Eda Gurcay

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.

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.

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.

Poststroke depression: risk factors and potential effects on functional recovery

The factors that may cause poststroke depression were investigated in the literature focusing on lesion localization, age, stroke severity, and impairments in physical and cognitive function. The aim of this study was to examine the risk factors influencing the development of poststroke depression and to determine the effect of depression on the patients’ functional improvement after rehabilitation. Patients in the first 6-month period after stroke who were hospitalized in the Physical Medicine and Rehabilitation Clinic were included in this study. Patients who were admitted to the hospital within 0–30 and 30–120 days from the date of stroke were considered early and late rehabilitation entrants, respectively. The sample of this study included 93 patients. Patients’ demographic and clinical characteristics, complications, and medical history were recorded. Upper extremity motor function, ambulation, and mood were evaluated according to the Frenchay Arm Test, the Functional Ambulation Scale, and the Beck Depression Inventory, respectively. The Functional Independence Measure (FIM) was applied to patients at admission to the hospital, at discharge, and 1 month after discharge (follow-up). The mean age of the patients was 58 years and the mean disease duration was 53 days. Depression was diagnosed in 49 (53%) patients. Except for age and disease duration, none of the factors of sex, hemiplegic side, stroke severity, stroke etiology, neglect, spasticity, sedentary lifestyle, poststroke immobility, and early-onset or late-onset to rehabilitation was found to induce statistically significant differences in the development of depression. Statistically significant changes occurred in total FIM levels between the groups with and without depression between admission and discharge, admission and follow-up, and discharge and follow-up. The levels were significantly higher in patients without depression than in patients with depression. Depression was found in a high frequency in stroke patients. Younger age and long disease duration were found to be factors affecting the development of depression. FIM scores were observed to be lower in stroke patients with depression.

Ultrasonographic Evaluation of the Radial Nerves in Patients with Unilateral Refractory Lateral Epicondylitis

Objective To evaluate the possible radial nerve entrapment of patients with unilateral refractory lateral epicondylitis (LE) by using ultrasound (US) and electroneuromyography. Design Cross-sectional study. Setting Three physical medicine and rehabilitation departments. Subjects Consecutive 44 patients (15 M, 29 F) with unilateral refractory LE. Methods All patients underwent detailed clinical, electrophysiological and ultrasonographic evaluations. Ultrasound imaging was used to evaluate thickness and presence of abnormal findings of the common extensor tendon (CET) and cross-sectional area (CSA) of the radial nerve (at spiral groove and before bifurcation) bilaterally. Unaffected sides of the patients were taken as controls. Results When compared with the unaffected sides, CET thickness and radial nerve CSAs (at both levels) were higher, and abnormal US findings regarding LE (47.7% vs. 6.8%) were more common on the affected sides than nonaffected sides (all P  < 0.001). Grip strength values were lower on the affected sides ( P  < 0.001). Electrophysiological studies were all normal, and similar between the two sides (all P  > 0.05). When subgroup analyses were performed after taking into account the hand dominance, affected and dominant sides were found to be the same in 31 and different in 13 patients. In subgroups, CETs and radial nerve CSAs at both levels were higher on the affected sides (all P  < 0.01). Conclusions Radial nerves and the CETs seem to be swollen on the affected sides, independent from the hand dominance of the patients with refractory LE. These results morphologically support the previous literature that attributes some of the chronic complaints of these patients actually to radial nerve entrapment.

Myopathy related to vitamin D deficiency in patient with celiac disease.

of Charcot-Marie-Tooth disease. Lancet Neurol 2009;7:654–667. 4. Matthews E, Fialho D, Tan SV, Venance SL, Cannon SC, Sternberg D, et al. The non-dystrophic myotonia: molecular pathogenesis, diagnosis and treatment. Brain 2010;133:9–22. 5. Lehmann-Horn F, Jurkat-Rott K and R€ udel R. Diagnostics and therapy of muscle channelopathies—guidelines of the Ulm Muscle Centre. Acta Myol 2008;XXVII:98—113. 6. Brugnoni R, Kapetis D, Imbrici P, Pessia M, Canioni E, Colleoni L, et al. A large cohort of myotonia congenita probands: novel mutations and a high-frequency mutation region in exons 4 and 5 of the CLCN1 gene. J Hum Genet 2013;58:581–587. 7. Leiden Open Variation Database. Chloride channel 1, skeletal muscle (CLCN1). http://chromium.liacs.nl/LOVD2/; 2012. 8. Aarskog NK, Vedeler CA. Real-time quantitative polymerase chain reaction. A new method that detects both the perypheral myelin protein 22 duplication in Charcot–Marie–Tooth type 1A disease and the peripheral myelin protein 22 deletion in hereditary neuropathy with liability to pressure palsies. Hum Genet 2000;107:494–498. 9. Kim HS, Chung KW, Kang SH, Choi SK, Cho SY, Koo H, et al. Myotonic dystrophy type I combined with X-linked dominant Charcot– Marie–Tooth neuropathy. Neurogenetics 2010;11:425–433. 10. Kurt S, Karner H, Kaplan Y, Akat I, Battaloglu E, Druslu D, et al. Combination of myotonic dystrophy and hereditary motor and sensory neuropathy. J Neurol Sci 2010;288:197–199. 11. Bergman C, Senderek J, Hermanns B, Jauch A, Janssen B, Schroder JM, et al. Becker muscular dystrophy combined with Xlinked Charcot–Marie–Tooth neuropathy. Muscle Nerve 2000;23: 818–823. 12. Schreiber O, Schneiderat P, Kress W, Rautenstrauss B, Senderek J, Schoser B, et al. Facioscapulohumeral muscular dystrophy and Charcot–Marie–Tooth neuropathy 1A—evidence for “double-trouble” overlapping syndromes. BMC Med Genet 2013;14:92. 13. Hodapp JA, Carter GT, Lipe HP, Michelson SJ, Kraft GH, Bird TD. Double trouble in hereditary neuropathy: concomitant mutations in the PMP-22 gene and another gene produce novel phenotypes. Arch Neurol 2006;63:112–117.

Sonographic Guide for Botulinum Toxin Injections of the Neck Muscles in Cervical Dystonia

Intramuscular botulinum toxin (BoTX) injection is the first-line treatment of cervical dystonia. Poor treatment outcomes and some side effects, however, have been reported after BoTX applications. One of the most important reasons is incorrect localization of the needle during toxin injections. Without imaging, it is impossible to verify precise needle positioning in the proper muscle. Ultrasound has been recommended because of its high capability in illustrating most of the neck muscles. This review article discusses how ultrasound imaging can be used to scan/access neck muscles, mainly from the perspective of BoTX injections.