Zeynep Tuna

Aerobic exercise improves oxidant-antioxidant balance in patients with rheumatoid arthritis.

[Purpose] Although oxidative stress is known to be present in rheumatoid arthritis (RA), the effects of exercise on oxidative parameters are unknown. The aim of this study was to investigate the effects of acute aerobic exercise on serum oxidant and antioxidant levels in patients with RA. [Subjects and Methods] Sixteen patients with RA and 10 age-matched healthy volunteers participated in this study. All participants wore polar telemeters and walked on a treadmill for 30 minutes at a speed eliciting 60–75% of maximal heart rates. Blood samples were obtained before, immediately and 24 hours after exercise and malondialdehyde (MDA) and total sulfhydrile group (RSH) levels were measured. [Results] Both groups had similar heart rates during the test but the treadmill speed of the RA patients was significantly lower than that of the healthy volunteers. Serum MDA levels were lower than in both groups immediately after exercise, with greater decrements in the RA patients than controls. MDA levels returned to baseline 24 hours after the exercise only in the controls; they remained low in the RA patients. There was a slight increase in serum RSH levels after exercise compared to baseline in both groups. [Conclusion] Moderate intensity treadmill exercise did not have any adverse effect on the oxidant-antioxidant balance. The results suggest that such an exercise may be safely added to the rehabilitation program of RA for additional antioxidant effects. Morever, this antioxidant environment is maintained longer in RA patients.

Relationship between kinesiophobia and pain, quality of life, functional status, disease activity, mobility, and depression in patients with ankylosing spondylitis

Background/aim: Our aim was to investigate the association of kinesiophobia with pain, quality of life, clinical measures, and depression in patients with ankylosing spondylitis (AS). Materials and methods: Patients with AS (n: 163) were enrolled in the study. Kinesiophobia was evaluated with the Tampa Scale of Kinesiophobia (TSK), pain with a visual analog scale (VAS), mobility with Bath Ankylosing Spondylitis Metrology Index (BASMI), disease activity with the Bath AS Disease Activity Index (BASDAI), functional status with the Bath AS Functional Index (BASFI), depression level with Becks Depression Inventory (BDI), and quality of life with the AS Quality of Life Questionnaire (ASQoL). Besides correlation analysis, outcome measures were compared between patients with (TSK ? 37) and without (TSK < 37) kinesiophobia. Results: Kinesiophobia was found to be common with a percentage of 66.6%. TSK scores were correlated with VAS, BASFI, ASQoL, and BDI scores (r = 0.259, r = 0.294, r = 0.392, and r = 0.398, respectively; P < 0.05 for each). There were no correlations between TSK and the BASDAI and BASMI scores (r = 0.142, r = 0.198, respectively; P > 0.05). Patients with kinesiophobia had more pain and poorer BASFI, ASQoL, and BDI scores than patients without kinesiophobia (P < 0.05).Conclusion: Our study is the first study that investigated the relationship between kinesiophobia and other clinical measures in AS patients. Pain and psychological status have an impact on fear of movement and thus functional status and quality of life.

Hand functions in systemic lupus erythematosus: a comparative study with rheumatoid arthritis patients and healthy subjects

Background/aim Systemic lupus erythematosus (SLE) frequently affects the small joints of the hand and may result in difficulty in activities of daily living. There are very few studies evaluating the problems encountered in the hands in patients with SLE. The aim of this study is to evaluate hand functions in patients with SLE and compare them with rheumatoid arthritis (RA) patients and healthy subjects. Materials and methods A total 46 female patients meeting the SLE classification criteria were recruited. Similarly, 51 female RA patients and 46 healthy female subjects served as the control groups. To assess the upper extremity disability level, the Disability Arm Shoulder and Hand Questionnaire (DASH) was used. Some functional performances such as hand grip and pinch strength were evaluated using a dynamometer and the Nine Hole Peg Test (NHPT), respectively. Results Hand functions were found to be impaired in both SLE and RA patients when compared to healthy controls. In addition, patients with SLE showed better performance in the NHPT, hand grip, and pinch strength than RA patients (P < 0.05). However, the patient-reported disability level was similar in both patient groups (P > 0.05). Conclusion Similar to patients with RA, hand functions are significantly impaired in patients with SLE in daily activities.

Fear of movement and its effects on hand function after tendon repair

After tendon injuries, it has been observed clinically that patient-reported disability is more severe than the patients actual performance. This is thought to result from a fear of movement (kinesiophobia) after surgery. The aim of this study was to investigate the presence of kinesiophobia in this patient population and its effects on the clinical outcomes. Patients (n=118) with tendon repairs were included. All the participants received early passive mobilization and were assessed at the end of the 8th week. Grip and pinch strengths were measured and the Nine-Hole Peg Test (9HPT) was conducted. Patients also filled out the Michigan Hand Outcomes Questionnaire (MHOQ) and Tampa Scale for Kinesiophobia (TSK). Patients were divided according to their kinesiophobia: Group 1 with low kinesiophobia (TSK<37) and Group 2 with high kinesiophobia (TSK≥37). The groups were compared on the assessed parameters. Fifty-nine percent of the patients had a high kinesiophobia level. The performance-based test results were similar between the groups (P>0.05). Patient-reported MHOQ and TSK scores were significantly lower in the high kinesiophobic group (P=0.001 and P=0.000, respectively). Patients with tendon repairs often develop kinesiophobia, which may contribute to difficulty when starting to re-use their hand in daily life. None of the objective results were affected by this fear of movement-only patient-reported disability. Clinicians should be aware that clinical outcomes may be affected by the patients kinesiophobic thinking and must be cautious during treatment.

The presence and influence of posterior capsule tightness on different shoulder problems

BACKGROUND In the literature it has been shown that posterior capsule flexibility is a precursor to shoulder problems. However, no study thus far has shown the influence of the flexibility of posterior capsule in different shoulder pathologies. OBJECTIVE This study set about to compare the role of posterior capsule tightness in different shoulder problems. METHODS One-hundred-twenty-five patients diagnosed with shoulder subacromial impingement syndrome (n= 52), partial rotator cuff tear (n= 31) or frozen shoulder (n= 42) and 30 asymptomatic peers participated in the study. Horizontal adduction was assessed in side-lying position for posterior capsule tightness. Pain was measured via the visual analogue scale and shoulder range of motion and active total elevation was assessed with goniometer. Hand behind the back (HBB) test was assessed the active internal rotation by measuring the distance between T5 and the thumb. RESULTS It was found that the affected side of the posterior capsules of the patients with subacromial impingement syndrome (p< 0.001), partial rotator cuff tear (p< 0.001) and frozen shoulder (p< 0.001) was stiffer than their healthy side. There were significant differences among groups in the level of tightness in the posterior capsule between the affected and the healthy sides (p< 0.001). All range of motion of the shoulder including HBB test and the posterior capsule tightness of the affected side are found to be correlated (p< 0.05). CONCLUSIONS This study emphasized that the posterior capsules susceptibility to tightness is most evident in frozen shoulder among different shoulder problems.

AB1232-HPR The Relationship Between Kinesiophobia and Quality of Life, Functional Status, Disease Activity and Depression in Patients with Ankylosing Spondylitis

Background Ankylosing spondylitis (AS) is a chronic, inflammatory disorder characterized by pain and stiffness especially on back and sacroiliac joint. Pain, reduced spine mobility, and decreased physical functioning are the major manifestations of AS. In the literature, the role of kinesiophobia in musculoskeletal pain disorders has been examined in studies of acute and chronic back pain, osteoarthritis and fibromyalgia. The results of these studies tend to support the important contribution of fear of movement in the evaluation of pain, disability, function and QoL and treatment of musculoskeletal disorders. Objectives To investigate the effects of kinesiophobia on quality of life (QoL), functional ftatus, disease activity and depression of AS patients. Methods 163 participants (18 men, 18 women) who were under a regular follow-up protocol in Gazi University Rheumatology Clinic and Rheumatologic Rehabilitation Unit with the diagnosis of AS. Primary outcome measure was kinesiophobia. Evaluation was done using the The Tampa Scale of Kinesiophobia (TSK). Exploratory measures were Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), BECK Depression Inventory (BDI) and AS quality of life questionnaire (ASQOL). Pearsons correlation test was used to verify correlations. Results Kinesiophobia was found to be very common in AS affecting 66.6% of patients. There were correlation found between TSK and BASDAI pain, BASFI, ASQOL, BDI scores (Respectively, r=.259, r=.294, r=.392, r=.398; p<.05). There were no correlations found between TSK and BASDAI total and BASMI scores (Respectively, r=.142, r=.198; p>.05). Conclusions Our study is the first clinical study designed to investigate the relationship of kinesiophobia with the other clinical measurements in AS patients. Their pain levels and psychological states have an impact on fear of movement. In relation, functional status and quality of life of them affected negatively. References Burwinkle T, Robinson JP, Turk DC. Fear of Movement:FactorStructure of the Tampa Scale of Kinesiophobia in Patients With Fibromyalgia Syndrome. The Journal of Pain, Vol 6, No 6 (June), 2005: pp 384-391. Vlaeyen JW, Kole-Snijders AM, Boeren RG, et al. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995; 62: 363-372. Dagfinrud H, Kvien TK, Hagen KB, Nghien FT, Donohue JT. Physiotherapy interventions for ankylosing spondylitis. Dochrana Databased System Reviews. 2008; 23(1): CD002822. Disclosure of Interest None declared

Restoration of function on bilateral absence of extensor pollicis longus and brevis: A case report

Gelis tarihi: 13.08.2012 Kabul tarihi: 23.09.2012 Gazi University Faculty of Health Sciences Department of Physiotherapy and Rehabilitation, PT, Assoc Prof*; Hacettepe University Faculty of Health Sciences Department of Physiotherapy and Rehabilitation, PT PhD**; PT, Prof ***; Gazi University Faculty of Health Sciences Department of Physiotherapy and Rehabilitation, PT, PhD****; PT, MSc***** OlGu sunuMu

Physiotherapy programme after toe-to-index transplantation: a case report

Amaç: Bu olgu sunumunun amacı, parmak transplantasyonu sonrası uygulanan fizyoterapi değerlendirme ve tedavi yöntemleri konusunda literatüre katkıda bulunmak ve bu tedavi programının sonuçlarını sunmaktır. Yöntemler: Vaka; sağ el 2. ve 3. parmakta travmatik amputasyon meydana gelmiş 17 yaşında erkek hastadır. Yaralanmadan 1 yıl sonra sol ayak 2. parmağı, sağ el indekse transplante edilmiştir. Dört haftalık immobilizasyon sonrası fizyoterapi için yönlendirilen hastanın tedavisi üç aşamalı olarak planlanmıştır. Birinci aşama erken dönem rehabilitasyondur. Cerrahi sonrası 8. haftaya kadar devam eden bu aşamada ödem kontrolü, pasif ve aktif-asistif eklem hareketinin arttırılması planlanmıştır. 8 ve 12. haftalar arasında programa transplantasyona yönelik dirençli egzersizler eklenmiştir. 12. haftadan sonraki geç dönem rehabilitasyon programında ise günlük yaşama geri dönüş hedeflenmiştir. Bulgular: Cerrahiden sonraki 4.,8. ve 12. haftalarda yapılan değerlendirmelerde transfer edilen parmağın eklem hareket açıklığı ve kavrama kuvvetlerinde artış olduğu görülmüş, en fazla artışın pinch kuvvetlerinde olduğu dikkati çekmiştir. Ayrıca, fonksiyonellik ölçütü olan el fonksiyon testi ve özür seviyesi skorlarında gelişmeler kaydedilmiştir. Cerrahi sonrası uygulanan planlı fizyoterapi programı ile hastada fonksiyonel kazanç sağlanmıştır. Sonuç: Hastaya uygun planlanan fizyoterapi programı ile, hastanın fonksiyonel geri dönüşüne katkıda bulunulacağı düşünülmektedir. Anahtar sözcükler: Parmak transplantasyonu, fizyoterapi, el fonksiyonu ABS TRACT Physiotherapy programme after toe-to-index transplantation: A case report

FRI0480-HPR Effects of an acute aerobic exercise bout on plasma oxidant and antioxidant levels in rheumatoid arthritis patients

Background Exercise can stimulate the oxidative metabolism and potentially affect oxidants and antioxidants. Meanwhile, oxidative stress also plays an important role in the pathobiology of rheumatoid arthritis (RA). Since the benefits of different exercise types in RA are well-established, the effects of an acute aerobic exercise bout on the plasma oxidant and antioxidant levels may be clinically relevant. Objectives This study aimed to assess the effects of an acute submaximal aerobic exercise bout on plasma malondialdehyde (MDA) and total sulfhydrile groups (RSH) levels in RA patients. Methods Sixteen RA patients in remission and 10 age-matched healthy volunteers participated in the study. The patients were confirmed to have no contraindications to take part in the study by a rheumatologist. The exercise intensity was determined by using heart rate which was followed during the whole test by a polar telemeter. All participants walked on the treadmill at the intensity of %60-75 of maximal heart rate for 30 minutes. Blood samples were obtained before, after and 24 hours later the test. Plasma MDA and RSH levels were assessen in the samples. Results Both groups reached similar heart rates (p>0.05) during the test but test speed of patients were significantly lower (p<0.05). Plasma MDA levels decreased after exercise in both groups (p<0.05) with a greater decrements in the RA patients (p<0.01). However, 24 hours later only control group returned to baseline levels compared to after-exercise levels (p<0.05). Plasma RSH levels increased slightly with exercise in both groups (p>0.05). Conclusions These results indicated that an acute bout of aerobic exercise decreased the plasma oxidant levels in RA patients. Therefore, such an acute aerobic exercise model could exert an antioxidant effect partly and this effect is highly preserved for longer in RA patients. Based on those results, moderate aerobic exercise like walking is safe in RA patients with additional benefits on the oxidative metabolism. References Banerjee, AK, Mandal, A, Chanda, D, Chakraboti, S. (2003) Oxidant, antioxidant and physical exercise. Molecular and Cellular Biochemistry, 253, 307-12. Kamanlı A, Nazıroğlu M, Aydilek N, Hacıevliyagil C. (2004) Plasma lipid peroxidation and antioxidant levels in patients with rheumatoid arthritis. Cell Biochemistry and Function, 22, 53–7. Hurkmans, E, van der Giesen, FJ, Vliet Vlieland, TPM, Schoones, J, Van den Ende, ECHM. (2009) Dynamic exercise programs (aerobic capacity and/or muscle strength training in patients with rheumatoid arthritis. Cochrane Database of Systematic Reviews, Issue 4 Disclosure of Interest None Declared