Evaluation of intrarater and interrater reliability of the Wisconsin Gait Scale with using the video taped stroke patients in a Turkish sample.

OBJECTIVE: To establish the intrarater and interrater reliability of Wisconsin Gait Scale (WGS) in hemiplegic patients. DESIGN: Repeated-measures reliability study using video data of stroke patients. SETTING: Rehabilitation department of the university hospital. PARTICIPITANTS: Nineteen hemiplegic patients with 3-9 months stroke history and two physiatrists and two physical therapists. INTERVENTIONS: Video recordings were assessed twice, at an interval of 2 days, by the two physiatrists and two physical therapists. MAIN OUTCOME MEASURE: Wisconsin Gait Scale. RESULTS: Internal consistency coefficients for the WGS were excellent; Cronbach scores were 0.91 and 0.94 for the first and third days. Coefficient of Repeatability (CR) for observers' WGS assessments were ranged between 4.23-5.76 and intraclass correlation coefficients for total WGS score were indicated very high interrater reliability at the begining and end, respectively 0.91 and 0.96. Intraclass correlation coefficients for fourteen items of WGS ranged from 0.81 to 1. "Hip hiking at mid-swing", "Circumduction at mid-swing" and "Hip extension of the affected leg" were the items with lowest correlation coefficients. Intrarater reliability for total WGS scores ranged from 0.75 to 0.90. CONCLUSION: WGS was found excellent in reliability and may provide an objective means to document the findings from observational gait analysis, which is frequently used in clinical practice by rehabilitation teams.

Reliability and validity of the Turkish version of spinal cord lesion-related coping strategies.

OBJECTIVE: Spinal Cord Lesion-Related Coping Strategies Questionnaire (SCL CSQ) is a specific test that is developed for evaluating the coping strategies of the persons with spinal cord injury (SCI). The aim of this study was to evaluate the reliability and validity of the Turkish version of SCL CSQ (SCL CSQ-T) in persons with SCI. METHODS: One hundred persons with SCI were included in the study. All participants were evaluated with SCL CSQ-T and Brief Coping Styles Inventory (BCSI) at the baseline. SCL CSQ-T was repeated twice in 15 days. American Spinal Injury Association Impairment Scale and Functional Independence Measurement were used for the evaluation of the neurological loss severity and functional status. Emotional status was assessed by Hospital Anxiety and Depression Scale (HADS). Internal consistency reliability, test-retest reliability and construct validity of SCL CSQ-T were evaluated. RESULTS: Intraclass correlation coefficients of the SCL CSQ-T were between 0.51-0.86. Cronbach's alpha values and test-retest reliability of the acceptance, fighting spirit and social reliance subscales were good. Three factors were found in exploratory factor analysis. There was a positive correlation between the subscales of SCL CSQ-T. There was a statistically significant positive correlation between acceptance strategy of SCL CSQ-T and self-confidence and optimism of BCSI. The fighting spirit strategy positively correlated with self-confidence and optimistic strategies. The social reliance strategy positively correlated with helplessness and seeking social support. Coping strategies did not correlate with HADS. CONCLUSION: The results of this study revealed good internal consistency reliability, test-retest reliability and concurrent validity of the SCL CSQ-T factors acceptance and fighting spirit in relation to general coping strategies. The coping strategy social reliance needs revisions.

Efficacy of supervised exercise combined with transcutaneous electrical nerve stimulation in women with fibromyalgia: a prospective controlled study.

The aim of this study was to investigate the results of a supervised exercise with transcutaneous electrical nerve stimulation (TENS) in an exercise controlled study in women with fibromyalgia. Sixty-six women with fibromyalgia who admitted to the outpatient clinic of our hospital were randomized into two treatment groups. The patients in both groups participated in a supervised combined exercise program for 12 weeks. The women in first group had additional TENS in the first 3 weeks of the study. All subjects were analyzed at the baseline, at the end of the 3rd and 12th weeks. Outcome measures were tender point count (TPC), myalgic pain score (MPS), Fibromyalgia Impact Questionnaire (FIQ) and Short Form-36 (SF-36) Health Survey. Sixty women with fibromyalgia completed the study. The patients in both groups showed improvement in terms of TPC, MPS, FIQ, physical and mental summary scores and total scores of SF-36 at the end of the 3rd and 12th weeks. The improvement in MPS at the third week was higher in the first group (p = 0.01). But there was no difference in terms of the improvement in MPS between the groups at the end of the 12th week control (p = 0.87). There was no significant difference between the improvement in the other outcome parameters of the two groups. As a result, supervised exercise program was successful to improve the myalgic pain, functional status and quality of life in women with fibromyalgia. Exercises combined with TENS might be useful due to quick myalgic pain relief in the treatment of fibromyalgia in everyday practice.

The use of hydrotherapy for the management of spasticity.

INTRODUCTION: Spasticity is a major problem for the rehabilitation team. Physiotherapy is a vital component of therapy. Oral medication and other modalities such as heat, cold, ultrasound, electrical stimulation, and surgery (neuro-surgical or orthopedic) can also be used. The aim of this study was to compare the effects of hydrotherapy on spasticity and Functional Independence Measure (FIM) scores of patients with spinal cord injury (SCI). MATERIALS AND METHODS: This is a control case matched study. Twenty SCI patients were divided into 2 groups and matched for age, gender, injury time, Ashworth scores, oral baclofen intake, American Spinal Injury Association, and FIM scores. The control group received passive range of motion exercise twice a day and oral baclofen for 10 weeks. The study group also received passive range of motion and oral baclofen, as well as 20 min of water exercises (at 71 degrees F, full immersion) 3 times per week. The authors evaluated spasm severity, FIM scores, oral baclofen intake, and Ashworth scales, between groups at the beginning and at the end of the treatment period. RESULTS: Both groups demonstrated a significant increase in FIM scores. However, the hydrotherapy group demonstrated a larger increase (P < 0.0001) than the control group. There was a statistically significant decrease in oral baclofen intake in the hydrotherapy group (P < 0.01). There was no statistical change in the control group. Spasticity was evaluated by the Ashworth scale. There was a statistical improvement in each group (P < 0.01, P < 0.02). However, when compared to the control group, the use of hydrotherapy produced a significant decrease in spasm severity (P < 0.02). CONCLUSION: Side effects are often seen when using oral drug treatment for spasticity. Adding hydrotherapy to the rehabilitation program can be helpful in decreasing the amount of medication required. Future studies must evaluate benefits of hydrotherapy for rehabilitation.

Pain following spinal cord injury.

Some patients with spinal cord injury (SCI) complain of severe pain. The purpose of this study was to investigate the prevalence and classification of SCI-related pain, in terms of severity, location, aggravating and alleviating factors. 47 SCI individuals were studied between 15 and 67 years of age. Sixty-one percent of subjects experienced pain of moderate to severe intensity. 32 subjects complained of pain in the lower limbs, five patients had pain in the visceral region, eight in the pelvic and perineal areas. The pain duration was for a median of 5 weeks. The patients with pain were older (median 41 years) than those without pain (median 23 years). Pain was reported to be more intense in the evening and at night. The incidence of pain was higher in patients with thoracolumbar and incomplete spinal cord lesions. Inactivity, stress, weather change, overactivity were identified as aggravating factors. Sleep and rest were demonstrated as alleviating factors.