Publications by authors named "Ilksan Demirbuken"

14 Publications

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Response to: Comment on "A Better Way to Decrease Knee Swelling in Patients with Knee Osteoarthritis: A Single-Blind Randomised Controlled Trial".

Pain Res Manag 2020 22;2020:1396539. Epub 2020 Dec 22.

Marmara University, Faculty of Health Sciences, Dept. of Physiotherapy and Rehabilitation, Istanbul, Turkey.

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http://dx.doi.org/10.1155/2020/1396539DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772038PMC
January 2021

A Better Way to Decrease Knee Swelling in Patients with Knee Osteoarthritis: A Single-Blind Randomised Controlled Trial.

Pain Res Manag 2019 2;2019:8514808. Epub 2019 May 2.

Marmara University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey.

Objective: In this study, we compared the effects of intermittent pneumatic compression along with conventional treatment with cold-pack treatment along with conventional treatment on clinical outcomes in patients with knee osteoarthritis.

Methods: Eighty-nine patients with knee osteoarthritis participated in this study. One group received ultrasound, transcutaneous electrical nerve stimulation, electrical stimulation, exercise, and cold packs. The second group received ultrasound, transcutaneous electrical nerve stimulation, electrical stimulation, exercise, and intermittent pneumatic compression. Range of motion, muscle strength, knee swelling, pain intensity, and functional status were measured at baseline and 4th week.

Results: We found significant improvements in range of motion, muscle strength, pain intensity, and functional status after the treatment in both groups ( < 0.05). When comparing the effects of these two treatment programs, it was observed that the intermittent pneumatic compression treatment group had a better outcome in terms of knee swelling (=0.028).

Conclusions: According to the results, we could report that intermittent pneumatic compression therapy in addition to conventional treatment has significant positive effects on clinical outcomes in patients with knee osteoarthritis. We could also report that intermittent pneumatic compression therapy along with conventional treatment is superior to cold-pack therapy along with conventional treatment in terms of knee swelling in patients with knee osteoarthritis. This trial is registered with NCT03806322.
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http://dx.doi.org/10.1155/2019/8514808DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6525802PMC
December 2019

Effects of chemotherapy process on postural balance control in patients with breast cancer.

Indian J Cancer 2019 Jan-Mar;56(1):50-54

Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University Istanbul, Turkey.

Background: Breast cancer (BC) is the most common type of cancer among women in the world. Patients can face musculoskeletal disorders due to treatment side effects that result in failure to walk, falling, or fractures associated with balance problems.

Purpose: The aim of this study was to determine whether postural balance would be affected during chemotherapy (CT) in people with BC.

Materİals And Methods: A total of 32 women who consulted the medical oncology department, between 31 and 63 years of age, were admitted to the study. For fear of falling, fall efficiacy scale; for static balance, double-leg, single-leg, and tandem stance tests with eyes opened and eyes closed; Romberg test; for dinamic balance, Sit To Stand (STS) test, and Time Up and Go (TUG) tests were performed in the patients.

Results: Reduced fear of falling between CT cycles (P < 0.0125), no change in postural sway in double-leg stance test with eyes opened (P = 0.734) and eyes closed (P = 0.127), significantly increased postural instability in single-leg and tandem stance test with eyes opened and eyes closed (P = 0.000), no change in postural stability in Romberg test (P > 0.05), significantly increased postural instability in STS (P = 0.000) and TUG tests (P = 0.000), and significantly increased time of finishing the STS (P = 0.021) and TUG tests (P = 0.010) were noted.

Conclusİon: Patients demonstrated postural instability which can ruin the daily life activities in many parameters of measurements. Postural balance exercises should be performed by BC survivors undergoing CT.
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http://dx.doi.org/10.4103/ijc.IJC_47_18DOI Listing
August 2019

Gender and age impact on plantar pressure distribution in early adolescence.

Acta Orthop Traumatol Turc 2019 May 21;53(3):215-220. Epub 2019 Mar 21.

Marmara University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey. Electronic address:

Objective: The aim of the study was to investigate gender and age effect on dynamic plantar pressure distribution in early adolescence.

Methods: A total of 524 adolescents (211 women and 313 men; mean age: 12.58 ± 1.11 years (range: 11-14 years)) participated in pedobarographic measurements during gait at self-selected speed. Data of peak pressure (PP), maximum force (MaxF-Newton), body weight corrected maximum force (BW_MaxF), contact area (CA-cm) were analyzed for total foot and four plantar regions (hindfoot, midfoot, forefoot and toes).

Results: Higher toes PP was found in the ages of 12-14 years in females compared to males (253.79 ± 104.93 vs 216.00 ± 81.12 for the age of 12, p = 0.011, 264.40 ± 65.02 vs 227.21 ± 83.4 for the age of 13, p = 0.044, 299.75 ± 140.60 vs 238.75 ± 103.32 for the age of 14, p = 0.005). Females' higher MaxF especially for toes (136.24 ± 48.54 vs 115.33 ± 46.03, p = 0.008) and smaller CA especially for forefoot (50.12 ± 5.79 vs 54.4893 ± 6.80, p = 0.001) were considerable in the late of early adolescence. Forefoot (305.66 ± 82.14 females p = 0.001, 281.35 ± 79.59 males p < 0.001) and total foot PP (374.08 ± 113.93 females, p = 0.035, 338.61 ± 85.85 males p = 0.009) at the age of 14 was significantly higher than in younger ages in both gender groups.

Conclusion: The results indicate that especially the age of 14 years in early adolescence is a critical age for alteration in plantar pressure distribution. Interestingly females tended to increase their toe and forefoot plantar pressures compared to males by increasing age. We suggest that gender and age impact on toes plantar pressure alterations in early adolescence may be a possible risk factor for further foot impairments.

Level Of Evidence: Level III, Diagnostic Study.
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http://dx.doi.org/10.1016/j.aott.2019.01.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599390PMC
May 2019

The relationship between objective balance, perceived sense of balance, and fear of falling in stroke patients.

Top Stroke Rehabil 2017 10 4;24(7):527-532. Epub 2017 May 4.

a Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Marmara University , Istanbul , Turkey.

Objective: The objective of our study was to investigate the relationship between objective balance, fear of falling, and perceived sense of balance (PSB) in stroke patients.

Methods: Seventy patients aged 18-65 years with chronically developed hemiplegia or hemiparesis were enrolled in the study. Patients' objective balance scores, fear of falling, and PSB were obtained using the berg balance scale (BBS), the falls efficacy scale (FES), and a visual analog scale, respectively. The Standard Mini-Mental Examination was performed to exclude patients with mental disorders from the study.

Results: There was a moderate negative correlation between PSB and BBS scores (p = 0.001, ρ = -0.588); a strong negative correlation between BBS and FES scores (p = 0.001, ρ = -0.808); and a strong positive correlation between PSB and FES scores (p = 0.001, ρ = 0.714). We found that BBS scores had negative correlation with PBS scores in left hemiplegic patients while there was no any relationship between BBS and PBS scores in right hemiplegic patients.

Conclusion: PSB assessment, besides the BBS, should be considered among the routine assessment methods that enable the rehabilitation team to be aware of patients' balance capacities.
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http://dx.doi.org/10.1080/10749357.2017.1322251DOI Listing
October 2017

The effects of therapeutic exercises on pain, muscle strength, functional capacity, balance and hemodynamic parameters in knee osteoarthritis patients: a randomized controlled study of supervised versus home exercises.

Rheumatol Int 2017 Mar 11;37(3):399-407. Epub 2017 Jan 11.

Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Başıbüyük Mah. Maltepe Başıbüyük Yolu Sk. Sağlık Bilimleri Fakültesi No:9/4/1 Maltepe, Istanbul, Turkey.

The aim of the study was to compare the effects of low-intensity exercise programs for lower extremities, either supervised or at home, on pain, muscle strength, balance and the hemodynamic parameters of knee osteoarthritis (OA) patients. This randomized study included 78 patients with knee OA in 2 groups of supervised and home-based exercise program. Exercises were applied to the first group in the clinic as a group exercise program and were demonstrated to the second group to be performed at home. Before and after the 6-week exercise program, assessment was made of pain, quadriceps and hamstring muscle strengths, 6-min walk test (6MWT), and non-invasive hemodynamic parameters. Results of the 78 patients, 56 completed the study. Pain, muscle strength, and 6MWT scores showed significant improvements in both groups. There were also significant differences in the amount of change in pain and muscle strength (pain: p = 0.041, Rqdc: 0.009, Lqdc: 0.013, Rhms: 0.04) which indicated greater improvements in the supervised group. The balance scores of supervised group showed a significant improvement (p = 0.009). No significant change was determined in hemodynamic parameters of either group. Conclusion according to the results of this study showed that low-intensity lower extremity exercises conducted in a clinic under the supervision of a physiotherapist were more effective than home-based exercises in reducing post-activity pain levels and improving quadriceps and right hamstring muscle strength. Both the supervised and home exercise programs were seen to be effective in reducing rest pain and increasing 6 MW distance in knee osteoarthritis patients.
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http://dx.doi.org/10.1007/s00296-016-3646-5DOI Listing
March 2017

Association between the physical activity level and the quality of life of patients with type 2 diabetes mellitus.

J Phys Ther Sci 2016 Jan 30;28(1):142-7. Epub 2016 Jan 30.

Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Turkey.

[Purpose] Physical activity and regular exercise play an important role in glycemic control, which is considered an important part of the treatment of type 2 diabetes mellitus. This study evaluated physical activity level and its relationship with quality of life in patients with type 2 diabetes mellitus. [Subjects and Methods] We evaluated 129 subjects with type 2 diabetes mellitus through a face-to-face interview using the short version of the International Physical Activity Questionnaire and Diabetes-39. Demographic data, diabetes symptoms, time of initial diagnosis, and treatment procedure/approaches were recorded. [Results] Of the study subjects, 51 (39.5%) had low, 67 had moderate (51.9%), and 11 (8.5%) had high activity levels. The mean weekly sitting duration was 302 minutes. The mean weekly walking time was 231.7 minutes. Except for the "diabetes control" domain, scores for all the subgroups and the total score in the quality-of-life assessment had a statistically significant negative correlation with physical activity level. [Discussion] Physical inactivity negatively affects the quality of life of diabetic patients. A planned exercise education program and incorporation of exercise into the lifestyle can improve the quality of life of patients with type 2 diabetes mellitus.
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http://dx.doi.org/10.1589/jpts.28.142DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755992PMC
January 2016

The immediate effect of patellar tendon strap on weight-bearing asymmetry during squatting in patients with unilateral knee osteoarthritis: A pilot study.

Prosthet Orthot Int 2016 Dec 28;40(6):682-688. Epub 2015 Oct 28.

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

Background: Knee osteoarthritis has commonly been associated with a symptom of pain resulting in an inter-limb weight-bearing asymmetry during functional tasks. Patellar tendon strap is one of the non-pharmacologic interventions to alleviate knee pain.

Objectives: To investigate the immediate effect of a patellar tendon strap on weight-bearing asymmetry during squatting in people with unilateral knee osteoarthritis.

Study Design: Cross-sectional study.

Methods: Ten patients with unilateral knee osteoarthritis and 10 healthy subjects were included in the study. Weight-bearing asymmetry of patients was assessed using a weight-bearing squat test during squatting at 30° and 60° both with and without patellar tendon strap. Pain intensity was assessed during squatting in unstrapped and strapped conditions with Visual Analog Scale.

Results: The decrease in weight-bearing asymmetry values immediately after wearing patellar tendon strap during 30° (p = 0.006) and 60° (p = 0.011) of squatting tests was significantly higher in knee osteoarthritis patients than in healthy subjects. Reported pain intensity was similar in unstrapped and strapped conditions (p = 0.066).

Conclusion: The results of this study showed improved inter-limb weight-bearing symmetry during squatting. Further research with larger sample sizes investigating the effect of patellar tendon strap on weight-bearing asymmetry during functional activities in people with knee osteoarthritis is warranted.

Clinical Relevance: Patellar tendon straps (easily fit and cheap unlike knee braces) had more improvements in inter-limb weight-bearing symmetry during squatting in people with knee osteoarthritis compared to healthy subjects. This study is a new insight for future studies to investigate clinical benefits of wearing patellar tendon straps in this population.
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http://dx.doi.org/10.1177/0309364615612251DOI Listing
December 2016

Beliefs towards mental illness in Turkish physiotherapy students.

Physiother Theory Pract 2015 22;31(7):461-5. Epub 2015 Jul 22.

b Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences , Marmara University , Istanbul , Turkey.

Mental health is a new area of specialization for physiotherapists. However, they usually meet patients with psychiatric co-morbidities secondary to other chronic diseases. It is important to explore the beliefs of future physiotherapists regarding mental illness in order to implement effective strategies to avoid possible stigmatizing attitudes that may interfere with the rehabilitation process. Moreover, the psychiatric field should be introduced to physiotherapists as a clinical and research area. Therefore, we aimed to question the beliefs of physiotherapy students regarding mental illness using the Beliefs towards Mental Illness Scale in two different universities in Turkey. The total score of 524 students was 46.5 ± 14.5 out of 105 while the Dangerousness Subscale score was 21.2 ± 5.8/40; Incurability and Poor Social and Interpersonal Skills Subscale score was 24.2 ± 9.3/55 and Shame Subscale score was 1.1 ± 1.9/10. Students who had a relationship with an individual having a mental problem and students who had consulted a psychiatrist/psychologist for any mental problem showed more positive beliefs. Future physiotherapists should be informed and trained regarding people with mental illness both to avoid stigma and to be aware of this area in physiotherapy settings. Therefore, it is important to implement new curricula for schools providing physiotherapy education including courses, lectures and clinical practices in the psychiatry field.
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http://dx.doi.org/10.3109/09593985.2015.1025321DOI Listing
July 2016

Is hypertension a risk factor for poor balance control in elderly adults?

J Phys Ther Sci 2015 Mar 31;27(3):901-4. Epub 2015 Mar 31.

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

[Purpose] The aim of this study was to investigate whether hypertension negatively affects the postural balance control of elderly adults under different sensory conditions. [Subjects and Methods] Fifty-four healthy elderly adults who were residents in a Geriatric Home Care Center were recruited for this study. Height, weight, body mass index and age of the volunteers were recorded. After applying the exclusion criteria, the final study group included 16 hypertensive (HT) and the control group included 10 non-hypertensive (Non-HT) healthy elderly adults. To evaluate postural balance control objectively, the modified Clinical Test of Sensory Interaction on Balance (modified CTSIB) test was performed under four different conditions: 1) eyes open on a stable surface; 2) eyes closed on a stable surface; 3) eyes open on an unstable surface; and 4) eyes closed on an unstable surface. [Results] The postural balance scores (center of gravity sway) of the HT group were slightly higher than those of the Non-HT group under conditions 1 (HT group=0.3°/sec, Non-HT group=0.2°/sec), 2 (HT group=0.8°/sec, Non-HT group=0.4°/sec) and 4 (HT group=4.5°/sec, Non-HT group=3.5°/sec), but no statistically significant differences were found between the HT and Non-HT groups under any sensory condition. [Conclusion] The result of this study indicate that controlled hypertension in elderly adults is not a cause of worse balance performance than controls on stable or unstable surfaces with the eyes open or closed.
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http://dx.doi.org/10.1589/jpts.27.901DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4395739PMC
March 2015

Kinesiophobia in relation to physical activity in chronic neck pain.

J Back Musculoskelet Rehabil 2016 ;29(1):41-7

Background: Little research is available concerning physical activity and its determinants in people with chronic neck pain.

Objective: To explore the relation between kinesiophobia and physical activity and gender effect on these relations in people with chronic neck pain.

Methods: Ninety-nine subjects (34 men and 65 women) with chronic neck pain were participated in the study. Pain intensity was assessed with Visual Analog Scale and kinesiophobia degree was determined by using Tampa Scale of Kinesiophobia. Level of physical activity was assessed with short form of the International Physical Activity Questionnaire.

Results: There was no statistically correlation between neck pain intensity and kinesiophobia degree (p= 0.246, r= 0.123) and physical activity level (p= 0.432, r= -0.083). It was also found that kinesiophobia degree was not correlated to physical activity level (p= 0.148, r= -0.153). There was a negative correlation between kinesiophobia degree and physical activity level only for women, not for men (p= 0.011, r= -0.318).

Conclusions: Our results showed that although people with chronic neck pain reported higher pain intensity and fear of movement, pain intensity and kinesiophobia degree did not associate to their physical activity levels. It can be speculated that high kinesiophobia degrees cause low physical activity levels for women, but not for men.
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http://dx.doi.org/10.3233/BMR-150594DOI Listing
October 2016

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

Altered movement strategies in sit-to-stand task in persons with transtibial amputation.

Prosthet Orthot Int 2014 Aug 3;38(4):303-9. Epub 2013 Sep 3.

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

Background: Sit-to-stand movement is an essential function for participation in many activities of daily living. Although this movement is one of the most important functional tasks, there is limited research investigating strategies of sit-to-stand movement in transtibial amputees.

Objectives: To examine movement strategies of the sit-to-stand task in persons with transtibial amputation and healthy non-amputated individuals.

Study Design: Cross-sectional study.

Methods: A total of 12 male unilateral transtibial amputees and 19 healthy male subjects participated in this study. Sit-to-stand movement was evaluated in terms of weight transfer time, weight-bearing symmetry, sway velocity, and rising index by using Balance Master System.

Results: Participants in both groups exhibited similar weight-bearing transfer time (p > 0.05). Transtibial amputees demonstrated significantly greater weight-bearing asymmetry, higher sway velocity, and lower rising index than healthy subjects during the sit-to-stand transfer movement (p < 0.05).

Conclusions: Transtibial amputees were unable to use the same movement strategies during a sit-to-stand task as healthy individuals; therefore, they had to develop new strategies to perform this task.

Clinical Relevance: Little is known about the altered movement strategies during sit-to-stand task in transtibial amputees. The results of the study might provide some new insight into the motor components of the sit-to-stand movement in persons with transtibial amputation for both clinicians and researchers.
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http://dx.doi.org/10.1177/0309364613497742DOI Listing
August 2014

Gender specific strategies in demanding hopping conditions.

J Sports Sci Med 2009 1;8(2):265-70. Epub 2009 Jun 1.

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

Difference in leg stiffness between females and males is considered to be a cause of higher rates of Anterior Cruciate Ligament injury in female athletes. Females are believed to have lower stiffness and as a consequence different recruitment strategies to adapt functional tasks. The aim of the current study was to evaluate how leg stiffness is tuned to demanding conditions. 22 healthy subjects (11 Male-11 Female; age: 20-43 years) participated in this study. Subjects performed two-legged hopping tasks (at their preferred rate, as fast as possible and with added mass of 10% bodyweight) on a force platform. Leg stiffness was calculated for each condition as the ratio between peak ground reaction force and vertical displacement of center of mass. In the preferred and added mass conditions males showed substantially higher leg stiffness than females (p= 0.006 and p = 0.002, respectively). When hopping as fast as possible the gender bias in leg stiffness disappeared (p = 0.880). Added mass had no significant effect on change in leg stiffness. Results have shown that females increased their leg stiffness more than males indicating they have no gender limiting capacity to reach objectives of higher demanding tasks (i.e.fastest hopping).The relationship between observed gender differences in leg stiffness and increased Anterior Cruciate Ligament injury rate in females requires further study. Key pointsLeg stiffness is an adaptable property of neuro musculoskeletal system to different functional loading conditions.Females can increase their leg stiffness more than males indicating they have no gender limiting capacity to reach objectives of higher demanding tasks as fastest hopping.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3761473PMC
October 2013