The relationship between severity of overactive bladder symptoms and cognitive dysfunction, anxiety and depression in female patients with multiple sclerosis: Running head: OAB-V8, BICAMS and HAD scale in MS.

BACKGROUND: Overactive bladder (OAB), cognitive dysfunction, depression and anxiety are common problems encountered in MS. This study was planned to investigate the relationship between the severity of OAB symptoms and cognitive function, anxiety and depression in MS. METHODS: 100 patients with MS diagnosis with OAB symptoms were recruited. OAB symptoms was assessed with the OAB-V8 questionnaire. Symbol Digit Modalites Test (SDMT), California Verbal Learning Test II (CVLT-II) and Brief Vasospatial Memory Test-Revised (BVMT-R) in BICAMS Battery were used to evaluate cognitive function. Depression and anxiety were assessed with the Hospital Anxiety Depression (HAD) Scale. RESULTS: The mean age of the patients was 40.9±12.3, the duration of the disease was 9.03±6.89 years, and the mean OAB-V8 score was 17.6±8.9. SDMT test (r=-0.299, p<0.01) showed a moderately significant, CVLT-II (r= -0.219, p<0.05) and BVMT-R (r=-0.218, p<0.05) tests showed a weakly significant negative correlation with OAB-V8 score. There was a moderate positive correlation between the OAB-V8 score and HAD-D (r=0.279, p=0.005) and HAD-A (r=0.318, p=0.001) scores. SDMT and BVMT-R scores were significantly lower in anticholinergic (Ach) drug users (especially oxybutynin users) compared to those who did not use Ach drugs. CONCLUSIONS: It has been observed that the severity of OAB symptoms is related to worsening of information processing speed and an increase in depression and anxiety. It has been determined that there is a significant effect on information processing speed, visual learning and memory in patients using Ach drugs, especially in those using oxybutynin, compared to those who do not use Ach drugs.

Efficacy and safety of mirabegron for treatment of neurogenic detrusor overactivity in adults with spinal cord injury or multiple sclerosis: a systematic review.

STUDY DESIGN: Systematic review. OBJECTIVE: To evaluate the efficacy and safety of mirabegron in patients with neurogenic detrusor overactivity due to SCI or MS. METHODS: A comprehensive search of the Pubmed, Cochrane, Scopus, and Embase databases was performed. Studies evaluating adult patients with neurogenic detrusor overactivity due to SCI or MS were analyzed according to clinical and urodynamic outcome parameters. RESULTS: A total of 488 patients were included in 11 studies, with sample sizes ranging from 15 to 91. The duration of the treatments varied from 4 weeks to 12 months. Mirabegron was used as a secondline treatment after anticholinergics in most of the studies. While clinical outcome parameters are used in studies involving only MS patients, urodynamic outcome parameters are also used in studies involving patients with SCI. The efficacy of mirabegron was found not to be different than anticholinergics when compared in MS patients. Comprehensive urodynamic evaluation was performed in 2 randomized, double-blind, placebo-controlled studies and no satisfactory results were obtained compared to placebo. In retrospective studies there were some significant improvements in Pdet(max), MCC and compliance. The major safety concern with mirabegron is cardiovascular safety. In one study, tachyarrhythmia and palpitations reported in a patient with SCI at C6 level, in another study tachycardia reported in one patient with MS. CONCLUSIONS: Although mirabegron demonstrates similar clinical efficacy to anticholinergics in MS patients, its effect on urodynamic parameters in patients with SCI cannot be considered satisfactory. It has a good safety profile with mild cardiovascular side effects.

Reliability and Validity of the Turkish Version of the Multiple Sclerosis Knowledge Questionnaire.

Introduction: Multiple Sclerosis Knowledge Questionnaire (MSKQ) is a self-administered inventory assessing patients' knowledge about Multiple Sclerosis. In this study, we aimed to test the reliability and validity of MSKQ in Turkish patients. Methods: Patients with Multiple Sclerosis who attended an education seminar in our university hospital were enrolled in the study. Results: Fifty-eight patients completed and returned the questionnaire twice, before and after the seminar. Mean number of items that were answered correctly in the first round was 12.8 (5.2), which increased to 18.7 (3.2) in the second round after the seminar. This increase was found to be significant (p<0.01). Conclusion: Questions regarding general characteristics of the disease were found to be answered correctly more often than those questions regarding diagnostic and treatment options. This finding indicates that patients may be more interested in the general characteristics of the disease and in the factors that may have started the disease process. Higher number of incorrect answers regarding diagnostic and treatment strategies may be caused by a lack of interest on the part of the patient who may perceive these subjects to be too complex or who may choose to leave decision-making to healthcare professionals. Also, physicians may be unable to inform patients in these areas because of a lack of time or resources. New molecules developed for the treatment of Multiple Sclerosis makes it even more difficult for patients to follow and form their own opinions about the treatment process. These results show us that patient education is essential and our patients need more educational resources, especially regarding treatment options. The significant increase in the number of correct answers after the education seminar supports the need for broader patient education (p<0.01). Turkish version of MSKQ is a reliable and valid measure for assessing patients' level of knowledge.

Assessment of nocturnal polyuria in patients with spinal cord injury at three different mobilization phases: A multicenter cross-sectional study.

OBJECTIVE: To determine the prevalence of nocturnal polyuria (NP) in patients with spinal cord injury (SCI) during three different particular phases, and investigate the impact of injury level and injury type on the prevalence of NP. DESIGN: A cross-sectional study. SETTING: Neurogenic Bladder Study Group from six different rehabilitation centers across the country. PARTICIPANTS: 40 patients with SCI. OUTCOME MEASURES: Patients were divided into three groups according to mobilization phase; 1st group included patients confined to bed (n = 14), 2nd group included patients sitting on a wheelchair (n = 19) and 3rd group included patients standing with an assistive ambulation device (n = 7). NP was assessed by nocturnal polyuria index (NPi) and nocturnal urine production (NUP) indexes. RESULTS: No significant difference was found between the groups (P = 0.312 for NPi and P = 0.763 for NUP) in terms of the presence of NP according to their mobilization phase. The night and 24-hour urine volumes showed no significant difference between the groups (P = 0.907 and P = 0.395 respectively). The NPi and NUP values did not show a significant difference between male and female patients (P = 0.826, P = 0.364 respectively), patients with the injury level of ≥T6 and

Evaluation and management of neurogenic bladder after spinal cord injury: Current practice among physical medicine and rehabilitation specialists in Turkey.

OBJECTIVES: This study aims to determine the current trends in evaluation and management of neurogenic bladder secondary to spinal cord injury (SCI) among Physical Medicine and Rehabilitation (PMR) specialists in Turkey. MATERIALS AND METHODS: Between September 2013 and November 2013, a total of 100 PMR specialists from 18 different provinces of Turkey were included in the study. A 23-item questionnaire was developed to evaluate the current practice on assessment and follow-up of upper and lower urinary tract dysfunction. The questionnaire was delivered via e-mail to the participants routinely providing care for patients with SCI and all responses were obtained electronically. RESULTS: For surveillance of the upper urinary tract dysfunction, 93% of the participants preferred ultrasonography. A total of 59% of the participants favored an annual assessment and 36% preferred six-month intervals. Multichannel urodynamics, voiding cystourethrography combined with urodynamics, and video-urodynamics were preferred by 62%, 25%, and 10% of the participants, respectively for surveillance of the lower urinary tract. Urodynamic evaluation was performed annually by 51% of the participants. In patients with detrusor overactivity unresponsive to the combination of intermittent catheterization (IC) and anticholinergic agents, 66% preferred to increase the dose and 22% preferred to switch to another medication. For treatment of areflexic bladder, 78% preferred IC and 12% preferred the Credé' or Valsalva maneuvers. Treatment of asymptomatic bacteriuria was not favored in patients on IC and indwelling urethral catheter by 33% and 44% of the participants respectively. Totally, 84% participants preferred to administer antibiotics for 10 to 14 days for the treatment of symptomatic urinary tract infection. CONCLUSION: Our study results indicate that there are some differences in the current practice of PMR specialists for surveillance and management of SCI patients with neurogenic bladder. These results also emphasize the need for development of guidelines and implementation of continuous medical education activities in this field.

The adaptation of the Turkish version of the Assessment of Knowledge in Ankylosing Spondylitis Patients by a Self-Administered Questionnaire.

OBJECTIVES: The aim of this study was to adapt the Assessment of Knowledge in Ankylosing Spondylitis Patients by a Self-Administered Questionnaire for the Turkish ankylosing spondylitis (AS) patients. PATIENTS AND METHODS: Between May 2016 and December 2016, a total of 100 AS patients (72 males, 28 females; mean age 43.4 years; range, 21 to 73 years) were included in the study. A forward (into Turkish) and backward translation of the questionnaire was performed. Reliability was evaluated using the Cronbach alpha (α) value, test-retest reliability, and intra-class correlations (ICCs). The correlations with demographic data including age, sex, time since diagnosis, and education status and with the disease-specific assessments including Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and the Ankylosing Spondylitis Quality of Life (ASQOL) questionnaire were investigated. RESULTS: The Turkish version of the questionnaire showed a good reliability (Cronbach-α: >0.70, ICC: >0.90). A significant correlation was found with the education status (p<0.001). However, no significant correlation was observed between the questionnaire and the other parameters (p>0.05). CONCLUSION: Our study results show that the Turkish version of the questionnaire seems to be reliable for use in Turkish AS patients.

Reliability and validity of the Turkish version of the intermittent self-catheterization questionnaire in patients with spinal cord injury.

PURPOSE: To evaluate the validity and reliability of the Turkish version of the Intermittent Self-Catheterization Questionnaire (ISC-Q) in patients with spinal cord injury (SCI). This questionnaire evaluates four problems related to the use of ISC, which are ease of use, convenience, discreetness and psychological well-being. METHODS: A total of 60 SCI (40 males, 20 females) patients were included in the study. Reliability was assessed using Cronbach's α and intraclass correlation coefficient (ICC) methods, and the validity was assessed using the correlations between the ISC-Q scores and the scores for the King's health questionnaire (KHQ). RESULTS: The mean age of the study sample was 37.07 ± 12.6 years. Of patients, 56.6% were completely injured. Both the internal consistency (Cronbach's alpha coefficient 0.899-0.947) and the test-retest reliability (intraclass correlation coefficient 0.899-0.947) of the ISC-Q were found to be high in patients with SCI. In the validity analysis, significant positive correlation was identified between convenience, psychological well-being, and total score domains and most subgroups of the KHQ, and also significant negative correlation was found between the discreetness of the domain and the impact of urinary incontinence, role limitation, physical limitation, social limitation and emotional status domains of the KHQ. CONCLUSION: The Turkish version of the ISC-Q can be considered a reliable and valid tool for the evaluation of quality of life related to catheterization in patients with SCI.

The course of post-stroke bladder problems and their relation with functional and mental status and quality of life: A six-month, prospective, multicenter study.

OBJECTIVES: The aim of this study was to evaluate the frequency and course of post-stroke lower urinary tract dysfunction (LUTD) from early term up to a period of six months and to investigate the relation of LUTD with functional and mental status and quality of life (QoL) in stroke patients. PATIENTS AND METHODS: This prospective study included a total of 70 stroke patients (44 males, 26 females; mean age 62.7±7.0 years; range, 46 to 79 years) from five different centers across Turkey between June 2015 and January 2017. The patients were questioned using the Danish Prostatic Symptom Score (DAN-PSS) to evaluate LUTD and evaluated using the Modified Barthel Index (MBI), Incontinence QoL Questionnaire (I-QOL), and Mini-Mental State Examination (MMSE) at one, three, and six months. RESULTS: At least one symptom of LUTD was observed in 64 (91.4%), 58 (82.9%), and 56 (80%) of the patients according to the DAN-PSS at one, three, and six months, respectively. A statistically significant improvement was found in the DAN-PSS, MBI, MMSE, I-QOL total scores, avoidance and psychosocial subgroup scores at six months compared to the first month scores (p<0.05). There was a significant negative correlation between the DAN-PSS symptom score at one month and the MBI, MMSE, and QoL scores at six months. The DAN-PSS bother and total scores were found to be significantly and negatively correlated only with the subscales of the QoL questionnaire. CONCLUSION: Based on our study results, LUTD was very common and the prevalence of LUTD findings decreased constantly during six-month follow-up, showing an association with a poor cognitive and functional status and QoL in stroke patients with LUTD.

Post-stroke lower urinary system dysfunction and its relation with functional and mental status: a multicenter cross-sectional study.

BACKGROUND: Review of the literature clearly reveals that little is known about the association between functional and mental status, and Lower Urinary Tract Dysfunction (LUTD) in patients with stroke. OBJECTIVE: The aim of this study was to assess functional and mental status in stroke patients and to identify possible associations with the prevalence, severity and bother of LUTD. MATERIAL AND METHODS: This study was designed as a cross-sectional study and included 260 stroke patients enrolled from six different hospitals in Turkey. The patients were questioned using the Danish Prostatic Symptom Score (DAN-PSS) Questionnaire to evaluate LUTD, and evaluated using the Modified Barthel Index (MBI), Incontinence Quality of Life Questionnaire (I-QoL), and the Mini Mental State Examination (MMSE). RESULTS: At least one LUTD finding was reported in 243 (93.5%) patients; the most commonly encountered complaint in these patients was nocturia (75.8%). The mean MBI, MMSE, and I-QoL scores were found to be significantly lower in LUTD (+) patients compared to LUTD (-) patients (p = 0.000, p = 0.005, and p < 0.01, respectively). Similarly all parameters (MBI, MMSE, and I-QoL scores) assessed were found to be significantly lower for patients with urinary incontinence than those without incontinence (p = 0.000, p = 0.000, and p < 0.01, respectively). CONCLUSION: LUTD is a common problem in patients with stroke. LUTD is associated with poorer cognitive and functional status and the quality of life in these patients. We, therefore, suggest that bladder dysfunction should not be overlooked during rehabilitation of stroke patients.

Bladder-related quality of life in people with neurological disorders: reliability and validity of the Turkish version of the King's Health Questionnaire in people with spinal cord injury.

OBJECTIVE: To assess the validity and reliability of the Turkish version of the King's Health Questionnaire (KHQ) in patients with spinal cord injury (SCI) and to compare the bladder- related quality of life between patients with SCI and multiple sclerosis (MS). MATERIAL AND METHODS: Thirty-five patients with SCI and 57 patients with multiple sclerosis (MS) were included in the study. For analysis of test-retest reliability, the Turkish version of the KHQ scale was developed using the back translation method, and it was administered on the day of admission and again one week later. The Qualiveen and SF-36 questionnaires were administered to the patients for validity analysis. Moreover, the results of KHQ that had been administered to 35 patients with SCI were compared with those of 57 patients with MS. RESULTS: Both the internal consistency (Cronbach's alpha coefficient: 0.68-0.93) and the test-retest reliability (intraclass correlation coefficient: 0.69-0.94) of the KHQ in patients with SCI were found to be high. Although a weak correlation between the subscales of the KHQ and SF-36, a moderate correlation between the subscales of KHQ, and the Qualiveen questionnaire (0.34

Reliability and validity of the Turkish version of the Danish Prostatic Symptom Score to assess lower urinary tract symptoms in stroke patients.

BACKGROUND: Lower urinary tract dysfunction (LUTD) is one of the most frequently encountered problems in stroke.OBJECTIVE:To assess the validity and reliability of the Turkish Danish Prostatic Symptom Score (DAN-PSS) in stroke patients with LUTD. METHODS: A total of 50 patients were included in the study. The reliability was assessed using Cronbach α and intraclass correlation coefficient (ICC) methods, and the validity using the correlations between the subgroup and overall scores of DAN-PSS and the scores of the Barthel Index (BI), International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and Short Form 36 (SF-36). RESULTS: The Cronbach α values were found >0.97 and ICC 0.953-0.990 for all subgroup scores. We found a significant negative correlation between all the sub-scores of DAN-PSS and the BI, and a significant positive correlation between all the sub-scores of DAN-PSS and ICIQ-SF (p < 0.05). The symptom score of DAN-PSS had a significant negative correlation with the physical functioning, physical and emotional role subdomains of the SF-36 survey (p < 0.05). CONCLUSIONS: We have shown the reliability and validity of the Turkish DAN-PSS, and we think that it will be useful to utilize it in the monitoring of patients with stroke and in clinical studies.

Hyperphosphatemia in a patient with spinal cord injury who received etidronate for the treatment of heterotopic ossification.

INTRODUCTION: Heterotopic ossification (HO) is defined as ectopic bone formation around peripheral joints and in soft tissues. HO is a common complication of diseases of the central nervous system, such as spinal cord injury (SCI) and traumatic brain injury. HO is seen in up to 50% of patients with SCI and typically occurs in the first 12 weeks after onset of injury. Although no treatment method is proven to be curative, nonsteroidal anti-inflammatory drugs, irradiation of the involved body part and bisphosphonates are commonly used in the management of HO. CASE PRESENTATION: Here we present a 27-year-old male patient with a T10 ASIA Impairment Scale (AIS) A SCI, who developed hyperphosphatemia as a complication of bisphosphonate therapy initiated for the treatment of HO during the 6th post-operative week. After cessation of etidronate use, phosphate levels gradually returned to normal over 2 weeks. DISCUSSION: Hyperphosphatemia is a rare complication of etidronate use. It is speculated to result from increased renal tubular phosphate reabsorption and is usually asymptomatic. Although mostly asymptomatic, this complication must be kept in mind while administering etidronate to SCI patients and blood phosphate levels should be monitored in the early weeks of treatment.

Cross-sectional study of urinary problems in adults with cerebral palsy: awareness and impact on the quality of life.

We aimed to assess the functional status, urinary problems, and awareness of these problems in adults with cerebral palsy (CP) and their relationship with the quality of life. One-hundred-seventeen adults with CP (53 women, 64 men) were included in this study. Subjects were asked to fill out a urological questionnaire which dealt with urinary symptoms, awareness of urinary problems, and pharmacological treatment they received. Subjects were also assessed with the Gross Motor Function Classification System (GMFCS), Functional Independence Measures (FIM), Functional Mobility Scale (FMS), and King's Health Questionnaire (KHQ). The mean age of the subjects was 25.3 ± 7.8 years. Of the patients, 83.8% were currently unemployed, 95.7% were single, and 96.5% were living with family. Of the patients, 20.5% had experienced frequency, 38.5% had nocturia, 48.7% had urgency, and 36.8% had urge urinary incontinence. Approximately 80% of the patients did not refer to physician due to urinary problems, and 60% of patients were not recorded history about urinary problem by any physician. Urge urinary incontinence was statistically more frequent in females than males (54.7 and 21.9%,respectively, p < 0.05).Female patients had significantly higher KHQ incontinence impact, role limitation, physical limitation, emotion, incontinence severity measures, and symptom severity subgroup scores than male patients (p < 0.05). Urge urinary incontinence was most frequent (65.4%) in spastic quadriplegic CP (p < 0.05). All functional status scores (GMFCS, FIM-toilet transfer, and FMSs) were worse in spastic quadriplegic patients than other topographical involvement of CP (p < 0.0125). Although the urinary problems are common in adult with CP, it is yet an overlooked condition that could affect quality of life. Therefore, health care professionals, patients, and their caregivers should be aware of the increased risk of urinary problems in these patients.

Assessment of voiding dysfunction in Parkinson's disease: Reliability and validity of the Turkish version of the Danish Prostate Symptom Score.

AIMS: To investigate the reliability and validity of the Turkish version of the Danish Prostate Symptom Score (Dan-PSS) questionnaire in patients with Parkinson's disease (PD) and to compare the burden of LUTS (Lower urinary tract symptoms) in men and women. METHODS: For analysis of test-retest reliability, the Turkish version of the Dan-PSS scale was developed using the back translation method, and it was administered on the day of admission and repeated 1 week after in 60 patients with PD. The OAB-q (Overactive Bladder Questionnaire) and PDQ-39 (Parkinson's Disease Questionnaire-39) were administered to 73 patients for validity analysis. RESULTS: Both the internal consistency (Cronbach's alpha coefficient: 0.99-1.00) and the test-retest reliability (intraclass correlation coefficient: 0.99-1.00) of the Dan-PSS were found to be high in patients with PD. Although weak to moderate correlations were found between the subscales of the Dan-PSS and PDQ-39 (r: 0.20-0.42; P < 0.05), a strong correlation was found with the OAB-q (r: 0.60-0.79; P < 0.05). Nocturnal urination was the most frequent (93.2%), and bothersome (54.8%) symptom. The majority of the symptom and bother responses were similar in men and women. CONCLUSIONS: Current study shows that the Turkish version of the Dan-PSS questionnaire is an internally consistent, reliable, and valid scale for patients with PD. Therefore, it can be used to evaluate frequency and severity of LUTS in PD. LUTS are commonly seen in patients with PD in both sexes. It is suggested that all patients with PD should be referred for urological assessment.

Telephone interview strategy can be used for screening inflammatory back pain in the community.

OBJECTIVE: Telephone surveys are less expensive and time-consuming for both interviewers and interviewees, with similar or even higher response rates than face-to-face interviews. In rheumatology, telephone technique has been used in a number of epidemiologic studies. In the present study, we conducted a telephone survey for screening inflammatory back pain (IBP) in the community. METHODS: One hundred and seventy-two patients with axial spondyloarthritis (axSpA) and 25 patients with chronic mechanical back pain were included. A telephone interview and a face-to-face interview was conducted by the same physician using a standardized questionnaire that elicited information on all the components of IBP addressed in the Calin, Berlin and ASAS (the Assessment of SpondyloArthritis International Society) criteria sets. The telephone survey was repeated by another rheumatologist within the same week to assess the inter-rater agreement. RESULTS: Of 172 patients with axSpA, 114 could be classified as ankylosing spondylitis (AS) according to the modified New York criteria (AS group).The remaining 58 patients had active sacroiliitis on magnetic resonance imaging and they constituted the non-radiographic axSpA group (nr-axSpA group). Calin's criteria showed the highest sensitivity but also the lowest specificity with both interview methods. Calin's criteria showed the best agreement between the interview methods (kappa = 0.60). CONCLUSION: The results of our study indicate that telephone surveys based on Calin's criteria for IBP has a moderate, almost substantial agreement with face-to-face interviews and can be used as an easily applicable, less expensive and time-saving method in screening subjects for IBP.

Postural deformities: potential morbidities to cause balance problems in patients with ankylosing spondylitis?

OBJECTIVE: This study aimed to assess the impact of postural deformities caused by ankylosing spondylitis (AS) on balance problems. MATERIAL AND METHODS: This study included 29 patients with AS and 21 healthy controls. For assessing exercise capacity and dynamic balance, timed up and go test, five times sit-to-stand test, gait speed, and 6-min walk test were performed. Romberg tests were used to evaluate static balance and proprioception, whereas Dynamic Gait Index (DGI), Functional Gait Assessment (FGA), Berg Balance Scale (BBS), Activity Specific Balance Confidence Scale (ABC), Dizziness Handicap Inventory (DHI), and functional reach test were used to assess dynamic balance and the risk of falling. Using Bath Ankylosing Spondylitis Metrology Index (BASMI) scores, patients with AS were divided into two groups: those with scores 0-4 were assigned to subgroup AS1, and those with scores 5-10 were assigned to subgroup AS2. RESULTS: In the whole group of patients with AS, five times sit-to-stand test, tandem Romberg test with eyes closed, and BBS and ABC scores were significantly worse than the healthy controls (p<0.05). In the AS2 subgroup having more severe and advanced disease, five additional parameters, including timed up and go test, 6-min walk test, functional reach test, FGA, and DHI scores were also significantly worse than the healthy controls (p<0.05). Comparing the two subgroups with each other, only BBS scores were significantly worse in the AS2 subgroup than in the AS1 subgroup. CONCLUSION: Although in clinical practice, poor balance is not a common problem in AS, possibly because of compensatory mechanisms, patients with AS have poorer static and dynamic balance than healthy subjects. Significantly worse BBS scores in the AS2 subgroup than in the AS1 subgroup may suggest the presence of more dynamic balance problems in advanced disease; however, future studies comprising larger samples are necessary to confirm this assumption.

Is customized vestibular rehabilitation effective in patients with multiple sclerosis? A randomized controlled trial.

BACKGROUND: Balance disorders are among the most common problems encountered by patients diagnosed with multiple sclerosis (MS). AIM: The purpose of this randomized, controlled trial was to investigate the effects of customized vestibular rehabilitation (VR) on balance, functional capacity, quality of life, and depression in patients with MS. DESIGN: This study was designed as a prospective, randomized, controlled trial. SETTING: The study was carried out in a single tertiary referral center. POPULATION: Forty consecutive patients referred with a diagnosis of MS were randomized into two groups: an exercise group (N.=20) and a control group (N.=20). METHODS: The experimental group underwent customized VR and the wait-listed control group received the usual medical care. All of the patients were assessed with objective balance tests (Romberg Test, Tandem Romberg Test, Foam Romberg Test, Static Posturography, Six-Meter Walk Test, Five Times Sit-to-Stand Test, Berg Balance Scale, Timed Up and Go Test, Functional Gait Assessment, and Dynamic Gait Index), subjective balance parameters (Activities-Specific Balance Confidence Scale and Dizziness Handicap Inventory), and functional capacity (Six-Minute Walking Test), quality of life (Multiple Sclerosis Quality of Life-54), and depression (Beck Depression Inventory) scales. RESULTS: At the end of the trial, the exercise group exhibited significant changes in most of the evaluated parameters compared to the control group [except the Tandem Romberg with eyes closed and the Foam Romberg, standing with eyes open (P<0.05). No significant differences were observed in any of the parameters in the control group (P>0.05). The intergroup comparisons of differences indicated significant recoveries in favor of the exercise group in all of the evaluated parameters (P<0.05). CONCLUSIONS: This study confirms the effects of customized VR programs on balance, quality of life, and functional capacity in patients with MS. CLINICAL REHABILITATION IMPACT: Customized VR is an effective method for treating balance disorders in patients with MS.

Overactive bladder symptoms in patients with multiple sclerosis: Frequency, severity, diagnosis and treatment.

OBJECTIVE: To determine the frequency and severity as well as the diagnosis and treatment of overactive bladder problems in patients with multiple sclerosis (MS) followed up at five centers in Turkey. DESIGN: Survey study. SETTING: Outpatient tertiary clinics of physical medicine and rehabilitation and neurology. PARTICIPANTS: Consecutive MS patients scheduled for outpatient follow-up (n = 309). INTERVENTION: MS patients were asked to complete a questionnaire regarding the frequency and severity, as well as the diagnosis and treatment of their overactive bladder problems. RESULTS: The mean age ± SD was 39.3 ± 10.6 years. Urinary urgency was the most common urinary symptom (62%), followed by frequency (50.4%), urge incontinence (44.7%) and nocturia (33%). Residual urine volume was measured using a portable ultrasound instrument in 13.3% of the patients and by catheterization in 16.2% of them. Urodynamic investigations and urinary tract ultrasound were performed on 26.5% and 35.3% of the patients, respectively. Anticholinergic medications were prescribed for 27.5% of the patients. Intermittent catheterization and indwelling catheterization were used on 8.1% and 1.9% of the patients, respectively. The overactive bladder symptom score (OABSS) was significantly higher in patients who had had residual urine measurement (P < 0.001), upper urinary tract assessment by ultrasound (P < 0.001), urodynamic assessment (P < 0.001), admitted to a doctor for urinary symptoms (P < 0.001), and current or past catheter use (P = 0.002). CONCLUSION: Urgency was the most common urinary symptom followed by frequency, urge incontinence and nocturia in MS patients. The patients with lower OABSS had detailed urological assessments less frequently than the patients with higher OABSS.

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.

Performance of different criteria sets for inflammatory back pain in patients with axial spondyloarthritis with and without radiographic sacroiliitis.

It is important to recognize inflammatory back pain (IBP) for an early diagnosis of ankylosing spondylitis (AS). Assessment of Spondyloarthritis International Society (ASAS) has recently published new criteria set for diagnosing IBP. In the present study, we evaluated the performance of the new ASAS IBP criteria and to compare the performance of IBP criteria sets in axial spondyloarthritis (axSpA) patients with and without radiographic sacroiliitis. The study sample included a total of 274 patients with a diagnosis of axSpA and 50 patients with a diagnosis of chronic (>3 months) mechanical back pain (MBP). A face-to-face interview by using a standardized questionnaire addressing all the components of IBP was performed. Data about HLA-B27 status and C-reactive protein levels were obtained from the patients' charts. There were significantly more male patients (P < 0.001) in the AS group (68.6 %) than in the non-radiographic axSpA group (29.6 %) and also than in the MBP group (37.5 %). Among the criteria sets, the Calin criteria showed the best sensitivity (91.2 %), and the Berlin criteria showed the best specificity (82.4 %) in differentiation of IBP from MBP. If the morning stiffness item of the Calin criteria was defined as lasting >30 min (Calin 30), the specificity improved (72.9 %), but at a price of loss in sensitivity (82.4 %). In this study, new ASAS criteria for IBP performed almost as good as but not better than the existing criteria sets. Performances of the criteria sets were quite comparable in the differentiation of IBP from MBP in patients with and without radiographic sacroiliitis.