Simin Hepguler

A comparison of muscle training methods in patients with knee osteoarthritis.

This study sought to compare the efficacy of isokinetic and progressive resistive exercise (PRE) programs in patients with knee osteoarthritis (OA). Forty-four patients with bilateral knee OA were included in the study. The patients in Group 1 (n=21) performed isokinetic exercises and the patients in Group 2 (n=18) performed a PRE program. Disease severity, pain, walking time, WOMAC, Lequesne index, AIMS2 and SF36 were compared before and after the treatments. All the patients were evaluated via a Cybex isokinetic device before and after treatment. Disease severity, pain, Lequesne, WOMAC and walking time improved with treatment in both groups. In SF36 and AIMS2 assessments, pain and social evaluation parameters in the PRE group showed better improvement. On isokinetic assessment flexor and extensor peak torque and peak torque body weight values improved significantly in both groups compared to pretreatment measurements. When the assessed parameters were taken into account no statistical significant difference was observed between the two groups. Our conclusions were that isokinetic and PRE programs are efficient in the treatment of knee OA; no statistically significant differences could be found between the two programs; and the PRE program, as it is cheaper, more easily performed and efficient, may be preferable for the treatment of knee OA.

EFFICACY OF NECK STABILIZATION EXERCISES FOR NECK PAIN: A RANDOMIZED CONTROLLED STUDY

OBJECTIVE To determine the efficacy of neck stabilization exercises in the management of neck pain. PATIENTS AND METHODS Sixty patients with neck pain were randomized to 3 groups, as follows: group 1--physical therapy agents including transcutaneous electrical nerve stimulation, continuous ultrasound and infra-red irradiation; group 2--physical therapy agents + isometric and stretching exercises; and group 3--physical therapy agents + neck stabilization exercises. The exercises were performed as a home training programme following a 3-week supervised group exercise. The patients were evaluated with a visual analogue scale, by intake of paracetamol, Neck Disability Index, Beck Depression Scale and range of motion in the 3 planes at baseline and at months 1, 3, 6, 9 and 12. RESULTS Compared with baseline, all groups showed a significant decrease in visual analogue scale scores during the first 6 months. However, this improvement was maintained only in group 3 at 9 and 12 months, with a significant difference among the groups (p<0.05). During the study, the improvement in disability was marked in group 3 with respect to Neck Disability Index, Beck Depression Scale and range of motion in the frontal plane (p<0.05). CONCLUSION This study demonstrates the superiority of the neck stabilization exercises, with some advantages in the pain and disability outcomes, compared with isometric and stretching exercises in combination with physical therapy agents for the management of neck pain.

Efficacy of therapeutic ultrasound for the management of knee osteoarthritis: a randomized, controlled, and double-blind study.

ObjectiveThe aim of this study was to compare whether the effectiveness of continuous ultrasound (US) was superior against pulsed US and against sham US in knee osteoarthritis. DesignA randomized controlled study was carried out on 60 patients diagnosed with knee osteoarthritis according to American College of Rheumatology. The patients were randomized into the following three treatments: (1) continuous US (at a frequency of 1 MHz with intensity of 1 W/cm2), (2) pulse US (same frequency and intensity on 1:4 pulse ratio), and (3) sham US. All treatments were applied with 5-cm2 head US device five times a week for 2 weeks in addition to home exercise program including quadriceps isometric exercise, muscle strength exercises, and stretching exercises of the lower extremity muscles for at least three times per week. Assessments were performed at baseline, at the end of the treatment, and at the end of the treatments and at the sixth month using the following measurements: Western Ontario and McMaster University Osteoarthritis Index–pain, stiffness, function, visual analog scale–pain at rest, visual analog scale–pain on movement, visual analog scale–disease severity, and 20-m walking time. Among these parameters, the Western Ontario and McMaster University Osteoarthritis Index–pain was the primary outcome. ResultsAll groups showed a significant improvement in all parameters in both following visits (P < 0.05). However, there was no significant difference between the groups. Although the mean reduction percent in Western Ontario and McMaster University Osteoarthritis Index–pain was significantly higher in group I (continuous US) when compared to sham group (46.5% vs 28.9%, P < 0.05) at the end of the treatment, this result was not found in other pain parameters. ConclusionsThe present study demonstrated that all assessment parameters significantly improved in all groups without a significant difference. This result suggested that therapeutic US provided no additional benefit in improving pain and functions in addition to exercise training.

Comparison of the effects of amitriptyline and paroxetine in the treatment of fibromyalgia syndrome

AbstractThe aim of this study is to research the efficiency and the side effects of paroxetine, which is a selective serotonin re-uptake inhibitor (SSRI), and to compare it with amitriptyline, whose efficiency in fibromyalgia syndrome (FMS) is well known. The 40 FMS-diagnosed patients that were involved in the research were separated into two groups randomly. The patients within the first group were given paroxetine tablets (for the first weeks 20 mg/day, later 40 mg/day); those within the second group were given amitriptyline drage (for the first two weeks 10 mg/day, later 20 mg/day). The treatment continued for two months. All of the patients were evaluated by a physician, who was not aware of the therapy options, in the 2nd, 4th and 8th weeks with regard to fatigue, morning stiffness, sleep disturbances, paraesthesia, headaches, tender point count and score, severity of global pain, Beck depression index, global efficiency and tolerance according to the patient and the physicians judgments. It is obse...

Prevalence of symptomatic knee, hand and hip osteoarthritis among individuals 40 years or older: a study conducted in İzmir city

OBJECTIVE This cross-sectional study was conducted to determine the prevalence of symptomatic knee, hand and hip osteoarthritis among men and women at or over 40 years of age, living in the Bayraklı Adalet district of İzmir. METHODS The study included a sample size of 522 people calculated using the Epi Info™ software. Demographic information, weight, height and body mass index were recorded. Patients were physically examined for evidence of osteoarthritis, such as joint tenderness, range of motion deficiency, deformity, 1st carpometacarpal joint involvement and Heberdens and/or Bouchards nodes. One hundred and ninety-one individuals were suspected of having knee/hand/hip osteoarthritis and 152 of these were called in for radiographs. RESULTS The prevalence of symptomatic knee, hand and hip osteoarthritis of adults aged ≥40 years was 20.9%, 2.8% and 1.0%, respectively. Symptomatic knee and hand osteoarthritis was significantly higher among women (p<0.05). However, there was no significant difference between two genders regarding symptomatic hip osteoarthritis. CONCLUSION Knee osteoarthritis is frequent in the region in which the study was conducted. An effective health policy regarding osteoarthritis can be created following further studies with larger samples representing the entire country.

Phagocytic and oxidative burst activity of neutrophils in patients with spinal cord injury.

OBJECTIVE To evaluate phagocytic activity and neutrophil oxidative burst functions in patients with spinal cord injury (SCI) because alterations in neutrophil metabolic activity can be one of the causes of immune mechanism damage contributing to repeated bacterial infections. DESIGN A controlled and cross-sectional study. SETTING Departments of physical medicine and rehabilitation and immunology. PARTICIPANTS Patients with SCI (N=34) and 28 healthy controls. INTERVENTIONS Phagocytosis and oxidative burst in whole-blood neutrophils were assessed by flow cytometry. The percentage of phagocytizing cells after in vitro incubation with Escherichia coli, phagocytic activity (mean intensity of fluorescence [MIF]) and the percentage of neutrophiloxidative burst, and the MIF value of the production of reactive oxygen intermediates (ROIs) were analyzed. In addition, clinical assessment including the level of injury, American Spinal Injury Association scores, and functional status were carried out. MAIN OUTCOME MEASURES Not applicable. RESULTS Although the percentage of E. coli phagocytizing neutrophils was not different between groups, the MIF value of absorbed E. coli was significantly lower in patients with SCI than in controls (P<.05). The MIF value of ROI production by neutrophils with both stimulator of phorbol 12-myristate 13-acetate and E. coli was significantly higher in patients with SCI (P<.05). CONCLUSIONS In patients with SCI, decreased phagocytic activity of neutrophils may be a result of a regulatory mechanism to minimize the deleterious effects of increased neutrophil burst activity.

Correlations among enthesitis, clinical, radiographic and quality of life parameters in patients with ankylosing spondylitis.

Abstract Objectives. To investigate the relationship between enthesitis and disease activity, functional status, fatigue, joint mobility, radiological damage, laboratory parameter and quality of life in patients with ankylosing spondylitis (AS). Methods. A total of 421 patients with AS (323 male and 98 female) who were included in the Turkish League Against Rheumatism Registry were enrolled in the study. The Bath AS Disease Activity Index (BASDAI), fatigue, the Bath AS Functional Index (BASFI), the Bath AS Metrology Index (BASMI), the Maastricht AS Enthesitis Score (MASES), AS quality of life (ASQoL), the Bath AS Radiology Index (BASRI) and erythrocyte sedimentation rate (ESR) were evaluated. Results. Enthesitis was detected in 27.3% of patients. There were positive correlations between MASES and BASDAI, BASFI and fatigue (p < 0.05). MASES was not correlated with BASRI, BASMI, ASQoL and ESR. The mean MASES score was 1.1 ± 2.4. The most frequent regions of enthesopathies were right iliac crest, spinous process of L5 and proximal to the insertion of left achilles tendon, respectively. Conclusions. Enthesitis was found to be associated with higher disease activity, higher fatigue, worse functional status and lower disease duration. As enthesitis was correlated with BASDAI, we conclude that enthesitis can reflect the disease activity in patients with AS.

2017 update of the Turkish League Against Rheumatism (TLAR) evidence-based recommendations for the management of knee osteoarthritis

In a Turkish League Against Rheumatism (TLAR) project, evidence-based recommendations for the management of knee osteoarthritis (OA) was developed for the first time in our country in 2012 (TLAR-2012). In accordance with developing medical knowledge and scientific evidence, recommendations were updated. The committee was composed of 22 physical medicine and rehabilitation specialists (4 have rheumatology subspeciality also) and an orthopaedic surgeon. Systematic literature search were applied on Pubmed, Embase, Cochrane and Turkish Medical Index for the dates between January the 1st 2012 and January the 29th of 2015. The articles were assessed for quality and classified according to hierarchy for the level of evidence, and the selected ones sent to committee members electronically. They were asked to develop new recommendations. In the meeting in 2015, the format of the recommendations was decided to be patient-based and considering the grade and the severity of the disease. By the discussion of the each item under the light of new evidences, the final recommendations were developed. Each item was voted electronically on a 10-cm visual analogue scale (VAS) and the strength of recommendation (SoR) was calculated. In the light of evidences, totally 11 titles of recommendations were developed; the first 7 were applicable to each patient in every stages of the disease, remaining were for defined specific clinical situations. The mean SoR value of the recommendations was between 7.44 and 9.93. TLAR-2012 recommendations were updated in a new format. We think that, present recommendations will be beneficial for the physicians who manage, as well as the patients who suffer from the disease.

Is QUALIOST Appropriate for the Patients With Orthotopic Liver Transplantation in Measuring Quality of Life

The quality of life questionnaire in osteoporosis (QUALIOST) measures the impact of this condition. The purpose of this study was to assess the psychometric properties of QUALIOST among 38 orthotopic liver transplantation (OLT) patients who had been diagnosed with osteoporosis or osteopenia versus 42 control subjects with osteoporosis or osteopenia associated with other conditions. Bone mineral density (gr/cm(2)) measurements were performed by dual-energy X-ray absorptiometry as well as thoracic and lumbar spine radiographs to assess fractures. Reliability studies evaluated by intraclass correlation coefficients (ICC) and internal consistency (Cronbach α). For the validity studies, correlation analysis was performed between this scale and Short Form-36 (SF-36) results. The questionnaire was filled out completely by all the patients with 0.9% and 1.3% of omitted answer rates for OLT and control patients. ICC and Cronbachs α values were good for all domains with values above .90. In both groups we observed significant negative high correlations between the domains of the questionnaire and all SF-36 dimensions (P < .001). At least one vertebral fracture was diagnosed in 17 (44.7%) and 20 (47.6%) patients with OLT and control respectively. The comparison analysis revealed that the scores of QUALIOST of patients with vertebral fracture were significantly higher than those without a fracture in both groups (P < .05). In conclusion, we evaluated the validity and reliability of a scale measuring quality of life in patients who had osteoporosis secondary to OLT. The results showed that the Turkish QUALIOST showed acceptable validity and reliability in these patients.