COVID-19-related anxiety and obsession levels in stroke patients and family caregivers and their effects on caregiver burden.

PURPOSE: The aim of this study is to describe coronavirus disease 2019 (COVID-19)-related dysfunctional anxiety and thinking in patients with stroke and caregivers who are family members and their effects on caregiver burden. METHODS: This cross-sectional study included 79 stroke patients and their primary caregivers who were hospitalised in a tertiary rehabilitation hospital. Coronavirus Anxiety Scale (CAS) and Obsession with COVID-19 Scale (OCS) were used to assess the levels of COVID-19-related dysfunctional anxiety and obsession of the patients and their caregivers. Caregiver burden was assessed via the Zarit Burden Interview (ZBI). RESULTS: In the patients with stroke, COVID-19-related anxiety and COVID-19-related obsession rates were 13.9% (n = 11) and 7.6% (n = 6), respectively, while 17.7% (n = 14) of caregiver family members had COVID-19-related anxiety and 11.4% (n = 9) had COVID-19-related obsession. The CAS score of caregivers showed a significant positive correlation with the CAS and OCS scores of patients (p = 0.000, r = 0.423; p = 0.007, r = 0.300, respectively). The OCS score of caregivers showed a significant positive correlation with the OCS scores of the patients (p = 0.000, r = 0.476). The mean ZBI score of caregiver family members was 31.9 ± 13.5. A significant positive correlation was observed between the caregiver's OCS and CAS scores and ZBI scores (p = 0.002, r = -0.349; p = 0.004, r = 0.323, respectively). CONCLUSION: In this study, a significant relationship between caregiver burden and COVID-19-related anxiety and obsession in the caregivers of stroke patients was identified. Therefore, caregivers of stroke patients should not be forgotten during pandemics and should receive physical and psychological support.

The effect of vitamin D treatment on quality of life in patients with fibromyalgia.

BACKGROUND: Fibromyalgia is a syndrome characterized by chronic widespread pain accompanied by fatigue, disrupted sleep quality, cognitive impairments, subjective soft tissue swelling, and somatic symptoms. There are conflicting results in the literature regarding the prevalence of vitamin D deficiency in fibromyalgia patients and the reduction of symptoms after supplementation. AIMS: Our study aims to evaluate the effectiveness and reliability of vitamin D supplementation in patients diagnosed with fibromyalgia. METHODS: In our cross-sectional clinical study, 180 female patients aged 18 to 65 diagnosed with fibromyalgia according to the 2010 American College of Rheumatology Diagnostic Criteria were included. Oral vitamin D3 replacement of 50,000 IU was administered for 12 weeks. Patients' Fibromyalgia Impact Questionnaire (FIQ)and Visual Analogue Scale (VAS) scores were evaluated before and after the study. RESULTS: Significant differences were observed in the FIQ scores of the 180 fibromyalgia patients before and after vitamin D supplementation (p < 0.05). There was also a significant improvement in VAS scores (p < 0.01). A negative correlation between vitamin D and VAS as well as FIQ scores was found in the study. CONCLUSION: We determined that vitamin D deficiency is significantly more prevalent in patients diagnosed with fibromyalgia. Vitamin D supplementation was observed to have a positive effect on quality of life and reduction of pain.

Prevalence and predictors of polypharmacy among community-based individuals with traumatic spinal cord injury.

OBJECTIVES: The objective of this study was to investigate the rate of polypharmacy and predictors in community-living people with traumatic spinal cord injury (TSCI). DESIGN: Cross-sectional study. SETTING: Outpatient clinic of the rehabilitation hospital. PARTICIPANTS: Seventy-five patients with TSCI ≥ 12 months were included in this study. ASSESSMENTS: Demographic features were noted. American Spinal Injury Association Impairment Scale (AIS) was used to measure the neurological injury severity. Functional status was evaluated by Spinal Cord Independence Measure (SCIM) III. The Cumulative Illness Rating Scale (CIRS) was used to determine the comorbidities. Daily drug use ≥5 was considered to be polypharmacy. RESULTS: The mean age was 41.3 ± 16.1 years. The mean injury duration was 55.5 ± 51.6 months. Thirty-nine (52%) patients were married, while 36 (48%) lived alone. The mean body mass index (BMI) was 25.4 ± 5.1 kg/m². AIS upper and lower extremity motor scores were 45.5 ± 11.1 and 10.3 ± 15.8, respectively. The mean SCIM III score was 56.4 ± 18.8. The mean system involvement number measured by CIRS was 5.2 ± 1.7. Fifty-two (70%) patients were motor complete, while 23 (30%) were motor incomplete. Thirty-eight (50.7%) patients had falls, 28 (37.3%) had car accidents, 6 (8%) had violence, and 3 (4%) had sports-related accidents. The rate of falling history in the last 6 months was 16% (12 patients). Polypharmacy was found in 38 (50.7%) patients. The predictors of the polypharmacy, according to the Regression analysis, were complete injury (Exp (B) i.e. Odds ratio = 7.491), advancing age (Odds ratio = 1.061) and injury duration (Odds ratio = 1.020). CONCLUSION: In this study, more than half of the patients with chronic traumatic SCI had polypharmacy. The predictors of polypharmacy were completeness, advancing age, and longer injury duration.

Comparison of transcutaneous electrical stimulation and suprascapular nerve blockage for the treatment of hemiplegic shoulder pain.

BACKGROUND: Hemiplegic shoulder pain (HSP) is a common morbidity of stroke. Different treatment modalities can be used for optimizing the results and limiting the possible side effects. This research compares the effects of two therapies used to reduce the pain and improve the quality of life of the patients with HSP. OBJECTIVE: This study aimed to compare the effects of transcutaneous electrical nerve stimulation (TENS) and suprascapular nerve blockage (SSNB) in patients with HSP. METHODS: In this clinical research, 24 patients with HSP who participated in a conventional rehabilitation program were randomized into TENS or SSNB treatment groups. A 100 mm visual analogue scale was used to assess the severity of pain. Passive range of motion (ROM) of the shoulder was measured. The Modified Ashworth Scale (MAS) was used to evaluate spasticity of the upper extremities, and the Modified Barthel Scale was used to assess activities of daily living (ADL). Quality of life was measured using the Stroke-specific Quality of Life (SS-QoL) questionnaire. RESULTS: The pain scores of the SSNB group decreased more significantly (p< 0.05) than in the TENS group. SS-QoL scores at the 3rd week in both groups were significantly higher than before treatment (p< 0.05). MAS scores and Barthel scores after treatment did not differ significantly between the groups. CONCLUSION: TENS and SSNB were beneficial in relieving pain and increasing passive shoulder ROM and ADL in all patients. The alleviating of pain was faster in patients who underwent SSNB.

Vitamin D levels in children with cerebral palsy.

PURPOSE: The aim of this study was to assess serum vitamin D levels and related factors in children with cerebral palsy (CP). METHODS: One hundred and nineteen children with CP between the ages of 1 year to 10 years 9 months who were admitted to the children's inpatient rehabilitation unit of a tertiary rehabilitation hospital between January 1, 2017, and December 31, 2018, were included in this study. Demographic and clinical characteristics were obtained from the patient files. CP types and serum 25 hydroxyvitamin D (25OHD) levels were recorded. Gross Motor Function Classification System (GMFCS) was used to assess the functional level. RESULTS: Mean age was 5.1±2.9 years. Forty-two (35.3%) were girls, 105 (88.3%) were spastic, and 14 (11.7%) were ataxic and mixed type CP. Mean GMFCS level was 4 (IQR:2). Thirty-one (26.1%) were getting extra liquid feed while the rest were eating a normal diet. Mean serum 25OHD level was 27.4±15.7 (3-79) ng/mL. Vitamin D levels were normal in 68 children (57.1%), whereas 36 (30.3%) had vitamin D insufficiency and 15 (12.6%) showed vitamin D deficiency. Those whose serum vitamin D levels were within a normal range had a median age of 3.8 (IQR:4.2) years. On the other hand, mean age was 6.4 (4.3) years for those with low vitamin D level (p < 0.0001). Vitamin D level was 19.8 (21.4) ng/mL in those (n = 88) who had regular diets, whereas it was 31.0 [16] ng/mL in those (n = 31) who were getting extra liquid feed (p = 0.015). There was no statistically significant correlation between vitamin D level and gender, GMFCS, CP type, season or antiepileptic drug treatment. A binary logistic regression model showed that older age and having only regular meals were significant risk factors for low vitamin D. CONCLUSION: In this study, 42.9% of the children with CP had low vitamin D. Older children with CP or those who had regular diets were higher risk groups in terms of low vitamin D.

Demographic and clinical characteristics of inpatient stroke patients in Turkey.

Objectives: This study aims to assess the stroke rehabilitation facilities provided by university hospitals (UHs) and training and research hospitals (TRHs) and to evaluate the geographical disparities in stroke rehabilitation. Patients and methods: Between April 2013 and April 2014 a total of 1,529 stroke patients (817 males, 712 females; mean age: 61.7±14.0 years; range, 12 to 91 years) who were admitted to the physical medicine and rehabilitation clinics in 20 tertiary care centers were retrospectively analyzed. Demographic, regional and clinical characteristics, details of rehabilitation period, functional status, and complications were collected. Results: The median duration of stroke was five (range, 1 to 360) months. The ratio of the patients treated in the TRH in the Marmara region was 77%, but only 25% of the patients were living in the Marmara region. Duration of hospitalization was longer in the TRHs with a median of 28 days compared to those of UHs (median: 22 days) (p<0.0001). More than half of the patients (55%) were rehabilitated in the Marmara region. Time after stroke was the highest in the Southeast region with a median of 12 (range, 1 to 230) months and the lowest in the Aegean region with a median of four (range, 1 to 84) months. Conclusion: This study provides an insight into the situation of stroke rehabilitation settings and characteristics of stroke patients in Turkey. A standard method of patient evaluation and a registry system may provide data about the efficacy of stroke rehabilitation and may help to focus on the problems that hinder a better outcome.

Interferon-Inducible Protein-10 as a Marker to Detect Latent Tuberculosis Infection in Patients with Inflammatory Rheumatic Diseases.

It is important to identify cases of latent tuberculosis infection (LTBI) who are at risk for tuberculosis (TB) reactivation. We aimed to evaluate the performance of interferon (IFN)-gamma-inducible protein 10 (IP-10) as a marker to detect LTBI in patients with inflammatory rheumatic diseases (IRD). This study comprised 76 consecutive subjects with IRD. Patients with a history of TB or having active TB were excluded. In all patients, IP-10 level was measured and tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube test (QFT-GIT) were performed. Seventy patients with complete test results were analyzed. Twenty-one (30%) QFT-GIT-positive patients were defined as having LTBI. IP-10 yielded 2197 pg/mL cut-off point. At this cut-off point, IP-10 showed 89% specificity with a sensitivity of 91% (AUC: 0.950, 95% CI 0.906-0.994). TST, QFT-GIT, and IP-10 were positive in 77.1%, 30%, and 44.3% of the patients, respectively. Concordance among the results of TST, QFT-GIT, and IP-10 tests was evaluated. Agreement was poor between IP-10 and TST (58.6%, κ = 0.19), whereas it was good between QFT-GIT and IP-10 (84.3%, κ = 0.65). The results of the present study demonstrated that sensitivity and specificity of released IP-10 were as high as those of QFT-GIT in indicating LTBI in IRD patient group.

Assessment of nocturnal polyuria in patients with spinal cord injury at three different mobilization phases: A multicenter cross-sectional study.

OBJECTIVE: To determine the prevalence of nocturnal polyuria (NP) in patients with spinal cord injury (SCI) during three different particular phases, and investigate the impact of injury level and injury type on the prevalence of NP. DESIGN: A cross-sectional study. SETTING: Neurogenic Bladder Study Group from six different rehabilitation centers across the country. PARTICIPANTS: 40 patients with SCI. OUTCOME MEASURES: Patients were divided into three groups according to mobilization phase; 1st group included patients confined to bed (n = 14), 2nd group included patients sitting on a wheelchair (n = 19) and 3rd group included patients standing with an assistive ambulation device (n = 7). NP was assessed by nocturnal polyuria index (NPi) and nocturnal urine production (NUP) indexes. RESULTS: No significant difference was found between the groups (P = 0.312 for NPi and P = 0.763 for NUP) in terms of the presence of NP according to their mobilization phase. The night and 24-hour urine volumes showed no significant difference between the groups (P = 0.907 and P = 0.395 respectively). The NPi and NUP values did not show a significant difference between male and female patients (P = 0.826, P = 0.364 respectively), patients with the injury level of ≥T6 and

A new method to determine stretch reflex latency.

INTRODUCTION/AIMS: Motion artifact signals (MASs) created by the relative movement of intramuscular wire electrodes are an indicator of the mechanical stimulus arrival time to the muscle belly. This study proposes a method that uses wire electrodes as an intramuscular mechanosensor to determine the stretch reflex (SR) latency without lag time. METHODS: Gastrocnemius SR was induced by tendon tap, heel tap, and forefoot tap. The MASs recorded by intramuscular wire electrodes were extracted from background electromyographic activity using the spike-triggered averaging technique. Simultaneous recordings were obtained from multiple sites to validate the MAS technique. RESULTS: Using intramuscular wire electrodes, the MASs were successfully determined and extracted for all stimulus sites. In the records from the rectus femoris, MASs were also successfully extracted; thus, the reflex latency could be calculated. DISCUSSION: Wire electrodes can be used as an intramuscular mechanosensor to determine the mechanical stimulus arrival time to the muscle belly.

The Effect of Postamputation Pain and Phantom Sensations on Prosthesis Use, Body Image, and Quality of Life in Patients with Lower-extremity Amputation.

OBJECTIVE: The aim of this study was to investigate phantom limb pain (PLP), phantom limb sensation (PLS), and residual limb pain (RLP) after lower-extremity amputation and their effect on patients' effective prosthesis use, body image, and quality of life in prosthetic users. METHODS: Fifty-seven patients with lower-extremity amputation who used prosthesis for at least three months were included in our study. PLP, PLS, and RLP were evaluated via the prosthesis evaluation questionnaire (PEQ). Prosthetic use, locomotor skills, body image, quality of life were measured by administering Houghton scale, locomotor capabilities index (LCI), amputee body image scale (ABIS), and short-form health survey (SF-36), respectively. RESULTS: On the PEQ, 43.9% of the patients reported PLP, while 63.2% reported PLS, and 40.4% reported RLP. Correlation analyses revealed that as the frequency and duration of PLP increased, the patients' basic and advanced locomotor skills and quality of life decreased. When the intensity of PLP and the degree of distress caused by it increased, the patients' quality of life decreased, and when the frequency of PLS increased, the patients' emotional state worsened. When the intensity of PLS and the degree of bother caused by it increased, the patients' body image, emotional state, and social status worsened. There was no correlation between the rate, frequency, severity, or duration of RLP and scores on Houghton scale, LCI, ABIS, or SF-36. CONCLUSIONS: The presence of PLP and PLS decreases the use of prostheses and impairs body image and quality of life in prosthetic users.

Risk factors predicting upper urinary tract deterioration in children with spinal cord injury.

AIM: The aim of this study is to determine the risk factors predicting upper urinary tract (UUT) deterioration in children with spinal cord injury (SCI). METHODS: The medical records of 108 children with SCI who were referred to our unit between 1996 and 2018 were retrospectively reviewed. The data included general patient demographics, SCI characteristics, bladder management methods, presence of urinary tract infection, radiological evaluation of the UUT and lower urinary tract (LUT), and videourodynamic findings. The receiver operating characteristic (ROC) curve analysis was performed to determine the cutoff values of the maximum detrusor pressure during filling and the bladder volume ratio (BVR) for predicting UUT deterioration. Multivariate analyses were used to determine the risk factors predicting UUT deterioration. RESULTS: Complete data were available for 76 children. The median patient age was 15 years (2-17). The leading causes of SCI were motor vehicle accidents (44%) and fall (33%). UUT deterioration was identified in 33 patients (43%). Iatrogenic SCI etiology, abnormal radiological LUT findings, and detrusor pressures greater than 70 cmH2 O were found to be independent risk factors for UUT deterioration using regression analysis. In addition, ROC analysis revealed that a BVR less than 0.7 was the cutoff value for UUT deterioration in children with SCI. CONCLUSION: Abnormal radiological LUT findings, iatrogenic SCI etiology, detrusor pressure greater than 70 cmH2 O, and a BVR less than 0.7 were independent risk factors for UUT deterioration in children with SCI.

Effects of microprocessor-controlled prosthetic knees on self-reported mobility, quality of life, and psychological states in patients with transfemoral amputations.

OBJECTIVE: This study aimed to determine the effects of the microprocessor-controlled prosthetic knee (MPK) joint on self-mobility, body perceptions, depression, and quality of life in patients with unilateral transfemoral amputations (TFAs). METHODS: Thirty consecutive patients (28 males, mean age=38.5 years, age range=22-57) who had previously used non-MPKs and who were approved to use swing and stance phase-control MPKs were included in this 12-week clinical study. Before the MPK use and after the three-month follow-up, prosthetic use and locomotor capabilities were evaluated using the Houghton Scale and the Locomotor Capabilities Index (LCI-5), respectively. Body perception was assessed using the Amputee Body Image Scale (ABIS). The depressive symptoms and quality of life were evaluated using the Beck Depression Inventory (BDI) score and the 36-Item Short- Form Health Survey (SF-36), respectively. RESULTS: After MPK use, statistically significant ameliorations were observed in all outcome measures. The basic and advanced LCI-5 increased from 26.7±2.2 and 24.8±5.2 to 27.6±1.2 (p=0.007) and 27±2.1 (p=0.004), respectively. Houghton scores improved from 9±1 to 10.3±0.8 (p=0.000). The ABIS and BDI scores decreased from 43.2±10.9 and 5.7±6.6 to 37.1±8.9 (p=0.000) and 3.8±4.5 (p=0.015), respectively. Also, the SF-36 physical function and vitality subscales increased from 71.2±24.0 and 75.5±14.6 to 85.6±16.6 (p=0.001) and 81.7±14.1 (p=0.015), respectively. CONCLUSION: MPK use provides significant improvements in the locomotor capabilities, quality of life, and activities of daily living to patients with TFAs as well as improves their body image perceptions and depressive symptoms. LEVEL OF EVIDENCE: Level III, Self controlled study.

Effects of robot-assisted gait training on lower extremity strength, functional independence, and walking function in men with incomplete traumatic spinal cord injury.

OBJECTIVES: The aim of this study was to investigate the effects of robotic treadmill training on lower extremity motor function, functional independence, and walking in men with traumatic incomplete spinal cord injury (SCI). PATIENTS AND METHODS: A total of 30 consecutive male patients (mean age 36.6 years; range, 19 to 53 years) with traumatic incomplete SCI who were admitted to our inpatient clinic of the rehabilitation hospital were included in this study. All patients had conventional rehabilitation for five days weekly. The patients were randomized into two groups as the robot-assisted gait training (RAGT) group (n=15) for 30 min for three times a week for a total of five weeks and the conventional rehabilitation group (control group, n=15). The patients were evaluated sociodemographically and neurologically at baseline. Lower Extremity Motor Score (LEMS), Spinal Cord Independence Measurement-III (SCIM-III), and Walking Index for Spinal Cord Injury-II (WISCI-II) were used at baseline, at the end of the fifth week, and at three months after the treatment. RESULTS: The mean disease duration was 23±33 months in the RAGT group and 28.6±17 months in the conventional rehabilitation group (p>0.05). A significant improvement was observed in the LEMS, WISCI-II, and SCIM-III scores after the treatment in both groups (p<0.05). The improvement in the LEMS scores was significantly higher in the RAGT group at the end of the fifth week and at three months (p=0.017). The SCIM-III scores were also significantly improved in the RAGT group at the end of the fifth week and at three months (p=0.038). CONCLUSION: Our study results show that conventional rehabilitation is useful in terms of the improvement in the lower extremity motor function, walking, and functional status in men with incomplete SCI. Additional RAGT provides a better improvement in the lower extremity motor function and functional independence.

Self-Reported Medication Adherence in Patients With Ankylosing Spondylitis: The Role of Illness Perception and Medication Beliefs.

OBJECTIVES: This study aims to investigate medication adherence in Turkish patients with ankylosing spondylitis (AS) and analyze the related factors for non-adherence. PATIENTS AND METHODS: Ninety-nine patients with AS (60 males, 39 females; mean age 41.3±8.4 years; range, 18 to 66 years) were included in the study. Sociodemographic and clinical data were collected. Disease activity (Bath Ankylosing Spondylitis Disease Activity Index, C-reactive protein, and erythrocyte sedimentation rate), functional status (Bath Ankylosing Spondylitis Functional Index), spinal pain and fatigue (visual analog scale), quality of life (Ankylosing Spondylitis Quality of Life), and depression and anxiety (Hospital Anxiety and Depression Scale) were evaluated. Adherence to anti-rheumatic drugs was elicited using the Compliance Questionnaire on Rheumatology (CQR). Medication beliefs were assessed using the Beliefs about Medicines Questionnaire (BMQ), and illness perception using the Brief Illness Perception Questionnaire (B-IPQ). RESULTS: Non-adherence was reported in 64 patients (64.6%). No significant relationship between demographic, clinical, or psychological factors and adherence was found, except for disease duration (p=0.031). High B-IPQ treatment follow-up, illness coherence, and BMQ-Specific necessity scores were associated with good adherence (p=0.007, p=0.039, and p=0.002, respectively). BMQ-General overuse and harm scores showed an inverse correlation with the CQR score (p=0.005 r=-0.278; p=0.029 r=-0.219, respectively). Longer disease duration [odds ratio (OR): 0.98, 95% confidence interval (CI): 0.97-0.99] and higher B-IPQ item-1 score regarding the effect of the illness on the individual's life (OR: 0.58, 95% CI: 0.42- 0.81) were important predictors of low adherence. CONCLUSION: Nearly three out of five AS patients were identified as at risk for non-adherence with the CQR. Medication adherence is influenced by the patient's beliefs about medicines and illness perceptions, and these may be key targets for future interventions to improve medication adherence.

The prevalence of comorbidity and predictors in ankylosing spondylitis.

OBJECTIVES: The aim of the present study was to investigate the prevalence of comorbidities and related factors in patients with ankylosing spondylitis (AS). PATIENTS AND METHODS: Between June 2013 and January 2014, a total of 100 patients with AS (64 males, 36 females; mean age 43.1±10.7 years; range, 25 to 73 years) who were under routine follow-up in the outpatient clinic were included in this cross-sectional study. The demographic characteristics of the patients were recorded. The Ankylosing Spondylitis Disease Activity Scale (ASDAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Bath Ankylosing Spondylitis Metrology Index (BASMI) scores were calculated. Comorbidities were evaluated using the modified Cumulative Illness Rating Scale (CIRS). Both the number and severity of the affected systems were scored. RESULTS: The mean amount of cigarette consumption was 17.3±13.5 pack/year. The mean disease duration was 191.3±122.4 months. The BASFI, BASDAI, BASMI, and ASDAS-C-reactive protein scores were 3.4±2.3, 3.7±2.0, 4.5±1.8, and 2.5±0.9, respectively. The mean number of system-related problems was 4.3 (range, 1 to 11). The mean CIRS scores for the severity of comorbidities were 7.36±3.48 (range, 3 to 23). The most frequent system combinations were hematopoietic, eye, ear, nose and throat, and upper gastrointestinal in 11 patients, hematopoietic, respiratory and upper gastrointestinal in 11 patients, and hematopoietic, respiratory and eye, ear, nose and throat in 10 patients. When the estimated total CIRS scores was assessed in the multivariate reduced model, age, disease duration, and BASFI values showed a significant independent effect. CONCLUSION: Our study results showed that the frequency of comorbidities was more than four, although the severity of system problems were mild in AS patients as measured by CIRS. The most frequently involved systems included hematopoietic, upper gastrointestinal, lower gastrointestinal, renal, and musculoskeletal-skin systems. Age, disease duration, and BASFI scores were found to be predictors of comorbidities in our patients.

Turkish League Against Rheumatism Consensus Report: Recommendations For Management of Axial Spondyloarthritis.

OBJECTIVES: This study aims to update 2011 Turkish League Against Rheumatism SpondyloArthritis Recommendations, and to compose a national expert opinion on management of axial spondyloArthritis under guidance of current guidelines, and implantation and dissemination of these international guidelines into our clinical practice. PATIENTS AND METHODS: A scientific committee of 28 experts consisting of 14 rheumatologists and 14 physical medicine and rehabilitation specialists (one of them also has an immunology PhD) was formed. The recommendations, systematic reviews, and meta-analyses including pharmacologic and non-pharmacologic treatment were scrutinized paying special attention with convenient key words. The draft of Turkish League Against Rheumatism opinion whose roof consisted of international treatment recommendations, particularly the Assessment of SpondyloArthritis International Society/European League Against Rheumatism recommendations was composed. Assessment of level of agreement with opinions by task force members was established through the Delphi technique. Voting using a numerical rating scale assessed the strength of each recommendation. RESULTS: Panel compromised on five basic principles and 13 recommendations including pharmacological and nonpharmacological methods. All of the recommendations had adequate strength. CONCLUSION: Turkish League Against Rheumatism expert opinion for the management of axial spondyloArthritis was developed based on scientific evidence. These recommendations will be updated regularly in accordance with current developments.

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

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

Recurrence rate after pressure ulcer reconstruction in patients with spinal cord injury in patients under control by a plastic surgery and physical medicine and rehabilitation team.

OBJECTIVES: This study aims to evaluate the recurrence rate after reconstruction of the pressure ulcer (PU) in patients with spinal cord injury (SCI) treated by a team consisted of plastic surgery and physical medicine and rehabilitation specialists. PATIENTS AND METHODS: Between February 2002 and December 2008, a total of 39 patients with SCI (32 males, 7 females; mean age 38.1±6.7 years; range, 19 to 71 years) aged ≥18 years who were admitted to our rehabilitation unit and operated for PU were retrospectively analyzed. Demographic data and physical examination findings and potential risk factors for recurrence of PU were recorded. All patients were followed for the PU recurrence after reconstruction. RESULTS: The recurrence of PU was observed in nine patients (23.1%) with SCI. The most common recurrent PU was sacral ulcer (82.1%), followed by ischial ulcers (20.5%), trochanteric ulcers (15.4%), and others (2.6%). No risk factor was found to be statistically significant between the two groups in terms of both demographic risk factors and clinical risk factors. No statistically significant effect of clinical and demographic risk factors was found on the risk of recurrence of PU. CONCLUSION: Our study results suggest that collaboration between plastic surgery and physical medicine and rehabilitation department with a strict follow-up protocol may help to prevent recurrences of PU after surgery in SCI patients.

Turkish League Against Rheumatism (TLAR) Recommendations for the Pharmacological Management of Rheumatoid Arthritis: 2018 Update Under Guidance of Current Recommendations.

OBJECTIVES: This study aims to report the assessment of the Turkish League Against Rheumatism (TLAR) expert panel on the compliance and adaptation of the European League Against Rheumatism (EULAR) 2016 recommendations for the management of rheumatoid arthritis (RA) in Turkey. PATIENTS AND METHODS: The EULAR 2016 recommendations for the treatment of RA were voted by 27 specialists experienced in this field with regard to participation rate for each recommendation and significance of items. Afterwards, each recommendation was brought forward for discussion and any alteration gaining ≥70% approval was accepted. Also, Turkish version of each item was rearranged. Last version of the recommendations was then revoted to determine the level of agreement. Levels of agreement of the two voting rounds were compared with Wilcoxon signed-rank test. In case of significant difference, the item with higher level of agreement was accepted. In case of no difference, the changed item was selected. RESULTS: Four overarching principles and 12 recommendations were assessed among which three overarching principles and one recommendation were changed. The changed overarching principles emphasized the importance of physical medicine and rehabilitation specialists as well as rheumatologists for the care of RA patients in Turkey. An alteration was made in the eighth recommendation on treatment of active RA patients with unfavorable prognostic indicators after failure of three conventional disease modifying anti-rheumatic drugs. Remaining principles were accepted as the same although some alterations were suggested but could not find adequate support to reach significance. CONCLUSION: Expert opinion of the TLAR for the treatment of RA was composed for practices in Turkish rheumatology and/or physical medicine and rehabilitation clinics.