Nilay Sahin

Effectiveness of back school for treatment of pain and functional disability in patients with chronic low back pain: a randomized controlled trial.

OBJECTIVE To evaluate the effectiveness of the addition of back school to exercise and physical treatment modalities in relieving pain and improving the functional status of patients with chronic low back pain. DESIGN A randomized controlled trial. PATIENTS A total of 146 patients with chronic low back pain were enrolled in the study. METHODS Subjects were divided into 2 groups: the back school group received exercise, physical treatment modalities and a back school programme; and the control group received exercise and physical treatment modalities. Treatment efficacy was evaluated at the end of treatment and 3 months post-treatment, in terms of pain, measured with the Visual Analogue Scale, and functional status, measured with the Oswestry Low Back Pain Disability Questionnaire. RESULTS In both groups, Visual Analogue Scale and Oswestry Low Back Pain Disability Questionnaire were significantly reduced after therapy (p < 0.01), but the difference between the scores at the end of treatment and 3 months post-treatment was not significant. There was a significant improvement in Visual Analogue Scale and Oswestry Low Back Pain Disability Questionnaire in the back school group compared with the control group at the end of therapy and 3 months post-treatment (p < 0.05). CONCLUSION The addition of back school was more effective than exercise and physical treatment modalities alone in the treatment of patients with chronic low back pain.

The effect of two exercise programs on various functional outcome measures in patients with osteoarthritis of the knee: A randomized controlled clinical trial

We aimed to investigate the effects of isometric and combined concentric-eccentric (C-E) isokinetic types of exercise applied to the knee muscles in patients with knee osteoarthritis (OA) in an attempt to identify which type of exercise would be most effective in terms of pain relief, functional status, quality of life, and muscular strength. This was a controlled trial in which 71 patients were randomized into three groups. The first group was assigned to C-E, the second group to isometric isokinetic exercises, while the third, control group, was only given paracetamol. A visual analog scale for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short From-36 (SF-36) for functional status and quality of life, and the isokinetic test for muscular strength were evaluated. Significant improvements were recorded in all groups for pre and post-treatment pain, the WOMAC and the SF-36 (P < 0.001). Among the exercise groups, improvement was significantly better in the C-E, isokinetic exercise group as compared with the isometric exercise group (P < 0.001). Isokinetic exercises are recommended as a treatment modality. However, the long-term effects of these exercises on pain and osteoarthritis progression need to be investigated.

Efficacy of therapeutic ultrasound in the treatment of spasticity: A randomized controlled study

The purpose of this study was to investigate the effect of ultrasound (US) on the spasticity occurring in the ankle plantar flexor muscles after a cerebrovascular event. According to the modified Ashworth scale (MAS), the hemiplegic patients with stage 2-3 spasticity on the ankle plantar flexor muscles were enrolled in the study and divided into two groups. Passive stretching exercise was applied to both groups. Additionally, 10-minute US was applied to one of the groups, using the mode of continuous wave of 1.5w/cm^{2} to the calf muscles before stretching. In order to monitor the efficacy of the treatment in the patients, MAS, Hmax/Mmax ratio, the ankle range of motion (ROM), Functional Independence Measure and Brunnstrom Motor Recovery Stage were evaluated. While a significant recovery was monitored in the MAS and ankle ROM measurements after treatment in both groups, no change was obtained in the other parameters. No significant difference was detected in any of the measurements between the groups. In this study, US treatment applied in combination with the ankle plantar flexor muscles passive stretching exercise was determined to have no effect on the stretching treatment in minimizing the spasticity.

Treatment of periodontoid pannus with infliximab in a patient with rheumatoid arthritis.

The craniocervical region is the most affected part of cervical spine, and one of the most dreaded complications of rheumatoid arthritis (RA) involvement in the cervical spine is compression of the spinal cord. Atlantoaxial dislocation and pannus (abnormal soft tissue) surrounding the dens are the most well-known reasons of spinal cord compression in RA. The T-lymphocyte mediated process results in an inflammatory synovitis and rheumatoid pannus. This pannus tissue can damage ligaments, bones, synovial joints in cervical spine, resulting in subluxation, instability, and spinal cord or brainstem compression. We describe a patient in whom periodontoid pannus size and cord edema reduced significantly after treatment of infliximab, a tumor necrosis factor (TNF) chimeric monoclonal antibody.

Comparison among pain, depression, and quality of life in cases with failed back surgery syndrome and non-specific chronic back pain

[Purpose] The aim of this study is to compare patients with failed back surgery syndrome (FBSS) with those with non-specific chronic back pain (NSCBP) in terms of pain, depression, and quality of life levels to explain the effects of surgery experience on low-back pain. [Subjects and Methods] A total of 50 patients with FBSS and 51 patients with NSCBP who consecutively applied to the outpatient clinic from September 2012 to April 2013 were included in the study. Patients completed questionnaires on demographics, body mass index, education level, work history, and pain duration (in months). Lumbar pain at rest, during movement, and at night were measured with a visual analogue scale (VAS). The Short Form 36 scale was used for evaluating quality of life, and the Beck Depression Inventory (BDI) was used for assessing depression. [Results] VAS scores reporting pain at rest and at night and BDI scores were significantly higher in the FBSS group than in the NSCBP group. Role limitations due to physical functioning, which is one of the measures of quality of life, were significantly higher in the FBSS group than in the NSCBP group. [Conclusion] These assessments show that surgery experience in patients with ongoing low-back pain makes their pain and depression worse.

Comparison of effectiveness of different exercise programs in treatment of failed back surgery syndrome: A randomized controlled trial.

BACKGROUND Failed back surgery syndrome (FBSS) is a condition characterized by persistent pain following back surgeries. OBJECTIVE To determine the effects of different exercises programs in FBSS. METHODS A Single-blind, randomized, controlled trial designed. One hundred participants with failed back surgery syndrome were randomly assigned to three different exercises groups (Isokinetic, Dynamic lumbar stabilization (DLS), and home exercises (HE) groups) and a control group. Patients were evaluated before and after 8-week exercise program and follow-ups at the 3rd and 6th months after the exercise program. Finger-floor distance and lumbar Schober for lumbar mobility, visual analog scale (VAS) for pain, modified Oswestry disability index, Beck depression inventory, fear-avoidance attitudes survey, and progressive-isoinertial weight lifting test were used as follow-up parameters. Lumbar muscle strength was assessed with the isokinetic dynamometer. RESULTS VAS levels were decreased from 67.7 to 22.8 in isokinetic and from 68.7 to 25.0 in DLS and from 64.6 to 47.1 in HE groups at the end of the program (p< 0.05). Also, all of other follow-up parameters of the isokinetic and DLS exercise groups viewed significant improvements compared to the control group. CONCLUSIONS According to our results either isokinetic or DLS exercises are more effective in FBSS patients.

Subgrouping and TargetEd Exercise pRogrammes for knee and hip OsteoArthritis (STEER OA): : a systematic review update and individual participant data meta-analysis protocol

Introduction Knee and hip osteoarthritis (OA) is a leading cause of disability worldwide. Therapeutic exercise is a recommended core treatment for people with knee and hip OA, however, the observed effect sizes for reducing pain and improving physical function are small to moderate. This may be due to insufficient targeting of exercise to subgroups of people who are most likely to respond and/or suboptimal content of exercise programmes. This study aims to identify: (1) subgroups of people with knee and hip OA that do/do not respond to therapeutic exercise and to different types of exercise and (2) mediators of the effect of therapeutic exercise for reducing pain and improving physical function. This will enable optimal targeting and refining the content of future exercise interventions. Methods and analysis Systematic review and individual participant data meta-analyses. A previous comprehensive systematic review will be updated to identify randomised controlled trials that compare the effects of therapeutic exercise for people with knee and hip OA on pain and physical function to a non-exercise control. Lead authors of eligible trials will be invited to share individual participant data. Trial-level and participant-level characteristics (for baseline variables and outcomes) of included studies will be summarised. Meta-analyses will use a two-stage approach, where effect estimates are obtained for each trial and then synthesised using a random effects model (to account for heterogeneity). All analyses will be on an intention-to-treat principle and all summary meta-analysis estimates will be reported as standardised mean differences with 95% CI. Ethics and dissemination Research ethical or governance approval is exempt as no new data are being collected and no identifiable participant information will be shared. Findings will be disseminated via national and international conferences, publication in peer-reviewed journals and summaries posted on websites accessed by the public and clinicians. PROSPERO registration number CRD42017054049.

Evaluation of tool-like receptor-2 and 4 and interleukin-6 gene expressions in Turkish rheumatoid arthritis patients.

Rheumatoid arthritis (RA) is a progressive inflammatory disease. Although the etiology and pathogenesis of RA are not known well, genetic and environmental factors are proposed to initiate an autoimmune process. We aimed to investigate mRNA expression levels of Toll-like receptor-2 (TLR-2), TLR-4, and interleukin-6 (IL-6) genes in RA disease. This study was conducted with 50 patients who were diagnosed with RA according to the American College of Rheumatology classification criteria for RA and 50 age-matched healthy control individuals who did not have any joint diseases and autoimmune diseases. We collected whole blood from all participants and analyzed expression of TLR-2, TLR-4, and IL-6 genes at mRNA level using real-time qPCR. TLR-2 expression was detected to increase 3.8-fold and IL-6 expression was detected to increase 6.8-fold in RA patients compared to healthy controls. No difference was found between patient and control groups with regard to TLR-4 expression. Overexpression of TLR-2 and IL-6 may be responsible for RA pathogenesis. Inhibition of both TLR and IL signaling pathways may prevent joint inflammation and destruction.

The Effectiveness of Exergames in Patients with Ankylosing Spondylitis: A Randomized Controlled Trial

BACKGROUND Exergames are a well-known type of game based on a virtual avatars body movements. This hightech approach promotes an active lifestyle. OBJECTIVES The aim of this randomized controlled trial was to evaluate the effects of exergames on pain, disease activity, functional capacity and quality of life in patients with ankylosing spondylitis (AS). MATERIAL AND METHODS The study involved 60 patients, who were randomized into either the exergame group (EG) or the control group (CG). The EG patients engaged in exergaming, and CG patients did not engage in any exercises. The exergaming sessions were performed five times a week for eight weeks (40 sessions in total). The patients were assessed before and after the eight-week program on a visual analog scale (VAS), the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Quality of Life (ASQOL) questionnaire. RESULTS A statistically significant improvement was observed in VAS, BASFI, BASDAI and ASQoL scores in the EG group after completion of the exercise program (p < 0.05). CONCLUSIONS This study is a first step in investigating the possibilities of using an exergame platform to help patients with spondyloarthropathies to adopt a more physically active lifestyle. The results of this study suggest that exergames increase physical activity and decrease the pain scores in AS patients and also could, therefore, be feasible and safe.

Clinical and demographic characteristics and functional status of the patients with fibromyalgia syndrome

OBJECTIVE: To investigate the clinical and demographic characteristics and functional status of the patients with fibromyalgia syndrome (FMS). METHODS: Ninety-four patients with the diagnosis of FMS were included in the study. All patients were evaluated with short form 36 for quality of life (SF-36), pain, depression, benign joint hypermobility syndrome (BJHS), myofacial pain syndrome (MPS), and demogrophic characteristics. End-point measurements were SF-36 for quality of life, visual analogue scale, Beck Depression Index, anamnesis, and physical examination. RESULTS: The majority of the patients were women who were suffering from generalised pain with a median age of 40.4. Mostly depression and sleep disorders were accompanying the syndrome. Physical examination revealed MPS and BJHS in most of the patients. CONCLUSION: BJHS and MPS must also be investigated in patients with the diagnosis of FMS.