Publications by authors named "Sevgi Özalevli"

24 Publications

  • Page 1 of 1

Association between core stability and physical function, functional performance in patients with systemic sclerosis.

Int J Rheum Dis 2021 Apr 19;24(4):548-554. Epub 2021 Jan 19.

Division of Rheumatology, Department of Internal Medicine, School of Medicine, Dokuz Eylül University, Izmir, Turkey.

Objective: To investigate the association of core stability with physical function and functional performance in patients with systemic sclerosis (SSc).

Methods: Forty patients who met the American College of Rheumatology / European League Against Rheumatism 2013 classification criteria for SSc were included in the cross-sectional study. For evaluation of core stability, trunk muscle endurance and trunk muscle strength were assessed. Trunk extensor and trunk flexor endurance tests were used for assessment of trunk muscle endurance. Trunk muscle strength was measured with a hand-held dynamometer and modified sit-up test. To measure physical function the Health Assessment Questionnaire Disability Index (HAQ-DI) and to measure functional performance 6-minute walking test (6MWT) and sit-to-stand test (STS) were used.

Results: Patients with SSc had lower mean trunk extensor and flexor endurance test times (49.87 ± 30.81 and 32.17 ± 15.42 seconds, respectively), modified sit-up test repetition (17.42 ± 7.81) and trunk extensor and flexor muscle strength (7.48 ± 2.29 kg and 6.20 ± 1.68 kg, respectively) when compared to the reference values in healthy individuals. All measurements were used to evaluate core stability associated with HAQ-DI score, 6DMWT walking distance and STS test duration (all P < .05).

Conclusion: Patients with SSc have markedly reduced core stability and this negatively affects the physical function and functional performance. Therefore, this study highlights the importance of trunk muscle in patients with SSc. We suggest that not only upper-lower extremity muscles, but also trunk muscle strength and endurance should be measured and core stability exercises can be added to the training programs to maintain and/or improve physical functions and functional performance in SSc patients.
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http://dx.doi.org/10.1111/1756-185X.14067DOI Listing
April 2021

Fatigue and its relationship with disease-related factors in patients with systemic sclerosis: A cross-sectional study

Turk J Med Sci 2021 04 30;51(2):530-539. Epub 2021 Apr 30.

Department of Immunology and Rheumatology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey

Background/aim: Fatigue is very common symptom in patients with systemic sclerosis (SSc) and adversely affects health-related quality of life and the ability to perform daily living activities. This study aimed to determine the severity of fatigue, and its related factors, in patients with SSc.

Materials And Methods: A total of 35 patients with SSc (6 males and 29 females, mean age of 50.71 ± 10.09 years) and 35 healthy control subjects (8 males and 27 females, mean age of 54.14 ± 9.51 years) were included in this study. The Fatigue Impact Scale for fatigue, Modified Medical Research Council Scale for dyspnea severity, 6-Minute Walking Test for functional capacity, Health Assessment Questionnaire Disability Index, Scleroderma Health Assessment Questionnaire and Short Form-36 Quality of Life Questionnaire for health-related quality of life were used in the evaluation of the subjects. Furthermore, pulmonary functions, diffusion capacity, and respiratory and peripheral muscle strength were evaluated.

Results: Of the SSc patients, 80% experienced fatigue and presented with higher total and cognitive, physical, and psychosocial subscale fatigue scores than the healthy control subjects (P < 0.05). Moreover, the SSc patients exhibited significantly increased dyspnea severity, impaired pulmonary function-diffusion capacity, decreased respiratory-peripheral muscle strength, reduced functional capacity, and worsened health-related quality of life when compared to the control group (P < 0.05). Fatigue in the SSc group was significantly associated with age, dyspnea severity, diffusion capacity, respiratory and peripheral muscle strength, functional capacity, and health- related quality of life (P < 0.05).

Conclusions: Along with the decrease in diffusion capacity, increase dyspnea, a decrease in both peripheral and respiratory muscle strength, and worsening functional capacity may have an effect on increased fatigue in SSc patients. Increased fatigue can also affect the life quality and daily life activities of a patient. Therefore, multidisciplinary approaches are recommended to evaluate and improve these parameters in the treatment of fatigue from the early period in SSc patients.
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http://dx.doi.org/10.3906/sag-2005-314DOI Listing
April 2021

Clinical Outcomes of Male Subjects With Moderate COPD Based on Maximum Mid-Expiratory Flow.

Respir Care 2021 Mar 8;66(3):442-448. Epub 2020 Sep 8.

Department of Chest Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.

Background: Although FEV and FEV/FVC are accepted as standard parameters in treatment follow-up, these parameters have a limited ability to predict clinical outcomes in patients with COPD. However, small airways dysfunction, which is determined by maximum mid-expiratory flow, is variable in the same stage of patients with COPD, even if their FEV and FEV/FVC are similar. The aim of this study was to compare pulmonary function, the severity of perceived dyspnea, the severity of fatigue, physical activity level, and health-related quality of life based on the severity of small airways dysfunction in male subjects with moderate COPD.

Methods: The study consisted of 96 subjects with moderate COPD. Pulmonary function tests, the distance achieved on the 6-min walk test, the modified Medical Research Council Dyspnea Scale, the International Physical Activity Questionnaire - short form, the Fatigue Severity Scale, the St George Respiratory Questionnaire, and Short Form 36 questionnaire were evaluated in all subjects. After calculating the mean percent of predicted maximum mid-expiratory flow for the entire sample, subjects were divided into 2 groups: below average (Group 1, = 54 subjects) and above average (Group 2, = 42 subjects).

Results: There were no differences between the groups in age, body mass index, cigarette consumption, percent of predicted FEV, and FEV/FVC ( = .55, .61, .19, .09, and .15, respectively). Scores from the Fatigue Severity Scale and the modified Medical Research Council dyspnea scale were significantly higher in Group 1 ( = .003 and = .002, respectively); in addition, results from the 6-min walk test and the International Physical Activity Questionnaire - short form scores were significantly lower ( = .001 and < .001, respectively).

Conclusions: Increased small airways dysfunction led to increased perception of dyspnea and fatigue, as well as poor exercise capacity and health-related quality of life in male subjects with COPD. We suggest that it may be useful to consider the maximum mid-expiratory flow in addition to FEV and FEV/FVC in the treatment and follow-up of male patients with moderate COPD.
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http://dx.doi.org/10.4187/respcare.07794DOI Listing
March 2021

Self-Management Training in Chronic Obstructive Lung Disease Improves the Quality of Life.

Turk Thorac J 2020 Jul;21(4):266-273

Department of Psychiatry, Dokuz Eylül University School of Medicine, İzmir, Turkey.

Objectives: Management of chronic obstructive pulmonary disease (COPD) includes interventions such as improving skills in coping with the disease. We aimed to examine the effect of self-management training on the quality of life and functional parameters in patients with moderate to severe COPD.

Materials And Methods: Sixty-one consecutive patients with COPD were recruited in the study prospectively. The patients were randomized into two groups: self-management training (n=31) and standard care (n=30). Each patient was evaluated by spirometry, COPD assessment test (CAT), St George's respiratory questionnaire (SGRQ), hospital anxiety and depression scale (HADS), modified British Medical Research Council (mMRC) dyspnea scale, and short form-36 (SF-36). A team of physiotherapists, psychologists, pulmonary disease specialists, and dietitians provided self-management training and biweekly counseling via phone. At the end of three months, both the groups were re-evaluated using the same assessment parameters.

Results: We found no significant difference between the baseline demographic characteristics of the self-management training and standard care groups. We observed a reduction in CAT (p<0.001), SGRQ impact (p=0.013), activity subscales (p<0.001) and the total scores (p=0.020), and HADS anxiety (p=0.012) and depression (p=0.014) scores in the self-management training group after the education session. A significant increase in SF-36 physical function score was also observed (p=0.008). No significant improvement in the functional parameters was observed in either group; however, the change in FEV1 was more pronounced in the self-management training group than in the control group (p=0.017). The hospital readmissions and 1-year survival rates were similar for both the groups after receiving education (p>0.05).

Conclusion: Our results suggest that the self-management training of the patients with COPD improves the quality of life and reduces the symptoms of depression and anxiety. Therefore, at the least, self-management training should be done as the first step of pulmonary rehabilitation in patients with COPD who cannot access pulmonary rehabilitation facilities.
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http://dx.doi.org/10.5152/TurkThoracJ.2019.19015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7371393PMC
July 2020

Effects of thoracic kinesio taping on pulmonary functions, respiratory muscle strength and functional capacity in patients with chronic obstructive pulmonary disease: A randomized controlled trial.

Explore (NY) 2020 Sep - Oct;16(5):332-338. Epub 2019 Sep 18.

Department of Chest Diseases, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey. Electronic address:

Context: Respiratory and peripheral muscle dysfunctions seen in Chronic Obstructive Pulmonary Disease (COPD) cause ventilatory limitation, dyspnea and inactivity, which then result in a reduction in functional capacity. Kinesio Taping (KT) is a rehabilitative technique performed by the cutaneous application of a special elastic tape, thus increasing muscle activation and blood circulation.

Objectives: To investigate the effects of KT application that was applied on respiratory muscles to improve pulmonary function, respiratory muscle strength and functional capacity in patients with COPD.

Patients And Methods: In total, 27 COPD patients (16 in KT group, 11 in control group) were included. Thoracic KT was applied to facilitate the respiratory muscles along the subcostal area for KT group. Deep breathing exercises were applied to both groups. Interventions were done 2 days a week, through 6 weeks. Pulmonary function and maximal respiratory mouth pressures were measured with a spirometer. Severity of dyspnea and fatigue were assessed with Modified Medical Research Council dyspnea scale and Modified Borg Scale, respectively. Functional capacity was evaluated using six-minute walk test.

Results: Percentage predicted of forced expiratory volume in one second (FEV%), peak expiratory flow (PEF) value, percentage predicted of peak expiratory flow (PEF%) and walking distance were significantly increased in KT group (p = 0.038, p = 0.011, p = 0.013, p = 0.004, respectively). The severity of dyspnea and fatigue were reduced in KT group (p < 0.05). There was no significant change for other variables in-group and between-group analyses (p > 0.05).

Conclusions: Thoracic KT may be beneficial for improving pulmonary function and functional capacity in patients with COPD.
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http://dx.doi.org/10.1016/j.explore.2019.08.018DOI Listing
September 2019

Factors Influencing Activities of Daily Living in Subjects With COPD.

Respir Care 2019 Feb 6;64(2):189-195. Epub 2018 Nov 6.

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

Background: Activities of daily living (ADL) are important for an independent life. As COPD progresses, the ability to complete ADL is usually reduced. Knowing the possible factors that influence the ability to perform ADL may allow better targeting of appropriate rehabilitation programs to increase the independence levels and/or to prevent further decreases in patients with COPD. Therefore, the aim of this study was to investigate ADL performance as measured by the London Chest Activity of Daily Living scale, which is a commonly used measure in patients with COPD.

Methods: This cross-sectional study included 44 clinically stable subjects who were not taking antibiotics and had not made any changes in their medications for at least three weeks with a COPD diagnosis based on Global Initiative for Chronic Obstructive Lung Disease. Demographic characteristics, pulmonary function, ADL measured by the London Chest Activity of Daily Living scale, functional exercise capacity via the 6-min walk distance, disease-related symptoms measured by the COPD Assessment Test, and peripheral and respiratory muscle strength were evaluated. A multiple linear regression (stepwise) analysis was used to determine the variables that have the greatest influence on ADL (ie, the London Chest Activity of Daily Living scale score).

Results: The London Chest Activity of Daily Living scale score had moderate correlations with the COPD Assessment Test score (r = 0.31, = .041), maximum expiratory pressure value (r = -0.37, = .01), 6-min walk distance (r = -0.48, = .001), knee extensor muscle strength (r = -0.47, = .001), handgrip strength (r = -0.44, = .003). The 6-min walk distance, COPD Assessment Test score and maximal expiratory pressure values were significant and independent determinants of the London Chest Activity of Daily Living scale, with 40.1% of the variance in subjects with COPD.

Conclusions: Functional exercise capacity, disease-related symptoms, and expiratory muscle strength have the greatest influence on ADL in the subjects with COPD. The level of independence to perform ADL can be increased by improving functional exercise capacity, reducing symptoms, and increasing expiratory muscle strength in subjects with COPD.
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http://dx.doi.org/10.4187/respcare.05938DOI Listing
February 2019

The effects of smoking on body composition, pulmonary function, physical activity and health-related quality of life among healthy women.

Tuberk Toraks 2018 Jun;66(2):101-108

Department of Chest Diseases, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.

Introduction: Smoking leads to more respiratory symptoms and negative effects on the health-related quality of life (HRQOL) in women than men for the same smoking burden. However, the relationship between smoking and body composition and its influencing factors remains unclear. In this study, we aim to investigate the effects of smoking on body composition, pulmonary function, physical activity and health-related quality of life (HRQOL) among healthy women.

Materials And Methods: A total of 73 young healthy women, current cigarette smokers and who had never smoked were included. The level of physical activity was assessed using the International Physical Activity Questionnaire; body mass index, circumference measurements, waist-to-hip ratio, skinfold measurements and body fat percentage were used to determine the body composition; HRQOL was assessed through the World Health Organization Quality of Life Instrument; level of depression and anxiety were evaluated using the Hospital Anxiety and Depression Scale; pulmonary functions were evaluated with spirometry.

Result: We found higher incidence of respiratory symptoms and lower physical activity levels in smokers than those of non-smokers (p< 0.05). There was no significant difference between smokers and non-smokers in respect of HRQOL, depression and anxiety (p> 0.05). In smokers whom cigarette consumption more than 150 p-years, we observed positive correlations between cigarette consumption and arm circumference, waist circumference, waist-to-hip ratio (p< 0.05).

Conclusions: Our results show that the smoking causes an increase in the incidence of respiratory symptoms and reduces the level of physical activity in healthy women. Additionally it leads to abdominal obesity depending on cigarette consumption.
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http://dx.doi.org/10.5578/tt.50724DOI Listing
June 2018

Effects of cigarette smoking on respiratory problems and functional levels in multiple sclerosis patients.

Mult Scler Relat Disord 2018 Oct 17;25:271-275. Epub 2018 Aug 17.

Department Of Neurology, Dokuz Eylul University, Izmir, Turkey.

Objective: The aim of the study was to investigate the effects of smoking on respiratory symptoms and functional levels by questioning use of cigarette in Multiple Sclerosis (MS) patients.

Methods: A questionnaire was sent via e-mail to the 135 MS patients, who clinically diagnosed with MS and EDSS score was determined.Perceived dyspnea was assessed by the mMRC scale.The severity of dyspnea and fatigue perceived during rest and effort was assessed by the mBORG scale.Functional levels of the patients were assessed by asking the average daily walking distance and the average sitting time daily.

Results: The mean EDSS score of the smoker and the non-smoker group were 2.85 ± 0.75, 2.96 ± 1.03 respectively(p = 0.48).There was no statistically difference found between groups in terms of age,height,weight,BMI,gender,EDSS scores(p > 0.05).The rate of cough, sputum and severity of perceived dyspnea was statistically higher in the smoker group(p < 0.05).The mean walking distance daily of the smokers was statistically lower (p < 0.001).The smoker group had a high level of sedanter lifestyle(p < 0.05).

Conclusion: It has been proven that smoking increases respiratory problems even in MS patients with a good EDSS score.Moreover, these problems lead to a further reduction in the functional levels of the patients, in addition to the disease progression.
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http://dx.doi.org/10.1016/j.msard.2018.08.016DOI Listing
October 2018

Efficacy of a Structured Exercise Program for Improving Functional Capacity and Quality of Life in Patients With Stage 3 and 4 Sarcoidosis: A RANDOMIZED CONTROLLED TRIAL.

J Cardiopulm Rehabil Prev 2018 03;38(2):124-130

Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey (Dr Naz), Dokuz Eylul University, School of Physical Therapy and Rehabilitation, Izmir, Turkey (Dr Ozalevli); and Dr Suat Seren Chest Disease and Thoracic Surgery Training and Research Hospital, Izmir, Turkey (Drs Ozkan and Sahin).

Purpose: This study investigated the effects of an exercise program on functional capacity and quality of life in patients with stage 3 and stage 4 sarcoidosis.

Methods: Eighteen patients with stage 3 and 4 sarcoidosis were recruited; 9 received 12 wk of supervised exercise training and 9 received usual care. Patients underwent the following evaluations at baseline and follow-up: 6-min walk test, maximal inspiratory and expiratory pressure tests, back and leg dynamometer test, modified Medical Research Council Dyspnea Scale, Fatigue Severity Scale, St George Respiratory Questionnaire, Short Form-36 Quality of Life Questionnaire, Hospital Anxiety and Depression Questionnaire, body plethysmography, carbon monoxide diffusing capacity test, and blood gas analysis.

Results: The median (interquartile range) increase in 6-min walk distance in the intervention group was 40 (31-62) m. Improvement in functional capacity; perception of dyspnea; fatigue; anxiety; peripheral and inspiratory muscle strength; partial arterial oxygen pressure; arterial oxygen saturation; and the symptom, activity, and total scores of the St George Respiratory Questionnaire were significantly greater in the intervention group than in the usual care group at follow-up (P < .05).

Conclusions: Exercise training improves functional capacity, muscle strength, dyspnea, quality of life, anxiety, fatigue, and oxygenation in patients with stage 3 and stage 4 sarcoidosis. Standard treatment of patients with late-stage sarcoidosis should integrate exercise training and pulmonary rehabilitation.
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http://dx.doi.org/10.1097/HCR.0000000000000307DOI Listing
March 2018

Preoperative parameters and their prognostic value in amyotrophic lateral sclerosis patients undergoing implantation of a diaphragm pacing stimulation system.

Ann Indian Acad Neurol 2017 Jan-Mar;20(1):51-54

Department of Thoracic Surgery, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.

Introduction: Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease with devastating and fatal respiratory complications. Diaphragm pacing stimulation (DPS) is a treatment option in diaphragm insufficient ALS patients. Ventilatory insufficiency depending on diaphragmatic failure is treated by the present study aimed to investigate prognostic value of preoperative clinical and functional characteristics of ALS patients undergoing implantation of a DPS system and to determine appropriate indications for the DPS system.

Methods: The study included 34 ALS patients implanted with DPS system. All patients underwent multidisciplinary and laboratory evaluations before the surgery. The laboratory examinations included pulmonary function tests and arterial blood gas analysis. Survival rates were recorded in a 2-year follow-up after the surgery.

Results: Twenty-eight of 34 patients with ALS survived after a 2-year follow-up. These patients were younger than those who died and had the disease for a longer time; however, the differences were not significant. Both right and left hemidiaghragms were thicker in the survived patients ( < 0.0001 for each). Pulmonary function tests revealed no significant differences between the patients who survived. Arterial blood gas analysis demonstrated lower partial pressure of carbon dioxide in the survived patients ( = 0.025).

Conclusions: DPS implantation was more efficacious in ALS patients with mild respiratory failure and thicker diaphragm. Predictors of long-term effectiveness of DPS system are needed to be addressed by large-scale studies.
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http://dx.doi.org/10.4103/0972-2327.192388DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5341268PMC
March 2017

Importance of diaphragm thickness in amyotrophic lateral sclerosis patients with diaphragm pacing system implantation.

Surg Endosc 2016 Jan 25;30(1):154-8. Epub 2015 Mar 25.

Thoracic Surgery Department, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.

Introduction: Severe respiratory failure develops as a result of the involvement of the respiratory muscles in patients with amyotrophic lateral sclerosis (ALS). Implantation of diaphragm pacing system (DPS) has been carried out on ALS patients since 2005 to avoid these situations, but the importance of diaphragm thickness has not yet been established clearly.

Material And Method: We retrospectively evaluated 34 ALS patients who had previously implanted DPS to detect the importance of diaphragm thickness. We investigated the effect of diaphragm thickness, which was measured by preoperative thorax computerized tomography on preoperative respiratory function tests (RFT), arterial blood gas (ABG) analysis, postoperative 3- and 6-month oxygen saturations and mortality.

Results: The right diaphragm thickness was calculated as 4.60 (2.95-6.00) mm, while the left diaphragm thickness was 4.10 (2.77-6.00) mm. Six patients died during the follow-up period. We did not detect a significant relationship between ABG parameters, RFT and diaphragm thickness. However, according to our observations, the diaphragm thickness was significantly related to mortality. The right diaphragm was significantly thinner in cases that required preoperative respiratory support and had percutaneous endoscopic gastrostomy. When the cut-off values for the diaphragm thickness were accepted as 3.50 mm, significantly higher mortality among patients below this was observed.

Conclusion: Diaphragm thickness is an important criterion in cases for which DPS implantation is planned. We consider that avoidance of DPS implantation is more suitable for cases with a diaphragm thickness below 3.50 mm because of mortality.
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http://dx.doi.org/10.1007/s00464-015-4175-0DOI Listing
January 2016

Determination of the relationship between cognitive function and hand dexterity in patients with chronic obstructive pulmonary disease (COPD): a cross-sectional study.

Physiother Theory Pract 2015 Jul 27;31(5):313-7. Epub 2015 Jan 27.

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

Background: Hand dexterity is important for daily living activities and can be related to cognitive functions in patients with chronic obstructive pulmonary disease (COPD).

Objective: The aim of this study was to investigate the relationship between cognitive dysfunction and hand dexterity in patients with COPD.

Methods: 35 COPD patients and 36 healthy individuals were assessed. The Minnesota Hand Dexterity Test and Mini Mental State Examination (MMSE) were used for assessment of cognitive function and hand dexterity.

Results: Hand dexterity test scores and cognitive function of COPD patients' were significantly lower than the healthy group (p < 0.01). The MMSE scores were negatively correlated with hand dexterity scores in the COPD group (p < 0.05).

Conclusions: There was a relationship between cognitive function and hand dexterity in the patients with COPD; however, hand dexterity did not alter according to hypoxemia severity. Hand dexterity which is important in daily living activities should be evaluated in greater detail with further studies in COPD patients.
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http://dx.doi.org/10.3109/09593985.2015.1004768DOI Listing
July 2015

[The relationship between pulmonary function and exercise capacity and quality of life in patients with ankylosing spondylitis].

Tuberk Toraks 2013 ;61(3):227-34

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

Introduction: Ankylosing spondylitis causes restrictive respiratory disorder by limiting the expansion of the chest because of the costosternal and costovertebral joints. Our study is planned to evaluate the respiratory functions of the ankylosing spondylitis patients who have a high rate of pulmonary involvement, and to compare the results with the exercise capacity and life quality of these patients.

Materials And Methods: There were 27 (18 male, 9 female) Norvegian patients who came to Turkey and had ankylosing spondylitis diagnose according to Modified New York criterias, to have a routine physical therapy and rehabilitation programme with an average age of 50.6 ± 6.6 years. The patients' clinical histories were taken. Pulmonary function tests were performed with spirometry and pulmonary muscle strength was measured with mouth pressure measure. 6 minute walk test was performed to determine exercise capacity and Short Form-36 Life Quality Questionairre was used to evaluate life quality of the patients.

Results: The patients had 18.85 ± 10.64 average diagnose duration and the expected FEV1 value of the patients was 3.75 ± 0.88 L/sec, FEV1/FVC ratio was 80.44 ± 6.42, MIP was 62.96 ± 20.61 and MEP was 80.22 ± 21.12. 40.7% of the patients had positive smoking history while 14.8 % had dyspnea and 11.1% had symptoms of caughing-sputum. Walking distance was 595.50 ± 83.20 metre. Life quality category scores were 42.82 ± 16.78 minimally, 83.58 ± 23.06 maximally. Pulmonary function and pulmonary muscle strength values were similar in smoking and non-smoking patients. But in smoking patients, physical function and social function categories of quality of life survey scores were found lower than non-smoking patients.

Conclusion: Respiratory and other parameters were high related to high standarts in treatment and following and exercise habit of the patients in Norway. Accordingly, it is thought that an appropriate medical treatment and exercise as a lifestyle habits of the patients reduce the negative effects of ankylosing spondylitis on respiratory system.
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http://dx.doi.org/10.5578/tt.4272DOI Listing
March 2015

Impact of physiotherapy on patients with advanced lung cancer.

Authors:
Sevgi Ozalevli

Chron Respir Dis 2013 ;10(4):223-32

Dokuz Eylul University, School of Physical Therapy and Re-habilitation, Izmir, Turkey.

Patients with lung cancer have high mortality and high morbidity. Lung cancer-related symptoms and problems such as dyspnea, fatigue, pain, and cachexia that begin in the early phase later result in poor physical functioning, psychosocial, and quality of life status. In addition, advancing age is associated with significant comorbidity. These patients may benefit from multidisciplinary therapy to reduce the perceived severity of dyspnea and fatigue and increase physical functioning and quality of life. Based on management of symptoms and problems such as dyspnea, physical inactivity, cancer-related fatigue, respiratory secretions, pain, and anxiety-depression of these patients, it is thought that physiotherapy techniques can be used on advanced lung cancer patients following a comprehensive evaluation. However, well-designed, prospective, and randomized-controlled trials are needed to prove the efficacy of physiotherapy and pulmonary rehabilitation in general for patients with advanced lung cancer.
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http://dx.doi.org/10.1177/1479972313508965DOI Listing
March 2014

Comparison of health-related quality of life and exercise capacity according to stages in patients with non-small cell lung cancer.

Tuberk Toraks 2013 ;61(2):131-9

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

Introduction: The aim of this study is to compare the exercise capacity and health-related quality of life parameters according to stages of patients with non-small cell lung cancer (NSCLC).

Materials And Methods: Fifty-two patients (who are able to ambulate independently) with stage I-II (group early-stage, n= 17) and stage IIIA-IV NSCLC (group advanced-stage, n= 35) were included. Exercise capacity (six minute walking test), strength of the peripheral muscle (Back and Leg Dynamometer), performance status (Karnofsky performance status scale), health-related quality of life- HRQOL (European Organization for Research and Treatment of Cancer Quality of life measure and Short Form-36 Health Survey), depression and anxiety (Hospital Anxiety and Depression Scale) were evaluated.

Results: No difference was found in age, body mass index, respiratory symptoms and the distribution of disease cell types between two groups (p> 0.05). In advanced-stage group, pulmonary function test values, peripheral muscle strength, walking distance and health-related quality of life scores especially the categories of functional capacity and pain were established significantly lower compared to early-stage group (p ≤ 0.05). Depression and anxiety levels were confirmed to be similar between groups (p> 0.05).

Conclusion: The exercise capacity of patients with advanced-stage NSCLC is lower due to reduced pulmonary functions and peripheral muscle strength compared to patients with early-stage NSCLC. Therefore, we can conclude that reduced exercise capacity negatively impacts functional categories of health related quality of life of patients with advanced-stage NSCLC.
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http://dx.doi.org/10.5578/tt.5396DOI Listing
December 2013

Association between disease-related factors and balance and falls among the elderly with COPD: a cross-sectional study.

Aging Clin Exp Res 2011 Oct-Dec;23(5-6):372-7

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

Background And Aims: To investigate the relationship between disease-related factors and balance, and a history of falls in chronic obstructive pulmonary disease (COPD).

Methods: Thirty-six patients with COPD and twenty healthy individuals were studied. Pulmonary function (pulmonary function test), hypoxemia (analysis of arterial blood gases), history of falls and tripping (number of falls and tripping in the past year), balance (Berg's Balance Scale-BBS), quadriceps femoris muscle strength (manual muscle test), and exercise capacity (6-minute walking test-6MWT) were assessed.

Results: BBS scores were significantly different between groups (p=0.001). BBS scores, frequency of falls and tripping were correlated in COPD patients (p ≤ 0.01). BBS score and frequency of falls were correlated with dyspnea and peripheral oxygen saturation measured after the 6MWT, partial arterial oxygen pressure, and arterial oxygen saturation values in COPD patients (p<0.05).

Conclusions: According to our results, hypoxemia, dyspnea and fatigue are disease- related factors, which are related with balance impairment and falls in COPD patients. For this reason, we suggest that assessment of and training to improve balance impairment among the elderly with COPD should be a component of pulmonary rehabilitation programs in clinical practice.
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http://dx.doi.org/10.1007/BF03325235DOI Listing
August 2012

Gait speed as a functional capacity indicator in patients with chronic obstructive pulmonary disease.

Ann Thorac Med 2011 Jul;6(3):141-6

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

Aim: Walking distance is generally accepted as a functional capacity determinant in chronic obstructive pulmonary disease (COPD). However, the use of gait speed in COPD patients has not been directly investigated. Thus, the aim of our study was to assess the use of gait speed as a functional capacity indicator in COPD patients.

Methods: A total 511 patients with mild-to-very severe COPD and 113 healthy controls were included. The lung functions (pulmonary function test), general health- and disease-related quality of life (Medical Outcomes Study 36-Item Short-Form of Health Survey, St George's Respiratory Questionnaire), and gait speed (6-minute walk test) were assessed.

Results: The mean gait speed values were slower in moderate (75.7 ± 14.0 m/min), severe (64.3 ± 16.5 m/min), and very severe (60.2 ± 15.5 m/min) COPD patients than controls (81.3 ± 14.3 m/min). There were significant correlations between gait speed and age, dyspnea-leg fatigue severities, pulmonary function test results (FEV(1), FVC, FVC%, FEV(1)/FVC ratio, PEF, PEF%), and all subscores of Medical Outcomes Study 36-Item Short-Form of Health Survey and activity, impact and total subscores of St George's Respiratory Questionnaire in patients with moderate, severe, and very severe COPD. However, these correlations were higher especially in patients with severe and very severe COPD.

Conclusions: As a conclusion, according to our results gait speed slows down with increasing COPD severity. Also, gait speed has correlations with age, clinical symptoms, pulmonary functions, and quality of life scores in COPD patients. Thus, we consider that gait speed might be used as a functional capacity indicator, especially for patients with severe and very severe COPD.
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http://dx.doi.org/10.4103/1817-1737.82448DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3131757PMC
July 2011

Reference accuracy in four respiratory medical journals.

Respiration 2010 10;80(2):171-2. Epub 2010 Mar 10.

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http://dx.doi.org/10.1159/000295808DOI Listing
November 2010

Effect of home-based pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis.

Multidiscip Respir Med 2010 Feb 28;5(1):31-7. Epub 2010 Feb 28.

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

Objective: The aim of this study was to investigate the effects of a home-based pulmonary rehabilitation program on the functional outcome parameters in patients with idiopathic pulmonary fibrosis (IPF).

Design: A prospective study.

Patients: Seventeen patients diagnosed with IPF.

Methods: A home-based pulmonary rehabilitation program was carried out in 17 IPF patients for 12 weeks. Dyspnea severity during daily life activities (Medical Research Council Scale), pulmonary function (pulmonary function test), exercise capacity (6-minute walking test, 6MWD), and general health related quality of life (Medical Outcomes Short Form-36) were evaluated.

Results: A significant decrease in perceived dyspnea (p = 0.003) and leg fatigue (p < 0.05) severities, and an increase in the 6MWD (p = 0.04) and general health related quality of life scores (health perception, physical role, and emotional status subscores) were found after the program (p < 0.05).

Conclusion: Home-based pulmonary rehabilitation may reduce dyspnea and fatigue severities, and improve exercise capacity and health-related quality of life in patients with IPF. In the treatment of IPF patients, home-based pulmonary rehabilitation programs should be placed alongside the routine treatment options.
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http://dx.doi.org/10.1186/2049-6958-5-1-31DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3463037PMC
February 2010

The effect of exercise on obstructive sleep apnea: a randomized and controlled trial.

Sleep Breath 2011 Jan 7;15(1):49-56. Epub 2009 Nov 7.

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

Purpose: The aim of the study was to assess the effect of breathing and physical exercise on pulmonary functions, apnea-hypopnea index (AHI), and quality of life in patients with obstructive sleep apnea syndrome (OSAS).

Methods: Twenty patients with mild to moderate OSAS were included in the study either as exercise or control group. The control group did not receive any treatment, whereas the exercise group received exercise training. Exercise program consisting of breathing and aerobic exercises was applied for 1.5 h 3 days weekly for 12 weeks. Two groups were assessed through clinical and laboratory measurements after 12 weeks. In the evaluations, bicycle ergometer test was used for exercise capacity, pulmonary function test, maximal inspiratory-expiratory pressure for pulmonary functions, polysomnography for AHI, sleep parameters, Functional Outcomes of Sleep Questionnaire (FOSQ), Short Form-36 (SF-36) for quality of sleep and health-related quality of health, Epworth Sleepiness Scale for daytime sleepiness, and anthropometric measurements for anthropometric characteristics.

Results: In the control group, the outcomes prior to and following 12-weeks follow-up period were found to be similar. In the exercise group, no change was found in the anthropometric and respiratory measurements (P > 0.05), whereas significant improvements were found in exercise capacity, AHI, and FOSQ and SF-36 (P < 0.05). After the follow-up period, it was shown that improvement in the experimental group did not lead to a statistically significant difference between the two groups (P > 0.05).

Conclusions: Exercise appears not to change anthropometric characteristics and respiratory functions while it improves AHI, health-related quality of life, quality of sleep, and exercise capacity in the patients with mild to moderate OSAS.
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http://dx.doi.org/10.1007/s11325-009-0311-1DOI Listing
January 2011

The effect of in-patient chest physiotherapy in lung cancer patients.

Support Care Cancer 2010 Mar 28;18(3):351-8. Epub 2009 May 28.

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

Goals Of Work: The aim of our study was to investigate the effect of the in-patient chest physiotherapy (ICP) in patients with lung cancer.

Patients And Methods: Eighteen patients with stage IIIA, IIIB, or IV lung cancer (3 females and 15 males) were included. The demographic characteristics and the clinical history of the patients were recorded. Pain (visual analog scale), pulmonary function (pulmonary function test), functional capacity (6-min walking test, Karnofsky performance status (KPS) scale), and health-related quality of life (Nottingham Health Profile (NHP)) parameters were evaluated. The ICP program, including breathing control, breathing exercises, relaxation training, upper and lower extremity exercises, mobilization, and transcutaneous nerve stimulation, was designed to meet each patient's individual needs.

Main Results: After the exercise program, there was a significant decrease in the severity of the dyspnea, fatigue, and pain symptoms (p < 0.05), improvement in the physical mobility, pain, energy, emotional status and sleep subcategories of the NHP (p < or = 0.05), and increase in the 6-min walking distance (75 +/- 15.95 m, p = 0.003). However, pulmonary function test results and KPS scores did not show statistically significant changes (p > 0.05).

Conclusions: ICP programs may be beneficial to lung cancer patients by reducing respiratory symptoms, pain, and improving health-related quality of life and exercise capacity. For this reason, the results of this study suggest that ICP programs, which are prepared by taking the individual requirements of lung cancer patients, should be placed in the treatment of the lung cancer.
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http://dx.doi.org/10.1007/s00520-009-0659-6DOI Listing
March 2010

Comparison of Short Form-36 Health Survey and Nottingham Health Profile in moderate to severe patients with COPD.

J Eval Clin Pract 2008 Aug 2;14(4):493-9. Epub 2008 May 2.

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

Objective: To compare the health-related quality of life (HRQoL) assessed by Short Form-36 Health Survey (SF-36) and Nottingham Health Profile (NHP) on the basis of lung function and exercise capacity parameters in patients with moderate to severe chronic obstructive pulmonary disease (COPD).

Methods And Materials: The investigation was a prospective, quality-of-life survey and cross-sectional study of 130 consecutive COPD patients. The NHP and SF-36 as generic HRQoL instruments, the Chronic Respiratory Disease questionnaire (CRQ) as a disease-specific HRQoL instrument and 6-minute walking test, severity of dyspnea, leg fatigue and lung function, were the measurements and instruments used in the study.

Results: It was determined that the subscales of both questionnaires were generally related with the FEV(1), walking distance, CRQ, severity of dyspnea and leg fatigue values (P<0.05). The much higher correlation coefficient was determined between these parameters and NHP compared with the SF-36. Only NHP was found to be correlated with the age, body mass index and smoking consumption (P<0.05).

Conclusions: The stronger relation of NHP with the clinical and physical parameters of the patients compared with that of SF-36 may be associated with the increased sensitivity of NHP to the clinical state owing to the increasing respiratory symptoms of our old patients with moderate to severe obstruction and/or the more intelligible and easy-to-respond nature of NHP compared with SF-36.
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http://dx.doi.org/10.1111/j.1365-2753.2007.00904.xDOI Listing
August 2008

Comparison of six-minute walking tests conducted with and without supplemental oxygen in patients with chronic obstructive pulmonary disease and exercise-induced oxygen desaturation.

Ann Saudi Med 2007 Mar-Apr;27(2):94-100

Doluz Eylul University, School of Physical Therapy and Rehabillitation, Izmir, Turkey.

Background: There are contradictory reports in the literature on the effects of supplemental oxygen administered before or after exercise tests. In light of this, we compared the results of 6-minute walking tests performed in room-air conditions (A6MWT) and with supplemental oxygen (O6MWT) in patients with chronic obstructive pulmonary disease (COPD) and exercise-induced oxygen desaturation.

Patients And Methods: Thirty-one patients with COPD were included in the study. The A6MWT and O6MWT were performed in randomized order on each patient. During the tests, severity of dyspnea and tiring of the leg were evaluated by the Modified Borg Scale. Heart rate and pulsed oxygen saturation and blood pressure were measured by pulse oximeter.

Results: Walking distance was longer with the O6MWT than with the A6MWT (P=0.001). The O6MWT resulted in a smaller increase in dyspnea, leg fatigue, and heart rate and a smaller drop in pulsed saturation than the A6MWT (P<0.05). The walking distance with the O6MWT correlated with respiratory function and hemodynamic parameters (P<0.05).

Conclusion: The O6MWT, which produced less hemodynamic stress and was safer than the A6MWT, might provide more accurate information on exercise limitation for patients with COPD. These results suggest that the O6MWT can be used as a standard walking exercise test for patients with COPD and exercise-induced oxygen desaturation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6077033PMC
http://dx.doi.org/10.5144/0256-4947.2007.94DOI Listing
November 2007

The comparison of different dyspnoea scales in patients with COPD.

J Eval Clin Pract 2006 Oct;12(5):532-8

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

Objectives: (i) To compare the relationship between different dyspnoea scales and physical and clinical parameters of patients with chronic obstructive pulmonary disease (COPD); and (ii) to determine the most suitable scale among these scales for this patient group.

Methods: Forty patients with COPD [mean 1st second forced expiratory volume (FEV(1)), 49.16 +/- 2.33% predicted], aged 53-85 participated in this study. The severity of dyspnoea was assessed with different five scales [Modified Borg Scale (MBS), Visual Analogue Scale (VAS), Medical Research Council Dyspnoea Scale (MRCS), Baseline Dyspnoea Index (BDI) and Oxygen Cost Diagram (OCD)]. As clinical parameters, respiratory function was measured by means of pulmonary function test and arterial blood gas analysis. As physical parameters, age and body mass index was recorded.

Results: Patient's dyspnoea severities were 1.59 +/- 2.75, 2.03 +/- 2.82, 2.14 +/- 1.44, 6.81 +/- 4.07, 4.56 +/- 2.47 for MBS, VAS, MRCS, BDI, OCD, respectively (P = 0.08). It was proven that only %FEV(1) had a correlation with MRCS (r = -0.67, P = 0.01) and BDI (r = 0.58, P = 0.02). In addition to these determinations MRCS, MBS and VAS had a strong correlation defining their relationships with each other (P < 0.05).

Conclusions: MRCS and BDI could assess dyspnoea during daily activities, so these scales showed strength correlation with physical and clinical values. Briefly MRCS is the most suitable dyspnoea scale for the patients with COPD, moreover, BDI, as the second suitable scale, is correlated only with MRCS. Based on these findings, we recommended that MRCS and BDI are appropriate scales for evaluation of dyspnoea in the patients with COPD.
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http://dx.doi.org/10.1111/j.1365-2753.2006.00658.xDOI Listing
October 2006