Gizem İrem Kinikli

Comparison of ultrasonographic patellar tendon evaluation methods in elite junior female volleyball players: thickness versus cross-sectional area.

PURPOSE The goal of the present study was to compare the patellar tendon cross-sectional area with the patellar tendon thickness and to determine the intra-observer compliance level in the cross-sectional area and thickness measurements. This comparison was used to describe the effects of playing volleyball on the patellar tendon. MATERIALS AND METHODS The patellar tendons of 60 volleyball players and 60 non-player female students, who were 11-16 years of age with similar physical characteristics, were examined using Doppler ultrasonography (US). Cross-sectional area and thickness measurements were conducted. RESULTS The proximal and distal thicknesses of the patellar tendon were similar, but the area was smaller for the distal portion. A correlation was observed between age and tendon thickness and between the thickness and area of the tendon. All of the measurements in the subjects with tendinosis were larger than those in the healthy controls. There were no pathological findings in the non-players. The intra-observer compliance was high. CONCLUSION The transverse plane area measurement was as reliable as the thickness measurement and exhibited a high level of intraobserver compliance. This measurement can be conducted during routine examinations. The patellar tendons in the athletes were observed to be widened and thickened, most likely because of overuse. Patellar tendinosis and Osgood-Schlatter Syndrome may be asymptomatic and incidentally detected. Therefore, routine US examinations may help prevent further injuries. Although the tendon thicknesses were observed to be the same in both extremities, any observed difference in the tendon areas may alert the physician to a risk factor for the development of tendinosis.

The effect of progressive eccentric and concentric training on functional performance after autogenous hamstring anterior cruciate ligament reconstruction: a randomized controlled study

OBJECTIVE The aim of this study was to assess the functional results of an early onset progressive eccentric and concentric training in patients with autogen hamstring anterior cruciate ligament (ACL) reconstruction. METHODS Thirty-three patients with autogenous hamstring ACL reconstruction were randomly divided into study (n=16, mean age; 33.87±8.19) and control (n=17, mean age; 32.64±8.21) groups and followed the same ACL rehabilitation program. Additionally, the study group followed a progressive eccentric and concentric training for 12 weeks on the Monitorized Functional Squat System (MFSS) beginning 3 weeks after surgery. The groups were compared according to the isokinetic strength of the knee extensors and flexors, functional performance (the vertical jump test, a single hop for distance test) and the Lysholm knee scale, the Anterior Cruciate Ligament-Quality of Life Questionnaire (ACL-QOL), before and 16 weeks after the surgery. RESULTS The functional outcomes in terms of the vertical jump test (p=0.012), a single hop-for-distance test (p=0.027), the Lysholm knee scale (p=0.002) and the ACL-QOL questionnaire (p=0.000) demonstrated significantly greater improvement in the study group. No significant difference was reported between groups for isokinetic strength of the knee extensors and flexors (p>0.05). CONCLUSION Adding progressive eccentric and concentric exercises to the standard rehabilitation protocol may improve the functional results after ACL reconstruction with autogen hamstring grafts.

Foot biomechanics and initial effects of infrapatellar strap on gait parameters in patients with unilateral patellofemoral pain syndrome

BACKGROUND There is limited information on the relationship between plantar foot pressure and patellofemoral pain syndrome (PFPS). In addition, there is not enough research on the effects of an infrapatellar strap on PFPS. OBJECTIVE The aim of this study was to evaluate the immediate effects of an infrapatellar strap on dynamic pedabarography in patients with unilateral PFPS. METHODS Clinical case control study design. 18 females subjects with unilateral PFPS were included in the study. Gait parameters were tested using pedabarography during barefoot walking with and without an infrapatellar strap. RESULTS There were no statistically significant differences in gait trials comparing infrapatellar strap to no strap (P>0.05). In addition, a significant difference (P=0.043) in the % forefoot surface on the involved side demonstrated that body weight is transferred to medial aspect of the foot. DISCUSSION Although our results show a difference between the forefoot surface % of the affected and unaffected sides of subjects with PFPS there was no indication that an infrapatellar strap had any immediate effect on this parameter. CONCLUSION It is not clear whether PFPS is a cause or effect of abnormal gait. Further research is warranted to investigate the long-term effects of wearing an infrapatellar strap and associated altered foot biomechanics due to PFPS.

Oxford Knee Score: cross-cultural adaptation and validation of the Turkish version in patients with osteoarthritis of the knee

OBJECTIVE The Oxford Knee Score (OKS) is a valid, short, self-administered, and site- specific outcome measure specifically developed for patients with knee arthroplasty. This study aimed to cross-culturally adapt and validate the OKS to be used in Turkish-speaking patients with osteoarthritis of the knee. METHODS The OKS was translated and culturally adapted according to the guidelines in the literature. Ninety-one patients (mean age: 55.89±7.85 years) with knee osteoarthritis participated in the study. Patients completed the Turkish version of the Oxford Knee Score (OKS-TR), Short-Form 36 Health Survey (SF-36), and Western Ontario and McMaster Universities Index (WOMAC) questionnaires. Internal consistency was tested using Cronbachs α coefficient. Patients completed the OKS-TR questionnaire twice in 7 days to determine the reproducibility. Correlation between the total results of both tests was determined by Spearmans correlation coefficient and intraclass correlation coefficients (ICC). Validity was assessed by calculating Spearmans correlation coefficient between the OKS, WOMAC, and SF-36 scores. Floor and ceiling effects were analyzed. RESULTS Internal consistency was high (Cronbachs α: 0.90). The reproducibility tested by 2 different methods showed no significant difference (p>0.05). The construct validity analyses showed a significant correlation between the OKS and the other scores (p<0.05). There was no floor or ceiling effect in total OKS score. CONCLUSION The OKS-TR is a reliable and valid measure for the self-assessment of pain and function in Turkish-speaking patients with osteoarthritis of the knee.

Paralytic and non-paralytic muscle adaptations to exercise training vs. high protein diet in individuals with long-standing spinal cord injury

This study compares the effects of an 8-wk isocaloric high-protein (HP) diet versus a combination exercise (Comb-Ex) regimen on paralytic vastus lateralis (VL) and nonparalytic deltoid muscle in individuals with long-standing spinal cord injury (SCI). Fiber-type distribution, cross-sectional area (CSA), levels of translation initiation signaling proteins (Erk-1/2, Akt, p70S6K1, 4EBP1, RPS6, and FAK), and lean thigh mass were analyzed at baseline and after the 8-wk interventions. A total of 11 participants (C5-T12 levels, 21.8 ± 6.3 yr postinjury; 6 Comb-Ex and 5 HP diet) completed the study. Comb-Ex training occurred 3 days/wk and consisted of upper body resistance training (RT) in addition to neuromuscular electrical stimulation (NMES)-induced-RT for paralytic VL muscle. Strength training was combined with high-intensity arm-cranking exercises (1-min intervals at 85-90%, V̇o2peak) for improving cardiovascular endurance. For the HP diet intervention, protein and fat each comprised 30%, and carbohydrate comprised 40% of total energy. Clinical tests and muscle biopsies were performed 24 h before and after the last exercise or diet session. The Comb-Ex intervention increased Type IIa myofiber distribution and CSA in VL muscle and Type I and IIa myofiber CSA in deltoid muscle. In addition, Comb-Ex increased lean thigh mass, V̇o2peak, and upper body strength ( P < 0.05). These results suggest that exercise training is required to promote favorable changes in paralytic and nonparalytic muscles in individuals with long-standing SCI, and adequate dietary protein consumption alone may not be sufficient to ameliorate debilitating effects of paralysis. NEW & NOTEWORTHY This study is the first to directly compare the effects of an isocaloric high-protein diet and combination exercise training on clinical and molecular changes in paralytic and nonparalytic muscles of individuals with long-standing spinal cord injury. Our results demonstrated that muscle growth and fiber-type alterations can best be achieved when the paralyzed muscle is sufficiently loaded via neuromuscular electrical stimulation-induced resistance training.

Does kinesiophobia affect the early functional outcomes following total knee arthroplasty

ABSTRACT The purpose of this study was to investigate the effects of kinesiophobia on early functional outcomes in patients following total knee arthroplasty (TKA) and how kinesiophobia is related to functional outcomes and pain. The Tampa Scale for Kinesiophobia (TSK), 2-minute walk test (2-MWT), and the timed up and go test (TUG) were used to assess 46 TKA patients on discharge day. The pain levels and active knee flexion range of motion (ROM) were recorded. Patients were divided into two groups as high kinesiophobia (Group I, n = 22) and low kinesiophobia (Group II, n = 24) based on the TSK levels. The TUG results were similar between groups (p = 0.826). 2-MWT results (p < 0.001), pain levels (p = 0.003), and knee flexion ROM (p = 0.025) scores were better in Group II when compared to Group I. The TSK scores were significantly correlated with 2-MWT results (r = −0.40; p = 0.003), pain levels (r = 0.80; p < 0.001), and knee flexion ROM (r = −0.47; p = 0.001). The regression analysis revealed that 41% of 2-MWT score, 47% of knee flexion ROM, and 60% of pain level changes could be explained by kinesiophobia level. The results suggest that early outcomes following TKA were affected by the pain-related fear of movement. The clinicians need to consider the interrelationships between fear of movement and functional outcomes when designing, implementing, and monitoring daily therapeutic exercise programs.

Do Pilates-based exercises following total knee arthroplasty improve postural control and quality of life?

ABSTRACT Purpose: The aim of this prospective, randomized, controlled study was to investigate the effects of the addition of Pilates-based exercises to standard exercise programs performed after total knee arthroplasty on quality of life and balance. Method: Forty-six volunteers were divided into two groups. The control group (n = 17) was assigned a standard exercise program after discharge; the study group (n = 17) was assigned Pilates-based exercises along with the standard exercise program. We carried out clinical evaluations of all patients on the day of discharge and after the completion of the 6-week exercise program. We also recorded sociodemographic data, Berg Balance test scores, and Short Form-36 (SF-36) health-related quality of life measurements. Results: When we compared the differences between pre- and post-treatment balance scores of the groups, we found a significant change in favor of the Pilates-based exercise group (13.64 ± 1.45; p < 0.01). The changes in the pre- and post-treatment SF-36 scores of the Pilates-based exercises group were found to be significant in terms of physical function (p = 0.001), physical role restriction (p = 0.01), and physical component score (p = 0.001). Conclusions: Pilates-based exercises performed along with standard exercise programs were more effective for improving balance and quality of life than standard exercise programs alone.

Comparison of short-term effects of mobilization with movement and Kinesiotaping on pain, function and balance in patellofemoral pain

Objective The aim of this study was to compare the short-term effects of Mobilization with movement (MWM) and Kinesiotaping (KT) on patients with patellofemoral pain (PFP) respect to pain, function and balance. Methods Thirty-five female patients diagnosed with unilateral PFP were assigned into 2 groups. The first group (n = 18) received two techniques of MWM intervention (Straight Leg-Raise with Traction and Tibial Gliding) while KT was applied to the other group (n = 17). Both groups received 4 sessions of treatment twice a week for a period of 2 weeks with a 6-week-home exercise program. Pain severity, knee range of motion, hamstring flexibility, and physical performance (10-step stair climbing test, timed up and go test), Kujala Patellofemoral Pain Scoring and Y-Balance test were assessed. These outcomes were evaluated before the treatment, 45 min after the initial treatment, at the end of the 4-session-treatment during 2-week period and 6 weeks later in both groups. Results Both treatment groups had statistically significant improvements on pain, function and balance (p < 0.05). Pain at rest (p = 0.008) and the hamstring muscle flexibility (p = 0.027) were demonstrated significant improvements in favor of MWM group. Conclusions Our results demonstrated similar results for both treatment techniques in terms of pain, function and balance. The MWM technique with exercise had a short-term favorable effect on pain at rest and hamstring muscle flexibility than the KT technique with exercise in patients with PFP. Level of evidence Level I, therapeutic study.

SAT0756-HPR Effect of nsaid intake on kinesiophobia in patients with ankylosing spondylitis

Background Spinal stiffness and loss of spinal mobility, explained byspinal inflammation and structural damage due to extensive osteoproliferation, are characteristics of Ankylosing Spondylitis (AS). AS usually disables a person with severe back pain and, in later stages, remarkable spinal kyphotic deformity.The deformity eventually may necessitate a major corrective procedure. Therefore, controlling the symptoms and progression of AS in early stages by effective medication is the main step in the management of AS. Objectives The aim of this study was to investigate the effectiveness of DMARD therapies on NSAID intake and kinesiophobia in patients with AS. Methods A total of 74 patients, diagnosed according to the modified New York criteria for AS, were enrolled. Patients were assessed to measure disease activity using the Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]. Fear of movement was assessed with the Tampa Scale for Kinesiophobia [TSK]. To calculate NSAID intake and the type of NSAID, dose, percentage of days with intake were recorded, along with DMARD therapy, age, body mass index (BMI), and disease duration. The NSAID equivalent scoring was calculated according to recommendations from longitudinal clinical studies. The drug therapy groups were compared using the Kruskal-Wallis test and the Chi-square test. Correlation analysis was evaluated by Spearmans correlation coefficient. Results Seventy-four patients (36 women, 38 men; mean age: 43.81±10.18 years; mean disease duration: 9.89±8.50 years; BMI: 28.20±5.07) treated with four types of DMARDs (adalimumab+golimumab =17; infliximab =19; etanercept =13; sulfasalazine =25) were included. There were no drug group differences in terms of age (p=0.179), sex (p=0.886), or BMI (p=0.821). BASDAI scores (mean: 3.9±2.4) and NSAID intake (mean: 68.1±76.1; p=0.003) were significantly higher in the sulfasalazine therapy (ST) group compared to other drug groups. BASDAI scores were not correlated with age (p=0.103), disease duration (p=0.131), BMI (p=0.641) or the TSK scores (p=0.376). Different NSAID intake groups (p=0.089) had similar TSK scores. Conclusions Patients with AS had fear of movement independent of age, BMI or disease duration, even when they experienced positive results from drug therapies and concomitant therapy with a single oral dose of NSAID or oral corticosteroids in stable dosages. References Braun J, Baraliakos X, Heldmann F, et al. Tumor necrosis factor alpha antagonists in the treatment of axial spondyloarthritis. Expert Opin Investig Drugs. 2014;23:647–659. Rohekar S, Chan J, Tse SM, et al. 2014 update of the Canadian Rheumatology Association/Spondyloarthritis Research Consortium of Canada treatment recommendations for the management of spondy- loarthritis. Part I: principles of the management of spondyloarthritis in Canada. J Rheumatol. 2015;42:654–664. Rohekar S, Chan J, Tse SM, et al. 2014 update of the Canadian Rheumatology Association/Spondyloarthritis Research Consortium of Canada treatment recommendations for the management of spondy- loarthritis. Part II: specific management recommendations. J Rheu- matol. 2015;42:665–681. Acknowledgements We would like to thank Rheumatology Nurse Ayten Yuksek in our department for monitoring and documenting of the data, and our patients for assistance with their valuable participation to our study. Disclosure of Interest None declared

THU0756-HPR Predictors of fear of movement in patients with rheumatoid arthritis

Background Rheumatoid arthritis (RA) is a systemic chronic autoimmune inflammatory disease characterized by synovial joint inflammation that results in functional limitations accompanied by social and psychological outcomes. Objectives The aim of this study was to investigate the association between fear of movement and age, upper and lower extremity functions and functional disability in patients with Rheumatoid Arthritis (RA). Methods A total of 88 patients with RA participated to the study. Disease activity was assessed using the Disease Activity Score in 28 joints (DAS28). Functional disability was assessed using the Health Assessment Questionnaire-Disability Index (HAQ-DI). The Disabilities of the Arm, Shoulder and Hand Score (QuickDASH) was used to assess the upper extremity function. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to assess the lower extremity function. The Tampa Scale for Kinesiophobia (TSK) was used to assess pain-related fear of movement. The multiple stepwise linear regression model with R-square (R2) was used to compare across the models and explain the total variance. Results Eight independent variables namely, age (r=0.215; p=0.044), QuickDASH (r=0.504; p<0.001), HAQ-DI (r=0.315; p=0.003), WOMAC Pain (r=0.512; p<0.001), WOMAC Stiffness (r=0.419; p<0.001), WOMAC Function (r=0.398; p<0.001), WOMAC Total (r=0.429; p<0.001), WOMAC range (r=0.419; p<0.001), demonstrated significant correlations with TSK. There were correlations between two independent variables (QuickDASH, p=0.013; WOMAC Pain, p=0.034) and TSK (R2=0.293). Conclusions Health professionals should keep in mind that fear of movement were likely to cause poorer upper extremity functional disability and lower extremity pain levels in spite of varied drug therapies in patients with RA. References Wan, S. W., He, H.-G., Mak, A., Lahiri, M., Luo, N., Cheung, P. P., & Wang, W. (2016). Health-related quality of life and its predictors among patients with rheumatoid arthritis. Applied Nursing Research, 30, 176–183. Doury-Panchout, F., Metivier, J., & Fouquet, B. (2015). Kinesiophobia negatively influences recovery of joint function following total knee arthroplasty. European journal of physical and rehabilitation medicine, 51(2), 155–161. Disclosure of Interest None declared