Publications by authors named "Banu Kuran"

51 Publications

Pain Symptoms in COVID-19.

Am J Phys Med Rehabil 2021 04;100(4):307-312

From the Division of Pain Medicine, Department of Physical Medicine and Rehabilitation, Science Health University, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey (TŞ); Department of Physical Medicine and Rehabilitation, Science Health University, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey (AA, BK); Physical Medicine and Rehabilitation Department, Marmara University Medical Faculty, Istanbul, Turkey (KG-A); Department of Neurosurgery, Science Health University, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey (CA); and Department of Orthopedics and Traumatology, Science Health University, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey (HMÖ).

Objective: The clinical manifestations of COVID-19 range from mild symptoms to severe pneumonia and severe organ damage. When evaluated specifically for pain, the data so far have shown that myalgia, headache, and chest pain can be seen in patients at varying rates; myalgia and headache, especially, are among the initial symptoms.

Design: This retrospective chart review, followed by a descriptive survey design study, was carried out by examining patients afflicted with COVID-19. After discharge, patients were asked about the severity and the body region of their pain, their use of analgesics, their mood and mental health, and their overall quality of life.

Results: A total of 206 patients with a mean age of 56.24 ± 16.99 yrs were included in the study. Pain during COVID-19 was found to be higher compared with the preinfectious and postinfectious states. The most frequent painful areas were reported to be the neck and back before the infection, whereas the head and limbs during the infection. The most frequently used analgesic during infection was paracetamol. There was no relationship between the patients' pain and anxiety and depression; the quality of life was found to be worse in patients with persistent pain.

Conclusions: This study showed that the head and limbs were the most common painful body regions during COVID-19. It was also found that pain can continue in the postinfection period.
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http://dx.doi.org/10.1097/PHM.0000000000001699DOI Listing
April 2021

The Turkish League Against Rheumatism Recommendations for the Management of Hand Osteoarthritis Under Guidance of the Current Literature and 2018 European League Against Rheumatism Recommendations.

Arch Rheumatol 2020 Sep 8;35(3):309-320. Epub 2020 Jan 8.

Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Akdeniz University, School of Medicine, Antalya, Turkey.

Objectives: This study aims to explore the accordance to the 2018 European League Against Rheumatism (EULAR) recommendations for the management of hand osteoarthritis (OA) among the Turkish League Against Rheumatism (TLAR) expert panel and composition of TLAR recommendations for the management of hand OA under guidance of the current literature.

Materials And Methods: The TLAR convener designated an expert panel of 10 physicians experienced in hand OA for this process. The 2018 EULAR recommendations for the management of hand OA and the systematic review of the literature were sent to the expert panel via e-mails. The e-mail process which included Delphi round surveys was completed. The EULAR standard operational procedure Appraisal of Guidelines for Research and Evaluation II was followed. The level of agreement was calculated for each item and presented as mean, standard deviations, minimum and maximum and comparisons of 2018 EULAR recommendations were performed.

Results: Five overarching principles and 10 recommendations were discussed. Revisions were held for the sixth, seventh, and ninth recommendations with lowest level of agreements. These recommendations were revised in accordance with suggestions from the experts and re-voted. The revised forms were approved despite the lack of statistically significant difference between these forms (p=0.400, p=0.451, p=0.496, respectively). Except for the ninth recommendation about surgery (p=0.008), no significant difference in level of agreements was observed between the EULAR and TLAR hand OA recommendations. The 11th recommendation about paraffin bath was added.

Conclusion: The optimal treatment of hand OA consists of personalized non-pharmacological (self-management, exercise, splint), pharmacological (topical non-steroidal anti-inflammatory drugs as the first choice), and interventional procedures (only for refractory cases) based on shared decision between the patient and physician. TLAR hand OA recommendations were created mainly based on the most recent literature and the last EULAR hand OA management recommendations, which are widely approved among the TLAR experts.
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http://dx.doi.org/10.46497/ArchRheumatol.2020.7693DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788652PMC
September 2020

Transient Osteoporosis of the Hip: A Case Report.

Sisli Etfal Hastan Tip Bul 2020 11;54(4):505-507. Epub 2020 Dec 11.

Department of Physical Medicine and Rehabilitation, University of Health Sciences Turkey, Sisli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey.

Transient osteoporosis of the hip, idiopathic, is a table, beginning with hip pain without a history of trauma, usually self-limiting and seen in middle-aged men and pregnant women. In this case report, a male patient who was admitted because of hip pain and detected transient osteoporosis go the hip was discussed. The purpose of the case presentation is to emphasize the necessity of transient osteoporosis of the hip in the differential diagnosis of sudden onset of hip pain and to review the literature on this subject.
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http://dx.doi.org/10.14744/SEMB.2019.26879DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7751251PMC
December 2020

The reliability and validity of The Turkish version of Multidimensional Fatigue Inventory-20 for the evaluation of different dimensions of fatigue in patients with fibromyalgia.

Turk J Phys Med Rehabil 2020 Dec 24;66(4):436-443. Epub 2020 Jun 24.

Bahçeşehir University, Health Sciences Institute, Istanbul, Turkey.

Objectives: In this study, we aimed to evaluate the validity and reliability of the Multidimensional Fatigue Inventory-20 (MFI-20) for Turkish patients with fibromyalgia (FM).

Patients And Methods: Between February 2011 and September 2011, a total of 120 female patients (mean age 45±9.1 years; range, 20 to 60 years) admitted to our outpatient clinic with extensive pain and fatigue and diagnosed with FM according to 1990 and 2010 American College of Rheumatology criteria were included in this study. The MFI-20 was translated according to forward-backward translation procedure. For the test-retest reliability, the patients re-filled out the scale 48 hours after the first application. Structural validity was evaluated with confirmatory factor analysis (CFA). Reliability was assessed by internal consistency with Cronbach alpha and test-retest reliability was assessed by intra-class correlation coefficient (ICC). For convergent validity, Spearman rho correlation coefficient was used for relevance analysis with the Fatigue Impact Scale (FIS), visual analog scale (VAS)-pain, VAS-fatigue, and Short Form-36 (SF-36) questionnaires.

Results: The total Cronbach alpha coefficient was found to be 0.92 (range, 0.78 to 0.93). The CFA showed good structural validity and revealed five dimensions. The ICC coefficient was found to be 0.934. All correlation coefficients between the MFI and FIS were calculated as above 0.80, indicating a strong relationship.

Conclusion: The results of this study show that the Turkish version of the MFI-20 has a high internal consistency and reasonable construct validity. It is a valid and reliable measurement of the assessment of fatigue in patients with FM multidimensionality.
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http://dx.doi.org/10.5606/tftrd.2020.5781DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756826PMC
December 2020

Idiopathic Lumbosacral Neuropathy Syndrome: Case Report.

Sisli Etfal Hastan Tip Bul 2020 24;54(3):384-387. Epub 2020 Aug 24.

Department of Physical Medicine and Rehabilitation, University of Health Sciences Turkey, Sisli Hamidiye Etfal Teaching and Resarch Hospital, Istanbul Turkey.

Idiopathic lumbosacral plexitis or lumbosacral radiculoplexus neuropathy is a disease characterized by nerve damage in lumbar and/or sacral plexus without trauma, mass effect or diabetic complications. A 47-year-old male patient with right groin pain and loss of right leg muscle strength is presented in this case report. Neuropathy was detected in the L4 nerve root by electromyography and magnetic resonance neurrographic imaging. The underlying cause was investigated; however, it is linked to the idiopathic outcome. Idiopathic lumbosacral neuropathy is a lumbosacral plexus disease in which no underlying pathology plays a role in causing severe pain and muscle weakness. Patients should be avoided urgently operation because of the sudden onset symptoms.
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http://dx.doi.org/10.14744/SEMB.2019.45143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729716PMC
August 2020

Use of Shear Wave Elastography for Quantitative Assessment of Muscle Stiffness After Botulinum Toxin Injection in Children With Cerebral Palsy.

J Ultrasound Med 2020 Dec 3;39(12):2327-2337. Epub 2020 Jun 3.

Departments of Physical Medicine and Rehabilitation, Health Sciences University, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.

Objectives: This study aimed to investigate the stiffness of the gastrocnemius (GC) muscle with acoustic radiation force impulse (ARFI) elastography after botulinum toxin-A (BTX-A) injection in children with spastic cerebral palsy (CP) and to examine the relationship between elastographic and clinical parameters.

Methods: This prospective randomized single-blind controlled clinical study included 49 lower extremities of 33 children with spastic CP. They were randomized into 2 groups: group 1 (n = 25 extremities in 17 children) received BTX-A injection and a home-based exercise program; group 2 (n = 24 extremities in 16 children) received only a home-based exercise program. Patients were evaluated in pretreatment and posttreatment periods in the first and third months with ARFI elastography, the Modified Ashworth Scale, Modified Tardieu Scale, Pediatric Functional Independence Measure, Gross Motor Function Classification System, and goniometric range of motion measurement of the ankle.

Results: A statistically significant difference was found in elastography of the GC muscle in group 1 only at the first month after treatment (P < .05). No statistical difference was found in elastography of the GC after treatment in group 2. According to the Modified Ashworth Scale, Modified Tardieu Scale, and ankle passive range of motion, group 1 showed significant improvements after treatment (P < .05). Also, there was a significant correlation between these clinical parameters and elastographic measurements (P < .05).

Conclusions: According to the results of this study, the measurements from ARFI elastography combined with clinical parameters might be useful for evaluation of spasticity after BTX-A treatment in children with CP. Also, they might be useful in distinguishing patients who will benefit clinically, especially in the early stages of treatment.
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http://dx.doi.org/10.1002/jum.15342DOI Listing
December 2020

Suprascapular nerve block in hemiplegic shoulder pain: comparison of the effectiveness of placebo, local anesthetic, and corticosteroid injections-a randomized controlled study.

Neurol Sci 2020 Nov 10;41(11):3243-3247. Epub 2020 May 10.

Department of Physical Medicine and Rehabilitation, Saglik Bilimleri University, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey.

Background: Shoulder pain is a common complication of hemiplegic patients that can interrupt their rehabilitation program and is associated with poorer outcomes. The usefulness of the suprascapular nerve block. (SSNB) in the stroke population has been suggested, but some concerns still remain.

Objectives: To investigate the effect of SSNB on pain intensity and passive range ofmotion (PROM) in patients with hemiplegic shoulder pain (HSP).

Study Design: A prospective, double blind, randomized controlled trial was conductedin 34 stroke patients with HSP. They were randomly divided into three groups: Localanesthetic (LA) injection into the trapezius muscle (placebo group), LA injection into thesuprascapular notch, and LA and corticosteroid (CS) injections into the suprascapularnotch.The main outcome was visual analog scale (VAS) scores evaluated before andafter administration of the injection at 1 hour, 1 week, and 1 month.

Results: There were significant decreases in the VAS scores with all three injections at all follow-up time points (p: 0.001 for the placebo group, p <0.001 for the LA group, and p <0.001 for the LA+CS group). When changes in VAS scores were compared between the groups, the LA+CS group demonstrated a higher decrease in VAS than the placebo group. Improvement in the PROM was seen only in the LA and LA+CS groups.

Conclusions: The findings of this study support the use of an SSNB with or without CS, to increase the range of motion in the affected shoulder, especially during the rehabilitation period.
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http://dx.doi.org/10.1007/s10072-020-04362-0DOI Listing
November 2020

[Dermatomyositis presenting with low back pain].

Agri 2020 Apr;32(2):99-102

Department of Physical Medicine and Rehabilitation, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.

Dermatomyositis (DM) is a rare connective tissue disease characterized by skin lesions and inflammatory changes observed in muscle biopsy findings. A definitive diagnosis of DM requires a characteristic rash in addition to proximal muscle weakness and muscle enzyme level elevation. DM is twice as common in women as men, with an age of onset of approximately 50 years. This case report describes a 29-year-old patient with low back pain and proximal muscle weakness in the legs diagnosed as lumbar disc herniation who was then referred by the neurosurgery department to our clinic. A physical examination revealed the characteristic skin lesions for dermatomyositis. Needle electromyography and a skin biopsy were performed, and corticosteroid treatment was initiated. In misdiagnosed patients, fatty infiltration in the muscles may cause irreversible weakness and gait disturbance. Early suppression of inflammation is important and can yield a dramatic response to treatment.
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http://dx.doi.org/10.5505/agri.2018.45578DOI Listing
April 2020

The long-term impacts of preterm birth and associated morbidities on bone health in preschool children: a prospective cross-sectional study from Turkey.

J Matern Fetal Neonatal Med 2020 Feb 26:1-8. Epub 2020 Feb 26.

Department of neonatology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.

To evaluate the impact of preterm birth on bone health in preschool children. A total of 166 preschool children (aged 7-8 years) born preterm ( = 86, <37-week gestation) and at term ( = 80, ≥37 weeks of gestation) in our hospital were included in this prospective cross-sectional study. Data on antenatal, perinatal, and early postnatal characteristics and maternal obstetric history were obtained from medical records. Bone densitometry data including total bone mineral content (BMC), bone mineral density (BMD; total, lumbar, and femoral), z-scores, and bone loss were collected for each participant. Current height, weight, and BMI values were significantly lower in the preterm group ( < .001). Serum calcium, phosphorus and alkaline phosphatase (ALP) levels did not differ among groups, whereas VitD3 levels were significantly higher in the preterm group ( = .039). The mean total BMC, total BMD, lumbar (L2-L4) BMD, femur BMD, total z-score, and L2-L4 z-score values were significantly lower for the preterm group, whereas the total, lumbar, and femoral bone loss were significantly higher ( < .001), regardless of the severity of prematurity. Intraventricular hemorrhage (IVH) and retinopathy were significantly associated with lower total BMC ( = .004,  = .012, respectively). Fortified breastfeeding was associated with lumbar bone loss ( = .043), and formula feeding was associated with both femur and lumbar bone loss ( = .006,  = .012, respectively). Our findings revealed long-term adverse effects of preterm birth on bone health, with significantly lower anthropometric values (weight, height, and BMI), lower scores for total BMC, BMD (total, lumbar, femoral), and z-scores (total, femur), along with higher bone loss (total, lumbar, femoral) and higher rates of osteopenia and osteoporosis in preschool children born preterm (whether moderate or very preterm) compared with those born at term. Exclusive breastfeeding appears to reduce the likelihood of long-term bone loss in preterm infants.
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http://dx.doi.org/10.1080/14767058.2020.1730801DOI Listing
February 2020

Assessing the validity and reliability of the Turkish version of the Trunk Impairment Scale in stroke patients.

North Clin Istanb 2019 14;6(2):156-165. Epub 2018 Aug 14.

Department of Physical Medicine and Rehabilitation, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.

Objective: To determine the validity and reliability of the Turkish version of the Trunk impairment scale (TIS), used in the evaluation of somatic, motor, and coordination disturbances in stroke patients, and provide a culturally adapted version for use in the Turkish population.

Methods: A total of 80 patients who were either hospitalized at our facility and rehabilitated for stroke or admitted at our outpatient clinics were included in this study. Reliability was evaluated by the internal consistency (Cronbach α) and test reproducibility [intra-class correlation coefficient (ICCC)] methods, and validity was evaluated by the correlation between subgroups and the total scores of the TIS and Berg Balance Scale (BBS), Brunnstrom phases, Barthel index (BI), Rivermead mobility index (RMI), and Short Form-36 (SF-36) scores.

Results: The mean age of the patients was 63.00±12.1 years. Out of a total of 80 subjects, 34 were female and 46 were male. The reliability of the scale was evaluated by the internal consistency, inter- and intra-observer reliability, and test reproducibility. The findings showed that the Turkish form of the scale was reliable at a good level. The test values were as follows; Cronbach α: >0.70, ICCC: 0.969-1, subgroups and total score comparison: 0. The correlation between TIS and BBS was considerably high in the validity analysis (p<0.001). Further, significant associations among the BI, RMI, KF-36, Brunnstrom, and TIS scores were found (p<0.001), which indicate the structural validity of this scale.

Conclusion: TIS is a scale used in measuring the motor derangement that develops after a stroke. It has sufficient reliability, internal consistency, and validity for use in clinical practice and stroke investigations. Our study has shown that TIS used for the evaluation of body balance is valid and reliable for the Turkish population.
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http://dx.doi.org/10.14744/nci.2018.01069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6593917PMC
August 2018

The efficiency of platelet-rich plasma treatment in patients with knee osteoarthritis.

J Back Musculoskelet Rehabil 2020 ;33(1):127-138

Department of Physical and Rehabilitation Medicine, Hamidiye Şişli Etfal Training and Research Hospital, Istanbul, Turkey.

Objective: The aim of this study was to determine the effects of platelet-rich plasma (PRP) treatment on pain, functionality, quality of life, and cartilage thickness in patients with knee osteoarthritis (OA).

Methods: Sixty patients with chronic knee pain were randomly separated into two groups. The first group was administered 4-ml PRP intra-articularly (IA) in three doses at one-week intervals, and the second group had only one dose of a 4-ml saline solution IA. The patients' pain was measured using the Visual Analogue Scale (VAS); functionality was measured using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). The distal femur cartilage thickness was assessed using ultrasonography (USG).

Results: All baseline parameters were similar (p> 0.05). In the first and sixth months after the treatment, the VAS scores of the PRP group were significantly low (p< 0.001). In the same group, only the pain sub-score was low in the WOMAC assessment in the first month after treatment. However, in the sixth month, all parameters of the WOMAC score were lower than those of the placebo group (p< 0.05). Cartilage thickness measurements were similar in the two groups (p< 0.05).

Conclusion: PRP treatment had positive effects on the pain, physical function, and quality of life of patients with knee OA, but it did not increase cartilage thickness.
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http://dx.doi.org/10.3233/BMR-181374DOI Listing
August 2020

Comparison of responsiveness of Michigan Hand Outcomes Questionnaire, Disabilities of the Arm, Shoulder and Hand Questionnaire, and Duruöz Hand Index in patients with traumatic hand injury.

J Back Musculoskelet Rehabil 2019 ;32(1):111-117

Romatem Physical Therapy and Rehabilitation Hospitals, Izmit, Turkey.

Objective: Patient-reported outcome measures assessing self-reported disability, pain, and function are primary endpoints for determination of optimal treatment strategies in hand-related conditions. In this study, we aimed to compare responsiveness of Michigan Hand Outcomes Questionnaire (MHQ), Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), and Duruöz Hand Index (DHI) in patients with traumatic hand injury.

Methods: Consecutive patients with traumatic hand injury who were referred to our polyclinic for rehabilitation were included in the study. Depending on clinical status, patients underwent at least 14 sessions of physical therapy consisting of infrared heating, water submersion ultrasound, electrical stimulation, and exercise. MHQ, DASH, and DHI questionnaires were filled in by all patients both before and 3 months after physical therapy.

Results: A total of 60 patients were enrolled in the study. MHQ (ES =-1.89; SRM =-1.84), DASH (ES = 1.66; SRM = 1.40), and DHI (ES = 1.68; SRM = 1.48) were all highly responsive in traumatic hand injuries.

Conclusion: Our study demonstrated that MHQ, DASH, and DHI are very responsive questionnaires for detection of treatment-induced changes in patients with traumatic hand injury. We suggest that when it is only intended to assess hand disability or when a quick assessment is desirable, DASH or DHI are more suitable, whereas MHQ will be more useful when a more detailed assessment including pain and aesthetical concerns is required.
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http://dx.doi.org/10.3233/BMR-181255DOI Listing
March 2019

Prevalence of Rheumatoid Arthritis and Spondyloarthritis in Turkey: A Nationwide Study.

Arch Rheumatol 2018 Jun 13;33(2):128-136. Epub 2017 Oct 13.

Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Sakarya University, School of Medicine, Sakarya, Turkey.

Objectives: This study aims to estimate the prevalence of rheumatoid arthritis (RA) and spondyloarthritis (SpA) in Turkey using the same telephone questionnaire developed for screening RA and SpA in France and used in Serbia and Lithuania.

Material And Methods: The study was performed in two steps. In step I, the French questionnaire was translated into Turkish and validated through a group of 200 patients (80 males, 120 females; mean age 44.0±13.1 years; range 19 to 75 years) followed up at the rheumatology departments of University Hospitals in Antalya and Ankara. In step II, the validated Turkish questionnaire was administered face-to-face to randomly selected 4,012 subjects (1,670 males, 2,342 females; mean age 41.5±16.8 years; range 16 to 97 years) by trained general practitioners across the country, in 25 prov- inces for case detection. The subjects who were suspected of having RA or SpA in accordance with the questionnaire were invited to the nearest university hospital for rheumatologic examination in order to confirm the diagnosis.

Results: In step II, a total of 25 subjects (2 males, 23 females) were diagnosed as RA. The standardized RA prevalence for the general population of Turkey was calculated as 0.56% (95% confidence interval [CI]; 0.33-0.79), 0.10% (95% CI; -0.05-0.25) for males and 0.89% (95% CI; 0.51-1.27) for females. A total of 18 subjects (3 males, 15 females) were diagnosed as SpA. The standardized SpA prevalence for the general population of Turkey was 0.46% (95% CI; 0.25-0.67), 0.17% (95% CI; -0.03-0.37) for males and 0.65% (95% CI; 0.32-0.98) for females. The prevalence of RA was highest in the Northern region (2.00%) and the prevalence of SpA was highest in the Central region (1.49%).

Conclusion: The prevalences of RA and SpA in Turkey are close to each other and there are significant inter-regional variations in prevalences of both RA and SpA.
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http://dx.doi.org/10.5606/ArchRheumatol.2018.6480DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6117145PMC
June 2018

Efficacy of therapeutic ultrasound in treatment of adhesive capsulitis: A prospective double blind placebo-controlled randomized trial.

J Back Musculoskelet Rehabil 2018 ;31(5):955-961

Department of Physical Medicine and Rehabilitation, Hamidiye Sisli Etfal Training and Research Hospital, Health Sciences University, Istanbul, Turkey.

Background: In treatment of adhesive capsulitis, deep heating agents have been shown to have positive effects on pain and function.

Objective: To evaluate if addition of ultrasound used in treatment of adhesive capsulitis will provide additional benefits.

Methods: Thirty patients with adhesive capsulitis were included in a prospective, double-blind, randomized controlled trial. Hotpack, TENS (Transcutaneus Electrical Nerve Stimulation), exercise and active ultrasound therapies were applied to the first group (n= 15), whereas sham ultrasound was applied to the second group (n= 15) in addition to hotpack, TENS and exercise. The patients were evaluated using joint range of motion, UCLA shoulder scale and Shoulder Disability Questionnaire scales at baseline and at 6th and 24th weeks post-treatment.

Results: When pain and the clinical and functional parameters were compared in both groups, significant improvement was found compared to baseline (p< 0.001). At week 24, no difference was found in terms of pain at rest, but all other parameters were improved compared to week 6. When the groups were compared, no difference was found in any comparison between 6th and 24th week (p> 0.05).

Conclusion: Adding ultrasound treatment to a combination of physical therapy modalities did not provide any additional benefits for the treatment of adhesive capsulitis.
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http://dx.doi.org/10.3233/BMR-150482DOI Listing
January 2019

[A rare cause of forearm pain: Schwannoma of the posterior interosseous nerve].

Agri 2018 Apr;30(2):99-101

Department of Physical Therapy and Rehabilitation, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.

A schwannoma, also known as a neurilemoma, is composed of Schwann cells, and is the most common benign tumor of the peripheral nerves. It commonly appears as a solitary lesion in the head and neck region. The diagnosis is based on ultrasonography, magnetic resonance imaging, and histopathological examination. This encapsulated tumor has a good prognosis with a low recurrence rate after surgical removal. This case report is a description of a forearm schwannoma that initially appeared to be a ganglion cyst.
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http://dx.doi.org/10.5505/agri.2016.04127DOI Listing
April 2018

The Effect of Associated Parkinsonism on Rehabilitation in Stroke Patients: A Case Series.

Sisli Etfal Hastan Tip Bul 2018 29;52(1):64-69. Epub 2018 Mar 29.

Department of Physical Therapy and Rehabilitation, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.

Stroke and Parkinson's disease are 2 major causes of movement impairment and a decreased ability to perform daily activities. The aim of this case series was to demonstrate the difficulty of rehabilitation in stroke patients with accompanying parkinsonism. Four stroke patients with parkinsonism who underwent rehabilitation at the Physical Medicine and Rehabilitation Clinic between March and May of 2016 were evaluated. The Standardized Mini-Mental State Examination (SMMSE), the Functional Independence Measure (FIM), the Barthel Index (BI), the Berg Balance Scale (BBS), and the Stroke Impact Scale version 3.0 (SIS) were used in the assessment. Of the 4 patients, 3 were female, and the mean age was 74.5±9.3 years. The mean hospital stay was 19±5.3 days. The initial test scores recorded were low, and they remained low at the time of discharge. After rehabilitation, the mean FIM score in the group was 42% of the maximum possible score, the mean SMMSE was 55%, the BI was 18%, the BBS was 0.08%, and the SIS was 25%. Three patients required a wheelchair, and 1 patient could ambulate with a walker at discharge. A stroke accompanied by parkinsonism negatively affects mobility and functional status, primarily through the deterioration of balance. In this study, cognitive function was reduced to half of the maximum, and the balance and function loss was more than 50%. Barthel index; berg balance scale; functional independence measure; mini-mental state examination; parkinsonism; stroke; stroke impact scale.
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http://dx.doi.org/10.14744/SEMB.2017.69772DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315070PMC
March 2018

A Different Perspective on the Phenomenon of Hemiplegic Encephalitis: A Case Report.

Sisli Etfal Hastan Tip Bul 2018 29;52(1):57-60. Epub 2018 Mar 29.

Department of Physical Therapy and Rehabilitation, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.

Encephalitis is an acute inflammation of the central nervous system that is characterized by fever, headache, and sleep disorders. Among the causes of meningoencephalitis are bacterial and viral infections, autoimmune diseases, and drug reactions. This case report describes a male patient who experienced hemiplegia following encephalitis. A 35-year-old patient consulted a physician with complaints of fever and headache. The clinical evaluation was encephalitis and the patient was treated accordingly. A severe neurological deficit developed, and the patient became bedridden, After treatment, the patient was included in an inpatient physical therapy program and was subsequently discharged with the ability to walk using parallel bars. The aim of this case report was to draw attention to the rehabilitation process applied after the diagnosis and treatment of a patient with hemiplegia that developed as a complication of encephalitis.
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http://dx.doi.org/10.14744/SEMB.2017.58070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315076PMC
March 2018

A rare cause of thigh pain: Morel-lavallée lesion.

Turk J Phys Med Rehabil 2018 Mar 5;64(1):80-82. Epub 2018 Feb 5.

Department of Physical Medicine and Rehabilitation, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.

Morel-Lavallée lesion is an unusual clinical entity which was first described by the French surgeon Maurice Morel-Lavallée in 1853. These lesions result from peeling off the surfaces between the fat tissue and the muscular fascia. During this decomposition, the rupture of small vessels may cause an effusion full of necrotic blood, lymph and fat cells. In prolonged cases, these lesions may become increasingly painful, leading to be confused with other diagnosis such as sciatalgia, piriformis syndrome, trochanteric bursitis or soft tissue tumor. Herein, we present a-65-year-old female case who had pain in the right thigh for one year and was referred to our clinic with radicular pain.
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http://dx.doi.org/10.5606/tftrd.2018.1184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6709606PMC
March 2018

Comparison of Ultrasonography and Short-Segment Nerve Conduction Study in Ulnar Neuropathy at the Elbow.

Arch Phys Med Rehabil 2018 01 5;99(1):116-120. Epub 2017 Oct 5.

Department of Physical Therapy and Rehabilitation, Sisli Hamidiye Etfal Education and Research Hospital, Sisli, Istanbul, Turkey.

Objective: To assess the correlation between ultrasonographic and electrodiagnostic findings to determine the localization of the ulnar trapping at the elbow.

Design: Cross-sectional and noninterventional trial.

Setting: Physical medicine and rehabilitation department of a teaching hospital.

Participants: Patients (N=14) diagnosed with ulnar nerve entrapment using short-segment nerve conduction study.

Interventions: The elbow area was divided into 4 segments with 2-cm intervals. All patients underwent ultrasonographic and electrodiagnostic examinations.

Main Outcome Measures: The nerve conduction velocity (NCV) of each segment was measured. The cross-sectional area (CSA) of the ulnar nerve was measured at 5 levels. The proximal CSA/distal CSA ratio (PDR) was calculated by proportioning the CSA values for each segment. The highest PDR was accepted as a trapping segment, whereas the segment with the lowest NCV was accepted electrophysiologically (provided it was <50m/s).

Results: A total of 80 PDR and NCV measurements were taken from 20 elbows. A statistically significant negative correlation (r=-.554; P<.001) was found between general PDR and NCV values. When we assumed that the NCV value <50m/s as the criterion standard for diagnosis, the cutoff value for the PDR was found to be 1.08, with a sensitivity of 70% and a specificity of 92.5%. The minimum NCV value and the maximum PDR value were mostly seen in the third segment compatible with the cubital tunnel.

Conclusions: Ultrasonography seems to be advantageous because it is more comfortable for the patient and requires shorter time than does electroneuromyography. To our knowledge, this is the first study to detect ulnar nerve entrapment by using not only CSA but also PDR as a ratio method with ultrasound.
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http://dx.doi.org/10.1016/j.apmr.2017.09.111DOI Listing
January 2018

Evaluation of the internal oblique, external oblique, and transversus abdominalis muscles in patients with ankylosing spondylitis: an ultrasonographic study.

Clin Rheumatol 2017 Nov 10;36(11):2497-2500. Epub 2017 Sep 10.

Department of Physical and Rehabilitation Medicine, Hamidiye Şişli Etfal Training and Research Hospital, İstanbul, Turkey.

The objectives of the study are to compare abdominal muscle thickness in ankylosing spondylitis (AS) patients with healthy subjects and determine the factors affecting these muscle thickness. Thirty-five male patients with a previous diagnosis of AS according to the Modified New York criteria and a control group consisting of 35 healthy male individuals were included in this cross-sectional and case-control study. Thicknesses of the internal oblique (IO), external oblique (EO), and transversus abdominalis (TrA) muscles were measured with ultrasound (US). AS patients were classified according to the International Physical Activity Questionnaire (IPAQ). There were 35 AS patients with a mean age of 35.17 ± 8.05 years and 35 healthy subjects with a mean age 32.57 ± 7.05 years. No significant difference was observed between the groups in terms of abdominal muscle thicknesses (p > 0.005). When the AS patients were classified according to the IPAQ scores, thicknesses of the IO and TrA muscles were significantly lower in patients who had the low level of IPAQ scores (p < 0.05). In the light of our first and preliminary results, muscle thickness of the IO, EO, and TrA muscles were similar in AS patients to healthy subjects. However, AS patients who had lower level of physical activity have also reduced thickness of IO and TrA muscles.
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http://dx.doi.org/10.1007/s10067-017-3827-yDOI Listing
November 2017

Medial calcaneal neuropathy: A rare cause of prolonged heel pain.

Agri 2017 Jan;29(1):43-46

Deparmemt of Physiotherapy and Rehabilitation, İstanbul Yeni Yuzyil University Faculty of Health Sciences, Istanbul, Turkey.

Pain heel constitutes 15% of foot pain. Pain may be caused by plantar fasciitis, calcaneal fractures, calcaneal apophysitis, heel pad atrophy, inflammatory diseases or related with nerve involvement. Tibial, plantar and/or medial nerve entrapment are the neural causes of pain. Most of the heel soft tissue sensation is provided by medial calcaneal nerve. Diagnosis of heel pain due to neural causes depends on history and a careful examination. Surgery should not be undertaken before excluding other causes of heel pain. Diagnosis should be reconsidered following conservative therapy.
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http://dx.doi.org/10.5505/agri.2015.13540DOI Listing
January 2017

Comparison of disability and quality of life between patients with pediatric and adult onset paraplegia.

J Spinal Cord Med 2018 11 19;41(6):645-652. Epub 2017 Jan 19.

d Hamidiye Sisli Etfal Training and Research Hospital, Department of Physical Medicine and Rehabilitation , Istanbul , Turkey.

Objective: To investigate the factors that affect disability and quality of life in patients with spinal cord injuries (SCIs) and to compare the degree of disability and quality of life in patients with SCI according to over and under 18 years of age when their injury occurred.

Design: Cohort study.

Setting: Two academic hospitals in Istanbul, Turkey.

Participants: Forty patients with SCI were included in this study. Group 1 included 20 patients with SCI who were younger than 18 years of age when their injury occurred, Group 2 included 20 patients who were older than 18 years of age when their injury occurred.

Outcome Measures: Patients' demographics, duration of SCI and degree of disability were assessed using the Craig Handicap Assessment and Reporting Technique (CHART). Quality of life was assessed using the World Health Organization Quality of Life Scale Short Form (WHOQOL-Bref). Depression was assessed using the Beck Depression Inventory (BDI).

Results: Although there was no significant difference between the BDI scores and CHART scores of the two groups, environment domain scores in the WHOQOL-Bref were significantly higher in Group 2 than in Group 1 (P<0.05). No significant correlation was found between age of SCI onset, disease duration, ASIA scores, depression scores, total CHART scores for all patients.

Conclusion: Adaptation to environment was significantly better in those who suffered SCI during adulthood than in pediatric patients with SCI. Disability level was not associated with age of disease onset, disease duration, neurological status, depression level.
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http://dx.doi.org/10.1080/10790268.2016.1275447DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6217506PMC
November 2018

Common Mistakes in the Dual-Energy X-ray Absorptiometry (DXA) in Turkey. A Retrospective Descriptive Multicenter Study.

Acta Medica (Hradec Kralove) 2016;59(4):117-123

Department of Physical Medicine and Rehabilitation, Beyhekim State Hospital of Konya, Konya, Turkey.

Background: Osteoporosis is a widespread metabolic bone disease representing a global public health problem currently affecting more than two hundred million people worldwide. The World Health Organization states that dual-energy X-ray absorptiometry (DXA) is the best densitometric technique for assessing bone mineral density (BMD). DXA provides an accurate diagnosis of osteoporosis, a good estimation of fracture risk, and is a useful tool for monitoring patients undergoing treatment. Common mistakes in BMD testing can be divided into four principal categories: 1) indication errors, 2) lack of quality control and calibration, 3) analysis and interpretation errors, and 4) inappropriate acquisition techniques. The aim of this retrospective multicenter descriptive study is to identify the common errors in the application of the DXA technique in Turkey.

Methods: All DXA scans performed during the observation period were included in the study if the measurements of both, the lumbar spine and proximal femur were recorded. Forearm measurement, total body measurements, and measurements performed on children were excluded. Each examination was surveyed by 30 consultants from 20 different centers each informed and trained in the principles of and the standards for DXA scanning before the study.

Results: A total of 3,212 DXA scan results from 20 different centers in 15 different Turkish cities were collected. The percentage of the discovered erroneous measurements varied from 10.5% to 65.5% in the lumbar spine and from 21.3% to 74.2% in the proximal femur. The overall error rate was found to be 31.8% (n = 1021) for the lumbar spine and 49.0% (n = 1576) for the proximal femur.

Conclusion: In Turkey, DXA measurements of BMD have been in use for over 20 years, and examination processes continue to improve. There is no educational standard for operator training, and a lack of knowledge can lead to significant errors in the acquisition, analysis, and interpretation.
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http://dx.doi.org/10.14712/18059694.2017.38DOI Listing
June 2017

Cross-cultural adaptation of the Orebro Musculoskeletal Pain Questionnaire among Turkish workers with low back pain.

J Back Musculoskelet Rehabil 2016 ;29(1):135-43

Background: Psychosocial risk factors are very important in the development of chronicity in low back pain. And Örebro Musculoskeletal Pain Questionnaire (ÖMPQ) is the screening instrument concerning these psychosocial and work-related risk factors in patients with low back pain.

Objective: The purpose of the study was to evaluate the reliability and construct validity of Turkish version of the ÖMPQ in patients with low back pain.

Methods: Turkish ÖMPQ was developed using the ``forward-backward translation'' method. It was administered to 120 working Turkish patients with acute-subacute low back pain. Test-retest reliability was assessed by intraclass correlation coefficients and internal consistency was assessed by Cronbach's alpha. Concurrent construct validity was evaluated by correlating the ÖMPQ with Oswestry Disability Index (ODI), fear avoidance beliefs questionnaire (FABQ), clinical and demographical variables and assessed with principal component analysis.

Results: The Turkish versions was re-tested for 110 patients with acute-subacute low back pain. Test-retest reliability was high with intraclass correlation coefficients of 0.93. Internal consistency was 0.96. The ÖMPQ score correlated highly (r> or = 0.60) with VAS-pain, ODI and sick-leave days; moderately (0.30 < r < 0.60) with FABQ and weakly (r< 0.30) with duration of pain and Schober test. Principal-components analysis revealed 3 factors explaining 43% of the variance. ÖMPQ had moderate predictive validity (AUC: 0.66; 95% CI 0.54; 0.81) in identifying patients with spinal pain that were under risk of long-term sick leave (> 15 days). The sensitivity was 0,54 and the specificity was 0.97.

Conclusion: Turkish version of ÖMPQ is a valid, reliable, and acceptible instrument among Turkish working population with low back pain.
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http://dx.doi.org/10.3233/BMR-150609DOI Listing
October 2016

Demographical, clinical, and psychological differences of patients who suffered hand injury accidentally and by punching glass.

Acta Orthop Traumatol Turc 2015 ;49(4):361-9

Pamukkale University Faculty of Medicine, Department of Psychiatry, Denizli, Turkey.

Objective: The aim of this study was to compare patients who were injured by punching glass with patients who were injured accidentally, according to demographical, clinical, and psychological parameters.

Methods: The Hand Injury Severity Score (HISS), the Duruöz Hand Index, the Quick Disabilities of the Arm, Shoulder and Hand scale (Q-DASH), the Impact of Event Scale-Revised (IES-R), the Adult Attention-Deficiency/Hyperactivity Scale (A-ADHS), the Borderline Personality Inventory (BPI), and the Beck Depression Inventory (BDI) were used for evaluating severity of the injury, functionality, impact of the injury on the patient, attention deficiency, patterns of borderline personality symptoms, and level of depression, respectively.

Results: Patients who were injured by punching glass were significantly younger and more likely to injure their dominant hand. The severity of injury and all psychological scales were significantly higher in patients who were injured by punching glass.

Conclusion: Hand therapy specialists should be aware of potential problems in patients who were injured by punching glass.
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http://dx.doi.org/10.3944/AOTT.2015.14.0255DOI Listing
May 2016

Comparison of body composition, nutritional status, functional status, and quality of life between osteoporotic and osteopenic postmenopausal women.

Medicina (Kaunas) 2015 5;51(3):173-179. Epub 2015 Jul 5.

Department of Physical Medicine and Rehabilitation, Sisli Etfal Education and Research Hospital, Istanbul, Turkey.

Background And Objective: Osteoporosis is a condition that affects body composition, physical activity, and psychological state. We aimed to examine the differences between osteoporotic and osteopenic postmenopausal women with respect to body composition, nutrition, functional status, and quality of life.

Materials And Methods: A total of 102 osteopenic (Group 1) and 100 osteoporotic (Group 2) patients were enrolled in the study. Bone mineral density (BMD), fat tissue mass (FTM), lean tissue mass (LTM), and bone mineral content (BMC) were evaluated using dual-energy X-ray absorbtiometry. Nutritional status of the patients was assessed with the Mini Nutritional Assessment (MNA), functional status with the Nottingham Extended Activities of Daily Living (NEADL) scale, and quality of life with the assessment of health-related quality of life in osteoporosis (ECOS-16).

Results: Group 2 had significantly lower FTM, LTM, and MNA scores than Group 1 (P<0.05). NEADL and ECOS-16 scores did not differ between the groups (P>0.05). A significant correlation was found between MNA and FTM, LTM, BMC, and BMD (P<0.05). Whereas the assessment of functional status showed a significant positive correlation with BMD and a significant negative correlation with age (P<0.05), no significant correlation was found between functional status and body composition (P>0.05).

Conclusions: We found lower FTM and LTM values and a poorer nutritional status in osteoporotic patients than in osteopenic ones. Nutritional status was correlated with body composition and BMD, and functional status was correlated with age and BMD.
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http://dx.doi.org/10.1016/j.medici.2015.05.003DOI Listing
July 2015

Assessment on self-care, mobility and social function of children with spina bifida in Turkey.

Neural Regen Res 2014 Jun;9(12):1234-40

Department of Physical Medicine and Rehabilitation, Sisli Etfal Education and Research Hospital, Istanbul, Turkey.

The aim of the study was to investigate the functional performance in children with spina bifida, using the Pediatric Evaluation of Disability Inventory (PEDI) to look into capacity of twenty-eight children with spina bifida with lesions at different levels in different dimensions of self-care, mobility and social function. Mean age of the patients was 3.5 ± 2.3 (1-10) years. In the muscle test carried out, 13 patients (44.8%) had no movements including pelvic elevation in lower extremity muscles and they were at level 5. Sixteen patients (54%) were non-ambulatory according to the Hoofer ambulation classification. Raw and scale scores in the self-care, mobility and social function domains both in the functional skill scale and in the caregiver scale were found to be lower compared to the data of the normal population. A statistically significant correlation was observed in the self-care values of the Functional Skills Scales and the Caregiver Assistance Scale measurements, which was positive for age and negative for Functional Ambulation Scale and muscle test (P < 0.05). A positive relation was found between the Functional Skills Scales-mobility area and age while a negative relation was observed between Functional Ambulation Scale and muscle test (P < 0.005). A negative relation was also found between Caregiver Assistance Scale-mobility and Functional Ambulation Scale and muscle test (P < 0.005). In our study, the functional performance of the children was found to be low. Low-level lesions, encouraging muscular strength and independence in mobility are all very important factors for functional independence.
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http://dx.doi.org/10.4103/1673-5374.135332DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4146288PMC
June 2014

Investigation of responsiveness indices of generic and specific measures of health related quality of life in patients with osteoporosis.

J Back Musculoskelet Rehabil 2014 ;27(4):391-7

Department of Physical Therapy and Rehabilitation, Sisli Etfal Education and Research Hospital, Istanbul, Turkey.

Purpose: To compare responsiveness Short Form-36 (SF-36), Nottingham Health Profile (NHP), and QUALEFFO-41 scales in patients diagnosed with osteoporosis.

Methods: A number of 70 osteoporosis patients who were in their menopause period at least for three years were enrolled in our study. The patients completed Short Form-36 (SF-36), Nottingham Health Profile (NHP), and QUALEFFO-41 scales during pretreatment period and one year after the termination of the treatment. Reponsiveness was compared between questionnaires using standardized responsiveness mean (SRM), the effect size (ES), and Guyatt's method.

Results: All scales revealed statistically significant improvement after the treatment. Upon this finding, calculations related with responsiveness indices for SF-36 (Physical Health and Mental Health), NHP (Total point), and QUALEFFO-41 (Total point) demonstrated highly responsive. ES=1.67 and 1.55, SRM=1.55 and 1.85, Guyatt value=2.20 and 1.91 for SF-36 Physical Health and Mental Health. ES=1.35, SRM=1.35, Guyatt value=1.72 for NHP. QUALEFFO-41's ES=2.56, SRM=4.32 and Guyatt value=2.31.

Conclusion: Osteoporosis specific scale as QUALEFFO-41, gives more specific information about the quality of life of osteoporotic patients. If patients with osteoporosis will be compared with other diseases regarding quality of life, then SF-36, one scale was used to evaluate general quality life of such patients, should be preferred against NHP.
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http://dx.doi.org/10.3233/BMR-140459DOI Listing
July 2015

Impact of the training on the compliance and persistence of weekly bisphosphonate treatment in postmenopausal osteoporosis: a randomized controlled study.

Int J Med Sci 2013 20;10(13):1880-7. Epub 2013 Nov 20.

1. Department of Physical Medicine and Rehabilitation, Istanbul University Cerrahpasa School of Medicine, Istanbul;

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 2(nd), 5(th), 8(th), and 11(th) months) and participated to four interactive social/training meetings held in groups of 10 patients (at 3(rd), 6(th), 9(th), and 12(th) 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 1(st) visit did not improve the persistence and compliance of the patients for bisphosphonate treatment.
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http://dx.doi.org/10.7150/ijms.5359DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3856379PMC
July 2014

The relationship between hand function, depression, and the psychological impact of trauma in patients with traumatic hand injury.

Int J Rehabil Res 2014 Jun;37(2):105-9

aDepartment of Physical and Rehabilitation Medicine, Sisli Etfal Education and Research Hospital, Istanbul bAnkara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara cDepartment of Physical and Rehabilitation Medicine, Sakarya Education and Research Hospital, Sakarya dDepartment of Physical Medicine and Rehabilitation, Faculty of Medicine, Pamukkale University, Denizli, Turkey.

The aim of this study was to investigate the acute-stage and later-stage impacts of trauma on a patient, and to determine the relationship between the degree of the impact of the event and recovery of hand function in patients with traumatic hand injury. The functional status of patients was assessed by the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire; psychological influence was assessed by the Beck Depression Inventory (BDI); and the impact of the event was assessed by the Impact of Event Scale-Revised (IES-R) both during the acute stage and at a later stage. Fifty-four patients completed the study. The DASH, BDI, and IES-R scores were significantly improved at a later stage compared with the acute stage (P<0.05). The DASH, BDI, and IES-R scores had significant positive correlations with each other in both the acute stage and later stage (P<0.05). In the linear regression analysis, the independent variables affecting the DASH score at a later stage were the DASH and IES-R scores in the acute stage (P<0.05), whereas depression scores had no effect on functional outcome (P>0.05). Our study suggests that depression status, functional status of the hand, and impact of the event improve at a later stage, and that the functional outcome at a later stage is affected by the degree of impact of the event, and the functional status of the hand in the acute stage, in patients with traumatic hand injury.
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http://dx.doi.org/10.1097/MRR.0000000000000040DOI Listing
June 2014
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