Ksenija Boskovic

The quality of life of lumbar radiculopathy patients under conservative treatment.

BACKGROUND/AIM The quality of life of lumbar radiculopathy patients conditioned by their health status is a result of both their subjective perception of the disease and their objective health status. The aim of this study was to evaluate the quality of life of lumbar radiculopathy patients under conservative treatment by means of generic and another lumbar syndrome specific questionnaires. METHODS A total of 50 patients (33 males, 17 females average age 46.1 years,) under conservative treatment in a hospital over four weeks were included in the study. They were interviewed using two questionnaires: the SF36 (Short form (36) Health Survey) generic questionnaire measuring eight domains of their quality of life summarized into two main ones (i.e. overall physical and overall mental health), and the lumbar syndrome specific North American Spine Society--Low Back Pain Outcome Instrument (NASS LBP), a questionnaire measuring four domains (functional limitations, motor and sensitive neurological symptoms, expectations from the treatment and satisfaction with it). RESULTS The values of physical health domain was low as 31.1 at the beginning of the treatment, were rising over the following six months and dropped insignificantly after four years (42.1/48.7 /47.0) The mental health values (47.2) did not alter as compared to that of the general population. A values of the quality of life stabilized within six months. The neurological symptoms domain did not correlate with other value scales and domains. CONCLUSION The quality of life of lumbar radiculopathy patients was impaired only from its physical aspect, but after conservative treatment it improved over the following six months. After four years there is an insignificant drop of all quality of life values, indicating a need for a longer term monitoring of their patients.

ADAPTED PHYSICAL ACTIVITY IN THE PREVENTION AND THERAPY OF OSTEOPOROSIS

INTRODUCTION Osteoporosis, a disease characterized by the progressive loss of bone tissue, is one of the most common complications of aging. EPIDEMIOLOGY According to some calculations, there were 25% of women and 4% of men older than 50 years with osteoporosis in the world in 2010. It is assumed that the number of patients with osteoporosis will increase by 30% in every 10 years in the 21st century. There are many reasons for that: the worlds population is growing older, diet is getting poorer in vitamins and minerals and physical activity is decreasing. THE QUALITY AND QUANTITY OF BONE TISSUE: Developing bones are much more responsive to mechanical loading and physical activity than mature bones. This suggests that training in early childhood may be an important factor in the prevention of osteoporosis in later life. It is important to note that the quality of bone achieved by training at younger age cannot be maintained permanently if it is not supported by physical activity later in life. Adapted physical activity represents physical activity individually tailored according to the psychosomatic capabilities of a person and the goal to be achieved. It can be applied at any age in order to maintain strong bones and reduce the risk of fracture. Adapted physical activity is different for men and women, for different age, as well as for the individuals. Aerobic exercises, which lead to an acceleration of breathing, increased heart rate and mild perspiration, as well as resistance exercises and exercises against resistance done by stretching elastic bands, for hands, legs and torso have been proven to increase bone density and improve bone strength. Coordination and balance exercises are important in an individual workout program. An explanation of the action of adapted physical activity is the basis for the theory of control and modulation of bone loss, muscle strength, coordination and balance. Physical activity is very effective in reducing sclerostin, which is known to inhibit bone formation. In addition, physical training enhances the levels of insulinlike growth factor, which has a very positive effect on bone formation. CONCLUSION The aim of adapted physical activity is to improve bone formation in youngsters, to preserve the bone mass in adults and to prevent the bone loss in the elderly thus reducing the risk of falls and resulting fractures; in other words, to minimize the disability caused by fractures and improve the quality of life.

Motor Ability and Emotions in Rheumatoid Arthritis Patients

Objective: The aim is to determine the influence of emotional status on motor response velocity in patients with rheumatoid arthritis. Materials and Method: The study included 53 women with rheumatoid arthritis and 27 healthy women. Depression was diagnosed using the Beck Scale for Depression (Beck Depression Inventory-BDI), anxiety using Spielberger’s anxiety test (Spielberger Trait Anxiety Inventory-State and Traite), functional status (Health Assessment Questionnaire, HAQ), and disease activity using the activity index disease (DAS 28). Simple and choice reaction time was determined using a computer program Donders. Results: Mean visuomotor reaction time (RT1, RT2, RT3) were significantly lower in the group of patients with rheumatoid arthritis than in the control group (p<0.001). In the group of anxious-depressive patients was found significant differences in average values of simple and choice reaction time when compared to the pain by the VAS scale (p<0.001), but not in the group of anxious patients with rheumatoid arthritis. Conclusion: The anxious-depressive patients had damaged motor abilities, which are manifested by significantly longer simple and choice reaction time, when compared to the anxious RA patients and healthy people. The anxiousdepressive RA patients had the higher intensity of pain which correlated with longer visuomotor reaction time.

Clinical characteristics of infectious spondylodiscitis.

Spondylodiscitis represents an inflammatory process, localized in the vertebrae body and in the intervertebral discs. The goals of this research were to identify subjective complaints, clinical findings, and laboratory characteristics in patients with spondylodiscitis, as well as to establish the importance of magnetic resonance imaging in diagnosing this disease. The data of 40 patients treated at the Clinic for Infectious diseases of the Clinical Center of Vojvodina from 2003 till 2007 were reviewed. Majority of the patients had low back pain (90%). Fever was present in 37.5% of patients (chi2 = 2.5; p > 0.05). Laboratory parameters of inflammation were higher than normal in most of the patients before the treatment. Diagnosis of spondylodiscitis was made using MRI in 97.5% of the patients. Keeping in mind unspecific subjective complaints and clinical findings in patients with spondylodiscitis, a health professional should always suspect spondylodiscitis when back pain occurs, in order to diagnose and treat this severe disease as early as possible. Magnetic resonance imaging is the most advantageous method in diagnosing spondylodiscitis.

An estimate of functional state in patients with rheumatoid arthritis

INTRODUCTION Rheumatoid arthritis is an inflammatory chronic disease that affects 0.5-1% of the population, many of whom develop disease as working-age adults. MATERIAL AND METHODS The aim of examination was to estimate functional disability in patients with rheumatoid arthritis and relationship between radiological damage, disease duration, disease activity, functional disability. The examination involved 60 patients with rheumatoid arthritis, aged (53.92 +/- 7.06) of both genders (48 female, 12 male). The following variables were assessed at one time point: swollen and tender joint count, visual analogue scale for pain, erythrocite sedimentation rate, health assessment questionnaire (HAQ) score, anatomical stage and functional class according to Stenbrockers criteria. Disease activity was expressed as 28 joint disease activity score (DAS28). Correlations were calculated by Spearmans coefficient of correlation. RESULTS In our study 82% of the patients had II and III anatomical stage and 80% of the patients had II and III functional class according to Steinbrockers criteria. The median HAQ score was 1.25 +/- 0.70, and the median DAS28 was 5.74 +/- 0.98. Poor functional status was observed in 37 (61.66%) of the patients with an HAQ score of = 2. Functional disability in patients with rheumatoid arthritis was most strongly related to the presence of pain (rs=0.338, p<0.01) and to a lesser extent to anatomical and functional stage, disease duration, disease activity. DISCUSSION AND CONCLUSION The results of the study show that functional disability significantly correlated with subjective pain score (rs=0.338, p<0.01). We observed strong correlation between functional disability presented by HAQ score and pain but no significant correlation with other common clinical variables used for rheumatoid arthritis patients evaluation such as disease duration, disease activity, radiological damage.

Auditory Event-Related P300 Potentials in Rheumatoid Arthritis Patients

The aim of the study was to assess P300 event-related potentials (ERPs) in patients suffering from rheumatoid arthritis (RA) in relation to the duration of illness, degree of disease activity, anatomical and functional stage of the disease, pain intensity, and pain unpleasantness. The cross-sectional study included 53 women with RA (RA group; mean age 50.58 ± 0.93 years) and 27 healthy women (control group, C; 49.41 ± 1.08 years). The intensity and unpleasantness of pain were determined using a visual analog scale (VAS); the functional status was assessed using HAQ (Health Assessment Questionnaire), and the disease activity was estimated using the disease activity scale (DAS28). The P300 waves initiated by auditory stimulations according to the oddball paradigm were recorded from leads Fz and Cz. There were no significant differences between the P300 latencies in both leads. At the same time, the average P300 amplitudes in both leads were found to be considerably lower (P < 0.05) in the RA group compared to the C group. Thus, there is a statistically significant amplitude difference between the P300 cognitive ERPs in RA patients and control subjects.

Massive traumatic myositis ossificans

Introduction Traumatic myositis ossificans (TMO) is a rare condition, which can jeopardize athletic careers, especially in cases when a large ossification is formed. The aim of this paper is to present the results of treating a large TMO mass by application of physical procedures. Case outline A TMO mass of large dimensions was detected in a 13-year-old competitive athlete two months after the patient sustained a direct blow to the quadriceps. Physical treatment lasted three months. The patient was able to carry out normal daily activities and recreational sports activities without limitation eight months after the initial injury. The imaging over a five-year follow-up detected a decrease in height and width of the ossification, but also a discrete increase in its length. Conclusion Physical therapy resulted in full functional recovery, regardless of the massive ossification. The height and width of the ossification was reduced, but its length increased.

Psychometric validation of the Serbian version of the Fear Avoidance Component Scale (FACS)

Objective The Fear Avoidance Components Scale (FACS) is a new patient-reported outcome (PRO) questionnaire designed to comprehensively evaluate fear avoidance (FA) beliefs and attitudes in persons with painful medical conditions. The original English version has demonstrated acceptable psychometric properties, including concurrent and predictive validity. Two factors have been identified: 1. general fear avoidance; and 2. types of activities that are avoided. Methods The FACS was first translated into Serbian, and then psychometrically validated. A cohort of 322 chronic musculoskeletal pain subjects completed the FACS-Serb and additional FA-related patient-reported outcome (PRO) measures. Their FACS-Serb scores were then compared to a cohort of 68 acute pain subjects. Results Test-retest reliability (ICC2,1 = 0.928) and internal consistency for both Factors (Cronbach α 0.904 and 0,880 respectively) were very good. An acceptable fit was found with a confirmatory factor analysis of the 2-factor model found with the original English version of the FACS. Strong associations were found among FACS-Serb scores and other PRO measures of pain catastrophizing, depressive/anxiety symptoms, perceived disability, and pain intensity (p<0.001 for all analyses). FACS-Serb total scores, separate Factor scores, and subjective pain ratings were significantly higher in the chronic vs. acute pain cohorts (p<0.001 for all analyses). Conclusions The FACS-Serb demonstrated strong psychometric properties, including strong reliability and internal consistency, criterion validity (through associations with other FA-related PRO measures), and discriminant validity (through comparisons with a separate acute pain cohort). The FACS-Serb appears to be a potentially useful pain-related assessment tool.

Utjecaj komorbiditeta na ishod rehabilitacije nakon ishemijskog moždanog udara

SUMMARY – Comorbidity decreases survival but it still remains unknown to what extent functional recovery after ischemic stroke is affected. The aim of this research was to determine the prevalence of the most common comorbidities in patients with ischemic stroke and to examine their predictive value on the functional status and recovery. In order to obtain relevant information for this research, we conducted a prospective study over a two-year period. It included patients with acute/subacute ischemic stroke who had inhospital rehabilitation treatment in our institution. Functional status of the patients was evaluated by the following three aspects at the beginning and at the end of rehabilitation treatment: Rivermead Mobility Index was used for mobility, Barthel Index for independence in activities of daily living, and modified Rankin Scale for total disability. Modified Charlston Comorbidity Index was used to assess comorbidity. Multivariate analysis was applied to evaluate the impact of recorded comorbidities on the patient functional outcome. Independent predictors of rehabilitation success in our study were the value of modified Charlston Comorbidity Index, atrial fibrillation and myocardial infarction. Our study demonstrated that patients with more comorbidities had worse functional outcome after stroke, so it is important to consider the comorbidity status when planning the rehabilitation treatment.

FUNCTIONAL STATUS OF PATIENTS AFTER STROKE.

INTRODUCTION Patients who have suffered from stroke become disabled and have specific problems due to the physical and mental disability that requires the implementation of rehabilitation and the creation of conditions for independent living, economic and social reintegration. The aim of this study was to evaluate the functional recovery of patients after ischemic stroke, during the subacute phase of medical rehabilitation. MATERIAL AND METHODS The study was organized as a prospective study, which included 74 patients (44 men, 30 women) treated after stroke at the Department of Medical Rehabilitation, Clinical Center of Vojvodina during 2013. Motor recovery was assessed by Signe-Brunnstrom scale, and Barthel Index, Rivermead Mobility Index, and modified Rankin scale were applied to assess the function. RESULTS The average age of patients after stroke was 66.59 ± 9.607 years. The mean hospital stay was 34.35 days. The majority of patients in this study had right-hand hemiparesis 47 (63.5%), and 27 (36.5%) had left-hand hemiparesis. By analyzing the average valueof motor recovery of the affected limb by S.Brunnstroms scale during rehabilitation at the Department of Medical Rehabilitation, it was found that the value at the end of subacute rehabilitation phase was significantly increased (p<0.01). The results of this testing showed a statistically significant improvement (p<0.0l) in the average values of Barthel Index, Rivermead Mobility Index and modified Rankin scale during the rehabilitation treatment of stroke patients. CONCLUSION The obtained results showed that the rehabilitation treatment resulted in better functional and motor recovery in the patients who had had ischemic stroke.