Publications by authors named "Didem Karadibak"

22 Publications

  • Page 1 of 1

Factors influencing physical activity in patients with colorectal cancer.

Ir J Med Sci 2021 May 9;190(2):539-546. Epub 2020 Aug 9.

Oncology Institute, Division of Medical Oncology, Dokuz Eylul University, Izmir, Turkey.

Background: Physical activity (PA) is a modifiable health behaviour in patients with colorectal cancer (CRC). Knowing the possible predictors of PA will contribute to producing physical and psychological benefits for CRC patients.

Objective: To investigate the factors that influence PA in patients with CRC.

Methods: This cross-sectional study was conducted with 47 participants with CRC. Demographic and clinical characteristics, neuropathic pain (Douleur Neuropathique 4 (DN4)), peripheral muscle strength (knee extensor and flexor, hip extensor and flexor, and ankle dorsiflexor muscle strength), balance (Balance Master System (BMS) and Berg Balance Scale (BBS)), fatigue (Brief Fatigue Inventory (BFI)), PA (International PA Questionnaire Short Form (IPAQ-SF)), and quality of life (36-item Short Form Health Survey (SF-36)) were evaluated. Multiple linear regression analysis was used to determine the variables that have the greatest influence on PA.

Results: IPAQ-SF score had moderate correlations with knee extensor muscle strength (r = 0.310, p = 0.034), BBS (r = 0.361, p = 0.013), and limit of stability test (movement velocity) score (r = 0.385, p = 0.008), BFI- severity of fatigue (r = - 0.488, p = 0.001), impact of fatigue on daily functioning (r = - 0.421, p = 0.003), and the SF-36 sub-parameters (role limitations due to physical health problems, physical functioning, general health perceptions and vitality) (p < 0.05). Role limitations due to physical problems, knee extensor muscle strength, and severity of fatigue had the greatest influence on PA in patients with CRC with explaining 43% of the variance in PA.

Conclusions: This study suggests that quality of life, knee extensor muscle strength, and fatigue have the greatest influence on PA in patients with CRC.
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http://dx.doi.org/10.1007/s11845-020-02338-9DOI Listing
May 2021

The Reliability and Validity of Quality of Life Questionnaire Upper Limb Lymphedema (ULL-27) Turkish Patient With Breast Cancer Related Lymphedema.

Front Oncol 2020 12;10:455. Epub 2020 May 12.

Physiotherapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey.

Breast cancer is the most common cancer amongst women both in Turkey and in the world. Lymphedema, which negatively affects the quality of life, is one of the most prevalent problems reported by breast cancer survivors. Upper Limb Lymphedama 27 () questionnaire is a valid and reliable tool that assesses the quality of life in patients with breast cancer-related lymphedema. Until now, a Turkish-language version was lacking. The aim of this study was to perform a cross-cultural validation and reliability of the Turkish version of the ULL-27 questionnaire. This cross-sectional study involved forward- backward translation, and cross-cultural adaptation. 81 women (mean age and body mass index 54.96 ± 11.35 years and 29.50 ± 5.74 kg/m) who had breast cancer related-upper extremity lymphedema were evaluated using the ULL-27 Quality of life questionnaire-Turkish version. Assessment of limb size was quantified by using circumferential limb measurements. European Organization for Research and Treatment of Cancer (EORTC) 30-item Quality of Life Questionnaire and Quality of Life Questionnaire breast cancer-23 (QLQ-BR23) were analyzed by Pearson's correlation analysis with the ULL-27 Turkish Version to indicate the convergent validity. Cronbach's alpha (internal consistency) and exploratory factor analysis were used to assess the questionnaire's reliability. The mean of lymphedema duration and severity were 23.12 ± 30.88 months. Mild lymphedema was reported in 42% (34 people) of the cases included in the study. It was observed that 33.3% (27 people) had moderate lymphedema and 24.7% (20 people) had severe lymphedema. The alpha coefficient (internal consistency) for the Turkish total score was high (alpha = 0.93). Content validity was good because all questions were understandable for all participants (The alpha coefficient for the subgroups of the scale of physical, psychological, social scores, were 0.90, 0.87, and 0.75, respectively). External construct validity was highly confirmed by expected correlations with comparator scales, EORTC-30, and QLQ-BR23 ( < 0.01). The Turkish version of the ULL-27 Questionnaire is a valid and reliable tool for evaluating QoL in women with upper limb lymphedema related to breast cancer.
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http://dx.doi.org/10.3389/fonc.2020.00455DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235329PMC
May 2020

Predictors of exercise capacity in chronic venous disease patients.

Phlebology 2020 Apr 25;35(3):190-198. Epub 2019 Aug 25.

Department of Cardiovasculary Surgery, Dr. Ersin Arslan Education and Research Hospital, Gaziantep, Turkey.

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http://dx.doi.org/10.1177/0268355519870895DOI Listing
April 2020

Effectiveness of Kinesio Taping on Anastomotic Regions in Patients with Breast Cancer-Related Lymphedema: A Randomized Controlled Pilot Study.

Lymphat Res Biol 2019 12 1;17(6):655-660. Epub 2019 Aug 1.

Institute for Oncology, Dokuz Eylul University, İzmir, Turkey.

The purpose of the study was to investigate the effect of using Kinesio Taping (KT) on anastomotic regions along with complex decongestive physiotherapy (CDP) in patients with breast cancer-related lymphedema (BCRL). Patients with unilateral BCRL were divided into two groups in this randomized controlled study: Group 1 (CDP,  = 14) and Group 2 (CDP+ KT,  = 18). Assessment of limb size was quantified by using circumferential limb measurements and then calculated for each segment by using the frustum formula. CDP included manual lymphatic drainage, compression bandages, exercises, and skin care. KT was applied to lymphatic anastomosis. All patients received treatment for 1 hour per day, 5 days per week for 4 weeks. The outcome measure was difference in the reduction of limb volumes between the groups. There was a significant difference in both groups before and after treatment ( < 0.05), but there was no significant difference between the two groups regarding changes in limb volume ( > 0.05). The results suggest that applying KT to lymphatic anastomotic regions is not effective in reducing limb volume in the management of BCRL.
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http://dx.doi.org/10.1089/lrb.2019.0003DOI Listing
December 2019

The relationship between learning styles and academic performance in TURKISH physiotherapy students.

BMC Med Educ 2018 Dec 4;18(1):291. Epub 2018 Dec 4.

School of Physical Therapy and Rehabilitation, Dokuz Eylul University, 35340, Inciralti, Izmir, Turkey.

Background: Learning style refers to the unique ways an individual processes and retains new information and skills. In this study, we aimed to identify the learning styles of Turkish physiotherapy students and investigate the relationship between academic performance and learning style subscale scores in order to determine whether the learning styles of physiotherapy students could influence academic performance.

Methods: The learning styles of 184 physiotherapy students were determined using the Grasha-Riechmann Student Learning Style Scales. Cumulative grade point average was accepted as a measure of academic performance. The Kruskal-Wallis test was conducted to compare academic performance among the six learning style groups (Independent, Dependent, Competitive, Collaborative, Avoidant, and Participant).

Results: The most common learning style was Collaborative (34.8%). Academic performance was negatively correlated with Avoidant score (p < 0.001, r = - 0.317) and positively correlated with Participant score (p < 0.001, r = 0.400). The academic performance of the Participant learning style group was significantly higher than that of all the other groups (p < 0.003).

Conclusions: Although Turkish physiotherapy students most commonly exhibited a Collaborative learning style, the Participant learning style was associated with significantly higher academic performance. Teaching strategies that encourage more participant-style learning may be effective in increasing academic performance among Turkish physiotherapy students.
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http://dx.doi.org/10.1186/s12909-018-1400-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6278061PMC
December 2018

Effect of Bandage Compliance on Upper Extremity Volume in Patients with Breast Cancer-Related Lymphedema.

Lymphat Res Biol 2018 12 19;16(6):553-558. Epub 2018 Oct 19.

4 Institute for Oncology, Dokuz Eylul University , İzmir, Turkey .

Background: Complex decongestive physiotherapy (CDP) is an effective treatment for patients with breast cancer-related lymphedema (BCRL). Bandaging is an important component of CDP. Although the literature suggests that bandages must be kept on for about 24 hours, some patients cannot tolerate keeping them on for this length of time. Also, it has been observed that limb volume decreased in patients who did not keep bandages on for 24 hours in clinical trials. But there is no evidence that this reduction in time is statistically significant. Our purpose was to compare the effectiveness of bandage compliance for a longer or a shorter period on limb volume in patients with BCRL.

Methods And Results: We retroprospectively reviewed the medical records of 39 patients who received CDP. Twenty-eight eligible patients were divided into two groups, group 1 (n = 18) and group 2 (n = 10), according to the average number of hours of bandage compliance, which was 13-24 and 7-12 hours, respectively. The primary outcome was the change in limb volume between groups. The values for the limb volumes showed a statistically significant decrease in both groups. There was no significant difference in volume reduction between the groups.

Conclusion: This study shows that keeping bandages on for between about 12 and 24 hours has the same effect on patients with BCRL as receiving CDP.
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http://dx.doi.org/10.1089/lrb.2017.0060DOI Listing
December 2018

The Turkish version of the MedRisk instrument for measuring patient satisfaction: measurement properties in physical therapy care among inpatients.

Disabil Rehabil 2020 01 6;42(2):247-254. Epub 2018 Sep 6.

School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey.

Our aim was to cross culturally adapt the MedRisk instrument for measuring patient satisfaction with physical therapy care for Turkish-speaking inpatients, provide information about its measurement properties, and determine the socio-demographic factors influencing satisfaction of Turkish patients. This was a cross-sectional, measurement-focused study. The MedRisk instrument for measuring patient satisfaction was translated and adapted into Turkish. Two hundred four inpatients with different health conditions from different units of a large university hospital were assessed using the Turkish version of the MedRisk instrument for measuring patient satisfaction. Forty-two patients were reassessed after 72 h. Construct validity, internal consistency, convergent validity, criterion-referenced validity, floor and ceiling effects, and test-retest reliability were evaluated. Factor analysis showed a two-factor structure. Cronbach's alpha values for the internal consistency ranged between 0.49 and 0.81. Corrected item-total correlations ranged between 0.29 and 0.72. Intraclass correlation coefficients ranged between 0.67 and 0.97, standard errors of measurement ranged between 0.34 and 2.61 points, and substantially good agreement was achieved. Eleven of twelve items were positively correlated with the global measures. No floor or ceiling effects were detected. The satisfaction level of inpatients was high. Our results suggested that the Turkish version of the MedRisk instrument for measuring patient satisfaction is a quite reliable and valid measurement to evaluate patient satisfaction with physical therapy care in Turkish-speaking inpatients. We determined that Turkish inpatients are highly satisfied with their physical therapy care, and they consider the patient-physical therapist relationship important.Implications for rehabilitationThe Turkish version of the MedRisk instrument for measuring patient satisfaction is a reliable and valid translation of the original MedRisk instrument for measuring patient satisfaction.However, it should be noted that three items from the original version were excluded.Clinicians and relevant researchers can use this instrument to evaluate satisfaction with physical therapy care among Turkish-speaking inpatients.
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http://dx.doi.org/10.1080/09638288.2018.1494216DOI Listing
January 2020

Effects of Aqua-Lymphatic Therapy on Lower Extremity Lymphedema: A Randomized Controlled Study.

Lymphat Res Biol 2017 09 7;15(3):284-291. Epub 2017 Sep 7.

1 Department of Physical Therapy and Rehabilitation, Health Science Faculty, European University of Lefke , Lefke, North Cyprus .

Background: The purpose of this study is to investigate the effects of the aqua-lymphatic therapy (ALT) on unilateral lower extremity lymphedema in the maintenance phase.

Materials And Methods: This is a randomized controlled trial with a blinded assessor. The study was completed with 30 ALT and 27 control group participants. Foot volume was assessed by a water displacement device, limb volume by circumference measurements, functional capacity by a 6-minute walk test, quality of life by Short Form-36, and social appearance by Social Appearance Anxiety Scale and hopeless by Beck Hopeless Scale. The ALT and the control group had group sessions twice in a week for 6 weeks directed by a physiotherapist.

Results: The mean age of ALT patients was 44.50 ± 13.69 years, whereas that of the control patients was 47.66 ± 16.82 years. After the intervention, both groups' measurement of edema, functional level, quality of life, as well as social and future concerns improved significantly but this improvement was higher in the ALT group (p < 0.05, p ≤ 0.001).

Conclusions: ALT was found to be a safe effective method for unilateral lower extremity lymphedema patients during the maintenance phase of Complex Decongestive Physiotherapy.
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http://dx.doi.org/10.1089/lrb.2017.0017DOI Listing
September 2017

Effects of Clinical Pilates Exercises on Patients Developing Lymphedema after Breast Cancer Treatment: A Randomized Clinical Trial.

J Breast Health 2017 Jan 1;13(1):16-22. Epub 2017 Jan 1.

Department of Clinical Oncology, Dokuz Eylül University Institute of Oncology, İzmir, Turkey.

Objective: The aim of the present study was to compare the effects of clinical Pilates exercises with those of the standard lymphedema exercises on lymphedema developing after breast cancer treatment.

Materials And Methods: The study comprised 60 female patients with a mean age of 53.2±7.7 years who developed lymphedema after having breast cancer treatment. The patients were randomized into two groups: the clinical Pilates exercise group (n=30), and the control group (n=30). Before, and at the 8th week of treatment, the following parameters were measured: the severity of lymphedema, limb circumferences, body image using the Social Appearance Anxiety Scale, quality of life with the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ-BR23), and upper extremity function using the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure. Both groups performed one-hour exercises three days a week for 8 weeks.

Results: After treatment, the symptoms recovered significantly in both groups. Reductions in the severity of lymphedema, improvements in the social appearance anxiety scale scores, quality of life scores, and upper extremity functions scores in the clinical Pilates exercise group were greater than those in the control group. Clinical Pilates exercises were determined to be more effective on the symptoms of patients with lymphedema than were standard lymphedema exercises.

Conclusions: Clinical Pilates exercises could be considered a safe model and would contribute to treatment programs.
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http://dx.doi.org/10.5152/tjbh.2016.3136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5351459PMC
January 2017

Tampa Scale of Kinesiophobia for Heart Turkish Version Study: cross-cultural adaptation, exploratory factor analysis, and reliability.

J Pain Res 2016 23;9:445-51. Epub 2016 Jun 23.

Department of Chest Disease, Faculty of Medicine, Dokuz Eylul University, İzmir, Turkey.

Purpose: Individuals with cardiac problems avoid physical activity and exercise because they expect to feel shortness of breath, dizziness, or chest pain. Assessing kinesiophobia related to heart problems is important in terms of cardiac rehabilitation. The Tampa Scale of Kinesiophobia Swedish Version for the Heart (TSK-SV Heart) is reliable and has been validated for cardiac diseases in the Swedish population. The aim of this study was to investigate the reliability, parallel-form validity, and exploratory factor analysis of the TSK for the Heart Turkish Version (TSK Heart Turkish Version) for evaluating kinesiophobia in patients with heart failure and pulmonary arterial hypertension.

Methods: This cross-sectional study involved translation, back translation, and cross-cultural adaptation (localization). Forty-three pulmonary arterial hypertension and 32 heart failure patients were evaluated using the TSK Heart Turkish Version. The 17-item scale, originally composed for the Swedish population, has four factors: perceived danger for heart problem, avoidance of exercise, fear of injury, and dysfunctional self. Cronbach's alpha (internal consistency) and exploratory factor analysis were used to assess the questionnaire's reliability. Results of the patients in the 6-minute walk test, International Physical Activity Questionnaire, and Nottingham Health Profile were analyzed by Pearson's correlation analysis with the TSK Heart Turkish Version to indicate the convergent validity.

Results: Cronbach's alpha for the TSK Heart Turkish Version was 0.75, indicating acceptable internal consistency. Although exploratory factor analysis showed a different subgroup distribution than the original questionnaire, the model was acceptable for the four-factor model hypothesis. Therefore, the questionnaire was rated as reliable.

Conclusion: These results supported the reliability of the TSK Heart Turkish Version. Since the acceptable four-factor model fits the subgroups and measures of reliability are sufficiently high, the questionnaire seems reliable for pulmonary arterial hypertension and heart failure patients.
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http://dx.doi.org/10.2147/JPR.S105766DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4922812PMC
July 2016

The Effect of Education on Upper Extremity Function in Patients with Lymphedema after Breast Cancer Treatments.

Lymphat Res Biol 2016 09 6;14(3):142-7. Epub 2016 Jun 6.

4 Department of Medical Oncology, Faculty of Medicine, Dokuz Eylul University , Izmir, Turkey .

Background: The aim of this study was to evaluate the effects of education on the upper extremity functions of patients with lymphedema (LE) after breast cancer treatments.

Methods: Thirty-eight patients with LE after breast cancer treatments participated in the study. The patients were separated into two groups. Group 1 (n = 19) was educated about the causes and symptoms of LE and the methods for minimizing complications from LE, such as skin care, changes that must be made in daily life activities, exercises, and protective clothing. Group 2 (n = 19) was treated through standard means (surgical, chemotherapy, radiotherapy). A universal goniometer was used to assess the range of motion of the upper extremity of the patients. The Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) and the Shoulder Pain and Disability Index (SPADI) were used to assess shoulder function. The measures were carried out once by the same physiotherapist. The chi-square and Mann-Whitney U tests were used to analyze the data.

Results: Group 1, educated about LE, performed better than the other group in shoulder flexion range. When shoulder abduction, internal-external rotation, and elbow flexion motions were compared by using the DASH and SPADI, no significant difference was observed between the groups (p > 0.05). However, when shoulder function was compared, Group 1 was better. There was no significant difference between the groups when the severity of LE was compared.

Conclusion: This study underscores the need to develop and implement strategies for LE prevention and education for all breast cancer patients.
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http://dx.doi.org/10.1089/lrb.2015.0010DOI Listing
September 2016

Evaluation of kinesthetic sense and hand function in women with breast cancer-related lymphedema.

J Phys Ther Sci 2015 Jun 30;27(6):1671-5. Epub 2015 Jun 30.

Oncology Institute, Dokuz Eylul University, Turkey.

[Purpose] This study evaluated the functional ability and kinesthetic sense of the hands of women with breast cancer-related lymphedema. [Subjects and Methods] Fifty-seven women experiencing lymphedema after breast surgery and adjuvant radiotherapy were included. The patients were divided into two groups: women with hand edema (HE+, n = 29) and without hand edema (HE-, n = 28) after breast cancer treatment. Arm edema severity, hand size, functional mobility and kinesthetic sense of the hand, and daily living skills were evaluated. [Results] The mean age of the patients was 55.8 years. In both groups, functional mobility, kinesthetic sense, and daily living skills decreased significantly with increasing edema severity. However, there was no significant difference between groups with respect to functional mobility or daily living skills. The kinesthetic sense of the hand was better in the HE- group than the HE+ group. There was a significant negative relationship between the severity of edema and hand function. [Conclusion] Breast cancer-related lymphedema can negatively impact women's functional mobility and kinesthetic sense of the hands as well as daily living skills.
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http://dx.doi.org/10.1589/jpts.27.1671DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499958PMC
June 2015

Manual lymphatic drainage for lymphedema following breast cancer treatment.

Cochrane Database Syst Rev 2015 May 21(5):CD003475. Epub 2015 May 21.

Research Director, JME Enterprises, 1905 West Rogers Ave, Baltimore, Maryland, USA, 21209.

Background: More than one in five patients who undergo treatment for breast cancer will develop breast cancer-related lymphedema (BCRL). BCRL can occur as a result of breast cancer surgery and/or radiation therapy. BCRL can negatively impact comfort, function, and quality of life (QoL). Manual lymphatic drainage (MLD), a type of hands-on therapy, is frequently used for BCRL and often as part of complex decongestive therapy (CDT). CDT is a fourfold conservative treatment which includes MLD, compression therapy (consisting of compression bandages, compression sleeves, or other types of compression garments), skin care, and lymph-reducing exercises (LREs). Phase 1 of CDT is to reduce swelling; Phase 2 is to maintain the reduced swelling.

Objectives: To assess the efficacy and safety of MLD in treating BCRL.

Search Methods: We searched Medline, EMBASE, CENTRAL, WHO ICTRP (World Health Organization's International Clinical Trial Registry Platform), and Cochrane Breast Cancer Group's Specialised Register from root to 24 May 2013. No language restrictions were applied.

Selection Criteria: We included randomized controlled trials (RCTs) or quasi-RCTs of women with BCRL. The intervention was MLD. The primary outcomes were (1) volumetric changes, (2) adverse events. Secondary outcomes were (1) function, (2) subjective sensations, (3) QoL, (4) cost of care.

Data Collection And Analysis: We collected data on three volumetric outcomes. (1) LE (lymphedema) volume was defined as the amount of excess fluid left in the arm after treatment, calculated as volume in mL of affected arm post-treatment minus unaffected arm post-treatment. (2) Volume reduction was defined as the amount of fluid reduction in mL from before to after treatment calculated as the pretreatment LE volume of the affected arm minus the post-treatment LE volume of the affected arm. (3) Per cent reduction was defined as the proportion of fluid reduced relative to the baseline excess volume, calculated as volume reduction divided by baseline LE volume multiplied by 100. We entered trial data into Review Manger 5.2 (RevMan), pooled data using a fixed-effect model, and analyzed continuous data as mean differences (MDs) with 95% confidence intervals (CIs). We also explored subgroups to determine whether mild BCRL compared to moderate or severe BCRL, and BCRL less than a year compared to more than a year was associated with a better response to MLD.

Main Results: Six trials were included. Based on similar designs, trials clustered in three categories.(1) MLD + standard physiotherapy versus standard physiotherapy (one trial) showed significant improvements in both groups from baseline but no significant between-groups differences for per cent reduction.(2) MLD + compression bandaging versus compression bandaging (two trials) showed significant per cent reductions of 30% to 38.6% for compression bandaging alone, and an additional 7.11% reduction for MLD (MD 7.11%, 95% CI 1.75% to 12.47%; two RCTs; 83 participants). Volume reduction was borderline significant (P = 0.06). LE volume was not significant. Subgroup analyses was significant showing that participants with mild-to-moderate BCRL were better responders to MLD than were moderate-to-severe participants.(3) MLD + compression therapy versus nonMLD treatment + compression therapy (three trials) were too varied to pool. One of the trials compared compression sleeve plus MLD to compression sleeve plus pneumatic pump. Volume reduction was statistically significant favoring MLD (MD 47.00 mL, 95% CI 15.25 mL to 78.75 mL; 1 RCT; 24 participants), per cent reduction was borderline significant (P=0.07), and LE volume was not significant. A second trial compared compression sleeve plus MLD to compression sleeve plus self-administered simple lymphatic drainage (SLD), and was significant for MLD for LE volume (MD -230.00 mL, 95% CI -450.84 mL to -9.16 mL; 1 RCT; 31 participants) but not for volume reduction or per cent reduction. A third trial of MLD + compression bandaging versus SLD + compression bandaging was not significant (P = 0.10) for per cent reduction, the only outcome measured (MD 11.80%, 95% CI -2.47% to 26.07%, 28 participants).MLD was well tolerated and safe in all trials.Two trials measured function as range of motion with conflicting results. One trial reported significant within-groups gains for both groups, but no between-groups differences. The other trial reported there were no significant within-groups gains and did not report between-groups results. One trial measured strength and reported no significant changes in either group.Two trials measured QoL, but results were not usable because one trial did not report any results, and the other trial did not report between-groups results.Four trials measured sensations such as pain and heaviness. Overall, the sensations were significantly reduced in both groups over baseline, but with no between-groups differences. No trials reported cost of care.Trials were small ranging from 24 to 45 participants. Most trials appeared to randomize participants adequately. However, in four trials the person measuring the swelling knew what treatment the participants were receiving, and this could have biased results.

Authors' Conclusions: MLD is safe and may offer additional benefit to compression bandaging for swelling reduction. Compared to individuals with moderate-to-severe BCRL, those with mild-to-moderate BCRL may be the ones who benefit from adding MLD to an intensive course of treatment with compression bandaging. This finding, however, needs to be confirmed by randomized data.In trials where MLD and sleeve were compared with a nonMLD treatment and sleeve, volumetric outcomes were inconsistent within the same trial. Research is needed to identify the most clinically meaningful volumetric measurement, to incorporate newer technologies in LE assessment, and to assess other clinically relevant outcomes such as fibrotic tissue formation.Findings were contradictory for function (range of motion), and inconclusive for quality of life.For symptoms such as pain and heaviness, 60% to 80% of participants reported feeling better regardless of which treatment they received.One-year follow-up suggests that once swelling had been reduced, participants were likely to keep their swelling down if they continued to use a custom-made sleeve.
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http://dx.doi.org/10.1002/14651858.CD003475.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4966288PMC
May 2015

Predictors of functional capacity in colorectal cancer patients.

Support Care Cancer 2015 Sep 8;23(9):2747-54. Epub 2015 Feb 8.

School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Inciralti, Izmir, Turkey,

Purpose: The aim of this study is to determine the predictors of functional capacity and explore the relationship between functional capacity, performance status, fatigue, quality of life, anxiety, and depression in colorectal cancer (CRC) patients.

Methods: Forty-two patients diagnosed as stage II-III CRC according to tumor, node, metastasis (TNM) classification were included the study. Functional capacity, performance status, fatigue, quality of life, anxiety, and depression of CRC patients were assessed using six-minute walk distance (6MWD) in the six-minute walk test (6MWT), Eastern Cooperative Oncology Group Performance Status (ECOG-PS), Brief Fatigue Inventory (BFI), Functional Assessment of Cancer Therapy-Colorectal (FACT-C), and Hospital Anxiety and Depression Scale (HADS), respectively. A multiple linear regression model was used to identify independent predictors of functional capacity.

Results: The six-minute walk distance (6MWD) was intermediately and negatively correlated with ECOG-PS score (p = 0.001, r = -0.415), BFI-impact of fatigue on daily functioning score (p = 0.013, r = -0.379), and age (p = 0.040, r = -0.319). An intermediate and positive correlation was found between 6MWD and FACT-C score (p = 0.016, r = 0.369). The multiple regression analysis revealed that only ECOG-PS score was significant and independent predictor of the 6MWD, accounted for 34.8 % of the variance.

Conclusion: Performance status was found to be the only significant predictor of functional capacity in this study. Assessing performance status may have an essential role in order to predict functional capacity in CRC patients. Future studies that include a larger sample size would more clearly elucidate the predictors and relationships of functional capacity.
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http://dx.doi.org/10.1007/s00520-015-2639-3DOI Listing
September 2015

Unilateral upper extremity lymphedema deteriorates the postural stability in breast cancer survivors.

Contemp Oncol (Pozn) 2014 22;18(4):279-84. Epub 2014 Jul 22.

Dokuz Eylül University, School of Physical Therapy and Rehabilitation, Sağlık Kampusü, Izmir, Turkey.

Aim Of The Study: There is little known about any change in postural balance caused by asymmetrical volume increase due to unilateral upper extremity lymphedema in patients who underwent breast surgery. The aim of this study was to determine whether there is a change in postural balance by measuring postural sway velocity (PSV), center of gravity (CoG) displacement and directional control (DCL) in patients with unilateral upper extremity lymphedema in breast cancer survivors.

Material And Methods: Eighteen females 38-60 (M = 53) years old diagnosed with upper extremity lymphedema due to breast cancer surgery, and 18 healthy females with similar ages (M = 52.5) were assessed using the Balance Master system (Neuro Com, Clackamas, USA). Unilateral stance (US) and bilateral stance (BS) tests in eyes open and closed conditions and the limit of stability (LOS) test were applied to quantify postural sway velocity (PSV), CoG displacement, and directional control (DCL).

Results: The lymphedema group showed a significant increase in PSV in the US test on the ipsilateral leg with eyes open (p = 0.02) and eyes closed (p = 0.005) as well as on the contralateral leg with eyes open (p = 0.004) and eyes closed (p = 0.0001). Average displacement and position of the CoG were 25% of LOS (p = 0.0001) towards the lymphedema side and 60.6 degrees respectively. DCL in the lymphedema group was significantly lower in forward (p = 0.0001), back (p = 0.003), ipsilateral (p = 0.002), and contralateral (p = 0.03) directions.

Conclusions: These findings suggest that unilateral upper extremity lymphedema may have challenging effects on postural balance.
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http://dx.doi.org/10.5114/wo.2014.44120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171475PMC
September 2014

Identifying factors associated with low back pain among employees working at a package producing industry.

J Back Musculoskelet Rehabil 2014 ;27(1):25-32

School of Physical Therapy and Rehabilitation, DokuzEylul University, Inciraltł/Izmir, Turkey.

Background: The purpose of this study was to identify factors associated with Low Back Pain (LBP) among employee working at a package producing industry.

Methods: A sample of 111 male blue-collar workers, between the ages of 18 to 50 years old and 31 white-collar workers between the ages of 17 to 50 years old completed a questionnaire which included demographic data, educational level, participation in sports activities, activity, postural habits, smoking, work conditions lifting and bending activities during the workday strenuous arm position and questions related with low back pain (LBP). The isometric strength of back muscles were measured using a dynamometer.

Result: The prevalence of LBP during the past 12 months was 55.9% for blue-collar workers and 51.6% for white-collar workers. The chi-square and t-test analysis showed statistically significant relations between LBP and smoking, number of years spent working in the last job, lifting activities between the ages of 30-34 years old. The incorrect standing and sitting posture of the blue-collar workers and the sitting posture with bending forward on the table of the white-collar workers were significantly related with LBP (p< 0.05).

Conclusions: Our results identified the risk factors of LBP in a package producing company. The protective approaches aiming to avoid the risk factors could decrease the low back pain prevalence that increases each year passed worked at the company.
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http://dx.doi.org/10.3233/BMR-130415DOI Listing
September 2014

The effect of TENS on pain, function, depression, and analgesic consumption in the early postoperative period with spinal surgery patients.

Turk Neurosurg 2011 ;21(4):618-24

Dokuz Eylul University, School of Physical Therapy, Inciraltı, Izmir, Turkey.

Aim: The aim of our study was to examine the effects of the use of Transcutaneous Electrical Nerve Stimulation (TENS) in patients who had undergone spinal surgery on pain, functionality, depression and consumption of analgesic agents.

Material And Methods: Fifty-Four patients were randomized and placed into two groups, patient-controlled analgesia (PCA) plus TENS and only PCA. To assess the pain levels of the patients, the Visual Analog Scale (VAS) was used. In the assessment of their functional levels, the Timed Up and Go test (TUG) was utilized and in the assessment of their depression, the Beck Depression Inventory (BDI) was used. The measurements were performed before the operation and on the first and second postoperative days. The side effects were recorded from the analgesic agents.

Results: During the first and second days after the operation, a decrease in the pain levels was noticed in the TENS group (p < 0.05. In the TENS group, the consumption of analgesic agents also decreased and thus side effects were less frequent. From the viewpoint of functional and depression levels, no significant difference between the groups was noticed (p > 0.05).

Conclusion: TENS was effective in reducing analgesic agent-related side effects and in reducing analgesic consumption. In addition, TENS also decreased activity related pain.
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http://dx.doi.org/10.5137/1019-5149.JTN .4985-11.0DOI Listing
April 2012

Haemodynamic effects of physiotherapy programme in intensive care unit after liver transplantation.

Disabil Rehabil 2010 ;32(17):1461-6

School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey.

Objective: To determine the haemodynamic effects of intensive care physiotherapy after liver transplantation.

Patients And Methods: Thirteen patients were included in the study after liver transplantation. The following physiotherapy programme were applied to the patients in intensive care unit: Respiratory physiotherapy, active joint movements, sitting in bed (first task), sitting at the edge of bed (second task), standing (third task), sitting out of bed (fourth task) and walking (fifth task). Heart rate (HR), mean, systolic and diastolic blood pressures (MBP, SBP, DBP), peripheral oxygen saturation (SpO(2)), respiration rate (RR) were recorded before treatment, after each task, after treatment and at the fifth minute of recovery. Pain level was assessed with Visual Analogue Scale (0-10).

Results: When compared with supine position before treatment, all of the parameters except RR increased after the first task whereas HR, SBP, MBP and pain increased after the second task. After the third task only HR and pain increased. There was no significant difference between the fourth task and pre-treatment values while HR, DBP and pain increased after the fifth task. When measurements of pre-treatment, immediately after treatment and the fifth minute of recovery were compared HR, MBP and pain increased after treatment whereas HR, RR and pain decreased after recovery. There was no significant difference between pre-treatment values and fifth minute of recovery measurements.

Conclusion: Returning to initial values after a 5-min period shows that cardiopulmonary changes caused by intensive care physiotherapy after liver transplantation are responded at physiological limits.
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http://dx.doi.org/10.3109/09638280903531212DOI Listing
December 2010

The effect of physiotherapy on ventilatory dependency and the length of stay in an intensive care unit.

Int J Rehabil Res 2009 Mar;32(1):85-8

School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Inciralti/Izmir, Turkey.

The aim of this study was to assess the effect of physiotherapy on ventilator dependency and lengths of intensive care unit (ICU) stay. Patients were divided into two groups. The control group, which received standard nursing care, was a retrospective chart review. The data of control patients who were not receiving physiotherapy were obtained from the hospital records. The intervention group was prospectively taken into the chest physiotherapy program. This study was planned on mechanically ventilated patients who were admitted to a six-bed multidisciplinary internal medicine intensive care unit of the university hospital. A total of 510 patients who were hospitalised in the ICU were included in the study. Demographics, diagnostic profiles, co-existing chronic diseases, respiratory parameters on admission, patient's overall severity by Acute Physiology and Chronic Health Evaluation II score, patient outcome, duration of stay in ICU, duration of ventilator support, and complications were assessed. The extubation time and length of ICU stay were compared between the two groups. Control patients had a longer period of ventilator dependency than the intervention patients and this difference was statistically significant (P<0.05). It was noted that the resulting length of stay in the ICU was significantly lower in the intervention group than in the control group (P<0.05). Although the patients had similar diagnoses and physical features, the length of stay in the ICU was significantly lower in the intervention group. The results show that physiotherapy has a great impact on ventilatory dependency and length of stay in the ICU.
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http://dx.doi.org/10.1097/MRR.0b013e3282fc0fceDOI Listing
March 2009

Prospective trial of intensive decongestive physiotherapy for upper extremity lymphedema.

J Surg Oncol 2008 Jun;97(7):572-7

School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey.

Background: The aim of this study was to evaluate the effects of kinesiophobia, quality of life, and home exercise programs on women with upper extremity lymphedema.

Methods: A total of 62 women with lymphedema after breast cancer treatments were provided a protocol of complete decongestive therapy (CDT). This protocol involved manual lymphatic drainage (MLD), compression garments, skin care, and remedial exercises. The women were taken to a 12-week therapy program once per day, 3 days per week. A home program, consisting of compression bandage exercises, skin care and walking was recommended. Absolute volume and percentage of volume of the lymphedema were compared before and after treatment. The kinesiophobia, quality of life, and home-based program were assessed before and after physiotherapy.

Results: Strong correlations were found between the severity of edema and fear of movement. There was a significant negative relationship among the fear of movement, quality of life, and home-based exercises program. Mean initial lymphedema volume was 925 ml, and the percentage of lymphedema was 47.1%. After decongestive physiotherapy, the lymphedema volume and percentage were 510 ml and 21.3% (P < 0.05), respectively. There was also a trend toward improvement in general well-being (P < 0.05).

Conclusion: In upper extremity lymphedema, the use of complex physiotherapy programs (CDP) can decrease edema and fear of activity, and increase the quality of life.
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http://dx.doi.org/10.1002/jso.21035DOI Listing
June 2008

The comparison of two different physiotherapy methods in treatment of lymphedema after breast surgery.

Breast Cancer Res Treat 2005 Sep;93(1):49-54

School of Physical Therapy and Rehabilitation, Dokuz Eylul University, 35340, Inciralti/Izmir, Turkey.

Background: The aim of this study was to compare two different physiotherapy methods in the treatment of lymphedema after breast surgery.

Methods: This study was performed on 53 patients who had developed unilateral lymphedema after the breast cancer treatment. Twenty-seven patients served as the experimental group and were treated with complex decongestive physiotherapy (CDP) applications including lymph drainage, multi layer compression bandage, elevation, remedial exercises and skin care. Twenty-six patients in the control group were treated with standard physiotherapy (SP) applications including bandage, elevation, head-neck and shoulder exercises and skin care. Both groups were recommended a home program consisting of compression bandage exercises, skin care and walking. Patients were taken to a therapy program once a day; 3 days a week for 4 weeks. The range of motion, circumferential measurement, and volumetric measurement were assessed before and after treatment.

Results: The overall improving in the CDP group was shown to be greater than the SP group but when the evaluation results of both groups were compared before and after treatment, a significant statistical difference in edema according to circumferential and volumetric measurements results was found in favor of the CDP group (p < 0.05).

Conclusion: In the patients with upper extremity lymphedema, the shoulder mobility can be increased and edema can be decreased by the use of complex physiotherapy programs.
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http://dx.doi.org/10.1007/s10549-005-3781-2DOI Listing
September 2005

The relationship between risk factors for falling and the quality of life in older adults.

BMC Public Health 2005 Aug 26;5:90. Epub 2005 Aug 26.

Dokuz Eylül University School of Physical Therapy and Rehabilitation, 35340 Inciralti-Izmir, Turkey.

Background: Falls are one of the major health problems that effect the quality of life among older adults. The aim of this study was to explore the relationship between quality of life (Short Form-12) and the risk factors of falls (balance, functional mobility, proprioception, muscle strength, flexibility and fear of falling) in older adults.

Methods: One hundred sixteen people aged 65 or older and living in the T.C. Emekli Sandigi Narlidere nursing home participated in the study. Balance (Berg Balance test), functional mobility (Timed Up and Go), proprioception (joint position sense), muscle strength (back/leg dynamometer), flexibility (sit and reach) and fear of falling (Visual Analogue Scale) were assessed as risk factors for falls. The quality of life was measured by Short Form-12 (SF-12).

Results: A strong positive correlation was observed between Physical Health Component Summary of SF-12, General Health Perception and balance, muscle strength. Proprioception and flexibility did not correlated with SF-12 (p > 0.05). There was negative correlation between Physical Health Component Summary of SF-12, General Health Perception and fear of falling, functional mobility (p < 0.05).

Conclusion: We concluded that the risk factors for falls (balance, functional mobility, muscle strength, fear of falling) in older adults are associated with quality of life while flexibility and proprioception are not.
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http://dx.doi.org/10.1186/1471-2458-5-90DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1208910PMC
August 2005