Berrin Durmaz

Impact of post-polio-related fatigue on quality of life.

OBJECTIVE To assess the impact of post-polio-related fatigue on quality of life. DESIGN Cross-sectional case control study. SUBJECTS Patients without additional health problems that may induce fatigue were selected from among 82 polio survivors. Twenty-six patients with post-polio syndrome and 10 without post-polio syndrome were included. Control group consisted of 30 healthy volunteers. METHODS We assessed presence and severity of fatigue by Fatigue Severity Scale, quality of life by Nottingham Health Profile, and impact of fatigue on quality of life by Fatigue Impact Scale. Leg muscle strength was measured by manual muscle testing. RESULTS Strength of leg muscles showed no differences between the patients with and without post-polio syndrome. Patients with post-polio syndrome reported significantly higher levels of fatigue and reduced quality of life compared with both patients without post-polio syndrome and control group. Fatigue Impact Scale revealed that fatigue did not significantly impair mental health, but had a negative impact especially on physical and psychosocial functioning of the patients with post-polio syndrome. CONCLUSION Post-polio-related fatigue seems to be an important factor for further impairment of quality of life in polio survivors.

EFFICACY OF NECK STABILIZATION EXERCISES FOR NECK PAIN: A RANDOMIZED CONTROLLED STUDY

OBJECTIVE To determine the efficacy of neck stabilization exercises in the management of neck pain. PATIENTS AND METHODS Sixty patients with neck pain were randomized to 3 groups, as follows: group 1--physical therapy agents including transcutaneous electrical nerve stimulation, continuous ultrasound and infra-red irradiation; group 2--physical therapy agents + isometric and stretching exercises; and group 3--physical therapy agents + neck stabilization exercises. The exercises were performed as a home training programme following a 3-week supervised group exercise. The patients were evaluated with a visual analogue scale, by intake of paracetamol, Neck Disability Index, Beck Depression Scale and range of motion in the 3 planes at baseline and at months 1, 3, 6, 9 and 12. RESULTS Compared with baseline, all groups showed a significant decrease in visual analogue scale scores during the first 6 months. However, this improvement was maintained only in group 3 at 9 and 12 months, with a significant difference among the groups (p<0.05). During the study, the improvement in disability was marked in group 3 with respect to Neck Disability Index, Beck Depression Scale and range of motion in the frontal plane (p<0.05). CONCLUSION This study demonstrates the superiority of the neck stabilization exercises, with some advantages in the pain and disability outcomes, compared with isometric and stretching exercises in combination with physical therapy agents for the management of neck pain.

Short-term effects of aerobic exercise on functional capacity, fatigue, and quality of life in patients with post-polio syndrome

Objective: To investigate and compare the impact of hospital and home exercise programmes on aerobic capacity, fatigue, and quality of life in patients with post-polio syndrome. Design: A prospective, randomized controlled trial. Setting: Department of Physical Medicine and Rehabilitation, University Hospital. Subjects: Thirty-two patients were divided into two groups for either hospital- or home-based aerobic exercise programme. Main outcome measures: Patients were assessed before and after the rehabilitation programme, with respect to functional capacity (pVo2), fatigue (Fatigue Severity Scale, Fatigue Impact Scale) and quality of life (Nottingham Heath Profile). Results: After the exercise programme, improvement was observed in the hospital exercise group compared to a pre-exercise period in all Nottingham Heath Profile scores (except sleep scores), pVo2, Fatigue Severity Scale and Fatigue Impact Scale (cognitive, physical, psychosocial, total) (P<0.05). In contrast, in the home exercise group a decrease was observed in pVo2 scores after the rehabilitation programme, compared to a pre-rehabilitation period (P<0.05). In addition, a significant improvement was observed in the home exercise group after the rehabilitation programme in all parameters excluding Fatigue Impact Scale—physical, Fatigue Impact Scale—psychosocial, and Nottingham Heath Profile—sleep (P<0.05). When the two exercise groups were compared, improvement was observed in the hospital exercise group compared to the home exercise group in pVo2 and Fatigue Severity Scale—total, Fatigue Impact Scale—physical, Fatigue Impact Scale—psychosocial, Fatigue Impact Scale—total, and Nottingham Heath Profile—energy scores (P<0.05). Conclusion: Fatigue and quality of life were both improved in the home and hospital exercise groups. An increase was also found in the functional capacity in the hospital exercise group. A regular exercise programme is beneficial to patients with post-polio syndrome.

Complex regional pain syndrome in a patient with spinal cord injury: management with pulsed radiofrequency lumbar sympatholysis

Study design:Short communication.Objectives:To report a case with bilateral lower extremity complex regional pain syndrome (CRPS) in a patient with paraplegia occurring following spinal disc herniation surgery, who was treated successfully with pulse radiofrequency (PRF) lumbar sympatholysis.Setting:Departments of Physical Medicine and Rehabilitation, Algology Department of Anaesthesiology and Nuclear Medicine, Medical Faculty of Ege University, Izmir, Turkey.Methods:A 55-year-old woman had neuropathic pain in her lower extremities after T12–L1 disc herniation surgery. The pain decreased to a tolerable level with conservative treatment and her condition remained stable for the following 6 months; then she developed swelling, redness and severe burning pain in both feet. Physical examination showed edema and redness in the feet. On the basis of clinical findings and Tc-99m methylene diphosphonate (MDP) three-phase bone scintigraphy, she was diagnosed to have CRPS.Results:The patient underwent a diagnostic sympathetic ganglion blockade with bupivacaine, which resulted in a marked decrease in the pain and edema of the feet. Consequently, PRF lumbar sympatholysis was performed with a successful outcome in pain, edema and color changes in the feet.Conclusion:When treatment of CRPS fails with conventional modalities, PRF sympatholysis may be used for control of pain and other symptoms in such patients.

The relationship between depressive symptoms and anxiety and quality of life and functional capacity in heart transplant patients.

ObjectiveTo establish the relationship between depressive symptoms and anxiety with both the quality of life and functional capacity of heart transplant patients.MethodsThirty-four patients were included. Outcome measures were the Beck Depression Inventory (BDI), the State- Trait Anxiety Inventory (STAI), the Short Form 36 (SF36) and peak oxygen consumption (pVO2).ResultsAfter the transplant there was a significant negative correlation between the BDI and most of subgroups on the SF36 (p<0.05). There were significant negative correlations found between the pVO2 and both the BDI and STAI-trait anxiety score (p<0.05). Statistically significant improvements were noted in all subgroups on the SF36 and all BDI scores after the transplant, in comparison to the pre-transplant period (p<0.05).ConclusionsThe functional capacity of a person affects the state of their depression and anxiety. We recommend participation in a cardiac rehabilitation program in the early stages of transplantation and believe that the quality of life, which has been shown to be related to the functional capacity and psychological symptoms, would benefit from this program.

Musculoskeletal pain in elite competitive male swimmers

AbstractMusculoskeletal problems that interfere with effective training is serious and may result in decreased performance in the swimming athlete. The aims of this study were to estimate the prevalence of musculoskeletal pain in our competitive male swimmers, and to investigate the relationship between stroke style and musculoskeletal pain. It was found that 23 of the 38 competitive male swimmers examined reported musculoskeletal pain in this study: 13 had shoulder pain, 7 had low back pain, and 3 had knee pain. Ten swimmers with pain never stopped training, and only one swimmer had to stop swimming for a period of one month. Knee pain was observed only in breaststrokers, but back pain from all strokes. Shoulder pain was not seen in breaststrokers; this pain instead occurred frequently in free-stylers. Injuries leading to pain may be acute or caused by repeated microtraumas, eventually leading to an overuse injury. Corrections of factors contributing to overuse injuries should be properly treated so that...

The prevalence of generalized soft tissue rheumatic conditions in Turkish medical students.

Objective:To assess the prevalence of generalized soft tissue rheumatism (GSTR) in medical students in Izmir, Turkey. Methods:Medical students from each grade of Medical School of Ege University, Izmir, Turkey, were evaluated by a survey and physical examination for GSTR including fibromyalgia (FM) syndrome, myofascial pain syndrome (MPS), benign joint hypermobility syndrome (BJHS), and chronic fatigue syndrome. FM Impact Questionnaire was assessed in FM diagnosed students. Short Form-36 (SF-36) was obtained from each student to determine the quality of life. Results:Among the participants (n = 306), 191 were women (62.4%) and 115 were men (37.6%) and mean age was 20.23 ± 1.56. Fifty-eight students (19%) were diagnosed with a GSTR. The distributions of the diagnoses were: 6 (2%) FM, 21 (6.9%) MPS, 28 (9.2%) BJHS, 1 (0.3%) chronic fatigue syndrome, and 2 students (0.7%) had both BJHS and MPS. Fifty-three (27.7%) women and 5 (4.3%) men were diagnosed with a GSTR (P < 0.01). Mean FM Impact Questionnaire score was 50.8 in FM diagnosed students. Physical role, vitality, and mental subscores of SF-36 were significantly lower in the students having a GSTR (P < 0.05). Conclusion:This is the first study performed in medical students to find out the prevalence of generalized soft tissue rheumatic conditions. Although medical students are under high stress due to hard training, the prevalence of GSTR in medical students was found similar to previous reports in the general population.

Intracranial dural arteriovenous fistula draining into spinal perimedullary veins: a rare cause of myelopathy.

We report a rare case of progressive myelopathy caused by intracranial dural arteriovenous fistula with venous drainage into the spinal perimedullary veins. A 45-yr-old man developed urinary and fecal incontinence and muscle weakness in the lower limbs. Magnetic resonance imaging revealed brainstem edema and dilated veins of the brainstem and spinal cord. Cerebral angiography showed a dural arteriovenous fistula fed by the neuromeningeal branch of the left ascending pharyngeal artery. Occlusion of the fistula could be achieved by embolization after a diagnostic and subsequent therapeutic delay. There was no improvement in clinical condition. For the neurologic outcome of these patients it is important that fistula must be treated before ischemic and gliotic changes become irreversible.

The frequency of fibromyalgia syndrome and quality of life in hospitalized cancer patients.

To explore the frequency of fibromyalgia syndrome (FMS) among hospitalized cancer patients and address the relationships between pain, fatigue and quality of life with regard to the extent of pain, a cross-sectional and descriptive study was carried out in the Oncology Supportive Care Unit on 122 hospitalized cancer patients. Pain, sleep, disease impact (Fibromyalgia Impact Questionnaire), fatigue (Brief Fatigue Inventory), quality of life (Short Form 36 and European Organization for Research on Treatment of Cancer questionnaires Quality of Life-C30) were gathered using standardized measures. Thirteen of the hospitalized cancer patients (10.7%) included in the study were diagnosed with FMS. There were no statistically significant differences among three pain groups with respect to demographic characteristics (P > 0.05). There were significant differences among groups with regard to the presence of metastasis, fatigue, sleep disorder, pain, Brief Fatigue Inventory, Fibromyalgia Impact Questionnaire, most of subscores of Short Form 36 and European Organization for Research on Treatment of Cancer questionnaires Quality of Life-C30 scores (P < 0.05). In the present study, we have calculated the frequency of FMS among patients admitted to the oncology hospital in addition to establishing the relationships between pain, fatigue and quality of life with regard to the extent of pain. We believe that the descriptive data presented in this study would be helpful in future studies and therapeutic approaches.

Does Pretransplantation Etiology Have Any Effect on Exercise Results in Heart Transplant Patients

OBJECTIVE The objective of this study was to analyze the effect of pre-transplantation etiology and post-transplantation exercise on pulmonary function tests, functional capacities, psychological symptoms and quality of life among heart transplant patients. METHODS An eight-week exercise program was applied to 35 heart transplant patients with histories of ischemic heart failure (HF; n = 20) or dilated HF (n = 15). All patients were evaluated before and after exercise in terms of breathing function tests, functional capacity (FVC; maximal oxygen consumption, pVO2), psychological symptoms (Beck Depression Scale (BDS), Spielbergers State-Trait Anxiety Inventory (STAI)) and quality of life (Short Form 36, SF-36). RESULTS At the end of the exercise compared to the pre-exercise period significant improvements were observed in all FVC%, FeV1%, FeV1/FVC%, pVO2, SF 36 scores reflecting physical function, physical role, pain, general health, vitality, social function, and emotional role (P < 0.05) among heart transplant patients who were operated due to ischemic or dilated heart failure. In contrast, no significant improvement was observed in the BDS and STAI scales (P > 0.05). There was no significant etiology-related difference between the groups in terms of the evaluated parameters (P > 0.05). CONCLUSION We demonstrated improvements in function tests, functional capacity and quality of life for both ischemic and dilated heart transplant patients following a supervised exercise program. We concluded that the positive effect achieved by exercise was not related to pre-transplantation etiology. Whatever the preoperative etiology, a regular exercise program is recommended for heart transplant patients in the rehabilitation unit.