The effect of local vibration applied to the forearm extensor muscles on hand function and muscle activation in stroke patients: a randomized controlled study.

OBJECTIVE: This study aims to reveal the effect of low-frequency local vibration applied to the forearm extensor muscles on stroke patients' muscle activation and hand functions. METHODS: Twenty-four stroke patients were randomized to the vibration group (n = 12) or control group (n = 12). The vibration was applied at a 30 Hz frequency to the forearm extensor muscles with a local vibration device three days a week after the routine, conventional physical therapy sessions for four weeks. Six vibration sets were applied, including one vibration for one minute and a rest for 2 min. Routine, traditional physical therapy was used for the control group in 60-min sessions for 4 weeks. Patients were assessed for muscle activation with surface electromyography (MVC) and The Wolf Motor Function Test (WMFT), Functional Independent Test (FIM) was applied to all patients before and after treatment. RESULTS: As a result of our study, MVC measurement, WMFT and FIM scores of the vibration group showed more improvement than the control group. Measurement results of vibration group; While MVC measurement increased from 10.21 to 13.79, WMFT-Functional Ability score increased from 42 to 50, WMFT-Performance Time duration increased from 68.78 to 61.83, and FIM score increased from 74.5 to 83. and the measurement results of the control group; MVC measurement increased from 12.28 to 12.22, WMFT-Functional Ability score increased from 48.5 to 51, WMFT-Performance Time duration increased from 70.39 to 70.61, and FIM score increased from 72.5 to 80.5. CONCLUSION: It was concluded that low-frequency local vibration applied to the forearm extensor muscles improve forearm extensor muscle activation and hand motor function. CLINICAL TRIAL REGISTRATION: NCT04562220.

Validity and reliability of the full cup test in patients with chronic low back pain.

OBJECTIVES: This study aims to determine the validity and reliability of the full cup test (FCT), evaluating the pain severity in patients with chronic low back pain. METHODS: A total of 100 patients (70 women and 30 men) aged over 18 years with mechanical low back pain were enrolled in the study. Demographic and clinical characteristics were recorded. Pain severity was evaluated using the visual analog scale (VAS) and FCT, the functional state was assessed by the Oswestry Disability Index (ODI), and the quality of life was assessed using the Nottingham Health Profile (NHP). FCT was performed on the 1st day by two independent observers (G1 and G2) and 3 days after the first application, patients were readministered the FCT by G1. RESULTS: The mean age of participants was 56.04±12.33 years and mean body mass index was 27.7±4.3 kg/m². The reliability of the FCT and intraclass correlation coefficient (ICC) was found to be 0.989 for intrarater compliance, ICC was found to be 0.984 for inter-rater compliance, and Cronbach's alpha reliability coefficient was α=0.994. External construct validity of the scale was confirmed with expected correlations with all subgroups of NHP except for social isolation, VAS and ODI (p<0.01). CONCLUSION: This study concludes that the FCT provides a reliable and valid instrument for measuring pain severity and loss of the function in patients with chronic mechanical back pain. We consider that FCT is a simple and easy test in patients with low education and advanced age.

Effect of plantar vibration on static and dynamic balance in stroke patients: a randomised controlled study.

OBJECTIVE: To investigate the effects of local vibration applied to the plantar region of the foot on static and dynamic balance in stroke patients. DESIGN: Randomised, controlled trial. SETTING: Inpatient. PARTICIPANTS: Thirty patients with stroke were randomised equally to the vibration and control groups. INTERVENTION: The control group underwent conventional physical therapy (CPT) for 4 weeks. The vibration group underwent local vibration therapy at a frequency of 80Hz and CPT for 4 weeks. OUTCOME MEASURES: The primary outcome measure was the Overall Stability Index (OSI). The secondary outcome measures were: the Anteroposterior Stability Index, Mediolateral Stability Index, fall risk, Berg Balance Scale, Functional Reach Test (FRT), and Timed Up and Go Test (TUG) to assess balance; the Trunk Impairment Scale to measure trunk function; and the 10-m Walk Test (10MWT) to measure walking speed. RESULTS: Participants receiving plantar vibration experienced greater improvements in static and dynamic balance assessments compared with participants in the control group. The mean change in OSI score between baseline and 4 weeks was 0.8 [standard deviation (SD) 0.8] for the vibration group and 0.02 (SD 0.6) for the control group [mean difference 0.4, 95% confidence interval (CI) 0.1 to 0.7]. The median change in fall risk score was 0.7 [interquartile range (IQR) 0.4 to 1.4] for the vibration group and 0.1 (IQR -0.1 to 0.6) for the control group (median difference 0.5, 95% CI 0.2 to 0.7). The median change in TUG time was 4 (IQR 1 to 7) seconds for the vibration group and 4 (IQR 0 to 2) seconds for the control group (median difference 2.5, 95% CI 1.5 to 3.5). CONCLUSION: These findings suggest that plantar vibration is useful in stroke patients. Plantar vibration can be applied to support CPT. GOV REGISTRATION NUMBER: NCT03784768.

Immediate Effects of Plantar Vibration on Fall Risk and Postural Stability in Stroke Patients: A Randomized Controlled Trial.

BACKGROUND: Local vibration can improve balance problems of individuals with stroke when applied to the plantar region. AIMS: This study aimed to determine the immediate effect of local vibration applied to the plantar region on fall risk and postural stability in patients with stroke. STUDY DESIGN: Randomized controlled study. METHODS: 30 patients (23 male,7 female) with stroke were randomized to either vibration (n = 15; 58.47 ± 8.23 years) or control (n = 15; 58.27 ± 9.50 years) groups. Before and after the intervention, the patients were evaluated using a Biodex Balance System. Local vibration was applied to the plantar region of two feet in the supine position using a vibration device for a total of 15 min to the individuals in the vibration group. While the patients in the placebo group were in the supine position, the device was brought into contact and no vibration was applied to the plantar region of two feet for 15 min. RESULTS: While significant improvements were observed in the postural stability and fall risk of the vibration group (p < 0.05), no significant change was observed in the placebo group (p > 0.05). Furthermore, significant improvements occurred in the SD values of the postural stability expressing postural oscillation in the vibration group (p < 0.05). CONCLUSION: As a result of local vibration applied to the plantar region, immediate (within 5 min) significant improvements in postural stability and fall risk values were detected.

The effect of low-intensity pulsed ultrasound on rib fracture: An experimental study.

BACKGROUND: In this study, we aimed to investigate the effects of lowintensity pulsed ultrasound on rib fracture healing in a rat model. METHODS: A total of 72 male Wistar-Albino rats were randomly divided into three equal groups. To induce a rib fracture, right thoracotomy was performed under general anesthesia and a 0.5-cm segment was removed from the fourth and fifth ribs. After 24 h of surgery, low-intensity pulsed ultrasound was implemented according to the groups. Group 1 served as the control group for the observation of normal bone healing. Low-intensity pulsed ultrasound was applied at a dose of 20% (2 msn pulse-8 msn pause) 100 mW/cm2 and 50% (5 msn pulse-5 msn pause) 200 mW/cm2 for six min, respectively in Group 2 and Group 3. All subjects were followed for six weeks. Eight animals from each group were sacrificed at two, four, and six weeks for further assessment. Histological alterations in the bone were examined. RESULTS: Although there was no statistically significant difference in osteoblasts, osteoclasts, new bone formation, and lymphocyte count among the groups, histological consolidation was significantly increased by low-intensity pulsed ultrasound. While low-intensity pulsed ultrasound induced osteoblastic, osteoclastic, and new bone formation, it inhibited lymphocyte infiltration. CONCLUSION: Low-intensity pulsed ultrasound, either at low or high doses, induced the histological consolidation of rib fractures and inhibited lymphocyte infiltration. This effect was more prominent in the long-term and at higher dose with increased daily and total administration time. We, therefore, believe that accelerating the natural healing process in patients with rib fractures would enable to treat more effectively in short-term.

Which swallowing difficulty of food consistency is best predictor for oropharyngeal dysphagia risk in older person?

PURPOSE: The present study aimed to investigate which swallowing difficulty of food consistency in participants over 65 years of age who did not have any disease that might affect swallowing functions, and which symptoms were most likely related to oropharyngeal dysphagia (OD). METHODS: The cross-sectional and multicenter study was conducted at 12 hospitals including 883 participants aged ≥65 years who were fed orally and who were admitted to the physical medicine and rehabilitation outpatient clinics between September 2017 and December 2018. Demographic characteristics were recorded. Katz Daily Living Activities Index (KDLAI), swallowing-related quality of life scale (Swal-QoL) and 10-item Eating Assessment Tool (EAT-10) were used. The participants were asked the "yes" or "no" questions including swallowing difficulty of various types of food consistency with the face-to-face interview. RESULTS: Participants were divided into two groups as normal swallowing (EAT-10 < 3 group) (n = 639) and OD risk groups (EAT-10 ≥ 3 group) (n = 244) according to the EAT-10 scores. While there was no difference related to number of teeth and KDLAI scores between groups (p = 0.327 and p = 0.221, respectively), the significant difference was found between groups in terms of yes/no questions and Swal-QoL scores (p < 0.05). Receiver operating characteristic analysis revealed that eating difficulty of mixed content food provided maximum sensitivity (99%) and eating/drinking difficulty of thick liquid had maximum specificity (77%). The higher area under curve was in eating/drinking difficulty of thick liquid (0.891), and higher positive likelihood ratio (LR) was eating/drinking difficulty of thick liquid (4.26) as well as lower negative LR was eating difficulty of mixed content food (0.01). The higher diagnostic odds ratio was eating difficulty of mixed content food (367.0), and the higher posttest probability was eating/drinking difficulty of thick liquid (0.211). CONCLUSION: While eating difficulty of hard solid food is the most common symptom in healthy participants over 65 years of age, the eating difficulty of thick liquids is the highest predictive value related to oropharyngeal dysphagia risk. Also, the eating difficulty of mixed content food had the highest diagnostic ratio.

The GUSS test as a good indicator to evaluate dysphagia in healthy older people: a multicenter reliability and validity study.

PURPOSE: Dysphagia is known to be a disorder of the swallowing function, and is a growing health problem in aging populations. Swallowing screening tests have mostly been studied in comorbidities such as stroke associated with old age. There is no simple, quick and easy screening test to best determine the risk of oropharyngeal dysphagia in geriatric guidelines. We aimed to evaluate whether the Gugging Swallowing Screen (GUSS) test is an effective method for evaluating swallowing difficulty in healthy older people. METHODS: This cross-sectional and multicenter study was conducted at 13 hospitals between September 2017 and February 2019. The study included 1163 participants aged ≥65 years and who had no secondary dysphagia. Reliability was evaluated for data quality, scaling assumptions, acceptability, reliability, and validity as well as cutoff points, specificity and sensitivity. RESULTS: The age distribution of 773 (66.5%) patients was between 65 and 74 years and 347 (29.8%) of them were male and 767 (66%) patients were female. The average total GUSS score was 18.57 ± 1.41. The Cronbach's alpha was 0.968. There was a moderate statistically significant negative correlation between the total GUSS and 10-item Eating Assessment Tool scores as well as between the total GUSS score and quality of life. The cutoff point of the total GUSS score was 18.50, sensitivity was 95.5% and specificity was 94.4%. CONCLUSIONS: The GUSS test is a valid and reliable test to identify possible oropharyngeal dysphagia risk in healthy older people who had no secondary dysphagia. It is suitable as a screen test for clinical practice.

Comparison of an epicondylitis bandage with a wrist orthosis in patients with lateral epicondylitis.

BACKGROUND:: Lateral epicondylitis is one of the most common causes of elbow pain. It is generally observed in people between the ages of 40 and 50 years, and the dominant extremity is more frequently affected. Various noninvasive methods are frequently used; however, studies investigating the effectiveness of the orthoses are limited and with controversial outcomes. OBJECTIVE:: To investigate the effectiveness of a hand-wrist resting orthosis and an epicondylitis bandage in lateral epicondylitis. STUDY DESIGN:: Randomized controlled trial. METHODS:: In total, 82 patients diagnosed with unilateral lateral epicondylitis were enrolled into the study. Hand-wrist resting orthosis was applied to 45 patients and epicondylitis bandage was applied to 41 patients. Patients were evaluated before treatment and at 6 weeks after treatment with a Visual Analogue Scale; Disabilities of the Arm, Shoulder, and Hand questionnaire; the Short Form 36; and a determination of hand grasping force. RESULTS:: Both groups were similar in terms of age, body mass index, gender, frequency of lateral epicondylitis on the dominant side, dominant extremity, and duration of complaints ( p > 0.05). A statistically significant recovery was detected in both groups between the pre-therapy values and the values at the sixth week in terms of Visual Analogue Scale scores; Disabilities of the Arm, Shoulder, and Hand questionnarie scores; hand grasping forces; and the Short Form 36 mental and physical component scores ( p < 0.05). However, there were no significant differences detected between the two therapy methods before the therapy and at the sixth week of treatment in all parameter values ( p > 0.05). CONCLUSION:: Our results suggest that both epicondylitis bandage and hand-wrist resting orthosis are effective treatment options for lateral epicondylitis-induced pain, functional status, muscle strength, and quality of life. Furthermore, neither treatment option was superior to the other. Large, randomized studies are necessary for more clear statements. CLINICAL RELEVANCE: Epicondylitis bandage and hand-wrist resting orthosis are equally effective treatment options for lateral epicondylitis-induced pain, functional status, muscle strength, and quality of life.

Long term effects of high intensity laser therapy in lateral epicondylitis patients.

The objective of this study is to investigate short- and long-term effects of high-intensity laser therapy (HILT) in lateral epicondylitis (LE) patients. Thirty patients with LE diagnosis (23 unilateral and 7 bilateral in total 37 elbows) were treated using HILT. LE patients were evaluated before, right after, and 6 months following HILT intervention post-treatment using visual analogue scale for pain (VAS) during activity and resting. Disabilities of the Arm, Shoulder, and Hand (DASH) Score and hand grip strength test (HGST) were used. The participants of the present study were also evaluated using Short-Form 36 (SF-36) before and 6 months after the treatment. Out of the 30 patients, 8 were male and 22 female with a mean age of 47.2 ± 9.7. The activity and resting VAS, DASH, and HGST scores revealed statistically significant improvement (p = 0.001) following treatment. Whereas VAS activity, DASH, and HGST scores increased after treatment until post-treatment 6 months significantly (p = 0.001), VAS resting scores remained stable (p = 0.476). A statistically significant improvement was also evident in the physical and mental components of SF-36 scores following treatment until post-treatment 6 months compared to pre-treatment scores (p = 0.001). In conclusion, the results of the present study suggest that HILT is a reliable, safe, and effective treatment option in LE patients in the short and long term considering pain, functional status, and quality of life.

Is pain the only symptom in patients with benign joint hypermobility syndrome?

The aims of this study were to evaluate pain, depression level, fatigue, sleep, and quality of life (QoL) among patients with benign joint hypermobility syndrome (BJHS) and to compare their results with those of healthy controls. The study involved 115 patients and 114 healthy volunteers. Pain level was rated using visual analogue scale (VAS) for all patients. Depression level, fatigue, sleep quality, and QoL of all the participants were evaluated by the Beck Depression Inventory (BDI), the Checklist Individual Strength (CIS), the Pittsburgh Sleep Quality Index (PSQI), and the Short Form-36 (SF-36), respectively. VAS value was 6.29 ± 0.94 in the patient group. Comparison of two groups showed that there were statistically significant differences between the patient group and the control group with respect to BDI, total CIS, PSQI scores, SF-36 subscales (physical function, role physical, bodily pain, general health, role emotional, and mental health), and mental component summary (p < 0.001). While pain is the predominant symptom among BJHS patients, depression, fatigue, impaired sleep, and QoL also commonly occur. Thus, all of these components should be taken into account when assessing patients with BJHS.