Emel Ozcan

The effectiveness of intensive group exercise on patients with ankylosing spondylitis

Objective: To compare, in patients with ankylosing spondylitis (AS), the effectiveness on pain, functional and psychological status of an intensive group exercise programme under the supervision of a physiotherapist and a home physiotherapy programme. Design: Fifty-one patients with AS were randomly allocated into study and control groups. The study was designed as a prospective, double-blind study. Setting: Outpatient department, Istanbul Medical Faculty. Subjects: Patients who consulted with complaints of pain, morning stiffness and restricted range of movement with a confirmed diagnosis of ankylosing spondylitis. Interventions: Before exercise, both groups were given an education programme about AS. For group I patients an intensive exercise programme was organized under the supervision of a physiotherapist for six weeks. Group II patients had to practise exercises individually at home. Main outcome measures: Both groups were evaluated and compared for pain, functional and psychological status before treatment, at the end of treatment and three months after treatment using a visual analogue scale (VAS) for pain, Beck Depression Scale and Bath Ankylosing Spondylitis Functional Index (BASFI). Results: Six patients withdrew, four from group I. Results from the remaining 45 showed more positive changes in the patients undertaking group exercise at six weeks and three months after treatment. Values showed a statistical significant difference in favour of group I. Conclusion: Group exercise in hospital may be more effective than home-based exercises at reducing impairment associated with ankylosing spondylitis.

The effectiveness of exercise programmes after lumbar disc surgery: a randomized controlled study:

Objective: To compare two different exercise programmes versus a control group, after lumbar disc surgery. Design: A prospective, single-blind, randomized controlled study. Setting: Outpatient clinic of Istanbul Faculty of Medicine, Department of Physical Medicine and Rehabilitation. Subjects: Sixty patients diagnosed as having single level lumbar disc herniation with clinical examination and MRI evaluation and who had undergone lumbar discectomy (post-operative first month) at a single level. Patients with serious pathologies involving the cardiac and respiratory systems that could prevent them from doing exercises were excluded. Intervention: The patients were randomly split into three groups. The first group received an intensive exercise programme and back school education while the second group received a home exercise programme and back school education. The third group was defined as the control group and did not receive education or exercise. Main measures: The patients were evaluated at the beginning and end of the treatment with clinical parameters, pain levels, endurance tests and weight-lifting tests, modified Oswestry Disability Index, Beck Depression Inventory, Low Back Pain Rating Scale and return to work. Results: The groups doing exercises experienced a decrease in the severity of pain and disability, also functional parameters showed better improvement than the control group. The intensive exercise programme was better than the home exercise programme. Conclusions: It seems that intensive exercise is more effective in reduction of pain and disability, but whether it is cost-effective is not clear.

A study to compare the therapeutic efficacy of aerobic exercise and paroxetine in fibromyalgia syndrome

A study to compare the therapeutic efficacy of aerobic exercise and paroxetine in fibromyalgia syndrome. The aim of this study is to compare the therapeutic efficacy of aerobic exercises versus paroxetine in a randomized, controlled study. Sixty female patients between ages 18–50, diagnosed as fibromyalgia syndrome by the 1990 American College of Rheumatology criteria were randomly allocated to one of three groups. Group I was given aerobic exercises on bicycle ergometer for 40 minutes, 3 times a week for 6 weeks, group II was given paroxetine 20 mg daily for 6 weeks and group III was given placebo Transcutaneous Electrical Nerve Stimulation for 20 minutes, 3 times a week for 6 weeks as a control group. All groups were evaluated at admission, termination and at the end of 6 months by Visual Analog Scale (VAS), pressure algometric testing, weekly analgesic consumption for pain intensity. They were also evaluated for psychological and social status, Beck Depression Inventory. Statistical analysis was done by the SPSS (Statistical Package for Social Sciences) program with T-test, OnewayAnova, Mann-Whitney U, Wilcoxon Rank Sum Test and post-hoc. Pain threshold with pressure algometer, pain intensity by VAS and BDI scores showed significant decrease compared to scores of the group III at termination of the study and at 6 months follow-up while base-line evaluation parameters demonstrate no significant statistical differences between groups. Analgesic consumption was reduced only in group I. As a result this study shows that paroxetine and aerobic exercises have better therapeutic effect when compared to placebo group on short and long-term follow-up with no significant difference on evaluation parameters

Musculoskeletal system disorders in computer users: Effectiveness of training and exercise programs

Various musculoskeletal system disorders occur as a result of the use of computers, which have become an integral part of modern life. The most important among such disorders is known as cumulative trauma disorder (CTD). In this study, we attempt to investigate CTDs effects on daily life and the effectiveness of training and exercise programs in the management of this disorder at a state department where computers are widely used. Fifty patients with CTD between the ages 25 and 50 were recruited for the study and were randomized into two groups. The complaints of patients with CTD had appeared after they had started working in this job and they reported that their complaints were related to their occupation. The patients complained of head, neck, shoulder, back and wrist pains and most of them were diagnosed as Myofascial Pain Syndrome (MPS) and Carpal Tunnel Syndrome (CTS). The first group was given mobilization, stretching, strengthening and relaxation exercises five days a week for a period of two months following a training course. The second group was given a training course only. Both groups were assessed in terms of the following outcome criteria before and after the treatment: Numeric Rating Scale (NRS) and Pain Disability Index for pain; Tiredness Scale for tiredness; and Beck Depression Scale for depression. At 2 months, the treatment group was observed to have experienced statistically significant improvements in NRS ( p< 0.001), pain disability index ( p< 0.05) and Beck depression scale ( p< 0.05) values as compared to the control group. Mobilization, stretching, strengthening and relaxation exercises reduce pain and depression levels of CTD patients in the short term. We propose that studies with long-term follow-up are needed to confirm the above results.

Development and validation of a functional disability index for chronic low back pain

OBJECTIVE To develop a valid and reliable functional disability scale for chronic low back pain (CLBP). METHODS Inpatients and outpatients suffering from low back pain (LBP) for at least 3 months were selected randomly. Patients with inflammatory LBP were not recruited. Interrater reliability and Cronbachs α were examined. Face, content, convergent and divergent validities were investigated. Factor Analysis and pearsons correlation coefficients (r) were performed. RESULTS 112 patients (71 females) with a mean age of 39.93 (SD: 12.92) answered the 66 questions on the provisional scale. Elimination left 18 daily activity questions. The interrater reliability of the scale was 0.79 and Cronbachs α was 0.90. Face and content validities were determined. It showed good convergence with the Quebec Back Pain Disability Scale (r: 0.82), the Oswestry Disability Index (r: 0.76), Waddells Functional Index (r: 0.68), and the Visual Analog Scale of Handicap (VAS-handicap) (r: 0.49) The scale showed no significant or fair relationship (divergence) with VAS-lumbar, VAS-radicular, Beck Depression Inventory, morning stiffness, night pain, finger tip-ground distance, radicular pain duration, or modified Schöbers index. The scale had two main factors. First represents activities implicating forward bending and second represents standing activities. CONCLUSION A practical functional disability scale for CLBP was developed and validated.

Poster 404 The Impact of Ankylosing Spondylitis on Work Productivity in Patients with Paid Work

Disclosures: Juewon Khwarg: I Have No Relevant Financial Relationships To Disclose Case/Program Description: A 46-year-old man with history of chronic tophaceous gout presented with one week of acute, severe back pain radiating into the lower extremities. Pain was associated with numbness and weakness. He denied bowel/bladder changes or previous history of back pain. Patient reported twenty-year history of using 5-day courses of prednisone, obtained from local area EDs, monthly for persistent gouty pain. Lumbar spine MRI found epidural lipomatosis producing canal narrowing with effacement of the CSF containing spaces diffusely at L1-S1 levels. Inpatient EMG of the lower extremities was suggestive of spinal canal stenosis. Neurosurgery recommended monitoring but declined laminectomy. Patient was admitted to ARU where he participated in physical and occupational therapy, optimization of anti-gout regiment, and initiation of a neuropathic pain medication regiment. Setting: Emergency room, Acute rehabilitation unit. Results: Patient was discharged home with close follow-up by rheumatology and PM&R. At time of discharge, patient was able to ambulate independently and with reduced pain. Discussion: Epidural lipomatosis is a rare phenomenon of excessive adipose tissue deposition in the epidural space, with potential compression of the spinal cord. Presentation is consistent with progressive back pain, myelopathy or radicular signs. Most cases are associated with exogenous steroid use, though this pathology has also been associated with Cushing’s disease, hypothyroidism and pituitary prolactinomas. Diagnosis is made by clinical exam and MRI, with characteristic findings of adipose deposition in the epidural space. From a review of the literature, a conservative treatment approach with a focus on treating underlying pathologies, weaning off exogenous steroids, encouraging weight loss, optimizing pain medication and engaging the patient in physical modalities is helpful. Laminectomy for epidural lipomatosis have been associated with high mortality rates in the post-treatment phase, but may be required in the setting of neurological emergencies. Conclusions: Epidural lipomatosis is a rare cause of back pain usually associated with exogenous steroid use. Level of Evidence: Level V

Poster 383 Effects of Dextrose Prolotherapy in the Treatment of Patients with Knee Osteoarthritis: A Randomized Controlled Trial.

Disclosures: Alketa Toska Sert: I Have No Relevant Financial Relationships To Disclose Objective: The aim of our study was to determine the effects of dextrose prolotherapy in patients with knee osteoarthritis (KOA). Design: Prospective, randomized, controlled clinical trial. Setting: The outpatient clinics in our department. Participants: A total of 66 patients who had knee pain for more than three months and diagnosed as Grade II or III KOA according to the Kellgren-Lawrence Classification were included in the study and allocated to three groups: Dextrose Prolotherapy Group (DPG; n. 22), Saline Group (SG; n. 22), and Control Group (CG; n. 22). Interventions: The prolotherapy dextrose and saline plus local anesthetic injection were administered to the DPG and SG, respectively at the beginning, 3-, and 6-week of the study. The patients in the CG group did not receive any type of injection. The same home exercise program was prescribed for all patients in the three groups. Main Outcome Measures: The pain, function status, and quality of life was evaluated by Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form36 (SF-36), respectively. Results: The mean age of the patients was 54.1 6.8 years. The VASpain and all of the WOMAC scores decreased significantly in the DPG compared with the SG and CG at 18-week follow-up (P <.05). While a significant improvement in the physical functioning, physical role restriction, pain, emotional role restriction, and physical health total scores of the SF-36 was determined in the DPG compared with the SFG and the KG (P <.05) at 18-week assessment, there were no significant difference in the general health, vitality, social function, and mental health total scores (P >.05). Conclusions: These data suggested that dextrose prolotherapy was effective in reducing pain and improving the quality of life and the functional status in patients with KOA. We can conclude that dextrose prolotherapy is an effective and safe treatment method in patients with KOA. Level of Evidence: Level I

The Effectiveness of a Participatory Ergonomic Intervention for Preventing Work-related Musculoskeletal Disorders in Nurses

Disclosures: S. Seetharama, No Disclosures: I Have Nothing To Disclose. Objective: The clinical utility of a psychological measure used to address emotional functioning in adolescent and preadolescent athletes who have sustained a concussion. Design: An observational study, longitudinal quantitative and qualitative observations of emotional functioning. Setting: Outpatient concussion clinic. Participants: 37 subjects, with a mean age of 15 (range 10-18) years. The sample consisted of 23 males and 14 females, 7 nonsports related concussions and 30 sports related concussions. Interventions: Participants were evaluated acutely within a median time frame of 9 days post injury (range 1-50 days). For those injured in sports, return to play occurred within a median of 31 days (range 5-71). Main Outcome Measures: Patient reported Outcomes Measurement Information System (PROMIS). Consists of six psychological domains: Anxiety, Anger, Depression, Fatigue, Pain, and Peer relationship. Results or Clinical Course: Acute concussions were associated with heightened levels of psychological distress in most PROMIS domains. Lower levels of psychological distress were reported at the time of return to play. At initial evaluation anxiety mean score for the sample was 7 (0-25) as compared to 0.6 (0-6) at time of return to play. The initial anger mean score was 5.2 (2-11) as compared to 0.86 (0-6) at return to play. Initial depression mean score was 3.7 (0-19) as compared to 0.32 (0-11) at return to play. At initial evaluation, fatigue mean score was 12.5 (2-30) as compared to 1.83 (0-14) at return to play. Pain, at initial evaluation, had a mean score of 10.5 (2-24) as compared to 1.08 (0-9) at return to play. Peer relationship mean score at initial evaluation was 28.4 (13-32) as compared to 32 (21-32) at return to play. Conclusions: The PROMIS pediatric self reported assessment provides a useful tool to measure and track the psychological effects of concussion in adolescents and preadolescents. This self reported measure is used to inform clinicians about treatment, return to school and play issues.

Poster 53: Comparison of the effectiveness of stabilization and isokinetic exercise programs in patients with chronic lumbar pain1

Abstract Objective: To compare dynamic lumbar stabilization and isokinetic exercise programs in patients with chronic lumbar pain. Design: Randomized controlled study. Setting: Exercise treatment. Participants: 84 patients between the ages of 18 and 55 years with complaints of lumbar pain due to at least 3 months of lumbar diskal hernia and who did not have any neurologic deficits. Interventions: Group 1 was given dynamic lumbar stabilization (DLS) exercises and lumbar school education (LSE) 3d/wk, 1h/d for a period of 6 weeks. Group 2 was given isokinetic exercises and LSE 3d/wk, 30min/d for a period of 6 weeks. Group 3 (control) was given only LSE. Main Outcome Measures: Visual analog scale (VAS), angular velocities of 90°/s and 120°/s performed by Biodex System 3 Pro isokinetic dynamometer, and lifting capacity with progressive isoinertial lifting evaluation (PILE). Results: Group 1 was the best, followed by group 2 and group 3 (P