Intermittent catheterization in patients with traumatic spinal cord injury: obstacles, worries, level of satisfaction.

OBJECTIVES: The aim of this study is to examine the obstacles in people with traumatic spinal cord injury (SCI) face performing intermittent catheterization (IC), also their worries and level of satisfaction. METHODS: Two hundred sixty-nine patients performing IC for at least 3 months were asked to fill-out a questionnaire about their opinions on IC. RESULTS: In total, 69.5% of patients performed IC themselves, 10.4% had performed by their mothers, 7.8% by another caregiver and 7.4% by their spouse. For the 72 (26%) patients unable to apply IC, reasons were insufficient hand function (56.1%), being unable to sit appropriately (35.4%) and spasticity (8.5%). In all, 70% of male patients had insufficient hand function, 20% could not sit and 10% had spasticity while 56.3% of female patients could not sit, 37.5% had insufficient hand function and 63% had spasticity. Difference between sexes was found to be statistically significant (P<0.05). Worries patients had when starting IC were fear of being dependent on IC (50.2%), accidentally injuring self (43.8%), embarrassment (43.2%), causing an infection (40.2%), bleeding (32.7%), fear of feeling pain (30.2%) and hygiene (24.7%). More women felt embarrassment; other items were similar in both sexes. In all, 46.9% of patients had urinary incontinence in intervals. CONCLUSION: In total, 69.5% of patients performed IC themselves. Men's most common obstacle was insufficient hand function while women's was being unable to sit appropriately. Patients' most common worries were being dependent on IC for life. In all, 46.9% had incontinence in intervals; 47.9% said IC improved their life quality; and 97.4% preferred IC over continuous catheterization.

Is vestibular rehabilitation as effective in bilateral vestibular dysfunction as in unilateral vestibular dysfunction?

BACKGROUND: Bilateral vestibular dysfunction causes serious disabilities and handicaps. Patients with bilateral dysfunction often restrict their activities and tend to be unsocial. AIM: To compare the effects of vestibular rehabilitation on disability, balance, and postural stability in patients with unilateral and bilateral vestibular dysfunction. DESIGN: Retrospective study. SETTING: Outpatient rehabilitation center. POPULATION: Patients with unilateral (group 1, N.=42) and bilateral vestibular dysfunction (group 2, N.=19). METHODS: All patients were evaluated before and after eight weeks of customized vestibular rehabilitation for disability (Dizziness Handicap Inventory [DHI], Activities-specific Balance Confidence Scale [ABC]), dynamic balance (Timed Up and Go Test [TUG], Dynamic Gait Index [DGI]), and postural stability (static posturography). RESULTS: The differences between DHI, TUG, DGI, and falling index (as assessed by static posturography) scores before and after the exercise program were statistically significant in both groups (P<0.05). There were no significant intergroup differences in any of the parameters evaluated (P>0.05). CONCLUSION: In this study, vestibular rehabilitation was found to be equally effective in unilateral and bilateral vestibular dysfunction patients for improving disability, dynamic balance, and postural stability. CLINICAL REHABILITATION IMPACT: Patients with bilateral dysfunction, causing more disability and greater handicap may indeed regain their functions as in patients with unilateral vestibular dysfunction by receiving appropriate and adequate vestibular rehabilitation.

Neurogenic bladder in patients with traumatic spinal cord injury: treatment and follow-up.

STUDY DESIGN: Multi-center, cross-sectional study. OBJECTIVES: Our aim was to evaluate the treatment methods and follow-up of neurogenic bladder in patients with traumatic spinal cord injury retrospectively using a questionnaire. SETTING: Turkey. METHODS: Three hundred and thirty-seven patients who had spinal cord injury for at least 2 years were enrolled from six centers in the neurogenic bladder study group. They were asked to fill-out a questionnaire about treatments they received and techniques they used for bladder management. RESULTS: The study included 246 male and 91 female patients with a mean age of 42±14 years. Intermittent catheterization (IC) was performed in 77.9% of the patients, 3.8% had indwelling catheters, 13.8% had normal spontaneous micturition, 2.6% performed voiding maneuvers, 1.3% used diapers and 0.6% used condom catheters. No gender difference was found regarding the techniques used in bladder rehabilitation (P>0.05). Overall, 63.2% of patients used anticholinergic drugs; anticholinergic drug use was similar between genders (P>0.05). The most common anticholinergic drug used was oxybutynin (40.3%), followed by trospium (32.6%), tolterodine (19.3%) darifenacin (3.3%), propiverine (3.3%) and solifenacin (1.1%). The specialties of the physicians who first prescribed the anticholinergic drug were physiatrists (76.2%), urologists (22.1%) and neurologists (1.7%). Only four patients had previously received injections of botulinum-toxin-A into the detrusor muscle and three of them stated that their symptoms showed improvement. Most of the patients (77%) had regular follow-up examinations, including urine cultures, urinary system ultrasound and urodynamic tests, when necessary; the reasons for not having regular control visits were living distant from hospital (15.3%) and monetary problems (7.7%). Of the patients, 42.7% did not experience urinary tract infections (UTI), 36.4% had bacteriuria but no UTI episodes with fever, 15.9% had 1-2 clinical UTI episodes per year and 5% had ⩾3 clinical UTIs. The clinical characteristics of patients with and without UTI (at least one symptomatic UTI during 1 year) were similar (P>0.05). The frequency of symptomatic UTI was similar in patients using different bladder management techniques (P>0.05). CONCLUSION: The most frequently used technique for bladder rehabilitation in patients with SCI was IC (77.9%). In all, 63.2% of patients used anticholinergic drugs, oxybutynin being the most commonly used drug. Also, 77% of patients had regular control visits for neurogenic bladder; 42.7% did not experience any UTIs.

Efficacy of the cardiac rehabilitation program in patients with end-stage heart failure, heart transplant patients, and left ventricular assist device recipients.

OBJECTIVE: The objective of this study was to assess the effects of cardiac rehabilitation on the functional capacity, pulmonary functions, quality of life, and psychological state of patients who had heart failure (HF), heart transplantation (HTx), or a left ventricular assist device (LVAD). METHODS: An 8-week exercise program was undertaken by 46 patients diagnosed with end-stage heart failure, 40 of whom had a heart transplantation and 11 were implanted with an LVAD. The patients' functionality was assessed with a maximal oxygen consumption test (pVO2), their psychological state with the Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI), their quality of life (QOL) with the Short Form 36 (SF 36), and their pulmonary condition with pulmonary function tests (PFTs). RESULTS: A significant improvement was observed in all forced vital capacity (%), forced expiratory volume in 1 second (%), pVO2, BDI, and most of the subscores of the SF 36 scores at the end of the exercise, compared with the pre-exercise period (P < .05). The intergroup evaluations showed no significant differences among the 3 groups in terms of all assessed changes (P > .05). CONCLUSION: An 8-week supervised exercise program was observed to improve functional capacity, PFT, QOL, and depression among patients who had HF, HTx, or LVAD. Supervised exercise should be recommended for every patient included in a heart transplant program.

Evaluation of changes in quality of life among Turkish patients undergoing ventricular assist device implantation.

BACKGROUND: Ventricular assist device (VAD) application has become an increasingly common method to treatment end-stage heart failure. In this study we evaluated the effect of VAD implantation upon the quality of life among Turkish patients with end-stage heart failure. METHODS: Twenty-eight VAD implantation patients included 3 (10.7%) with biventricular support using the Berlin Heart Excor; 15 (53.6%), left ventricular support with the Berlin Heart Excor; and 10 (35.7%), Heartware implantation for left ventricular support. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) and Short Form 36 (SF-36) Health Questionnaire were used to assess changes in the quality of life (QOL). RESULTS: Of the 28 patients, 2 were females (7.1%) and 26 were males (92.9%) of overall mean age of 44.6 ± 15.3 years (range, 8-66). Preoperative mean score of MLHFQ was significantly improved at 200.4 ± 147.4 days follow-up (72.8 ± 11.5 vs 13.7 ± 10.5; P < .05). SF-36 physical scores and mental scores were improved postoperatively (physical scores, 20.0 ± 24.4 vs 70.2 ± 19.9; mental scores, 38.4 ± 18.8 vs 73.9 ± 15.7; P < .05). No significant relation was observed between the postoperative scores of questionnaires and type of surgery. More improvement in postoperative MLHFQ scores was seen in patients younger than 45 years of age (P = .027). The severity of chronic heart failure (CHF) regressed from New York Heart Association (NYHA) class IV to NYHA class II in 26 and to NYHA class III in 2 patients (P = .000). CONCLUSION: The QOL among patients with end-stage heart failure improved dramatically soon after VAD implantation.

What do patients really know about cardiopulmonary rehabilitation: a cross-sectional survey study.

BACKGROUND: Although it is known that cardiopulmonary rehabilitation (CPR) reduces mortality and morbidity, it is not widely implemented as is in Turkey. One factor might be lack of demand since the levels of knowledge and awareness among patients who are eligible for CPR seem to be insufficient. AIM: It is aimed to investigate the level of awareness and knowledge of CPR among patients with cardiopulmonary problems. DESIGN: Cross-sectional survey study. SETTING: Outpatient. METHODS: Knowledge regarding CPR was assessed by questionnaires given to 690 patients recruited in seven university hospitals and six training and research hospitals in which either comprehensive or limited CPR services are available. POPULATION: Patients who have cardiopulmonary problems RESULTS: Of the patients, 34.7% were given information on CPR by healthcare staff, and 25.3% reported that their source of information was physicians. Although 49.9% of the patients knew that they needed to exercise for their cardiac/pulmonary problems, only 23.4% and 32.1% of those were aware that fast walking and climbing stairs, respectively, would not pose a risk to their cardiac/pulmonary health. The majority of the patients believed that activities of daily living, which comprise the most important component of exercise-based CPR, were harmful for their cardiopulmonary health. We found that 31.1% of the patients exercised regularly. During their stay at the hospital, certain kinds of exercises were suggested to 62.7% of the patients, and 34.7% of these patients performed various exercises. Of the patients who were given detailed information on cardiopulmonary rehabilitation, 69% stated that they would be willing to participate in a similar program. CONCLUSION: Although nearly half of the patients stated that they needed CR, it was observed that the ratio of patients who had true knowledge of CPR was low among patients. It is imperative to furnish patients with information on CPR, both in the field of PMR and throughout Turkey, and to put more effort into running those services effectively. Furthermore, we should make an effort to increase the level of liaison between patients and physicians and other healthcare professionals who participate in the treatment of cardiac/pulmonary patients.

Does pretransplantation etiology have any effect on exercise results in heart transplant patients?

OBJECTIVE: The objective of this study was to analyze the effect of pre-transplantation etiology and post-transplantation exercise on pulmonary function tests, functional capacities, psychological symptoms and quality of life among heart transplant patients. METHODS: An eight-week exercise program was applied to 35 heart transplant patients with histories of ischemic heart failure (HF; n = 20) or dilated HF (n = 15). All patients were evaluated before and after exercise in terms of breathing function tests, functional capacity (FVC; maximal oxygen consumption, pVO2), psychological symptoms (Beck Depression Scale (BDS), Spielberger's State-Trait Anxiety Inventory (STAI)) and quality of life (Short Form 36, SF-36). RESULTS: At the end of the exercise compared to the pre-exercise period significant improvements were observed in all FVC%, FeV1%, FeV1/FVC%, pVO2, SF 36 scores reflecting physical function, physical role, pain, general health, vitality, social function, and emotional role (P < 0.05) among heart transplant patients who were operated due to ischemic or dilated heart failure. In contrast, no significant improvement was observed in the BDS and STAI scales (P > 0.05). There was no significant etiology-related difference between the groups in terms of the evaluated parameters (P > 0.05). CONCLUSION: We demonstrated improvements in function tests, functional capacity and quality of life for both ischemic and dilated heart transplant patients following a supervised exercise program. We concluded that the positive effect achieved by exercise was not related to pre-transplantation etiology. Whatever the preoperative etiology, a regular exercise program is recommended for heart transplant patients in the rehabilitation unit.

Comparison of the use of conventional, hydrophilic and gel-lubricated catheters with regard to urethral micro trauma, urinary system infection, and patient satisfaction in patients with spinal cord injury: a randomized controlled study.

BACKGROUND: Management of the lower urinary tract is crucially important in patients with spinal cord injuries in order to prevent damage to the upper urinary tract and to preserve renal function. AIM: This study was designed to compare the use of standard polyvinyl chloride (PVC), hydrophilic-coated, and gel-lubricated non-hydrophilic catheters with regard to urethral micro trauma, urinary system infection, and patient satisfaction in patients with spinal cord injuries. Study design. Randomized, controlled study. SETTING: University hospital, inpatient clinic. POPULATION: Twenty-five male patients with spinal cord injuries. METHODS: The patients were asked to use 3 different types of catheters. The selection of catheter order was determined randomly, and all 3 catheters were used for 6 weeks consecutively. All patients were assessed at the beginning of treatment and at weeks 6, 12, and 18, in terms of urethral cytology, urinalysis, urine culture, and patient satisfaction (Visual Analog Scale, VAS). RESULTS: Ten patients completed the study. Regarding the urethral trauma evaluation, urethral cell counts were reduced with gel-lubricated non-hydrophilic catheter use (P<0.05), increased with PVC catheter use (P<0.05), and showed no change with hydrophilic-coated catheter use (P>0.05). The number of leucocytes in the urine sediment was significantly reduced after gel-lubricated catheter use (P<0.05). There was significantly less microhematuria with hydrophilic-coated and gel-lubricated non-hydrophilic catheter use compared with PVC catheter use (P<0.05). There were no significant differences among catheters with respect to symptomatic urinary tract infection and microbiological analysis of urine culture (P>0.05). The mean VAS was better with the gel-lubricated non-hydrophilic catheter than with the other two catheter types (P<0.05). CONCLUSION: The hydrophilic-coated catheter and especially the gel-lubricated non-hydrophilic catheter reduce trauma to the urethral surfaces and enable easy and comfortable catheterization. CLINICAL REHABILITATION IMPACT: The hydrophilic and gel-lubricated catheters represent an attractive alternative to standard PVC catheters for urological rehabilitation in patients with spinal cord injuries.

Effects of pilates exercises on functional capacity, flexibility, fatigue, depression and quality of life in female breast cancer patients: a randomized controlled study.

BACKGROUND: There are very few randomized controlled studies on exercise in cancer patients. Consequently, there are no guidelines available with regard to the exercises that can be recommended and difficulties are encountered in the clinical practice as to which exercise is more suitable to the patients. AIM: The purpose of this study was to investigate the impact of pilates exercises on physical performance, flexibility, fatigue, depression and quality of life in women who had been treated for breast cancer. DESIGN: Randomized controlled trial. SETTING: Out patient group, Department of Physical Medicine and Rehabilitation and Medical Oncology Department, University Hospital. POPULATION: Fifty-two patients with breast cancer were divided into either pilates exercise (group 1) and control group (group 2). METHODS: Patients in Group 1 performed pilates and home exercises and patients in group 2 performed only home exercises. Pilates exercise sessions were performed three times a week for a period of eight weeks in the rehabilitation unit. MAIN OUTCOME MEASURES: Subjects were assessed before and after rehabilitation program, with respect to, 6-min walk test (6MWT), modified sit and reach test, Brief Fatigue Inventory (BFI), Beck Depression Index (BDI) and the European Organisation for Research and Treatment of Cancer Quality of Life C30 (EORTC QLQ-C30) and EORTC QLQ BR23. RESULTS: After the exercise program, improvements were observed in Group 1 in 6-minute walk test, BDI, EORTC QLQ-C30 functional, and EORTC QLQ-C30 BR23 functional scores (P<0.05). In contrast, no significant improvement was observed in Group 2 after the exercise program in any of parameters in comparison to the pre-exercise period (P>0.05). When the two exercise groups were compared, there were significant differences in 6MWT in pilates-exercise group (P<0.05). CONCLUSION: Pilates exercises are effective and safe in female breast cancer patients. There is a need for further studies so that its effect can be confirmed. CLINICAL REHABILITATION IMPACT: This study addressed the effects of pilates exercise, as a new approach, on functional capacity, fatigue, depression and quality of life in breast cancer patients in whom there are doubts regarding the efficacy and usefulness of the exercise.

Are swimming or aerobic exercise better than conventional exercise in ankylosing spondylitis patients? A randomized controlled study.

AIM: The aim of the study was to compare the effects of conventional exercise (CE), swimming and walking on the pulmonary functions, aerobic capacity, quality of life, Bath indexes and psychological symptoms in patients with ankylosing spondylitis (AS). METHODS: Forty-five patients were randomised into either swimming (group 1), walking (group 2), CE group (group 3). Patients in Group 1 performed CE and swimming, patients in Group 2 performed CE and walking and patients in Group 3 performed CE only. Exercise sessions were performed three times a week for a period of six weeks. Patients were assessed before and after the rehabilitation program, with respect to, pulmonary function test (forced vital capacity [FVC, mL], forced expiration volume in one second [FEV1, mL], FEV1/FVC (%) and vital capacity [VC, mL]), maximal oxygen uptake (pV.O2), 6-minute walking test (6MWT), Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Metrology Index, Nottingham Health Profile and Beck Depression Inventory. RESULTS: There were significant increases in pVO2 and 6MWT after treatment in Groups 1 and 2 (P<0.05). FeV1, FVC and VC improved significantly with treatment in all three groups (P<0.05). A statistically significant improvement was observed in energy, emotional reaction and physical mobility sub-scores of NHP in three exercise groups after completion of the exercise program (P<0.05). CONCLUSIONS: Swimming, walking and CE had beneficial effects on the quality of life and pulmonary functions. Aerobic exercises such as swimming and walking in addition to CE increased functional capacities of patients.

The frequency of fibromyalgia syndrome and quality of life in hospitalized cancer patients.

To explore the frequency of fibromyalgia syndrome (FMS) among hospitalized cancer patients and address the relationships between pain, fatigue and quality of life with regard to the extent of pain, a cross-sectional and descriptive study was carried out in the Oncology Supportive Care Unit on 122 hospitalized cancer patients. Pain, sleep, disease impact (Fibromyalgia Impact Questionnaire), fatigue (Brief Fatigue Inventory), quality of life (Short Form 36 and European Organization for Research on Treatment of Cancer questionnaires Quality of Life-C30) were gathered using standardized measures. Thirteen of the hospitalized cancer patients (10.7%) included in the study were diagnosed with FMS. There were no statistically significant differences among three pain groups with respect to demographic characteristics (P > 0.05). There were significant differences among groups with regard to the presence of metastasis, fatigue, sleep disorder, pain, Brief Fatigue Inventory, Fibromyalgia Impact Questionnaire, most of subscores of Short Form 36 and European Organization for Research on Treatment of Cancer questionnaires Quality of Life-C30 scores (P < 0.05). In the present study, we have calculated the frequency of FMS among patients admitted to the oncology hospital in addition to establishing the relationships between pain, fatigue and quality of life with regard to the extent of pain. We believe that the descriptive data presented in this study would be helpful in future studies and therapeutic approaches.

The level of satisfaction in cancer patients with completed treatments: a 7-year screening.

PURPOSE: Cancer patients encounter many problems in the post-diagnosis period and they want to establish a good contact with the treatment team in order to get better information about their condition. This study attempted to investigate in patients with completed treatment the level of satisfaction they derived from the treatment and the treatment team. METHODS: The archive of medical records of the Medical Oncology Department comprising 4622 patients was randomly screened between the years 2000 and 2006. Charts of 528 patients were reached via phone and analysed for clinical data. RESULTS: Approximately 78.8% of the patients had been informed about their malignant diseases. The rates of satisfaction from the treatment team, the treatment itself, and communication with the physician was higher among informed patients compared to uninformed ones (p<0.05). Of all the evaluated patients, 38.5% had been recommended to practise general exercises. CONCLUSION: The great majority of our patients were informed about their diseases and treatments, although without being given adequate importance, and the satisfaction rates were higher among informed patients. We believe that our study will provide new approaches in relation to the importance and methods of communicating with and informing patients.

Comparison of hospital-supervised exercise versus home-based exercise in patients after orthotopic heart transplantation: effects on functional capacity, quality of life, and psychological symptoms.

UNLABELLED: In heart transplant patients it is common to observe a reduced exercise capacity and diminished quality of life. The objective of this study was to compare the effectiveness of a hospital-based exercise program versus that of a home-based exercise program on the functional capacity, quality of life, and psychological symptoms among heart transplant patients. METHODS: Thirty-eight heart transplant patients were randomly placed into two groups: a hospital-based exercise program (group 1, n = 15) or a home-based exercise program (group 2, n = 13). All patients performed flexibility, stretching, aerobic, strengthening, breathing, and relaxation exercise programs for 8 weeks. We performed estimates of functional capacity (maximal oxygen consumption-pVO2), quality of life (Short Form-36-SF36), and psychological symptoms (Beck Depression Inventory-BDI, the State-Trait Anxiety Inventory-STAI). RESULTS: In group 1, significant increases were observed in pVO2 and all SF36 subgroups, with the exception of vitality and social function subgroups (P < .05). Significant increases were not observed on the BDI or STAI (P > .05). Group 2 failed to show significant improvements in any variable, with the exception of the score on the bodily pain subgroup of the SF36 (P > .05). CONCLUSION: Based on our clinical results, we recommend a well-organized exercise program performed in a rehabilitation unit to improve postoperative exercise capacity and quality of life among heart transplant patients.

The relationship between depressive symptoms and anxiety and quality of life and functional capacity in heart transplant patients.

OBJECTIVE: To establish the relationship between depressive symptoms and anxiety with both the quality of life and functional capacity of heart transplant patients. METHODS: Thirty-four patients were included. Outcome measures were the Beck Depression Inventory (BDI), the State- Trait Anxiety Inventory (STAI), the Short Form 36 (SF36) and peak oxygen consumption (pVO2). RESULTS: After the transplant there was a significant negative correlation between the BDI and most of subgroups on the SF36 (p<0.05). There were significant negative correlations found between the pVO2 and both the BDI and STAI-trait anxiety score (p<0.05). Statistically significant improvements were noted in all subgroups on the SF36 and all BDI scores after the transplant, in comparison to the pre-transplant period (p<0.05). CONCLUSIONS: The functional capacity of a person affects the state of their depression and anxiety. We recommend participation in a cardiac rehabilitation program in the early stages of transplantation and believe that the quality of life, which has been shown to be related to the functional capacity and psychological symptoms, would benefit from this program.