Inci Yuksel

Comparison of Manual Lymph Drainage Therapy and Connective Tissue Massage in Women With Fibromyalgia: A Randomized Controlled Trial

OBJECTIVE This study analyzed and compared the effects of manual lymph drainage therapy (MLDT) and connective tissue massage (CTM) in women with primary fibromyalgia (PFM). METHODS The study design was a randomized controlled trial. Fifty women with PFM completed the study. The patients were divided randomly into 2 groups. Whereas 25 of them received MLDT, the other 25 underwent CTM. The treatment program was carried out 5 times a week for 3 weeks in each group. Pain was evaluated by a visual analogue scale and algometry. The Fibromyalgia Impact Questionnaire (FIQ) and Nottingham Health Profile were used to describe health status and health-related quality of life (HRQoL). Wilcoxon signed rank test and Mann-Whitney U test were used to analyze the data. RESULTS In both groups, significant improvements were found regarding pain intensity, pain pressure threshold, and HRQoL (P < .05). However, the scores of FIQ-7 (P = .006), FIQ-9 (P = .006), and FIQ-total (P = .010) were significantly lower in the MLDT group than they were in the CTM group at the end of treatment. CONCLUSIONS For this particular group of patients, both MLDT and CTM appear to yield improvements in terms of pain, health status, and HRQoL. The results indicate that these manual therapy techniques might be used in the treatment of PFM. However, MLDT was found to be more effective than CTM according to some subitems of FIQ (morning tiredness and anxiety) and FIQ total score. Manual lymph drainage therapy might be preferred; however, further long-term follow-up studies are needed.

Static Balance in Patients With Patellofemoral Pain Syndrome

Background: The relationship between one-leg static standing balance (OLSSB) and patellofemoral pain syndrome (PFPS) is unknown. Hypothesis: OLSSB decreases in patients with PFPS. Design: Prospective case series. Methods: Fifty-two women with unilateral PFPS were enrolled in this study. OLSSB was evaluated with a stabilometer. Q angle was measured with a lengthened-arm universal goniometer. Lower extremity alignment was analyzed with full-length standing anteroposterior teleroentgenograms. Quadriceps and hamstring strength was measured on an isokinetic dynamometer. Results: There were significant differences in OLSSB, Q angle, and strength of quadriceps and hamstring between the symptomatic and asymptomatic sides. There was a correlation between the strength of the quadriceps and hamstring and OLSSB, while there was no correlation between OLSSB and the severity of pain, lower extremity alignment, and Q angle on the symptomatic side. Conclusions: OLSSB and quadriceps and hamstring strength decreased and Q angle increased on the symptomatic side in PFPS patients. A relationship between OLSSB and pain, Q angle, and lower extremity alignment was not detected, while there was a correlation between the strength of the quadriceps and hamstring and OLSSB. Clinical Relevance: A quadriceps and hamstring strengthening may be beneficial to improve OLSSB in patients with PFPS.

The Effect of an Exercise Program in Conjunction With Short-Period Patellar Taping on Pain, Electromyogram Activity, and Muscle Strength in Patellofemoral Pain Syndrome

Background: McConnell recommended that patellar tape be kept on all day, until patients learn how to activate their vastus medialis obliquus (VMO) during an exercise program. This application may pose problems because prolonged taping may be inadvisable for some patients or even contraindicated owing to skin discomfort, irritation, or allergic reaction. Hypothesis: Wearing patellofemoral tape for a shorter duration during an exercise program would be just as beneficial as a prolonged taping application. Study Design: Prospective cohort. Methods: Twelve patients and 16 healthy people participated. Patients underwent short-period patellar taping plus an exercise program for 3 months. Numeric pain rating, muscle strength of the knee extensors, and electromyogram activity of the vastus lateralis and VMO were evaluated. Results: There were significant differences in electromyogram activity (P = .04) and knee extensor muscle strength (P = .03) between involved and uninvolved sides before treatment. After treatment, pain scores decreased, and there were no significant differences between involved and uninvolved sides in electromyogram activity (P = .68) and knee extensor strength (P = .62). Before treatment, mean VMO activation started significantly later than that of vastus lateralis, as compared with the matched healthy control group (P = .01). After treatment, these differences were nonsignificant (P = .08). Conclusion: Short-period patellar taping plus an exercise program improves VMO and vastus lateralis activation. Clinical Relevance: A shorter period of taping for the exercise program may be as beneficial as a prolonged taping application.

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.

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.

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.

Is There a Relation Between Shoulder Dysfunction and Core Instability

Objectives: Little is known about the relationship between core stability and shoulder dysfunction in shoulder impingement syndrome. The purpose of this study was to analyze the difference between healthy volunteers and patients with shoulder dysfunction in regard to core stability measures. Secondary purpose was to explore the relationship between measures of core stability and measures of shoulder dysfunction. Methods: 15 patients with shoulder impingement syndrome (mean age: 32.2±4.2 years) and 15 healthy volunteers (mean age: 33.8±6.2 years) participated in this study. Sorenson test, front plank and side bridge exercise was performed to assess anterior, lateral and posterior core endurance, respectively. Simple shoulder test (SSS) and seated medicine ball throw test was used to evaluate the functions of the shoulder joints. Mann-Whitney U test was used for comparison of variables between groups. Analyses of relationships between variables were examined with Spearman correlation test. Results: There was a statistically significant difference between patients with shoulder impingement syndrome and healthy controls in core stability and function (p<0.05). A strong positive correlation was found between shoulder functional test (SSS) and lateral bridge test (r= .874, p < .05). Additionally, a modest positive correlation was found between the SSS and the Sorenson test at (r= .695, p < .05), and a weak positive correlation was found between the SSS and the front plank test at (r= .365, p < .05). Conclusion: Core stability and functional deficiency was found in patients with subacromial impingement syndrome. According to this study, greater shoulder dysfunction is correlated with greater stability deficiency. Therapists should consider incorporating core strengthening as an integral component of rehabilitation program in patients with shoulder dysfunction.

AB1242-HPR Fear of Movement Affects Functional Levels and Quality of Life After Total Hip Arthroplasty

Background Though total hip arthroplasty (THA) is a successful procedure for the late stage of hip osteoarthritis, high pain levels and functional impairment are considerable. In addition, THA patients suffer from psychological symptoms such as kinesiophobia/fear of movement. Objectives The purpose of this study was to determine the fear of movement impact on functional levels and quality of life. Methods Forty-two patients who underwent unilateral THA were included in the study. Tampa Scale for Kinesiophobia (TSK) was applied to detect fear of movement level. A high value on the TSK indicates a high degree of fear of movement and a score of 37 differentiates between high and low scores. Patients were divided into two groups either to have high scores (Group I; high kinesiophobia, n=22) or low scores (Group II; low kinesiophobia, n=20). Western Ontario and McMaster Osteoarthritis Index (WOMAC) pain, stiffness and activity of daily living questionnaire and Hip Osteoarthritis Outcome Survey-Physical Function Survey (HOOS-PS) were used to determine the functional status. Physical component summary (PCS) and mental component summary (MCS) of Short Form-12 (SF-12) was used to define the quality of life level. Intensity of pain was measured with visual analog scale (VAS). Assessments were applied at least three months after surgery and time after surgery was recorded. Statistical analysis of the data was performed with Mann Whitney-U test. Results There were no differences in age (p=0.72), BMI (p=0.31), time from surgery (p=0.11), WOMAC pain (p=0.41), WOMAC stiffness (p=0.87), SF-12 MCS (p=0.57)scores between Group I and Group II (Table I).The pain levels (p=0.02), HOOS-PS (p<0.001) WOMAC-ADL and SF-12 PCS (0.02) scores were better in Group II (low kinesiophobia) when compared to Group I (high kinesiophobia). Conclusions Fear of movement has an adverse effect on pain, functional levels and activity of daily living in THA patients. References Cheatham SW, Mokha M, Lee M. Postoperative Rehabilitation After Hip Resurfacing: A Systematic Review.J Sport Rehabil. 2015 Jan 22. Peter WF, Dekker J, Tilbury C, Tordoir RL, Verdegaal SH, Onstenk R, Bénard MR, Vehmeijer SB, Fiocco M, Vermeulen HM, van der Linden-van der Zwaag HM, Nelissen RG, VlietVlieland TP. The association between comorbidities and pain, physical function and quality of life following hip and knee arthroplasty. Rheumatol Int. 2015 Jan 14. Disclosure of Interest None declared

Effects of Different Isokinetic Training Programs on Hamstring/Quadriceps Ratio and Proprioception in Patients with Patellofemoral Pain.

Objectives: To determine the effects of different isokinetic training programs; eccentric training, concentric training and combined (concentric-eccentric) training on quadriceps and hamstring muscle strength functional ratio (H/Qfunc ) and knee proprioception in Patellofemoral Pain Syndrome (PFPS) patients. Methods: Thirty patients with unilateral PFPS were randomly assigned to 3 groups: concentric (CON, n=10) (31.23±3.12 years), eccentric (ECC, n=10) (33.73±2.21 years) and combined (combined, n=10) (30.41±4.35 years). In accordance with the progression principle, the training program was divided into 3 mesoscycles, and the sets and angular speeds were increased in each mesocycle. All groups were treated for 8 weeks. To determine H/Qfunc, eccentric quadriceps and concentric hamstring peak torques were evaluated at 60°/sec with Biodex System 3 (Biodex® Corp., Shirley, NY, USA). 20° and 60° of knee flexion target angles were used to evaluate the knee proprioception. Peak torques and proprioception were evaluated before and 8-week after training. Repeated measure of ANOVA was used for the analysis. Results: There was a significant difference in H/Qfunc between groups at 60°/sec (F= 9.048, p<0.001). The mean improvement difference in ECC and CON-ECC groups were better than CON group. Proprioception improvement was found significant after 8-weeks training for both on 20° (F=150.879 p<0.001) and 60° (F=247.561, p<0.001) of knee flexion. The mean improvement was similar for 20° (F=1.964, p=0.132) and 60° (F=0.493, p=0.711) of knee flexion between the groups. Conclusion: Isokinetic training with the emphasis on eccentric training of quadriceps muscle had a significant effect in H/Qfunc in PFPS patients. This is mostly based on the improvement in quadriceps eccentric peak torque and the improvement in balance between hamstring and quadriceps muscles. Eccentric and combined (concentric-eccentric) training is more appropriate model for strengthening compared to only concentric training.

Upper Quarter Y-Balance Test Score of Patients with Shoulder Impingement Syndrome

Objectives: The Upper Quarter Y Balance Test (UQYBT) is a reliable upper extremity closed kinetic chain test that can be used to assess unilateral upper extremity performance in a closed chain manner. However, UQYBT was tested only in recreational athletes and there are no studies investigating UQYBT scores in patients with various upper extremity musculoskeletal injuries. The purpose of this study was to examine differences in performance on the Upper Quarter Y Balance Test between patient with shoulder impingement syndrome and healthy controls. Methods: A sample of fifteen patients with shoulder impingement syndrome (mean age 32.2±4.2 years) and fifteen healthy control (mean age 33.8±6.2 years) performed the UQYBT. UQYBT was collected bilaterally in three directions (medial, inferolateral, and superolateral). The maximum reach distance for each direction was normalized to upper extremity length (spinous process of C7 to tip of middle finger) and used for analysis Results: A significant difference in performance between patients with shoulder impingement syndrome and healthy controls existed in the medial direction (P<0.05) and the inferolateral direction (P<0.05) where the healthy controls performed better. There was no significant difference in superolateral performance. Conclusion: The results of this study suggest that patients with shoulder impingement syndrome will perform worse on the UQYBT in the medial and inferolateral directions than healthy controls. Thus, upper extremity closed kinetic chain exercises should be added in shoulder rehabilitation programs.