Nurdan Paker

Efficacy of supervised exercise combined with transcutaneous electrical nerve stimulation in women with fibromyalgia: a prospective controlled study

The aim of this study was to investigate the results of a supervised exercise with transcutaneous electrical nerve stimulation (TENS) in an exercise controlled study in women with fibromyalgia. Sixty-six women with fibromyalgia who admitted to the outpatient clinic of our hospital were randomized into two treatment groups. The patients in both groups participated in a supervised combined exercise program for 12xa0weeks. The women in first group had additional TENS in the first 3xa0weeks of the study. All subjects were analyzed at the baseline, at the end of the 3rd and 12th weeks. Outcome measures were tender point count (TPC), myalgic pain score (MPS), Fibromyalgia Impact Questionnaire (FIQ) and Short Form-36 (SF-36) Health Survey. Sixty women with fibromyalgia completed the study. The patients in both groups showed improvement in terms of TPC, MPS, FIQ, physical and mental summary scores and total scores of SF-36 at the end of the 3rd and 12th weeks. The improvement in MPS at the third week was higher in the first group (pxa0=xa00.01). But there was no difference in terms of the improvement in MPS between the groups at the end of the 12th week control (pxa0=xa00.87). There was no significant difference between the improvement in the other outcome parameters of the two groups. As a result, supervised exercise program was successful to improve the myalgic pain, functional status and quality of life in women with fibromyalgia. Exercises combined with TENS might be useful due to quick myalgic pain relief in the treatment of fibromyalgia in everyday practice.

Lokomat: A therapeutic chance for patients with chronic hemiplegia

BACKGROUNDnTreadmill training with partial body weight support has been suggested as a useful strategy for gait rehabilitation after stroke.nnnOBJECTIVESnThis prospective, randomized, controlled study of gait training tested the feasibility and potential efficacy of using a robotic-assisted gait device, Lokomat, for treadmill training with partial body weight support in subjects with chronic hemiplegia; the device was also compared with conventional home exercise.nnnMETHODSnTwenty-two male ambulatory ischemic or hemorrhagic induced stroke patients with chronic hemiplegia lasting at least 12 months were enrolled in this prospective study. The patients were assigned to either the Lokomat group or the conventional exercise group. The Lokomat group underwent active robotic training for ten sessions (five sessions per week for two weeks). Each session lasted 30 minutes. If a patient missed three consecutive training sessions, he was removed from the study. The Timed Up and Go Test is used to assess mobility and requires both static and dynamic balance. The 10-m Timed Walking Speed Test is designed to determine the patients overground walking speed. The Mini-Mental State Examination and Hospital Anxiety and Depression Scale were used for mental and psychological evaluation; the Functional Ambulation Categories was used to assess ambulatory status.nnnRESULTSnWithin each eight-week interval, the patients undergoing the Lokomat training demonstrated significantly greater improvement on the Timed Up and Go Test and 10-m Timed Walking Speed Test than those undergoing conventional training.nnnCONCLUSIONnDespite the small number of patients in the study, the present data suggests that the robotic-assisted device, Lokomat, provides innovative possibilities for gait training in chronic hemiplegia rehabilitation by training at higher intensity levels for longer durations than traditional home exercise.

Effects of robotic treadmill training on functional mobility, walking capacity, motor symptoms and quality of life in ambulatory patients with Parkinson's disease: A preliminary prospective longitudinal study

BACKGROUNDnDecreased mobility and walking capacity occur frequently in Parkinsons disease (PD). Robotic treadmill training is a novel method to improve the walking capacity in rehabilitation.nnnOBJECTIVESnThe primary aim of this study was to investigate the effects of robotic treadmill training on functional mobility and walking capacity in PD. Secondly, we aimed to assess the effects of the robotic treadmill training the motor symptoms and quality of life in patients with PD.nnnMETHODSnSeventy patients with idiopathic Parkinsons disease who admitted to the outpatient clinic of the rehabilitation hospital were screened and 12 ambulatory volenteers who met the study criteria were included in this study. Patients were evaluated by Hoehn Yahr (HY) scale clinically. Two sessions robotic treadmill training per week during 5 weeks was planned for every patient. Patients were evaluated by the Timed Up and Go (TUG) test, 10 meter walking test (10 MWT), Unified Parkinsons Disease Rating Scale (UPDRS) motor section and Parkinsons Disease Questionnaire-39 (PDQ-39) at the baseline, at the 5 and 12 weeks. Cognitive and emotional states of the patients were assessed by Mini Mental State Examination (MMSE) test and Hospital Anxiety and Depression Scale (HADS) at the baseline. All patients were under medical treatment for the PD in this study and drug treatment was not changed during the study.nnnRESULTSnTen patients completed the study. The mean age was 65.6 ± 6.6 years. Five patients (50%) were women. Disease severity was between the HY stage 1-3. Two patients did not continue the robotic treadmill training after 7 sessions. They also did not want to come for control visits. TUG test, 10 MWT and UPDRS motor subscale scores showed statistically significant improvement after robotic treadmill training (p = 0.02, p = 0.001, p = 0.016). PDQ-39 scores improved significantly after robotic treadmill training (p = 0.03), however, the scores turned back to the baseline level at the 12. week control.nnnCONCLUSIONnAs a result of this preliminary study, robotic treadmill training was useful to improve the functional mobility, walking capacity and motor symptoms in mild to moderate PD. Robotic treadmill training provided a transient improvement in the quality of life during the treatment.

The relationship between Knee Injury and Osteoarthritis Outcome Score (KOOS) and Timed Up and Go test in patients with symptomatic knee osteoarthritis

Both self-reported and physical performance tests are used as outcome measures in knee osteoarthritis (OA). The aim of this study is to investigate the relationship between Knee Injury and Osteoarthritis Outcome Score (KOOS) and Timed Up and Go (TUG) test in the patients with symptomatic knee OA. Eighty-nine patients with symptomatic knee OA who admitted to the outpatient clinic of the hospital were included in the study. All patients had bilateral medial tibiofemoral knee OA. After physical examination, radiological severity of the disease was evaluated with Kellgren–Lawrence scale. All patients completed KOOS that is a knee-related disorder-specific questionnaire. TUG test was used for the evaluation of performance-based functional status. Seventy-seven patients (84.5xa0%) were female. Mean age was 62.9xa0±xa09.5 (50–85) years, and body mass index was 32.10xa0±xa04.39xa0kg/m2. Mean symptom duration was 7.08xa0±xa06.52xa0years. Mean radiological stage was 3.22xa0±xa00.69. There was a statistically significant negative correlation between all of the KOOS domains and TUG (pxa0<xa00.01). As a result of this study, a moderate relationship was found between the all KOOS dimensions and TUG in knee OA.

Frequency and predictors for falls in the ambulatory patients with rheumatoid arthritis: a longitudinal prospective study

The aim of this multicentre study is to investigate the incidence and risk factors for falls in ambulatory rheumatoid arthritis (RA) patients. One hundred and eighty-five ambulatory RA patients who have been followed up in 3 different centres were included in study. Patients were a part of Turkish League Against Rheumatism-Follow-up Program. All patients were evaluated at the baseline in terms of demographic features, falls history in the last year, disease-specific characteristics and co-morbidities. Functional status was evaluated by chair stand test with five repetitions and heel–toe walking. Erythrocyte sedimentation rate and CRP values were measured. Study patients were followed by the three monthly visits during a year. Patients were asked to fill the fall diary and/or call the doctor when a fall happens. The features of falls were recorded to the files at the time of the fall. The mean age was 56.7xa0±xa011.4xa0years. Four patients were drop out the study. Thirty-four patients fell and 2 had fractures during 1xa0year. Falls were found to be correlated with age, visual analogue score for pain, previous falls, use of assistive devices for ambulation, use of two or more medications and ability to do heel–toe walking. In the multivariate regression analysis, previous falls and use of assistive device for ambulation were found to be independent risk factors for falls (pxa0=xa00.004 OR 3.3 95xa0% CI 1.5–7.4, pxa0=xa00.001 OR 6.2 95xa0% CI 2–19.1). Fall history in the last year and using an assistive ambulation device are the predictors of the falls.

Effect of body mass index on functional recovery after total knee arthroplasty in ambulatory overweight or obese women with osteoarthritis

OBJECTIVEnThe aim of this study was to evaluate the relationship between body mass index (BMI) and functional status after total knee arthroplasty (TKA) in ambulatory overweight or obese women with knee osteoarthritis (OA).nnnMETHODSnThe study included 78 women who underwent elective primary TKA for osteoarthritis. Age, height, body weight and BMI were recorded. Functional status was evaluated using the Turkish version of the Knee Injury and Osteoarthritis Outcome Score (KOOS). The Timed Up and Go (TUG) test was used to evaluate performance-based functional assessment.nnnRESULTSnMean age of the patients was 66.5 ± 5.8 (range: 56 to 79) years and mean duration of symptoms was 9.56 ± 7.1 years. Body mass index was 30 or higher in 47 patients (60%) and between 25 and 29 in 31 (40%). Body mass index did not correlate with the KOOS or TUG test. Postoperative KOOS scores showed a statistically significant increase (p<0.01). Postoperative TUG test values showed significant improvement (p<0.01).nnnCONCLUSIONnBody mass index had no negative effect on functional recovery and mobility in the ambulatory overweight or obese women undergoing TKA. Physical function improved significantly after knee arthroplasty.

Reliability of the Turkish version of the hospital anxiety and depression scale in the people with traumatic spinal cord injury.

BACKGROUNDnEmotional problems are common in spinal cord injury (SCI). Self report questionnaires are easy and useful for screening the emotional status in clinical practice.nnnOBJECTIVESnThe aim of this study was to assess the reliability of the Turkish version of the Hospital Anxiety and Depression Scale (HADS) as well as to investigate the frequency of anxiety and depression in a group with SCI admitted to the outpatient clinic of a rehabilitation hospital.nnnMETHODSnOne hundred seventy-five persons with traumatic SCI were included in this study. The American Spinal Injury Association Impairment Scale, Functional Independence Measure (FIM) and HADS were used for assessments.nnnRESULTSnThe mean age of the participants was 35 ± 13 years, and the mean time elapsed since injury was 13 ± 29 months. The mean motor FIM score was 41 ± 21. The Cronbachs alpha coefficient was 0.90 and 0.77 for the anxiety and depression subscales of the HADS, respectively. Forty percent of the participants had anxiety and 28% had depression. Anxiety was positively correlated with time since injury (r = 0.2). Depression was negatively correlated with the education level (r = 0.25), and positively correlated with age (r = 0.17). There was a positive correlation with completeness and anxiety and depression (r = 0.49, r = 0.55).nnnCONCLUSIONnThe Turkish version of the HADS is a reliable psychological screening test for anxiety and depression in people with SCI. Rehabilitation team should gather maximum information about the emotional status of the person with SCI, and plan the appropriate treatment for anxiety and depression.