Tunay Sarpel

Efficacy of pneumatic compression and low-level laser therapy in the treatment of postmastectomy lymphoedema: a randomized controlled trial:

Objective: To compare the long-term efficacy of pneumatic compression and low-level laser therapies in the management of postmastectomy lymphoedema. Design: Randomized controlled trial. Setting: Department of Physical Medicine and Rehabilitation of Cukurova University, Turkey. Subjects: Forty-seven patients with postmastectomy lymphoedema were enrolled in the study. Interventions: Patients were randomly allocated to pneumatic compression (group I, n=24) and low-level laser (group II, n=23) groups. Group I received 2 hours of compression therapy and group II received 20 minutes of laser therapy for four weeks. All patients were advised to perform daily limb exercises. Main measures: Demographic features, difference between sum of the circumferences of affected and unaffected limbs (▵C), pain with visual analogue scale and grip strength were recorded. Results: Mean age of the patients was 48.3 (10.4) years. ▵C decreased significantly at one, three and six months within both groups, and the decrease was still significant at month 12 only in group II (P = 0.004). Improvement of group II was greater than that of group I post treatment (P = 0.04) and at month 12 after 12 months (P = 0.02). Pain was significantly reduced in group I only at posttreatment evaluation, whereas in group II it was significant post treatment and at follow-up visits. No significant difference was detected in pain scores between the two groups. Grip strength was improved in both groups, but the differences between groups were not significant. Conclusions: Patients in both groups improved after the interventions. Group II had better long-term results than group I. Low-level laser might be a useful modality in the treatment of postmastectomy lymphoedema.

The Turkish version of the Bath Ankylosing Spondylitis Functional Index: reliability and validity

The purpose of this study was to investigate the reliability and validity of the Turkish version of the Bath Ankylosing Spondylitis (AS) Functional Index (BASFI). The Turkish version of the BASFI was obtained after a process of translation and back-translation. Eighty-one consecutive patients meeting the 1984 New York criteria for AS were enrolled. Patients were evaluated and requested to complete the questionnaire at days 1 and 2 and on a third occasion between days 15–90. Reliability, reproducibility, validity and sensitivity to change of the Turkish version of the index were assessed. Each score correlated closely with the index score, with coefficients between 0.727 and 0.844. Reliability analysis showed a Cronbach’s alpha score of 0.926. Correlations were found between all items of the BASFI and Schober’s test (r=−0.258 to −0.531, p<0.001–0.05), occiput-to-wall distance (r=0.284 and 0.589, p<0.001–0.05), and finger-to-floor distance (r=0.334 to 0.613, p<0.001–0.01). The total index score was correlated with the number of nocturnal awakenings (r=0.515, p<0.001), Schober’s test (r=−0.444, p<0.001), finger-to-floor distance (r=0.567, p<0.001), occiput-to-wall distance (r=0.535, p<0.001), chest expansion (r=−0.403, p<0.001), and the Dougados articular index (r=0.371, p<0.01). A good correlation was found between day 0 and 1 BASFI indices (r=0.765–0.917, p<0.001), showing good reproducibility of the index. The Turkish version of the BASFI showed reliability, reproducibility, and validity, confirming its utility in the research of AS in Turkey. However, sensitivity to changes due to drug therapy and/or rehabilitation remains to be determined.

Effectiveness of therapeutic ultrasound in adhesive capsulitis

OBJECTIVEnThere is a lack of evidence about the effectiveness of therapeutic ultrasound (US) compared with placebo US in the treatment of adhesive capsulitis. This study was performed to assess the effectiveness of therapeutic US in the treatment of adhesive capsulitis.nnnMETHODSnForty-nine patients with adhesive capsulitis were randomized to US (n=25) and sham US (n=24) groups. Superficial heat and an exercise program were given to both groups. Ultrasound was applied to US group and imitative ultrasound was applied to sham US group for 2 weeks. Shoulder range of motion (ROM), pain and Shoulder Pain and Disability Index (SPADI) were assessed at the beginning, after treatment and after 3 months (control). Short Form-36 (SF-36) was applied for assessing general health status at the beginning and after 3 months. Compliance with the home exercise program was recorded daily on a chart for 3 months.nnnRESULTSnShoulder ROM, pain with motion, two subscales and total score of SPADI and physical component summary score of SF-36 were improved significantly in both groups after the treatment and after 3 months (p<0.0001). Improvements in flexion, inner and outer rotation values were significantly higher in the US group when we compared the differences between post- and pre-treatment values of shoulder ROM. The differences between control and pre-treatment values of inner and outer rotation were also significantly higher in the US group (p=0.002 and p=0.02 respectively). No significant difference was detected in pain, SPADI and SF-36 scores between groups. The exercise compliance was significantly higher in the sham US group (p=0.04).nnnCONCLUSIONnOur results suggest that US compared with sham US gives no relevant benefit in the treatment of adhesive capsulitis. Effectiveness of US might be masked by worse pre-treatment values of the US group and higher exercise compliance of the sham US group.

Impact of the Training on the Compliance and Persistence of Weekly Bisphosphonate Treatment in Postmenopausal Osteoporosis: A Randomized Controlled Study

Long-term patient adherence to osteoporosis treatment is poor despite proven efficacy. In this study, we aimed to assess the impact of active patient training on treatment compliance and persistence in patients with postmenopausal osteoporosis. In the present national, multicenter, randomized controlled study, postmenopausal osteoporosis patients (45-75 years) who were on weekly bisphosphonate treatment were randomized to active training (AT) and passive training (PT) groups and followed-up by 4 visits after the initial visit at 3 months interval during 12 months of the treatment. Both groups received a bisphosphonate usage guide and osteoporosis training booklets. Additionally, AT group received four phone calls (at 2nd, 5th, 8th, and 11th months) and participated to four interactive social/training meetings held in groups of 10 patients (at 3rd, 6th, 9th, and 12th months). The primary evaluation criteria were self-reported persistence and compliance to the treatment and the secondary evaluation criteria was quality life of the patients assessed by 41-item Quality of Life European Foundation for Osteoporosis (QUALEFFO-41) questionnaire.. Of 448 patients (mean age 62.4±7.7 years), 226 were randomized to AT group and 222 were randomized to PT group. Among the study visits, the most common reason for not receiving treatment regularly was forgetfulness (54.9% for visit 2, 44.3% for visit 3, 51.6% for visit 4, and 43.8% for visit 5), the majority of the patients always used their drugs regularly on recommended days and dosages (63.8% for visit 2, 60.9% for visit 3, 72.1% for visit 4, and 70.8% for visit 5), and most of the patients were highly satisfied with the treatment (63.4% for visit 2, 68.9% for visit 3, 72.4% for visit 4, and 65.2% for visit 5) and wanted to continue to the treatment (96.5% for visit 2, 96.5% for visit 3, 96.9% for visit 4, and 94.4% for visit 5). QUALEFFO scores of the patients in visit 1 significantly improved in visit 5 (37.7±25.4 vs. 34.0±14.6, p<0.001); however, the difference was not significant between AT and PT groups both in visit 1 and visit 5. In conclusion, in addition to active training, passive training provided at the 1st visit did not improve the persistence and compliance of the patients for bisphosphonate treatment.

Evaluation of the turkish version of the bath ankylosing Spondylitis Patient Global Score (BAS-G)

The objective of this study was to investigate the reliability and validity of the Turkish version of the Bath Ankylosing Spondylitis (AS) Patient Global Score (BAS-G). Seventy-one consecutive patients with AS were enrolled into the study. Patients were requested to fill in the questionnaire on the day of admission (first visit), on a second occasion within 24 h after admission (second visit) for test-retest reliability analysis, and on a third occasion for assessing sensitivity to change. Construct validity was assessed by correlation analysis with the Bath AS Functional Index (BASFI), Dougados Functional Index (DFI), Dougados Articular Index (DAI), physical examination findings, and several other parameters. Test-retest reliability analysis of individual BAS-G scores at initial and second visits showed good intraclass correlations [n=46, intraclass correlation =0.928 (0.870–0.960) and intraclass correlation =0.853 (0.725–0.920), for 1-week and 6-month scores, respectively]. Both 1-week and 6-month scores showed moderate correlations with the BASFI (r=0.586 and r=0.503, respectively, P=0.000 for both). The 1-week score also showed moderate correlation with the DFI (r=0.530, P=0.000). The 1-week score showed weak correlations with finger-to-floor distance (r=0.263, P=0.027), chest expansion (r=−0.245, P=0.039), and DAI (r=0.271, P=0.036). Change in the 1-week score at the third visit showed good correlation with the BASFI score (r=0.670, P=0.000, n=36) and moderate correlation with the DFI (r=0.440, P=0.017, n=29). The Turkish version of the BAS-G has good reliability and validity. It is a good tool for assessing patients with AS or other rheumatic diseases in clinical practice and research.

Evaluation of the Turkish version of the Dougados functional index in ankylosing spondylitis

To investigate the reliability and validity of the Turkish version of the Dougados functional index (DFI) in patients with ankylosing spondylitis (AS). The Turkish version of DFI was obtained after a translation and back-translation process. Seventy consecutive patients with AS were enrolled. Patients were requested to complete the questionnaire on the day of admission (first visit), a second time within 24xa0h after admission (second visit), and on a third occasion. Reliability, validity and reproducibility of the Turkish version of the index were assessed. All the items showed significant correlations with the total index score with r-values ranging from 0.516 to 0.817. Cronbach α score was calculated as 0.908. Significant correlations were found between the total DFI score and Schober test (r=−0.293, P<0.05), occiput-wall distance (r=0.384; P<0.01) finger-to-floor distance (r=0.450, P<0.001), chest expansion (r=−0.331, P<0.01) and Dougados articular index (r=0.352, P<0.05). Good correlations were found between individual DFI items and the total score (r=between 0.533 and 0.882, p< 0.001) for the first and second visits, showing good reproducibility of the index. Conclusion: the Turkish version of DFI has good reliability, validity and reproducibility, confirming its utility for trials in Turkish AS patients.

Short-term treatment experience with teriparatide in pregnancy- and lactation-associated osteoporosis.

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They have got the blues: patient’s mood- and disease activity-related psychological burden of rheumatoid arthritis on caregivers

Abstract Objective: Rheumatoid arthritis (RA), as a long-lasting disease, not only affects the musculoskeletal health but also deteriorates the psychological well-being of the patient. What about their caregivers? There exist a limited number of studies on this issue. The objectives of the present study were (i) to evaluate the psychological health among caregivers of RA patients and (ii) to determine the confounding factors playing role on their psychological status. Methods: Fifty-three RA patients and their caregivers were included in this cross-sectional study. Disease activity was assessed by using the disease activity score 28 based on C-reactive protein (DAS28-CRP) and rheumatoid arthritis disease activity index-5 (RADAI-5), while disability was evaluated by disability of the arm, shoulder, and hand (DASH) questionnaire. Psychological status was tested by Becks depression and anxiety inventories (BDI and BAI). Results: A total of 53 patients with RA were included in the study. Caregivers depression score was weakly correlated with disease activity variables including DAS28-CRP, RADAI and DASH scores (rsu2009=u2009.304, rsu2009=u2009.392 and rsu2009=u2009.301, respectively); and moderately correlated with patients depression score and caregivers comorbidity (rsu2009=u2009.407 and rsu2009=u2009.451, respectively). Conclusions: The psychological impact of RA on caregivers appears to be associated with patients’ mood, disease activity and upper extremity functionality.

Hemiplejik omuzun EMG biofeedback kullanılarak yeniden eğitimi

Amac: Calismamizin amaci, EMG biofeedback’in hemiplejik omuzun yeniden egitimi uzerindeki etkisinin degerlendirilmesidir. Gerec ve Yontem: Calismaya toplam 30 hasta alindi. Hastalarin tutulan tarafinda yer alan ust trapezius kasina, omuz hareketleri sirasinda, relaksasyon saglamak amaciyla 10 seans EMG biofeedbackxa0 egitimi verildi.xa0 Hastalarin, tedavi oncesi ve sonrasinda; ust trapezius kasinin myoelektrik aktivitesi ile tonusu, deltoideus kasinin ise sadece tonusu olculdu. Omuzdaki fonksiyonel iyilesmeyi degerlendirmek icin Manuel Fonksiyon Testi kullanildi. Bulgular: Tedavi sonunda ust trapezius kasinin tonusundaxa0 ve myoelektrik aktivitesindexa0 azalma, deltoideus kasinin tonusunda ise artma oldugu goruldu. MFT sonuclarina gore, tedavi sonunda omuz fonksiyonelliginde yuzdece anlamli bir iyilesme oldugu tespit edildi. El fonksiyonlarinda ise herhangi bir iyilesme olmadi. Sonuc: Calismamizda EMG biofeedback egitiminin, hemiplejik hastalarda omuz fonksiyonlarinin iyilestirilmesi uzerine etkili oldugu goruldu. Hemiplejik hastalarda, EMG biofeedback ile yapilan omuz egzersizlerinin kliniklerde kullanilmasiyla tedavide olumlu sonuclar alinabilecegi sonucuna varildi.

Neuropathic pain: is it an underestimated symptom in systemic sclerosis?

Pain is one of the most common symptoms in systemic sclerosis (SSc) patients, yet not considered in the assessment of disease severity. This study aimed to investigate the frequency of neuropathic pain (NP) and to evaluate its interference with the quality of life (QoL) in SSc patients. Diffuse and Limited SSc patients diagnosed by American College of Rheumatology 2013 criteria were included in the study. Pain was evaluated with Visual Analogue Scale (VAS); presence of NP was screened with The Leeds Assessment of Neuropathic Symptoms and Signs (LANNS) questionnaire; disease activity was evaluated with modified Medsger Severity Scale (MSS) and QoL with short-form 36 (SF-36). One hundred twenty patients were included in the study (mean age 53.64u2009±u200911.44xa0years, female/male 83.3–16.7%). Total pain frequency was found 69.2% and NP was 35.9% in the entire patient group. Pain was most frequently seen in wrist-hand (50.6%) and ankle-foot (43.4%) regions; albeit, NP rates were highest in face (94.4%), lower leg (87.5%), and hip-thigh (78.6%) regions. SF-36 scores were significantly lower in patients with NP than the patients without NP (Pu2009<u20090.05). The most associated factors with NP were MSS score for muscle involvement and drug consumption of the patient. According to our results, high frequency of NP is seen in SSc patients, and NP is associated with low QoL. Differential diagnosis of NP is important to consider right treatment options and accurate management of pain in all rheumatologic diseases including SSc.