy solutions in the beginning, third, and sixth week of the study, for a total of three times, and took 20 min of SWD after injection (true or sham). Outcome measures: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analogue Scale (VAS) for pain, and Short Form Health Survey (SF-36) were applied before, after (sixth week), and at the third month of treatment. Results: Both groups showed improvements in VAS, WOMAC, and SF-36 scores (p < 0.05). Between-group analyses showed no significant differences (p > 0.05). Conclusions: This study shows that prolotherapy is effective for pain, functionality, and quality of life in patients with OA of the knee. The effects of additional SWD require more evidence. More studies of higher quality are required to make a statement.

Effects of cardiopulmonary rehabilitation on pulmonary arterial hypertension: A prospective, randomized study.

OBJECTIVES: This study aims to investigate the effects of cardiopulmonary rehabilitation (CPR) on cardiopulmonary function, quality of life, depression, and hemodynamic parameters in patients with pulmonary arterial hypertension (PAH) and to compare the efficacy of hospital- and home-based exercise programs. PATIENTS AND METHODS: Between December 2014 to May 2016, a total of 30 patients with PAH were included in the study. The patients were randomly assigned to either a hospital-based (n=15) or home-based exercise program (n=15). The hospital group was assigned to a cardiac rehabilitation (three days/week, 1 hour/week 50 to 70% maximal oxygen uptake [PvO2]) program for eight weeks. The home-based exercise group received home exercises alone. Before and after eight weeks of rehabilitation, all patients were evaluated for their functional status (PvO2), pulmonary function including forced expiratory volume in one sec (FEV1), mL, forced vital capacity (FVC), mL and FEV1/FVC%, quality of life using Short Form-36 (SF-36), depression severity using Beck Depression Inventory, and hemodynamic parameters including left ventricular ejection fraction, right ventricular ejection fraction, left ventricular end-systolic diameter, left ventricular end-diastolic diameter, and systolic pulmonary arterial pressure. RESULTS: Of the patients, 12 completed the study in each group. There was no statistically significant difference in the functional status, quality of life, depression severity, and hemodynamic parameters after the rehabilitation compared baseline between the groups. CONCLUSION: Based on our study results, short-term CPR seems not to be beneficial in patients with PAH. We recommend long-term rehabilitation programs to achieve more benefits from aerobic exercise training in this patient population.

Bladder-related quality of life in people with neurological disorders: reliability and validity of the Turkish version of the King's Health Questionnaire in people with spinal cord injury.

OBJECTIVE: To assess the validity and reliability of the Turkish version of the King's Health Questionnaire (KHQ) in patients with spinal cord injury (SCI) and to compare the bladder- related quality of life between patients with SCI and multiple sclerosis (MS). MATERIAL AND METHODS: Thirty-five patients with SCI and 57 patients with multiple sclerosis (MS) were included in the study. For analysis of test-retest reliability, the Turkish version of the KHQ scale was developed using the back translation method, and it was administered on the day of admission and again one week later. The Qualiveen and SF-36 questionnaires were administered to the patients for validity analysis. Moreover, the results of KHQ that had been administered to 35 patients with SCI were compared with those of 57 patients with MS. RESULTS: Both the internal consistency (Cronbach's alpha coefficient: 0.68-0.93) and the test-retest reliability (intraclass correlation coefficient: 0.69-0.94) of the KHQ in patients with SCI were found to be high. Although a weak correlation between the subscales of the KHQ and SF-36, a moderate correlation between the subscales of KHQ, and the Qualiveen questionnaire (0.34