Best Practice Recommendations for Dysphagia Management in Intensive Care Unit (ICU): A Delphi Study from Multidisciplinary Experts in Turkey.

There is no study about all aspects of oropharyngoesophageal (OPE) dysphagia from diagnosis to follow-up in a multidisciplinary manner in the world. In order to close this gap, we aimed to create a recommendation study that can be used in clinical practice, addressing all aspects of dysphagia in the ICU in detail with the opinion of experienced multidisciplinary experts. This recommendation paper was generated by a multidisciplinary team, using the seven-step process and a three-modified Delphi round via e-mail. Firstly, 15 open-ended questions were created, and then detailed recommendations including general principles, management, diagnosis, rehabilitation, and follow-up were created with the answers from these questions, Each recommendation item was voted on by the experts as overall consensus (strong recommendation), approaching consensus (weak recommendation), and divergent consensus (not recommended).In the first Delphi round, a questionnaire consisting of 413 items evaluated with a scale of 0-10 was prepared from the opinions and suggestions given to 15 open-ended questions. In the second Delphi round, 55.4% were accepted and revised suggestions were created. At the end of the third Delphi round, the revised suggestion form was approved again and the final proposals containing 133 items were created. This study includes comprehensive and detailed recommendations, including a broad perspective from diagnosis to treatment and follow-up, as detailed as possible, for management of dysphagia in patients with both oropharyngeal- and esophageal-dysphagia in ICU.

Validity and reliability of the Turkish version of the shoulder rating questionnaire in patients with shoulder pain.

OBJECTIVES: The aim of this study was to translate the Shoulder Rating Questionnaire (SRQ-T) into Turkish and to determine the validity and reliability of the translated version in patients shoulder pain. METHODS: The Turkish version of the SRQ-T was applied to patients after translation from English into Turkish. Patients with various shoulder pain complaint were included into the study if they were over 18 years. The patients with mixed-type pain, cancer pain, headache, substance abuse, severe depression, and fibromyalgia syndrome were excluded. The musculoskeletal and neurological examinations of the patients were performed. The Turkish version of the SRQ-T and Disabilities of arm, shoulder, hands-T (DASH-T) were applied to all patients. RESULTS: 122 patients were included in the study, and then patients are divided into two groups: Group 1, working group (n = 72); Group 2, non- working group (n = 50). The reliability and consistency of SRQ-T for all the samples were acceptable with a Cronbach's coefficient of 0.979. The test-retest method was used to determine reliability of the scale. Cronbach's alpha was measured pre-assessment and post- assessment; the values were 0.815 and 0.770, respectively. The correlation analysis was determined for all the samples and calculated as 0.780. Also, the test-retest method with Wilcoxon Signed Rank Test was used to determine reliability of the SRQ- T and its domains in group 1 and group 2. CONCLUSION: The Turkish version of the SRQ-T seems to be a valid and reliable self-administered questionnaire to evaluate the shoulder pain in Turkish patients. LEVEL OF EVIDENCE: Level II, Diagnostic Study.

Effects of Single-Task Versus Dual-Task Training on Balance Performance in Elderly Patients With Knee Osteoarthritis.

OBJECTIVES: This study aims to compare the effects of single-task and dual-task training on balance performance in elderly patients with knee osteoarthritis (OA). PATIENTS AND METHODS: Fifty elderly osteoarthritic patients with balance impairment (16 males, 34 females; mean age 72.9±5.5 years; range 65 to 84 years) were included in this study. Patients were randomly assigned to single-task balance training (group 1) or dual-task balance training (group 2) groups. Balance activities were given to both groups for three times a week for four weeks. Patients in group 2 also performed cognitive tasks simultaneously with these exercises. Patients were evaluated with Berg balance scale (BBS), kinesthetic ability trainer static and dynamic scores, timed up and go (TUG) test and walking speed (WS) for single and dual tasks, number of stopping and activities-specific balance confidence (ABC) scale at baseline and at the end of four weeks. RESULTS: At the end of the therapy, there were statistically significant improvements in BBS, KAT 2000 static and dynamic scores, TUG test and WS for single and dual tasks, number of stopping and ABC scale in both groups (p<0.05). But there was no statistical difference in any parameter between the groups (p>0.05). CONCLUSION: Both single- and dual-task trainings are effective in improving balance performance under single- and dual-task conditions in elderly patients with knee OA. Dual-task training is not superior to single-task training for balance improvement in elderly osteoarthritic patients.

Validity and Reliability of Turkish Version of the Identification Pain Questionnaire in the Assessment of Neuropathic Pain.

Objectives: This study aims to assess the validity and reliability of a Turkish version of the identification (ID) pain (ID pain-T) questionnaire in Turkish patients. Patients and methods: The Turkish version of ID pain questionnaire was obtained after translation from English into Turkish. The study included 194 patients of which 100 (34 males, 66 females; mean age 59.8±14.3 years; range, 28 to 88 years) were diagnosed as neuropathic pain (NP) and 94 (31 males, 63 females; mean age 47.2±16.5 years; range, 20 to 78 years) were diagnosed as non-neuropathic pain. Patients with mixed-type pain, cancer pain, headaches, substance abuse, severe depression or fibromyalgia syndrome were excluded. Results: The reliability and consistency of ID pain-T questionnaire were acceptable, with a Cronbach's alpha coefficient of 0.701. Statistical analysis of the ID pain-T questionnaire calculated an optimal cut-off score of ≥2 for determining NP with a sensitivity of 77.2% and a specificity of 85%. Further, with an excellent value of 0.92 for area under the curve, a good diagnostic value was indicated. Conclusion: The Turkish version of ID pain questionnaire assessed in the present study is a valid and reliable self-administered questionnaire to identify NP in Turkish patients.

Terminal Latency Index, Residual Latency, and Median-Ulnar F-Wave Latency Difference in Carpal Tunnel Syndrome.

INTRODUCTION: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, but no electrodiagnostic test alone shows sufficient sensitivity for CTS. We aimed to investigate the value of median motor terminal latency index (mTLI), median motor residual latency (mRL), and median-ulnar F-wave latency difference (FdifMU) as additional tests to nerve conduction studies which are performed traditionally in electromyography laboratories. METHODS: This is a retrospective study. The results of electrodiagnostic studies performed on patients with CTS were examined. We divided the enrolled hands of the patients diagnosed with CTS into two groups: affected hands with abnormal electroneuromyographic parameters indicating CTS diagnosis (CTS group) and hands with normal electroneuromyographic parameters (control group). Then, we analyzed the results of these completed electrodiagnostic studies. RESULTS: A total of 320 hands of 160 patients were studied. FdifMU and mRL were found to be significantly higher in CTS group compared with the control group (P < 0.001). mTLIs were found to be significantly higher in control group compared with the CTS group (P < 0.001). Given that, the area under the curve is more than 70% for mTLI and mRL, but not for FdifMU. CONCLUSION: When combined with mMDL, both mTLI and mRL have excellent specificity for the diagnosis of mild and moderate CTS. However, the sensitivities for both parameters were lower. In suspected patients, FdifMU can be an additional tool for the diagnosis of CTS also, but alone it is not valuable.

EFFECT OF FLAMINGO EXERCISES ON BALANCE IN PATIENTS WITH BALANCE IMPAIRMENT DUE TO SENILE OSTEOARTHRITIS.

OBJECTIVE: To investigate the effect of flamingo exercise with or without KAT 2000 device on the balance problems due to senile OA. PARTICIPANTS: Ninety elderly osteoarthritic patients with balance impairment. INTERVENTIONS: Participants were randomly assigned into three groups; Kinesthetic ability trainer (KAT 2000) training group (Group 1) (n = 30), Flamingo training group (Group 2) (n = 30), Combined training group (Group 3) (n = 30) group. 45 minutes individualized training sessions as three times a week for 4 weeks were given to all participants. MAIN OUTCOME MEASURES: Patients were evaluated with Berg balance scale (BBS), kinesthetic ability trainer (KAT 2000) static and dynamic scores, timed up and go test (TUGT), walking speed (WS), Activities Specific Balance Confidence (ABC) Scale and Functional Reach Test (FRT) at the baseline and at the end of 4 weeks. RESULTS: At the end of the therapy, there were statistically significant improvements in KAT 2000 static and dynamic scores, TUGT scores, WS and ABC Scale in all groups (p < 0.05). At the end of the therapy there were statistically significant differences in Group 3 for KAT 2000 static and dynamic scores, TUGT scores, WS and ABC Scale than the other groups (p < 0.05). But there were no statistical difference in BBS and FRT score between the groups (p > 0.05). CONCLUSIONS: Both flamingo and KAT2000 exercises device have positive effects on the balance problems due to senile OA. Combined with the KAT2000 device, the effects of flamingo exercises on balance disorder in senile osteoarthritis patients are more pronounced.

The effectiveness of Kinesio taping on pain and clinical features in chronic non-specific low back pain: A randomized controlled clinical trial.

OBJECTIVES: This study aims to investigate the effectiveness of Kinesio taping (KT) and sham KT on pain, lumbar range of motion (ROM) and disability in chronic non-specific low back pain. PATIENTS AND METHODS: This is a randomized, placebo controlled study. Sixty patients (22 males, 38 females; mean age 21.5±1.7 years, range, 19 to 25 years) with chronic low back pain were randomized into either intervention or placebo groups. Group 1 (n=30) was treated with KT and group 2 (n=30) was treated with sham taping six times by intervals of three days. Patients were evaluated according to pain, modified Schober's test value, hand-ground distance and lumbar ROM and disability at baseline and at the end of the first and sixth months of intervention. Pain was assessed by using Visual Analog Scale (VAS), while ROM was assessed by modified Schober's test value, hand-ground distance and lumbar lateral flexion ROM. Disability was assessed with Oswestry Disability Index (ODI). RESULTS: Statistically significant improvements for all parameters were found for both groups after one month of intervention (p<0.05). These effects were sustained after six months of follow-up for modified Schober's test, hand-ground distance and ODI. There were statistically significant differences between the groups for all outcome measures at the first month of intervention (p<0.05). However, at sixth-month follow-up, only modified Schober's test, hand-ground distance and ODI values were significantly different between groups (p<0.05) except VAS (p>0.05). CONCLUSION: Kinesio taping provided significant improvements in pain, ROM and disability at short term. These positive effects were sustained for ROM and disability at long term but not for pain.

Association Between Gender, Body Mass Index, and Ulnar Nerve Entrapment at the Elbow: A Retrospective Study.

INTRODUCTION: Entrapment of the ulnar nerve is the second most common compression neuropathy in the upper extremity, but the etiology is multifactorial and still not clearly understood. The authors aimed to determine whether gender and body mass index (BMI) are risk factors for ulnar nerve entrapment (UNE) at the elbow. METHODS: Results of electrodiagnostic studies performed on patients with UNE between January 2008 and February 2013 were examined retrospectively. Patients with BMI ≤22 were considered slender, those with a BMI between 22 and 29, normal, and those with a BMI >29, overweight. The authors compared the data for patients with and without UNE. RESULTS: A total of 622 subjects were studied; 295 were UNE cases (154 men, 141 women) and 327 were controls (110 men, 217 women). There was no difference between control and UNE groups in terms of BMI. In univariate analysis, age and gender are independent risk factors for UNE, but when included in a stepwise Cox regression model, only gender was a significant factor. Male gender was found to be a risk factor for UNE. CONCLUSIONS: Male gender is a risk factor for developing UNE, but age and BMI are not significant risk factors. Further studies which examine BMI and gender differences with data about occupational risk factors are required.