Ipek Yeldan

Group exercise training for balance, functional status, spasticity, fatigue and quality of life in multiple sclerosis: a randomized controlled trial

Objective: To determine the effectiveness of group exercise training on balance, functional status, spasticity, fatigue and quality of life in patients with multiple sclerosis. Design: A randomized single-blind controlled study. Setting: University hospital, outpatient physical therapy department. Subjects: Ambulatory patients with multiple sclerosis. Interventions: Exercise group completed a 12-week group exercise programme under the physical therapists’ supervision. Control group was included in the waiting list. Main measures: The primary outcome measures were the Berg Balance Scale, 10-metre walk test, 10-steps climbing test and secondary outcome measures were the Modified Ashworth Scale, Fatigue Severity Scale and Multiple Sclerosis International Quality of Life. Results: Ninety-nine patients completed the study. There were statistically significant improvements for all outcome measures in the group exercise group (n = 51) (p < 0.01). In the control group (n = 48), there were statistically significant negative change in the Berg Balance Scale and 10-metre walk test measures (p = 0.002, p = 0.001) and statistically significant increment only in the Fatigue Severity Scale score (p = 0.002). The Berg Balance Scale score was increased 4.33 in the exercise group, while a decreased of 2.33 in control group. The 10-metre walk test duration (second) was decreased 2.72 in exercise group, while increased 1.44 in control group. In comparing inter-groups changes, both primary and secondary outcome mesures showed significant improvements in favour of the exercise group after the training (p < 0.05). Conclusion: The study demonstrated that supervised group exercise training is effective in improving balance, functional status, spasticity, fatigue and quality of life in moderately affected people with multiple sclerosis, with no worsening of their clinical status.

The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: A randomised controlled clinical trial

Objective: To compare the efficacy of three-dimensional (3D) Schroth exercises in patients with adolescent idiopathic scoliosis. Design: A randomised-controlled study. Setting: An outpatient exercise-unit and in a home setting. Subjects: Fifty-one patients with adolescent idiopathic scoliosis. Interventions: Forty-five patients with adolescent idiopathic scoliosis meeting the inclusion criteria were divided into three groups. Schroth’s 3D exercises were applied to the first group in the clinic and were given as a home program for the second group; the third group was the control. Main Measures: Scoliosis angle (Cobb method), angle of rotation (scoliometer), waist asymmetry (waist – elbow distance), maximum hump height of the patients and quality of life (QoL) (SRS-23) were assessed pre-treatment and, at the 6th, 12th and 24th weeks. Results: The Cobb (-2.53°; P=0.003) and rotation angles (-4.23°; P=0.000) significantly decreased, which indicated an improvement in the clinic exercise group compared to the other groups. The gibbosity (-68.66mm; P=0.000) and waist asymmetry improved only in the clinic exercise group, whereas the results of the other groups worsened. QoL did not change significantly in either group. Conclusion: According to the results of this study the Schroth exercise program applied in the clinic under physiotherapist supervision was superior to the home exercise and control groups; additionally, we observed that scoliosis progressed in the control group, which received no treatment.

The effectiveness of low-level laser therapy on shoulder function in subacromial impingement syndrome

Purpose. To investigate the effectiveness of low-level laser therapy (LLLT) in addition to exercise programme on shoulder function in subacromial impingement syndrome (SAIS). Method. Sixty-seven patients with SAIS were randomly assigned to either a group that received laser (n = 34) or a group that received placebo Laser (n = 26). Pain, functional assessment, disability and muscle strength of shoulder were assessed before and after a 3-week rehabilitation programme. Besides Laser or placebo Laser, superficial cold and progressive exercise programme were administered to both groups, 5 days a week, for 3 weeks. A progressive exercise programme that was done daily twice under supervision in clinic and at home was given to the patients. Results. After the treatment, all outcome measurements had shown significant improvement except muscle strength in both the groups. When the parameters of the improvement were compared, there were no significant differences between the two groups after treatment. Conclusion. We concluded that there is no fundamental difference between LLLT and placebo LLLT when they are supplementing an exercise programme for rehabilitation of patients with shoulder impingement syndrome.

EFFICACy OF A LAND-BASED HOME ExERCISE PROGRAMME FOR PATIENTS wITH JUvENILE IDIOPATHIC ARTHRITIS: A RANDOMIzED, CONTROLLED, SINGLE-BLIND STUDy

OBJECTIVE To investigate the effects of a land-based home exercise programme on pain, functional ability and quality of life in patients with juvenile idiopathic arthritis. DESIGN A randomized, controlled, single-blind study. PATIENTS Eighty-one patients with juvenile idiopathic arthritis participated in this study. METHODS Functional ability, pain, and quality of life were assessed with a 6-minute walk test, Childhood Health Assessment Questionnaire, visual analogue scale, and the Pediatric Quality of Life Inventory. The patients were randomly assigned to an exercise or control group. The exercise group (n = 43) completed a 12-week individually planned land-based home exercise programme once a week at the hospital for 4 days per week. The control group (n = 38) was placed on the waiting list until the end of the study. RESULTS Statistically significant improvements (p < 0.001) were found in all the outcome measures in the exercise group. The visual analogue scale score decreased significantly (p < 0.01) in the control group after 12 weeks. Other than the visual analogue scale score (P > 0.05), the changes in the other outcome measures (P < 0.001) were significant in favour of the exercise group. CONCLUSION The study demonstrated that participating in a 12-week individually planned land-based home exercise programme may result in improved physical function and quality of life in patients with juvenile idiopathic arthritis.

Comparison study of chest physiotherapy home training programmes on respiratory functions in patients with muscular dystrophy

Objective: To compare the effects of home training programmes, threshold inspiratory muscle training and breathing exercise on spirometry and maximal pressures in patients with muscular dystrophy. Design: Prospective blinded 12-week study. Settings: Cardiopulmonary department of university hospital. Subjects: Twenty-three patients with muscular dystrophy (17 patients with limb girdle muscular dystrophy and 6 patients with Becker muscular dystrophy) assigned to the threshold inspiratory muscle training and breathing exercise groups with alternate allocation. Methods: Spirometry, maximal inspiratory pressure (PImax) and maximal expiratory pressure (PE max) were measured before and after training. In the threshold inspiratory muscle training group threshold pressure load was determined as equal to 30% of weekly PImax measurement. In the breathing exercise group, patients performed deep and forceful diaphragmatic and segmental exercises. All patients performed exercises at home and once a week at hospital under supervision. Results: The improvement of PImax in the threshold inspiratory muscle training group was more significant than the improvement observed in the breathing exercise group (P= 0.05). PEmax increased significantly only in the breathing exercise group (P= 0.01). Spirometry results did not change significantly in both groups after the training. Conclusions: We conclude that respiratory muscle strength is enhanced by training in the patients with muscular dystrophy who are ambulatory, but inspiratory and/or expiratory training effect is specific to the trained muscles. The techniques that improve the strength of respiratory muscles should be included in the physiotherapy management of patients with muscular dystrophy.

Attitudes of physiotherapists and physiotherapy students toward euthanasia: a comparative study.

This interventional study was undertaken to assess the impact of physiotherapy education on the knowledge and attitudes of physiotherapists (PTs) and physiotherapy students (PSs) toward euthanasia. The study, which was conducted during the period between 2004 and 2005, included a total of 494 participants (311 PTs; 183 PSs) aged 18 to 52 y from the western and central portions of Turkey, who responded to a self-report questionnaire (response rate, 96.4%) that was based on data from the literature. Results indicated that PTs (48.9%) were more likely to approve of euthanasia than PSs (38.3%) (P<.05). The legalization of euthanasia was favored by 43.7% of PTs, compared with 29.5% of PSs (P<.05). On the other hand, PTs and PSs expressed similar views regarding euthanasia, including reasons for accepting or opposing euthanasia and acceptable conditions for its use (P> .05). Overall results showed that sex and age had no effect on whether euthanasia was accepted (P> .05); religiousness was found to have the greatest effect on attitudes toward euthanasia (P<.05). The findings of the current study suggest that (1) the attitudes of PTs are different from those of PSs, and (2) the Islamic point of view has a negative impact on the attitudes of PTs and PSs toward euthanasia.

The effects of very early mirror therapy on functional improvement of the upper extremity in acute stroke patients

[Purpose] The aim of the study was to evaluate the effects of a very early mirror therapy program on functional improvement of the upper extremity in acute stroke patients. [Subjects] Eight stroke patients who were treated in an acute neurology unit were included in the study. [Methods] The patients were assigned alternatively to either the mirror therapy group receiving mirror therapy and neurodevelopmental treatment or the neurodevelopmental treatment only group. The primary outcome measures were the upper extremity motor subscale of the Fugl-Meyer Assessment, Motricity Index upper extremity score, and the Stroke Upper Limb Capacity Scale. Somatosensory assessment with the Ayres Southern California Sensory Integration Test, and the Barthel Index were used as secondary outcome measures. [Results] No statistically significant improvements were found for any measures in either group after the treatment. In terms of minimally clinically important differences, there were improvements in Fugl-Meyer Assessment and Barthel Index in both mirror therapy and neurodevelopmental treatment groups. [Conclusion] The results of this pilot study revealed that very early mirror therapy has no additional effect on functional improvement of upper extremity function in acute stroke patients. Multicenter trials are needed to determine the results of early application of mirror therapy in stroke rehabilitation.

FRI0477-HPR The efficacy of land-based home exercise program in patients with juvenile idiopathic arthritis: A randomized-controlled, single-blind study

Background Juvenile idiopathic arthritis (JIA) is a common chronic illness that affects 1 in 1,000 children (1). Patients with JIA may experience significant disability due to muscular weakness, joint pain, contracture, and physical deconditioning. Children with arthritis have been shown to participate in less physical activities and to have low functional ability and decreased physical fitness than their peers (2-5). Objectives To investigate the effects of land-based home exercise program on pain, functional ability, and health-related quality of life in patients with JIA. Methods A randomized controlled single-blind study design including 81 patients (ages 5-17 years) with JIA was used. Socio-demographic data and clinical features were assessed. Functional ability was assessed with 6-Minute Walking Test (6-MWT) and Childhood Health Assessment Questionnaire (CHAQ). Pain was measured using a Visual Analog Scale (VAS). Quality of life was evaluated with The Pediatric Quality of Life Inventory (PedsQL). Patients were randomly assigned to the exercise or control group. Exercise group (n=43) completed 12-week individually planned land-based home exercise program once a week at hospital for 4 days per week. Control group (n=38) was included in waiting list until the end of the study. All patients continued stable dosage on medication through the study. Results In comparison of first assessment values for 6-MWT, CHAQ, VAS, PedsQL-self report and PedsQL-parent report, there was no statistically significant difference in all outcome measures between two groups. While only VAS score decreased significantly (p<0.01) in control group, statistically significant improvements (p<0.001) were found in all outcome measures in exercise group after 12 weeks. Except that VAS score (p>0.05), changes in other outcome measures (p<0.001) were significant in favour of exercise group. Conclusions The study demonstratedthat participating in 12-week individually planned land-based home exercise program may result improved physical function and quality of life in patients with JIA. References Manners PJ, Bower C. Worldwide prevalence of juvenile arthritis: why does it vary so much? J Rheumatol 2002; 29: 1520–30. Henderson CJ, Lovell DJ, Specker BL, Campaigne BN. Physical activity in children with juvenile rheumatoid arthritis: quantification and evaluation. Arthritis Care Res 1995; 8: 114–9. Tarakci E, Yeldan I, Kaya Mutlu E, Baydogan SN, Kasapcopur O. The relationship between physical activity level, anxiety, depression, and functional ability in children and adolescents with juvenile idiopathic arthritis.Clin Rheumatol 2011; 30: 1415–20. Takken T, Hemel A, Van der Net J, Helders PJM. Aerobic fitness in children with juvenile idiopathic arthritis: a systematic review. J Rheumatol 2002; 29: 2643–7. Lelieveld OT, van Brussel M, Takken T, van Weert E, van Leeuwen MA, Armbrust W. Aerobic and anaerobic exercise capacity in adolescents with juvenile idiopathic arthritis. Arthritis Rheum 2007; 57(6): 898–904. Disclosure of Interest None Declared

The effects of closed kinetic chain exercise on pain and functional performance of patients with knee osteoarthritis

Objective: The purpose of this study was to study the effects and therapeutic value of closed kinetic chain exercises on pain and functional performance of patients with knee osteoarthritis. Patients and methods: Thirty individuals with knee osteoarthritis (28 females, 2 males), with a mean age of 54.5 years were introduced into this study. Subjects were randomly divided into 2 groups and were assessed before and after a 5-week therapy phase. Muscle strength of quadriceps femoris was measured with Cybex 350 isokinetic dynamometer in 30◦ and 60◦ positions. Pain intensity was scored on a visual analogue scale (VAS) and on a knee pain scale (KPS). A functional performance test was also applied. One group performed De Lorme technique, which is one of the progressive resistance exercise (PRE) techniques, while the other group performed closed kinetic chain exercise (CKCE). Data were analyzed using the SPSS program. Results: Statistically significant differences were found before and after therapy for muscle strength, VAS, KPS and functional performance in both groups. When the two groups were compared, muscle strength and functional performance tests were found to be significantly better in the CKCE group than in PRE group after the therapy. summary

Respiratory muscle strength in patients with pulmonary hypertension: The relationship with exercise capacity, physical activity level, and quality of life.

Pulmonary hypertension (PH) is characterized by exertional dyspnea, fatigue, chest pain, dizziness, and syncope. Physical activity, peripheral, and respiratory muscle strength reduces in pateints with PH. Little is known about respiratory muscle weakness and related outcomes.