Nocturnal pain in adhesive capsulitis and subacromial ımpingement syndrome

Background: Subacromial impingement syndrome (SIS) and adhesive capsulitis (AC) are the most common causes of shoulder pain. It is known that patients with both disorders have impaired sleep quality and increased levels of anxiety and depression. This study aimed to compare the sleep, disability, and affective states of patients with untreated AC and SIS. Method: Patients with shoulder pain for more than three months and diagnoses of AC and SIS were included in the study. Pain was assessed by visual analog scale (VAS), disability by shoulder pain and disability index (SPADI), sleep quality by Pittsburgh sleep quality index (PSQI), and anxiety and depression by hospital anxiety and depression scale (HADS). Results: The study included 65 patients (n=24 AC, n=41 SIS. Sleep was affected in both of the groups. The patients with AC had worse scores than patients with SIS including SPADI pain, SPADI-total, sleep latency, sleep duration, sleep disturbance, using sleep mediation (p<0.05).  Sleep problems were correlated to anxiety and depression. Conclusions: Despite the patients with SIS had higher SPADI-pain levels, the patients with AC had higher scores of SPADI-disabilities. Both of the groups had nocturnal pain and sleep problems but patients with AC had higher amount of sleep problems and depression mood compared to patients with SIS

Demographic and clinical characteristics of patients with sustained and switching treatments using biological and targeted synthetic disease-modifying antirheumatic drugs: A multicenter, observational cross-sectional study for rheumatoid arthritis

Introduction Rheumatoid arthritis is a chronic inflammatory disease with different disease activity grades. Several registries have been designed to determine the appropriate regimens of disease-modifying antirheumatic drugs to obtain sustained clinical remission. We examined epidemiological and clinical characteristics of rheumatoid arthritis patients using a clinical registry database (BioSTaR) and analyzed the differences in patients with sustained and switched therapies. Methods A multicenter, observational cross-sectional study for rheumatoid arthritis was performed between February 2019 and September 2020 using the BioStaR-RA registry. Demographic and clinical characteristics were prospectively recorded into a specifically designed electronic database. The patients were divided into three groups due to the heterogeneity of the study cohort. Patients were grouped as Group I (Initial; within the first 6 months of treatment with biological/targeted synthetic drugs), Group ST (Sustained Treatment; any first drug lasting for at least 6 months without any change), and Group S (Switch; any switching to another drug). Comparative analysis was performed between sustained treatment (Group ST) and drug switching (Group S) groups. Results The study included a total of 565 patients. The mean age was 53.7 +/- 12.8 years, and the majority were female (80.4%). There were 104, 267, and 194 patients in Groups I, ST, and S, respectively. Erosive arthritis and hematological extra-articular involvement were more frequently detected in Group S than Group ST (p = 0.009 and p = 0.001). The patients in Group S had significantly higher disease activity scores (DAS28-CRP, CDAI, and SDAI) (p = 0.025, p = 0.010, and p = 0.003). There were significantly more patients with moderate disease activity in Group S (p < 0.05). Conclusions The groups with sustained treatment and switching included patients with different disease activity status, although higher disease activity was determined in switchers. Overall, moderate disease activity and remission were the most common disease activity levels. Lower disease activity scores, lower hematologic manifestations, better functional status, and lesser radiographic damage are associated with sustained treatment.Turkish Medicine and Medical Devices Agency ; Ankara Numune Egitim ve Arastirma Hastanes

The effects of Covid-19 on physical medicine and rehabilitation in Turkey in the first month of pandemic

Objectives: The outbreak of novel coronavirus-2019 (COVID-19) has affected Turkey very seriously, as well as all around the world. Many urgent and radical measures were taken due to the high contagious risk and mortality rate of the outbreak. It is noteworthy that isolation recommendations and the provision of health services for pandemic have a negative impact on Physical Medicine and Rehabilitation (PMR) services. In this study, we aimed to evaluate the effects of COVID-19 on the PMR services and physiatrists immediately after the first month of pandemic in Turkey. Patients and methods: An online survey consisting of 45 items was sent to the members of the Turkish Society of Physical Medicine and Rehabilitation. The main goal of the survey was to evaluate the changes in the provided service of PMR and conditions of physiatrists one month after the first reported COVID-19 case in Turkey. Results: A total of 606 PMR specialists and residents responded to the survey. The mean number of the patients visited the outpatient clinics was 148.2 +/- 128.5 per week before the pandemic, it significantly decreased to 23.4 +/- 33.1 per week after the first month of the reported first COVID-19 case. Similarly, the mean number of the patients of inpatient service significantly decreased from 21.7 +/- 39.3 per week to 2.5 +/- 10.0 per week after the first month of the pandemic. Most of the residents (69%) reported that their training was seriously affected due to pandemic. From the economic aspect, 69.2% of the participants who were working at private hospitals reported a decrease in their monthly salary, and 21% of them were sent to an unpaid vacation. A total of 21.9% of private-practice institutions paused their services. During the first month, 46.9% of the participants were assigned to the different services such as COVID-19 inpatient service, emergency or COVID-19 outpatient clinics. According to the Republic of Turkey, Ministry of Health guideline and algorithm, 15.7% of the physicians were in the category of healthcare workers with suspected COVID-19. Conclusion: The COVID-19 pandemic affected seriously both the services and the PMR physicians as early as the first month. This effect is expected to become worse, when the duration of pandemic prolongs. Proper arrangements and measures should be planned to ameliorate the negative effects of the pandemic on the patients and PMR physicians

Lomber spinal dar kanal tanılı hastalarda paraspinal haritalama yönteminin radyolojik ve klinik bulgularla ilişkisi

Bu çalışmanın amacı lomber spinal dar kanal (LSDK) tanısında bir elektrofizyolojik teknik olan paraspinal haritalama (PSH) yönteminin, görüntüleme ve klinik bulgular ile ilişkisinin incelenmesidir. Çalışmaya Marmara Üniversitesi Fiziksel Tıp ve Rehabilitasyon Polikliniği’ne başvuran 60 hasta alındı. Hastalar deneyimli bir klinisyen tarafından değerlendirilerek klinik ve görüntüleme bulgularına göre klinik ve radyolojik LSDK, radyolojik LSDK ve kontrol olmak üzere 3 gruba ayrıldı. Hastaların lomber spinal manyetik rezonans görüntüleme (MRG) bulguları klinik bulgulardan habersiz bir radyolog tarafından değerlendirildi. Klinik ve radyolojik değerlendirmeyi bilmeyen bir elektrofizyolog tarafından sinir iletim çalışmaları, alt ekstremitelere yönelik iğne elektromiyografi (EMG) ve PSH yöntemleri uygulandı. İki hasta polinöropati saptanması nedeni ile çalışma dışı kaldı. Elde edilen klinik, görüntüleme ve elektrofizyolojik veriler karşılaştırılarak PSH’nın LSDK tanısındaki etkinliği araştırıldı. Klinik ve radyolojik LSDK grubunda PSH ile %96.4 hastada LSDK saptandı. Yalnızca bir hastada (%3.6) spontan aktivite bulguları yoktu. Ortalama toplam PSH skoru 33.64±21.17 idi. Radyolojik LSDK grubunda ise %93.8 PSH normal olarak değerlendirilirken bir hastada spontan aktivite bulgusu saptandı. Kontrol grubunda 8 hastanın PSH skoru 0 iken 6 hastanın skoru yüksek (0-9) bulundu. PSH pozitif olan bu hastalarda lomber disk hernisi vardı. PSH yönteminin sensitivitesi 9 ve üstü skorlar için %96.8 bulundu. Klinik ve radyolojik LSDK grubunda ekstremite EMGsinde %50 hastada patolojik spontan aktivite bulguları, %46.4 oranında ise kronik nörojenik tutulum bulguları saptandı. PSH yönteminin semptomatik hastalarda ekstremite EMG’sine göre daha duyarlı olduğu görüldü. Paraspinal haritalama LSDK tanısında sensivitesi yüksek bir yöntemdir ve ekstremite EMG’sine göre sinir köklerinin fizyolojisini daha iyi yansıtmaktadır. Anahtar kelimeler: lomber spinal dar kanal, paraspinal haritalama, elektromiyografi, manyetik rezonans görüntüleme ABSTRACT Title: The Realationship Of Paraspinal Mapping Technique With Radiological and Clinical Findings In Patients With Lomber Spinal Stenosis The aim of this study is to evaluate the correlation of paraspinal mapping (PSM) which is an electrophysiological technique in diagnosis of lumbar spinal stenosis (LSS) with clinical and radiological findings. Sixty patients who referred to Marmara University Physical Medicine and Rehabilitation Outpatient Clinic were enrolled to study. The patients were assessed by an experienced clinician and divided in to tree groups as follows: clinical and radiological LSS, radiological LSS and control group. The magnetic resonance imaging studies of the patients were assessed by a radiologist who was masked to clinical features. An electromyographer who was also masked to patients’ findings performed nerve conduction tests, lower extremity EMG and PSM. Two patients were dropped out because diagnosed as polyneuropathy. The clinical, radiological and electrophysiological findings were analized to assess the effectiveness of PSM in LSS diagnosis. Electrophysiological LSS was diagnosed 96.4% in clinical and radiological LSS group. There was no pathologic spontaneous activity only in one patient (3.6%). The mean PSM score was 33.64±21.17. In radiological group PSM were normal in 93,8% patients. There was pathologic spontaneous activity only in one patient. In the control group in 6 of 14 patients had high PSM scores (range 0-9). All of these patients were diagnosed as radiculopathy due to disc herniation. In clinical and radiological LSS group extremity EMG were found as 50% acute neurogenic and 46.4% chronic neurogenic. PSM was found more sensitive than extremity EMG in symptomatic patients. PSM technique is sensitive method in diagnosis of LSS and reflects physiology of nevre roots beter than ekstremity EMG Keywords: Lumbar spinal stenosis, paraspinal mapping, electromyography, magnetic resonance imagin

Scientific papers from Turkey in the field of physical medicine and rehabilitation

[Özet Yok

Transkraniyal magnetik stimulasyon fibromiyalji hastalarında ek bir tedavi yöntemi mi?

WOS: 000343521400006Objective: To investigate the effectiveness of low-frequency (LF) repetitive transcranial magnetic stimulation (rTMS) to the motor cortex area in fibromyalgia patients who are resistant to medical treatment. Material and Methods: A total of 25 patients were randomly assigned to the study, who were in the active rTMS (n=13) or sham stimulation (n=12) group. For the rTMS group, the main stimulation parameters were 90% of motor threshold for 60 seconds at 1 Hz and a 45-second interval between each train. Ten sessions of low-frequency rTMS, which had a total of 1200 pulses at each session, were applied to the left primary motor cortex area daily over a period of 2 weeks. For the sham group, the same parabolic coil was placed at 90 degrees angles to the motor cortex area, and the patients received 10 sessions of sham stimulation. The outcome parameters were pain intensity, which was measured by visual analog scale (VAS), Fibromyalgia Impact Questionnaire (FIQ), and the Beck Depression Inventory (BDI). Results: A significant improvement in pain intensity, FIQ, and BDI scores was seen at the 10th day and first and third months in both groups. Although the mean of parameters of the rTMS groups was better than the sham group, the difference did not reach statistical significance, except FIQ scores at the 10th day in the real rTMS group. Conclusion: Patients with fibromyalgia who enroll in real TMS did not present significant differences in long-term follow-ups with respect to those who enrolled in the sham TMS group.Amaç: Medikal tedaviye dirençli fibromiyalji hastalarında motor korteks alana uygulanan düşük frekanslı tekrarlayıcı transkraniyal manyetik stimülasyonun (tTMS) etkinliğini araştırmak. Gereç ve Yöntemler: Toplam 25 hasta randomize olarak aktif ve plasebo gruplarına ayrılarak çalışmaya alındı. Aktif tTMS grubu için stimülasyon sol primer motor korteks üzerinden motor eşik değerin %90’ı hesaplanarak 1 Hz ve 20 dakika uygulandı. Her seansta 1200 uyarı olmak üzere, iki hafta boyunca toplam 10 seans tedavi uygulandı. Plasebo grup için, parabolik koil 90° açı ile motor kortekse yerleştirildi ve aynı şekilde toplam 10 seans stimülasyon uygulandı. Sonuçlar, ağrı için vizüel analog skalası (VAS), Fibromiyalji Etkinlik Anketi (FIQ) ve Beck Depresyon Skalası (BDS) ile değerlendirildi. Bulgular: Her iki grupta da tedavi sonunda, 1 ve 3. ay sonunda ağrı derecesinde, FIQ ve BDS’de anlamlı iyileşme gözlendi. Ancak, aktif tTMS grubunda iyileşme plasebo gruba göre daha iyiydi. Tedavi sonu FIQ skorlarında aktif grupta, plasebo gruba göre istatistiksel olarak anlamlı iyileşme gözlendi. Diğer değerlendirmelerde gruplar arasında istatistiksel farklılık saptanmadı. Sonuç: Primer motor korteks üzerine düşük doz tTMS uygulamasının uzun süreli takiplerde fibromiyalji hastalarında plaseboya göre anlamlı iyileşme göstermediği görülmüştü

Impact de l’entraînement aérobie avec et sans entraînement aux vibrations ducorps entier sur les caractéristiques métaboliques et la qualité de vie chez lespatients atteints de stéatose hépatique non alcoolique

The present study examined the effectiveness of adding exercises with whole-body vibration (WBV) to aerobic training in terms of metabolic features and quality of life. Patients with non-alcoholic fatty liver disease (NAFLD), confirmed on imaging, underwent an 8-week individualized exercise program randomized between aerobic training with and without WBV. Training was performed at 60-80% heart rate workload for 165 min/week. The WBV amplitude was 2-4 mm and the training frequency was 30 Hz, for 15 min. Assessments were carried out on surrogate scores of steatosis and fibrosis including transient elastography (FibroScan), metabolic features (biochemical analysis) and quality of life (SF-36). Insulin resistance was markedly reduced ( -2.36; 95% CI: -4.96 to -0.24; P: 0.049) in aerobic training with WBV. The decrease in serum aspartate transaminase was significantly greater in aerobic training without WBV ( -14.81; 95% CI: -23.36 to -6.25; P: 0.029). There were no significant differences between groups for the other metabolic features (P< 0.05). All quality of life well-being domains improved in both groups (P< 0.05). Given this reduction in insulin resistance, WBV can usefully be added to aerobic training. However, WBV did not provide further benefits in improving metabolic properties or quality of life.La présente étude a examiné l’efficacité de l’ajout d’exercices avec vibrations globales du corps (WBV)à l’entraînement aérobie en termes de caractéristiques métaboliques et de qualité de la vie. Lespatients présentant une stéatose hépatique non alcoolique (NAFLD), confirmée en imagerie médicale et par les données cliniques, ont subi un programme d’exercice, individualisé de 8 semaines,randomisé entre un entraînement aérobie avec ou sans WBV. L’entraînement a été effectué avecune charge de travail correspondant à une fréquence cardiaque de 60 à 80 % pendant 165 min parsemaine. L”amplitude WBV était de 2 à 4 mm avec une fréquence de 30 Hz, pendant 15 min. Des évaluations ont été effectuées sur les scores de substitution de la stéatose et de la fibrose, y comprisl’élastographie transitoire (FibroScan), les caractéristiques métaboliques (analyse biochimique) et laqualité de vie (SF-36). La résistance à l’insuline a été nettement réduite (IC −2,36 : −4,96 à −0,24 ;p : 0,049) lors de l’entraînement aérobie avec le groupe WBV. La diminution des transaminases aspartiques sériques était significativement plus élevée dans l’entraînement aérobie sans WBV (IC −14,81 :−23,36 à −6,25 ; p : 0,029). Il n’y avait pas de différence entre les groupes dans les autres caractéristiquesmétaboliques (p < 0,05). Tous les domaines du « bien-être » et de la qualité de vie se sont améliorésdans les deux groupes (p < 0,05). Compte tenu de la réduction de la résistance à l’insuline, le WBV estune option additionnelle à l’entraînement aérobique. Cependant, la WBV n’a pas apporté d’avantagessupplémentaires pour améliorer les propriétés métaboliques etla qualité de la vie