Evaluation of pain, quality of life, and patient satisfaction in parenterally treated patients with postmenopausal osteoporosis

Objectives: This study aims to evaluate pain, quality of life, and patient satisfaction in parenterally treated patients with postmenopausal osteoporosis (OP). Patients and methods: Between May 2016 and January 2018, a total of 138 patients (mean age 63.78 years; range, 50 to 70 years) with postmenopausal OP were retrospectively analyzed. All patients were previously treated with denosumab (DEN) and parenteral forms of bisphosphonates such as zoledronic acid (ZOL) and ibandronate (IBN). The pain severity was evaluated using the Visual Analog Scale (VAS) and Brief Pain Inventory-Short Form (BPI-SF). The quality of life was evaluated using the Quality of Life Questionnaire of the European Foundation for Osteoporosis (Qualeffo-41). For the evaluation of patient satisfaction, a three-item questionnaire including satisfaction with the medication, route, and frequency of administration was applied. Results: Of the patients, 50 received DEN, 48 received ZOL, and 40 received IBN treatment. There was no significant difference in any of the pain parameters. All domains of the Qualeffo-41 were similar among the three groups. The patients in the DEN group were more satisfied with their medication (DEN: 88%, ZOL: 43.75%, and IBN: 52.5%), its administration route (DEN: 84%, ZOL: 43.8%, and IBN: 57.5%), and the frequency of its administration (DEN: 84%, ZOL: 56.25%, and IBN: 52.5%) (p=0.0001). Conclusion: Neither of the medication showed a superior effect on quality of life. However, patients were more satisfied with medications used in a six-month interval and applied subcutaneously. Of these three treatment options, DEN seems to be a step ahead in terms of patient satisfaction

Effects of Alphacalcidol on Fall and Balance in Elderly People with Vitamin D Deficiency

Objective: The aim of the present study was to investigate the impact of vitamin D treatment on balance and falls in elderly patients with vitamin D deficiency. Materials and Methods: This study was carried out in 63 women older than 65 years of age with determined vitamin D deficiency (<50 nmol/L) who can be mobilized independently. 33 patients were given a daily dose of 1 mcg alphacalcidol and 500 mg of ionized calcium, while 30 patients were given 500 mg of ionized calcium. The patients were evaluated with the Timed Up and Go (TUG) test, Romberg test (RT), Berg balance scale (BBS), and 10-meter walk time at baseline and at the 3(rd) and 6(th) months of treatment. Furthermore, the number of falls within the last year and during treatment was recorded. Results: In the alphacalcidol+calcium group, significant improvements were found in TUG and BBS at the 3rd month; in TUG, RT and BBS at the 6th month. In the control group, there was no statistically significant difference in all balance tests at the 3rd and 6th months. Also, no statistically significant difference was determined between the groups at follow-up. There was no significant difference in or between the groups regarding 10-meter walk time test. Considering the number of falls, no significant difference was found between the groups at the 3rd and 6th months. Conclusion: It is thought that active vitamin D treatment has positive effects on balance in elderly women with vitamin D deficiency, however, its effect on number of falls is inadequate. Turk J Phys Med Rehab 2011;57:89-93

Assessment of the Relationships Between Spinopelvic Radiologic Parameters and Balance, Gait and Falls Efficacy in Patients with Postmenopausal Osteoporosis

Objective: The aim of this study is to investigate the relationship between sagittal balance, spinopelvic parameters, bone mineral density, balance, and falls efficacy in postmenopausal osteoporosis patients. Materials and Methods: Forty patients between the ages of 40-80 with a diagnosis of postmenopausal osteoporosis were included in the study. Spinopelvic parameters (sagittal vertical axis (SVA), thoracic kyphosis, lumbar lordosis, pelvic tilt, pelvic incidence, sacral slope) were calculated from spine radiographs. Patients were applied Tinetti Balance and Gait Assessment and Falls Efficacy Scale. Relationship between bone mineral density measurements, clinical parameters, spinopelvic parameters, balance and gait, and falls efficacy were investigated. Results: Mean age of the patients was 63.42 +/- 8.98 and the mean L1-L4 T score was 2.5 +/- 0.68. Statistically significant negative correlation was found between the L1-L4 and L2-L4 vertebrae bone mineral density and T score, and sacral slope. Negative statistical correlations were found between SVA and Tinetti Balance and Gait Assessment balance subtest and total scores. There was no statistically significant relationship with other spinopelvic parameters. There was no significant correlation between SVA and spinopelvic parameters and Falls Efficacy Scale, while a statistically significant negative correlation detected between Falls Efficacy Scale and Tinetti Balance and Gait Assessment balance and gait subtests and total scores. Among the patients with normal, mild and severe deformity sagittal balance, there was statistically significant difference in terms of Tinetti Balance and Gait Assessment balance and gait subtests scores and total scores, while there was no difference with regards to Falls Efficacy Scale. Conclusion: In postmenopausal women with osteoporosis, SVA, sagittal balance parameters, and balance and gait functions were found to be associated

Impact of the Training on the Compliance and Persistence of Weekly Bisphosphonate Treatment in Postmenopausal Osteoporosis: A Randomized Controlled Study

Long-term patient adherence to osteoporosis treatment is poor despite proven efficacy. In this study, we aimed to assess the impact of active patient training on treatment compliance and persistence in patients with postmenopausal osteoporosis. In the present national, multicenter, randomized controlled study, postmenopausal osteoporosis patients (45-75 years) who were on weekly bisphosphonate treatment were randomized to active training (AT) and passive training (PT) groups and followed-up by 4 visits after the initial visit at 3 months interval during 12 months of the treatment. Both groups received a bisphosphonate usage guide and osteoporosis training booklets. Additionally, AT group received four phone calls (at 2nd, 5th, 8th, and 11th months) and participated to four interactive social/training meetings held in groups of 10 patients (at 3rd, 6th, 9th, and 12th months). The primary evaluation criteria were self-reported persistence and compliance to the treatment and the secondary evaluation criteria was quality life of the patients assessed by 41-item Quality of Life European Foundation for Osteoporosis (QUALEFFO-41) questionnaire.. Of 448 patients (mean age 62.4 +/- 7.7 years), 226 were randomized to AT group and 222 were randomized to PT group. Among the study visits, the most common reason for not receiving treatment regularly was forgetfulness (54.9% for visit 2, 44.3% for visit 3, 51.6% for visit 4, and 43.8% for visit 5), the majority of the patients always used their drugs regularly on recommended days and dosages (63.8% for visit 2, 60.9% for visit 3, 72.1% for visit 4, and 70.8% for visit 5), and most of the patients were highly satisfied with the treatment (63.4% for visit 2, 68.9% for visit 3, 72.4% for visit 4, and 65.2% for visit 5) and wanted to continue to the treatment (96.5% for visit 2, 96.5% for visit 3, 96.9% for visit 4, and 94.4% for visit 5). QUALEFFO scores of the patients in visit 1 significantly improved in visit 5 (37.7 +/- 25.4 vs. 34.0 +/- 14.6, p<0.001); however, the difference was not significant between AT and PT groups both in visit 1 and visit 5. In conclusion, in addition to active training, passive training provided at the 1st visit did not improve the persistence and compliance of the patients for bisphosphonate treatment

Congenital Muscular Torticollis: Diagnosis and Treatment Options

Congenital muscular torticollis (CMT) is the most frequent reason of torticollis in children. Children with CMT should be examined for revealing concomitant deformities. Preferred use of one upper extremity, delayed acquisition of gross motor skills, decreased cognitive function below normal levels, abnormal postural patterns and balance control may also be seen in these children. Therefore, an early rehabilitation program should be initiated. Full recovery may be expected to be more than 98%, if treatment begins within the first month of life. Surgery should be considered for children, who do not benefit from conservative therapy within six months and who have craniofacial deformity. Turk J Phys Med Rehab 2012;58:52-7

The reliability and validity of the Turkish version of the brief pain inventory-short form in patients with cancer pain

© 2022 All right reserved by the Turkish Society of Physical Medicine and Rehabilitation.Objectives: The aim of this study was to evaluate the reliability and validity of the Turkish version of the Brief Pain Inventory (BPI-TR) in patients with cancer pain. Patients and methods: The study included 130 patients (70 females, 60 males; mean age: 56.1±13.3 years; range, 18 to 87 years) diagnosed with any type and stage of cancer between April 2017 and March 2018. Brief Pain Inventory, Pain Disability Index, EORTC QLQ C30 and Pain Management Index were used to collect data. The reliability of the scale was tested with \"internal consistency\" and its validity with \"construct validity\". Cronbach’s alpha values of >0.70 were accepted as the threshold for internal consistency. Construct validity was tested in the context of structural validity with factor analysis and also tested in terms of convergent construct validity by investigating its correlation with the Pain Disability Index (PDI) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Results: The internal consistency of pain severity and pain-related interference was found as 0.91 and 0.95, respectively. The alpha coefficient was found to be between 0.795 and 0.873 for the pain severity index and between 0.729 and 0.861 for the pain-related interference index. There was a clear link between the BPI-TR pain severity index and the ninth question in the EORTC QLQ-C30 (rho=0.66, p<0.05). The association between the BPI-TR interference index and the 19th question in the EORTC QLQ-C30 was also strong (rho=0.77, p<0.05). The correlation between the BPI-TR interference index and the PDI was found to be moderate (rho=0.50, p<0.05). Conclusion: The BPI-TR was found to be a reliable and legitimate tool to evaluate cancer pain in the Turkish population

World Report on Disability: A Call to Action

The World Report on Disability (WRD), a joint effort of the World Health Organization and the World Bank, is a document that presents a global picture of disability based on a best evidence synthesis available worldwide. Additionally, the WRD provides a number of recommendations, particularly for the facilitation of the implementation of the United Nations 'Convention on the Rights of Persons with Disabilities' and calls to action at national and international levels. The call to action in the WRD imposes a responsibility and obligation on the medical specialty of physical medicine and rehabilitation (PMR) with its unique approach to a health condition not only with a medical treatment perspective, but also with the perspectives of functioning and disability with the aim of improving functioning to the best possible level. The medical specialty of PMR can make substantial contributions to the implementation of the WRD, especially in the areas of specific programs and services for persons with disabilities as defined particularly in the activities and participation as well as environmental factors components of the International Classification of Functioning, Disability and Health (ICF) along with good quality scientific research. The WRD poses a challenge to promote and emphasise the value and the importance of the medical specialty of PMR. Turk J Phys Med Rehab 2012;58:255-8

Anatomy and Assessment of the Autonomic Nervous System

Autonomic Nervous System (ANS) is responsible for the vegetative functions of the body. It is composed of many ganglions, plexi, cerebrospinal nuclei and nerves. ANS, which is also known as visceral or vegetative nervous system, helps to control many functions, such as blood pressure, gastrointestinal motility, glands, bladder functions, sweating and body temperature. ANS innervates all the smooth muscles and the heart, and keeps to stabilize body functions within certain limits. ANS is composed of 3 components: sympathetic system (thoracolomber-adrenergic), parasympathetic system (craniosacral- cholinergic) and enteric system (nonadrenergic- noncholinergic). Autonomic nerves are classified with regard to their origin from central nervous system, the distribution of peripheral ganglions, their various physiological effects on visceral organs, and response to pharmacological agents. It is essential to know the anatomy and the physiology of the ANS, in order to evaluate disorders, achieve the correct diagnosis and to plan accurate treatment

The effect of adding robot-assisted hand rehabilitation to conventional rehabilitation program following stroke: A randomized-controlled study

© 2022 All right reserved by the Turkish Society of Physical Medicine and Rehabilitation.Objectives: This study aimed to investigate the effectiveness of adding robot-assisted hand therapy (HandTutor) to conventional rehabilitation program compared to a conventional rehabilitation program alone in stroke survivors. Patients and methods: Between March 2012 and December 2012, a total of 33 stroke patients (21 males, 12 females; median age: 56 years; range, 38 to 73 years) were included in this prospective, randomized-controlled study. The patients were randomly divided into two groups as experimental (n=16) and control (n=17). Both groups received conventional rehabilitation for 3 h/day, for two days/week, totally for five weeks, while the experimental group received additional 1-hour robot-assisted hand therapy during each session. Outcome measures were the Fugl-Meyer Assessment, Box and Block Test, Nine-Hole Peg Test, Jebsen-Taylor Hand Function Test, grip strength, and pinch strength. All patients were assessed at baseline, at the end of the treatment, and three months after the treatment. Results: Both groups showed statistically significant improvements in all the parameters (p0.05). The changes between baseline and three-month follow-up after the treatment revealed that adding robot-aided hand therapy led to greater changes in all the parameters related to functional activities and muscle strength, except for the Fugl-Meyer Assessment. Conclusion: Adding robot-assisted therapy to conventional rehabilitation may provide greater changes in upper extremity rehabilitation of subacute stroke patients compared to conventional rehabilitation program alone

Can assessment of disease burden and quality of life based on mobility level in patients with end-stage cancer provide an insight into unmet needs? An exploratory cross-sectional study

Purpose The purpose of this study was to: 1) investigate the differences in the needs of end-stage cancer who can move independently, using mobility aids (MA), or are bedridden; and 2) determine the effects of these different mobility levels on the patients\" current quality of life (QoL), fatigue, and mental conditions. Methods The study employed an exploratory prospective cross-sectional study design, which was carried out in two hospitals. The study included 99 end-stage cancer. The mobility levels of the patients were evaluated in three groups: Group 1: bedridden; Group 2: mobile with MA; and Group 3: ambulatory (under supervision or fully independent). A core cancer-specific questionnaire-integrating system for assessing health-related QOL (EORTC-QLQ-C15-PAL), the Piper Fatigue Scale (PFS), and the Hospital Anxiety-Depression scale were utilized. The median age was 60years (31-83). Cancer types were as follows: gastrointestinal (45.5%), lung (38.4%), breast (4%), genitourinary system (4%), and others (8%). Forty-two percent of the patients were completely bedridden, 42.2% used MA, and 15.2% were independently ambulatory. The EORTC QLQ-C15-PAL physical (=.000) and emotional function values (=.029) differed among mobilization statuses. There was a significant difference among mobilization groups, in terms of behavioral values, in the PFS (=.006). The depression rate in the independent ambulatory group was lower than in the bedridden and MA groups (=0.011; =0.004). p p p p1 p2 Conclusion Health-related QoL, fatigue level, and emotional state vary in end-stage cancer who undergo evaluations according to their mobility levels. These patients should be assessed comprehensively, and treatment plans should be organized carefully, with a multidisciplinary approach