Sacide Nur Saracgil Cosar

Compliance with clean intermittent catheterization in spinal cord injury patients: a long-term follow-up study.

Study design:Retrospective review of medical notes.Objective:To evaluate spinal cord injury (SCI) patients’ compliance with bladder emptying method at long-term period after discharge and determine the frequency of urinary tract infections (UTIs).Setting:Inpatient rehabilitation unit of tertiary research hospital.Methods:Bladder management method of 164 new spinal cord injured patients were noted at discharge from rehabilitation center and follow-up. Patients were questioned whether they continued the initial bladder emtying method at follow-up, reasons for discontinuation and the history of treated UTIs.Results:The most common bladder management method at discharge from inpatient rehabilitation center was clean intermittent catheterization (CIC) (63.4%). At follow-up 42% of the patients who used CIC changed their bladder emptying method. Rate of reverting to urethral indwelling catheter (IC) was 21.4%. Reasons for the patients who switched to IC application were recurrent UTIs, incontinence, nephrolithiasis, dependence on care givers and urethral strictures. For all patients, the frequency of treated UTI in 1 year was 38.8%. The number of UTIs were highest in patients using IC.Conclusion:Many factors, including urological complications, patient’s preference, living environment, life-style and level of injury should be considered in deciding the method of bladder management in SCI patients. The CIC is a reliable and effective method in selected SCI patients. Despite changes in bladder emptying method, CIC was the most preferred method at long-term follow-up. Education of patients on catheterization technique and periodic follow-up is necessary to maintain patient compliance.

Demographic characteristics after traumatic and non-traumatic spinal cord injury: a retrospective comparison study

Study design:Retrospective, 12-year case series.Objective:To compare neurological and functional outcomes, and complications of patients with traumatic vs non-traumatic spinal cord injury (SCI) after in-patient rehabilitation.Setting:In-patient rehabilitation unit of a tertiary research hospital.Materials and Methods:The sample consisted of 165 newly injured patients with traumatic and non-traumatic spinal cord lesions whose medical records were retrospectively reviewed. Demographic characteristics, etiology, American Spinal Injury Association (ASIA) impairment scale, functional independence measurement (FIM) subgroup scores, length of stay and medical complications in both groups were compared.Results:In all, 38 patients (23%) were non-traumatic and 127 patients (77%) were traumatic in etiology. Compared with patients with traumatic SCI (mean age 37.81±13.65 years), patients with non-traumatic SCI (mean age 53.97±14.48 years) were significantly older (P<0.05). Incomplete SCI was significantly higher in the non-traumatic group when compared with the traumatic group (P<0.001). In the non-traumatic group, admission motor FIM scores were significantly higher (28.29±16.04) than scores from the traumatic group (36.60±21.65; P=0.029); however, there was no significant difference in discharge motor FIM scores between the two groups (P=0.140). ASIA impairment scale scores were significantly higher in non-traumatic group both at admission and discharge (P=0.000 and P=0.000, respectively). The length of hospital stay was significantly shorter in the non-traumatic group (P=0.002).Conclusion:According to the results of this study, although patients with non-traumatic SCI had shorter length of stay and higher ASIA scores, there was no significant difference in functional outcomes between traumatic and non-traumatic SCI patients.

Association of vitamin D deficiency with muscle strength and quality of life in postmenopausal women

Abstract Aim The aim of this study was to analyze the effect of vitamin D deficiency on muscle strength and quality of life in postmenopausal women. Methods Self-sufficient, community-dwelling, postmenopausal women over 55 years old attending the Physical Medicine and Rehabilitation outpatient clinic were included in the study. 25-Hydroxyvitamin D levels below 20 ng/ml were accepted as indicative of vitamin D deficiency. A computerized isokinetic dynamometer (Cybex 770 Norm, Lumex Inc., Ronkonkoma, NY, USA) was used for testing knee extensor muscle strength. Results Forty-nine postmenopausal women with median age 64.3 years (interquartile range 59.0–69.5 years) were included in the study. Vitamin D deficiency was detected in 49% of the participants. There was no relation between vitamin D deficiency and knee muscle strength in both right and left legs. Vitamin D deficiency was found not to be associated with any of the domains of SF-36. Conclusions Vitamin D deficiency is not related to decreased muscle strength and lowered quality of life in postmenopausal women. Other factors rather than vitamin D deficiency should be investigated for illuminating the causalities of these two common clinical conditions.

Effect of mirror therapy on upper extremity motor function in stroke patients: a randomized controlled trial

[Purpose] This study aimed to evaluate the effectiveness of mirror therapy combined with a conventional rehabilitation program on upper extremity motor and functional recovery in stroke patients. [Subjects and Methods] Thirty-one hemiplegic patients were included. The patients were randomly assigned to a mirror (n=16) or conventional group (n=15). The patients in both groups underwent conventional therapy for 4 weeks (60–120 minutes/day, 5 days/week). The mirror group received mirror therapy, consisting of periodic flexion and extension movements of the wrist and fingers on the non-paralyzed side. The patients in the conventional group performed the same exercises against the non-reflecting face of the mirror. The patients were evaluated at the beginning and end of the treatment by a blinded assessor using the Brunnstrom stage, Fugl-Meyer Assessment (FMA) upper extremity score, and the Functional Independence Measure (FIM) self-care score. [Results] There was an improvement in Brunnstrom stage and the FIM self-care score in both groups, but the post-treatment FMA score was significantly higher in the mirror therapy group than in the conventional treatment group. [Conclusion] Mirror therapy in addition to a conventional rehabilitation program was found to provide additional benefit in motor recovery of the upper extremity in stroke patients.

Can High-Sensitivity C-Reactive Protein and Ferritin Predict Functional Outcome in Acute Ischemic Stroke? A Prospective Study

Abstract Background: Inflammation may not only be the consequence of brain infarction but it may also contribute to ischemic damage. However, the role of inflammatory markers in predicting functional outcome in stroke remains controversial. Objective: This study was conducted to evaluate the predictive value of admission high-sensitivity C-reactive protein (hs-CRP) and ferritin levels for functional disability in patients with acute ischemic stroke at 3-month follow-up and investigate the relationship between inflammatory markers and subtypes, severity, and risk factors of ischemic stroke. Methods: Sixty-two patients were examined prospectively within 48 hours after onset of ischemic stroke. Plasma hs-CRP and ferritin measurements were obtained from patients within 48 hours after onset and at 3-month follow-up. Patients were divided into 2 groups based on the level of hs-CRP: elevated (serum hs-CRP ≥0.5 mg/dL) and normal (serum hs-CRP<0.5 mg/dL) hs-CRP groups. Stroke severity was analyzed by the National Institutes of Health Stroke Scale (NIHSS) and functional disability was assessed by the Functional Independence Measure (FIM) and Functional Ambulation Scale (FAS). Stroke subtypes were classified according to the Oxfordshire Community Stroke Project. Results: Except for the correlation between hs-CRP levels and FIM scores on admission, no significant correlation was found between laboratory markers and FIM, FAS, and NIHSS scores and stroke subtypes on admission and at 3-month follow-up (P > .05). Conclusion: This study revealed that neither hs-CRP nor ferritin levels could predict functional disability 3 months after stroke onset. FIM, FAS, and NIHSS scores were more useful in predicting functional outcome 3 months after stroke onset than the laboratory markers evaluated in this study.

Neuropathic Pain in Patients with Spinal Cord Injury

Background: The aims of this study were to determine the prevalence of neuropathic pain in patients with spinal cord injury (SCI) during rehabilitation and follow-up, and to examine the relationship between neuropathic pain and the demographic and clinical characteristics of the patients. Methods: The medical records of 93 patients who were admitted to our inpatient rehabilitation hospital with a diagnosis of SCI were evaluated. Patients with neuropathic pain were contacted by telephone after discharge and questioned whether the pain continued and whether they were on any medication. Results: The mean age was 38.73 ± 15 years. Thirty-two percent of the group consisted of women. Based on neurological levels, 28 (30.4%) patients were tetraplegic, 49 (53.3%) were paraplegic and 15 (16.3%) had conuscauda equina injury. Sixty-four patients (68.8%) had complete lesions and 28 patients had incomplete lesions (The American Spinal Injury Association Impairment Scale (AIS) grade B-D). Neuropathic pain was present in 49 (52.7%) and absent in 44 (47.3%) patients during their hospital stay. While a statistically significant difference was found between the groups in terms of gender, there was no such difference for mean age, SCI etiology, neurological level and AIS grade (p=0.021, p=0.151, p=0.368, p=0.686, p=0.340). During follow-up, the pain continued in 36 (78.3%) patients and had resolved in 10 (21.7%) patients. The daily living activities were affected in 23 (55%) patients. When we questioned the treatment in the neuropathic pain group, 28 (77.8%) of the patients did not take any medication for neuropathic pain while 8 (22.2%) were on related medication. Conclusion: Taking into account that neuropathic pain is an important factor that affects daily living activities, SCI patients should be evaluated in detail to determine the characteristic of any pain, and the medical treatment prescribed to the patient should be closely monitored.

Spondylodiscitis associated with multiple level involvement and negative microbiological tests: an unusual case.

Study Design. A case report. Objective. To report an unusual case of spondylodiscitis with multiple level involvement. Summary of Background Data. Spondylodiscitis, an infection of the intervertebral disc space, vertebral bodies, or the paraspinal epidural space can be a serious disease because of diagnostic delay and inadequate treatment. Methods. A previously healthy, 52-year-old man was presented to our outpatient clinic with a complaint of acute, atraumatic onset of severe back pain for more than 1 month. Initially, he was misdiagnosed at another clinic as myofascial pain and treated with nonsteroidal antiinflammatories and physical therapy, which he did not benefit from. He never complained of fever; however, laboratory tests revealed raised erythrocyte sedimentation values, increased C-reactive protein values but normal leukocyte count. Thoracal and lumbal plain radiographs were nonspecific. Magnetic resonance imaging demonstrated increased signal intensity in vertebral bodies and intervertebral disc space through T12–L4 and in the paravertebral musculature at L2–L3 with contrast enhancement. Blood cultures and computed tomography-guided needle biopsy and cultures were negative. Results. The patient was treated with oral amoxicillin and clavulanate and responded very well clinically; however, imaging examinations were repeated up to 6 months because of multilevel involvement. Follow-up magnetic resonance imaging findings at 3 months and 6 months showed decreased signal intensity, and luckily, there was no evidence of vertebral destruction. Conclusion. Diagnosis of spondylodiscitis could be challenging and commonly missed; however, it should always be included in the differential diagnoses of back pain in the middle aged and healthy population.

Longitudinal Associations Between Provision of Autonomy Support and Well-Being in Spouses of Individuals With Chronic Pain

BACKGROUND Caregiving spouses of individuals with chronic pain often experience poor well-being. PURPOSE The current study aimed to examine the association between chronic pain-related provision of autonomy support and well-being in support providers (spouses) of individuals with chronic pain. METHODS Spouses of individuals with a diagnosed musculoskeletal chronic pain condition (N = 172) were recruited for a five-time point longitudinal study. Participants completed the questionnaires once every 6 months across 2 years. In a follow-up diary study, participants (N = 41) completed daily records of provision of autonomy support and well-being. RESULTS Multilevel analyses showed that provision of autonomy support was associated with greater well-being in support providers at both within-person and between-person levels. Longitudinal cross-lagged analyses also provided some evidence that it is provision of autonomy support that predicts well-being, and not the opposite. These effects held true in the follow-up diary study; however, some findings also suggested that the short-term associations between provision of autonomy support and well-being could be reciprocal. CONCLUSIONS Current findings extend the existing literature by suggesting provision of autonomy support as a beneficial type of support for the provider within the chronic pain context and lay the groundwork for caregiver-focused interventions.

An unresolved relationship: the relationship between lesion severity and neurogenic bladder in patients with spinal cord injury.

Objectives: We aimed to investigate the relationship between the severity of the spinal lesion and urodynamic findings, bladder drainage method at discharge, and incidence of renal calculi in patients with spinal cord injury (SCI). Studydesign: Retrospective. Setting: In-patient rehabilitation unit of a tertiary research hospital. Methods: A total of 131 patients who were admitted to our clinic with a diagnosis of SCI and placed into a rehabilitation program were included in the study. The severity of the lesion was determined according to the American Spinal Injury Association Impairment Scale (AIS). We evaluated the relationship between the severity of the lesion and the detrusor hyperactivity and compliance as determined by urodynamic investigation, the bladder drainage method used at discharge, and the renal calculi rate as determined by ultrasonography. Results: While no difference was found between the patients with complete and incomplete injuries in terms of age, sex, disease duration, detrusor hyperactivity and compliance, the bladder drainage method was found to show a significant change according to the severity of the lesion. None of the patients were found to have hydronephrosis and the rate of renal calculi showed no statistically significant difference according to the severity of the lesion. Conclusions: We concluded that urodynamic examination is required in each patient with SCI as the severity of the lesion is not sufficient to determine the bladder type, and patients with complete and incomplete injuries should be monitored with the same sensitivity in terms of complications.