Nilgun Simsir Atalay

Comparing the efficacy of mature mud pack and hot pack treatments for knee osteoarthritis

OBJECTIVE The objective of this study is to compare the efficacy of mature mud pack and hot pack therapies on patients with knee osteoarthritis. DESIGN This study was designed as a prospective, randomized-controlled, and single-blinded clinical trial. Twenty-seven patients with clinical and radiologic evidence of knee osteoarthritis were randomly assigned into two groups and were treated with mature mud packs (n 15) or hot packs (n=12). Patients were evaluated for pain [based on the visual analog scale (VAS)], function (WOMAC, 6 min walking distance), quality of life [Short Form-36 (SF-36)], and serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and insulin-like growth factor-1 (IGF-1) at baseline, post-treatment, and 3 and 6~months after treatment. RESULTS The mud pack group shows a significant improvement in VAS, pain, stifness, and physical function domains of WOMAC. The difference between groups of pain and physical activity domains is significant at post-treatment in favor of mud pack. For a 6 min walking distance, mud pack shows significant improvement, and the difference is significant between groups in favor of mud pack at post-treatment and 3 and 6 months after treatment. Mud pack shows significant improvement in the pain subscale of SF-36 at the third month continuing until the sixth month after the treatment. Significant improvements are found for the social function, vitality/energy, physical role disability, and general health subscales of SF-36 in favor of the mud pack compared with the hot pack group at post-treatment. A significant increase is detected for IGF-1 in the mud pack group 3 months after treatment compared with the baseline, and the difference is significant between groups 3 months after the treatment. CONCLUSION Mud pack is a favorable option compared with hotpack for pain relief and for the improvement of functional conditions in treating patients with knee osteoarthritis.

Comparison of ultrasound and ketoprofen phonophoresis in the treatment of carpal tunnel syndrome.

OBJECTIVE The aim of this study was to compare the efficacy of ultrasound (US) and ketoprofen phonophoresis (PH) in the treatment of carpal tunnel syndrome (CTS). DESIGN This study was a prospective, randomised, controlled, double-blinded clinical trial with follow-up at 8 weeks. Fiftyone patients (76 median nerves) with clinical and electrophysiologic evidence of mild or moderate CTS were included in the study. They were randomly assigned to one of three groups; group 1 received sham US and splinting, group 2 received US and splinting, and group 3 received ketoprofen phonophoresis and splinting. Patients were evaluated by use of electrophysiological variables such as median motor distal latency (mMDL), median sensory distal latency (mSDL), functional status scale (FSS), symptom severity scale (SSS) and visual analog scale (VAS). Electrophysiological variables and scales were evaluated at the beginning, end of therapy (2nd week) and 8th week. RESULTS All the randomised patients were included in the intention-to-treat (ITT) analysis. The per protocol (PP) analysis included only those patients who complied with the study protocol. After completing 2 weeks of treatment, seven out of 51 randomized patients did not finish the study protocol due to non-compliance to splinting, illness and lost to follow-up. Those patients were excluded from PP analysis. Participants were similar in all clinical, electrophysiological and demographic respects (p>0.05). An improvement was found in all parameters (VAS, FSS, SSS, mMDL and mSDL) for all groups at the end of the treatment and 8th week. It was found that pain score was significantly lower in group 3 compared to other treatment groups at 8th week according to ITT and PP analysis (p= 0.002, p=0.004 and p=0.001, p=0.001). CONCLUSION Ketoprofen PH as adjuvant therapy on splinting is effective with respect to reduction of pain. Adding US therapy to the splinting is not superior to the splinting alone in patients with CTS.

Relationship between the body image and level of pain, functional status, severity of depression, and quality of life in patients with fibromyalgia syndrome

The aims were to investigate how the body image is affected in fibromyalgia syndrome (FMS) in comparison to healthy people, as well as to explore the relationship of the body image with the level of pain, functional status, severity of depression, and quality of life (QoL). Demographic variables, symptoms of fibromyalgia, and number of fibromyalgia tender points for 51 patients with FMS and 41 control subjects were recorded. All patients were asked to mark the level of pain on visual analogue scale (VAS). Six-minute walking test was recorded for functional assessment. The impact of the disease was evaluated by fibromyalgia impact questionnaire (FIQ). All patients were asked to complete body image scale (BIS), Beck depression inventory (BDI), and short form-36 (SF-36). There were no differences between groups with regard to demographic variables (p > 0.05). Mean VAS was 7.5 ± 1.4 for the patients with FMS and 0.3 ± 0.4 for control subjects (p < 0.05). Mean FIQ was 70.8 ± 13.2 and 8.2 ± 9.6 for the FMS and control groups, respectively (p < 0.05). Mean BIS and BDI were 106.5 ± 24.0 and 20.2 ± 11.2 for FMS group and 66.3 ± 23.4 and 3.4 ± 4.0 for control group, respectively (p < 0.05). SF-36 subscores were found to be significantly lower in patients with FMS than control subjects (p < 0.05), except for the social function subscore. BIS score had significant relationships both with VAS (r = 0.843) and FIQ (r = 0.290) in patients with FMS (p < 0.05). There were significant relationships between BIS scores and SF-36 pain (r = −0.288), energy/vitality (r = −0.519), mental health (r = −0.442), and general health (r = −0,492) subscores (p < 0.05). Body image was associated with VAS in the multivariate linear regression analysis. The results of the present study indicate that body image is disturbed in patients with FMS compared to control subjects. For the evaluation of the level of pain, impact of the disease, and QoL in patients with FMS, it would be useful to consider the relationship of the body image disturbance with these parameters.

Comparison of effectiveness of Transcutaneous Electrical Nerve Stimulation and Kinesio Taping added to exercises in patients with myofascial pain syndrome.

BACKGROUND Although there are several studies of Transcutaneous Electrical Nerve Stimulation (TENS) and exercise in myofascial pain syndrome, there are no studies comparing the effectiveness of Kinesio Taping (KT) and TENS in myofascial pain syndrome patients. OBJECTIVE To compare the early and late effects of TENS and KT on pain, disability and range of motion in myofascial pain syndrome patients. METHODS Sixty-nine patients were divided into three groups randomly as TENS+Exercise, KT+Exercise and exercise groups. Visual Analogue Scale (VAS), pain threshold, Neck Disability Index and cervical contralateral lateral flexion were employed in the evaluation of the patients performed before treatment, after treatment and 3rd month after treatment. RESULTS The VAS, pain threshold, Neck Disability Index and contralateral lateral flexion values were improved in all groups both in after treatment and 3rd month after treatment (p< 0.01). In the comparison of after treatment vs. before treatment evaluations, VAS score was decreased in KT group compared to the TENS and control group (p= 0.001), in the TENS group compared to control group (p= 0.011). In the comparison of 3rd month and before treatment evaluations, VAS score was decreased in the TENS group compared to control group (p= 0.001) and in the KT group compared to the control group (p= 0.001). There was no significant difference between TENS and KT groups. All other parameters did not differ between the groups. CONCLUSIONS TENS and KT added exercises can decrease pain severity and increase pain threshold, function and cervical range of motion in myofascial pain syndrome patients. Addition of TENS or KT to the exercise therapy resulted in more significant improvement compared to exercise therapy alone with a more pronounced improvement in KT group compared to the TENS group in the early period. Because KT was found to be more effective in decreasing the pain and had the advantage of being used in every 3 days, it seems to be beneficial in acute painful periods in myofascial pain syndrome patients.

Effects of weighted and un-weighted pendulum exercises on ultrasonographic Acromiohumeral distance in patients with subacromial impingement syndrome.

BACKGROUND Although functional results of combined rehabilitation programs are reported, there have been no reports studying the effects of solo pendulum exercises on ultrasonographic measurements of acromiohumeral distance (AHD). OBJECTIVE To investigate the effects of weighted and un-weighted pendulum exercises on ultrasonographic AHD and clinical symptoms in patients with subacromial impingement syndrome. METHODS Patients with subacromial impingement syndrome were randomized to performing weighted (1.5 kilograms hand held dumbbell, N= 18) or un-weighted (free of weight, N= 16) pendulum exercises for 4 weeks, 3 sessions/day. Exercises were repeated for each direction of shoulder motion in each session (ten minutes). Clinical situation was evaluated by Constant score and Shoulder Pain Disability Index (SPADI). Ultrasonographic measurements of AHD at 0°, 30° and 60° shoulder abduction were performed. All clinical and ultrasonographic evaluations were performed at the beginning of the exercise program and at end of 4 weeks of exercise program. RESULTS Thirty-four patients (23 females, 11 males; mean age 41.7 ± 8.9 years) were evaluated. Significant clinical improvements were detected in both exercise groups between pre and post-treatment evaluations (p < 0.05). There was no significant difference for pre and post-treatment AHD measurements at 0°, 30°, and 60° shoulder abduction between groups (p > 0.05). There was no significant difference for pre and post-treatment narrowing of AHD (narrowing of 0°-30°, and 0°-60°) between groups (p > 0.05). CONCLUSION While significant clinical improvements were achieved with both weighted and un-weighted solo pendulum exercises, no significant difference was detected for ultrasonographic AHD measurements between exercise groups.

Demographical, clinical, and psychological differences of patients who suffered hand injury accidentally and by punching glass

OBJECTIVE The aim of this study was to compare patients who were injured by punching glass with patients who were injured accidentally, according to demographical, clinical, and psychological parameters. METHODS The Hand Injury Severity Score (HISS), the Duruöz Hand Index, the Quick Disabilities of the Arm, Shoulder and Hand scale (Q-DASH), the Impact of Event Scale-Revised (IES-R), the Adult Attention-Deficiency/Hyperactivity Scale (A-ADHS), the Borderline Personality Inventory (BPI), and the Beck Depression Inventory (BDI) were used for evaluating severity of the injury, functionality, impact of the injury on the patient, attention deficiency, patterns of borderline personality symptoms, and level of depression, respectively. RESULTS Patients who were injured by punching glass were significantly younger and more likely to injure their dominant hand. The severity of injury and all psychological scales were significantly higher in patients who were injured by punching glass. CONCLUSION Hand therapy specialists should be aware of potential problems in patients who were injured by punching glass.

Reply to a letter from Ozgur Tanriverdi and Derya Kaskari regarding “Frequency of fibromyalgia syndrome in breast cancer patients”

We would like to thank Tanriverdi and Kaskari for their interest in our study regarding the frequency of fibromyalgia syndrome in breast cancer patients which was accepted for publication in International Journal of Clinical Oncology. We think that the letter of Tanriverdi and Kaskari consists of the subjects which we mentioned in our manuscript as discussion, limitations or suggestions for future studies. The first issue raised by Tanriverdi and Kaskari was the missing ‘‘adjuvant’’ terminology in our study. Tanriverdi and Kaskari said that, as they know, in postmenopausal women, aromatase inhibitors (AIs) cause musculoskeletal menopausal symptoms by further lowering the estrogen level; and in previous studies, when Tmx and placebo were compared with AIs, the women using AIs had more musculoskeletal side effects, and arthralgia and myalgia were the most common musculoskeletal side effects reported [1]. Tanriverdi and Kaskari suggested that, therefore, in the study’s design the study group was statistically poor, the frequency of fibromyalgia syndrome (FM) was analyzed and in fact this situation removed the study from the topic it described. Rheumatologic symptoms and FM cases have been reported as a result of adjuvant treatments or chemotherapy used in breast cancer, as we mentioned in our study [2]. The history of chemotherapy, hormonotherapy or radiotherapy in our patients was explained in the results section of our manuscript. The main topic of our study was to explore whether the frequency of FM after mastectomy depended on adjuvant therapy or not. In any case the authors overlooked that the main question of our study was not to investigate the effect of adjuvant therapy after mastectomy for the development of FM. The aim of our manuscript was not to investigate the reasons for widespread pain or fibromyalgia in breast cancer patients. We do not agree with the authors for this comment because we explained the aims of our study previously. The second issue raised by Tanriverdi and Kaskari was that if the study’s title was ‘‘The effect of regional and widespread pain on the quality of life in breast cancer patients’’ perhaps it could reflect the complete article. The first aim of the study was to determine the frequency of FM in breast cancer patients after mastectomy, and the second aim of the study was to explore the relationships between FM, fatigue severity, and quality of life. We do not agree that the suggested title of ‘‘The effect of regional and widespread pain on the quality of life in breast cancer patients’’ could reflect complete article, since the suggested title does not consist of the term ‘‘fibromyalgia,’’ which is the main topic of our study. We would like to bring to light first the definitions of widespread pain and fibromyalgia, and the differences of these disorders. Fibromyalgia is a chronic widespread pain disorder characterized by sleep disorders, fatigue, psychiatric illnesses (depression, anxiety), and somatic disorders (irritabl bowel syndome, headache, fatigue, paresthesia on extremities). FM diagnosis is based on two criteria established by the American College of Rheumatology (ACR): one of which is a history of widespread pain lasting more than 3 months, and the This reply refers to the comment available at doi:10.1007/s10147-013-0545-6.