Evaluation of an upper limb robotic rehabilitation program on motor functions, quality of life, cognition, and emotional status in patients with stroke: a randomized controlled study.

OBJECTIVE: This study aims to find out whether including robotic therapy in addition to a conventional rehabilitation program affects the quality of life, motor function, cognition, and emotional status of hemiplegic patients. DESIGN: Thirty-seven stroke patients recruited between April 2016 and April 2019 were included in the study. The patients were randomized into 2 groups (Robotic rehabilitation group-RR n:17, Control group n:20), RR was arranged to be 30-45 min, 5 days per week for 4 weeks. All patients were assessed at the beginning of therapy and the end of 4th week with Brunnstrom stages of motor recovery, Fugl-Meyer Assessment (FMA), handgrip strength, Purdue peg test, Minnesota manual dexterity test, Modified Ashworth Scale (MAS), Functional Independence Measure (FIM), Stroke Specific Quality of Life Scale (SS-QOL), Nottingham Extended Activities of Daily Living (NEADL) Scale, Montreal Cognitive Assessment (MoCA) and Center for Epidemiological Studies Depression Scale (CES- D). RESULTS: Improvements in motor function scores, spasticity, general functioning, activities of daily living, cognitive assessment were better in the robotic group when compared to the control group but this difference was not statistically significant (p > 0.05). Improvement in the CES-D in the RR-group was better in comparison to the control group (p = 0.018). CONCLUSION: Improvements in motor functions were observed after the treatment in both groups. Although RR group improved better in numbers, none of the outcomes except the CES-D scale were significant. Robotic rehabilitation provides a favorable alternative bringing slight benefits, and also is advantageous in terms of work power and psychological recovery, making its addition to conventional neurological rehabilitation effective and useful in patient management after stroke. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04393480.

Evaluation of bone mineral density and related parameters in patients with haemophilia: a single center cross-sectional study.

Haemophilia has been associated with low bone mineral density (BMD) probably due to some predisposing factors. The aim of this study was to evaluate the relationship between BMD and potential clinical predictors in adult haemophilic patients. Fortynine patients with moderate and severe haemophilia were enrolled. BMD was measured by Dual Energy X-Ray Absorptiometry (DXA) and blood tests were performed for vitamin D, calcium, phosphore, alkaline phosphatase and parathormone levels. Functional Independence Score in Haemophilia (FISH) and Haemophilia Joint Health Score (HJHS) were used to assess musculoskeletal functions. Body mass index (BMI), Hepatitis C virus (HCV)/Human immunodeficiency virus (HIV) seropositivity and smoking status were also recorded. BMD was found lower than expected for reference age in 34.8% of patients of less than 50 years old. In patients older than 50 years, 66.6% of them had osteoporosis and 33.3% of them had normal BMD. FISH score was statistically significant correlated with BMD of total hip (TH) and femur neck (FN) but not with lumbar spine (LS). In eligible patients, there was also a statistically significant correlation between BMD of TH and HJHS. Vitamine D deficiency was common and found in 77.5% of patients, although there was no significant correlation with BMD. Also no correlation was found between BMD and blood tests, HCV/HIV status, BMI and smoking. This study confirmed that patients with haemophilia have an increased prevelance of low BMD even in younger group. Our results showed that there are significant correlations between FISH score and BMD of TH and FN and also between HJHS score and BMD of TH. Thus, using scoring systems may be beneficial as a simple predictors of BMD to reflect the severity of haemophilic arthropathy.

Longitudinal study of bone loss in chronic spinal cord injury patients.

[Purpose] This prospective longitudinal study evaluated the changes in bone metabolism markers and bone mineral density of spinal cord injury patients over 3 years. We also assessed the relationships among the bone mineral density, bone metabolism, and clinical data of spinal cord injury patients. [Subjects and Methods] We assessed the clinical data (i.e., immobilization due to surgery, neurological status, neurological level, and extent of lesion) in 20 spinal cord injury patients. Bone mineral density, and hormonal and biochemical markers of the patients were measured at 0, 6, 12, and 36 months. [Results] Femoral neck T score decreased significantly at 36 months (p < 0.05). Among the hormonal markers, parathyroid hormone and vitamin D were significantly elevated, while bone turnover markers (i.e., deoxypyridinoline and osteocalcin) were significantly decreased at 12 and 36 months (p < 0.05). [Conclusion] Bone mineral density of the femoral neck decreases significantly during the long-term follow-up of patients with spinal cord injury due to osteoporosis. This could be due to changes in hormonal and bone turnover markers.

Prevalence of symptomatic knee, hand and hip osteoarthritis among individuals 40 years or older: a study conducted in Izmir city.

OBJECTIVE: This cross-sectional study was conducted to determine the prevalence of symptomatic knee, hand and hip osteoarthritis among men and women at or over 40 years of age, living in the Bayrakli Adalet district of Izmir. METHODS: The study included a sample size of 522 people calculated using the Epi Info™ software. Demographic information, weight, height and body mass index were recorded. Patients were physically examined for evidence of osteoarthritis, such as joint tenderness, range of motion deficiency, deformity, 1st carpometacarpal joint involvement and Heberden's and/or Bouchard's nodes. One hundred and ninety-one individuals were suspected of having knee/hand/hip osteoarthritis and 152 of these were called in for radiographs. RESULTS: The prevalence of symptomatic knee, hand and hip osteoarthritis of adults aged ≥40 years was 20.9%, 2.8% and 1.0%, respectively. Symptomatic knee and hand osteoarthritis was significantly higher among women (p<0.05). However, there was no significant difference between two genders regarding symptomatic hip osteoarthritis. CONCLUSION: Knee osteoarthritis is frequent in the region in which the study was conducted. An effective health policy regarding osteoarthritis can be created following further studies with larger samples representing the entire country.

Pulsed radiofrequency versus conventional transcutaneous electrical nerve stimulation in painful shoulder: a prospective, randomized study.

OBJECTIVE: To compare the efficacy of pulse radiofrequency applied to the suprascapular nerve with the efficacy of conventional transcutaneous electrical nerve stimulation treatment in patients with shoulder pain. DESIGN: A randomized, controlled trial. SETTING: An outpatient physical therapy and rehabilitation clinic. SUBJECTS: Forty patients with shoulder pain lasting at least three months were included in the study. Subjects were randomly allocated into either a pulsed radiofrequency treatment or a conventional transcutaneous electrical nerve stimulation treatment. All patients received exercise therapy. MAIN MEASUREMENTS: Outcome measurements were performed using the visual analogue scale for pain and range of motion; the Shoulder Pain and Disability Index was used for disability; and the Short Form-36 was used to establish quality of life. All of the measurements were assessed at four points in time (before the intervention, and for 1, 4 and 12 weeks afterwards). RESULTS: When the groups were compared, no significant difference was found between the groups in terms of visual analogue scale, range of motion, the Shoulder Pain and Disability Index (except for the Shoulder Pain and Disability Index total score), Short Form-36 subscores, and paracetamol consumption for all weeks (P >0.05). CONCLUSION: Our results showed that there is no difference in effect between transcutaneous electrical nerve stimulation and pulsed radiofrequency treatment for shoulder pain.

Comparison of isokinetic exercise versus standard exercise training in patients with chronic low back pain: a randomized controlled study.

OBJECTIVE: To compare the effectiveness of an isokinetic exercise programme and a standard exercise programme in patients with chronic low back pain in terms of pain, mobility, disability, psychological status and muscle strength. DESIGN: A randomized controlled trial. SETTING: An outpatient rehabilitation clinic. SUBJECTS: A total of 40 patients with low back pain were included in the study. INTERVENTIONS: Patients with low back pain were randomly allocated into group 1 (n=20, isokinetic exercises) and group 2 (n=20, standard exercise). MAIN MEASURES: Outcome measures included a visual analogue scale (VAS) for pain, fingertip-to-floor test for spinal mobility, Modified Oswestry Low Back Disability Questionnaire (MOLBDQ), Beck Depression Inventory and isokinetic muscle testing. RESULTS: The isokinetic and standard exercise groups demonstrated significant improvement in the VAS, fingertip-to-floor test, MOLBDQ, Beck Depression Inventory scores, and muscle strength compared with the baseline that persisted until the end of the first month (P<0.05). Comparison of both exercise groups in terms of these parameters obtained at the end of the treatment and at the first month after treatment showed no significant difference (P>0.05). CONCLUSION: Isokinetic and standard exercise programmes have an equal effect in the treatment of low back pain, with no statistically significant difference found between the two programmes. The standard exercise programme was easily performed and had a low cost, making it the preferred option for exercise.

Bone mineral density in mild and advanced ankylosing spondylitis.

To compare the bone mineral density (BMD) and determine the frequency of osteoporosis in mild and advanced ankylosing spondylitis (AS) cases. Seventy three patients with AS were enrolled in this study. The BMD was analyzed at the lumbar spine and hip by dual energy X-ray absorptiometry. The patients were diagnosed as being "normal, osteopenia, or osteoporosis" according to the WHO classification. Using the BASRI-lumbar and BASRI-hip scores, the patients were grouped in mild and advanced AS categories. The mean BMD in the lumbar spine and hip of patients with mild and advanced AS was similar (p > 0.05). While 61.6% of the patients were found to have osteopenia or osteoporosis in the lumbar spine, 46.6% had osteopenia or osteoporosis in the total hip. Of the patients with advanced AS 54.3% had osteopenia or osteoporosis in the lumbar spine, 75% in the total hip. Of the patients with mild AS patients had 68.4% osteopenia or osteoporosis in the lumbar spine, and 42.3% in the total hip. The osteopenia or osteoporosis frequency of the mild and advanced cases of AS in the lumbar spine was similar (p > 0.05). In the advanced AS patients, osteopenia or osteoporosis frequency was significantly higher in the total hip than in the mild AS patients (p < 0.05). In conclusion, there was evidence of osteoporosis in both the advanced AS and mild AS patients. The reason why the anteroposterior lumbar DXA results in the advanced AS patients were similar to the mild ones may be due to the existence of syndesmophytes and ligament calcification. In these cases, it is more convenient to use a hip DXA for assessing the extent of osteoporosis.