The effect of proprioceptive vestibular rehabilitation on sensory-motor symptoms and quality of life.

BACKGROUND: Peripheral vestibular hypofunction (PVH) is characterized by balance and gait disorders and vestibulo-autonomic findings. The vestibular system and proprioceptive system work together to regulate sensorimotor functions. Vestibular exercises are effective in PVH, but their superiority over each other is still unclear. OBJECTIVE: This study aims to examine the effect of proprioceptive vestibular exercises on patients with PVH. METHODS: 30 individuals with unilateral PVH were assigned to 3 groups. Group 1 received proprioceptive vestibular rehabilitation, group 2 received standard vestibular rehabilitation. Both groups were given standard vestibular exercises as home exercises. No exercise was applied to the group 3. Patients were evaluated in terms of balance, functional mobility, posture, sensory profile, and quality of life. RESULTS: Although there was a significant intra-group difference in balance, functional mobility, and quality of life results in all groups (p < 0.05), the difference between groups was generally in favor of group 1 (p < 0.05). There was a significant difference between the groups in the posture analysis results (p < 0.05), while there was a significant difference in the 1st group (p < 0.05). There was a significant difference between the groups in the results of sensory sensitivity, sensory avoidance, and low recording (p < 0.05). There was no significant difference between the groups in sensory-seeking results (p > 0.05). There was a significant difference in quality of life between and within groups (p < 0.05). CONCLUSION: Proprioceptive vestibular rehabilitation is an effective method in PVH. We think that our study will guide clinicians and contribute to the literature. TRIAL REGISTRATION: NCT04687371.

ANTECEDENTES: A hipofunção vestibular periférica (HVP) é caracterizada por distúrbios do equilíbrio e da marcha e achados vestíbulo-autonômicos. O sistema vestibular e o sistema proprioceptivo trabalham juntos para regular as funções sensório-motoras. Os exercícios vestibulares são eficazes na HVP, mas sua superioridade entre si ainda não está clara. OBJETIVO: Este estudo tem como objetivo examinar o efeito de exercícios vestibulares proprioceptivos em pacientes com HVP. MéTODOS: Trinta indivíduos com HVP unilateral foram divididos em três grupos. O grupo 1 recebeu reabilitação vestibular proprioceptiva, o grupo 2 recebeu reabilitação vestibular padrão. Ambos os grupos receberam exercícios vestibulares padrão como exercícios caseiros. Nenhum exercício foi aplicado ao grupo 3. Os pacientes foram avaliados quanto a equilíbrio, mobilidade funcional, postura, perfil sensorial e qualidade de vida. RESULTADOS: Embora tenha havido uma diferença significativa intragrupo nos resultados de equilíbrio, mobilidade funcional e qualidade de vida em todos os grupos (p < 0,05), a diferença entre os grupos foi geralmente a favor do grupo 1 (p < 0,05). Houve diferença significativa entre os grupos nos resultados da análise postural (p < 0,05), embora tenha havido diferença significativa no 1° grupo (p < 0,05). Houve diferença significativa entre os grupos nos resultados de sensibilidade sensorial, esquiva sensorial e baixo registro (p < 0,05). Não houve diferença significativa entre os grupos nos resultados de busca sensorial (p > 0,05). Houve diferença significativa na qualidade de vida entre e dentro dos grupos (p < 0,05). CONCLUSãO: A reabilitação vestibular proprioceptiva é um método eficaz na HVP. Acreditamos que nosso estudo orientará os médicos e contribuirá para a literatura. REGISTRO DE TESTE: NCT04687371.

The relationship between cognitive function and functional capacity, and cognitive reserve and reaction time in patients with multiple sclerosis.

BACKGROUND: Cognitive dysfunction is frequently seen in multiple sclerosis (MS). However, there are conflicting findings regarding the factors it is associated with. OBJECTIVE: To investigate the relationship between aerobic capacity, strength, disability, depression, fatigue, and cognitive reserve and function. METHODS: The mobile applications Trail Making Test (TMT A-B), Digit Span Test (DST), Visuospatial Memory Test (VSMT), and Tap Fast were used in the cognitive function evaluation. Functional performance was assessed with the 6-minute walk test (6MWT), 5-Time Sit-to-Sand (5STS) test, and grip strength. Cognitive Reserve Index (CRI), Beck Depression Inventory, Fatigue Severity Scale (FSS), and Nottingham Health Profile were also used. RESULTS: A significant difference was found between the MS and control groups only in the 6MWT, STS-5, grip strength, TMT, VSMT, and Tap Fast. Good correlation was found between the TMT-A and 6MWT and physical mobility. A fair correlation was shown between grip strength, energy, and pain status. A good correlation was found between TMT-B and 6MWT, and a fair relationship with disability, cognitive reserve, and pain. Good correlation was observed between the DST and 6MWT, left grip strength, pain, and energy status; fair correlations were found between right grip strength, cognitive reserve, and physical mobility. Good correlation was found between the VSMT and energy. A fair relationship between disability, cognitive reserve, and pain was demonstrated. Good correlation was observed between the Tap Fast score and disability, 5STS, FSS, energy, and physical mobility. A fair relationship was found between pain and social isolation. CONCLUSION: It has been shown that cognitive performance in MS is related to disability, functional performance, cognitive reserve, fatigue, and general health. TRIAL REGISTRATION: NCT06084182.

ANTECEDENTES: A disfunção cognitiva é frequentemente observada na esclerose múltipla (EM). No entanto, existem resultados conflitantes sobre os fatores aos quais está associada. OBJETIVO: Investigar a relação entre capacidade aeróbica, força, incapacidade, depressão, fadiga e reserva e função cognitiva. MéTODOS: Os aplicativos móveis Trail Making Test (TMT A-B), Digit Span Test (DST), Visuoespacial Memory Test (VSMT) e Tap Fast foram utilizados na avaliação da função cognitiva. O desempenho funcional foi avaliado por meio do teste de caminhada de 6 minutos (TC6), Teste de Sentar-Levantar Cinco Vezes (TSL5) e força de preensão manual. Também foram utilizados Índice de Reserva Cognitiva (IRC), Inventário de Depressão de Beck, Escala de Gravidade de Fadiga (EGF) e Perfil de Saúde de Nottingham. RESULTADOS: Foi encontrada diferença significativa entre os grupos EM e controle apenas no TC6, TSL5, força de preensão, TMT, VSMT e Tap Fast. Foi encontrada boa correlação entre o TMT-A e o TC6 e a mobilidade física. Foi demonstrada uma correlação razoável entre força de preensão, energia e estado de dor. Foi encontrada uma boa correlação entre o TMT-B e o TC6, e uma relação razoável com incapacidade, reserva cognitiva e dor. Foi observada boa correlação entre o DST e o TC6, força de preensão esquerda, dor e estado energético; correlações justas foram encontradas entre força de preensão direita, reserva cognitiva e mobilidade física. Foi encontrada boa correlação entre o VSMT e a energia. Foi demonstrada uma relação justa entre incapacidade, reserva cognitiva e dor. Foi observada boa correlação entre o escore Tap Fast e incapacidade, TLS5, EGF, energia e mobilidade física. Foi encontrada uma relação justa entre dor e isolamento social. CONCLUSãO: Foi demonstrado que o desempenho cognitivo na EM está relacionado com incapacidade, desempenho funcional, reserva cognitiva, fadiga e saúde geral. REGISTRO DE TESTE: NCT06084182.

A New Measuring Approach in Assessing Hamstring Flexibility: Reliability, Validity, and Applicability of Isolated Hamstring Flexibility Test.

OBJECTIVE: This study was planned to determine the reliability, validity, and applicability of the isolated hamstring flexibility test (IHFT). DESIGN: A cohort study (diagnosis); level of evidence, 2. SETTING: It was performed in the research and application laboratory. PARTICIPANTS: Seventy-five individuals aged 18 to 25 years, selected through simple probability random sampling, with a normal Beighton Horan and Joint Mobility Index scores, and who volunteered to participate, were included for evaluation. INTERVENTIONS: On then first and third days, participants underwent muscle strength, sit-and-reach test, active knee extension test, IHFT for validity and reliability. Stretching exercises were prescribed as a home program for 31 patients with limited knee extension, and measurements were repeated at the end of the eighth week. MAIN OUTCOME MEASURES: Sit-and-reach test, active knee extension test, IHFT. RESULTS: The test-retest reliability was high (intraclass correlation coefficient, 0.993). Our test demonstrated validity when compared in terms of flexibility gained. A significant difference was found between pre-post stretching exercise training in all 3 tests ( P < 0.05). CONCLUSION: It was observed that the IHFT is reliable and applicable in determining hamstring flexibility. Given the absence of another test specifically measuring hamstring flexibility in isolation, its indirect validity was established through analysis with other tests using the gold standard for assessing gains in hamstring flexibility.

The effect of vestibular and somatosensory rehabilitation in addition to early rehabilitation on balance after stroke: a randomized controlled trial.

BACKGROUND: The goal of post-stroke early rehabilitation is to regain ambulation, standing and balance. OBJECTIVE: The purpose of this study was to investigate the effects of vestibular and somatosensory rehabilitation in addition to early rehabilitation on balance in patients with early subacute stroke. DESIGN AND SETTING: A randomized controlled trial was conducted at a university hospital. METHODS: The study was included 52 hemiplegic hospitalized early suacute stroke patients. The experimental group (n: 30), was applied with vestibular and somatosensorial rehabilitation together with early rehabilitation. Vestibular exercises, included Cawthorne-Cooksey exercises, stimulate the vestibulo-ocular and vestibulo-spinal reflex. Somatosensory exercises, which included Frenkel exercises, stimulate the sensory proprioception and somatosensory systems. The control group (n: 22) patients with early subacute stroke were treated with the early rehabilitation program only. The balance parameters of the patients were evaluated with the Korebalance System, Functional Reach Test, Postural Assessment Scale for Stroke, and Functional Ambulation Scale. RESULTS: The mean age of the patients was 67.32 ± 9.46 years, and the mean number of days that had passed since the stroke occurred was 17.90 ± 7.26. In calculating the balance scores, statistically significant differences were observed in the experimental and control groups, with a statistically greater improvement in the rehabilitation group. Statistically significant differences were determined between the groups in respect of the balance scores. CONCLUSIONS: Based on these findings, the use of vestibular and somatosensory rehabilitation can be recommended for better functioning of the compensatory mechanism of early subacute-stroke hemiplegic patients in early ambulation, and this can lead to considerably improved standing and dynamic upper and lower body balance.

The effect of motor learning-based telerehabilitation on quality of life of children with cerebral palsy during the COVID-19 pandemic.

BACKGROUND: During the pandemic, the access of children with cerebral palsy (CP) to rehabilitation services was adversely affected due to the significant risk of infection. AIMS: We assessed whether the effect of a motor learning-based treatment provided via a telerehabilitation method on the quality of life of children with cerebral palsy during the COVID-19 period was equivalent to face-to-face treatment. METHODS: Distance exercises were explained by a physiotherapist to the patients in the telerehabilitation group, and motor learning-based treatment was applied by their families; the physiotherapist followed the sessions with video conferencing. Motor learning-based treatment was offered to the face-to-face group by a physiotherapist in the clinic. RESULTS: In the comparison between the groups, there was a significant difference in the parameters of play activities, pain-hurt, fatigue, eating activities, and speech communication activities after treatment (p<0.05). However, in the test performed by considering the nonhomogeneous parameters before the treatment, no time-dependent difference was found in the repeated measurements before and after the treatment in all parameters (p>0.05). CONCLUSION: Motor learning-based treatment provided using the telerehabilitation method has a positive effect on the quality of life of children with CP, but the results are similar to face-to-face treatment.

The effect of graded motor imagery training on pain, functional performance, motor imagery skills, and kinesiophobia after total knee arthroplasty: randomized controlled trial.

Background: The aim was to investigate the effect of graded motor imagery (GMI) added to rehabilitation on pain, functional performance, motor imagery ability, and kinesiophobia in individuals with total knee arthroplasty (TKA). Methods: Individuals scheduled for unilateral TKA were randomized to one of two groups: control (traditional rehabilitation, n = 9) and GMI (traditional rehabilitation + GMI, n = 9) groups. The primary outcome measures were the visual analogue scale and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcome measures were knee range of motion, muscle strength, the timed up and go test, mental chronometer, Movement Imagery Questionnaire-3, lateralization performance, Central Sensitization Inventory, Pain Catastrophizing Scale, and Tampa Kinesiophobia Scale. Evaluations were made before and 6 weeks after surgery. Results: Activity and resting pain were significantly reduced in the GMI group compared to the control group (P < 0.001 and P = 0.004, respectively). Movement Imagery Questionnaire-3 scores and accuracy of lateralization performance also showed significant improvement (P = 0.037 and P = 0.015, respectively). The Pain Catastrophizing Scale and Tampa Kinesiophobia Scale scores were also significantly decreased in the GMI group compared to the control group (P = 0.039 and P = 0.009, respectively). However, GMI did not differ significantly in WOMAC scores, range of motion, muscle strength, timed up and go test and Central Sensitization Inventory scores compared to the control group (P > 0.05). Conclusions: GMI improved pain, motor imagery ability, pain catastrophizing, and kinesiophobia in the acute period after TKA.

Postoperative rehabilitation versus early mobilization following scoliosis surgery: A single-blind randomized clinical trial.

BACKGROUND: To compare the effect of five days of intensive postoperative rehabilitation and early mobilization following scoliosis surgery. METHODS: Forty adolescent patients who had undergone scoliosis surgery were randomly allocated into a rehabilitation group (RG, n = 20) and a mobilization group (MG, n = 20). The RG received five days of intensive exercise program and early ambulation, the MG received five days of a standard gait training and early ambulation. The patients were evaluated for severity of pain using a visual analog scale, thorax mobility with the thoracic mobility index, balance with the functional reach test, walking distance with the 2-min walk test, and quality of life with the Scoliosis Research Society-22 questionnaire. The length of hospital stay was recorded. RESULTS: The RG was favored over the MG for improvements from 0 to 1 week for pain. Improvements from 0 to 1 week were significantly better in the RG than the MG group for thorax mobility, balance, and walking distance. Quality of life scores improvements from 0 to 1 week were significantly better in the RG group than in the MG group. The length of hospital stay was significantly shorter in the RG group. CONCLUSION: Five days of intensive postoperative rehabilitation were superior to early mobilization in reducing the length of hospital stay, and in improving physical and functional outcomes following scoliosis surgery.

Effect of psoriatic arthritis on the strength, proprioception, skill, coordination, and functional condition of the hand.

BACKGROUND: This study was planned to evaluate the strength, proprioception, skill, coordination, and functional condition of the hand in individuals with psoriatic arthritis and to correlate disease activity with these parameters. METHODS: Fifty-six individuals (psoriatic arthritis group, n = 36; control group, n = 20) were included in the study. Evaluations were performed of disease activity with Disease Activity Score 28; grip strength with a dynamometer and pinch strength with pinch gauge dynamometers; joint position sensation with a goniometer; finger skills with a mobile application; and coordination and skill of both hands with the Purdue Pegboard test. The Michigan Hand Outcomes Questionnaire (MHQ) was used for hand functional evaluation. RESULTS: There was a significant difference between the grip and pinch strength of the psoriatic arthritis group and the control group (P < 0.05). There was no significant difference between the joint position sense measurements and the mobile application scores between the groups (P > 0.05). Purdue Pegboard scores showed a significant difference only in both hands and assembly subsections (P < 0.05). With Disease Activity Score 28, significant correlations were found between grip and pinch strength, mobile application scores, Purdue Pegboard all subsections, and left-hand joint position sense average error amount, and between MHQ and grip and pinch strength. CONCLUSIONS: This study is the first to show that psoriatic arthritis has a negative effect especially on hand strength; grip strength decreases as disease severity increases and, skill, coordination, and functionality of hand deteriorate.

Cross-cultural adaptation and validation of the Turkish Yellow Flag Questionnaire in patients with chronic musculoskeletal pain.

BACKGROUND: Yellow flags are psychosocial factors shown to be indicative of longterm chronicity and disability. The purpose of the study was to evaluate the psychometric properties of the Turkish Yellow Flag Questionnaire (YFQ) in patients with chronic musculoskeletal pain (CMP). METHODS: The cross-cultural adaptation was conducted with translation and backtranslation of the original version. Reliability (internal consistency and test-retest) was examined for 231 patients with CMP. Construct validity was assessed by correlating the YFQ with the Hospital Anxiety and Depression Scale (HADS), Orebro Musculoskeletal Pain Questionnaire (OMPQ), and Tampa Kinesiophobia Scale (TKS). Factorial validity was examined with both exploratory and confirmatory factorial analysis. RESULTS: The YFQ showed excellent test/retest reliability with an Intraclass correlation coefficient of 0.82. The internal consistency was moderate (Cronbach's alpha of 0.797). As a result of the exploratory factor analysis, there were 7 domains compatible with the original version. As a result of confirmatory factor analysis, the seven-factor structure of YFQ was confirmed. There was a statistically significant correlation between YFQ-total score and OMPQ (r = 0.57, P < 0.001), HADS-anxiety (r = 0.32, P < 0.001), HADS-depression (r = 0.44, P < 0.001), and TKS (r = 0.37, P < 0.001). CONCLUSIONS: This study's results provide considerable evidence that the Turkish version of the YFQ has appropriate psychometric properties, including test-retest reliability, internal consistency, construct validity and factorial validity. It can be used for evaluating psychosocial impact in patients with CMP.

Determine the Relationship Between Abdominal Muscle Strength, Trunk Control and Urinary Incontinence in Children with Diplegic Cerebral Palsy.

PURPOSE: The aim of this study is to determine the relationship between abdominal muscle strength, trunk control and urinary incontinence in children with diplegic cerebral palsy. MATERIALS AND METHODS: The current study had a cross-sectional design using analytical study as well as an observational research model. Fifty children between the ages of 5 and 18 years who were diagnosed with diplegic clinical type of cerebral palsy were included in this study using improbable-random sampling method. After patients' demographic information were obtained, Dysfunctional Voiding and Incontinence Symptoms Score Questionnaire (DVISS), Dysfunctional Voiding Symptom Score (DVSS), the manual muscle test of the muscles, Trunk ControlTest (TCT) and Trunk Control Measurement Scale (TCMS) were completed in order to evaluate trunk control. Also, Gross Motor Function Classification System (GMFCS) was performed in order to define the functional level. RESULTS: In this study, a highly correlated negative relationship was found between DVISS and DVSS scores with muscle abdominal strength, TCMS and TCT. In addition, a highly correlated positive relationship was found between both GMFCS and DVISS and GMFCS and DVSS. CONCLUSION: This is the first study that describes the effect of trunk control and muscle strength on urinary incontinence in children with diplegic cerebral palsy. This study showed that there is a correlation between trunk control, muscle strength and urinary incontinence.

The effect of different ankle and knee supports on balance in early ambulation of post-stroke hemiplegic patients.

The purpose of this study was to compare the effects of different ankle and knee supports on balance in early ambulation of post-stroke hemiplegic patients. This is a randomized experimental study. The study sample included 20 hemiplegic patients who were able to stand with support and who had been diagnosed with a cerebrovascular accident within the last month. A knee immobilization brace (KIB) was first placed on each individual (first application), followed by placement of knee immobilizer brace and Foot Lifter Orthosis ® (FLO) (second application), and lastly, placement of KIB and rigid taping (RT) (third application). The balance parameters of the patients were evaluated using the Korebalance system. The mean age of the patients was 65.1 ± 4.7 years, and the mean number of days that had passed since stroke occurred was 14.6 ± 4.97. In calculating the front/left balance scores of the applications, statistically significant differences were observed in the comparisons of all three supports and first-second applications performed (p = 0.041 and p = 0.021, respectively). Regarding the total scores between the applications, statistically significant differences were determined in balance in the comparisons on all three supports, in comparisons between the first and second applications, and in the comparisons between the second and third applications (p = 0.004, p = 0.007, and p = 0.001, respectively). Based on the findings from this study, it is recommended that the use of a knee immobilizer brace in combination with a foot lifter orthosis for post-stroke hemiplegic patients in early ambulation can lead to considerably improved standing balance.

Effects of hallux valgus deformity on rear foot position, pain, function, and quality of life of women.

[Purpose] To investigate the relationship between hallux valgus (HV) deformity and the position of rearfoot joints, and its effects on the quality of life, pain, and related functional status of women with bilateral hallux valgus (HV). [Subjects and Methods] The subjects were 27 right-dominant women. Demographic data, HV angle, weight-bearing and non-weight-bearing subtalar pronation (SP), and navicular height were recorded. Visual Analog Pain Scale, Foot Function Index (FFI), and the American Orthopaedic Foot and Ankle Society (AOFAS) first metatarsophalangeal- interphalangeal (MTP-IP) and AOFAS Mid foot (MF) Scales, and SF-36 were also used. [Results] HV angle, weight-bearing SP, and pain intensity of the left foot were higher. HV angle of left foot was correlated with all sub-scales of FFI, the pain parameter of AOFAS MTP-IP, and pain and total scores of AOFAS-MF Scale. HV angle of the left foot correlated with physical role, pain, and social function sub-domains of SF-36. Right HV angles were correlated with right foot pain and non-weight-bearing SP. [Conclusion] Increasing HV angle and pathomechanical changes in the rear foot are correlated, resulting in increasing pain and thus decreasing functional status as well as decreasing quality of life. Although all the participants were right-dominant, their left foot problems were more prominent.

Validity and reliability of the Turkish version of the Manchester-Oxford Foot Questionnaire for hallux valgus deformity evaluation.

OBJECTIVE: The aim of this study was to evaluate the reliability and validity of the Turkish version of the Manchester-Oxford Foot Questionnaire (MOXFQ) in patients affected by hallux valgus in order to assess the accuracy of this cross-cultural adaption. METHODS: Thirty female volunteers aged between 18 and 55 years were included in the study. Subjects with hallux valgus were asked to complete the MOXFQ and the Short-Form 36 Health Survey (SF-36). After receiving permission from the author, the MOXFQ was translated into Turkish twice and then back translated to English, after which its compatibility was evaluated. The Turkish version of the MOXFO was applied twice, 1-3 days apart, to the study subjects. Internal consistency and test-retest reliability were assessed using Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. Construct validity was assessed with the use of Spearman's rank correlation coefficient, using a priori hypothesized correlations with SF-36 domains. RESULTS: Subjects achieved similar scores at the first and second administration of the questionnaire (<0.001). The internal consistency reliability was acceptable for all MOXFQ domains (pain, walking/standing, social interaction), with Cronbach's alpha coefficients ranging from 0.775 to 0.779. The assessment of test-retest reliability revealed satisfactory values, with ICCs ranging from 0.91 to 0.96. Construct validity was supported by the presence of all the hypothesized correlations, with SF-36 within its physical parameters. CONCLUSION: The Turkish version of the MOXFQ is a valid and reliable tool for evaluating foot pain and functional status in patients affected by hallux valgus.

Evaluation of sleep disorder and its effect on sexual dysfunction in patients with Fibromyalgia syndrome.

OBJECTIVE: Sexual problems are commonly seen in women with fibromyalgia syndrome (FMS). The objective of this study was to reveal the relationship between the severity of symptoms, sleep disorder, and sexual dysfunction in women with FMS. MATERIALS AND METHODS: A total of 140 sexually active women with FMS aged 17-67 years who presented to our physical medicine and rehabilitation outpatient clinic between January 2016 and June 2016 were enrolled in the study. The patients' age, height, body weight, body mass index (BMI), and general pain score [visual analogue scale, (VAS)] for the last 1 week were recorded. The patients were given three different sets of questionnaires: the Pittsburgh Sleep Quality Index (PSQI), Fibromyalgia Impact Questionnaire (FIQ), and Female Sexual Function Index (FSFI). RESULTS: The mean age of the patients was 40.3±8.5 years; the mean BMI was 27.1±4.4 kg/m2, VAS (last 1 week) was 6.9±2 cm, the mean PSQI was 24.8±10.8 (one patient with PSQI ≤5), FIQ was 65.9±19.2, and FSFI was 19.0±6.9. No significant relationship was observed between the mean PSQI and BMI values (p=0.401), whereas a significant relationship was found between the mean values of VAS, FIQ, and FSFI (p=0.03; p=0.034; p<0.001, respectively). In Pearson's correlation analysis, a positive correlation was noted between PSQI and VAS (r=0.324; p<0.001) and FIQ values (r=0.271; p=0.001). A significant relationship was found between the FIQ and VAS values (p<0.001). P less than 0.005 was considered statistically significant. CONCLUSION: Sleep disorder is regarded as the underlying cause for many signs and symptoms in FMS. Sexual dysfunction may develop in women with FMS, based on the severity of the disease and poor sleep quality. We found that sleep dysfunction was significantly related with the severity of disease, pain, and sexual disfunction. We also found a positive correlation between VAS and PSQI.