Fatma Uygur

Reliability and validity of the Turkish version short-form McGill pain questionnaire in patients with rheumatoid arthritis

The translation of existing pain measurement scales is considered important in producing internationally comparable measures for evidence based practice. In measuring the pain experience, the short-form of McGill’s pain questionnaire (SF-MPQ) is one of the most widely used and translated instruments. The purpose of this study was to examine whether the Turkish version of the SF-MPQ is a valid and reliable tool to assess pain and to be used as a clinical and research instrument. Translation retranslation of the English version of the SF-MPQ was done blindly and independently by four individuals and adapted by a team. Eighty-nine rheumatological patients awaiting control by a rheumatologist were assessed by the Turkish version of the SF-MPQ in the morning and in the afternoon of the same day. Internal consistency was found adequate at both assessments with Cronbach’s alpha 0.705 for test and 0.713 for retest. For reliability of the total, sensory, affective, and evaluative total pain intensity, high intraclass correlations were demonstrated (0.891, 0.868, 0.716, and 0.796, respectively). Correlation of total, sensory and affective score with the numeric rating scale was tested for construct validity demonstrating r = 0.637 (p < 0.001) for test and r = 0.700 (p < 0.001) for retest. Correlation with erythrocycte sedimentation rates for concurrent validity was found to be r = 0.518 (p < 0.001) for test and r = 0.497 (p < 0.001) for retest. The results of this study indicate that the Turkish version of the SF-MPQ is a reliable and valid instrument for the measurement of pain in Turkish speaking patients with rheumatoid arthritis.

Outcome of Orthoses Intervention in the Rheumatoid Foot

This study was carried out to determine the effect of foot orthoses on pain, gait, and energy expenditure in patients with rheumatoid arthritis. Eighteen patients were evaluated for these parameters. Each patient was given a foot insert or shoe modification suitable for his or her foot deformity. Following 3 months of orthosis use, a significant difference was found in regards to pain (p <.05), step length and stride length (p <.05), and physiological cost index (p <.05). The results suggest that foot orthoses are an important feature in the rehabilitation of the rheumatoid foot.

The effects of dynamic ankle-foot orthoses in chronic stroke patients at three-month follow-up: a randomized controlled trial:

Objective: To investigate the short- and long-term effects of dynamic ankle foot orthoses on functional ambulation activities in chronic hemiparetic patients. Design: Randomized controlled trial. Setting: University’s neurological rehabilitation outpatient clinic and orthotics department. Subjects: Twenty-eight chronic hemiparetic patients of level 3–5 according to Functional Ambulation Classification and with a maximum spasticity level of 3 according to Modified Ashworth Scale, were randomly assigned to the study and control groups. Interventions: The control group (n = 14) was assessed with tennis shoes whereas the study group (n = 14) was assessed initially with tennis shoes and after three months with dynamic ankle foot orthosis. Measures: Functional Reach, Timed Up and Go, Timed Up Stairs, Timed Down Stairs, gait velocity and Physiological Cost Index. Results: In the initial assessment no difference was found between the groups for any of the measured parameters (P > 0.05). After three months, intergroup comparisons while the patients in the study group were wearing dynamic ankle-foot orthosis showed a significant difference in favour of the study group for Timed Up Stairs 12.00 (10.21) seconds study versus 15.00 (7.29) seconds control group; for gait velocity 0.99 (0.45) m/s study versus 0.72 (0.20) m/s control group and for Physiological Cost Index 0.12 (0.06) beats/min study versus 0.28 (0.13) beats/min control group (P < 0.05). No difference was found between the groups for Functional Reach, Timed Up and Go, Timed Down Stairs (P > 0.05). Conclusion: Chronic hemiparetic patients may benefit from using dynamic ankle-foot orthosis.

The effect of orthotic treatment of posterior tibial tendon insufficiency on pain and disability

AbstractPosterior Tibial Tendon Insufficiency (PTTI) is the major reason for acquired flat-foot. The purpose of this study, which was planned as a single-group pre- and post-intervention repeated measures design, was to investigate whether orthotic intervention is effective in treating pain caused by PPTI. Ten males and 15 females, whose mean age was 30.66 ± 12.67 years, completed the pain and disability subscales of the foot function index at their first visit and after 6 weeks of orthotic wear. There was a 47.64% decrease in pain and a 53.07% decrease in disability levels, and a high correlation between pain and disability subscales. The results of our study imply that orthotic management of PTTI is effective in alleviating pain and the amount of difficulty expressed by the patient.

Effects of Nerve Mobilization Exercise as an Adjunct to the Conservative Treatment for Patients with Tarsal Tunnel Syndrome

OBJECTIVE This study was carried out with the aim of investigating the contribution of nerve mobilization exercises to the conservative treatment of tarsal tunnel syndrome. METHODS In this clinical trial, 28 patients were randomly allocated into 2 groups. The control group was composed of 14 patients who were treated conservatively with a program consisting of physiotherapy and supportive inserts, whereas 14 patients in the study group were given nerve mobilization exercises in addition to the same treatment. Allpatients were followed up for 6 weeks. Before treatment, subjects were evaluated for muscle strength, range of motion, pain, sensory tests, and clinical manifestations of tarsal tunnel syndrome. The evaluations were repeated after 6 weeks. RESULTS There was a significant difference in favor of posttreatment values for range of motion, muscle strength, and pain in both groups (P < .05). Intergroup comparisons showed no difference between the groups for these parameters. Significant results were attained in the study group for 2-point discrimination and light touch and Tinel sign after treatment (P < .05). CONCLUSION Patients in both groups showed improvement from conservative treatment. The results of the study group showed that nerve mobilization exercises have a positive effect on 2-point discrimination and light touch and Tinel sign.

Effects of unilateral backpack carriage on biomechanics of gait in adolescents: a kinematic analysis

OBJECTIVE The aim of this study was to analyze the biomechanical alterations during unilateral backpack carriage in adolescents and to compare the kinematic parameters of the loaded and unloaded sides. METHODS Twenty adolescents (mean age: 13 ± 1.2 years) were assessed during walking with no backpack and with a backpack on one shoulder. The kinematic parameters of a gait at a self-selected speed were analyzed using motion analysis. Specific kinematic peak points were compared between asymmetric walking; unloaded, loaded side and mean of unloaded walking. RESULTS Peak ankle dorsal flexion, mean knee varum angle, peak value of hip extension and range of pelvic rotation decreased; and knee flexion at initial contact, hip adduction angle, mean pelvic anterior tilt and mean pelvic obliquity increased on the loaded side relative to the unloaded side and unloaded walking. Decreased maximum hip extension during late stance, increased hip adduction, elevated pelvis and increased anterior pelvic tilt were seen on the loaded side and the pelvis was lowered, ankle dorsal flexion increased and the hip was abducted on the unloaded side as a counter effect. CONCLUSION Both the unloaded and loaded sides were affected by asymmetrical backpack carriage. The biomechanical alterations seen in asymmetrical backpack carriage may put some extra load on the lumbar vertebral joints and altered frontal knee biomechanics contribute to low back pain and pathologies in the knee joint.

Comparison of connective tissue massage and spray-and-stretch technique in the treatment of chronic cervical myofascial pain syndrome

AbstractThe aim of this study was to investigate whether ischemic pain tolerance changed in patients who had successfully undergone treatment for chronic cervical myofascial pain syndrome (MPS). In a controlled study, patients with the diagnosis of MPS were assessed for pain intensity using a visual analogue scale (VAS), number of trigger points, range of motion (ROM) in cervical region, and ischemic pain threshold and tolerance using a modified tourniquet technique. Patients were randomly allocated into two groups. The first group was treated with connective tissue massage and the second with vapocoolant spray and stretch technique. No difference was found between the groups as regards to the assessed parameters except VAS, which was higher in the group treated with the spray and stretch technique. Following treatment, although there was a significant decrease in pain intensity and number of trigger points, and an increase in ROM in both groups, there was no difference in ischemic pain threshold or toler...

Home-based general versus center-based selective rehabilitation in patients with posterior tibial tendon dysfunction

OBJECTIVE The aim of this study was to compare the effect of home-based and supervised center-based selective rehabilitation in patients with Grade 1 to 3 posterior tibial tendon dysfunction (PTTD). METHODS The study included 49 subjects diagnosed with PTTD and referred to physiotherapy by an orthopedic surgeon. Subjects were randomly assigned into a home-based rehabilitation (21 cases; mean age: 33.56 ± 17.59) group or center-based rehabilitation (28 cases; mean age: 28.57 ± 14.74 years). The patients in the home-based rehabilitation group followed a home program of cold application, strengthening exercises for the posterior tibial and intrinsic muscles, and stretching in the subtalar neutral position. The patients in the center-based rehabilitation group followed a selective, supervised treatment consisting of the home protocol plus re-education of the non-functional tibialis posterior, proprioceptive neuromuscular facilitation methods, electrical stimulation, joint mobilization and taping techniques. Both groups received appropriate orthotics. All subjects were assessed before and after treatment for pain, muscle strength, foot function index (FFI) scores and specific tests for PTTD. RESULTS Statistical analysis showed significant differences between pre- and post-treatment results for pain, first metatarsophalangeal angle, forefoot abduction angle, FFI scores and foot and ankle muscle strengths in the center-based group and for the tibialis posterior muscle strength in the home-based group (p<0.05). Intergroup comparison, however, showed no differences between the groups at the end of the treatment program with the exception of posterior tibial muscle strength (p<0.05). CONCLUSION Home- and center-based forms of rehabilitation seem to be equally effective in relieving pain and improving functional outcome in patients with Grade 1 to 3 PTTD. A patient-selective, supervised program may provide a better improvement in tibialis posterior strength than home-based rehabilitation.

Intravascular papillary endothelial hyperplasia in the finger: not a premier diagnosis

To the Editor, A 58-year-old lady was seen for a tender swelling in her left hand. Two days before, she had noticed a small purplish swelling on the dorsal side of her left fourth finger. Despite her medical history being otherwise non-contributory, on detailed questioning, she recalled having dealt with different types of vegetables (including squash, okra) just one day before she noticed the lesion. She also declared that the bruised area eventually became a lentil-sized nodule. On physical examination, a slightly tender moveable nodule was palpated adjacent to the proximal interphalangeal joint of the fourth finger in the left hand. There were no signs of local inflammation nor any problem pertaining to the tendons, and the digital nerves could be uncovered. An immediate sonography was performed and it revealed a 1.5 3 2.1 mm mass with mixed echogenicity without any relation to the extensor tendon. Then she was consulted to the hand surgeons and, as the patient also accepted, the mass was excised. The pathological diagnosis was established as intravascular papillary endothelial hyperplasia (IPEH). IPEH was first described by the French pathologist Masson as a neoplastic lesion vegetant intravascular hemangioendothelioma’. In 1976, Clerkin and Enzinger proposed the term IPEH, which is currently known as a non-neoplastic reactive endothelial proliferation. It is most commonly located in the skin or the subcutaneous tissue, usually in various vessels following thrombosis. Although there is a predilection for the deep dermis and subcutis of the head, neck, fingers and trunk; IPEH may occur in any location in the body. In subcutaneous localizations the lesion may appear clinically as a small, firm, superficial nodule imparting a red to blue discoloration of the overlying skin. The exact pathogenesis is unknown, but an unusual form of thrombus organization following a trauma is considered to play role. The release of b-fibroblast growth factor (b-FGF) from macrophages attracted to the site is proposed to trigger the proliferation of endothelial cells, which in turn release more b-FGF, leading to a vicious cycle. On the other hand, a history of trauma is rarely noted by the patients – in only 4%. Endothelial proliferation and obstruction of the luminal space of the vascular structures may lead to the enlargement of the mass lesion, necessitating differentiation from a neoplasm. In this regard, intravascular confinement of IPEH, absence of pleomorphism and mitotic atypia are helpful for histological distinction. Overall, excision of the lesion seems to be quite reasonable both for the diagnosis and the treatment.

Orthotic management of the lower limb in children with hereditary motor sensory neuropathy (HMSN)

The lower limbs of 55 paediatric patients, with the diagnosis of hereditary motor sensory neuropathy (HMSN) referred to the Orthotics and Biomechanics Department of Hacettepe University, were assessed for appropriate orthotic intervention. Since in the natural history of HMSN symptoms and complaints are variable there is a wide range of interventions possible. The biomechanics of deforming forces and the consequential incidence of deformities in these 55 children, its orthotic implications and the efficacy of orthotic applications are discussed in detail.