Özlem Solak

Clinical Effectiveness of Aquatic Exercise to Treat Chronic Low Back Pain: A Randomized Controlled Trial

Study Design. This study was a prospective, randomized, controlled study. Objective. To compare the effectiveness of aquatic exercise interventions with land-based exercises in the treatment of chronic low back pain (CLBP). Summary of Background Data. Land-based exercise and physiotherapy are the main treatment tools used for CLBP. Clinical experience indicates that aquatic exercise may have advantages for patients with musculoskeletal disorders. Methods. A total of 65 patients with CLBP were included in this study. Patients were randomly assigned to receive aquatic exercise or land-based exercise treatment protocol. Aquatic exercise program consisted of 20 sessions, 5 × per week for 4 weeks in a swimming pool at 33°C. Land-based exercise (home-based exercise) program were demonstrated by a physiotherapist on one occasion and then they were given written advice The patients were assessed for spinal mobility, pain, disability, and quality of life. Evaluations were performed before treatment (week 0) and after treatment (week 4 and week 12). Results. In both groups, statistically significant improvements were detected in all outcome measures (except modified Schober test) compared with baseline. However, improvement in modified Oswestry Low Back Pain Disability questionnaire and physical function and role limitations due to physical functioning subpart of Short-Form 36 Health Survey were better in aquatic exercise group (P < 0.05). Conclusion. It is concluded that a water-based exercises produced better improvement in disability and quality of life of the patients with CLBP than land-based exercise.

The prevalence of obstructive sleep apnoea syndrome in ankylosing spondylitis patients

OBJECTIVE To assess the prevalence of obstructive sleep apnoea syndrome (OSAS) in AS patients. METHODS Thirty-one patients with AS were included in the study. The demographic data, spinal mobility measures and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores were recorded for each patient. All participants underwent one night of sleep recording, which was performed using a polysomnography (PSG). Pulmonary function test (PFT) was performed for all subjects and symptoms of OSAS were questioned. RESULTS Seven (22.6%) of 31 AS patients had OSAS according to PSG assessments. The mean BMI, disease duration, BASDAI score, neck circumference and occiput-wall distance were higher in patients with OSAS, but the differences were not significant. The mean ages of patients with OSAS were significantly higher than the patients without OSAS. The prevalence of OSAS in patients under the age of 35 years was found to be 6.3%, whereas the prevalence of OSAS in patients at the age of 35 years or over was 40.0% (P = 0.037). The prevalence of OSAS in AS patients with a disease duration <5 years was 11.8% and its prevalence in AS patients with a disease duration of >or=5 years was 35.7% (P = 0.198). PFT was restrictive in 16 (53.3%) patients and obstructive in none. CONCLUSIONS The prevalence of OSAS in AS patients is higher than reported in the general population. The diagnosis of OSAS should be kept in mind and OSAS symptoms should be considered especially in AS patients at the age of >or=35 years and in AS patients with a disease duration of >or=5 years.

A comparative study of conventional physiotherapy versus robotic training combined with physiotherapy in patients with stroke.

Abstract Background: There has been a growing interest in the use of robotic therapy to improve walking ability in individuals following stroke. Objectives: The aim of this retrospective study was to compare conventional physiotherapy (CP) with robotic training (RT) combined with CP and to measure the effects on gait, balance, functional status, cognitive function, and quality of life in patient with stroke. Methods: We retrospectively identified 107 cases of new cerebral stroke. They were allocated into 2 groups. In the RT group (n = 36), patients received RT (Lokomat; 2 times per week) combined with CP (3 times per week) for at least 30 sessions. In the CP group (n = 71), patients received a program at least 30 sessions, 5 times per week. The evaluation parameters included modified Ashworth Spasticity Scale (MASS), Brunnstrom Recovery Scale (BRS), Functional Independence Measure (FIM), Functional Ambulation Categories (FAC), Berg Balance Scale (BBS), Mini-Mental State Examination (MMSE), and Short Form-36 (SF-36) Health Survey. Results: Posttreatment results showed significant improvements for all parameters (except lower extremity MASS scores) in both groups. However, when we compared the percentage changes of parameters at discharge relative to pretreatment values, improvements in FIM, MMSE, and all subparts of SF-36 were better in the RT group (P < .05). Comparison of posttreatment evaluation parameters for categorical variables showed that the lower extremity categories in the BRS were significantly better in the RT group than the CP group (P < .05). Conclusion: RT combined with CP produced better improvement in FIM, MMSE, BRS lower extremity categories, and all subparts of SF-36 of the patients with subacute and chronic stroke (up to 1 year) than the CP program.

Effects of balneotherapy with exercise in patients with low back pain

Low back pain (LBP) is an important clinical, social, and public health problem. Balneotherapy is a type of therapy by hot or warm waters containing minerals. The aim of this study was to investigate the effects of balneotherapy with exercise on pulmonary functions, aerobic exercise capacity, resting metabolic rate, body fat %, psychosocial condition and its efficiency on therapy in patients with LBP. Balneotherapy and exercise program were applied to group 1 (14 female, 9 male). Only an exercise program was applied to group 2 (13 female, 8 male). The measurements of maximal oxygen consumption, resting metabolic rate, pulmonary function tests, body fat %, Oswestry disability index, visual analog scale, quality of life measure, symptom checklist-90-revised, the hospital anxiety and depression scale, spine joint mobility tests from all participants were performed before and after the treatment. An improvement was found in pulmonary function test (maximal volunteer ventilation), aerobic exercise capacity, pain and disability scores, spine mobility (extension distance), quality of life, and all psychiatric symptoms (except anxiety) in group 1 following therapy period. Also some improvements were observed in body fat percentage, pulmonary function tests (forced vital capacity, forced expiratory volume in 1 second, forced expiratory flow at 25% to 75% vital capacity and peak expiratory flow), and other spine joint mobility tests before and after therapy in group 1, though they were not statistically significant. Balneotherapy with exercise could be alternative therapy methods in patients with LBP.

Effect of high-intensity laser therapy in the management of myofascial pain syndrome of the trapezius: a double-blind, placebo-controlled study

Myofascial pain syndrome (MPS) of the trapezius muscle is one of the main causes of neck pain. In this randomized, double-blind study, we evaluated the effects of high-intensity laser therapy (HILT) in female patients with chronic MPS of the trapezius muscle. The patients were assigned to two groups. The HILT group was treated with HILT and exercise, and the sham therapy group was treated with placebo HILT and exercise. The patients were assessed for pain, cervical active range of motion, disability, and quality of life. Evaluations were performed before treatment (week 0) and after treatment (weeks 4 and 12). Both groups showed significant improvement in all parameters at weeks 4 and 12. However, in a comparison of the percentage changes in the parameters at weeks 4 and 12 relative to pretreatment values, the HILT group showed greater improvement in pain scores, the neck disability index, and several subparts of the short-form 36 health survey (SF-36) (physical functioning, role limitations due to physical functioning, bodily pain, general health perceptions, social functioning, and role limitations due to emotional problems) than did the sham therapy group. We conclude that HILT is an effective therapeutic method in the treatment of patients with chronic MPS of the trapezius muscle.

The effectiveness of transdermal opioid in the management multiple rib fractures: randomized clinical trial.

BACKGROUND The most commonly observed pathology in chest traumas is rib fracture, and the most important clinical symptom is severe pain. AIMS To investigate the effectiveness of intramuscular opioid (IMO), intravenous patient-controlled analgesia (IVPCA) and the Fentanyl transdermal therapeutic system (TTS) in the management of rib fracture pain. STUDY DESIGN Prospective randomized clinical trial. METHODS In our prospective and randomised study, we included 45 patients with a diagnosis of multiple rib fractures. There were three groups and intercostal nerve blockage (ICB) in the first day and oral paracetamol for five days was administered to each group as standard. In Group IMO (n=15), 4×40 mg pethidine HCl was administered to the patients, while in Group IVPCA (n=15) this was 5 μg/mL continuous intravenous fentanyl and was 50 μg fentanyl TTS in Group TTS (n=15). The demographics, injury data and vital signs of the patients were recorded. Pain was scored using Visual Analogue Scale (VAS). The pain during lying down (VASl) and mobilisation (VASm) was detected. RESULTS There were no differences between the three groups regarding age, sex, the trauma pattern, the number and distribution of costal fracture localisations, the presence of additional pathology, complications, thoracal catheter and the duration of thoracal catheter. No significant difference between the groups regarding systolic and diastolic arterial tension, number of breaths and beats in a minute was observed (p>0.05). We observed an improvement in the mean VAS score after treatment in all three groups. The mean VASl score significantly decreased after treatment in each group (p<0.05). The mean VASl and VASm scores measured on the 1(st), 2(nd), 3(rd), 4(th) and 5(th) days were found to be higher in Group IMO than in Groups IVPCA and TTS; however, these differences were not statistically significant (p>0.05). CONCLUSION In the analgesia of patients with multiple rib fractures, TTS administration with ICB showed similar effectiveness with IVPCA administration with ICB. In the management of pain due to multiple rib fractures, TTS administration is a safe, non-invasive and effective procedure.

Ultrasonographic assessment of pes anserinus tendon and pes anserinus tendinitis bursitis syndrome in patients with knee osteoarthritis

Abstract Objective. The aim of this study was to assess the ultrasonographic (US) findings of pes anserinus tendon and bursa in patients with knee osteoarthritis (OA) with or without clinical pes anserinus tendinitis bursitis syndrome (PATBS). Methods. A total of 157 female patients with the diagnosis of knee OA on both knees (314 knees), and 30 age, and body mass index- matched healthy female controls without knee pain (60 knees), were included in the study. PATBS was clinically diagnosed. US evaluation parameters were the measurement of the thickness of pes anserinus tendon insertion region (PA) and examination of the morphologic intratendinous PA tissue characteristics and pes anserinus bursitis (PAB). Radiographic knee osteoarthritis graded I-IV according to Kellgren and Lawrence (KL) for each knee was recorded. Pain and functional status were assessed by the Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results. There were 183 PATBS (58.3%) clinical diagnoses among the 314 knees with OA. The mean thickness of PA in the patients with knee OA graded 1,2,3,4 with/without PATBS was significantly greater than the controls (p = 0.001). The mean thickness of PA in knees with OA KL graded 3 and 4 with/without PATBS, was greater than knees with OA KL graded 1 and 2 with/without PATBS (p < 0,05) (except knee OA KL graded 2 with PATBS versus knee OA KL graded 4 without PATBS).The knee OA KL graded 1,2,3,4 with PATBS had significantly more PAB and less loss of normal fibrillar echotexture of PA compared to controls and knees with OA KL graded 1,2,3,4 without PATBS (p < 0.05). The VAS scores of knees with OA KL graded 3, 4 with PATBS were significantly greater than those of knees with OA KL graded 3,4 without PATBS (p < 0.05). PA thickness was significantly associated with the KL grade (r: 0.336, p:0.001) and PATBS (r: 0.371, p < 0.001). Conclusion. It is concluded that the mean thickness of PA in knees with OA with/without PATBS was significantly greater than the controls. The mean thickness of PA in knees with OA, KL graded 3 and 4 with/without PATBS, was greater than in knees with OA KL graded 1 and 2 with/without PATBS. The knee OA with PATBS had significantly more PAB, less loss of normal fibrillar echotexture of PA, and higher VAS scores compared to the knees with OA without PATBS. US can serve as a useful diagnostic tool for detection of PATBS in knee OA.

Shoulder pain and functional consequences: Does it differ when it is at dominant side or not?

PURPOSE The shoulder complex plays an integral role in the activities of daily living and the limitation of its function can greatly affect the patient. The aim of this study was to research the functional consequences of painful conditions in the shoulder region. METHODS Sixty five adult patients with shoulder pain for longer than one month in duration were included to the study. Dominant hands of the patients were determined. The subjects were divided into two groups: shoulder pain at the dominant upper extremity (Group I) or the nondominant one (Group II). The subjects were evaluated for shoulder pain with visual analog scale (VAS), range of motion and functional status with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. RESULTS In Group I, DASH score was significantly correlated with the VAS score measuring the pain during activity (p< 0.0001, r=0,625). In Group II, no relationship between DASH score, VAS scores and any other parameters was detected. CONCLUSION The most important parameter disturbing the daily living of a patient with shoulder disease is the pain at the shoulder of dominant extremity occurring in active movement.

Efficacy of neuromuscular electrical stimulation in patients with COPD followed in intensive care unit

Serious problems on muscle strength and functional status can be seen in bedridden‐patients with chronic obstructive pulmonary diseases (COPD) receiving mechanical ventilation. We aimed to investigate the impact of active extremity mobilization and neuromuscular electrical stimulation (NMES) on weaning processes, discharge from hospital and inflammatory mediators in COPD patients receiving mechanical ventilation.

The Complementary Role of the Kinect Virtual Reality Game Training in a Patient With Metachromatic Leukodystrophy

Metachromatic leukodystrophy (MLD) is a lysosomal storage disease characterized by demyelination of the peripheral and central nerves. Patients with MLD can present with gait disturbances, progressive spastic quadriparesis, diffuse muscle atrophy, and areflexia attributable to central or peripheral nerve involvements. The rehabilitation of patients with MLD generally focuses on gait disturbances, balance impairments, and muscle weaknesses. Here, we present a case of MLD in which virtual reality (VR) training was used as an adjunctive therapy. We also discuss the complementary role of VR therapy, which was successfully integrated with a conventional rehabilitation program for a young patient with MLD who had impaired balance and gait. After completion of the integrated rehabilitation program, the patient demonstrated improvements in functional independency, mobility, walking speed, and balance. His total Functional Independence Measure score increased from 97 to 109, 6‐minute walk test increased from 342 to 396 m, 10‐minute walk test decreased from 11 to 7 seconds, and Berg Balance Scale score increased from 38 to 42 points. Moreover, 6 weeks after completion of the therapy, these improvements were sustained for the most part. Adding VR to a conventional rehabilitation program is an emerging trend in neurologic rehabilitation. Our patient with MLD demonstrated considerable improvements with a high level of enjoyment and satisfaction.