Banu Kuran

Efficacy of dynamic lumbar stabilization exercise in lumbar microdiscectomy.

OBJECTIVE The aim of this study was to determine the efficacy of dynamic lumbar stabilization exercises in patients with lumbar microdiscectomy. DESIGN A prospective, randomized, controlled study. SUBJECTS Forty-two patients who were diagnosed as having lumbar disc herniation and had been operated on using the microdiscectomy method were divided randomly into 3 groups. METHODS Dynamic lumbar stabilization exercises were set for the first group and a home exercise programme for the second. The third group given no exercises was considered as a control group. All patients were examined twice, once before the exercise programme and once 8 weeks later. RESULTS Improvement in the first group was highly significant after the treatment (p < 0.0001). The second group improved significantly more in some parameters (pain, functional disability, lumbar Schober, progressive isoinertial lifting evaluation (neck), trunk endurance (flexion-extension)) than did the third group. The third group of patients showed some improvement in fingertip-floor distance, functional disability, modified lumbar Schober and left rotation in 8 weeks, but there were no significant improvements in the other parameters. CONCLUSION Dynamic lumbar stabilization exercises are an efficient and useful technique in the rehabilitation of patients who have undergone microdiscectomy. They relieve pain, improve functional parameters and strengthen trunk, abdominal and low back muscles.

Efficacy of salmon calcitonin in complex regional pain syndrome (type 1) in addition to physical therapy

The aim of the study was to assess the efficacy of salmon calcitonin, which was suggested as effective in the treatment of complex regional pain syndrome type 1 (CRPS 1). Patients who had suffered trauma to their upper extremities and developed CRPS 1 were included into this randomised, controlled single-blind study. The diagnosis was made according to the clinical examination and scintigraphy. The evaluation parameters were: pain [visual analogue scale (VAS)], the angle of dorsiflexion (DF) and palmar flexion (PF) of the wrist, distance between the fingertip and distal palmar crease (FT-DPC), allodynia, hyperalgesia and trophic changes. One group received paracetamol 1500 m/day and the other group salmon calcitonin 200 IU/day for 2 months. All of the patients participated in a physical therapy and exercise programme. A total of 35 patients were divided into two groups, who were found to be similar for age, body mass index, period of trauma, period of rest in a plaster splint or bandage, the duration of symptoms, VAS, DF and PF angle, FT-DPC, presence of allodynia, hyperalgesia and trophic changes (p>0.05). The control examination showed similar results for allodynia, hyperalgesia and trophic changes, whereas remarkable improvement was observed in the rest of the parameters within groups. On the other hand, between the two groups there was no significant difference in any of the parameters (p>0.05) This randomised, single-blind study showed that all of the patients with acute CRPS 1 in their upper extremities after trauma, who were treated with either paracetamol or calcitonin along with physical therapy, recovered in all parameters significantly, but without any difference between groups. We can conclude that calcitonin does not make any favourable contribution in the treatment of patients with acute CRPS 1; physical therapy combined with only a simple analgesic is an efficient means of therapy.

Blind or ultrasound-guided corticosteroid injections and short-term response in subacromial impingement syndrome: a randomized, double-blind, prospective study.

ObjectiveThe aim of this study was to compare the accuracy of blind vs. ultrasonography-guided corticosteroid injections in subacromial impingement syndrome and determine the correlation between accuracy of the injection location and clinical outcome. DesignForty-six patients with subacromial impingement syndrome were randomized for ultrasonography-guided (group 1, n = 23) and blind corticosteroid injections (group 2, n = 23). Magnetic resonance imaging analysis was performed immediately after the injection. Changes in shoulder range of motion, pain, and shoulder function were recorded. All patients were assessed before the injection and 6 wks after the injection. ResultsAccurate injections were performed in 15 (65%) group 1 patients and in 16 (70%) group 2 patients. There was no statistically significant difference in the injection location accuracy between the two groups (P > 0.05). At the end of the sixth week, regardless of whether the injected mixture was found in the subacromial region or not, all of the patients showed improvements in all of the parameters evaluated (P < 0.05). ConclusionsBlind injections performed in the subacromial region by experienced individuals were reliably accurate and could therefore be given in daily routines. Corticosteroid injections in the subacromial region were very effective in improving the pain and functional status of patients with subacromial impingement syndrome during the short-term follow-up.

Quality of life assessments with SF 36 in different musculoskeletal diseases

The aim of this study is to evaluate comparatively the life quality of patients with knee osteoarthritis (KO), shoulder impingement syndrome(SIS), fibromialgia(FM), or osteoporosis(OP) using SF 36 and establish the impact of these diseases on quality of life (QoL). A total of 193 patients with one of the above-mentioned different diagnoses completed SF 36 scale. The diseases were compared to each other with SF 36 subgroups scores. There were significant differences among patients with KO and SIS,SIS and FM with respect to all SF 36 subgroups scores. According to these assessments, QoL of KO and FM patients was worst than that of SIS. The QoL scores of KO patients were worse than those of FM patients considering the physical function, while QoL scores of FM patients were lower than those of KO patients with respect to their general well-being. Scores of physical function and pain in KO patients were lower than those of OP patients. In domains of social functioning, emotional role, energy, pain, and general health condition QoL of FM patients was worse than that of OP patients. Quality of life of SIS patients was less affected than the patients of the other disease groups. In spite of their young age, FM patients appear to be the group with the worst quality of life scores.

Reiter Syndrome Following Intracavitary BCG Administration

BCG vaccine was given intravesically to a patient with bladder tumour. After the fifth dose she developed bilateral conjunctivitis, painful swelling in her wrist, dysuria and arthritis in her left knee and right metacarpophalangial joints. The diagnosis was Reiter syndrome and is the second case in the literature.

Psychometric characteristics of Duruoz Hand Index in patients with traumatic hand flexor tendon injuries

Introduction. The aim of the study was to assess reliability, validity and responsiveness of Duruoz Hand Index (DHI), which has been developed for evaluation of activity limitation in rheumatoid arthritis in patients with traumatic hand flexor tendon injuries. Material and method. Sixty-five patients older than 16 years who underwent surgical intervention after flexor tendon injuries were enrolled. Reliability was assessed by internal consistency (with Cronbachs-α) and test-retest intraclass correlation coefficient (ICC). Construct validity was estimated correlating the scale with the DASH and VAS-hd. Also responsiveness was estimated using standardised response mean (SRM) and effect size (ES). Result. Mean age of the patients was 30.25  ±  11.07 years and totally 140 fingers were evaluated. Cronbachs-α and ICC values of DHI were found to be 0.87 and 0.99, respectively. In validation study, highly significant correlation was detected between DHI with DASH and VAS-hd (r  ==  0.86, r  ==  0.54, p  <  0.0001, respectively). SRM values and ES values (excepting workplaces subgroup score) were higher than 0.80 for total and all subgroup scores. Conclusion. DHI is a reliable, valid questionnaire to assess hand-related activity limitation in patients with traumatic hand flexor tendon injuries. Also, due to its high level responsiveness DHI can be used for assessing the clinical course of the traumatic hand flexor tendon injured patient.

The Efficacy of Physical Therapy and Physical Therapy Plus Calcitonin in the Treatment of Lumbar Spinal Stenosis

Purpose The aim of our study was to compare the efficacy of physical therapy alone and in combination with calcitonin in patients with neurogenic claudication (NC). Materials and Methods In this single blind, and randomized study, patients with lumbar spinal canal stenosis who were diagnosed by clinical findings and MRI and having NC were included. Patients were observed for 8 weeks and evaluated before and after treatment. Patients were randomized between the salmon calcitonin 200 U/day + physical therapy (n = 23) (Group 1) and paracetamol 1,500 mg/day + physical therapy (n = 22) (Group 2) treatment groups. Both groups received the same physical therapy (interferential current + hot pack + short wave diathermy) and exercise protocol. The association of various clinical and functional parameters was assessed statistically by using paired and unpaired t test, chi square test and McNemars test. p < 0.05 indicated statistical significant. Results Mean age of the patients in Group 1 was 57.6 ± 11.2 and in Group 2 54.5 ± 10.6 years. Before treatment, there were no significant differences between groups with respect to age, body mass index, spinal axial diameter, Visual Analogue Scale (VAS), spinal mobility, functional status and walking distance (p > 0.05). After 8 weeks of treatment, both groups benefited significantly with respect to VAS, functional status and walking distance (p < 0.001). There was no statistically significant difference between groups (p > 0.05). Conclusion In 45 patients with lumbar spinal stenosis who received 8 weeks of treatment, concomitant use of calcitonin with physical therapy and exercise did not have any benefical effect on the patients pain, functional status, lumbar mobility and walking distance.

Long-term follow-up of patients with spinal cord injury.

Objective. The aim of this study was to evaluate the motor, sensory, and functional recovery in patients with spinal cord injury (SCI). Methods. Forty-one patients with SCI participated in this study. Twenty patients were evaluated after discharge. Each patient was evaluated by the American Spinal Injury Association (ASIA) impairment scale and the Functional Independence Measure (FIM) at admission, before discharge, and at least at 6 months after discharge. Friedman, Dunn, and Mann-Whitney U tests were used for statistical analysis. Results. There were 17 male and 3 female patients. Seven patients had complete SCI, and 13 patients had incomplete SCI. The evaluation of motor, sensory, and FIM scores at admission showed significant improvement in all of the patients during the follow-up period (P < 0.0001). Five incompletely injured cases improved with regard to ASIA staging. Motor and FIM scores significantly increased at follow-up for converted and unconverted patients. All parameters increased at follow-up in patients who were complete and incomplete. Motor scores significantly increased at discharge and at follow-up. FIM scores also increased significantly at follow-up in incomplete patients. Conclusion. Motor, sensory, and FIM scores increased in patients with SCI after a follow-up period of 18 months. Improvement to a higher ASIA stage could be accomplished by 25% of the patients. Although both complete and incomplete patients recovered significantly at the follow-up period, only incompletely injured cases could convert to a higher ASIA stage.

Which questionnaire is more effective for follow-up diagnosed subacromial impingement syndrome? A comparison of the responsiveness of SDQ, SPADI and WORC index.

OBJECTIVES To compare responsiveness for the two region specific questionnaires Shoulder Disability Questionnaire (SDQ) and Shoulder Pain Disability Index (SPADI) and the disease specific Western Ontario Rotator Cuff (WORC) index in subacromial impingement syndrome (SIS) receiving physical therapy or subacromial corticosteroid injection. MATERIAL AND METHODS Sixty-four patients with SIS diagnosed participated in this study. All the patients were provided either physical therapy or subacromial corticosteroid injection treatment. The SDQ, the SPADI and WORC index were assessed both at the beginning and after the 3rd month of treatment. The responsiveness of the three questionnaires was compared by using the effect size (ES), the standardized responsiveness mean (SRM) and Guyatts method. RESULTS For both treatment groups there was no statistical difference observed between the pre- and post treatment measurement results versus improvement differences (p> 0.05). SDQ (ES=0.94; SRM=1.14; Guyatt value=0.95), SPADI (ES=1.55; SRM=2.14; Guyatt value=1.08), WORC index (ES=1.37; SRM=1.70; Guyatt value=1.15) were highly responsive for SIS. CONCLUSIONS The SDQ, the SPADI and the WORC index are suitable for measuring changes in patients with SIS. Of these three indices, the SDQ and the SPADI are more suitable for a rapid assessment whereas the WORC index is better in cases where a more detailed assessment including the psychological impact created by the functional status needs to be assessed.

Reliability and validity of the Turkish version of the Nottingham Extended Activities of Daily Living Scale

Background and aims: The aim of this study was to develop a Turkish version of the Nottingham Extended Activities of Daily Living Scale (NEADLS) and to assess its reliability and validity. Methods: Sixty healthy volunteers over 67 years old were included in the study. After translation, the Turkish version of the scale was filled in by each participant over a period of 2 weeks. Reliability was assessed by internal consistency, test-retest intraclass correlation coefficient (ICC) and Spearman’s correlation. Converging validity was determined correlating the scale with the Modified Barthel Index (MBI). Results: The mean age of participants was 77±5.67 years. In the reliability studies, internal consistency within the subsections and items of the NEADLS was good and very good, with Cronbach’s a values ranging between 0.84–0.93 and 0.74–0.97 respectively. The Cronbach’s a for the total NEADLS score was also determined as 0.97. Test-retest intraclass correlation coefficients, determined as 0.97 in total score, ranged from 0.84–0.97 between items. The converging validity study for the NEADLS total score was correlated with the MBI and the r value was found statistically significant (r=0.84, p<0.0001). Conclusions: The Turkish version of the NEADLS is a reliable and valid scale and can be used in activities of daily living assessment of Turkish elderly persons.