An assessment of the relation between bone mineral density and clinic-demographic properties and life quality during postmenopausal period.

OBJECTIVES: This study was conducted to assess the relation between bone mineral density (BMD) and clinic-demographic properties and life quality during postmenopausal period. METHODS: The study group consisted of 172 postmenopausal women who applied to the physical therapy and rehabilitation outpatient clinic at a training and research hospital in Ankara, the capital of Turkey. The Survey Form, The 36-item Short Form Health Survey (SF-36) and the FRAX™ were used as data collection tools in this study. RESULTS: The osteoporosis and osteopenia frequencies were respectively 28.5% and 42.4% in this study. The 10-year major osteoporotic fracture risk was 5.15% and the femur fracture risk was estimated as 0.9%. In this study, there was a positive and significant relation found between the L1⁢-⁢4 and FN T-score and SF-36 scale score average (p< 0.05). There was a significant relation between the body mass index and SF-36 subscale 'mental health' (p< 0.05). In this study, the most significant determinant of life quality was exhibited as the "L1⁢-⁢4 T-score" (ß= 55.509, p= 0.000). CONCLUSIONS: We determined that approximately one of every four women had osteoporosis and as the BMD dropped, the life quality of the women declined. Hence, we think that improving the awareness of health professionals working in this field is essential.

The effects of acupuncture versus sham acupuncture in the treatment of fibromyalgia: a randomized controlled clinical trial.

OBJECTIVE: The aim of this manuscript is to determine and to compare the efficacy of real acupuncture with sham acupuncture on fibromyalgia (FM) treatment. METHODS: 50 women with FM were randomized into 2 groups to receive either true acupuncture or sham acupuncture. Subjects were evaluated with VAS (at night, at rest, during activity), SF-36, Fibromyalgia Impact Questionnaire (FIQ), Beck Depression scale (BDI), Fatigue Severity Scale (FSS) at baseline, 1 month and 2 months after the 1st session. Patients in both groups received 3 sessions in the 1st week, 2 sessions/week during 2 weeks and 1 session/week in the following 5 weeks (totally 12 sessions). RESULTS: 25 subjects with a mean age of 47,28±7,86 years were enrolled in true acupuncture group and 25 subjects with a mean age of 43,60±8,18 years were enrolled in sham acupuncture group. Both groups improved significantly in all parameters 1 month after the 1st session and this improvement persisted 2 months after the 1st session (p<0,05). However, real acupuncture group had better scores than sham acupuncture score in terms of all VAS scores, BDI and FIQ scores either 1 or 2 months after the 1st session (all p<0,05). CONCLUSION: Acupuncture significantly improved pain and symptoms of FM. Although sham effect was important, real acupuncture treatment seems to be effective in treatment of FM.

An Unusual Cause of Myelopathy: Ochronotic Spondyloarthropathy With Positive HLA B27.

Ochronosis is a late developing complication of alkaptonuria, a black brownish pigment in the fibrous and cartilaginous tissues. Although most previous studies reported alkaptonuria and back pain due to ochronosis, thoracic myelopathy is an extremely rare complication. In this report, a paraparetic patient who has ochronotic spondiloarthropathy with the presence of HLA B27 antigen is described. He had low back and leg pain and morning stiffness for 5 yrs. Last year, these were followed by tingling, numbness, and weakness the in lower extremities and he was operated on with preliminary diagnosis of prolapsed disc herniation and cord compression. Surgery is suggested for disc herniations related to ochronotic spondyloarthropathy if it is necessary or neurologic symptoms are present. However, his pain and weakness have partially recovered after the operation. After medical and physical treatment, he showed clinically significant improvements. This case report demonstrates that the management of ochronosis needs a multidisciplinary approach with physiologic, neurologic, and psychologic effects and proper treatment may significantly improve functional outcomes in these patients.

Dynamic Thiol/Disulphide Homeostasis in Patients With Fibromyalgia.

OBJECTIVES: This study aims to investigate dynamic thiol/disulphide homeostasis in patients with fibromyalgia syndrome (FMS). PATIENTS AND METHODS: Fifty female patients with FMS (mean age 40.5±7.2 years; range 21 to 55 years) and 40 healthy female controls (mean age 39±9.4 years, range 22 to 55 years) were included in the study. Pain visual analog scale, tender points, Fibromyalgia Impact Questionnaire, and Beck Depression Inventory were evaluated. Age, body mass index (BMI), and symptom durations were also recorded. Native thiol, disulphide and total thiol levels were measured with a novel automated method. RESULTS: Serum disulphide levels were 14.7±3.4 µmol/L and 22.2±3.6 µmol/L in the FMS and control groups, respectively (p<0.001). Native thiol levels were 452.1±33.8 µmol/L and 433.5±37.6 µmol/L in the FMS and control groups, (p=0.015), while total thiol levels were 481.7±35.6 µmol/L and 477.5±38.9 µmol/L in the FMS and control groups, respectively (p=0.593). In the FMS group, disulphide/native thiol percent ratios and disulphide/ total thiol percent ratios were statistically significantly lower and native/total thiol percent ratios were statistically significantly higher than those of the control group. There were no correlations between serum thiol/disulphide profiles and pain scores & clinical variables in patients with FMS. CONCLUSION: Because of the decreased disulphide and increased native thiol levels, the thiol/disulphide balance has shifted to the reductive side. This metabolic disturbance may have a role in the pathogenesis of FMS.

The prevalence and risk factors for osteoporosis among 18- to 49-year-old Turkish women.

The aim of this study was to determine the prevalence of osteoporosis and associated risk factors in Turkish women aged 18-49 years. A population-based, cross-sectional study was conducted between January and April 2014. The sample (n = 1,792) was comprised of women aged 18-49 years, who resided in Cubuk, Ankara, Turkey, and were selected by simple random sampling. The data were collected in face-to-face interviews using an Individual Information Form and an Osteoporosis Risk Estimation Scale. Bone mineral density was assessed using standard dual-energy X-ray absorptiometry. Multiple logistic regression and chi-square analyses were used for analyses. Most participants (80.1%) were at low risk of developing osteoporosis, while 6.9% were at medium to high risk of developing the disease. From bone mineral density levels, 33.3% were osteopenic; 4.0% were osteoporotic; 33.3% were osteopenic at the femoral neck; and 6.7% were osteoporotic at the lumbar vertebra L1-L4. Further, results of multiple logistic regression analyses showed that osteoporosis risk was significantly associated with smoking, having light skin, multiparity, and having a family history of osteoporosis (p < .05). These results indicated that public health screening strategies for protecting women's bone health at earlier ages than previously thought might be beneficial.

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.

Chronic complications of spinal cord injury.

Spinal cord injury (SCI) is a serious medical condition that causes functional, psychological and socioeconomic disorder. Therefore, patients with SCI experience significant impairments in various aspects of their life. The goals of rehabilitation and other treatment approaches in SCI are to improve functional level, decrease secondary morbidity and enhance health-related quality of life. Acute and long-term secondary medical complications are common in patients with SCI. However, chronic complications especially further negatively impact on patients' functional independence and quality of life. Therefore, prevention, early diagnosis and treatment of chronic secondary complications in patients with SCI is critical for limiting these complications, improving survival, community participation and health-related quality of life. The management of secondary chronic complications of SCI is also important for SCI specialists, families and caregivers as well as patients. In this paper, we review data about common secondary long-term complications after SCI, including respiratory complications, cardiovascular complications, urinary and bowel complications, spasticity, pain syndromes, pressure ulcers, osteoporosis and bone fractures. The purpose of this review is to provide an overview of risk factors, signs, symptoms, prevention and treatment approaches for secondary long-term complications in patients with SCI.

Muscle strength, motor performance, cardiac and muscle biomarkers in detection of muscle side effects during and after acute lymphoblastic leukemia treatment in children.

Muscle side effects have not been frequently assessed in childhood acute lymphoblastic leukemia (ALL) patients. Our objective was to determine the early and late muscle side effects during childhood ALL treatment. To this end, we examined the early muscle side effects in 15 newly diagnosed "therapy patients" (group I), and the late side effects in 18 ALL survivors "off therapy patients" (group II). Muscle side effects were assessed by measuring hand grip strength (HGS), the "timed up and go" (TUG) test, creatine phosphokinase, myoglobin, plasma electrolytes, cardiac troponin I before and after induction chemotherapy in group I. The same parameters and cranial radiotherapy dose were examined in group II at a single timepoint. Cumulative doses of chemotherapy were calculated, and echocardiograms were obtained for each group. As a result, we found that the HGS and TUG measures of group I at the end of induction were poorer than measures of the first admission, control subjects, and group II. Low HGS measures had been normalized over time, but the TUG measures remained poor. Overt rhabdomyolysis and pyomyositis were not detected in any of the patients. These results suggested that muscle side effect monitoring might be helpful in the follow-up of children with ALL.

Adult case of acrodysostosis with severe neurologic involvement.

OBJECTIVE: Acrodysostosis is a rare syndrome characterized by peripheral dysostosis, nasal hypoplasia and frequently mental retardation. Only one adult case of acrodysostosis has been reported to have neurologic symptoms. We report one further adult case of acrodysostosis with severe neurologic findings including myelopathy and spastic paraparesis due to diffuse spinal stenosis and recurrent deep vein thrombosis possibly caused by neurologic deficits. RESULTS: We report a 43-year-old woman who had back and neck pain with weakness in the extremities of several years. 1~year before admission to our hospital, she had been treated with a missed diagnosis of sero (-) spondyloarthropathy but had not benefited. She became unable to walk, thereafter she underwent decompression surgery with a diagnosis of degenerative spinal stenosis. She presented at our outpatient department complaining of lowback pain and difficulty walking. She had marked facial and peripheral appearance of acrodysostosis. Spinal MRI revealed extensive spinal stenosis. A diagnosis was made through the genetic investigation, clinical and radiological findings. Spastic paraparesis were detected. There was widespread neuropathic pain. 15 days after admission, she developed swelling and redness of the left lower extremity and the venous doppler ultrasonography showed left acute and right past DVT. We treated DVT with anticoagulant therapy. Gabapentin and Baclofen were initiated for neuropathic pain and spasticity. A conventional rehabilitation program was performed. She left walking with a walker without pain and spasticity. CONCLUSIONS: We would like to remind physicians to be aware of peripheral malformations as signs of skeletal dysplasias and to consider acrodysostosis in the differential diagnosis. Although it is a rare condition, if diagnosed early, possible complications can be treated and outcomes may be improved.

Low-frequency pulsed electromagnetic field therapy in fibromyalgia: a randomized, double-blind, sham-controlled clinical study.

OBJECTIVE: To evaluate the clinical effectiveness of low-frequency pulsed electromagnetic field (PEMF) therapy for women with fibromyalgia (FM). METHODS: Fifty-six women with FM, aged 18 to 60 years, were randomly assigned to either PEMF or sham therapy. Both the PEMF group (n=28) and the sham group (n=28) participated in therapy, 30 minutes per session, twice a day for 3 weeks. Treatment outcomes were assessed by the fibromyalgia Impact questionnaire (FIQ), visual analog scale (VAS), patient global assessment of response to therapy, Beck Depression Inventory (BDI), and Short-Form 36 health survey (SF-36), after treatment (at 4 wk) and follow-up (at 12 wk). RESULTS: The PEMF group showed significant improvements in FIQ, VAS pain, BDI score, and SF-36 scale in all domains at the end of therapy. These improvements in FIQ, VAS pain, and SF-36 pain score during follow-up. The sham group also showed improvement were maintained on all outcome measures except total FIQ scores after treatment. At 12 weeks follow-up, only improvements in the BDI and SF-36 scores were present in the sham group. CONCLUSION: Low-frequency PEMF therapy might improve function, pain, fatigue, and global status in FM patients.

Mirror therapy improves hand function in subacute stroke: a randomized controlled trial.

OBJECTIVE: To evaluate the effects of mirror therapy on upper-extremity motor recovery, spasticity, and hand-related functioning of inpatients with subacute stroke. DESIGN: Randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 6 months. SETTING: Rehabilitation education and research hospital. PARTICIPANTS: A total of 40 inpatients with stroke (mean age, 63.2y), all within 12 months poststroke. INTERVENTIONS: Thirty minutes of mirror therapy program a day consisting of wrist and finger flexion and extension movements or sham therapy in addition to conventional stroke rehabilitation program, 5 days a week, 2 to 5 hours a day, for 4 weeks. MAIN OUTCOME MEASURES: The Brunnstrom stages of motor recovery, spasticity assessed by the Modified Ashworth Scale (MAS), and hand-related functioning (self-care items of the FIM instrument). RESULTS: The scores of the Brunnstrom stages for the hand and upper extremity and the FIM self-care score improved more in the mirror group than in the control group after 4 weeks of treatment (by 0.83, 0.89, and 4.10, respectively; all P<.01) and at the 6-month follow-up (by 0.16, 0.43, and 2.34, respectively; all P<.05). No significant differences were found between the groups for the MAS. CONCLUSIONS: In our group of subacute stroke patients, hand functioning improved more after mirror therapy in addition to a conventional rehabilitation program compared with a control treatment immediately after 4 weeks of treatment and at the 6-month follow-up, whereas mirror therapy did not affect spasticity.

Influence of knee osteoarthritis on exercise capacity and quality of life in obese adults.

OBJECTIVE: The objective was to determine whether knee osteoarthritis (OA) reduces exercise ambulatory capacity and impairs quality of life (QOL) in obese individuals. RESEARCH METHODS AND PROCEDURES: There were 56 subjects, with and without knee OA, who were obese. The subjects were evaluated with anthropometric measurements, a body composition assessment, maximal cardiopulmonary exercise test, 6-minute walk test (6-MWT), perceived exertion (RPE), self-reported disability [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)], and the Medical Outcomes Study Short Form 36 (SF-36). RESULTS: VO2peak was significantly higher in the controls when compared with the patients (mean +/- standard deviation, 1.584 +/- 0.23 L/kg per min vs. 0.986 +/- 0.20 L/kg per min; p < 0.001). Obese subjects without knee OA walked a significantly longer distance in the 6-MWT than obese patients with knee OA (p < 0.001). We also observed significant negative correlation between VO2max and RPE, WOMAC pain and physical limitation, and bodily pain and general health domains of short-form 36. DISCUSSION: Knee OA reduces exercise and ambulatory capacity and impairs QOL in obese individuals. RPE, WOMAC pain, and SF-36 items might provide information about exercise capacity in the obese subjects with knee OA. Our study confirms that exercise capacity and QOL might be improved by energetic and intensive treatment of pain resulting from knee OA.

Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke: a randomized controlled trial.

OBJECTIVE: To evaluate the effects of mirror therapy, using motor imagery training, on lower-extremity motor recovery and motor functioning of patients with subacute stroke. DESIGN: Randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 6 months. SETTING: Rehabilitation education and research hospital. PARTICIPANTS: A total of 40 inpatients with stroke (mean age, 63.5 y), all within 12 months poststroke and without volitional ankle dorsiflexion. INTERVENTIONS: Thirty minutes per day of the mirror therapy program, consisting of nonparetic ankle dorsiflexion movements or sham therapy, in addition to a conventional stroke rehabilitation program, 5 days a week, 2 to 5 hours a day, for 4 weeks. MAIN OUTCOME MEASURES: The Brunnstrom stages of motor recovery, spasticity assessed by the Modified Ashworth Scale (MAS), walking ability (Functional Ambulation Categories [FAC]), and motor functioning (motor items of the FIM instrument). RESULTS: The mean change score and 95% confidence interval (CI) of the Brunnstrom stages (mean, 1.7; 95% CI, 1.2-2.1; vs mean, 0.8; 95% CI, 0.5-1.2; P=.002), as well as the FIM motor score (mean, 21.4; 95% CI, 18.2-24.7; vs mean, 12.5; 95% CI, 9.6-14.8; P=.001) showed significantly more improvement at follow-up in the mirror group compared with the control group. Neither MAS (mean, 0.8; 95% CI, 0.4-1.2; vs mean, 0.3; 95% CI, 0.1-0.7; P=.102) nor FAC (mean, 1.7; 95% CI, 1.2-2.1; vs mean, 1.5; 95% CI, 1.1-1.9; P=.610) showed a significant difference between the groups. CONCLUSIONS: Mirror therapy combined with a conventional stroke rehabilitation program enhances lower-extremity motor recovery and motor functioning in subacute stroke patients.

Clinimetric properties of the Duruoz hand index in patients with stroke.

OBJECTIVE: To investigate the reliability, validity, and responsiveness of the Duruoz Hand Index (DHI) in assessing activity limitation related to hand function in patients with stroke. DESIGN: Prospective validation study. A consecutive sample of stroke patients was evaluated on 3 occasions: 2 baseline measurements with a 24-hour interval in between, and again 1 month later immediately after a 4-week inpatient rehabilitation program. SETTING: Three different inpatient rehabilitation centers. PARTICIPANTS: A consecutive sample of 56 patients with stroke (33 men, 23 women) with a mean age 62 years and a mean time since stroke 84 days. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Brunnstrom stages, Modified Ashworth Scale, sensory status, FIM instrument, and DHI. Test-retest reliability was tested using the intraclass correlation coefficient (ICC) and internal consistency was tested using the Cronbach alpha coefficient. Indexes of measurement error were calculated by standard error of measurement and minimal detectable change (MDC). Construct validity was assessed by association with the FIM instrument (Spearman rho correlation coefficient). Responsiveness was assessed by calculation of the effect size and paired t test. RESULTS: The test-retest reliability and internal consistency of the DHI were excellent, with an ICC of .99 (95% confidence interval, .93-.99) and alpha of .97. The MDC was 1.4 DHI points. The correlation between the DHI and the FIM self-care items was high (rho=-.73). The DHI significantly discriminated the patients with dominant side paresis versus nondominant side paresis (P<.01). The DHI score improved significantly after a 4-week inpatient rehabilitation program (P<.05). CONCLUSIONS: The DHI is a time and labor efficient, practical instrument that can be used to assess the hand-related activity level for clinical and research purposes in patients with stroke.

The effect of pulsed electromagnetic fields in the treatment of cervical osteoarthritis: a randomized, double-blind, sham-controlled trial.

The purpose of this study was to evaluate the effect of electromagnetic field therapy (PEMF) on pain, range of motion (ROM) and functional status in patients with cervical osteoarthritis (COA). Thirty-four patients with COA were included in a randomized, double-blind study. PEMF was administrated to the whole body using a mat 1.8 x 0.6 m in size. During the treatment, the patients lay on the mat for 30 min per session, twice a day for 3 weeks. Pain levels in the PEMF group decreased significantly after therapy (p<0.001), but no change was observed in the placebo group. The active ROM, paravertebral muscle spasm and neck pain and disability scale (NPDS) scores improved significantly after PEMF therapy (p<0.001) but no change was observed in the sham group. The results of this study are promising, in that PEMF treatment may offer a potential therapeutic adjunct to current COA therapies in the future.

Cardiopulmonary and metabolic responses to maximum exercise and aerobic capacity in hemiplegic patients.

This study evaluated cardiopulmonary and metabolic responses to maximum exercise and aerobic capacity in hemiplegic patients and clarified the relationship between the resulting data and motor disability. Twenty patients with stroke and fifteen healthy controls were included in the study. Cardiopulmonary and metabolic responses to maximum exercise were investigated with an electronically braked arm crank ergometer. Vital capacity, forced expiratory volume in 1 second, peak expiratory flow rate, forced vital capacity, maximum voluntary ventilation, peak power output, respiratory exchange ratio, and exercise time were reduced in stroke patients when compared with the controls. No relationship was found between these data and motor disability. The hemiplegic patients showed a significant respiratory dysfunction and reduced exercise tolerance. These findings suggest that a program of ventilatory and aerobic training should be considered early after stroke to avoid cardiorespiratory problems and deconditioning.