Ela Tarakci

Group exercise training for balance, functional status, spasticity, fatigue and quality of life in multiple sclerosis: a randomized controlled trial

Objective: To determine the effectiveness of group exercise training on balance, functional status, spasticity, fatigue and quality of life in patients with multiple sclerosis. Design: A randomized single-blind controlled study. Setting: University hospital, outpatient physical therapy department. Subjects: Ambulatory patients with multiple sclerosis. Interventions: Exercise group completed a 12-week group exercise programme under the physical therapists’ supervision. Control group was included in the waiting list. Main measures: The primary outcome measures were the Berg Balance Scale, 10-metre walk test, 10-steps climbing test and secondary outcome measures were the Modified Ashworth Scale, Fatigue Severity Scale and Multiple Sclerosis International Quality of Life. Results: Ninety-nine patients completed the study. There were statistically significant improvements for all outcome measures in the group exercise group (n = 51) (p < 0.01). In the control group (n = 48), there were statistically significant negative change in the Berg Balance Scale and 10-metre walk test measures (p = 0.002, p = 0.001) and statistically significant increment only in the Fatigue Severity Scale score (p = 0.002). The Berg Balance Scale score was increased 4.33 in the exercise group, while a decreased of 2.33 in control group. The 10-metre walk test duration (second) was decreased 2.72 in exercise group, while increased 1.44 in control group. In comparing inter-groups changes, both primary and secondary outcome mesures showed significant improvements in favour of the exercise group after the training (p < 0.05). Conclusion: The study demonstrated that supervised group exercise training is effective in improving balance, functional status, spasticity, fatigue and quality of life in moderately affected people with multiple sclerosis, with no worsening of their clinical status.

Wii-based Balance Therapy to Improve Balance Function of Children with Cerebral Palsy: A Pilot Study.

[Purpose] Cerebral palsy is a sensorimotor disorder that affects the control of posture and movement. The Nintendo® Wii Fit offers an inexpensive, enjoyable, suitable alternative to more complex systems for children with cerebral palsy. The aim of this study was to investigate the efficacacy of Wii-based balance therapy for children with ambulatory cerebral palsy. [Subjects] This pilot study design included fourteen ambulatory patients with cerebral palsy (11 males, 3 females; mean age 12.07 ± 3.36 years). [Methods] Balance functions before and after treatment were evaluated using one leg standing, the functional reach test, the timed up and go test, and the 6-minute walking test. The physiotherapist prescribed the Wii Fit activities,and supervised and supported the patients during the therapy sessions. Exercises were performed in a standardized program 2 times a week for 12 weeks. [Results] Balance ability of every patient improved. Statistically significant improvements were found in all outcome measures after 12 weeks. [Conclusion] The results suggest that the Nintendo® Wii Fit provides a safe, enjoyable, suitable and effective method that can be added to conventional treatments to improve the static balance of patients with cerebral palsy; however, further work is required.

EFFICACy OF A LAND-BASED HOME ExERCISE PROGRAMME FOR PATIENTS wITH JUvENILE IDIOPATHIC ARTHRITIS: A RANDOMIzED, CONTROLLED, SINGLE-BLIND STUDy

OBJECTIVE To investigate the effects of a land-based home exercise programme on pain, functional ability and quality of life in patients with juvenile idiopathic arthritis. DESIGN A randomized, controlled, single-blind study. PATIENTS Eighty-one patients with juvenile idiopathic arthritis participated in this study. METHODS Functional ability, pain, and quality of life were assessed with a 6-minute walk test, Childhood Health Assessment Questionnaire, visual analogue scale, and the Pediatric Quality of Life Inventory. The patients were randomly assigned to an exercise or control group. The exercise group (n = 43) completed a 12-week individually planned land-based home exercise programme once a week at the hospital for 4 days per week. The control group (n = 38) was placed on the waiting list until the end of the study. RESULTS Statistically significant improvements (p < 0.001) were found in all the outcome measures in the exercise group. The visual analogue scale score decreased significantly (p < 0.01) in the control group after 12 weeks. Other than the visual analogue scale score (P > 0.05), the changes in the other outcome measures (P < 0.001) were significant in favour of the exercise group. CONCLUSION The study demonstrated that participating in a 12-week individually planned land-based home exercise programme may result in improved physical function and quality of life in patients with juvenile idiopathic arthritis.

Effects of Nintendo Wii-Fit(®) video games on balance in children with mild cerebral palsy.

This study compared the effects of Nintendo Wii‐Fit® balance‐based video games and conventional balance training in children with mild cerebral palsy (CP).

Effect of strengthening versus balance-proprioceptive exercises on lower extremity function in patients with juvenile idiopathic arthritis: a randomized, single-blind clinical trial.

ObjectiveThe aim of this study was to investigate the effects of two exercise programs on lower extremity function in patients with juvenile idiopathic arthritis. DesignThirty patients with juvenile idiopathic arthritis participated in this study. Pain, passive range of motion, muscle strength, balance, and functional abilities were assessed with the Numeric Rating Scale, goniometer, handheld dynamometer, Flamingo Balance Test, Functional Reach Test, 10-meter walking test, 10-stair climbing test, and Childhood Health Assessment Questionnaire. Participants were randomly assigned to the strengthening exercise group (group 1, n = 15) or the proprioceptive-balance exercise group (group 2, n = 15). ResultsIntragroup analysis showed statistically significant improvements in all outcome measures except muscle strength in the hip and ankle after strengthening exercises in group 1. However, statistically significant improvements were found in all outcome measures after the proprioceptive-balance exercises in group 2. Intergroup analysis showed statistically significant improvement in all outcome measures in group 2 except for the Numeric Rating Scale, Childhood Health Assessment Questionnaire, and passive range of motion scores and hip extension and knee flexion muscle strengths. ConclusionsThis study demonstrates that exercise treatment significantly improves musculoskeletal symptoms in patients with juvenile idiopathic arthritis. However, balance-proprioceptive exercises prove to be effective more than strengthening exercises for improving lower extremity function such as walking, climbing stairs, and balance in patients with juvenile idiopathic arthritis.

The effects of very early mirror therapy on functional improvement of the upper extremity in acute stroke patients

[Purpose] The aim of the study was to evaluate the effects of a very early mirror therapy program on functional improvement of the upper extremity in acute stroke patients. [Subjects] Eight stroke patients who were treated in an acute neurology unit were included in the study. [Methods] The patients were assigned alternatively to either the mirror therapy group receiving mirror therapy and neurodevelopmental treatment or the neurodevelopmental treatment only group. The primary outcome measures were the upper extremity motor subscale of the Fugl-Meyer Assessment, Motricity Index upper extremity score, and the Stroke Upper Limb Capacity Scale. Somatosensory assessment with the Ayres Southern California Sensory Integration Test, and the Barthel Index were used as secondary outcome measures. [Results] No statistically significant improvements were found for any measures in either group after the treatment. In terms of minimally clinically important differences, there were improvements in Fugl-Meyer Assessment and Barthel Index in both mirror therapy and neurodevelopmental treatment groups. [Conclusion] The results of this pilot study revealed that very early mirror therapy has no additional effect on functional improvement of upper extremity function in acute stroke patients. Multicenter trials are needed to determine the results of early application of mirror therapy in stroke rehabilitation.

FRI0477-HPR The efficacy of land-based home exercise program in patients with juvenile idiopathic arthritis: A randomized-controlled, single-blind study

Background Juvenile idiopathic arthritis (JIA) is a common chronic illness that affects 1 in 1,000 children (1). Patients with JIA may experience significant disability due to muscular weakness, joint pain, contracture, and physical deconditioning. Children with arthritis have been shown to participate in less physical activities and to have low functional ability and decreased physical fitness than their peers (2-5). Objectives To investigate the effects of land-based home exercise program on pain, functional ability, and health-related quality of life in patients with JIA. Methods A randomized controlled single-blind study design including 81 patients (ages 5-17 years) with JIA was used. Socio-demographic data and clinical features were assessed. Functional ability was assessed with 6-Minute Walking Test (6-MWT) and Childhood Health Assessment Questionnaire (CHAQ). Pain was measured using a Visual Analog Scale (VAS). Quality of life was evaluated with The Pediatric Quality of Life Inventory (PedsQL). Patients were randomly assigned to the exercise or control group. Exercise group (n=43) completed 12-week individually planned land-based home exercise program once a week at hospital for 4 days per week. Control group (n=38) was included in waiting list until the end of the study. All patients continued stable dosage on medication through the study. Results In comparison of first assessment values for 6-MWT, CHAQ, VAS, PedsQL-self report and PedsQL-parent report, there was no statistically significant difference in all outcome measures between two groups. While only VAS score decreased significantly (p<0.01) in control group, statistically significant improvements (p<0.001) were found in all outcome measures in exercise group after 12 weeks. Except that VAS score (p>0.05), changes in other outcome measures (p<0.001) were significant in favour of exercise group. Conclusions The study demonstratedthat participating in 12-week individually planned land-based home exercise program may result improved physical function and quality of life in patients with JIA. References Manners PJ, Bower C. Worldwide prevalence of juvenile arthritis: why does it vary so much? J Rheumatol 2002; 29: 1520–30. Henderson CJ, Lovell DJ, Specker BL, Campaigne BN. Physical activity in children with juvenile rheumatoid arthritis: quantification and evaluation. Arthritis Care Res 1995; 8: 114–9. Tarakci E, Yeldan I, Kaya Mutlu E, Baydogan SN, Kasapcopur O. The relationship between physical activity level, anxiety, depression, and functional ability in children and adolescents with juvenile idiopathic arthritis.Clin Rheumatol 2011; 30: 1415–20. Takken T, Hemel A, Van der Net J, Helders PJM. Aerobic fitness in children with juvenile idiopathic arthritis: a systematic review. J Rheumatol 2002; 29: 2643–7. Lelieveld OT, van Brussel M, Takken T, van Weert E, van Leeuwen MA, Armbrust W. Aerobic and anaerobic exercise capacity in adolescents with juvenile idiopathic arthritis. Arthritis Rheum 2007; 57(6): 898–904. Disclosure of Interest None Declared

FRI0475-HPR Comparison the effect to the lower extremity functions of strengthening exercises and proprioceptive-balance exercises in juvenile idiopathic arthritis

Background Juvenile idiopathic arthritis (JIA) is the most common chronic pediatric rheumatic disease and an important cause of acquired impairment and disability in children and adolescents (1). Patients with JIA commonly experience acute and chronic pain, decreased mobility, and joint stiffness leading to restrictions on activities and isolation from their peers (2).Knee is the most commonly affected joint in JIA (3). Physical therapy for patients with JIA has been aimed at managing pain and inflammation, preserving range of motion, and maintaining muscle strength through rest and limiting the strain on arthritic joints (4,5). The best therapeutic exercise program for children with arthritis is as yet unknown. Objectives The aim of the study was to compare the effect to the lower extremity functions of strengthening exercises and proprioceptive-balance exercises in Juvenile Idiopathic Arthritis. Methods 30 patients (6-18 ages) were included in this study. The patients were divided into 2 groups randomly. The first group received a program of treatment consisting of bicycle ergonometer, stretching exercises, strengthening exercises, cold application, second group received a program of treatment consisting of bicycle ergonometer, strengthening exercises, proprioceptive-balance exercises, cold application for 3 days in a week through 12 weeks. The patients’ pain by The Visual Analog Scale (VAS), range of motion (ROM) by goniometer, muscle strength by Hand Held Dynamometer (HHD), balance by Berg Balance Test (BBT), Flamingo Balance Test (FBT), Functional Reach Test (FRT), walking by Video-Based Observational Gait Analiysis (VBOGA), functional status by 10 meters walking duration test (10mWT), 10 steps climbing duration test (10SC), the functional abilities by Childhood Health Assessment Questionaire (CHAQ) were evaluated. Results After treatment in both groups, the scores of VAS decreased, muscle strength and ROM increased (p<0.05). The changes of BBT, FBT, FRT, 10mWT, 10SC, VBOYA, CHAQ scores were significant in both groups. All scores, except CHAQ, were different significantly between groups (p<0,05). Conclusions According to the results of the study, in the patients with JIA, thanks to exercise therapy, a decrease in pain, increases in ROM and muscle power, an improvement in balance, a progress in walking and functional abilities were obtained. The balance-proprioception exercises were found to be more to the strengthening exercises. References Petty RE, Cassidy JT. Chronic arthritis. In: Cassidy JT, Petty RE, editor. Textbook of Pediatric Rheumatology. Elsevier Saunders Company; 5th edition 2005. pp. 206-341. Moe N, Rygg M. Epidemiology of juvenile chronic arthritis in Northern Norway: a ten-year retrospective study. Clin Exp Rheumatol 1998;16:99-101. Warren RW, Perez MD, Curry MR, Wilking AP, Myones LB. Juvenile Idiopathic Arthritis (Juvenile Rheumatoid Arthritis). In Koopman WJ, editor. Arthritis and Allied Conditions. Lippincott Williams & Wilkins, Philadelphia, 2001; pp. 781-96. Klepper SE. Exercise in pediatric rheumatic diseases. Curr Opin Rheumatol 2008;20:619–24. Long AR, Rouster-Stevens KA. The role of exercise therapy in the management of juvenile idiopathic arthritis. Curr Opin Rheumatol 2010;22:213–17. Disclosure of Interest None Declared

Lymphoedema functioning, disability and health questionnaire Turkish version:translation, cross-cultural adaptation and validation

[Purpose] The purpose of this study was to adapt the Lymphoedema Functioning, Disability and Health Questionnaire into the Turkish language, and to evaluate the psychometric properties of the Turkish version in patients with breast cancer-related lymphedema. [Subjects and Methods] After the translation, inter-rater and test-retest reliability were assessed between patients and physiotherapists using the intra-class correlation coefficient. Thirty patients with breast cancer-related lymphedema were asked to fill out the Turkish version of the Lymphoedema Functioning, Disability and Health Questionnaire two times, one week apart. Internal consistency was tested using Cronbach’s alpha, and the test-retest reliability was assessed by calculating the intra-class correlation coefficient. Construct validity was investigated by comparing the results of the Lymphoedema Functioning, Disability and Health and Short Form-36 questionnaires. [Results] The test-retest reliability and inter-tester reliability of the Lymphedema Functioning, Disability and Health Questionnaire total score, physical function score, mental function score, household activities score, mobility activities score, life and social activities score were excellent. [Conclusion] The Turkish version of the Lymphoedema Functioning, Disability and Health Questionnaire was found to be valid and reliable for patients with breast cancer related lymphedema.

Turkish version of the Motor Function Measure Scale (MFM-32) forneuromuscular diseases: a cross-cultural adaptation, reliability, and validity study

Background/aim: The Motor Function Measure (MFM-32) is a classification system for ambulant and nonambulant patients with neuromuscular diseases (NMDs). We aimed to translate it into Turkish, culturally adapt it, and test its reliability and validity for Turkish patients with NMDs.Materials and methods: The translation of the 32 items assessing three functional areas: standing position and transfers (D1: 13), axial/proximal (D2: 12), and distal (D3: 7) motor functions was performed according to the established guidelines for cross-cultural adaptation. Totally 51 patients (12.56 ± 8.84 years; F/M 12/39) were tested. Vignos and Brooke scores for the lower and upper extremities, respectively, were used for the validity of the MFM-32-TR items, which were rated on a 4-point Likert scale. Results: The agreement coefficients for interrater reliability were excellent (0.72-0.93) for 10 items, good (0.58-0.77) for 16 items, and moderate (0.42-0.56) for 6 items of the MFM-32-TR. The intertester reliability varied from good to excellent and the intraclass correlation coefficient was 0.76-0.93. The MFM-32-TR positively correlated with Vignos and Brooke scores with coefficients 0.47 to 0.75, indicating concurrent validity.Conclusion: The MFM-32-TR is a reliable and valid outcome measure for the assessment of motor function of people with NMDs in our sociocultural context.