Ali Kitis

DASH questionnaire for the analysis of musculoskeletal symptoms in industry workers : A validity and reliability study

PURPOSE The disabilities of the arm, shoulder and hand (DASH) questionnaire is a self-administered region-specific outcome instrument developed as a measure of self-rated upper-extremity disability and symptoms. The aim of this study was to evaluate the reliability and the construct validity of the DASH questionnaire by establishing its correlation to the Medical Outcomes Study Short Form-36 (SF-36) in industry workers. Also we aimed to investigate whether the DASH can be used as a standardized questionnaire to evaluate the work-related musculoskeletal disorders (WMSDs) in upper extremity in industrial settings and epidemiological studies. MATERIAL AND METHODS The Turkish versions reliability and construct validity were evaluated in 240 industry workers with upper-extremity musculoskeletal complaints. Workers were asked to complete a packet that included the DASH and the SF-36. Test-retest reliability was assessed in all workers who filled in the DASH questionnaire 15 days later. Construct validity was evaluated by comparing the overall and work component DASH scores with SF-36 summary and subscales. RESULTS The mean DASH score for the textile workers whose duties were confection, dyeing, sewing, quality control and packaging was calculated as 65, 55, 68, 54 and 67, respectively. As a result of this study, pain intensity in shoulder, wrist and hand was significantly associated with the DASH score (p<0.05). Internal consistency of the DASH was high (Cronbach alpha 0.91). Test-retest reliability was excellent for the overall DASH (intraclass correlation coefficient (ICC) 0.92). Moderate correlations (p<0.05) were found between the overall and work component DASH and the SF-36 summary scales. Pearson correlation coefficients of the overall and work component DASH to the SF-36 subscales ranged from -0.33 to -0.82. CONCLUSION These results support that DASH is a reliable and valid instrument to measure functional disability and investigate the ergonomic risk factors in textile workers with upper-extremity musculoskeletal complaints.

The Effect of Gender and Level of Vision on the Physical Activity Level of Children and Adolescents with Visual Impairment.

This study was planned in order to determine physical activity levels of visually impaired children and adolescents and to investigate the effect of gender and level of vision on physical activity level in visually impaired children and adolescents. A total of 30 visually impaired children and adolescents (16 low vision and 14 blind) aged between 8 and 16 years participated in the study. The physical activity level of cases was evaluated with a physical activity diary (PAD) and one-mile run/walk test (OMR-WT). No difference was found between the PAD and the OMR-WT results of low vision and blind children and adolescents. The visually impaired children and adolescents were detected not to participate in vigorous physical activity. A difference was found in favor of low vision boys in terms of mild, moderate activities and OMR-WT durations. However, no difference was found between physical activity levels of blind girls and boys. The results of our study suggested that the physical activity level of visually impaired children and adolescents was low, and gender affected physical activity in low vision children and adolescents.

Investigation of Disability Level, Leisure Satisfaction, and Quality of Life in Disabled Employees

The purpose of this study is to investigate the disability level, leisure satisfaction, and quality of life in employees who were disabled. Six hundred twenty-seven employees who were disabled were included in this study and classified according to age, gender and disability level. In quality of life, there was significant difference between genders and age groups (p < .05). There was no significant difference neither in leisure satisfaction nor in disability level between groups (p > .05). In disability assessment, males were better and there was a significant difference in leisure satisfaction (p < .05). Age, gender, and disability level were important factors affecting disability, leisure satisfaction, and quality of life among employees who were disabled.

Relationship of side dominance and ultrasonographic measurements of pronator quadratus muscle along with handgrip and pinch strength.

Aims: We ascertained effects of hand dominance in both right and left-handed volunteers on the thickness and cross sectional area (CSA) of pronator quadratus (PQ) muscle as measured by the axial and sagittal views of ultrasound imaging. Secondly, we also aimed to document the extent of the relationship between the PQ measurements and handgrip. Materials and methods: Healthy adults from the volunteer medical staff were included in the study. Handedness was assessed via The Flinders Handedness survey. The sonographic appearance of the PQ was evaluated on sagittal and axial images for both hands. CSA of PQ muscle was digitally drawn and calculated on the axial plane. Handgrip was measured by using adjustable-handle dynamometer. Results: Eighty-nine healthy volunteers were included (54 right and 35 left-handed). Significant difference was detected between dominant and non-dominant hands in CSA and muscle thickness in both right and left-handed volunteers (p<0.05). These measurements were correlated with the handgrip strength (p<0.05, r=0.55, and r=0.43 for right-handed volunteers, r=0.67 and r=0.48 for left-handed volunteers, respectively). There were also significantly high correlations between the measurements of CSA and PQ thickness of the corresponding extremity in both right-handed and left-handed volunteers (p<0.05). Conclusions: A statistically significant difference exists between dominant and non-dominant hands in CSA and muscle thickness measured by US in both right and left handed volunteers, and this is correlated with handgrip strength. Hand dominance should be considered to compare healthy and affected sites during US of PQ while investigating for occult fractures of distal forearm or PQ atrophy due to anterior interosseous nerve injury.

Investigation of the relationship between severity of injury, return to work, impairment, and activity participation in hand and forearm injuries

BACKGROUND Forearm and hand injuries are the main cause of work-related disability. This study was planned to investigate the relationship between severity of injury, time of return to work, impairment, and activity participation of patients with hand and forearm injuries. METHODS One hundred and thirty patients who had patients who had had forearm or hand injuries with a mean age of 31±11.13 years participated in this study. Injury severity was evaluated using Modified Hand and Forearm Injury Severity Scoring (MHISS) after surgery. Patients were evaluated using the Jebsen Hand Function Test (JHFT) and Buck-Gramko scoring eight weeks after injury. Additionally, grip strength was evaluated with a dynamometer, and disability/symptom score was evaluated using the Turkish version of the Disabilities of the Arm, Shoulder, and Hand (DASH-T) questionnaire twelve weeks after injury. RESULTS A significant relationship between MHISS, hand strength, time of return to work, DASH-T, and Buck-Gramko scores of patients with forearm and hand injuries was identified (p≤0.05). Higher impairment was significantly related to body structure and body functions (1.86±1.47), and the most limited activity was writing (2.06±1.50) regarding ICF framework. CONCLUSION Higher MHISS scores were associated with delays in returning to work and lower activity participation. The DASH-T score was the most strongly associated with time of return to work. Furthermore, there is a positive relation between time of return to work and activity participation of patients.

Middle-term therapeutic effect of the sacroiliac joint blockade in patients with lumbosacral fusion-related sacroiliac pain

OBJECTIVE The aim of this study was to compare the therapeutic effect of sacroiliac (SI) blockade in patients with and without lumbosacral fusion. METHODS This study included 72 patients diagnosed with SI pain and who received blockade injection (methylprednisolone and lidocaine). Patients were divided into 2 groups; 22 patients in the fusion group who underwent previous lumbosacral fusion and 50 patients in the non-fusion group. Average follow-up was 17.7 (range: 6 to 30) months. All patients were evaluated before and after intervention using the Visual Analog Scale (VAS), Oswestry Disability Index, Rivermead Mobility Index and SF-36. Results were statistically analyzed. RESULTS Activity pain (a component of VAS) was significantly better in the non-fusion group than the fusion group (p=0.042). No other statistically significant differences were observed between groups (p>0.05). CONCLUSION Sacroiliac blockade has a similar therapeutic effect on patients who underwent lumbosacral fusion surgery as on non-operated patients in the middle-term. Therefore, alternative treatment options are not necessary in patients with fusion.

Effects of musculoskeletal system problems on quality of life and depression in students preparing for university entrance exam

Background This study was planned to investigate the relationship between musculoskeletal problems, depression, and quality of life in students preparing for university entrance exams. Methods A total of 180 students were included in the study, 104 were female (57.77%), and 76 were male (42.22%). Students were reached through the cram schools (“dershane”) in Denizli. Musculoskeletal system problems, depression status, and quality of life were determined with the Musculoskeletal-Postural Discomfort Scale (MDS), Boratav Depression Screen Scale (Bordepta), and Short Form-36 (SF-36), respectively. Demographic data, daily study, and sleep duration were also recorded. Results Students have moderate musculoskeletal discomfort. Musculoskeletal disorders and depressive symptoms are more observed in female students than male students (P = 0.000). The SF-36 results were significantly negatively correlated with the MDS and Bordepta scores. A significant positive correlation was found between musculoskeletal disorders and depression status (r = 0.351, P = 0.000). Sleep duration was negatively correlated with the MDS and Bordepta (r = −0.209, P = 0.005; r = −0.148, P = 0.047, respectively) and positively correlated with the SF-36 role limitation/emotional and social functioning subscales (r = 0.225, P = 0.002 and r = 0.191, P = 0.010 respectively). Conclusions Musculoskeletal problems and depression status negatively affects general health status especially in female students who are preparing for university entrance examinations. Students should be informed about musculoskeletal problems by healthcare professionals and the study room, tables, and chairs should be arranged ergonomically. Further studies might be determined that why musculoskeletal disorders and depression status are more widely among female students.

Isolated abnormalities in the mamillary bodies on MRI in a patient with Wernicke’s encephalopathy

A 48-year-old woman with a history of alcohol abuse presented at the emergency department (ED) with confusion, progressive gait disturbance, nausea, and vomiting since 2 weeks. She had history of alcohol-related diarrhea since 3 months. Neurological examination revealed apathy, impaired recent memory, dysarthria, bilateral dysmetria, and truncal ataxia. Mild proximal muscle weakness (grade 4/5) was noted. Deep tendon reflexes were hypoactive. There was no dysmetria or dysdiadochokinesia. Brain magnetic resonance imaging (MRI) revealed mild hyperintensity of the mammillary bodies with higher prominence on the right side on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images. In addition, marked contrast enhancement was seen in the right mammillary body. Increased signal intensity of the right mammillary body was present on diffusion-weighted images (DWI) (Fig. 1). There was no reduced apparent diffusion coefficient (ADC) value compatible with restricted diffusion, however. Patient’s history, clinical signs, and MRI findings were consistent with the diagnosis of Wernicke’s encephalopathy (WE). Intravenous thiamine (200 mg, drip 3 times a day) was immediately administered. Her clinical features dramatically improved. Wernicke’s encephalopathy is a medical emergency caused by thiamine (vitamin B1) deficiency, characterized by oculomotor disorders, ataxia, and mental status changes. It has a high mortality (20 %) and morbidity rate [1]. The disorder is often associated with chronic alcoholism. WE can also occur in gastrointestinal tract tumors, anorexia nervosa, patients on dialysis, starvation for treatment of obesity, psychogenic food refusal, hyperemesis gravidarum, and unbalanced total parenteral nutrition [2]. Clinical suspicion, detailed history taking, and neurologic evaluations are important for early diagnosis. However, the disorder is greatly underdiagnosed. While there is no specific laboratory test for the diagnosis of WE, cranial MRI is considered to be the most effective method in supporting the diagnosis of WE. Typical MRI findings are symmetrical T2W and FLAIR hyperintensities in the medial thalamus, mammillary bodies, tectal plate, and periaqueductal area in acute stage [3]. Mammillary bodies are generally affected in WE, but signal changes limited to the mammillary bodies are unusual. In atypical cases cerebellum, cerebral cortex, basal ganglia, and cranial nerves may be affected. Atypically localized lesions are almost always associated with the typical findings [4]. Diffusion-weighted imaging (DWI) findings are nonspecific in WE. Normal, increased or decreased ADC values can be seen. DWI findings may be partially related to the timing of MR imaging, with true restricted diffusion in the early period reflecting cytotoxic edema changing over time to vasogenic edema (T2 shine-through effect). In our case, there was no signal loss on the ADC-map, and hence, the diffusion abnormalities reflected vasogenic edema [4]. MR images, obtained after gadolinium administration, are critical to the diagnosis. Lesions can be enhancing in about 50 % of cases [5]. Contrast enhancement of the thalamus and mammillary bodies is seen significantly more & Tarkan Ergun tarkanergun@yahoo.com

Analysis of Community Participation Levels of Individuals Who Are Physically Disabled and Working in Industrial Environments.

The purpose of this study was to determine quality of life, leisure time satisfaction, activity performance, and community participation and analyze the relationship between these determinants and community participation in both physically disabled individuals working in industrial environments and nonworking individuals who are physically disabled. Sociodemographic data was registered into a sociodemographic form. World Health Organization Disability Assessment Schedule 2.0 was used to assess community participation. Activity performance was evaluated with Canadian Occupational Performance Measure. Leisure Satisfaction Scale was used to determine leisure time satisfaction. Short Form-36 was used for evaluating quality of life. When the participants were compared in terms of working status, a significant difference according to their WHO-DAS-II total scores were found (p < 0.05). When all participants were compared in terms of activity performance, lesisure time satisfaction, quality of life a significant differences according to their WHO-DAS-II total scores were found (p>0.05). This study shows that community participation was affected by working status, disability level, activity performance, leisure time satisfaction and quality of life. In this regard, occupational therapy and physiotherapy approaches were found necessary for developing community participation. We conclude that this studys results can be used as a guide for community participation in disabled people in community based rehabilitation politics.