Cerebral infarct due to meningovascular neurobrucellosis: a case report

Brucellosis is a common and multisystemic zoonotic infectious disease. Central nervous system involvement is rarely seen in brucellosis, with an incidence of 0.5–25%. The aim of this report is to underline the importance of brucellosis, which is an endemic infection in our country, during the diagnostic evaluation of strok

Reliability, construct validity and measurement potential of the ICF comprehensive core set for osteoarthritis

<p>Abstract</p> <p>Background</p> <p>This study aimed to investigate the reliability and construct validity of the International Classification of Functioning, Disability and Health (ICF) Comprehensive Core Set for osteoarthritis (OA) in order to test its possible use as a measuring tool for functioning.</p> <p>Methods</p> <p>100 patients with OA (84 F, 16 M; mean age 63 yr) completed forms including demographic and clinical information besides the Short Form (36) Health Survey (SF-36^®) and the Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC). The ICF Comprehensive Core Set for OA was filled by health professionals. The internal construct validities of "Body Functions-Body structures" (BF-BS), "Activity" (A), "Participation" (P) and "Environmental Factors" (EF) domains were tested by Rasch analysis and reliability by internal consistency and person separation index (PSI). External construct validity was evaluated by correlating the Rasch transformed scores with SF-36 and WOMAC.</p> <p>Results</p> <p>In each scale, some items showing disordered thresholds were rescored, testlets were created to overcome the problem of local dependency and items that did not fit to the Rasch model were deleted. The internal construct validity of the four scales (BF-BS 16 items, A 8 items, P 7 items, EF 13 items) were good [mean item fit (SD) 0.138 (0.921), 0.216 (1.237), 0.759 (0.986) and -0.079 (2.200); person item fit (SD) -0.147 (0.652), -0.241 (0.894), -0.310 (1.187) and -0.491 (1.173) respectively], indicating a single underlying construct for each scale. The scales were free of differential item functioning (DIF) for age, gender, years of education and duration of disease. Reliabilities of the BF-BS, A, P, and EF scales were good with Cronbach's alphas of 0.79, 0.86, 0.88, and 0.83 and PSI's of 0.76, 0.86, 0.87, and 0.71, respectively. Rasch scores of BF-BS, A, and P showed moderate correlations with SF-36 and WOMAC scores where the EF had significant but weak correlations only with SF36-Social Functioning and SF36-Mental Health.</p> <p>Conclusion</p> <p>Since the four different scales derived from BF-BS, A, P, and EF components of the ICF core set for OA were shown to be valid and reliable through a combination of Rasch analysis and classical psychometric methods, these might be used as clinical assessment tools.</p

An initial application of computerized adaptive testing (CAT) for measuring disability in patients with low back pain

<p>Abstract</p> <p>Background</p> <p>Recent approaches to outcome measurement involving Computerized Adaptive Testing (CAT) offer an approach for measuring disability in low back pain (LBP) in a way that can reduce the burden upon patient and professional. The aim of this study was to explore the potential of CAT in LBP for measuring disability as defined in the International Classification of Functioning, Disability and Health (ICF) which includes impairments, activity limitation, and participation restriction.</p> <p>Methods</p> <p>266 patients with low back pain answered questions from a range of widely used questionnaires. An exploratory factor analysis (EFA) was used to identify disability dimensions which were then subjected to Rasch analysis. Reliability was tested by internal consistency and person separation index (PSI). Discriminant validity of disability levels were evaluated by Spearman correlation coefficient (r), intraclass correlation coefficient [ICC(2,1)] and the Bland-Altman approach. A CAT was developed for each dimension, and the results checked against simulated and real applications from a further 133 patients.</p> <p>Results</p> <p>Factor analytic techniques identified two dimensions named "body functions" and "activity-participation". After deletion of some items for failure to fit the Rasch model, the remaining items were mostly free of Differential Item Functioning (DIF) for age and gender. Reliability exceeded 0.90 for both dimensions. The disability levels generated using all items and those obtained from the real CAT application were highly correlated (i.e. > 0.97 for both dimensions). On average, 19 and 14 items were needed to estimate the precise disability levels using the initial CAT for the first and second dimension. However, a marginal increase in the standard error of the estimate across successive iterations substantially reduced the number of items required to make an estimate.</p> <p>Conclusion</p> <p>Using a combination approach of EFA and Rasch analysis this study has shown that it is possible to calibrate items onto a single metric in a way that can be used to provide the basis of a CAT application. Thus there is an opportunity to obtain a wide variety of information to evaluate the biopsychosocial model in its more complex forms, without necessarily increasing the burden of information collection for patients.</p

Rehabilitasyon alanında sonuç değerlendirim ve izleminin Avrupa düzeyinde standardizasyonu

Bu projenin amacı, Türkiye'de tıbbi rehabilitasyon alanında sonuç değerlendirim ve izleminin ulusal ve uluslararası düzeyde standardizasyonunu sağlamaktır. Bu amaçla romatolojik rehabilitasyon alanında kullanılmak üzere iki, nörolojik rehabilitasyon alanında ise üç ölçeğin standardizasyonu hedeflenmiştir. Bu ölçekler, romatoid artritte (RA) fiziksel disabilite değerlendiren Sağlık Değerlendirme Sorgulaması (HAQ) ve yaşam kalitesi değerlendiren Romatoid Artrit Yaşam Kalitesi Ölçeği (RAQoL) ile beyin hasarlılarda bilişsel durum değerlendiren Mini Mental Durum İncelemesi (MMSE), Middlesex Mental Durum Değerlendirimi (MEAMS) ve Rivermead Davranışsal Bellek Testi (RBMT) dir. Ölçeklerin önce toplumumuza adaptasyonları yapılmış, daha sonra hem klasik psikometrik yöntemlerle hem de Rasch ölçüm yöntemiyle güvenilirlik ve geçerlilikleri incelenmiştir. Güvenilirlik, içsel tutarlılıkla (Cronbach $\alpha$ ), internal yapısal geçerlilik ve kültürler arası geçerlilik Rasch ölçüm yöntemiyle, eksternal yapısal geçerlilik ise ölçeğin disabilite, bozukluk gibi çeşitli parametrelerle ilişkisi (Spearman korelasyon analizi, Kruskal Wallis analizi) araştırılarak test edilmiştir. Çalışmaya HAQ için 75, RAQoL için 71 RA'lı hasta alınmış, kognitif değerlendirme ölçeklerinden MMSE için 207, MEAMS için 155, RBMT için ise 171 beyin hasarlı hasta değerlendirilmiştir. Çalışmaya alman tüm hastalar Ankara Üniversitesi Tıp Fakültesi Fiziksel Tıp ve Rehabilitasyon Kliniğinde tedavi gören hastalardır. Bilişsel durum değerlendirme ölçekleri yaş ve eğitim düzeyine göre norm belirlenmesini gerektirdiğinden, bu ölçeklerin, geçerlilik/güvenilirlik çalışmalarından önce normatif değerleri belirlenmiştir. Normatif skor belirlemek amacıyla MMSE için 406, MEAMS için 350, RBMT için 266 normal erişkin birey bu testlerle değerlendirilmişlerdir. Bu normal bireyler hastane personeli, hastane personeli yakınları ve hasta yakınları arasından seçilmiştir. Bulgular, HAQ ve RAQoL'in Türkçe versiyonlarının, romatoid artritte kullanılmak üzere güvenilir ve geçerli olduğunu göstermiştir. HAQ ve RAQoL için Cronbach $\alpha$ değerleri 0.97 ve 0.95 olup içsel tutarlılıkları yüksektir. Her iki ölçeğin de Rasch modeline uyumlarının çok iyi olması internal yapısal geçerliliklerini desteklemektedir (ortalama madde uyumu HAQ için 0.205, RAQoL için 0.236). Her iki ölçek de bozukluk ve disabilite parametreleriyle beklenen düzeyde ilişki göstererek eksternal yapısal geçerlikleri saptanmıştır. İngiliz verileriyle karşılaştırılan analizlerde Rasch uyum istatistikleri HAQ ve RAQoL için her iki kültürde de benzer bulunmuş, HAQ için 1, RAQol için 4 maddede hafif bir ayrımsal madde fonksiyonu gözlenmiştir. Bu bulgular, bu iki ölçeğin kültürler arası geçerliliklerini göstermektedir. Analizler, MMSE'nin Türkçe versiyonunun, beyin hasarlı hastalarda geçerli ve güvenilir olduğunu göstermiştir. Ölçeğin içsel tutarlılığı grup düzeyinde yeterli (Cronbach $\alpha$ : 0.75), internal yapısal geçerliliği (ortalama madde uyumu -0.362) kabul edilebilir düzeydedir. Kognitif disabilite ile beklenen düzeyde ilişki (Spearman r: 0.60) saptanmıştır. Rasch analizinde ölçeğin iki maddesi Türkiye ile İtalya arasında ayrımsal madde fonksiyonu göstermiştir; bu iki madde için düzenleme yapılarak İtalya ile ortak çalışmalarda karşılaştırma yapılabilir. MMSE, beyin hasarlılarda kognitif tarama testi olarak kullanılabilir. Ancak, ölçüm özelliklerinin okur-yazar olmayanlarda farklılık göstermesi ve güvenilirliğinin bireysel değerlendirme için sınırda olması, ölçeğin dezavantajlarıdır; ölçekle değerlendirme yapılırken bu dezavantajlarının göz önünde bulundurulması gerekmektedir. Diğer bilişsel ölçekler MEAMS ve RBMT'nin, beyin hasarlı hastalarda geçerli ve güvenilir oldukları belirlenmiştir. Her iki ölçeğin de içsel tutarlılıkları iyidir (Cronbach $\alpha$ değerleri, MEAMS için 0.81, RBMT için 0.84). Her iki ölçeğin de Rasch modeline uyumlarının çok iyi olması internal yapısal geçerliliklerini desteklemektedir (ortalama madde uyumu MEAMS için -0.027, RBMT için -0.219). Her iki ölçek de kognitif disabilite ile beklenen düzeyde ilişkili (Spearman r MEAMS için 0.565, RBMT için 0.670) bulunmuş, bu da ölçeklerin eksternal yapısal geçerliliklerini göstermiştir. MEAMS, genel bilişsel durum, RBMT ise bellek fonksiyonunu değerlendirmek amacıyla güvenle kullanılabilir. Sonuç olarak, bu proje kapsamında kültürümüze adapte edilen sonuç değerlendirim ve izlem ölçekleriyle, Türkiye'de nörolojik ve romatolojik rehabilitasyon alanında kullanılmak üzere standart sonuç değerlendirim ve izlem protokolleri belirlenmiştir ve bu protokollerin bazıları Avrupa düzeyinde standardizasyonları da içermektedir

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

WOS:000435672000003PubMed ID: 30207568Objectives: This study aims to estimate the prevalence of rheumatoid arthritis (RA) and spondyloarthritis (SpA) in Turkey using the same telephone questionnaire developed for screening RA and SpA in France and used in Serbia and Lithuania. Material and methods: The study was performed in two steps. In step I, the French questionnaire was translated into Turkish and validated through a group of 200 patients (80 males, 120 females; mean age 44.013.1 years; range, 19 to 75 years) followed up at the rheumatology departments of University Hospitals in Antalya and Ankara. In step II, the validated Turkish questionnaire was administered face-to-face to randomly selected 4,012 subjects (1,670 males, 2,342 females; mean age 41.516.8 years; range, 16 to 97 years) by trained general practitioners across the country, in 25 provinces for case detection. The subjects who were suspected of having RA or SpA in accordance with the questionnaire were invited to the nearest university hospital for rheumatologic examination in order to confirm the diagnosis. Results: In step II, a total of 25 subjects (2 males, 23 females) were diagnosed as RA. The standardized RA prevalence for the general population of Turkey was calculated as 0.56% (95% confidence interval [CI]; 0.33-0.79), 0.10% (95% CI; -0.05-0.25) for males and 0.89% (95% CI; 0.51-1.27) for females. A total of 18 subjects (3 males, 15 females) were diagnosed as SpA. The standardized SpA prevalence for the general population of Turkey was 0.46% (95% CI; 0.25-0.67), 0.17% (95% CI; -0.03-0.37) for males and 0.65% (95% CI; 0.32-0.98) for females. The prevalence of RA was highest in the Northern region (2.00%) and the prevalence of SpA was highest in the Central region (1.49%). Conclusion: The prevalences of RA and SpA in Turkey are close to each other and there are significant inter-regional variations in prevalences of both RA and SpA

Consensus recommendations for botulinum toxin injections in the spasticity management of children with cerebral palsy during COVID-19 outbreak

Spasticity is the most common motor disturbance in cerebral palsy (CP). Lockdown in the COVID-19 outbreak has profoundly changed daily routines, and similarly caused the suspension of spasticity treatment plans. Besides, the delay in botulinum toxin (BoNT) injection, which is important in the management of focal spasticity, led to some problems in children. This consensus report includes BoNT injection recommendations in the management of spasticity during the COVID-19 pandemic in children with CP. In order to develop the consensus report, physical medicine and rehabilitation (PMR) specialists experienced in the field of pediatric rehabilitation and BoNT injections were invited by Pediatric Rehabilitation Association. Items were prepared and adapted to the Delphi technique by PMR specialists. Then they were asked to the physicians experienced in BoNT injections (PMR specialist, pediatric orthopedists, and pediatric neurologists) or COVID-19 (pediatric infectious disease, adult infectious disease). In conclusion, the experts agree that conservative management approaches for spasticity may be the initial steps before BoNT injections. BoNT injections can be administered to children with CP with appropriate indications and with necessary precautions during the pandemic

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

Objectives: This study aims to estimate the prevalence of rheumatoid arthritis (RA) and spondyloarthritis (SpA) in Turkey using the same telephone questionnaire developed for screening RA and SpA in France and used in Serbia and Lithuania. Material and methods: The study was performed in two steps. In step I, the French questionnaire was translated into Turkish and validated through a group of 200 patients (80 males, 120 females; mean age 44.0±13.1 years; range, 19 to 75 years) followed up at the rheumatology departments of University Hospitals in Antalya and Ankara. In step II, the validated Turkish questionnaire was administered face-to-face to randomly selected 4,012 subjects (1,670 males, 2,342 females; mean age 41.5±16.8 years; range, 16 to 97 years) by trained general practitioners across the country, in 25 provinces for case detection. The subjects who were suspected of having RA or SpA in accordance with the questionnaire were invited to the nearest university hospital for rheumatologic examination in order to confirm the diagnosis. Results: In step II, a total of 25 subjects (2 males, 23 females) were diagnosed as RA. The standardized RA prevalence for the general population of Turkey was calculated as 0.56% (95% confidence interval [CI]; 0.33-0.79), 0.10% (95% CI; -0.05-0.25) for males and 0.89% (95% CI; 0.51-1.27) for females. A total of 18 subjects (3 males, 15 females) were diagnosed as SpA. The standardized SpA prevalence for the general population of Turkey was 0.46% (95% CI; 0.25-0.67), 0.17% (95% CI; -0.03-0.37) for males and 0.65% (95% CI; 0.32-0.98) for females. The prevalence of RA was highest in the Northern region (2.00%) and the prevalence of SpA was highest in the Central region (1.49%). Conclusion: The prevalences of RA and SpA in Turkey are close to each other and there are significant inter-regional variations in prevalences of both RA and SpA