Buse Ozcan Kahraman

Developing a Reliable Core Stability Assessment Battery for Patients with Nonspecific Low Back Pain.

Study Design. Test-retest design. Objective. The objective was to examine the intrarater (test-retest) reliability of the core stability related tests and to develop a reliable core stability assessment battery. Summary of Background Data. Studies suggest that core stability exercises may improve function and decrease pain in patients with nonspecific low back pain (LBP). Reliable clinical tests are required to implement adequate rehabilitation and to evaluate results of these interventions. Methods. The study had a test-retest design. Thirty-three different tests that might relate to core stability were identified with their mostly used protocols. Five different components of core stability including endurance, flexibility, strength, functional performance, and motor control were assessed in 38 patients with nonspecific LBP. The same testing procedure was performed again after 48 to 72 hours. Intraclass correlation coefficients (ICCs), standard error of measurement, and minimal detectable change were calculated to assess the intrarater reliability. Results. The intrarater reliability of the tests ranged from little to very high (ICC = 0.08–0.98). Partial curl-up (ICC = 0.90), lateral bridge (ICC = 0.95–0.96), trunk flexor endurance (ICC = 0.97), sit and reach (ICC = 0.98), single-legged hop (ICC = 0.98–0.97), lateral step-down (ICC = 0.93–0.92), eyes open right and left leg unilateral stance (ICC = 0.97 and 0.91) tests had the highest intrarater reliability for each core stability component. Conclusion. The results indicated that the partial curl-up test (strength), side bridge and trunk flexor tests (endurance), sit-and-reach test (flexibility), single-legged hop, and lateral step-down (functional), unilateral stance test with eyes open (motor control) had very high intrarater reliability. A core stability assessment battery involving these tests can be used in patients with nonspecific LBP to assess all components of core stability. Level of Evidence: 3

Gender differences in postural control in people with nonspecific chronic low back pain

BACKGROUND Many studies have reported that there are several differences between genders which may result in altered neuromuscular control. Although the existing evidence suggests that low back pain (LBP) affects the ability to control posture, there is little evidence the gender differences in postural control in people with nonspecific chronic LBP. RESEARCH QUESTION Are there any gender differences in postural control and correlations between postural control, pain, disability, and fear of movement in people with nonspecific chronic LBP? METHODS Static and dynamic postural control were evaluated using a computerized postural control assessment tool including assessments for limits of stability (LOS), unilateral stance, and modified clinical test of sensory interaction on balance. Pain intensity and fear of movement were assessed using a visual analogue scale and the Tampa Scale of Kinesiophobia, respectively. RESULTS This cross-sectional study included 51 people (25 females and 26 males) with nonspecific chronic LBP. Mean reaction time in the LOS test was significantly less in male participants compared with females when adjusted for pain intensity and disability level, F(1,45) = 4.596, p = .037, ηp2 = 0.093. There was no significant difference in the remaining LOS variables as well as unilateral stance, and modified clinical test of sensory interaction on balance variables between the genders (p > .05). Many correlations were observed between the LOS variables, pain intensity, and Tampa Scale of Kinesiophobia score in female participants (p < .05). The Tampa Scale of Kinesiophobia score was also correlated with the movement velocity and endpoint excursion in the LOS test in the male participants (p < .05). SIGNIFICANCE This study suggests that there is no difference in most of the static and dynamic postural control variables between females and males; however, higher fear of movement, and pain intensity during activity are more associated with impaired dynamic balance in females with nonspecific chronic LBP.

Tampa Scale of Kinesiophobia for Heart Turkish Version Study: cross-cultural adaptation, exploratory factor analysis, and reliability.

Purpose Individuals with cardiac problems avoid physical activity and exercise because they expect to feel shortness of breath, dizziness, or chest pain. Assessing kinesiophobia related to heart problems is important in terms of cardiac rehabilitation. The Tampa Scale of Kinesiophobia Swedish Version for the Heart (TSK-SV Heart) is reliable and has been validated for cardiac diseases in the Swedish population. The aim of this study was to investigate the reliability, parallel-form validity, and exploratory factor analysis of the TSK for the Heart Turkish Version (TSK Heart Turkish Version) for evaluating kinesiophobia in patients with heart failure and pulmonary arterial hypertension. Methods This cross-sectional study involved translation, back translation, and cross-cultural adaptation (localization). Forty-three pulmonary arterial hypertension and 32 heart failure patients were evaluated using the TSK Heart Turkish Version. The 17-item scale, originally composed for the Swedish population, has four factors: perceived danger for heart problem, avoidance of exercise, fear of injury, and dysfunctional self. Cronbach’s alpha (internal consistency) and exploratory factor analysis were used to assess the questionnaire’s reliability. Results of the patients in the 6-minute walk test, International Physical Activity Questionnaire, and Nottingham Health Profile were analyzed by Pearson’s correlation analysis with the TSK Heart Turkish Version to indicate the convergent validity. Results Cronbach’s alpha for the TSK Heart Turkish Version was 0.75, indicating acceptable internal consistency. Although exploratory factor analysis showed a different subgroup distribution than the original questionnaire, the model was acceptable for the four-factor model hypothesis. Therefore, the questionnaire was rated as reliable. Conclusion These results supported the reliability of the TSK Heart Turkish Version. Since the acceptable four-factor model fits the subgroups and measures of reliability are sufficiently high, the questionnaire seems reliable for pulmonary arterial hypertension and heart failure patients.

Functional Reach and Lateral Reach Tests in Turkish Children.

ABSTRACT Aims: The functional reach test (FRT) and lateral reach test (LRT) provide important measures of postural stability. The aims of this study were to (1) establish the normative values for FRT and LRT, and (2) examine the effects of age, gender, and various anthropometric measurements on FRT and LRT. Methods: Two hundred eighty children, aged 6–12 years, completed the study. One hundred fifty-two subjects were females. The mean age was 9.0 ± 2.0 years. Each child performed two trials of FRT and LRT. Results: No significant differences were detected in any age group between males and females. The normal values of FRT ranged between 23.0 and 36.5 cm, and that of LRT between 18.0 and 28.0 cm. Height, length of upper and lower extremity, and arm span had a higher correlation with FRT. Age and weight showed a good correlation with FRT. Age, height, weight, length of upper and lower extremity, and arm span showed good correlation with LRT. Conclusions: These normative data will be useful for clinicians in the assessment of balance of individual children and in the diagnosis of potential balance deficits at an early age in the Turkish population.

Effect of disease severity on upper extremity muscle strength, exercise capacity, and activities of daily living in individuals with pulmonary arterial hypertension

OBJECTIVE Pulmonary arterial hypertension (PAH) is a rare disease. Although muscle strength, exercise capacity, quality of life, and activities of daily living of patients with PAH are affected, it is not known how they are affected by disease severity. The purpose of the present study was to investigate effects of disease severity on upper extremity muscle strength, exercise capacity, and performance of activities of daily living in patients with PAH. METHODS Twenty-five patients with disease severity classified according to the New York Heart Association (NYHA) as functional class II (n=14) or class III (n=11) were included in the study. Upper-extremity exercise capacity and limitations in performing activities of daily living were assessed with 6-minute pegboard and ring test (6PBRT) and the Milliken activities of daily living scale (MAS), respectively. Shoulder flexion, elbow extension, elbow flexion muscle strength, and handgrip strength were measured with dynamometer. RESULTS There were no significant differences in age, gender, body mass index, or mean pulmonary artery pressure between groups (p>0.05). The 6PBRT, MAS, and elbow flexion (right) and grip strength (right and left) results were significantly lower in NYHA III group than in NYHA II group (p=0.004, p=0.002, p=0.043, p=0.002 and p=0.003, respectively). There was no significant difference in shoulder flexion, elbow flexion (left), or elbow extension between groups (p>0.05). CONCLUSION Results suggest that upper extremity exercise capacity, elbow flexion muscle strength (right), and handgrip strength decrease and that limitations in activities of daily living grow as disease severity increases in patients with PAH. When planning rehabilitation programs, disease severity should be considered and evaluations and treatments for the upper extremities should be included.

Clinical correlation between the 6-min walk test andcardiopulmonary exercise testing in patients with pulmonary arterial hypertension.

BACKGROUND/AIM The aims of the present study were to assess the relationship between the distance walked during the 6-min walk test (6MWT) and exercise capacity as determined by cardiopulmonary exercise testing (CPET) in patients with pulmonary arterial hypertension (PAH) and to investigate the prognostic value of the 6MWT in comparison to clinical parameters of CPET and echocardiography findings. MATERIALS AND METHODS Thirty PAH patients participated in the study. Subject characteristics and New York Heart Association (NYHA) classifications were recorded. All subjects completed the 6MWT and CPET. Relationships among the variables were analyzed by the Pearson correlation test. Correlation coefficients between 6MWT distance and other variables were determined by linear regression analysis. RESULTS Distance walked in the 6MWT was significantly correlated with the following exercise parameters: peak oxygen consumption, work load, and metabolic equivalents. Additionally, cardiac index was correlated with peak oxygen consumption and metabolic equivalents. We also showed that cardiac index and age were two significant determinants for exercise performance, accounting for 35.4% of the variance in the 6MWT. CONCLUSION The 6MWT provides information that may be a better index for the patients NYHA functional class determination than maximal exercise testing.