Funda Atamaz

Impact of post-polio-related fatigue on quality of life.

OBJECTIVE To assess the impact of post-polio-related fatigue on quality of life. DESIGN Cross-sectional case control study. SUBJECTS Patients without additional health problems that may induce fatigue were selected from among 82 polio survivors. Twenty-six patients with post-polio syndrome and 10 without post-polio syndrome were included. Control group consisted of 30 healthy volunteers. METHODS We assessed presence and severity of fatigue by Fatigue Severity Scale, quality of life by Nottingham Health Profile, and impact of fatigue on quality of life by Fatigue Impact Scale. Leg muscle strength was measured by manual muscle testing. RESULTS Strength of leg muscles showed no differences between the patients with and without post-polio syndrome. Patients with post-polio syndrome reported significantly higher levels of fatigue and reduced quality of life compared with both patients without post-polio syndrome and control group. Fatigue Impact Scale revealed that fatigue did not significantly impair mental health, but had a negative impact especially on physical and psychosocial functioning of the patients with post-polio syndrome. CONCLUSION Post-polio-related fatigue seems to be an important factor for further impairment of quality of life in polio survivors.

EFFICACY OF NECK STABILIZATION EXERCISES FOR NECK PAIN: A RANDOMIZED CONTROLLED STUDY

OBJECTIVE To determine the efficacy of neck stabilization exercises in the management of neck pain. PATIENTS AND METHODS Sixty patients with neck pain were randomized to 3 groups, as follows: group 1--physical therapy agents including transcutaneous electrical nerve stimulation, continuous ultrasound and infra-red irradiation; group 2--physical therapy agents + isometric and stretching exercises; and group 3--physical therapy agents + neck stabilization exercises. The exercises were performed as a home training programme following a 3-week supervised group exercise. The patients were evaluated with a visual analogue scale, by intake of paracetamol, Neck Disability Index, Beck Depression Scale and range of motion in the 3 planes at baseline and at months 1, 3, 6, 9 and 12. RESULTS Compared with baseline, all groups showed a significant decrease in visual analogue scale scores during the first 6 months. However, this improvement was maintained only in group 3 at 9 and 12 months, with a significant difference among the groups (p<0.05). During the study, the improvement in disability was marked in group 3 with respect to Neck Disability Index, Beck Depression Scale and range of motion in the frontal plane (p<0.05). CONCLUSION This study demonstrates the superiority of the neck stabilization exercises, with some advantages in the pain and disability outcomes, compared with isometric and stretching exercises in combination with physical therapy agents for the management of neck pain.

Do the Benefits Gained Using a Short-Term Pulmonary Rehabilitation Program Remain in COPD Patients After Participation?

The aim of this study was to evaluate the short-term benefits of a pulmonary rehabilitation program in chronic obstructive pulmonary disease (COPD) patients. The study was a randomized controlled trial that included 54 mild and moderate COPD patients. Patients were assigned to either an 8-week-long pulmonary rehabilitation program, which consisted of exercise plus education (rehabilitation group), or were controls. All the patients were evaluated at baseline at the completion of the 8th week of the program and one month after the completion of the pulmonary rehabilitation program using five instruments: arterial blood gas analysis, postbronchodilator pulmonary function test, 6-minute walk test (6MWT), Saint George Respiratory Questionnaire (SGRQ), and the dyspnea visual analog scale (VAS) There were no statistically significant differences in the pulmonary functions and pulmonary gas analysis between baseline, discharge (8th week), and the 12th-week visit in both groups (p > 0.05). Rehabilitation resulted in significant improvements in both the VAS and the 6MWT at the 8th week, but by the 12th week all of these improvements had deteriorated. All of the SGRQ domains improved both at the 8th and the 12th week, with a significant difference between the groups (p < 0.05). We conclude that rehabilitation resulted in improvements in exercise capacity, health status, and dyspnea. All of these benefits, however, tend to deteriorate in the first month after rehabilitation. Therefore, it is strongly recommended that all patients with COPD be kept motivated in order to continue with rehabilitation and maintain the benefits gained.

Efficacy of therapeutic ultrasound for the management of knee osteoarthritis: a randomized, controlled, and double-blind study.

ObjectiveThe aim of this study was to compare whether the effectiveness of continuous ultrasound (US) was superior against pulsed US and against sham US in knee osteoarthritis. DesignA randomized controlled study was carried out on 60 patients diagnosed with knee osteoarthritis according to American College of Rheumatology. The patients were randomized into the following three treatments: (1) continuous US (at a frequency of 1 MHz with intensity of 1 W/cm2), (2) pulse US (same frequency and intensity on 1:4 pulse ratio), and (3) sham US. All treatments were applied with 5-cm2 head US device five times a week for 2 weeks in addition to home exercise program including quadriceps isometric exercise, muscle strength exercises, and stretching exercises of the lower extremity muscles for at least three times per week. Assessments were performed at baseline, at the end of the treatment, and at the end of the treatments and at the sixth month using the following measurements: Western Ontario and McMaster University Osteoarthritis Index–pain, stiffness, function, visual analog scale–pain at rest, visual analog scale–pain on movement, visual analog scale–disease severity, and 20-m walking time. Among these parameters, the Western Ontario and McMaster University Osteoarthritis Index–pain was the primary outcome. ResultsAll groups showed a significant improvement in all parameters in both following visits (P < 0.05). However, there was no significant difference between the groups. Although the mean reduction percent in Western Ontario and McMaster University Osteoarthritis Index–pain was significantly higher in group I (continuous US) when compared to sham group (46.5% vs 28.9%, P < 0.05) at the end of the treatment, this result was not found in other pain parameters. ConclusionsThe present study demonstrated that all assessment parameters significantly improved in all groups without a significant difference. This result suggested that therapeutic US provided no additional benefit in improving pain and functions in addition to exercise training.

Interferential current therapy in patients with knee osteoarthritis: comparison of the effectiveness of different amplitude-modulated frequencies.

ObjectiveThis study aimed to compare the effectiveness of different amplitude-modulated frequencies of interferential current (IFC) and sham IFC on knee osteoarthritis. DesignA randomized and single-blind study was performed on 60 patients diagnosed with knee osteoarthritis. The patients were allocated to three active IFC groups (40, 100, and 180 Hz), and one sham IFC group. Treatments were performed 5 times a week for 3 wks consecutively. Each patient was assessed at the end of the treatments and at the first month using the following measurements: visual analog scale (pain at rest, pain on movement and disability), physician and patient judgments regarding treatment effectiveness, 15-m walking time (in minutes), range of motion (ROM), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and paracetamol intake (g/wk). ResultsAlthough there were significant improvements in all variables, except WOMAC stiffness and range of motion, measured in all groups at the end of the treatment and during the follow-up, this improvement was greater in active IFC groups than in the sham group. The improvement in WOMAC stiffness was observed only in active IFC treatment groups (P < 0.05). No significant difference between different amplitude-modulated frequencies of IFC treatments was observed. ConclusionsThis study demonstrated the superiority of the IFC with some advantages on pain and disability outcomes when compared with sham IFC for the management of knee osteoarthritis. However, the effectiveness of different amplitude-modulated frequencies of IFC was not superior when compared with each other.

Effects of platelet-rich plasma on nerve regeneration in a rat model

OBJECTIVE The aim of this study was to determine whether platelet-rich plasma has a regenerative effect on a sciatic nerve injury model in rats. METHODS A sciatic nerve cut model was created in 24 nerves of 12 rats. All nerves were repaired with epineural sutures by the same surgeon. Rats were randomly divided into two groups; platelet-rich plasma was applied to the injury site in the platelet-rich plasma group and saline only to the same area in the control group. Motor and electromyographic assessments were performed at the end of 12th postoperative week and all rats were euthanized for histological specimens. RESULTS Motor recovery was significantly better in the platelet-rich plasma group than the control group. The differences in electromyographic and histomorphometric findings between the groups were significant (p<0.05). CONCLUSION Our experimental study demonstrated positive effects of platelet-rich plasma on nerve regeneration.

Intracranial dural arteriovenous fistula draining into spinal perimedullary veins: a rare cause of myelopathy.

We report a rare case of progressive myelopathy caused by intracranial dural arteriovenous fistula with venous drainage into the spinal perimedullary veins. A 45-yr-old man developed urinary and fecal incontinence and muscle weakness in the lower limbs. Magnetic resonance imaging revealed brainstem edema and dilated veins of the brainstem and spinal cord. Cerebral angiography showed a dural arteriovenous fistula fed by the neuromeningeal branch of the left ascending pharyngeal artery. Occlusion of the fistula could be achieved by embolization after a diagnostic and subsequent therapeutic delay. There was no improvement in clinical condition. For the neurologic outcome of these patients it is important that fistula must be treated before ischemic and gliotic changes become irreversible.

Phagocytic and oxidative burst activity of neutrophils in patients with spinal cord injury.

OBJECTIVE To evaluate phagocytic activity and neutrophil oxidative burst functions in patients with spinal cord injury (SCI) because alterations in neutrophil metabolic activity can be one of the causes of immune mechanism damage contributing to repeated bacterial infections. DESIGN A controlled and cross-sectional study. SETTING Departments of physical medicine and rehabilitation and immunology. PARTICIPANTS Patients with SCI (N=34) and 28 healthy controls. INTERVENTIONS Phagocytosis and oxidative burst in whole-blood neutrophils were assessed by flow cytometry. The percentage of phagocytizing cells after in vitro incubation with Escherichia coli, phagocytic activity (mean intensity of fluorescence [MIF]) and the percentage of neutrophiloxidative burst, and the MIF value of the production of reactive oxygen intermediates (ROIs) were analyzed. In addition, clinical assessment including the level of injury, American Spinal Injury Association scores, and functional status were carried out. MAIN OUTCOME MEASURES Not applicable. RESULTS Although the percentage of E. coli phagocytizing neutrophils was not different between groups, the MIF value of absorbed E. coli was significantly lower in patients with SCI than in controls (P<.05). The MIF value of ROI production by neutrophils with both stimulator of phorbol 12-myristate 13-acetate and E. coli was significantly higher in patients with SCI (P<.05). CONCLUSIONS In patients with SCI, decreased phagocytic activity of neutrophils may be a result of a regulatory mechanism to minimize the deleterious effects of increased neutrophil burst activity.

The types of talar articular facets and morphometric measurements of the human calcaneus bone on Turkish race

IntroductionThere are three facets over upper side of talocalcaneal joint: anterior talar facet, middle and posterior. Three types of calcaneus that have distinct talar facets were defined as types A, B and C.Materials and methodsA total of 221 calcanei (98 right, 123 left), with unknown gender, were dried and evaluated.ResultsIn our study type B calcaneus (58%) was defined as the most common type, and type A calcaneus (39.3%) as the second most common type. By using facet joint differences and bone measurement, we tried to define calcaneus bone.DiscussionIn many diseases of foot, such as the talocalcaneal artritis and coalition, intraarticular fractures and congenital dysmorphology, flatfood, valgus deformities, the size and shape of the bones, the relationships of the talus and calcaneus with each other and other bones of the foot must be considered for the internal and external fixation and surgical procedures. Type B calcaneus was defined as the most comman type in Turkish race and these results correlate with the ones which were performed on bones of American, Indian and African people, and it was uncorrelated with the results of the researches performed in Europe.

Validity and reliability of a Turkish Brief Pain Inventory Short Form when used to evaluate musculoskeletal pain

BACKGROUND The Brief Pain Inventory (BPI) is both a questionnaire and an outcome measure that is used widely in clinical trials to assess pain associated with many conditions. The BPI Short Form has been extensively translated into foreign languages. The aim of this study was to assess the validity and reliability of a Turkish Brief Pain Inventory Short Form (BPI-TR) to evaluate musculoskeletal pain. METHODS In total, 297 patients with musculoskeletal pain participated in the study. Demographic characteristics and brief medical histories were recorded. Pain intensity was assessed using a visual analogue scale (VAS) and quality-of-life was assessed using the Short Form 36 (SF-36). Pain was evaluated using the BPI-TR in all patients. Internal consistency and test-retest analysis were used to assess reliability. The internal consistency of the scale items was assessed by calculating Cronbachs α value, which was expected to be > 0.7. The criterion validity of the BPI-TR was assessed by correlation with VAS scores. RESULTS Pain intensity, pain interference, and other components of the Turkish version were consistent with validity thereof. Cronbachs α was 0.84 for pain intensity and 0.89 for pain interference. The extent of BPI-TR and VAS correlation was statistically significant. CONCLUSIONS The BPI-TR may be used for assessment of musculoskeletal pain.