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.

Use of traditional and complementary medicine for musculoskeletal diseases

Background/aim: We aimedto determine the prevalence of traditional and complementary medicine (TCM) use among patients with musculoskeletal disorders (MSDs) and to examine the methods used, frequency, and experienced benefits of therapies; the reasons for using TCM; and the sources of information about therapies. We also compared demographic characteristics of users and nonusers of TCM. Materials and methods: The descriptive study was conducted with 839 patients who attended the physical therapy and rehabilitation units of 3 public hospitals between September 2014 and March 2015. A self-administered questionnaire including demographic characteristics, medical history, and details of TCM use was applied. Results: Of the 839 individuals in the study (592 female, 247 male; mean age 48.9 ± 13.0 years), 35.4% reported using TCM. There was no significant statistical difference between users and nonusers in terms of age, gender, body mass index, socioeconomic status, or educational level (P > 0.05). The disease duration of TCM users was significantly higher than that of nonusers (P < 0.05). The most commonly used TCM methods were balneotherapy (31%), herbal therapies (30%), wet cupping (22.2%), and massage-manipulation methods (21.2%). Of TCM users, 75.1% were satisfied. Conclusion: The prevalence of TCM use and satisfaction levels are high in patients with MSDs. Physicians should be well informed about TCM methods and raise the awareness of patients to prevent improper use of TCM.

The effect of a 12 week prehabilitation program on pain and function for patients undergoing total knee arthroplasty: A prospective controlled study.

BACKGROUND: The concept of preparing the body before a stressful event, such as surgery, has been termed "prehabilitation" (preoperative physiotherapy and exercise programs). Prehabilitation programs for people awaiting total knee arthroplasty (TKA) have positive effects on patients health status and may also lead to better postoperative outcomes. AIM: The purpose of this study was to examine effect of a prehabilitation program on knee pain, functional ability among patients with knee osteoarthritis after TKA surgery. STUDY DESIGN: A Prospective Controlled Study. PATIENTS AND METHODS: Subjects enrolled in this prospective controlled study who referred to our Orthopedics and Traumatology outpatient clinic between 2014 April-2015 May, had severe OA with pain not responsive to conservative treatment and scheduled for unilateral TKA. Subjects were assigned to a control or prehabilitation group. Patients of prehabilitation group were recruited from the orthopaedic waiting lists for primary unilateral TKA. Partipicants in the prehabilitation group were prescribed a training program that consisted of education and home-based exercise 12 weeks before the operation. After the TKA, all subjects partipicated in the same postoperative rehabilitation protocol. Evaluations were made before the surgery, with follow-up assessments at 3 and 6 months after surgery. Knee pain was assessed by the use of a 10-cm Visual Analog Scale (VAS) and function assesed by Knee injury and Osteoarthritis Outcome Score (KOOS) scale. RESULTS: A statistically significant improvement was observed in the values of VAS and all subsclaes of KOOS in both groups at third and sixth month compared to baseline. The intergroup comparison of the improvement (pre-post scores at sixth month) did not show any statistically significant diffeferences in VAS and KOOS scores. CONCLUSION: Our results show that prehabilitation before TKA is not superior to surgical treatment alone but about 20% of the patients changed their operation decision. So it is important to be able to postpone this process especially in the early period.

Affective temperaments in patients with rheumatoid arthritis.

AIM: The issue whether patients with rheumatoid arthritis (RA) have certain personality characteristics has been discussed. The temperament and personality characteristics of the patient may influence success in competing with stress. The aims of the study were to determine the most common dominant affective temperaments in patients with RA and whether temperament affects the disability. METHODS: A total of 88 patients with RA participated in this cross-sectional study. The Turkish version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto Questionnaire scale was used to determine the dominant affective temperament, and the Health Assessment Questionnaire (HAQ) was used to determine functional ability. RESULTS: Depressive temperament was found in 52 patients (59.1%) as the most common dominant affective temperament followed by irritable temperament in 17 patients (19.3%). There was no significant difference in HAQ scores of the patients according to the subscales of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto Questionnaire. Disability levels of patients were found as low-level disability in 65 patients and high-level disability in 23 patients. Multiple linear regression analysis indicated that HAQ score was not associated with gender, body mass index, duration of the disease, depressive temperament, anxious temperament, cyclothymic temperament or irritable temperament. CONCLUSION: The current study showed that depressive and irritable temperaments are the most common affective temperaments in patients with RA. The dominant affective temperament does not affect the functional ability of patients with RA.

Brachial plexus injury complicating the labor: mother is the victim at this time.

OBJECTIVE: Postpartum nerve injuries are rare complications of labor and the lower extremity peripheral nerves are the frequently affected ones. In this case report, we are presenting a patient who developed brachial plexus injury after a forceful vaginal delivery. CASE REPORT: The patient is a 28-year-old woman with right upper extremity pain, numbness and weakness, whose symptoms started just after labor. According to the clinical evaluation, electrodiagnostic study and magnetic resonance imaging, it was diagnosed as the brachial plexus injury. CONCLUSION: We concluded that similar to the ones seen after some surgeries, brachial plexus may be injured also during delivery and the labor positions should be considered.