Factors affecting on gait function in chronically hemiplegic patients

Bu çalışmada, serebrovasküler (SVO) sonrası kronik hemiparezisi olan hastalarda gövde, diz, ayak bileği kas güçlerinin izokinetik analizi yapılarak yürüme, denge ve gövde kontrol parametreleri ile olan ilişkisinin araştırılması, SVO sonrası hemiparezik hastalarda sağlıklı kontrollere göre yürümenin nasıl etkilendiğinin tespit edilmesi amaçlanmıştırMateryal ve metod: Bu çalışma, Selçuk Üniversitesi Meram Tıp Fakültesi Fiziksel Tıp ve Rahabilitasyon Anabilim Dalı'nda, 2008/029 sayılı etik kurul kararıyla yapılmıştır. Çalışmaya 70 hemiparetik hasta (34 kadın, 36 erkek) ile 20 sağlıklı gönüllü birey (10 kadın, 10 erkek) alındı. Hastaların dengesini değerlendirmek için Berg denge skalası (BBS), gövde kontrolü için gövde kontrol testi (TKT), mobilite değerlendirmesi için Rivermead motor değerlendirmesi (RMA) kullanıldı. Hasta ve sağlıklı kontrollerin yürümesi 20 m yürüme testi, 6 dk yürüme testi, merdiven tırmanma yeteneği (MTY) ve zamanlı ayağa kalma yürüme testi (ZAKYT) ile değerlendirildi. Diz, ayak bileği ve gövde kas güçlerinin maksimum pik torklarını (PT) belirlemek için ise software destekli izokinetik test ve egzersiz sistemi (Biodex System 3 Pro, ABD) kullanıldı. İzokinetik ölçümler 60º/sn ve 120º/sn açısal hızlarda, konsantrik-konsantrik modda yapıldıBulgular: Her iki grubun da yaş, cinsiyetleri birbiriyle uyumluydu. Hastaların 38'i (%54.3) sol, 32'si (%45.7) sağ hemiparezikti. Hasta grubu ile kontrol grubu karşılaştırıldığında yürüme testleri ile kas gücü PT'larının tümünde anlamlı farklılık vardı. (p0.05) Hasta grubunda TKT ile 20 m YT, 6 dk YT ve MTY arasında orta, ZAKYT arasında yüksek ilişkili korelasyon mevcuttu. BBS ve RMA ile ise tüm yürüme testleri arasında yüksek ilişkili korelasyon mevcuttu. Yürüme testleri ile izokinetik ölçümleri karşılaştırdığımızda hem 60º/sn hem de 120º/sn açısal hızdaki kas güçlerinin PT'larından sadece ayak bileği plantar fleksiyon PT'ları ile tüm yürüme testleri arasında çok zayıf ilişkili diğer PT'lar ile zayıf-orta ilişkili korelasyon mevcuttu. BBS, RMA, TKT ile kas güçlerini karşılaştırdığımızda; testlerle sadece ayak bileği plantar fleksörlerinin PT'ları arasında çok zayıf ilişkili, diğer PT'larla orta-zayıf ilişkili korelasyon mevcuttuSonuç: Bu çalışmanın sonucunda, inmeli hastalarda yürüme fonksiyonu ve dengenin sağlıklı kontrollere göre daha kötü düzeyde olduğu saptadık. Bu hastaların yürüme fonksiyonunu iyileştirmek için rehabilitasyon programına mutlaka izokinetik dinamometre veya konvansiyonel yöntemlerle güçlendirme egzersizleri eklenmesi gerekmektedir. Yine hastanın dengesini geliştirecek egzersizler de rehabilitasyon programında yer almalıdır.In this clinical trial, we aimed to make isokinetic analysis of muscle strength of trunk, knee and ankle joints on the patients with chronic hemiparesis after stroke to find out the relationship between walking, balance and body control parameters and how the walking ability is affected according to healthy control groups in hemiparesic patientsMaterials and methods: This trial was organised at Selcuk University Faculty of Medicine, Department of Physical Medicine and Rehabilitation with the ethical assize numbered 2008/029. We did this trial on 70 hemiparetic patients (34 women, 36 men) with 20 healthy volunteer people (10 women, 10 men). To measure the balance we used Berg balance scale (BBS), to assess body control we used trunk control test (TCT) and to assess mobility we used Rivermead motor assessment (RMA) tests. Patients and healthy controls? walking assessed by 20 min. walking test, 6 min walking test, stair climbing test (SCT) and time up and go tests (TUG). To measure maximum peak torques (PT) of knee, body and ankle muscle strength we used software based isokinetic test and exercise system (Biodex System 3 Pro, USA). Isokinetic measurements were made with 60º/min and 120º/min angular velocities under consantric-consantric modResults: Gender and age of both groups were similar. 38 (54.3%) of patients were left and 32 (45.7%) were right hemiparetic. Significant difference was found in all walk test and muscle strength tests between patients and control group (p0.05). Correlation was present between TCT and 20m WT, 6m WT and SCT were mean and between TUG were high in patients group. High correlation was present between BBS and RMA and all walk tests. When walk tests and isokinetic measurements were compared the following were found: weak-middle relation was found between all walk tests and all 60º/sec and 120º/sec angular velocity's muscles strength PTs, except ankle plantar flexion PTs where very weak relation was observed. When BBS, RMA, TCT were compared to muscle strength, very weak relation was present only in ankle plantar flexion PTs, weak-middle relation was present in all other testsConclusion: At the end of this clinical trial we determined that walking and balance function were at worse levels than in healthy group. To improve walking function in these patients isokinetic dynamometer exercises or strengthening by use of conventional methods must be added to their physiotherapy programme. Also balance improving exercises must be included in physiotherapy programme

Effects of Reproductive Factors on Bone Mineral Densitometry

Aim: To determine the effects of reproductive factors on bone mineral density (BMD) in postmenopausal women. Materials and Methods: A total of 1196 postmenopausal women with BMD (g/cm2) measurements at lumbar vertebra (LS) and femur neck (FN) were enrolled. Demographic, reproductive characteristics and Body Mass Index (BMI) of patients were defined. In order to define BMD related factors, multiple regression analysis was employed. Results: Main results were as follows: mean age= 59.97±8.56 yrs; weight= 73.49±13.06 kg; BMI= 29.25±5.22kg/m², age of menarche= 14.00±1.64 yrs; number of deliveries 4.22±2.09; total breastfeeding duration= 60.77±38.80 months; number of breastfeeding per day= 8.23±3.91; menopausal age= 47.12±4.22 yrs; duration of menopause= 12.80±9.10 yrs; LS BMD= 0.993±0.171 gr/cm2; FN BMD 0.844±0.14 gr/cm2. There were negative correlations between LS BMD and FN BMD values and age, menopause duration, total breastfeeding duration, and number of breastfeeding per day. There were positive correlations between LS and FN BMD values, and weight and BMI scores. Additionally, there were negative correlations between LS and FN BMD values, and age of menarche and number of deliveries. In linear stage regression analysis, weight, number of breastfeeding per day, postmenopausal duration, duration of total breastfeeding and age of menarche were defined as the most significant predictors for LS BMD, whereas weight, postmenopausal duration and number of breastfeeding per day were defined as the most significant predictors for FN BMD. Conclusion: LS and FN BMD in postmenopausal women are related to reproductive factors, so reproductive factors should also be considered in the evaluation of risk factors in postmenopausal women. (Turkish Journal of Osteoporosis 2012;18:8-12

Can systemic involvements, therapeutic approaches, and sociodemographic features of individuals be associated with depression in rheumatic diseases? Reply

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Reproduktif faktörlerin kemik mineral dansitometresi üzerine etkileri

Amaç: Postmenopozal kadınlarda reprodüktif faktörlerin kemik mineral yoğunluğu (BMD) üzerine etkilerini tespit etmek amaçlandı. Gereç ve Yöntemler: Çalışmaya lomber vertebra (L1-4) (LS) ve femur boyun (FN) düzeyinde BMD (gr/cm²) ölçümleri yapılmış olan 1196 postmenopazal kadın dahil edildi. Hastaların demografik, reprodüktif özellikleri ve vücut kütle indeksi (BMI) (kg/m²) belirlendi. BMD ile ilişkili faktörleri belirlemede çoklu regresyon analizi kullanıldı. Bulgular: Hastalarda ortalama yaş 59,978,56, ağırlık 73,4913,06 kg, VKİ 29,255,22 kg/m², adet yaşı 14,001,64, doğum sayısı 4,222,09, toplam emzirme süresi 60,7738,80 ay, günlük emzirme sayısı 8,233,91, menapoz yaşı 47,124,22, menopoz süresi 12,809,10 yıl, LS BMD 0,9930,171 gr/cm², FN BMD 0,8440,14 gr/cm² idi. Hastalarda LS BMD ve FN BMD değerleri ile yaş, menopoz süresi, toplam emzirme süresi, günlük emzirme sayısı arasında negatif korelasyon saptandı. LS ve FN BMD değerleri ile, ağırlık ve BMI skorları arasında pozitif korelasyon saptandı Yine LS ve FN BMD değerleri ile adet yaşı ve doğum sayısı arasında negatif korelasyon saptandı. Lineer basamak regresyon analizlerinde, ağırlık (p0,001), günlük emzirme sayısı (p0,001), menapoz sonrası geçen süre (p0,001), toplam emzirme süresi (p0,012), ilk adet yaşı (p0,007) LS BMD için, ağırlık (p0,001), menapoz sonrası geçen süre (p0,001) ve günlük emzirme sayısı (p0,001) FN BMD için en önemli belirleyiciler olarak bulundu. Sonuç: Postmenopozal dönemdeki kadınlarda LS ve FN BMD, reprodüktif faktörler ile ilişkili gözükmektedir. Bu nedenle postmenopozal kadınlarda osteoporoz risk faktörleri değerlendirirken reproduktif faktörlerde dikkate alınmalıdır. (Türk Os te opo roz Dergisi 2012;18:8-12)Aim: To determine the effects of reproductive factors on bone mineral density (BMD) in postmenopausal women. Materials and Methods: A total of 1196 postmenopausal women with BMD (g/cm2) measurements at lumbar vertebra (LS) and femur neck (FN) were enrolled. Demographic, reproductive characteristics and Body Mass Index (BMI) of patients were defined. In order to define BMD related factors, multiple regression analysis was employed. Results: Main results were as follows: mean age 59.97±8.56 yrs; weight 73.49±13.06 kg; BMI 29.25±5.22kg/m², age of menarche 14.00±1.64 yrs; number of deliveries 4.22±2.09; total breastfeeding duration 60.77±38.80 months; number of breastfeeding per day 8.23±3.91; menopausal age 47.12±4.22 yrs; duration of menopause 12.80±9.10 yrs; LS BMD 0.993±0.171 gr/cm2; FN BMD 0.844±0.14 gr/cm2. There were negative correlations between LS BMD and FN BMD values and age, menopause duration, total breastfeeding duration, and number of breastfeeding per day. There were positive correlations between LS and FN BMD values, and weight and BMI scores. Additionally, there were negative correlations between LS and FN BMD values, and age of menarche and number of deliveries. In linear stage regression analysis, weight, number of breastfeeding per day, postmenopausal duration, duration of total breastfeeding and age of menarche were defined as the most significant predictors for LS BMD, whereas weight, postmenopausal duration and number of breastfeeding per day were defined as the most significant predictors for FN BMD. Conclusion: LS and FN BMD in postmenopausal women are related to reproductive factors, so reproductive factors should also be considered in the evaluation of risk factors in postmenopausal women. (Turkish Journal of Osteoporosis 2012;18:8-12

Diz osteoartritli hastalarda ev egzersiz programının etkinliği

Diz osteoartritli (OA) hastalarda izotonik, izometrik ve eklem hareket açıklığı (EHA) egzersizlerinden oluşan ev programının ağrı, fonksiyonel kapasite ve yaşam kalitesi üzerine etkisini araştırmak. Diz OA tanısı alan 75 hasta çalışmaya alındı. Hastalara 8 hafta aktif EHA, kuadriseps ve hamstringler için izometrik ve izotonik egzersizlerden oluşan ev programı uygulandı. Hastalarda bazalde, tedavi bitiminde ve tedavi bittikten sonra 12 haftada Vizüel Analog Skala (VAS) ile ağrı şiddeti, The Western Ontario and Mcmaster Universities Arthritis İndeks (WOMAC) ile fonksiyonel durum, Lequesne diz eklemi şiddet indeksi (LŞİ) ile hastalığın şiddeti, 36- Item Short-Form Health Survey (SF-36) ile yaşam kalitesi belirlendi. 8 haftanın sonundaDiz OAli 75 hastanın 52nin ev egzersiz programını düzenli uyguladığı tespit edildi. 52 diz OAli hastanın tedavi bitiminde VAS, WOMAC, LŞİ ve SF-36 alt skorlarından fiziksel fonksiyon, ağrı ve sosyal fonksiyon skorlarında bazale göre belirgin düzelme mevcuttu ve bu düzelme azalmakla birlikte tedavi bittikten sonra 12 haftada da devam ediyordu. Yine hastalarda egzersiz programı bitiminde SF-36 alt skorlarından mental sağlık, emosyonel rol, fiziksel rol, genel sağlık ve vitalite skorlarında bazale göre belirgin düzelme mevcuttu, ancak bu düzelme tedavi bittikten sonra 12 haftada devam etmiyordu. Sonuçlarımız diz OAli hastalarda ev egzersiz programının fonksiyonel düzeyi arttırdığı, ağrı düzeyini azalttığı ve yaşam kalitesini düzelttiğini göstermektedir. Bu nedenle diz OAli hastaları takip eden sağlık profesyonelleri tedavi planlarken ev egzersiz programlarını mutlaka gözönünde bulundurmalıdır.To investigate effects of home exercise program including isotonic, isometric and joint range of motion (ROM) exercises on pain, functional capacity and quality of life in knee OA patients. Seventy-five patients with knee OA were included into the study. Patients were exposed to home exercise program including 8-week active ROM, and isometric and isotonic exercises for quadriceps and hamstrings. In patients, severity of pain, functional capacity, severity of disease and quality of life were assessed with Visual Analogue Scale (VAS), The Western Ontario and McMaster Universities Arthritis Index (WOMAC), Lequesnes knee severity index (LSI) and 36-Item Short-Form Health Survey (SF-36) on admission, at the end of and 12th week after the treatment, respectively. At the end of 8th week, of 75 patients, 52 were determined to perform home exercise program regularly. At the end of treatment for 52 patients with knee OA, a significant improvement was seen in physical function, bodily pain and social functioning scores among subscales of SF-36, and VAS, WOMAC and LSI, compared to basal findings. The improvement also continued at 12th week after the treatment. Also, a marked amelioration was observed in role limitation physical, health perception, mental health, role limitation emotional and energy scores among subscales of SF-36, after completing exercise program; however, the amelioration disappared at 12th week after the teratment. Our findings indicate home exercise program increases functional level, decreases pain severity and improves quality of life. Therefore, physicians following-up patients with knee OA should take home exercise programs into consideration while planning treatment regimes

Quality of Life in Osteoporosis: A Controlled Study

Aim: To evaluate quality of life in women without vertebral and nonvertebral fractures, with postmenopausal osteoporosis (PMO), osteopenic and normal bone mineral density (BMD), and to determine effective factors on quality of life. Materials and Methods: Without fractures, 266 women with PMO, 310 with osteopenia and 255 with normal women BMD were enrolled in the study. BMD measurement was performed on lumbar vertebra (L1-L4) and femur neck via dual energy X-ray absorbtiometry (DXA). Quality of life was assessed with Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO). QUALEFFO total scores and subscales were compared in all groups. Factors about quality of life in women with PMO were defined with correlation analysis. Variations of the highest correlation and quality of life were included into linear regression model. Results: In non-fractured women with PMO, QUALEFFO total scores and subscales were higher than those with osteopenia and normal BMD. In women with PMO, a positive correlation was found between QUALEFFO total scores, and age, Body Mass İndex (BMI), parity and duration of menopause, and a negative correlation between QUALEFFO total scores, and level of education, economical status and femur neck BMD scores. In linear regression analysis, among significant factors of quality of life were BMI, femur neck BMD, parity and duration of menopause. Conclusion: Our results indicate that quality of life in non-fractured women with PMO is disordered higher than those with osteopenia and normal BMD, and quality of life are affected by numerous factors. (Turkish Journal of Osteoporosis 2012;18: 47-52

Quality of Life in Osteoporosis: A Controlled Study

Amaç: Bu çalışmada vertebral veya non-vertebral kırığı olmayan postmenopozal osteoporozlu (PMO), osteopenik ve normal kemik mineral yoğunluğuna (KMY) sahip kadınların yaşam kalitesini değerlendirmek ve yaşam kalitesi üzerine etkili faktörleri belirlemek amaçlandı. Gereç ve Yöntemler: Kırığı olmayan PMO’lu 266 kadın, 310 osteopenik kadın ve 255 normal KMY’li kadın çalışmaya alındı. KMY ölçümü, dual enerji X-ray absorbsiyometri (DXA) ile lomber vertebra (L1-4) ve femur boyundan yapıldı. Yaşam kalitesi Avrupa Osteoporoz Kurumu Yaşam Kalitesi Anketi (QUALEFFO) kullanılarak değerlendirildi. Grupların QUALEFFO total skorları ve alt grup skorları karşılaştırıldı. Korelasyon analizi ile PMO’lu kadınlarda yaşam kalitesi ile ilişkili faktörler belirlendi. Yaşam kalitesi ile en yüksek korelasyona sahip değişkenler lineer regresyon modeline alındı. Bulgular: Kırığı olmayan PMO’lu kadınlarda QUALEFFO total skor ve alt grup skorları osteopenik ve normal KMY’e sahip gruba göre anlamlı derecede yüksekti. PMO’lu kadınlarda QUALEFFO total skoru ile yaş, vücut kitle indeksi (VKİ), doğum sayısı ve menapoz süresi arasında pozitif korelasyon, eğitim düzeyi, gelir düzeyi, femur boyun KMY skorları arasında negatif korelasyon tespit edildi. Lineer regresyon analizi sonucunda, yaşam kalitesinin en önemli belirleyicileri olarak VKİ, femur boyun KMY, doğum sayısı ve menapoz süresi tespit edildi. Sonuç: Bu çalışmanın sonuçları kırığı olmayan PMO’lu kadınların yaşam kalitelerinin osteopenik ve normal KMY’ye sahip kadınlara göre belirgin derecede bozulduğunu ve yaşam kalitesinin birçok faktörden etkilendiğini göstermektedir. (Türk Osteoporoz Dergisi 2012;18: 47-52)Aim: To evaluate quality of life in women without vertebral and nonvertebral fractures, with postmenopausal osteoporosis (PMO), osteopenic and normal bone mineral density (BMD), and to determine effective factors on quality of life. Materials and Methods: Without fractures, 266 women with PMO, 310 with osteopenia and 255 with normal women BMD were enrolled in the study. BMD measurement was performed on lumbar vertebra (L1-L4) and femur neck via dual energy X-ray absorbtiometry (DXA). Quality of life was assessed with Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO). QUALEFFO total scores and subscales were compared in all groups. Factors about quality of life in women with PMO were defined with correlation analysis. Variations of the highest correlation and quality of life were included into linear regression model. Results: In non-fractured women with PMO, QUALEFFO total scores and subscales were higher than those with osteopenia and normal BMD. In women with PMO, a positive correlation was found between QUALEFFO total scores, and age, Body Mass İndex (BMI), parity and duration of menopause, and a negative correlation between QUALEFFO total scores, and level of education, economical status and femur neck BMD scores. In linear regression analysis, among significant factors of quality of life were BMI, femur neck BMD, parity and duration of menopause. Conclusion: Our results indicate that quality of life in non-fractured women with PMO is disordered higher than those with osteopenia and normal BMD, and quality of life are affected by numerous factors. (Turkish Journal of Osteoporosis 2012;18: 47-52

Common mistakes in the dual-energy x-ray absorptiometry (dxa) in turkey. A retrospective descriptive multicenter study

Background: Osteoporosis is a widespread metabolic bone disease representing a global public health problem currently affecting more than two hundred million people worldwide. The World Health Organization states that dual-energy X-ray absorptiometry (DXA) is the best densitometric technique for assessing bone mineral density (BMD). DXA provides an accurate diagnosis of osteoporosis, a good estimation of fracture risk, and is a useful tool for monitoring patients undergoing treatment. Common mistakes in BMD testing can be divided into four principal categories: 1) indication errors, 2) lack of quality control and calibration, 3) analysis and interpretation errors, and 4) inappropriate acquisition techniques. The aim of this retrospective multicenter descriptive study is to identify the common errors in the application of the DXA technique in Turkey. Methods: All DXA scans performed during the observation period were included in the study if the measurements of both, the lumbar spine and proximal femur were recorded. Forearm measurement, total body measurements, and measurements performed on children were excluded. Each examination was surveyed by 30 consultants from 20 different centers each informed and trained in the principles of and the standards for DXA scanning before the study. Results: A total of 3,212 DXA scan results from 20 different centers in 15 different Turkish cities were collected. The percentage of the discovered erroneous measurements varied from 10.5% to 65.5% in the lumbar spine and from 21.3% to 74.2% in the proximal femur. The overall error rate was found to be 31.8% (n = 1021) for the lumbar spine and 49.0% (n = 1576) for the proximal femur. Conclusion: In Turkey, DXA measurements of BMD have been in use for over 20 years, and examination processes continue to improve. There is no educational standard for operator training, and a lack of knowledge can lead to significant errors in the acquisition, analysis, and interpretation

Common Mistakes in the Dual-Energy X-ray Absorptiometry (DXA) in Turkey. A Retrospective Descriptive Multicenter Study

Background: Osteoporosis is a widespread metabolic bone disease representing a global public health problem currently affecting more than two hundred million people worldwide. The World Health Organization states that dual-energy X-ray absorptiometry (DXA) is the best densitometric technique for assessing bone mineral density (BMD). DXA provides an accurate diagnosis of osteoporosis, a good estimation of fracture risk, and is a useful tool for monitoring patients undergoing treatment. Common mistakes in BMD testing can be divided into four principal categories: 1) indication errors, 2) lack of quality control and calibration, 3) analysis and interpretation errors, and 4) inappropriate acquisition techniques. The aim of this retrospective multicenter descriptive study is to identify the common errors in the application of the DXA technique in Turkey. Methods: All DXA scans performed during the observation period were included in the study if the measurements of both, the lumbar spine and proximal femur were recorded. Forearm measurement, total body measurements, and measurements performed on children were excluded. Each examination was surveyed by 30 consultants from 20 different centers each informed and trained in the principles of and the standards for DXA scanning before the study. Results: A total of 3,212 DXA scan results from 20 different centers in 15 different Turkish cities were collected. The percentage of the discovered erroneous measurements varied from 10.5% to 65.5% in the lumbar spine and from 21.3% to 74.2% in the proximal femur. The overall error rate was found to be 31.8% (n = 1021) for the lumbar spine and 49.0% (n = 1576) for the proximal femur. Conclusion: In Turkey, DXA measurements of BMD have been in use for over 20 years, and examination processes continue to improve. There is no educational standard for operator training, and a lack of knowledge can lead to significant errors in the acquisition, analysis, and interpretation