Can YouTube be used as an educational tool in lymphedema rehabilitation?

Abstract Background Lymphedema is defined as the abnormal accumulation of interstitial fluid and fibro-adipose tissues resulting from injury, infection, or congenital abnormalities of the lymphatic system. The gold standard approach in the treatment of lymphedema is Complete Decongestive Therapy and it has many components that require practical knowledge and skills. YouTube can be a useful tool to provide these skills to healthcare professionals and patients. The aim of this study was to examine the videos about lymphedema rehabilitation on YouTube and analyze their technical features, sources, contents, educational value and reliability. Methods The YouTube database was searched using the “lymphedema rehabilitation”, “lymphedema treatment”, “complete decongestive therapy”, “lymphedema massage”, and “lymphedema exercises” keywords. Two reviewers (Physical medicine and rehabilitation specialist) assessed videos for educational quality using a Global Quality Scale (GQS). To evaluate the reliability the 5-point Discern scale was used. Results A total of 90 videos, which met the inclusion criteria were included in the analysis. The mean duration of the videos was 8.9 ± 10.5 min. The mean number of daily views was 22.7 ± 47.1 for a day. The majority of the videos were created to inform patients (57.8%).The uploaders were mostly private healthcare institutions or healthcare professionals (65.6%). Information providers were lymphedema therapists mostly (63.3%). Manual lymphatic drainage was observed to stand out as the most mentioned lymphedema rehabilitation component on YouTube. The mean of reliability and GQS scores of the videos were 2.2 ± 1.0 and 2.7 ± 1.0, respectively. Conclusions The biggest obstacle for YouTube to be an excellent source of information is that it hosts large volumes of uncontrolled and low-quality data. When Youtube content related to lymphedema rehabilitation was examined, it was observed that many videos were quite insufficient and incomplete even though there were useful videos. If careful controlling measures are implemented and if medical videos aim to meet reliability and GQS criteria, YouTube can become an effective and useful source of information for lymphedema rehabilitation

Whıch muscles’ strength in upper extremity are related to disease activity, functionality, and disability in female patients with rheumatoid arthritis

“16. TIHUD International Internal Medicine Training Meetings” kongresinde sözel bildiri olarak sunulmuştur (22 - 24 Şubat 2019, Bükreş/ Romanya)Bu çalışmada kas gücü kaybına neden olan romatoid artrit (RA) hastalarında; dominant üst ekstremitede hangi kas gruplarının etkilendiğinin, bu etkilenmelerin hastalık aktivitesi, fonksiyonellik ve engellilik ile ilişkisinin araştırılması amaçlanmıştır. Çalışmaya 30 RA hastası, 30 sağlıklı gönüllü dahil edildi. Hasta grubunda “hastalık aktivite skoru-28 (DAS28)”, “üst ekstremite fonksiyonel indeksi-15 (UEFI-15)” ve “sağlık değerlendirme anketi (HAQ)” skorları hesaplandı. Gönüllülerin dominant üst ekstremitelerinden; başparmak interfalanjiyal (IP) ve metakarpofalanjiyal (MKF), diğer parmakların proksimal interfalanjiyal (PIP) ve MKF eklem fleksörlerinden, el bileği ile dirsek fleksör ve ekstansörleri ile omuzun fleksör, ekstansör, iç rotator (IR), dış rotator (ER), abduktör ve addüktör kaslarının maksimum ve ortalama kas güçleri ölçüldü. Hastaların toplam PIP ve MKF (PIPtoplam, MKFtoplam) değerleri elde edildi. Hasta ve kontrol grubu arasında yaş ve boy açısından anlamlı fark görülmemiştir. Kas güçleri açısından; RA grubunda, başparmak IP ve MKF ile PIPtoplam, MKFtoplam ve el bileği fleksiyonunun maksimum ve ortalama değerleri, kontrol grubundan anlamlı düşük tespit edilirken; omuz ekstansiyonu ortalama ve adduksiyon, abduksiyon maksimum ve ortalama kas güçleri RA grubunda düşük tespit edilmiştir. DAS28 ile parmak fleksörleri, el bilek ekstansörleri ve dış rotatorlar haricindeki omuz kasları negatif ilişkiliyken; UEFI-15 skorları ile bilek ekstansör ve omuz kuşağı kasları pozitif ilişkili bulunmuştur. HAQ skorlarının ortalama el bilek fleksiyonu, dirsek ekstansiyonu ve omuz kuşak kasları ile ilişkili olduğu saptanmıştır. El ve el bileği kasları hastalık aktivitesinden en çok etkilenenler olmalarına rağmen dirsek ve omuz kuşağı kaslarının fonksiyonelliği ve engelliliği daha çok etkilediği görülmüştür. Üst ekstremite kaslarının toplam kuvveti, hastalık aktivitesi; fonksiyonellik ve engellilik ile ilişkili bulunmuştur.The aim of this study is to investigate which muscle groups are affected in dominant upper extremity, and relation of these effects with disease activity, functionality, disability in patients with rheumatoid arthritis (RA) which causes muscle strength loss. 30 RA patients, 30 healthy volunteers were included in this study. In patient group, "disease activity score-28 (DAS28)", "upper extremity functional index-15 (UEFI-15)", "health assessment questionnaire (HAQ)" scores were calculated. From dominant upper extremities of volunteers; maximum and average muscle strengths of thumb interphalangeal (IP), metacarpophalangeal (MCP), proximalinterphalangeal (PIP) and MCP joint flexors of other fingers, wrist and elbow flexors/extensors, flexor, extensor, internal rotator (IR), external rotator (ER), abductor/adductor muscles of shoulder were measured. Total PIP/MCP (PIPtotal, MCPtotal) values of patients were obtained. There was no significant difference between patient and control groups in age/height. In muscle strengths; thumb IP, MCP/PIPtotal, MCPtotal, wrist flexion mean and maximum values were significantly lower in RA group than control group; mean shoulder extension, maximum adduction/abduction, mean muscle strengths were low in RA group. DAS28, finger flexors, wrist extensors, shoulder muscles except ER were negatively related; UEFI-15 scores, wrist extensor, shoulder girdle muscles were positively related. HAQ scores were associated with mean wrist flexion, elbow extension, shoulder girdle muscles. Although hand and wrist muscles are the most affected by disease activity, it has been observed that elbow and shoulder girdle muscles affect functionality and disability more. Total strength of upper extremity muscles has been associated with disease activity, functionality and disability

Axial Spondyloarthritis and Autosomal Dominant Polycystic Kidney Disease in Two Siblings: A Rare Cooccurrence

Autosomal dominant polycystic kidney disease (ADPKD) is the most frequently occurring hereditary kidney disease, and axial spondyloarthritis (SpA) is one of the most frequently occurring rheumatic diseases. Treatment-related decisions for axial SpA may pose a challenge in case of renal involvement. The authors describe two siblings with cooccurrence of these two diseases. The association of these two diseases is not well known. Practitioners should monitor renal function in SpA patients and take treatment-related decisions regarding renal involvement. Antitumor necrosis factor-alpha (anti-TNF-α) agents may be used in case nonsteroidal anti-inflammatory drugs (NSAIDs) cannot be utilized

Neuropathic pain questionnaire and neuropathic pain questionnaire-short form: Translation, reliability, and validation study of the Turkish version

AIM: To perform reliability and validity studies of the Neuropathic Pain Questionnaire (NPQ) and NPQ-Short Form (SF) in the Turkish language. MATERIAL and METHODS: The Turkish translation and cross-cultural validation were performed. Then, 101 patients (36 males, 65 females; mean age: 50.4 ± 14.49; range: 20-87) with chronic pain were asked to fill out a pack of questionnaires, including the NPQ, NPQ-SF, Douleur Neuropathique 4 (DN4), Leeds Assessment of Neuropathic Symptoms (LANSS), and Numeric Rating Scale (NRS). A subgroup of 41 patients (11 males, 30 females) completed the NPQ and NPQ-SF for the second time after 3 days by telephone. Internal consistency was tested by Cronbach's-α and test-retest reliability was assessed by calculating the intraclass correlation coefficients (ICC). Construct validity was assessed by comparing NPQ, NPQ-SF, and NRS. Concurrent validity was tested by comparing NPQ, NPQ-SF, DN4, and LANSS. RESULTS: Internal consistency by Cronbach's-α was 0.84 and 0.67 for the NPQ and NPQ-SF, respectively, indicating adequate and low internal consistency, respectively. ICC was 0.96 (p < 0.001; 95% confidence interval [CI], 0.95-0.97) for NPQ and 0.97 (p < 0.001; 95% CI, 0.95-0.97) for NPQ-SF, indicating a high test-retest reliability for both questionnaires. CONCLUSION: The Turkish versions of NPQ and NPQ-SF were reliable and valid for patients with chronic pain. To our knowledge, this is the first Turkish adaptation and test of the reliability and validity of the NPQ and NPQ-SF (short-form). These questionnaires could potentially help clinicians who seek to assess neuropathic pain for clinical and investigational purposes

How does cross-education affects muscles of paretic upper extremity in subacute stroke survivors?

Introduction This study aimed to evaluate the benefits of adding electromuscular stimulation (EMS) to the flexors of wrist muscles on the nonparetic limb in conventional stroke training to strengthen homologous agonist and antagonist muscles on the paretic side in patients with subacute stroke. Methods The EMS group patients (n = 15) received conventional therapy for 30 sessions for 6 weeks (60 min/session) with 30 min of electrical stimulation to their nonparetic forearm using wrist flexors, with 5 min of pre- and post-warm-up. The transcutaneous electrical nerve stimulation (TENS) group patients (n = 15) received the same conventional rehabilitation training with 30 min of conventional antalgic TENS at a barely sensible level to their nonparetic forearm. The Fugl-Meyer motor function assessment for upper extremity (FMA-UE), functional independence measure (FIM), Brunnstrom staging of recovery for hand, maximum and mean wrist flexion force (flexion(max) and flexion(mean)), and wrist extension force (extension(max) and extension(mean)) of paretic untrained limb were evaluated before and after the treatment. Results EMS and TENS group patients improved similarly in terms of FMA-UE, FIM, and Brunnstrom staging for hand recovery. However, flexion(max) and flexion(mean) of the paretic limb increased more in the EMS group than in the TENS group. Extension(max) and extension(mean) on the paretic side increased in the EMS group but did not differ in the TENS group. Conclusion Cross-education via EMS may have a beneficial effect as an adjunct to conventional treatment methods. This study is retrospectively registered and is available at (ID: NCT04113369).Coordinatorship of Scientific Research Projects of Bezmialem Universit

Fear Assessment in Inflammatory Rheumatic diseases (FAIR) questionnaire: A cross-cultural adaptation and validation to the Turkish language

WOS: 000451729300012PubMed ID: 30054752In chronic inflammatory rheumatic diseases (CIRD), it is important to understand patients' fears towards their disease in order to improve patient-physician dialog, to raise the quality of care offered, and to optimize treatment adherence. In this study, we aimed to translate the Fear Assessment in Inflammatory Rheumatic diseases (FAIR) questionnaire into Turkish and evaluate its psychometric properties in patients with CIRD. One hundred fifteen patients filled the provided socio-demographic information form, FAIR-Tr questionnaire, Hospital Anxiety and Depression Scale (HADS), and Beck's Hopelessness Scale (BHS). For the analysis of short-term reliability, 50 patients re-filled the FAIR-Tr questionnaire 1week later. Internal consistency was evaluated with Cronbach's coefficient and test-retest reliability was evaluated with intraclass correlation coefficients (ICC). Construct validity analysis was investigated based on the correlation with HADS and BHS. All patients found FAIR-Tr easily understandable and acceptable. FAIR-Tr internal consistency (Cronbach's =0.93) and test-retest reliability (ICC=0.91) were excellent. Psychometric validation was proved upon observing high correlation with HADS (Anxiety, r=0.77; Depression, r=0.70) and moderate correlation with BHS (r=0.65). FAIR-Tr is a questionnaire that has excellent internal consistency and test-retest reliability. The successful correlation with HADS and BHS supported its psychometric validity in terms of evaluating the fear in CIRD cases. We think that FAIR-Tr is a specific scale that can help to evaluate the disease- and treatment-related fears of the Turkish patients with CIRD and may be useful in both routine practice and clinical studies

Cross-cultural adaptation and validation of the Turkish version of the Functional Index for Hand Osteoarthritis (FIHOA)

Background: To perform reliability and validity study of the Functional Index for Hand Osteoarthritis (FIHOA) in the Turkish language. Methods: FIHOA was translated into Turkish following the principles of cross-cultural adaptation. Our translation was firstly tested in 40 patients with hand osteoarthritis. Adapted FIHOA questionnaire was then administrated to 100 hand OA patients successively with Modified Health Assessment Questionnaire (mHAQ), Numerical Rating Scale (NRS), and Short Form-36 (SF-36). Patients filled out the FIHOA questionnaire one more time after five days for test-retest assessment. Patients were divided into two groups as symptomatic or asymptomatic, with a NRS score of 5 or above defining symptomatic OA. Internal consistency was assessed by Cronbach's alpha and intraclass correlation coefficient (ICC) of test-retest reliability. Spearman correlation analysis was used to determine the correlation and validity between data. External construct validity was assessed using the correlation between FIHOA, mHAQ, hand pain NRS, and negative correlation with SF-36 subgroups. Results: According to the total score, Cronbach-alpha was found as 0.90, while ICC was determined as 0.98 for test-retest reliability. When the correlations between the FIHOA questionnaire, mHAQ, and NRS questionnaires were examined, significant correlations were determined, and negative correlations between FIHOA and SF-36 subgroups were observed. Conclusion: Turkish FIHOA is a reliable and valid method for assessing functionality in Turkish patients with hand osteoarthritis

Clinical characteristics, disease activity, functional status, and quality of life results of patients with psoriatic arthritis using biological and conventional synthetic disease-modifying antirheumatic drugs

Objectives: This study aims to compare the clinical characteristics, disease activity, and quality of life (QoL) of patients with psoriatic arthritis (PsA) who use biological and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) in a nationwide cohort throughout Turkey. Patients and methods: A total of 961 patients (346 males, 615 females; mean age: 46.9±12.2 years; range, 18 to 81 years) with PsA according to the classification criteria for PsA were included in the study. The patients’ demographic and clinical characteristics, physical examination results, Disease Activity Score 28, Disease Activity Index for Psoriatic Arthritis and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Psoriasis Area and Severity Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, Hospital Anxiety and Depression Scale, Health Assessment Questionnaire, Psoriatic Arthritis Quality of Life (PsAQoL), and Short Form-36 scores were all recorded. Results: Of the patients, 23% underwent biological DMARD (bDMARD) monotherapy, 42% underwent conventional synthetic DMARD (csDMARD) monotherapy, 10% underwent a csDMARD combination therapy, and 10% underwent a combination bDMARD and csDMARD treatment. The Visual Analog Scale (VAS pain), patient global assessment, physician global assessment, and BASDAI scores were found to be lower among patients using combination treatment of csDMARD and bDMARD, while the swollen joint count was found to be lower among patients using bDMARD. The PsAQoL score was found to be the lowest among patients not using any medication and the highest among those using bDMARD. Conclusion: In our study, patients with PsA were successfully treated with both csDMARD and bDMARD monotherapy. When the biological treatments used for PsA were compared with csDMARD, it was found that biological treatments had a positive effect on both disease activity and the QoL. Combinations of csDMARDs and bDMARDs were preferred in cases in which the disease activity was still high or increased. Because of the highest efficacy of the combined treatment, we highly suggest increasing the number of patients on combined treatment

Enthesitis and its relationship with disease activity, functional status, and quality of life in psoriatic arthritis: A multi-center study

Psoriatic arthritis (PsA) is an inflammatory arthritis with distinct phenotypic subtypes. Enthesitis is assigned as a hallmark of the disease, given its significant relations to disease activity and quality of life. Our objective is to evaluate the prevalence of enthesitis and its association with some clinical parameters, particularly quality of life, using data from a national registry. Patients with PsA meeting ClASsification criteria for Psoriatic Arthritis (CASPAR) were enrolled by means of a multi-centre Turkish League Against Rheumatism (TLAR) Network Project. The following information was recorded in web-based case report forms: demographic, clinical and radiographic data; physical examination findings, including tender and swollen joint counts (TJC and SJC); nail and skin involvement; Disease Activity Score-28 for Rheumatoid Arthritis with Erythrocyte Sedimentation Rate (DAS 28-ESR); Bath Ankylosing Spondylitis Disease Activity Index (BASDAI); Maastricht Ankylosing Spondylitis Enthesitis Score (MASES); Psoriasis Area Severity Index (PASI); Bath Ankylosing Spondylitis Radiology Index for the spine (BASRI-s); Health Assessment Questionnaire (HAQ); Bath Ankylosing Spondylitis Functional Index (BASFI); Health Assessment Questionnaire for the spondyloarthropathies (HAQ-s); Psoriatic arthritis quality of Life scale (PsAQoL); Short Form 36 (SF-36); Hospital Anxiety Depression Scale (HADS); Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F); and Fibromyalgia Rapid Screening Tool (FiRST) scores. The patients were divided into two groups, namely with and without enthesitis, based on the triple Likert-type physician-reported statement of ‘active enthesitis’, ‘history of enthesitis’ or ‘none’ in the case report forms. Patients with active enthesitis were compared to others in terms of these clinical parameters. A total of 1130 patients were enrolled in this observational study. Of these patients, 251 (22.2%) had active enthesitis according to the clinical assessment. TJC, HAQ-s, BASDAI, FiRST and PsAQoL were significantly higher whereas the SF-36 scores were lower in patients with enthesitis (p < 0.05). Chronic back pain, dactylitis, and tenosynovitis were more frequent in the enthesopathy group (59.4%/39%, 13.1%/6.5% and 24.7%/3.4%, respectively). Significant positive correlations between the MASES score and the TJC, HAQ, DAS 28-ESR, BASDAI, FiRST and PsAQoL scores, and a negative correlation with the SF-36 score were found. When linear regression analysis was performed, the SF-36 MCS and PCS scores decreased by − 9.740 and − 11.795 units, and the FiRST scores increased by 1.223 units in patients with enthesitis. Enthesitis is an important involvement of PsA with significant relations to quality of life determined with PsAQoL and SF-36 scores. Our study found higher frequency of dactylitis and chronic back pain, and worse quality of life determined with SF-36 and PsAQoL scores in patients with enthesitis

The impact of fatigue on patients with psoriatic arthritis: A multi-center study of the TLAR-network

Fatigue is a substantial problem in patients with psoriatic arthritis (PsA) that needs to be considered in the core set of domains. This study aimed to evaluate fatigue and its relationship with disease parameters, functional disability, anxiety, depression, quality of life, and correlation with disease activity as determined by various scales. A total of 1028 patients (677 females, 351 males) with PsA who met the CASPAR criteria were included [Turkish League Against Rheumatism (TLAR) Network multicenter study]. The demographic features and clinical conditions of the patients were recorded. Correlations between fatigue score and clinical parameters were evaluated using the Disease Activity Score 28 (DAS28), Disease Activity in Psoriatic Arthritis (DAPSA), Clinical DAPSA (cDAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Fibromyalgia Rapid Screening Tool (FiRST), minimal disease activity (MDA), and very low disease activity (VLDA). Fatigue was assessed with the Functional Assessment of Chronic Illness Therapy (FACIT-F) and a 10-point VAS (VAS-F). The mean age of the patients was 47 (SD: 12.2) years, and the mean disease duration was 6.4 (SD: 7.3) years. The mean VAS-F score was 5.1 (SD: 2.7), with fatigue being absent or mild, moderate, and severe in 12.8%, 24.6%, and 62.5% of the patients, respectively. Fatigue scores were significantly better in patients with DAS28 remission, DAPSA remission, cDAPSA remission, MDA, and VLDA (p < 0.001). Fatigue scores significantly increased with increasing disease activity levels on the DAS28, DAPSA, and cDAPSA (p < 0.001). VAS-F scores showed correlations with the scores of the BASDAI, BASFI, PsAQoL, HAD-A, FiRST, pain VAS, and PtGA. FiRST scores showed fibromyalgia in 255 (24.8%) patients. FACIT-F and VAS-F scores were significantly higher in patients with fibromyalgia (p < 0.001). In regression analysis, VLDA, BASDAI score, FiRST score, high education level, HAD-Anxiety, and BMI showed independent associations with fatigue. Our findings showed that fatigue was a common symptom in PsA and disease activity was the most substantial predictor, with fatigue being less in patients in remission, MDA, and VLDA. Other correlates of fatigue were female gender, educational level, anxiety, quality of life, function, pain, and fibromyalgia