Aydan Oral

Differences between the right and the left foot in calcaneal quantitative ultrasound measurements

A total of 621 women, aged 30–80 years, who were grouped according to having single (group 1) or duplicate measurements of their both calcanei with quantitative ultrasound (QUS) on the same day (group 2) or on a different day than the first measurement (group 3) were evaluated for differences between the right and left foot. Despite similar mean values of QUS indices on both sides, individual percentage differences were found varying from 7.3 to 9.5% in the quantitative ultrasound index (QUI), from 11.1 to 12.5% in broadband ultrasound attenuation (BUA), from 0.62 to 0.86% in speed of sound (SOS) and from 8.9 to 10.9% in estimated heel bone mineral density as measured using the Sahara Clinical Bone Sonometer in three groups of subjects. The percentage of subjects with a proportional difference exceeding the coefficient of variation of duplicate measurements of the same heel was the highest for BUA, varying from 63 to 76.7%, and ranged between 43.1 and 76.7% in other QUS indices. We conclude that there is a real inter-individual difference between the right and left foot in QUS parameters, whether measured once or twice or on different occasions. We recommend measuring both sides when using QUS to avoid misleading implications regarding a subject’s bone status.

Radial Extracorporeal Shock Wave Therapy Is Not More Effective Than Placebo in the Management of Lateral Epicondylitis: A Double-Blind, Randomized, Placebo-Controlled Trial.

ObjectivesThe aim of this study was to investigate the effects of radial extracorporeal shock wave therapy (rESWT) on pain, function, and grip strength in the treatment of patients with lateral epicondylitis unresponsive to previous treatments. DesignA double-blind, randomized, placebo-controlled trial was conducted in outpatient clinics in a medical faculty hospital. Fifty-six patients with lateral epicondylitis were randomized to rESWT (n = 28) or sham rESWT (n = 28) groups. Both the patients and the outcome assessing investigator were blinded to group assignment. The rESWT was administered to the painful epicondyle at the elbow with a total of 2000 pulses of 10 Hz frequency at a 1.8 bar of air pressure at each session at three once weekly sessions. Sham rESWT was applied without the contact of the applicator at the same area. Study patients were assessed at baseline and at 1 and 3 mos after treatment using a visual analog scale for pain and Roles and Maudsley scale and Patient-Rated Tennis Elbow Evaluation for pain and function. Grip strength of the affected extremity was also measured using a hand dynamometer. ResultsBoth rESWT and sham rESWT groups showed a significant improvement in all outcome measures at posttreatment follow-up points. Favorable absolute and percentage changes in assessments at 1- and 3-mo posttreatment did not show any significant difference between groups. ConclusionsThe rESWT does not seem to be more effective either in reducing pain or improving function or grip strength in patients with lateral epicondylitis at least at 3 mos after treatment when compared with sham rESWT.

The utility of the International Classification of Functioning, Disability and Health checklist for evaluating disability in a community-dwelling geriatric population sample.

The aim of this study was to investigate disability in community-dwelling individuals aged 65 years and over using the International Classification of Functioning, Disability and Health (ICF) checklist and the World Health Organization Disability Assessment Schedule II (WHODAS-II) and to compare how these two ICF-based instruments measured disability in an attempt to show the utility of the ICF checklist in a field setting to describe disability. In this population-based, cross-sectional and descriptive study, data on the ICF checklist and the WHODAS-II were collected from 200 selected participants who lived in a small town. Both the ICF checklist and the WHODAS-II identified a considerable proportion of the elderly with a disability in life areas relevant to cognition and domestic life in a similar manner, the proportions ranging from 52.5 to 68.5%. However, the proportions of those with a disability showed a statistically significant difference in the domains of the two instruments relevant to mobility, self-care, and participation in society. Although the absolute intrarater agreement for matching items of the instruments ranged from 40.5 to 87.5%, kappa statistics showed slight to moderate agreement for the original ICF qualifier and mostly moderate agreement with reduced response options. ICF qualifiers were found to discriminate between the WHODAS-II domain scores in those with no, mild-moderate and severe-complete difficulty. The disparity between the data obtained from the ICF checklist and the WHODAS-II in some domains may have resulted from differing interpretations of the items of the ICF checklist, lower reliability of some of the items, and the current feature of the qualifiers used without any adaptations. The ICF checklist has the potential to be used in a field setting, provided that some modifications are made.

The utility of dual-energy X-ray absorptiometry, calcaneal quantitative ultrasound, and fracture risk indices (FRAX® and Osteoporosis Risk Assessment Instrument) for the identification of women with distal forearm or hip fractures: A pilot study.

ABSTRACT Purpose: Dual-energy X-ray absorptiometry (DXA) is considered the “gold standard” in predicting osteoporotic fractures. Calcaneal quantitative ultrasound (QUS) variables are also known to predict fractures. Fracture risk assessment tools may also guide us for the detection of individuals at high risk for fractures. The aim of this case–control study was to evaluate the utility of DXA bone mineral density (BMD), calcaneal QUS parameters, FRAX® (Fracture Risk Assessment Tool), and Osteoporosis Risk Assessment Instrument (ORAI) for the discrimination of women with distal forearm or hip fractures. Materials and methods: This case–control study included 20 women with a distal forearm fracture and 18 women with a hip fracture as cases and 76 age-matched women served as controls. BMD at the spine, proximal femur, and radius was measured using DXA and acoustic parameters of bone were obtained using a calcaneal QUS device. FRAX® 10-year probability of fracture and ORAI scores were also calculated in all participants. Receiver operating characteristic (ROC) analysis was used to assess fracture discriminatory power of all the tools. Results: While all DXA BMD, and QUS variables and FRAX® fracture probabilities demonstrated significant areas under the ROC curves for the discrimination of hip-fractured women and those without, only 33% radius BMD, broadband ultrasound attenuation (BUA), and FRAX® major osteoporotic fracture probability calculated without BMD showed significant discriminatory power for distal forearm fractures. Conclusions: It can be concluded that QUS variables, particularly BUA, and FRAX® major osteoporotic fracture probability without BMD are good candidates for the identification of both hip and distal forearm fractures.

Discriminative ability of calcaneal quantitative ultrasound compared with dual-energy X-ray absorptiometry in men with hip or distal forearm fractures

Objectives The aim of this case–control study was to compare the discriminatory ability of bone mineral density (BMD) measurements and calcaneal quantitative ultrasound (QUS) parameters for fractures and to determine fracture thresholds for each variable in men with hip or distal forearm fractures. Patients and methods A total of 20 men with hip and 18 men with distal forearm fractures and 38 age-matched controls were included in this study. Dual-energy X-ray absorptiometry (DXA) BMD (spine and hip) and calcaneal QUS measurements were made. Area under the curves (AUCs) were calculated to assess fracture discriminatory power of DXA and QUS variables. Results Quantitative Ultrasound Index (QUI) T-score and Speed of Sound (SOS) were found to be the best parameters for the identification of hip and distal forearm fractures, respectively, with AUCs greater than those of DXA BMD and other QUS parameters. While a QUI T-score of ≤−1.18 could identify and rule out hip fracture cases with approximately 80% sensitivity and specificity, a SOS value of ≤1529.75 reached to almost 90% for ruling in and out distal forearm fractures. Conclusion The discriminatory performance of calcaneal QUS variables between fractured and non-fractured men was as good as those of the DXA BMD and even better. Since men appear to sustain fractures at closer QUS variable levels than those of the DXA BMD regardless of the fracture type, it may be speculated that calcaneal QUS may be more helpful in predicting the risk of fractures when BMD alone does not demonstrate impaired bones. Level of Evidence: Level III, Study of Diagnostic Test

Compliance, persistence, and preference outcomes of postmenopausal osteoporotic women receiving a flexible or fixed regimen of daily risedronate: A multicenter, prospective, parallel group study

OBJECTIVE The aim of this study was to examine the level of compliance and persistence in patients with postmenopausal osteoporosis (OP) receiving daily risedronate (5 mg) with either fixed dosing of three different timing regimens (A: before breakfast; B: in-between meals; C: before bedtime) or with flexible dosing and the effect on urinary N-terminal telopeptide of Type 1 collagen (NTX-1). METHODS The study included 448 patients with postmenopausal OP. Patients were randomly assigned into six treatment groups each with a permutation of the treatment sequence (ABC, BCA, etc.) in the crossover phase (3 x 1 week) and randomized to 23 weeks of either the daily flexible (either regimen A, B or C) or fixed timing (only regimen A, B, or C) in the patients preference phase. Urinary NTX-1 was tested. RESULTS A total of 433 patients participated in the patients preference phase (49.7% preferred flexible and 50.3% fixed timing). There was no significant difference between the proportion of responders who were both compliant and persistent in the flexible (54.4%) and fixed regimens (53.7%) (p=0.8803). A significant difference between the flexible and fixed regimens was seen in persistence in favor of the flexible regimen (p=0.0306). There was no significant difference between the flexible and fixed regimens in terms of compliance (p=0.4611). Change in urinary NTX-1 did not show any difference between the two regimens. At the final visit, 51% of patients in the flexible and 55% in the fixed regimen group considered the used risedronate regimen as excellent or very good (p=0.1440). CONCLUSION A flexible dosing with daily risedronate appears be a valuable option in terms of compliance and persistence for patients with postmenopausal OP.

Revisiting the management of fatigue in multiple sclerosis in the context of rehabilitation: a narrative review of current evidence.

Fatigue is one of the most frequently reported symptoms of multiple sclerosis, interfering with functioning and resulting in activity limitations and participation restrictions. Therefore, it is important to manage fatigue in a rehabilitation context considering not only disability associated with impaired functioning but also all the problems relevant to environmental and personal factors as defined in the International Classification of Functioning, Disability and Health (ICF). In addition to pharmacological treatment, there are many rehabilitation interventions with evidence of effectiveness in reducing fatigue and thereby facilitating improvement, particularly in body functions and structures and activities and participation components of the ICF. However, more research is required to provide evidence for effective treatment strategies in overcoming fatigue and related problems, especially in the components of contextual factors of the ICF.

Does cognitive rehabilitation improve occupational outcomes including employment and activities of daily living, as well as quality of life and community integration in individuals with traumatic brain injury? - A Cochrane Review summary with commentary

The aim of this commentary is to discuss in a rehabilitation perspective the published Cochrane Review “Cognitive rehabilitation for adults with traumatic brain injury to improve occupational outcomes” by Kumar, Samuelkamaleshkumar, Viswanathan, & Macaden1, under the direct supervision of Cochrane Work. This Cochrane Corner is produced in agreement with NeuroRehabilitation by Cochrane Rehabilitation.

THU0375 Can Radial Speed of Sound Measurements Identify Osteoporosis at the Radius as Measured by DXA

Background One-third radius (33% radius) bone mineral density (BMD) measurements of the non-dominant forearm using dual-energy X-ray absorptiometry (DXA) may be used for the diagnosis of osteoporosis in certain circumstances. Objectives The aim of this study was to investigate the ability of radial speed of sound (SOS) measurements for identifying osteoporosis at the radius as measured by DXA. Methods Both 1/3 radius BMD and SOS of the non-dominant forearm were measured in 128 women aged between 21 and 79 years using DXA (Hologic QDR® 4000) and a multi-site quantitative ultrasound (QUS) device (Sunlight Omnisense™ 8000), respectively. Osteoporosis at the radius was defined according to the WHO criteria (a T-score ≤-2.5) in postmenopausal women in the sample studied. In premenopausal women, Z-scores of ≤-2.0 were used for defining osteoporosis or BMD below the expected range for age. Results Pearson correlation coefficients revealed statistically significant correlations between DXA 1/3 radius BMD and radial SOS measurements (r=0.496; p<0.001) as well as 1/3 radius and radial SOS T-scores (r=0.495; p<0.001). The areas under the receiver operating characteristic curves (AUCs) for radial SOS and its T-score for predicting osteoporosis or BMD below the expected range were 0.762 (p<0.001) and 0.760 (p<0.001), respectively. Conclusions Significant correlations between radial BMD measurements and QUS parameters and fair AUCs for QUS parameters for identifying osteoporosis or BMD below the expected range found in this small sample of women may have implications that radial SOS measurements may provide valuable information for treatment decisions when DXA cannot be done in any region of interest. Disclosure of Interest None Declared