The Association of Vitamin D Levels and the Frailty Phenotype Among Non-geriatric Dialysis Patients: A Cross-sectional Study.

OBJECTIVES: The aim of this study was to investigate the frequency of frailty and the association of vitamin D levels and the frailty phenotype among non-geriatric dialysis patients. METHOD: Seventy-four stable, chronic hemodialysis patients from the hemodialysis unit of the hospital were enrolled in the study. The patients' medical histories and laboratory findings were obtained from the medical records of the dialysis unit. Serum parathyroid hormone and 25-hydroxy vitamin D levels were determined using chemiluminometric immunoassays. Frailty was defined by Fried et al. as a phenotype; shrinking, weakness, self-reported exhaustion, decreased activity and slowed walking speed were evaluated. RESULTS: Forty-one (55%) of the patients were males. The patients were divided into 3 groups according to frailty scores: 39 (53%) patients were frail, 6 (8%) patients were intermediately frail, and 28 (39%) patients were normal. Significant differences were found for 25-hydroxy vitamin D and hemoglobin levels among the groups; however, no differences were observed in body mass index, comorbidities, sex, marital status, education, disease and dialysis durations, or parathyroid hormone, creatinine, serum calcium, phosphorus, and potassium levels. CONCLUSIONS: Weakness and slowness are serious outcomes of both vitamin D deficiency and frailty, and vitamin D deficiency has been associated with increased risks of decreased physical activity, falls, fractures and death in postmenopausal women and older men. Although studies on frailty have focused on older adults, growing evidence indicates that the frailty phenotype is becoming a factor associated with poor health outcomes in non-geriatric populations with chronic disease.

Reliability and validity of Duruoz Hand Index in carpal tunnel syndrome.

OBJECTIVES: The aim of this study is to investigate the reliability and validity of Duruoz Hand Index (DHI) in patients with carpal tunnel syndrome (CTS). PATIENTS AND METHODS: A total of 55 patients (50 females, 5 males; mean age 51.0±10.2 years: range, 30 to 73 years) aged ≥18 years who were admitted to the outpatient clinic of a rehabilitation hospital between December 2010 and December 2012 with the diagnosis of CTS both clinically and electrophysiologically were included in this study. All patients completed DHI at baseline and repeated after a week interval. The Boston Questionnaire (BQ) and Health Assessment Questionnaire Disability Index (HAQ-DI) were filled out at baseline. And the internal consistency reliability was tested using the Cronbach's alpha. For the test-retest reliability, intraclass correlation coefficients (ICC) were calculated. The correlations between the DHI and both BQ and HAQ-DI were investigated for the construct validity. RESULTS: Of the patients, 41 (74.5%) were housewives. Carpal tunnel syndrome was bilateral in 29 patients (52.7%). The Mean Body Mass Index was 31.2±5.5 kg/m2. The mean symptom duration was 22.8±23.7 months. The mean DHI scores for the first and second evaluations were 23.25±20.64 and 20.45±20.07, respectively. The mean BQ symptom severity and functional status scores were 2.87±0.80 and 2.72±1.03, respectively. The mean HAQ-DI score was 0.91±0.66. The Cronbach's alpha was 0.97 indicating excellent internal consistency reliability. There was a statistically significant correlation between the two measurements of DHI. The ICC value for total score was 0.88 indicating good reliability. There was a statistically significantly positive correlation between the DHI and BQ (r=0.638, p<0.001). Also, DHI was significantly correlated with the HAQ-DI (0.613, p<0.001). CONCLUSION: Our study results suggest that DHI is a reliable and valid test which can be used for evaluating hand functions in CTS patients.

The association of vitamin D levels and the frailty phenotype among non-geriatric dialysis patients: a cross-sectional study

OBJECTIVES: The aim of this study was to investigate the frequency of frailty and the association of vitamin D levels and the frailty phenotype among non-geriatric dialysis patients. METHOD: Seventy-four stable, chronic hemodialysis patients from the hemodialysis unit of the hospital were enrolled in the study. The patients' medical histories and laboratory findings were obtained from the medical records of the dialysis unit. Serum parathyroid hormone and 25-hydroxy vitamin D levels were determined using chemiluminometric immunoassays. Frailty was defined by Fried et al. as a phenotype; shrinking, weakness, self-reported exhaustion, decreased activity and slowed walking speed were evaluated. RESULTS: Forty-one (55%) of the patients were males. The patients were divided into 3 groups according to frailty scores: 39 (53%) patients were frail, 6 (8%) patients were intermediately frail, and 28 (39%) patients were normal. Significant differences were found for 25-hydroxy vitamin D and hemoglobin levels among the groups; however, no differences were observed in body mass index, comorbidities, sex, marital status, education, disease and dialysis durations, or parathyroid hormone, creatinine, serum calcium, phosphorus, and potassium levels. CONCLUSIONS: Weakness and slowness are serious outcomes of both vitamin D deficiency and frailty, and vitamin D deficiency has been associated with increased risks of decreased physical activity, falls, fractures and death in postmenopausal women and older men. Although studies on frailty have focused on older adults, growing evidence indicates that the frailty phenotype is becoming a factor associated with poor health outcomes in non-geriatric populations with chronic disease.

The clinical factors associated with benefit finding of complementary medicine use in patients with back pain: A cross-sectional study with cluster analysis.

BACKGROUND: Complementary and alternative medicine (CAM) use has been increasing. OBJECTIVE: To identify the factors associated with perceived benefit from CAM methods in back problems. METHODS: The study was conducted on patients who practiced any CAM methods due to complaints of back pain. Social-demographic properties, details of CAM methods employed were questioned. Severity of pain was measured by visual analog scale (VAS); benefits were evaluated by the Likert scale. Hierarchical cluster analysis was used to discover relationships among variables. RESULTS: In total, 500 patients (265 female, 235 male) were included in the study. Mostly used methods were herbal therapy (32%), balneotherapy (31%), cupping (19.4%) and massage-manipulation (19.2%). Of patients, 355 (71%) were satisfied. The variables associated with benefit finding were female gender, age, chronicity and severity of pain, high educational level, upper middle income status, use as a result of recommendation, dissatisfaction with conventional methods, residence in an urban area, non-herbal method use, being married, and social insurance (p < 0.005). CONCLUSION: The majority of patients using CAM perceived benefits; in particular, women living in urban areas, highly educated, aged more than 40, who suffer from severe chronic back pain, may be more inclined to go to CAM therapists.

Long-Term Results of Mini-Open Repair Technique in the Treatment of Acute Achilles Tendon Rupture: A Prospective Study.

An ideal surgical treatment of acute Achilles tendon rupture includes restoring the original length of the tendon, minimizing possible adhesions with the surrounding tissues, minimizing the risk of repeat rupture, alleviating wound problems, and providing an acceptable cosmetic outcome. In the mini-open repair technique, unlike the percutaneous repair technique, the quality of the tenodesis can be visualized without disturbing the healing potential of the surrounding tissues, thus minimizing wound problems. The purpose of the present study was to assess the long-term results of the mini-open repair technique in patients with acute Achilles tendon rupture. A total of 20 consecutive patients with acute Achilles tendon rupture, admitted to our inpatient clinic from October 2003 to March 2008, were included in the present study. The patients underwent Achilles tenodesis with the mini-open repair technique, and each patient was followed up for 5 years. The study was completed in April 2013. The surgical procedure was performed with the assistance of a device designed in our orthosis laboratories, similarly to that defined by Assal et al. Of the 20 patients, 18 were male and 2 were female. Their mean age was 39.3 (range 21 to 55) years. The Achilles tendon rupture was located on the left side in 15 patients (75%) and on the right side in 5 patients (25%). The mean follow-up duration was 58.5 (range 18 to 60) months and no complications occurred during the follow-up period, including repeat rupture, wound site infection, and sural nerve injury. The mean American Orthopaedic Foot and Ankle Society scale score for the patients was 99.2 (range 94 to 100) points at the final follow-up visit. All our patients were able to return to work and sporting activities. According to the Trillat scores, the outcome was excellent in 19 patients and good in 1 patient at the 18th postoperative month. No complaint, such as pain or loss of function, that might have a negative effect on the patients' business or social life was detected in 18 patients who were assessed at 5 years after surgery; 2 patients could not be reached at 5 years. In conclusion, as a technique combining percutaneous and open surgical techniques, mini-open repair of Achilles tendon rupture allows a satisfactory end-to-end approximation of the tendon just in the open surgery and provides the wound healing advantages of percutaneous surgery.

The effect of neuromuscular electrical stimulation on functional status and quality of life after knee arthroplasty: a randomized controlled study.

[Purpose] The aim of this study was to investigate the effect of the addition of NMES to the post-TKA rehabilitation protocol on the functional status and quality of life of the patients. [Subjects and Methods] Patients were randomized into an exercise (control) and electrical stimulation (NMES) group. A home exercise program was prescribed for the control group. For the neuromuscular stimulation group 30 minute electrical stimulation applied to the vastus medialis muscle 5 days a week for 4 to 6 weeks. VAS, the timed up and go test, WOMAC and SF-36 scores were evaluated preoperatively and postoperatively at the first month and the third month of the follow-up period. [Results] Both the NMES group had 30 patients each, with 2 and 1 male patients respectively. The comparisons of WOMAC results at month 1 revealed that pain, stiffness, and total scores of the NMES group was significantly better than those of control group at the first and third months. Significantly better physical function and SF-36 subscales, except mental health, were found for the NMES group at the first month of follow-up. [Conclusion] The inclusion of the neuromuscular electrical stimulation program after knee arthroplasty was more effective at providing rapid improvements in knee pain, walking distance and quality of life.

The relationship between vitamin D status, physical activity and insulin resistance in overweight and obese subjects.

Type 2 diabetes mellitus (T2DM) incidence has been increasing worldwide along with the rise of obesity and sedantery lifestyle. Decreased physical activity (PA) and obesity have also been associated with the low vitamin D levels. We aimed to determine the association between PA, vitamin D status and insulin resistance in overweight and obese subjects. A total of 294 (186 female, 108 male) overweight or obese subjects were included in this cross-sectional study. 25-hydroxy vitamin D (25(OH)D), insulin, fasting plasma glucose (FPG) and HbA1c levels were measured in blood samples. Body mass index (BMI), HOMA-index and total score of International Physical Activity Questionnaire-long form (IPAQ) were calculated. Insulin resistant subjects were compared with the non-resistant group. The mean age of the participants was 45 ± 12.25 and 41.39 ± 10.32; 25(OH)D levels were 8.91 ± 4.30 and 17.62 ± 10.47 ng/dL; BMIs were 31.29 ± 4.48 and 28.2 ± 3.16 kg/m², IPAQ total scores were 548.71 ± 382.81 and 998 ± 486.21 in the insulin resistant and nonresistant subjects, respectively. There was a statistically significant difference in terms of 25(OH)D, FPG, insulin levels, IPAQ total score and BMI between the two groups (p = 0.001, p = 0.001, p = 0.001, p = 0.001, p = 0.001).Significantly low 25(OH)D levels, high BMI and low PA in insulin resistant subjects confirm the importance of active lifestyle and the maintenance of normal vitamin D levels in overweight and obese subjects in prevention of T2DM.

Relationship between restless leg syndrome and quality of life in uremic patients.

OBJECTIVES: Patients with RLS suffer nonrestorative sleep, daytime sleepiness, fatigue, and concentration problems. In addition, dialysis itself effects the psychological and social life of the patient negatively. The aim of this study was to determine the prevalence of RLS in patients on regular hemodialysis, and its relationship with patients' quality of life, socio-demographic and laboratory data. METHODS: One hundred and eighteen stable chronic hemodialysis (HD) patients referring to the hemodialysis unit of Turkish Kidney Foundation and 49 patients that met IRLSSG diagnostic criteria were included into the study. IRLSSG Diagnostic Criteria and International Restless Leg Syndrome rating scale were used as a guideline to diagnose and evaluate the severity of RLS. Short form-36 health survey was used to evaluate the quality of life. For statistical analysis, the "SPSS for Windows" package program was used. RESULTS: A total of forty-nine patients, of whom 26 were female and 23 were male, that met IRLSSG diagnostic criteria were included into the study. Mean age of the patients was 61.35 ± 13.17 years. There was a negative correlation between the IRLSS score and SF36 Physical Score, Mental Score and Total Score, respectively (p=0.018 r=-0.351, p=0.01 r=-0.380, p=0.00 r=-0.499). There was no significant correlation between the IRLSS score and dialysis duration, blood ferritin and parathyroid hormone and other comorbid diseases. CONCLUSION: RLS is a common distressing problem in patients with ESRD, which negatively impacts functional health status. Clinicians should be aware of the symptoms of RLS to decrease morbidities related with quality of life.

Efficacy of conventional ultrasound therapy on myofascial pain syndrome: a placebo controlled study.

OBJECTIVES: Myofascial pain syndrome (MPS) is a complex pain syndrome characterized with trigger points (TP) in skeletal muscles. We aimed to assess the efficacy of ultrasound (US) therapy, which is one of the main devices used in physical medicine and rehabilitation, for the treatment of TP in MPS. METHODS: Fifty nine patients (49 females, 10 males) with active TP on the upper trapezius fibers were randomized into the treatment (n=30) and the control groups (n=29). The treatment group received conventional US therapy for 6 minutes, on 1.5 Watt/cm2 dose with 1 MHz frequency for 15 days whereas a placebo US therapy was administered to the control group. Prior to the treatment, immediately and 3 months later pain severity during rest and physical activity was assessed with visual analog scale (VAS), TP tenderness was measured with 0-5 scale, pressure pain threshold (PPT) was analyzed with algometer and the depression level was evaluated with Beck's depression questionnaire (BDP) by a clinician blinded to the groups. RESULTS: The mean age of the patients were 37.43±9.07 and 35.83±5.68 years, in the treatment and control groups, respectively. Compared to the pre-treatment values VAS, 0-5 scale and BDP scores decreased (p<0.01) along with an increase in PPT (p<0.01) in both groups at the follow-up visits. 0-5 scales and BDP scores were significantly lower and PPT was significantly higher in the treatment group, compared to the control group (p<0.001). CONCLUSION: Our results revealed that US treatment is effective on MPS.

Gait speed and related factors in Parkinson's disease.

[Purpose] The aim of this study was to investigate the relationship between gait speed and various factors in ambulatory patients with idiopathic Parkinson's disease. [Subjects] Fifty ambulatory patients with idiopathic Parkinson's disease who were admitted to an outpatient clinic were included in this cross-sectional study. [Methods] The Hoehn and Yahr Scale was used for measurement of the disease severity. Gait speed was measured by the 10-Meter Walk Test. Mobility status was assessed by Timed Up and Go Test. The Hospital Anxiety and Depression Scale was used for evaluation of emotional state. Cognitive status was examined with the Mini-Mental State Examination. The Downton Index was used for fall risk assessment. Balance was evaluated with the Berg Balance Scale. Comorbidity was measured with the Cumulative Illness Rating Scale. The 36-Item Short Form Health Survey was completed for measurement of quality of life. [Results] The mean age was 66.7 (47-83) years. Twenty-eight (56%) patients were men. Gait speed was correlated positively with height, male gender, Mini-Mental Examination score, Berg Balance Scale score and physical summary scores of the 36-Item Short Form Health Survey. On the other hand, there was a negative correlation between gait speed and age, disease severity, TUG time, Downton Index, fear of falling, previous falls and the anxiety and depression scores of the Hospital Anxiety and Depression Scale. There was no correlation between gait speed and comorbidity. [Conclusion] The factors related with the slower gait speed are, elder age, clinically advanced disease, poor mobility, fear of falling, falling history, higher falling risk, and mood disorder.

Effectiveness of platelet-rich plasma in the treatment of moderate knee osteoarthritis: a randomized prospective study.

[Purpose] To assess the effects of different numbers of platelet-rich plasma (PRP) applications on pain and physical function in grade 3 knee osteoarthritis (OA). [Subjects and Methods] A total of 102 patients with grade 3 knee OA were randomly divided into three groups: Group 1 received a single injection of PRP, Group 2 received two injections of PRP two weeks apart, Group 3 received three injections of PRP at 2-weeks intervals. All patients were evaluated with a visual analog scale (VAS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and the Timed-Up and Go test (TUG) before the treatment and at 1, 3 and 6 months after the treatment. [Results] Ninety-eight patients (15 males, 83 females) completed the study. The mean ages of the patients were 53.5±6.6, 54.9±5.3, and 55.1±5.6 years in Group 1, Group 2, and Group 3, respectively. Statistically significant improvements were noted in all of the evaluated measures in all of the groups. The mean differences of Group 1-Group 2 and Group 1-Group 3 WOMAC total, WOMAC pain, WOMAC stiffness, and WOMAC function scores were statistically significant. [Conclusion] PRP is an effective treatment for functional status and pain in moderate knee osteoarthritis and a minimum of two injections is appropriate.

Effect of body mass index on functional recovery after total knee arthroplasty in ambulatory overweight or obese women with osteoarthritis.

OBJECTIVE: The aim of this study was to evaluate the relationship between body mass index (BMI) and functional status after total knee arthroplasty (TKA) in ambulatory overweight or obese women with knee osteoarthritis (OA). METHODS: The study included 78 women who underwent elective primary TKA for osteoarthritis. Age, height, body weight and BMI were recorded. Functional status was evaluated using the Turkish version of the Knee Injury and Osteoarthritis Outcome Score (KOOS). The Timed Up and Go (TUG) test was used to evaluate performance-based functional assessment. RESULTS: Mean age of the patients was 66.5 ± 5.8 (range: 56 to 79) years and mean duration of symptoms was 9.56 ± 7.1 years. Body mass index was 30 or higher in 47 patients (60%) and between 25 and 29 in 31 (40%). Body mass index did not correlate with the KOOS or TUG test. Postoperative KOOS scores showed a statistically significant increase (p<0.01). Postoperative TUG test values showed significant improvement (p<0.01). CONCLUSION: Body mass index had no negative effect on functional recovery and mobility in the ambulatory overweight or obese women undergoing TKA. Physical function improved significantly after knee arthroplasty.

Factors affecting the outcome of osteochondral autografting (mosaicplasty) in articular cartilage defects of the knee joint: retrospective analysis of 152 cases.

OBJECTIVE: The purpose of this retrospective study was to evaluate the results and prognostic factors affecting the outcome of osteochondral autografting (mosaicplasty) in articular cartilage defects of the knee joint. MATERIALS AND METHODS: One hundred fifty-two patients who underwent mosaicplasty for femoral condylar cartilage defects (modified Outerbridge classification: Grade III and IV) of the knee joint between 1998 and 2007 in our institution were included. There were 126 male and 26 female patients with a mean age of 24.8 ± 4.6 years. The average size of the lesion was 2.7 ± 0.7 cm(2). Of these patients, 33 had concomitant meniscal and/or cruciate ligament injuries which were treated simultaneously. All patients were followed up with a mean of 18.2 ± 4.2 months (range 12-24 months) using Lysholm knee score. We analyzed the relationship between the outcome variable (Lysholm knee score at the final follow-up) and the predictor variables (age, gender, lesion size, lesion grade, localization, accompanying intra-articular injuries and duration of follow-up). RESULTS: The mean preoperative Lysholm knee score was 55.2 ± 3.6 points and increased to 88.2 ± 2.5 points at the final follow-up. There was a significant increase in Lysholm score during follow-up period (p = 0.0001). The results were excellent in 2 cases (1.3 %), good in 144 cases (94.7 %) and fair in 6 cases (3.9 %). No patients had infection, systemic complication and revision surgery. Backward regression analysis showed that age, lesion size, localization and associated intraarticular injuries are the only predictors of the final Lysholm knee score in best fit model (R (2) = 0.442, p = 0.0001). The linear regression equation was (Lysholm score at final follow-up) = 93.4 - [0.2 (age of patient) + 0.8 (lesion size) + 0.9 (localization) + 2.8 (presence of associated intraarticular injuries)]. CONCLUSIONS: Mosaicplasty is an effective technique for the treatment of articular cartilage defects of the knee joint which restores the joint function in a short period of follow-up. Furthermore, age, lesion size, localization, and concomitant surgical interventions are major factors affecting the final outcome. The final knee score deteriorates as the age of the patient and size of the lesion increases. Furthermore, concomitant surgical interventions and lesions located on the medial femoral condyle have a negative effect on the final knee score.

Open mosaicplasty in osteochondral lesions of the talus: a prospective study.

Osteochondral lesions of the talus present with symptoms of pain and painful motion, affecting the quality of the patient's daily life. We evaluated the 2-year short-term outcomes of patients whose large osteochondral lesions of the talus were treated with medial malleolar osteotomy and a mosaic graft harvested from the knee on the same side. A total of 32 patients who had cartilage lesions due to osteochondritis dissecans in the medial aspect of the talus underwent mosaicplasty after medial malleolar osteotomy. The patients were followed up for a mean period of 16.8 (range 12 to 24) months. The staging and treatment plan of the osteochondral lesions of the talus were made according to the Bristol classification. The follow-up protocol for the patients included direct radiography and magnetic resonance imaging. The American Orthopaedic Foot and Ankle Society scoring system was used to assess the patients during the pre- and postoperative periods. Of the 32 patients, 3 (9.4%) were female and 29 (90.6%) male, with a mean age of 27.5 (range 20 to 47) years. The mean preoperative American Orthopaedic Foot and Ankle Society score was 59.12 ± 7.72 but had increased to 87.94 ± 3.55 during the postoperative 2 years. The increase in American Orthopaedic Foot and Ankle Society score was statistically significant (p < .05). We have concluded that open mosaicplasty is a reliable and effective method for the treatment of osteochondral lesions with subchondral cyst formation in the talus, exceeding 1.5 cm in diameter.