Aytul Cakci

Evaluation of dynamic postural balance using the Biodex Stability System in rheumatoid arthritis patients

The aim of this study was to investigate dynamic postural balance in patients with rheumatoid arthritis (RA) in relation to the disease characteristics. Seventy-four patients with RA and 42 controls of the same age group were tested using the Biodex Stability System (Biodex Medical Systems, Shirley, NY, USA). Anterior/posterior (AP), medial/lateral (ML), and overall (OA) indices were obtained with bilateral stance at platform stabilities of 2 and 8. Subjects were tested with “eyes open” at all times. At the same time, Disease Activity Score, functional disability [Health Assessment Questionnaire, (HAQ)], and Steinbrocker Functional Class (SFC) were assessed. Both the AP and OA indices in the RA group were significantly higher than in the control group for level 8. For OA index, the results were 2.7±0.9 in RA and 2.2±0.7 in the control group (p=0.006), and for AP index, the results were 2.1±0.7 in RA and 1.7±0.6 in the control group (p=0.002). Eleven patients (15.9%) and three controls (7.1%) could not complete the test at level 2. When the patients and controls who completed the test were compared, a significant difference was found only in the ML index. The results were 4.6±2.4 in RA and 3.8±1.6 in the control group (p=0.047). A positive correlation between HAQ and postural balance for all three stability indices at level 8 was detected. A positive correlation between SFC and postural balance for OA and ML at level 8 was also found. Multiple linear regression analyses revealed age and body mass index (BMI) to be the most important factors influencing postural dynamic balance at both levels in the RA group and in healthy controls. RA has a negative effect on dynamic postural stability. The functional status affects dynamic balance more than disease activity. Age and BMI were the most important factors influencing postural dynamic balance in the RA group and in healthy controls. Level 2 does not appear to be an appropriate level for evaluating postural stability in RA.

Factors affecting drug treatment compliance in patients with rheumatoid arthritis

Abstract We prospectively examined 100 rheumatoid arthritis (RA) patients to calculate drug compliance rates, characteristics of compliant and non-compliant patients, and changes in compliance over time. Three assessments were obtained over a one-year follow–up. Detailed drug history of RA and for concomitant disease was queried. Sedimentation rate, C-reactive protein, and rheumatoid factor values, Ritchie articular index, morning stiffness, and health assessment questionnaire were evaluated. Twenty-six patients (30.2%) were consistently compliant and 10 patients (11.6%) were consistently non-compliant. Older age was associated with a greater likelihood of compliance. Comparison of compliant and non-compliant groups revealed no statistically significant difference in distribution of gender, disease duration, and total number of pills taken for RA and/or total number of pills taken for any reason. In conclusion, compliance to drugs in RA patients is a common problem. Clinical and laboratory activity of RA had less influence on drug compliance. Older age is associated with a greater likelihood of compliance.

Auditory event-related brain potentials in fibromyalgia syndrome

ObjectiveThe aim of this study was to investigate cognitive functions using auditory event-related brain potentials (ERP) in fibromyalgia syndrome (FMS).MethodsThe P300 component of ERP was studied in 36 female FMS patients and 22 control subjects. The short form 36 (SF-36) medical outcome study was used to determine quality of life. Number of tender points and disease duration were noted. Cognitive functions were evaluated with P300.ResultsThe symptoms were discrepant in FMS (P<0.001). The scores of the eight SF-36 subgroups in FMS patients were significantly lower than in the control group (P<0.001). Fibromyalgia syndrome patients had prolonged latency and reduced amplitude of P300 (P<0.001). No correlation was found between the subgroups of SF-36, tender point count, disease duration, and P300.ConclusionThe results of our study reveal that FMS affects quality of life and dysfunction in cognitive abilities can be determined by brain event-related potentials.

Reliability of isokinetic ankle inversion- and eversion-strength measurement in neutral foot position, using the Biodex dynamometer

This study was designed to investigate the intratester and intertester reliability of isokinetic ankle inversion and eversion-strength measurement in neutral foot position in healthy adults using the Biodex dynamometer. Twenty-five men and women performed five maximal concentric contractions at 60 and 180°/s angular velocities. Two physicians tested each subject. The first physician applied the test four times, and the second physician three times. Reliability of peak torque was assessed by calculating the intraclass correlation coefficient (ICC). At both angular velocities, inversion strength was greater than eversion, and when the angular velocity was increased, inversion and eversion strength were decreased, as tested by both physicians. The first measurements of inversion and eversion strength of the first physician were significantly lower than the other measurements (p<0.01). The intratester ICCs for ankle inversion in healthy young adults were highly reliable (ICC 0.92–0.96), and for the eversion values ranged from 0.87 to 0.94. Intertester ICCs for ankle inversion and eversion peak torque values demonstrated a value of 0.95. Isokinetic tests of ankle inversion and eversion strength at 60 and 180°/s angular velocities in neutral foot position for healthy adults are highly reliable with the Biodex dynamometer.

Low-level laser therapy in subacromial impingement syndrome.

BACKGROUND DATA AND OBJECTIVE Although previous studies have evaluated the effect of different kinds of physical therapy in subacromial impingement syndrome (SIS), there have been few investigations assessing the effectiveness of low-level laser therapy (LLLT) in shoulder disorders. The goal of this prospective randomized study was to assess whether gallium-arsenide (Ga-As) laser therapy improves the outcome of a comprehensive home exercise program in patients with SIS. MATERIALS AND METHODS Forty-four newly-diagnosed SIS patients were enrolled in this study. Group 1 patients (n = 22) received Ga-As laser therapy combined with a 12-wk comprehensive home exercise program, and group 2 patients (n = 22) received the same 12-wk comprehensive home exercise program alone. Night pain, shoulder pain and disability index (SPADI), and University of California-Los Angeles end-result (UCLA) scores were used as outcome measures. RESULTS Both groups showed a significant reduction in night pain and SPADI scores at the second and 12th weeks with respect to baseline values, with the exception of the SPADI total score at the second week in group 1. UCLA results improved significantly in both groups at the 12th in comparison to the second week. There were no significant differences between groups in mean actual changes in night pain and SPADI scores at the second week from baseline. When values at the 12th week were compared to baseline, mean actual changes in night pain differed significantly between the groups, with a larger change in group 1, but there was no difference between groups in mean actual change in SPADI scores. Second- and 12th-week UCLA scores did not differ between the two groups. CONCLUSION Our study was unable to demonstrate any distinct advantage of low-level laser therapy over exercise alone. Comprehensive home exercise programs should be the primary therapeutic option in the rehabilitation process in SIS.

Health-related quality of life in first-ever stroke patients.

Background and Objectives: Health-related quality of life (HRQOL) is important to measure as it is an indication of outcome after stroke. Our objectives were to assess HRQOL in patients 3 months after stroke and to identify factors that predict HRQOL in stroke survivors. Patients and Methods: This cross-sectional study included 67 first-ever stroke patients hospitalized in the Ministry of Health Ankara Diskapi Yildirim Beyazit Education and Research Hospital Physical Therapy and Rehabilitation Clinic. HRQOL was measured by means of the Stroke Impact Scale-16 (SIS-16). Patients were characterized by age, sex, duration of education, comorbidities, stroke type, affected side, concordance (pa-retic arm=dominant hand), cognitive function (Mini-Mental State Examination [MMSE]), and functional status (Functional Independence Measure [FIM]). We used a linear regression model to examine the influence of de-mographic and clinical characteristics on the different SIS-16 domains. Results: The mean (SD) for age of the 67 patients was 62.03 (13.22) years (range, 33 to 81 years). The MMSE and FIM scores were significantly correlated with the SIS-16 score (P< .001). Linear regression analysis showed that age and functional status were the major independent determinants affecting HRQOL (P=.002 and P< .001,respectively). Conclusion: In this study, we found that age and functional status had a powerful influence on HRQOL. Comprehensive therapy programs aimed to improve HRQOL should focus on improving functional disability,particularly in older stroke patients. There is a need for long-term follow-up studies in stroke patients throughout all recovery stages to evaluate HRQOL in more detail.

Does hyaluronan affect inflammatory cytokines in knee osteoarthritis

Our aim was to investigate the effects of hyaluronan on inflammatory cytokines in the synovial fluid of patients with knee osteoarthritis. The study was single blind, placebo-controlled, and randomized. We administered hyaluronan to 22 patients in the study group and placebo to 19 in the control group. Enzyme-linked immunosorbent assay was used to determine the levels of cytokines. Both HA and placebo caused a significant decrease in interleukin (IL)-6 levels (P=0.0001 and P=0.04, respectively). But it was more significant in the study group. However, IL-8 and tumor necrosis factor alpha (TNF-α) levels did not change in either group (P>0.05). The amount of effusion decreased significantly in the study group (P=0.001) but not in the control group (P=0.133). It can be concluded that hyaluronan considerably decreased IL-6 levels, which correlated with clinical improvement, but had no effect on IL-8 and TNF-α levels in synovial fluid. However, larger studies with longer follow-up periods are needed to explain the effect of hyaluronan on cytokines.

Quality of life in patients with spinal cord injury.

The primary objective of this study was to assess the quality of life (QoL) in spinal cord injury (SCI) survivors. Secondary objectives were to determine the effects of various sociodemographic and clinical characteristics on QoL. This cross-sectional study included 54 patients with SCI. The Turkish version of the Short-Form-36 Health Survey was used to assess health-related QoL. Functional status was measured with Functional Independence Measure. Higher values were obtained in younger individuals for bodily pain, in paraplegic patients for physical functioning, role-physical, social functioning, and role-emotional. Moreover, it was observed that functional status correlated well with physical functioning, role-physical, social functioning, and role-emotional. Among the complications investigated, bladder incontinence is related to low health-related QoL in most domains. SCI may interfere with some health domains of QoL according to the patients age, neurologic levels, functional status and presence of complications, mainly bladder incontinence.

Stanger bath therapy for ankylosing spondylitis: illusion or reality?

We compared the short-term effects of Stanger bath therapy and conventional exercises on spinal mobility, functional capacity, disease activity, and quality of life with conventional exercise alone in ankylosing spondylitis (AS) patients. A total of 58 patients with a diagnosis of AS according to the modified New York criteria were included in this randomized prospective study. The patients were divided into two groups. Patients in group I (n = 30) received Stanger bath therapy and an exercise program. Group II (n = 28) patients were given the same exercise program but did not receive Stanger bath therapy. Patients were evaluated before (T0) and at the end of the treatments (T1). Evaluation parameters were the Bath AS Metrology Index (BASMI), Bath AS Functional Index (BASFI), Bath AS Disease Activity Index (BASDAI), and AS Quality of Life (ASQoL). In both patient groups, a significant improvement was determined in all clinical outcomes between T0 and T1 except for BASMI in group II. Comparison of the groups showed significantly superior results in group I parameters of BASMI, BASFI, BASDAI, and ASQoL. Stanger bath therapy showed beneficial effects in spinal mobility, functional capacity, disease activity, and quality of life in AS patients immediately after the treatment period. We recommend Stanger bath therapy for AS patients in the short-term, but further research is imperative to assess whether improvement is sustained over a long-term follow-up.

Effects of chronic pain on function, depression, and sleep among patients with traumatic spinal cord injury.

BACKGROUND AND OBJECTIVES The main objectives of this cross-sectional study were (1) to examine chronic pain using the Multidimensional Pain Inventory-Spinal Cord Injury (MPI-SCI) version and (2) to assess the relationship between chronic pain and functional status, depression, and sleep quality among patients with SCI. DESIGN AND SETTINGS This was a cross-sectional study of all eligible patients admitted to the Ministry of Health Ankara Diskapi Yildirim Beyazit Education and Research Hospital Physical Therapy and Rehabilitation Clinic between January 2007 and July 2010. METHODS Forty-four patients (33 male, 11 female) with traumatic SCI, aged ≥18 years, who had pain continuing for ≥6 months and were hospitalized in the physical therapy and rehabilitation clinic were included in this cross-sectional study. Chronic pain intensity, functional status, depression, and sleep quality were assessed according to the MPI-SCI, Functional Independence Measure (FIM), Hamilton Rating Scale for Depression (HAM-D), and Pittsburg Sleep Quality Index (PSQI), respectively. RESULTS A positive correlation was observed between “Pain Severity” (one of the subscales of the MPI-SCI) and HAM-D (r=0.487, P=.001) and PSQI (r=0.312, P=.039). “Pain Severity” was significantly higher in the “impaired sleep” group (P<.05) than in the “normal sleep” group and in the “depression” group (P<.05) than in the “no depression” group. CONCLUSION We identified a strong interrelationship between SCI-related “Pain Severity” and both depression and sleep quality. Hence, a comprehensive pain examination and management strategies including psychosocial interventions should be given particular consideration to address the critical issue of chronic pain in individuals with SCI.