O. Kuru

Reliability and validity of the Turkish version of the Falls Efficacy Scale International (FES-I) in community-dwelling older persons.

The FES-I is a questionnaire which was developed to assess fear of falling. The aim of this study was to evaluate validity and reliability of a Turkish language version of the FES-I in Turkish older people. The study sample included 70 volunteers with an age range of 65-81. To assess the test-retest reliability of the Turkish FES-I, questionnaire was applied again 10-15 days after the first interview (interclass correlation: ICC). FES-I was compared with The Modified Barthel Index (MBI), the timed up and go test (TUG), and The Berg Balance Scale (BBS) for construct validity. Cronbachs alpha (α) was used to evaluate the internal consistency. The internal structure of the FES-I was examined by factor analysis. ROC plots were used to define cut-point for the FES-I scales. Cronbachs α of the Turkish FES-I was 0.94 and the individual item ICC ranged from 0.97 to 0.99. The Turkish FES-I total scores were correlated with TUG positively, and MBI, and BBS negatively. The cut-off score to differentiate between persons with fear of falling and persons without fear of falling was 24 points. It was found that the Turkish version of the FES-I was a reliable and valid measure of fear of falling in Turkish older people.

HLA-B27 polymorphism in Turkish patients with ankylosing spondylitis

The aim of this study was to determine the distribution of human leukocyte antigen (HLA)-B27 subtypes in serologically HLA-B27-positive ankylosing spondylitis (AS) patients and healthy controls from the Turkish population and to compare this with other reports from other populations. We subtyped HLA-B27 in 38 HLA-B27-positive Turkish patients with AS and 47 HLA-B27-positive healthy controls without AS by polymerase chain reaction with specific sequence primers (PCR-SSP). The results demonstrated that: B*2705 was the predominant subtype among both of the patients (71.1%) and controls (68.0%). B*2702 was observed in 26.3% and 32.0% of the patients and controls, respectively. B*2708 subtype was found in 2.6% of the patients but not among the control group. When the distribution of B27 subtypes in Turkish populations was compared with that in other populations, similar frequencies with the Caucasian–Europe groups were noted. However, this should be interpreted carefully because of the small number of individuals in our study.

Psychiatric symptoms in ankylosing spondylitis: their relationship with disease activity, functional capacity, pain and fatigue

OBJECTIVES The aim of this study is to evaluate psychiatric symptoms in patients with ankylosing spondylitis (AS) and to investigate the relationship of the disease activity, functional capacity, pain, and fatigue with psychiatric symptoms. METHODS Eighty AS patients and 80 healthy controls were included in the study. Spinal pain by visual analog scale (pain VAS-rest), disease activity by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional capacity by Bath Ankylosing Spondylitis Functional Index (BASFI), and fatigue by Multidimensional Assessment of Fatigue (MAF) were assessed in patients. Psychiatric symptoms were measured using the Symptom Checklist-90-R (SCL-90 R), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Pittsburgh Sleep Quality Index (PSQI) and Rosenberg Self-Esteem Scale (RSES). RESULTS SCL-90-R total and all subscale scores (except interpersonal sensitivity and psychoticism) and BDI scores were significantly higher in the AS group compared to control group. PSQI total and all subscale scores were significantly higher in the AS group. State anxiety scale score was significantly higher and RSES score was significantly lower in the AS group. Psychiatric symptoms (except Rosenberg Self-Esteem score) were significantly correlated with BASDAI, BASFI, pain VAS rest, and MAF scores. CONCLUSION Psychiatric symptoms are often seen in patients with AS. Disease activity, functional capacity, pain and fatigue were correlated with psychiatric symptoms but self-esteem was not. Therefore, psychiatric symptoms should be taken into consideration in the management of AS.

Quality of Life in Patients with Lower Limb Amputation: Does It Affect Post-amputation Pain, Functional Status, Emotional Status and Perception of Body Image?

Abstract Objective: Comparison of quality of life [QOL] and emotional status in male patients with traumatic lower limb amputation [LLA] and controls and evaluation of the relationship between these outcomes and post-amputation pain, functional status and perception of body image. Methods: Thirty male patients aged between 20 and 45 years, with traumatic LLA and 30 healthy normal controls were enrolled. The Nottingham Health Profile [NHP], Beck Depression Inventory [BDI], Beck Anxiety Inventory [BAI], visual analog scale [VAS], Locomotor Capabilities Index [LCI] and Amputee Body Image Scale [ABIS] were used. Results: There were significantly higher NHP, BDI and BAI scores in patients with LLA than control subjects [p < 0.05]. In patients with LLA, all subgroups of NHP were positively correlated with BDI, BAI and ABIS scores [p < 0.05]. The NHP energy and physical disability subgroups scores were negatively correlated with LCI scores. The positive correlation was found between the NHP pain subgroup score and post-amputation pain VAS score [p < 0.05]. There was no correlation between NHP scores and age and time since amputation [p > 0.05]. The positive correlation was found between BDI, BAI and ABIS score [p < 0.05]. Conclusion: It was found that QOL and emotional status deteriorated in male patients with LLA. According to the results of this study, depression, anxiety and body image disturbances may be the determinants of QOL. Having lower functional status were higher post-amputation pain were associated with the poor QOL for some domain. Emotional status of LLA patients may be linked to perception of body image.

A new value of proximal femur geometry to evaluate hip fracture risk: true moment arm.

This study was undertaken to determine the influence of proximal femur geometry on hip fracture risk independent of bone mineral density. We examined 34 hip fracture subjects (17 men, 17 women) and 36 control subjects (18 men, 18 women). The control subjects were matched with the hip fracture patients by femoral neck bone mineral density (+ or - 0.100 g/cm(2)). Hip axis length (HAL), femoral axis length (FAL), femoral neck-shaft angle (Theta angle), lateral and medial femoral cortical thickness were measured on standart pelvic radiographs. In the literature, there are conflicting views of the relationship between femur geometry and hip fracture risk which may be explained by different definitions of some parameters. We investigated the effect of a new parameter called true moment arm (TMA) on hip fracture risk. Longer TMA may be correlated to higher transmission of impact energy to the femoral neck. Thus it may be useful to define fracture prone individuals. The results of this study showed that HAL, FAL and TMA were significantly longer in the hip fracture subjects compared to the control group (p<0.001). Hip fracture patients had thinner lateral and medial femoral cortical thickness (p<0.001). Theta angle was wider in the hip fracture group than in the control group (p<0.001). In conclusion, our study showed that evaluation of TMA in addition to HAL, FAL, Theta angle, MCT and LCT can be used to determine of the fracture risk independently of BMD.

Spondyloarthritis Research Consortium of Canada (SPARCC) enthesitis index in turkish patients with ankylosing spondylitis: Relationship with disease activity and quality of life

The aim of this study was to investigate the relationship between Spondyloarthritis Research Consortium of Canada (SPARCC) enthesitis index and disease activity and health‐related quality of life in patients with ankylosing spondylitis (AS).

Alternative approach to evaluating lumbar lordosis on direct roentgenograms: projection area per length squared.

Several methods have been described to evaluate the degree of lumbar lordosis. However, suggested methods have used non-standardized terminology and landmarks to measure the degree of lumbar lordosis. In the present study a practical method for evaluating the degree of lumbar lordosis is described and, for this purpose, 24 lateral roentgenograms were obtained retrospectively from the archive of Department of Physical Medicine and Rehabilitation, Ondokuz Mayis University, Samsun, Turkey. The length between the superior and inferior angles of the first and fifth lumbar vertebral bodies, and the area behind the lumbar vertebral bodies, were estimated using the point counting and planimetry methods. A new unit, the projection area per length squared (PAL) was described on lateral roentgenograms. The planimetric approach was used as the gold standard in the present study. The point-counting method was also used to estimate the PAL and it was repeated three times to determine the variability of the technique. To evaluate the estimates’ accuracy, the results of point-counting were compared with those of the planimetry methods. The PAL changed by between 3.93 and 13.59% for the examined subjects. A high correlation was also noted between the results of the point-counting and planimetry methods (r = 0.997). It is concluded that the PAL approach could provide accurate and reproducible data for evaluating the degree of lumbar lordosis and low back pain.

The Relationship of Fibromyalgia Syndrome with Neuropathic Pain, Quality of Life and Emotional Status in Male Traumatic Lower Limb Amputees

Objective The aim of this study was to evaluate the presence of fibromyalgia syndrome [FMS] in male traumatic lower limb amputees [LLAs] and to determine the relationship between FMS clinical findings and neuropathic pain [NeP], quality of life [QOL], and emotional status in LLAs with FMS. Methods Thirty male traumatic LLAs were enrolled. Twelve LLAs [40 percent] included in the study were diagnosed with FMS [Group 1]. Group 2 [n = 18] included patients without FMS. The FMS-related measurements [Fibromyalgia Impact Questionnaire [FIQ], myalgic scoring, number of tender points, widespread pain, the presence of accompanying symptoms of FMS], NeP-related measurements [Leeds Assessment of Neuropathic Symptoms and Signs [LANSS] scale, the presence and severity of phantom–residual limb pain], QOL [Nottingham Health Profile [NHP]], emotional status [Beck Depression Inventory [BDI], and Beck Anxiety Inventory [BAI]] were gathered using standardized measures. Results While there were significant differences between the groups in FMS-related measurements, NHP, BDI, and BAI scores [P < 0.05], there were no significant differences between the groups in NeP-related measurements [P > 0.05]. The FIQ score was positively correlated with NHP-QOL domains and BAI scores in LLAs with FMS [P < 0.05]. No correlation was found between other FMS-related measurements and demographics, the LANSS scale, postamputation pain visual analog scale, BDI, BAI, or NHP scores in LLAs with FMS [P > 0.05]. Conclusion In the current study, QOL and emotional status are impaired in male traumatic LLAs with FMS than those without. More severe FMS leads to less QOL and more anxiety. There is no relationship between FMS-related measurements and NeP-related measurements in LLAs with FMS.

Turkish League Against Rheumatism Consensus Report: Recommendations For Management of Axial Spondyloarthritis

Objectives This study aims to update 2011 Turkish League Against Rheumatism SpondyloArthritis Recommendations, and to compose a national expert opinion on management of axial spondyloArthritis under guidance of current guidelines, and implantation and dissemination of these international guidelines into our clinical practice. Patients and methods A scientific committee of 28 experts consisting of 14 rheumatologists and 14 physical medicine and rehabilitation specialists (one of them also has an immunology PhD) was formed. The recommendations, systematic reviews, and meta-analyses including pharmacologic and non-pharmacologic treatment were scrutinized paying special attention with convenient key words. The draft of Turkish League Against Rheumatism opinion whose roof consisted of international treatment recommendations, particularly the Assessment of SpondyloArthritis International Society/European League Against Rheumatism recommendations was composed. Assessment of level of agreement with opinions by task force members was established through the Delphi technique. Voting using a numerical rating scale assessed the strength of each recommendation. Results Panel compromised on five basic principles and 13 recommendations including pharmacological and nonpharmacological methods. All of the recommendations had adequate strength. Conclusion Turkish League Against Rheumatism expert opinion for the management of axial spondyloArthritis was developed based on scientific evidence. These recommendations will be updated regularly in accordance with current developments.

Turkish League Against Rheumatism (TLAR) Recommendations for the Pharmacological Management of Rheumatoid Arthritis: 2018 Update Under Guidance of Current Recommendations

Objectives This study aims to report the assessment of the Turkish League Against Rheumatism (TLAR) expert panel on the compliance and adaptation of the European League Against Rheumatism (EULAR) 2016 recommendations for the management of rheumatoid arthritis (RA) in Turkey. Patients and methods The EULAR 2016 recommendations for the treatment of RA were voted by 27 specialists experienced in this field with regard to participation rate for each recommendation and significance of items. Afterwards, each recommendation was brought forward for discussion and any alteration gaining ≥70% approval was accepted. Also, Turkish version of each item was rearranged. Last version of the recommendations was then revoted to determine the level of agreement. Levels of agreement of the two voting rounds were compared with Wilcoxon signed-rank test. In case of significant difference, the item with higher level of agreement was accepted. In case of no difference, the changed item was selected. Results Four overarching principles and 12 recommendations were assessed among which three overarching principles and one recommendation were changed. The changed overarching principles emphasized the importance of physical medicine and rehabilitation specialists as well as rheumatologists for the care of RA patients in Turkey. An alteration was made in the eighth recommendation on treatment of active RA patients with unfavorable prognostic indicators after failure of three conventional disease modifying anti-rheumatic drugs. Remaining principles were accepted as the same although some alterations were suggested but could not find adequate support to reach significance. Conclusion Expert opinion of the TLAR for the treatment of RA was composed for practices in Turkish rheumatology and/or physical medicine and rehabilitation clinics.