Ayse Yaliman

Comparison of the effects of a physiotherapist-supervised exercise programme and a self-supervised exercise programme on quality of life in patients with Parkinson’s disease

Objectives: To compare the effects of a physiotherapist-supervised exercise programme in an exercise unit and self-supervised home exercise programme on quality of life in patients with Parkinson’s disease. Design: Assessor-blinded, quasi-randomized trial (alternate allocation). Setting: An outpatient exercise unit; home settings. Participants: Thirty patients with idiopathic Parkinson’s disease, Hoehn & Yahr I—III, stable medication use. Interventions: Patients were included in the physiotherapist-supervised or home group. The exercise programme was performed for 10 weeks, three times/week either under the supervision of a physiotherapist or at home without supervision. Main outcome measures: Parkinson’s Disease Quality of Life Questionnaire (PDQLQ), Nottingham Health Profile (NHP), Unified Parkinson’s Disease Rating Scale (UPDRS), Beck Depression Inventory (BDI). Results: Patients in the supervised physiotherapy group improved more than the home exercise group in Parkinson’s Disease Quality of Life Questionnaire (total score, Parkinson’s symptoms, emotional function), Nottingham Health Profile total, Unified Parkinson’s Disease Rating Scale (all domains) and Beck Depression Inventory scores. Conclusions: The exercise programme under physiotherapist supervision was found to be more effective at improving activities of daily living, motor, mental, emotional functions and general health quality in patients with Parkinson’s disease compared with a self-supervised home programme.

Validity of the Turkish version of the Kujala patellofemoral score in patellofemoral pain syndrome

OBJECTIVES Patellofemoral pain syndrome is one of the most common knee problems, with major effects on quality of life and function. The Kujala patellofemoral score is a functional evaluation instrument to evaluate knee problems related to the patellofemoral system. The aim of this study was to evaluate the validity of the Turkish version of the Kujala patellofemoral score in patients with patellofemoral pain syndrome. METHODS After obtaining permission from Kujala et al., the Kujala patellofemoral score was translated into Turkish. The translated version was administered to 40 patients (32 women, 8 men; mean age 33+/-12 years; range 17 to 54 years) twice at a two-week interval to test internal consistency and test-retest reliability of the scale. All the patients had patellofemoral pain syndrome and did not receive any treatment before administration of the scale. Cronbachs alpha coefficient was used to assess internal consistency and Spearmans correlation analysis was used to assess test-retest reliability. RESULTS Cronbachs alpha calculated for internal consistency of the Kujala patellofemoral score was 0.84. Correlation coefficients of the items to estimate test-retest reliability ranged from 0.613 (p=0.004) to 1.000 (p=0.000), with the mean correlation coefficient of 0.944 (p=0.000). CONCLUSION There has been no functional assessment scale validated for Turkish patients with patellofemoral pain syndrome. Internal consistency of the Turkish version of the Kujala patellofemoral score showed good reliability and test-retest results showed high reliability, suggesting that it is an appropriate functional instrument for Turkish patients with patellofemoral pain syndrome.

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.

Comparison of the effects of mirror therapy and electromyography-triggered neuromuscular stimulation on hand functions in stroke patients: a pilot study.

To determine the effectiveness of mirror therapy and electromyography (EMG)-triggered neuromuscular stimulation on improvement of functions of the upper extremity in patients with subacute stroke in comparison with conventional therapy as well as to evaluate the advantage of each treatment over another, we conducted a prospective, randomized, and controlled trial involving 24 patients with ischemic stroke. The mean age and mean time since stroke of the patients were 58.79±11.49 years and 5.25±2.25 months. Patients were assigned randomly to a mirror therapy group (MT group, n=9), which consisted of therapy with a mirror box 5 days/week, 30 min/day, for 3 weeks, an electrostimulation group (ES group, n=7), which consisted of therapy with EMG-triggered stimulation (EMG-stim) of similar duration and frequency of treatment as the MT group, and a control group (n=8). All the groups received conventional physiotherapy for the same period as the MT group. Patients in the MT group practiced their therapy at home after supervised sessions. The Fugl-Meyer scores of the upper extremity, grip force, wrist extension, and Box and Block Test were evaluated at baseline, after treatment, and at 3 months after the treatment. All of these measures were evaluated by a blinded researcher. We found that there was no significant improvement in wrist extension range and grip force in control group. The MT and EMG-stim were effective in increasing the Fugl-Meyer motor scale for upper extremity (MT group: P<0.01), increasing wrist extension range, grip force, and hand dexterity determined by the Box and Block Test (MT group and ES group P<0.05). Furthermore, hand skills were increased significantly in the MT group compared with the ES group at the follow-up assessment (P<0.05). This pilot study suggested that MT was more efficient in improving motor performance than physiotherapy alone. Also, MT may be more useful in improving the hand skills compared with EMG-stim. We assume that this difference might be related to the feasibility of maintenance of MT at home.

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.

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.

THU0565 The Effects of Radial Shock Wave Therapy and Low Level Laser Therapy in the Treatment of Chronic Plantar Fasciitis: A Randomized Controlled Trial

Objectives The aim of this prospective, randomized controlled 3-month interventional trial was to investigate the effects of Radial Shock Wave Therapy (RSWT) and Low Level Laser Therapy (LLLT) on foot pain and plantar fascia thickness in patients with chronic plantar fasciitis. Methods Ninety (82 female, 8 male) eligible patients with chronic plantar fasciitis who had no response to the conservative treatment methods for at least 6 months were included in the study and allocated to three groups, RSWT, LLLT and control groups. The RSWT program consisted of three sessions of the RSWT once a week. The LLLT program consisted of 12 sessions of the LLLT, three times a week for 4 weeks. All patients received instruction for home stretching exercises for three months. Foot pain was evaluated by the Visual Analogue Scale (VAS) and Foot Function Index (FFI) pain subscale. The thickness of plantar fascia was measured by ultrasound. All assessments were performed at baseline, immediately and three months after treatment. Statistical tests were conducted at the 0.05 significance level for all outcome measures. Results Eighty-one patients (150 feet) completed the study. The mean age of the patients was 48.8±8.3 years (range 31-70). The pain intensity (VAS) was decreased significantly in RSWT group only at the 3-month assessments (0<0.001) compared with the LLLT and control groups. Moreover, there was a significant reduction in the foot pain assessed by the FFI pain subscale in the RSWT compared with the controls at the 3-month assessment (0<0.001). There was a significant decrease in the plantar fascia thickness in all three groups, but, these reductions were more significant in the RSWT group at immediately after treatment (p<0.01) and 3-month assessments (0<0.001). Conclusions These data suggest that the RSWT is effective on reducing pain and both the RSWT and LLLT can be effective in reducing the plantar thickness in patients with chronic plantar fasciitis specially at three months after treatment. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.3359

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