Validation of the Comprehensive ICF Core Set for Multiple Sclerosis: A Turkish clinical perspective.

Objectives: The aim of this study was to evaluate the results of the construct validity of the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Multiple Sclerosis (MS) and to identify the impact of MS on specific health domains according to the ICF categories in Turkish individuals. Patients and methods: Between December 2011 and December 2012, a total of 150 individuals with MS (69 males, 81 females; mean age: 39.8±8.0 years; range, 19 to 52 years) who were diagnosed by a neurologist at least six months previously were included. The Comprehensive ICF Core Set for MS was used to assess functioning, disability, and environmental factors in all participants. The Spearman correlation coefficient was used to determine construct validity of the ICF Core Set between the ICF components and disease-specific and general measurements. Results: The most frequently coded impairments in the body functions component were b280 sensation of pain, b134 sleep functions, b1301 motivations, and b740 muscle endurance functions. The most frequently coded impairments in the body structures component were s110 structure of brain, s120 spinal cord and related structures and s750 structure of lower extremity. A significant problem was documented in 47 of the 53 categories of the activities and participation. Of the 38 categories in the environmental factors, 23 were identified as a facilitator, while 12 categories were identified as a barrier. All body function, structure, activities and participation and environmental factors categories showed a significant correlation with disease-specific and generic measures. Conclusion: Based on these results, the ICF Core Set may help to determine major facilitators or barriers to functioning and disability and a targeted rehabilitation approach in patients with MS.

Applying the WHO ICF framework to long COVID patients with persistent respiratory symptoms.

Objectives: The aim of this study was to evaluate long COVID patients with persistent respiratory symptoms through the application of the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) framework. Patients and methods: This national, prospective, multicenter, cross-sectional study was conducted with 213 patients (118 females, 95 males; median age 56 years; range, 20 to 85 years) with long COVID between February 2022 and November 2022. The ICF data were primarily collected through patient interviews and from the acute medical management records, physical examination findings, rehabilitation outcomes, and laboratory test results. Each parameter was linked to the Component Body Functions (CBF), the Component Body Structures (CBS), the Component Activities and Participation (CAP), the Component Environmental Factors (CEF), and Personal Factors according to the ICF linking rules. Analysis was made of the frequency of the problems encountered at each level of ICF category and by what percentage of the patient sample. Results: In the ICF, 21 categories for CBF, 1 category for CBS, and 18 categories of CAP were reported as a significant problem in a Turkish population of long COVID patients with persistent respiratory symptoms. Furthermore, eight categories for CEF were described as a facilitator, and four as a barrier. Conclusion: These results can be of guidance and provide insight into the identification of health and health-related conditions of long COVID patients with persistent respiratory symptoms beyond the pathophysiological aspects, organ involvement, and damage of COVID-19. The ICF can be used in patients with long COVID to describe the types and magnitude of impairments, restrictions, special needs, and complications.

COVID-19, cardiac involvement and cardiac rehabilitation: Insights from a rehabilitation perspective - State of the Art.

Since the beginning of the pandemic, many novel coronavirus disease 2019 (COVID-19) patients have experienced multisystem involvement or become critically ill and treated in intensive care units, and even died. Among these systemic effects, cardiac involvement may have very important consequences for the patient's prognosis and later life. Patients with COVID-19 may develop cardiac complications such as heart failure, myocarditis, pericarditis, vasculitis, acute coronary syndrome, and cardiac arrhythmias or trigger an accompanying cardiac disease. The ratio of COVID-19 cardiac involvement ranges between 7 and 28% in hospitalized patients with worse outcomes, longer stay in the intensive care unit, and a higher risk of death. Furthermore, deconditioning due to immobility and muscle involvement can be seen in post-COVID-19 patients and significant physical, cognitive and psychosocial impairments may be observed in some cases. Considering that the definition of health is "a state of complete physical, mental and social well-being", individuals with heart involvement due to COVID-19 should be rehabilitated by evaluating all these aspects of the disease effect. In the light of the rehabilitation perspective and given the increasing number of patients with cardiac manifestations of COVID-19, in this review, we discuss the rehabilitation principles in this group of patients.

Is there a role of pulmonary rehabilitation in extrapulmonary diseases frequently encountered in the practice of physical medicine and rehabilitation?

There is a group of diseases such as low back pain, osteoporosis, fibromyalgia and obesity for which pulmonary rehabilitation can be applied. Although these diseases do not directly impact the lungs, respiratory dysfunction occurs through various mechanisms during the disease process and complicates the underlying primary disease. Respiratory dysfunction and spirometric abnormalities have been observed from the early stages of these diseases, even without obvious signs and symptoms. These patients should be carefully evaluated for pulmonary problems as a sedentary lifestyle may hide the presence of respiratory symptoms. Once pulmonary problems have been detected, pulmonary rehabilitation should be added to the routine treatment of the primary disease.

Quality of life, body image, and mobility in lower-limb amputees using high-tech prostheses: A pragmatic trial.

BACKGROUND: High-tech prostheses are supposed to achieve better functional recovery over mechanical-controlled prostheses in lower-limb amputees. However, quantitative data are insufficient. OBJECTIVE: We aimed to evaluate changes in quality of life, life satisfaction, perception of body image, and functional performance of lower-limb amputees when using a mechanical-controlled prosthesis versus a microprocessor-controlled knee (MPK) or transtibial vacuum-assisted suspension system (VASS) prosthesis. METHODS: In this pragmatic study, 57 lower-limb amputees were assessed with the Satisfaction with the Prosthesis Questionnaire (SATPRO), revised Amputee Body Image Scale (ABIS-R), Trinity Amputation and Prosthesis Experience Scales (TAPES), Medical Outcomes Study Short Form-36 (SF-36) and 6-min walk test (6MWT). All assessments were performed under 2 conditions (i.e., using a mechanical-controlled prosthesis vs. an MPK/VASS prosthesis. RESULTS: Amputees who used an MPK/VASS prosthesis showed significant increases in all SF-36 subscale scores and all subscale scores of TAPES except adjustment to limitation (P=0.156). The amputees showed clinically relevant improvements in 6MWT (P<0.001) and in SATPRO and ABIS-R scores (P<0.001). CONCLUSION: Lower-limb amputees using an MPK/VASS prosthesis had better life satisfaction, quality of life and functional performance than those using a mechanical-controlled prosthesis.

Pulmonary rehabilitation principles in SARS-COV-2 infection (COVID-19): A guideline for the acute and subacute rehabilitation.

Coronavirus disease 2019 (COVID-19) is a contagious infection disease, which may cause respiratory, physical, psychological, and generalized systemic dysfunction. The severity of disease ranges from an asymptomatic infection or mild illness to mild or severe pneumonia with respiratory failure and/or death. COVID-19 dramatically affects the pulmonary system. There is a lack of knowledge about the long-term outcomes of the disease and the possible sequelae and rehabilitation. This clinical practice guideline includes pulmonary rehabilitation (PR) recommendations for adult COVID-19 patients and has been developed in the light of the guidelines on the diagnosis and treatment of COVID-19 provided by the World Health Organization and Republic of Turkey, Ministry of Health, recently published scientific literature, and PR recommendations for COVID-19 regarding basic principles of PR. In this guideline, the contagiousness of COVID-19, recommendations on limited contact of patient with healthcare providers, and the evidence about possible benefits of PR were taken into consideration.

Validation and application of the International Classification of Functioning core set for spinal cord injury in the Turkish patients.

OBJECTIVES: The aim of this study was to apply the Comprehensive International Classification of Functioning, Disability and Health (ICF)- Core Set for spinal cord injury (SCI) -early post-acute-situation in the Turkish SCI patients and to investigate its construct validity. PATIENTS AND METHODS: One-hundred and twenty patients with SCI were included in this prospective and descriptive study. ICF data were primarily collected by conducting interviews with patients as well as from their acute medical management records, physical examination findings and laboratory measurements. The percentage of participants and the frequency of the problems encountered at each level of ICF category were reported. Furthermore, the construct validity was evaluated by calculating the Spearman correlation between the ICF categories and other generic and disease specific measures. RESULTS: The study illustrated that 55 of the 63 ICF categories of the Component Body Functions (CBF) and each and every category for the Component Body Structures (CBS) as well as the Component Activities and Participation (CAP) were reported as a problem among the Turkish patients with SCI. Furthermore, 24 ICF categories for the Component Environmental Factors (CEF) were determined as a facilitator while 6 ICF categories were identified as a barrier. The ICF-Core Set for SCI illustrated a high construct validity with some of the generic and disease-specific measures. CONCLUSION: Our results identified the common problems, complications and special needs in a Turkish population with SCI. We suggest that the application of ICF-Core Set in our patients provided us with a unique capability to assess their every aspect of disability, health and functioning.

The Effectiveness of Fluidotherapy in Poststroke Complex Regional Pain Syndrome: A Randomized Controlled Study.

OBJECTIVE: To evaluate whether combining fluidotherapy to conventional rehabilitation program provides additional improvements on pain severity, upper extremity functions, and edema volume in patients with poststroke complex regional pain syndrome (CRPS). DESIGN: Randomized controlled trial. SETTING: Training and research hospital. PARTICIPANTS: Thirty hemiplegic patients with subacute stage CRPS type-1 of the upper extremity. INTERVENTIONS: The patients randomly divided into 2 groups. Both groups received a 3 week conventional rehabilitation program (5 days/week, 2-4 hours/day). Experimental group received 15 sessions additional fluidotherapy application to the affected upper extremity (40 °C, 20 minutes in continuous mode, 5 sessions/week). MAIN OUTCOME MEASURES: We evaluated the distal upper arm edema with a volumeter. Other used clinical assessment scales were Brunnstrom recovery stages of the arm and hand for motor recovery, motor items of the functional independence measure for functional status, visual analog scale for pain severity, and the painDETECT questionnaire for presence and the severity of neuropathic pain. RESULTS: The mean age of the participants was 64.3 ± 11.66 (28-84). At the post-treatment evaluation, significant improvements were revealed regarding to the edema volume, pain visual analog scale, painDETECT and functional independence measure scores, and the Brunnstrom stages of upper extremity and hand in both groups (P < .05). But among the parameters mentioned above, only the decrease in edema volume and the painDETECT scores were greater in fluidotherapy group than the control group (P < .05). CONCLUSIONS: Addition of the fluidotherapy to the conventional rehabilitation program provides better improvements on neuropathic pain and edema volume in subacute stage poststroke CRPS.

Musculoskeletal pain and related factors in coronary artery disease: An observational cross-sectional study.

BACKGROUND AND AIM: In patients diagnosed with coronary artery disease (CAD), we aimed to determine the characteristics and risk factors of co-occurring musculoskeletal pain and examine its effects on functional capacity, psychological status and health-related quality of life. PATIENTS AND METHODS: A total of 100 patients with (n= 50) and without (n= 50) musculoskeletal pain were enrolled. All patients were assessed on sociodemographic and clinical properties. The Duke Activity Status Index (DASI), the Hospital Anxiety and Depression Scale (HADS) and the Short Form-36 (SF-36) were applied as clinical assessment scales. RESULTS: Patients with musculoskeletal pain were mostly female, and had a lower education level and annual income. The pain was mostly nociceptive, intermittent, sharp/stabbing in character, and located in the chest and spine. Having musculoskeletal pain resulted in lower levels on the DASI and all subgroups of the SF-36, and higher levels on the HADS. Female gender, lower education level and severity of emotional distress proved to be independent risk factors for the development of musculoskeletal pain. CONCLUSIONS: In CAD, the co-occurrence of musculoskeletal pain leads to a further decrease in health-related quality of life and functional status, and increased severity of anxiety and depression. This stresses the importance of the detection and optimal treatment of musculoskeletal pain in patients diagnosed with CAD.

Complex Decongestive Therapy Enhances Upper Limb Functions in Patients with Breast Cancer-Related Lymphedema.

BACKGROUND: We aimed to evaluate the effects of complex decongestive therapy (CDT) on upper extremity functions, the severity of pain, and quality of life. We also searched the impact of the sociodemographic and clinical characteristics on the improvement in upper extremity functions. METHODS: A total of 37 women with breast cancer-related lymphedema (BCRL) [age, 53.6 ± 11.2 (28-72)] were included in this study. All patients underwent CDT-phase 1 program, including meticulous skin care, manual lymphatic drainage, remedial exercises, and compression bandages. Arm volume was calculated by a formula for truncated cone using circumferential measurements. A baseline questionnaire, including sociodemographic and clinical properties, was used for each patient. Short Form-36 (SF-36), Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and Visual Analog Scale (VAS) for pain and heaviness were used as clinical assessment scales. RESULTS: The mean of the posttreatment volume of the affected limb was lower compared to pretreatment volume (2741.81 ± 696.85 and 2990.67 ± 745.49, respectively), and the mean percentage change in edema volume was 38.1% ± 26.5%. We observed a statistically significant reduction in pain and heaviness VAS scores and improvement of shoulder mobility among upper extremities with lymphedema (p < 0.001) after CDT. The mean of posttreatment DASH score was lower compared to pretreatment score (37.19 ± 16.01, 49.81 ± 18.84, respectively, p < 0.001). All subgroups of the SF-36 parameters were increased after the CDT application (p < 0.01). Besides being under 65 years old, having a body mass index above 30 and short duration of lymphedema were found to be related to greater improvement in upper extremity functions. CONCLUSIONS: CDT provides enhancement of upper extremity functions and quality of life in patients with BCRL. The reduction in lymphedema volume, pain, and heaviness and the improvement in shoulder mobility may be the contributed factors.

Comparison of the short-term effects of the conventional motorized traction with non-surgical spinal decompression performed with a DRX9000 device on pain, functionality, depression, and quality of life in patients with low back pain associated with lumbar disc herniation: A single-blind randomized-controlled trial.

OBJECTIVES: This study aims to compare the efficiency of conventional motorized traction (CMT) with non-surgical spinal decompression (NSD) using the DRX9000™ device in patients with low back pain associated with lumbar disc herniation (LDH). PATIENTS AND METHODS: Between March 2009 and September 2009, a total of 48 patients (29 females, 19 males; mean age 43.1±9.8 years; range, 18 to 65 years) were randomized into two groups. The first group (n=24) underwent CMT and the second group (n=24) underwent NSD for a total of 20 sessions over six weeks. The patients were evaluated before and after the treatment. Pain was assessed using the Visual Analog Scale (VAS), functional status using the Oswestry Disability Index (ODI), quality of life using the Short Form-36 (SF-36), state of depression mood using the Beck Depression Inventory (BDI), and the global assessment of the illness using the Patient's Global Assessment of Response to Therapy (PGART) and Investigator's Global Assessment of Response to Therapy (IGART) scales. RESULTS: There was no significant difference in the evaluation outcomes before the treatment between the groups. However, a statistically significant decline was found in the VAS, ODI, and BDI scores after the treatment in both groups (all p<0.001). Except for two subgroups, no significant changes were observed in the SF-36 form. Assessment of "marked improvement" was globally most frequently reported one in both groups. No significant difference was observed in the evaluation outcomes after treatment between the groups. CONCLUSION: Our study results show that both CMT and NSD are effective methods in pain management and functional status and depressive mood improvement in patients with LDH, and NSD is not superior to CMT in terms of pain, functionality, depression and quality of life.

Can kinesio tape be used as an ankle training method in the rehabilitation of the stroke patients?

OBJECTIVE: To investigate the effects of the kinesio tape application to the tibialis anterior on rehabilitation outcomes of the stroke patients. DESIGN AND SETTING: Twenty patients with stroke were allocated into two groups: the first group of ten patients was assigned to receive kinesio tape in addition to the conventional rehabilitation program while a second group of 10 patients was assigned to receive a conventional rehabilitation program only. MAIN OUTCOME MEASURES: The clinical variables and health-related quality of life (HRQoL) were evaluated at baseline and at the end of the forth week. RESULTS: The present study showed that kinesio tape application to the tibialis anterior has significant effects on motor recovery of the lower extremity, spasticity, ambulation capacity, HRQoL and gait compared to the control group and baseline. CONCLUSIONS: The results of this study suggest that kinesio tape can be used as an ankle training method.

Is There a Possible Neuropathic Pain Component in Knee Osteoarthritis?

OBJECTIVES: This study aims to investigate the neuropathic pain (NP) component in patients with osteoarthritis (OA) of the knee and its association with physical function, risk factors, and stages of OA. PATIENTS AND METHODS: One hundred and nine patients (16 males, 93 females; mean age 62.5±8.5 years; range 44 to 81 years) diagnosed with knee OA according to the American College of Rheumatology criteria were enrolled in this study between July 2014 and June 2015. Patients were evaluated with visual analog scale for pain severity, PainDETECT questionnaire for presence and severity of neuropathic pain, Western Ontario and McMaster Universities osteoarthritis index for physical function, and the Kellgren-Lawrence system for severity of OA. Presence of the associated risk factors were also questioned. RESULTS: A total of 12 patients (11%) were classified as having likely NP and 23 patients (21.1%) were classified as having possible NP. PainDETECT scores were significantly correlated with the visual analog scale scores and Western Ontario and McMaster Universities osteoarthritis index pain, physical function and total scores. Patients with neuropathic pain had significantly longer symptom duration than the patients without NP. However, we found no relationship between the other risk factors and NP. CONCLUSION: This study demonstrated that some of the knee OA patients had a NP component as the underlying cause of knee pain. Patients with NP had longer symptom duration, increased severity of pain, and disability. Therefore, the presence of NP component in these patients should be considered. Once it is determined, appropriate intervention strategies for NP should be incorporated in the routine treatment modalities of knee OA.

The impact of lower extremity pain conditions on clinical variables and health-related quality of life in patients with stroke.

BACKGROUND: The presence of lower extremity pain may be associated with poorer motor recovery, impaired activities of daily living (ADL), reduced quality of life, and disability in patients with stroke. OBJECTIVE: The aims of the study were to describe the characteristics of lower extremity pain conditions and to evaluate the impact of lower extremity pain on clinical variables, and health-related quality of life in patients with stroke. METHODS: One hundred and eighty-five patients with stroke who have self-reported pain in the lower extremity were included in the study. Lower extremity pain characteristics of stroke survivors including etiology, intensity, onset time, frequency, aggravating factors, relieving factors, site, and location of pain were evaluated and recorded. The Brunnstrom motor recovery scale, the functional ambulation category, the mini-mental state examination, the star cancellation test, the beck depression inventory, the Barthel Index, and the Short Form-36 Questionnaire (SF-36) were used. RESULTS: The causes of lower extremity pain were diagnosed as osteoarthritis (51.1%), central neuropathic pain (28.7%), mixed pain (10.3%), low back pain associated with leg pain (8.6%), greater trochanteric pain syndrome (5.2%), prior hip fracture (2.4%), heterotopic ossification (2%), developmental hip luxation (1%), hallux valgus (0.5%), and malignancy (0.5%). The intensity of lower extremity pain was a significant predictor of cognitive functions, ADL, depression, and all SF-36 subscales except emotional role and vitality. The duration of lower extremity pain was a significant predictor of depression and lower extremity spasticity. CONCLUSIONS: Since lower extremity pain conditions have a significant important influence on clinical variables and health-related quality of life in stroke survivors, early identification and appropriate treatment of the lower extremity pain conditions should be carried out in order to reduce the level of disability in stroke patients.

Training postural control and sitting in children with cerebral palsy: Kinesio taping vs. neuromuscular electrical stimulation.

OBJECTIVE: To elucidate the effects of Kinesio Taping (KT) in addition to neurodevelopmental therapy (NDT) on posture and sitting, and to compare the effects of KT and neuromuscular electrical stimulation (NMES). MATERIALS-METHODS: Seventy-five children were randomized into control, KT, and NMES groups. NDT was applied to all children 4 times a week for 4 weeks. In addition, KT and NMES were applied to KT and NMES groups, respectively. Sitting subset of Gross Motor Function Measure (GMFM) and kyphosis levels of the groups were analyzed by two way mixed ANOVA. RESULTS: GMFM and kyphosis values improved significantly in all groups (all p < 0.01), yet change levels were more prominent in the KT and NMES groups than the control group. Moreover, NMES group showed better improvement. CONCLUSION: KT or NMES application for four weeks in addition to NDT is effective on improving kyphosis and sitting. Besides, NMES is more effective than KT.

Horseback riding therapy in addition to conventional rehabilitation program decreases spasticity in children with cerebral palsy: A small sample study.

OBJECTIVE: To evaluate the short-term effects of horseback riding therapy in addition to a conventional rehabilitation program in children with cerebral palsy. METHODS: Nine children receiving horseback riding therapy in addition to conventional rehabilitation (Group 1) and seven children receiving conventional rehabilitation alone (Group 2) were assessed at baseline and 5 weeks later. Assessed were: modified functional reach test (MFRT), hip abduction angle, the Ashworth Scale for hip adductor muscle spasticity, knee distance test, and the Gross Motor Function Classification System (GMFCS). RESULTS: The percentage change in hip adductor spasticity on the Ashworth Scale was 22% in Group 1 and 0% in Group 2 (significant difference; p = 0.016). Comparison of changes on the MFRT, GMFCS, knee distance test and hip abduction angle showed that the differences between Groups 1 and 2 were not significant. CONCLUSIONS: In these children, horseback riding therapy in addition to conventional rehabilitation resulted in significant improvement in adductor spasticity on short-term follow-up.

Gabapentin-Induced Urinary Incontinence: A Rare Side Effect in Patients with Neuropathic Pain.

Gabapentin is a first-line agent for neuropathic pain management and has a favorable safety profile. The literature includes a few cases of gabapentin-induced incontinence, and most of them involved patients with epilepsy who were between the ages of 12 and 43 years. Herein, we present three patients with neuropathic pain due to different diagnoses, and, to our knowledge, these are the oldest reported cases of urinary incontinence caused by gabapentin therapy. A 56-year-old female patient who underwent hip arthroplasty developed a sciatic nerve injury and neuropathic pain postoperatively. Ten days after she began taking gabapentin to relieve her pain, she experienced daily urinary incontinence. In another instance, a 63-year-old female patient was diagnosed with complex regional pain syndrome, and seven days after the initiation of gabapentin therapy, urinary incontinence developed. In addition, a 66-year-old male patient with neuropathic pain due to cervical disc pathology complained of urinary incontinence after the onset of gabapentin therapy. After discontinuing this drug, the incontinence symptoms resolved in these patients on the seventh, the first, and the second days, respectively. Physicians who administer gabapentin should inform their patients about the potential risk of gabapentin-induced incontinence and its negative impact on quality of life.

Timing of inpatient rehabilitation initiation in stroke patients: factors influencing early admission.

[Purpose] Early admission to inpatient rehabilitation is critical for reducing post-stroke disability. Assessing admission timing and other trends in inpatient rehabilitation are essential for improving health outcomes. This study is the first to evaluate the timing of admission of stroke patients to inpatient rehabilitation in Turkey. [Subjects and Methods] We retrospectively analyzed acute stroke survivors who were admitted to the inpatient rehabilitation program in the Ministry of Health, Ankara Physical Medicine and Rehabilitation Training and Research Hospital between January 2009 and December 2010. [Results] The mean onset of inpatient rehabilitation was 9.8 ± 6.7 weeks post-stroke in the entire cohort. Occurrence of ischemic stroke and undergoing acute stroke care at a teaching hospital were most strongly associated with early admission. These results did not change after multivariate analysis. [Conclusion] Turkish stroke survivors begin inpatient rehabilitation later than patients in other countries. The type of stroke and type of hospital in which the patient undergoes acute stroke treatment affects early admission.

Greater trochanteric pain syndrome: frequency and associated factors in patients with stroke.

BACKGROUND: Greater trochanteric pain syndrome (GTPS) is a common cause of lower extremity pain and is estimated to affect between 10% and 25% of the population. Despite all the research, there are no data in the literature about GTPS in the stroke population. OBJECTIVE: The aim of the study was to determine frequency and related factors of GTPS in patients with stroke. METHODS: Eighty-six patients with stroke were recruited from an inpatient rehabilitation department. Presence or absence of lateral thigh or hip pain was recorded. All patients with stroke (with or without self-reported pain) were examined using clinical criteria for the diagnosis of GTPS. RESULTS: Lateral thigh or hip pain was reported on initial interviews by 29 of 86 patients. GTPS was diagnosed by means of structured physical examination maneuvers in 17 patients with stroke and self-reported pain and 11 patients with stroke without self-reported pain. Twenty-eight patients (32.6%) had GTPS. The following factors were significantly associated with GTPS: lower extremity spasticity, depression, and iliotibial band syndrome. No correlation was found between GTPS and age, sex, lesion localization, motor status, neglect, sensory loss, time since stroke, low back pain, knee and hip osteoarthritis, or health-related quality of life. CONCLUSION: In this study, we showed that patients with stroke have a high percentage of GTPS. Early diagnosis and treatment of pain from GTPS are important in this population, because GTPS may limit applicability of motor training and affect rehabilitation outcomes.