Deniz Evcik

New Approach in Fibromyalgia Exercise Program: A Preliminary Study Regarding the Effectiveness of Balance Training

OBJECTIVES To determine the effectiveness of balance exercises on the functional level and quality of life (QOL) of patients with fibromyalgia syndrome (FMS) and to investigate the circumstances associated with balance disorders in FMS. DESIGN Randomized controlled trial. SETTING Physical medicine and rehabilitation clinic. PARTICIPANTS Patients (N=57) (age range, 18-65y) with FMS were randomly assigned into 2 groups. INTERVENTIONS Group 1 was given flexibility and balance exercises for 6 weeks, whereas group 2 received only a flexibility program as the control group. MAIN OUTCOME MEASURES Functional balance was measured by the Berg Balance Scale (BBS), and dynamic and static balance were evaluated by a kinesthetic ability trainer (KAT) device. Fall risk was assessed with the Hendrich II fall risk model. The Nottingham Health Profile, Fibromyalgia Impact Questionnaire (FIQ), and Beck Depression Inventory (BDI) were used to determine QOL and functional and depression levels, respectively. Assessments were performed at baseline and after the 6-week program. RESULTS In group 1, statistically significant improvements were observed in all parameters (P<.05), but no improvement was seen in group 2 (P>.05). When comparing the 2 groups, there were significant differences in group 1 concerning the KAT static balance test (P=.017) and FIQ measurements (P=.005). In the correlation analysis, the BDI was correlated with the BBS (r=-.434) and Hendrich II results (r=.357), whereas body mass index (BMI) was correlated with the KAT static balance measurements (r=.433), BBS (r=-.285), and fall frequency (r=.328). CONCLUSIONS A 6-week balance training program had a beneficial effect on the static balance and functional levels of patients with FMS. We also observed that depression deterioration was related to balance deficit and fall risk. Higher BMI was associated with balance deficit and fall frequency.

Correlations among enthesitis, clinical, radiographic and quality of life parameters in patients with ankylosing spondylitis.

Abstract Objectives. To investigate the relationship between enthesitis and disease activity, functional status, fatigue, joint mobility, radiological damage, laboratory parameter and quality of life in patients with ankylosing spondylitis (AS). Methods. A total of 421 patients with AS (323 male and 98 female) who were included in the Turkish League Against Rheumatism Registry were enrolled in the study. The Bath AS Disease Activity Index (BASDAI), fatigue, the Bath AS Functional Index (BASFI), the Bath AS Metrology Index (BASMI), the Maastricht AS Enthesitis Score (MASES), AS quality of life (ASQoL), the Bath AS Radiology Index (BASRI) and erythrocyte sedimentation rate (ESR) were evaluated. Results. Enthesitis was detected in 27.3% of patients. There were positive correlations between MASES and BASDAI, BASFI and fatigue (p < 0.05). MASES was not correlated with BASRI, BASMI, ASQoL and ESR. The mean MASES score was 1.1 ± 2.4. The most frequent regions of enthesopathies were right iliac crest, spinous process of L5 and proximal to the insertion of left achilles tendon, respectively. Conclusions. Enthesitis was found to be associated with higher disease activity, higher fatigue, worse functional status and lower disease duration. As enthesitis was correlated with BASDAI, we conclude that enthesitis can reflect the disease activity in patients with AS.

The Effectiveness of Portable Audio Biofeedback Device in Myofascial Pain Syndrome in Neck and Upper Trapezius Muscles

Abstract Objective: The aim of this study was to investigate the effectiveness of a portable audio biofeedback device in the treatment of myofascial pain syndrome [MPS]. Methods: Patients referred to the clinic with MPS involving the upper neck and trapezius who were were randomly assigned into two groups. Group 1 was to use a portable audio biofeedback device for 30 min twice a day in addition to completing a home based exercise program. Group 2 received only the home-based exercise program. The home-based exercise program was comprised of neck isometric-isotonic, back extensor stretching and posture exercises five times a week, performing each exercise once a day with 15 repetitions for 4 weeks. Measurements were taken before and after the treatment. The severity of the pain was measured by visual analog scale. The number of trigger points, pressure pain threshold, cervical joint range of motion and head-shoulder angles were also recorded. Disability was assessed by the Neck Pain Disability Scale. Results: About 90 patients with MPS were recruited and 60 patients [45 females, 15 males, 30 patients per treatment group] completed the study. All parameters were improved in both groups [p < 0.05] except cervical range of motion values [p > 0.05] after the treatment. In Group 1, more improvements were detected in head angles compared to Group 2 and the differences were statistically significant [p = 0.017]. There were statistically significant differences between the groups in head angles, while no significant differences were detected in the visual analog scale, number of trigger points, pressure pain threshold, cervical range of motion, shoulder angle or Neck Pain Disability Scale scores [p > 0.05] after the treatment. Conclusion: Exercise therapy seems to be effective in the treatment of MPS; however, portable audio biofeedback treatment does not provide any additive effect except correcting head angle in the treatment of MPS.

Laser Acupuncture Treatment Improves Pain and Functional Status in Patients with Subacromial Impingement Syndrome: A Randomized, Double-Blind, Sham-Controlled Study

Objective The present study aims to determine the effect of laser acupuncture in patients with subacromial impingement syndrome (SAIS). Design Randomized, double-blind, sham-controlled study. Setting Physical medicine and rehabilitation outpatient clinic. Subjects A total 73 patients with SAIS were randomly assigned into a treatment group (n = 36) and a control group (n = 37). Methods The treatment group received laser acupuncture, and the control group received sham laser acupuncture. Eleven acupuncture points (GB 21, LI 4, LI 11, LI 14, LI 15, LI 16, SI 9, SI 10, SI 11, TE 14, and TE 15) were irradiated using a gallium-aluminium-arsenide continuous wave diode-laser, with a wavelength of 850 nm and a power output of 100 mV. The laser acupuncture treatment at each acupuncture point was administered at 4 joules/cm 2 (total dose = 40 joules). All patients were also treated with a hot pack. The patients were assessed at baseline and after 15 sessions of laser treatment. Pain severity and doctors and patients global assessments were measured via visual analog scale (VAS). Range of motion (ROM) and functional status were measured using a digital inclinometer and the Shoulder Pain Disability Index, respectively. Results Statistically significant improvements were observed in all parameters in the treatment group. All parameters of pain and functional status in the treatment group were significantly better than those in the control group at week 3. Conclusions To the best of our knowledge, this is the first study that investigates the effect of laser acupuncture in SAIS. The positive results of the present study should lead to further laser acupuncture studies with combinations of different acupuncture points, at different wavelengths, and with long-term follow-up periods.

The effectiveness of Kinesio Taping on pain and disability in cervical myofascial pain syndrome

OBJECTIVE The aim of this study was to investigate the effectiveness of Kinesio Taping and sham Kinesio Taping on pain, pressure pain threshold, cervical range of motion, and disability in cervical myofascial pain syndrome patients (MPS). METHODS This study was designed as a randomized, double-blind placebo controlled study. Sixty-one patients with MPS were randomly assigned into two groups. Group 1 (n=31) was treated with Kinesio Taping and group 2 (n=30) was treated sham taping five times by intervals of 3 days for 15 days. Additionally, all patients were given neck exercise program. Patients were evaluated according to pain, pressure pain threshold, cervical range of motion and disability. Pain was assessed by using Visual Analog Scale, pressure pain threshold was measured by using an algometer, and active cervical range of motion was measured by using goniometry. Disability was assessed with the neck pain disability index disability. Measurements were taken before and after the treatment. RESULTS At the end of the therapy, there were statistically significant improvements on pain, pressure pain threshold, cervical range of motion, and disability (p<0.05) in both groups. Also there was a statistical difference between the groups regarding pain, pressure pain threshold, cervical flexion-extension (p<0.05); except cervical rotation, cervical lateral flexion and disability (p>0.05). CONCLUSION This study shows that Kinesio Taping leads to improvements on pain, pressure pain threshold and cervical range of motion, but not disability in short time. Therefore, Kinesio Taping can be used as an alternative therapy method in the treatment of patients with MPS.

THU0324 Is Balance Training Exercise Program Effective in Fibromiyalgia Syndrome

Background Central nervous system dysfunction in fibromiyalgia syndrome (FMS) may affect other sensorimotor functions of the patients, besides widespread pain. Balance disorder in FMS was stated in a few studies. Objectives To determine the effectiveness of the balance training exercise program in FMS and to find out the factors that associate with balance disorders in FMS. Methods A total of 68 patients, aged 18-65, diagnosed with FMS, joined in 6 weeks exercise program. The patients were randomly assigned into two groups. Group 1 (n=35) recieved flexibility exercises (15 min./day), balance exercises recommended by American Sport College (20 min./day) for 5 days a week and static (5min./day) and dynamic (5min./day) balance training with Kinesthetic Ability Trainer (KAT) 4000 device for 3 days a week (each one 5 min./day). Group 2 (n=33) received only flexibility program for 5 days a week. Patients were evaluated by means of balance, fall risk,functional level, quality of life and depression. Functional balance was measured by Berg Balance Scale (BBS), dynamic and static balance were assessed by Sport Kinesthetic Ability Trainer (KAT) 4000 device. Fall risk of the patients was specified by Hendrich II Fall Risk Model. Fibromiyalgia Impact Questionnaire (FIQ), Nottingham Health Profile were used to determine functional level and quality of life and Beck Depression Inventory was applied to evaluate depression level. The assesments were performed at baseline and after six week at end of the exercise program. Results Exercise program was accomplished by 57 patients and there were no significant differences between group 1 (n=28, mean age=48.11±13.42) and group 2 (n=29, mean age=48.17±12.68) according to sociodemographic characteristics. In balance exercise group statistical significant improvements were observed in all parameters (p<0.05), however there was no improvement in flexibility exercise group (p>0.05) at sixth weeks. In the comparison of two groups, there were significant differences in balance group for KAT 4000 static balance (p=0.017) and FIQ measurements (p=0.005). Additionally negative correlation was shown between depression levels and BBS (r= -0.434, p<0.01), where as depression level was also correlated with fall risk (r=0.357, p<0.01). Conclusions A 6-week balance training program has found to have beneficial effect on static balance and functional level in patients with FMS, however it has no effect on dynamic and functional balance, and quality of life. It was observed that depression is correlated with balance deficit and fall risk. References Russek LN, Fulk GD. Pilot study assessing balance in women with fibromyalgia syndrome. Physiother Theory Pract. 2009 Nov;25(8):555-65. Staud R. Biology and therapy of fibromyalgia: pain in fibromyalgia syndrome. Arthritis Res Ther. 2006;8(3):208. Jones KD, Horak FB, Winters-Stone K, Irvine JM, Bennett RM. Fibromyalgia is associated with impaired balance and falls. J Clin Rheumatol. 2009 Feb;15(1):16-21. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.4211

SAT0417 Cost-Effectiveness of Inpatient and Outpatient Physical Therapy of Patients with Lumbar Intervertebral Disc Herniation

Background Low back pain is a common health problem and is quite important because of high costs due to direct and indirect costs for the community (1,2) Objectives The aim of this study is to compare cost-effectiveness of inpatient and outpatient physical therapy programs for patients with lumbar intervertebral disc herniation. Methods Sixty patients withlumbar intervertebral disc herniation diagnosed by using Magnetic Resonance Imaging were included in the study. Patients were divided into two groups; Group 1 (n=30) received inpatient Physical therapy program (electrotherapy, superficial-deep heat administration and basic lumbar exercise program) and group 2 (n=30) received outpatient physical therapy program (the same treatment schedule). Assessment parameters were pain, functional capacity and quality of life(QoL). Pain intensity, patients’ global assesment and doctor’s global assessment were measured with visual analog scale (VAS), functional capacity with Rolland Morris disability questionnaire and QoL with short form 36 (SF-36). The expenses spent were calculated as direct health, direct non-health and indirect costs. All expenditures and all measurements were assessed for five times during the entire study: before treatment, just after treatment, and after first, third and sixth months of the treatment. Results In our study, we found that out-patient treatment had the the lowest cost compared to inpetient group. The estimated total costs for 6 months of out-patient and in-patient treatments were1.804,330TL (approximately 753.195 EUR) and 3.885,943TL (approximately 1.621,98 EUR) respectively. Total utilities of these treatments were 2,28 and 3,16 respectively. An additional 2.359,179TL (approximately 984 EUR) per one patient were gained compaired to in-patient treatment Conclusions This study suggested that physical therapy programs were effective in the treatment of lumbar intervertebral disc herniation. However, inpatient physical therapy program was more cost and more effective than outpatient physical therapy program References Critchley DJ, Ratcliffe J, Noonan S, Jones RH, Hurley MV. Effectiveness and cost-effectiveness of three types of physiotherapy used to reduce chronic low back pain disability: a pragmatic randomized trial with economic evaluation. Spine (Phila Pa 1976). 2007 Jun 15;32(14):1474-81. Maas ET, juch JN, Groeneweg JG, Ostelo RW, Koes BW, Verhogen AP, van Raamt M, Wille F, Huygen FJ, van Tulder MW. Cost-effectiveness of minimal interventional procedures for chronic mechanical low back pain: design of four randomized controlled trials with an economic evalution BMJ Musculoskelet disord 2012 Dec 28;13:260 Disclosure of Interest None Declared