How does pain localization affect physical functioning, emotional status and independency in older adults with chronic musculoskeletal pain?

[Purpose] The aim of this study was to show the impact of chronic musculoskeletal pain of the spinal column and lower extremities on physical functioning, emotional status, and independency in older adults. [Subjects] In this cross-sectional study, 258 older adults (mean age, 71.98 +/- 5.86 years, 50.8% males, 49.2% females) living in their own residences were evaluated. [Methods] Pain intensity was analyzed using a visual analogue scale. Physical functioning was evaluated with the Timed Up and Go Test (TUG) and a Six-Minute Walk Test. The Geriatric Depression Scale was used to determine emotional status. The independency in daily living of the participants was evaluated using the Lawton Brody IADL Scale. All participants were divided into two groups in accordance with the pain localization: the (1) spinal pain and (2) lower extremity pain groups. [Results] When the pain scores were compared, no significant differences between the two groups were found. The same results were found in terms of TUG scores. The spinal pain group had higher scores in terms of aerobic capacity than the lower extremity pain group. [Conclusion] The results indicate that chronic musculoskeletal pain in the lower extremities decreased aerobic capacity much more than spinal pain in older adults

Survival results according to Oncotype Dx recurrence score in patients with hormone receptor positive HER-2 negative early-stage breast cancer: first multicenter Oncotype Dx recurrence score survival data of Turkey

BackgroundThe Oncotype Dx recurrence score (ODx-RS) guides the adjuvant chemotherapy decision-making process for patients with early-stage hormone receptor-positive, HER-2 receptor-negative breast cancer. This study aimed to evaluate survival and its correlation with ODx-RS in pT1-2, N0-N1mic patients treated with adjuvant therapy based on tumor board decisions.Patients and methodsEstrogen-positive HER-2 negative early-stage breast cancer patients (pT1-2 N0, N1mic) with known ODx-RS, operated on between 2010 and 2014, were included in this study. The primary aim was to evaluate 5-year disease-free survival (DFS) rates according to ODX-RS.ResultsA total of 203 eligible patients were included in the study, with a median age of 48 (range 26-75) and median follow-up of 84 (range 23-138) months. ROC curve analysis for all patients revealed a recurrence cut-off age of 45 years, prompting evaluation by grouping patients as ≤45 years vs. >45 years. No significant difference in five-year DFS rates was observed between the endocrine-only (ET) and chemo-endocrine (CE) groups. However, among the ET group, DFS was higher in patients over 45 years compared to those aged ≤45 years. When stratifying by ODx-RS as 0-17 and ≥18, DFS was significantly higher in the former group within the ET group. However, such differences were not seen in the CE group. In the ET group, an ODx-RS ≥18 and menopausal status were identified as independent factors affecting survival, with only an ODx-RS ≥18 impacting DFS in patients aged ≤45 years. The ROC curve analysis for this subgroup found the ODx-RS cut-off to be 18.ConclusionThis first multicenter Oncotype Dx survival analysis in Turkey demonstrates the importance of Oncotype Dx recurrence score and age in determining treatment strategies for early-stage breast cancer patients. As a different aproach to the literature, our findings suggest that the addition of chemotherapy to endocrine therapy in young patients (≤45 years) with Oncotype Dx recurrence scores of ≥18 improves DFS

Effect of neuromuscular electrical stimulation on functional mobility in children with hemiplegic cerebral palsy

GİRİŞ ve AMAÇ: Serebral palsili (SP) çocuklarda ayak bileği deformiteleri sıklıkla görülmekte ve çocukların fonksiyonelliğini olumsuz yönde etkilemektedir. Bu çalışmanın amacı, hemiplejik spastik tip SP’li çocukların tibialis anterior, peroneus longus ve peroneus brevis kaslarına uygulanan elektrik stimulasyonunun eklem hareket açıklığı ve fonksiyonel hareket becerileri üzerine olan etkinliğini araştırmaktır. YÖNTEM ve GEREÇLER: Çalışmaya 5-15 yaş arası toplam 40 hemiplejik spastik tip SP tanılı çocuk alınmıştır. Çocuklar randomize olarak 2 gruba ayrılmıştır. Tedavi grubuna (n=20) nörogelişimsel tedavi ile birlikte nöromuskuler elektrik stimulasyonu (NMES), kontrol grubuna (n=20) ise sadece nörogelişimsel tedavi uygulanmıştır. Tüm tedavi yöntemleri haftada 3 gün olmak üzere 12 hafta boyunca toplam 36 seans uygulanmıştır. Tüm çocukların yaş, vücut kütle indeksi, kaba motor fonksiyon sınıflandırma sistemine (KMFSS) göre seviyeleri kaydedildikten sonra kaba motor fonksiyon ölçeği-88(KMFÖ-88) ile motor fonksiyonları, gonyometre ile ayak bileği eklem hareket açıklıkları, zamanlı ayağa kalk yürü ve zamanlı merdiven çıkıp inme testleri ile fonksiyonel hareket becerileri değerlendirilmiştir. İstatistiksel analizinde SPSS 22.0 programı kullanılarak p<0,05 düzeyi anlamlı kabul edilmiştir. BULGULAR: Çalışmaya katılan çocukların yaş ortalaması 8.30±2.49’dur. Tedavi öncesi ve sonrası gruplar arası ve gruplar içerisinde yapılan karşılaştırmalarda tedavi grubunun aktif dorsi fleksiyon açıklığı, zamanlı kalk yürü testi ve zamanlı merdiven çıkıp inme testlerinde istatistiksel olarak anlamlı iyileşme gözlenmiştir(p=0,033; 0,015; 0,036). TARTIŞMA ve SONUÇ: NMES tedavisinin,hemiplejik SP’li çocukların zayıf olan kaslarını kuvvetlendiren, spastik kaslarda germe etkisi oluşturarak gevşemelerini sağlayan ve kas imbalansını normalize ederek kaba motor fonksiyonlar, yürüme kabiliyeti ve fonksiyonel yeteneğin artmasını sağlayan bir yöntem olduğu belirlenmiştir.INTRODUCTION: Ankle deformities are frequently seen in children with cerebral palsy (CP) and affect the functioning of children negatively. The purpose of this study was to investigate the effect of electrical stimulation on the range of motion and functional mobility of movements of tibialis anterior, peroneus longus and peroneus brevis muscles in children with hemiplegic spastic type CP. METHODS: A total of 40 hemiplegic spastic type CP children between 5 and 15 years of age were included in the study. Children are randomly divided into 2 groups. Neurodevelopmental therapy and neuromuscular electrical stimulation (NMES) was applied to the treatment group (n = 20), only neurodevelopmental therapy was applied to the control group (n = 20). A total 36 treatments were administered for 12 weeks, with 3 treatment sessions per week. After recording the age, body mass index, and gross motor function levels of the children, motor functional levels with the Gross Motor Function Scale (GMFM-88), ankle range of motion with goniometer, functional mobility skills with timed up and go test, timed stairs up and down test were evaluated. Statistical analysis was done by SPSS 22.0 program and significance was accepted as p <0.05. RESULTS: The average age of the children participating in the study was 8.30 ± 2.49 years. Comparisons between groups before and after treatment showed statistically significant improvement in range of active dorsi flexion, timed up and go test, and timed stairs up and down test in the treatment group (p=0.033, 0.015, 0.036). DISCUSSION and CONCLUSION: NMES therapy has been identified as a method that strengthens the weak muscles of children with hemiplegic CP, relaxes them by creating stretching effects on spastic muscles, and normalizes muscle imbalance, thereby increasing gross motor functions, walking ability, and functional ability

Use of Creative Activities in Physiotherapy and Rehabilitation

WOS: 000446931200003Objective: A survey was performed to study the use of creativity in the field of physiotherapy and rehabilitation. There has been little research on this topic in Turkey and only a few studies are reported to have used music therapy for children. Therefore, the present study aimed to perform a similar survey as conducted in Sweden. Methods: In this study, we sent a survey to physiotherapists in Istanbul via email. Recorded data included sociodemographic characteristics (gender, age, and education) of the physiotherapists; where and how long they had been working; the specialties of the physicians that they work with; whether they continued training/education after graduation, and if so how did they maintain their studies; whether/how often they involve creative activities in the treatment sessions; which activities they prefer; whether they get any negative reaction from patients or colleagues while applying the creative activities; and whether they apply any treatment method other than conventional methods. Results: According to the results of the study, 59% of the physiotherapists benefit from using creative activities during their sessions. While 21% of them use handcrafts, 19% make use of computer games, 8% take advantage of music/theater activities, 6% use exercise painting, and 2% use practice gardening. Conclusion: There has been no previous study on this topic in Turkey, this study provides insight into existing practices and may encourage further use of creative methods in therapy. Further studies should expand on the experience of physiotherapists concerning the benefits of creative activities

Grip strength in hipermobility syndrome.

İstanbul Bilim Üniversitesi, Sağlık Yüksekokulu.Amaç: Kas gücü, bir dirence karsı kuvvet uygulamak için gereken kas veya kas grubu yeteneği olarak tanımlanabilir. El kavrama gücü, total kas gücünü gösteren iyi bir belirleyici olarak kabul edilmektedir ama kavrama gücü kisinin gün içindeki fonksiyonel durumu ve otonomisine göre de fizyolojik değiskenlik göstermektedir. Eklem hipermobilite sendromu; eklem esnekliği, hipermobilite ve yorgunlukla karakterize sık görülen bir kalıtsal bağ dokusu hastalığıdır.Objective: Muscle strength can be defined as the ability of a muscle or muscle group to exert force against a resistance. Manuel gripping strength has been referred to as being a good indicator of total muscle strength but this is an indispensable physiologic variable for the performance of day to day tasks, maintenance of functional independence and autonomy. Joint hypermobility is a common and heritable connective tissue disorder that mainly characterized by joint hypermobility, joint instability and fatigue

Karpal Tünel Sendromunun Tedavisinde Bazı Kombine Konservatif Yöntemlerin Etkinliği: Randomize, Kontrollü, Klinik ve Elektrofizyolojik Bir Çalışma

Amaç: Bu çalışmada, hafif karpal tünel sendromu (KTS) tedavisinde bazı konservatif yöntemlerle birlikte uygulanan deksametazon iyontoforezi veya ultrason veya plasebo iyontoforezin (deksametazonsuz) etkinliği karşılaştırıldı.Hastalar ve yöntemler: Elektromiyografi ile doğrulanmış hafif KTS tanılı 58 hasta çalışmaya dahil edildi. Hastalar rastgele üç gruba ayrıldı: (i) deksametazon iyontoforezi ile tedavi edilen iyontoforez grubu (n=20); (ii) ultrason ile tedavi edilen grup (n=20) ve (iii) plasebo iyontoforezi uygulananlar (n=18). Bu tedavilerden biri, tüm hastalara üç aylık tendon ve sinir kaydırma egzersizleri, gece splinti ve aktivite modifikasyonları gibi fizyoterapi prosedürleri ile beraber 15 seans uygulandı. Tedavinin başında, tedavi sonunda ve tedavi bitiminden sonra takip sırasında 3. ayda el bileği eklem hareket açıklığı ve kas testleri, Görsel Analog Skalası (VAS), el sıkma testi, pinçmetre ölçümleri, monofilaman ile duyu testleri, iki nokta diskriminasyon testi, Phalen, ters Phalen, Tinel ve karpal kompresyon testleri, Sağlık Değerlendirme Anketi (HAQ), Boston Sorgulama Anketi (BQ) ve elektrofizyolojik ölçümler değerlendirildi. İstatistiksel analiz SPSS (versiyon 10.0, Windows) yazılımı kullanılarak yapıldı.Bulgular: Çalışma sonunda tüm grupların klinik değerlendirmelerinde istatistiksel olarak anlamlı iyileşmeler görüldü (p<=0.05). Ultrason ve plasebo grubu ile karşılaştırıldığında, iyontoforez grubunda daha başarılı sonuçlar alındı; KTS'li hastaların üç ay sonraki takiplerinde pinçmetre, monofilaman, iki nokta diskriminasyon testleri ve BQ skorlarında istatistiksel anlamlı iyileşme gözlemlendi (p<=0.05). İyontoforez ve ultrason grubunda yapılan elektrofizyolojik ölçümlerde de, istatistiksel olarak anlamlı iyileşmeler kaydedildi (p<=0.05).Sonuç: Bu çalışmanın sonuçları, hafif KTS'li hastaların deksametazon iyontoforezi, tendon kaydırma egzersizleri, splint ve aktivite modifikasyonu ile beraber tedavisinin güvenilir ve etkili olduğunu önermektedir. Ancak, bulgularımızı destekleyen daha geniş ölçekli başka çalışmalara da ihtiyaç vardır.Objectives: In this study, we aimed to compare the efficacy of some conservative methods in combination with dexamethasone iontophoresis, ultrasound therapy or placebo iontophoresis (without dexamethasone) in the treatment of mild carpal tunnel syndrome (CTS). Patients and methods: Fifty-eight patients diagnosed with mild CTS confirmed by electromyography were included in the study. The subjects were divided randomly into three groups: (i) iontophoresis group-treated with dexamethasone iontophoresis (n=20); (ii) ultrasound group-treated with ultrasound (n=20), and (iii) placebo group-treated with placebo iontophoresis (n=18). All patients received one of these treatments in 15 sessions for three months in combination with physiotherapeutic procedures, such as tendon/nerve gliding exercises, night splinting and activity modifications. Wrist range of motion, muscle test, the Visual Analog Scale (VAS), handgrip test, pinch meter measurement, sensory testing with monofilaments, two-point discrimination test, Phalen's, reverse Phalen's, Tinnel's and carpal compression test, the Health Assessment Questionnaire (HAQ), the Boston Questionnaire (BQ) and electrophysiological assessment were performed at baseline, at the end of therapies and at threemonths during follow-up. Statistical analysis was performed using SPSS software (version 10.0 for Windows). Results: Statistically significant improvements in the clinical status of all groups were observed at the end of the study (p&lt;=0.05). Compared to ultrasound group and placebo group, more successful outcomes were seen in the iontophoresis group, resulting in statistically significant improvements in the pinch meter measurements, monofilament and two-point discrimination tests, and in BQ scores at three months during follow-up (p&lt;=0.05). A statistically significant improvement was also recorded in the electrophysiological measurements in the iontophoresis group and ultrasound group (p&lt;=0.05). Conclusion: Our study results suggest that dexamethasone iontophoresis administration combined with tendon gliding exercises, splint and activity modification is reliable and effective in the treatment of patients with mild CTS. However, further large-scale studies are required to confirm these finding