Chronic lateral elbow tendinopathy with a supervised graded exercise protocol.

STUDY DESIGN: Prospective Case Series. BACKGROUND: Variety of studies inquired the effectiveness of exercise treatment in LET (Lateral Elbow Tendinopathy). The research on the effectiveness of these approaches are still ongoing and very much needed due to the uncertainty of the subject. PURPOSE: We aimed to understand how the application of exercises in a graded manner affect the treatment outcomes in terms of pain and function. METHODS: This study is completed by 28 patients with LET and it was planned as a prospective case series. Thirty participants were included to participate in the exercise group. Basic Exercises (Grade 1) were performed for four weeks. Advanced Exercises (Grade 2) were performed for another four weeks. The VAS (Visual Analog Scale), pressure algometer, the PRTEE (Patient-Rated Tennis Elbow Evaluation) and a grip strength dynamometer were used to measure outcomes. The measurements were performed at baseline, at the end of four weeks and at the end of eight weeks. RESULTS: Investigation of the pain scores revealed that all VAS scores (p < 0.05, ES = 1.35; 0.72; 0,73 activity, rest, and night respectively) and pressure algometer results were improved both during basic (p < 0.05, ES = 0.91) and advanced exercises (p < 0.05, ES = 0,41). PRTEE scores were found to be improved in patients with LET after basic and advanced exercises (p > 0.001, ES = 1.15; p > 0.001, ES = 1.56 respectively). The grip strength only changed after basic exercises (p = 0.003, ES = 0.56). CONCLUSIONS: The basic exercises were beneficial for both pain and function. However, advanced exercises are required for obtaining further improvements in terms of pain, function, and grip strength.

The Reliability and Validity of the Turkish Version of Smartphone Impact Scale.

The Smartphone Impact Scale (SIS) was originally developed in English to determine the cognitive, affective, social, and behavioral impacts of smartphones. This study aimed to translate and cross-culturally adapt the SIS instrument into Turkish and investigate its psychometric properties. Two hundred and sixty-four young and middle-aged adults (186 females) with a mean age of 36.24 years (SD = 14.93; range, 18-65 years) were included. For cross-cultural adaptation, two bi-lingual translators used the back-translation procedure. Within a 5-to-7-day period after the first assessment, the participants completed the Turkish version of SIS (SIS-T) to evaluate test-retest reliability. Cronbach's alpha (α) was used to assess internal consistency. The correlation between the Turkish version of the Smartphone Addiction Scale (SAS-T) and the Nottingham Health Profile was determined to check the validity. The SIS-T had a high-level internal consistency (α = 0.86) and test-retest reliability (ICC2,1 = 0.56 to 0.89 for subscales). The SIS-T subscales were correlated with the SAS-T (r = 0.31 to 0.66, p < 0.01), indicating a good concurrent validity. The results show that the SIS-T is semantically and linguistically adequate to determine smartphones' cognitive, affective, social, and behavioral impacts on young and middle-aged adults. Good internal validity and test-retest reliability of the SIS-T were defined to evaluate the impacts of smartphones among Turkish-speaking young and middle-aged adults.

The Effectiveness of Neuromuscular Electrical Stimulation in Patients With Subacromial Impingement Syndrome: A Randomized Controlled Study.

OBJECTIVE: The aim of the study is to compare the effects of exercise training plus neuromuscular electrical stimulation with exercise training alone on shoulder function, pain, range of motion, and muscle strength in patients with subacromial impingement syndrome. DESIGN: Patients were randomly divided into groups of exercise training ( n = 24) and exercise training + neuromuscular electrical stimulation ( n = 24). Shoulder function was evaluated with the Disabilities of the Arm, Shoulder and Hand Questionnaire, pain level was assessed with a visual analog scale, range of motion was measured with a goniometer, and muscle strength was assessed with a handheld dynamometer baseline and at the end of treatment (week 8). RESULTS: In both groups, shoulder function, range of motion, and muscle strength (except flexion muscle strength in the exercise training group) increased, while pain decreased ( P < 0.05). Compared with the exercise training group, visual analog scale-activity and visual analog scale-night decreased more, and external-rotation range of motion and whole muscle strength increased more in the exercise training + neuromuscular electrical stimulation group ( P < 0.05). On the other hand, the effect sizes were medium to large for both groups. CONCLUSIONS: The addition of neuromuscular electrical stimulation treatment to exercise training did not improve shoulder function, which is the primary outcome, more than exercise training alone, but increased muscle strength and range of motion (external-rotation only) and decreased pain (activity-night), which are the secondary outcomes.

The effectiveness of Kinesio taping on playing-related pain, function and muscle strength in violin players: A randomized controlled clinical trial.

OBJECTIVES: This study aimed to investigate the effectiveness of Kinesio taping (KT) on playing-related pain, upper extremity and hand function, grip and pinch strength in violin players. DESIGN: Randomized controlled trial. SETTING: Faculty of health sciences. PARTICIPANTS: One hundred seventeen participants who were professional violinists for at least two years (82 women; mean age, 22.76 ± 3.87 years) were randomized to receive either therapeutic tape application (KT group), a sham tape application (placebo group), or no application (control group) for one week. OUTCOME MEASURES: The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) in one week. The secondary outcomes were the Visual Analogue Scale (VAS), the Purdue Pegboard Test, grip and pinch strength. Outcome measures were performed at baseline, immediately after the intervention, and one week later (follow-up). Participants were asked to play the "Violin Concerto No.2, Op.35 (Rieding, Oskar)"; pre-and post-performance pain and grip and pinch strength were assessed. RESULTS: The overall group-by-time interaction was not significant for DASH, but the improvement in the mean VAS-playing was slightly better in the KT group than in others (p < 0.05). The mean post-performance VAS-playing remained similar in the KT group while slightly increasing in the other groups (p < 0.05). In addition, a decrease in the mean post-performance grip strength of the left hand was significantly lower in the KT group than in the other groups (p < 0.05). CONCLUSIONS: Violin players receiving an application of KT represented minor improvements in playing-related pain, and post-performance pain intensity and grip strength of the left hand slightly remained after 1 week kT application. The possible post-performance effect of the tape on the pain intensity and grip strength must also be considered because KT can be used during the performance.

Chest Wall Mobility: Identification of Underlying Predictors.

OBJECTIVE: The purpose of this study was to identify factors contributing to normal mobility or hypermobility of the chest wall. METHODS: Seventy-eight young adults were divided into 2 groups: patients with normal mobility (group 1, n = 40) and hypermobility of the chest wall (group 2, n = 38). The mean mobility of the chest wall in groups 1 and 2 was 9.9 and 6.1 cm, respectively. The mean age of groups 1 and 2 was 22.2 and 21.5 years, respectively. The Brief Symptom Inventory, State-Trait Anxiety Inventory, Beck Depression Inventory, and the Perceived Stress Scale were used to evaluate the psychometric properties. Quality of life was assessed using 12-Item Short Form Health Survey. Smoking status was determined via self-report of current smoking status. Chest wall mobility was measured using thoracic and axillary cirtometry. Pulmonary functions were evaluated using a Spirobank II device. Subsequently, forced vital capacity (FVC), forced expiratory volume in 1 second, peak expiratory flow, and forced expiratory flow 25% to 75% were verified. Carefusion Micro RPM and the 6-minute walk test were used to evaluate maximal respiratory pressures and functional capacity, respectively. RESULTS: With backward linear regression models, FVC and obsessive-compulsive traits were significant predictors of chest wall mobility (R²â€¯= 0.27; P < .001 and P = .01, respectively). In logistic regression models, FVC, maximum inspiratory pressure, and obsessive-compulsive traits were significant predictors of normal mobility/hypermobility of the chest wall (R²â€¯= 0.42; P < .001, P = .01, and P = .03, respectively). CONCLUSION: Forced vital capacity, maximum inspiratory pressure, and obsessive-compulsive traits are significant predictors of chest wall mobility and normal mobility or hypermobility of the chest wall.

The effectiveness of trigger point treatment in rotator cuff pathology: A randomized controlled double-blind study.

BACKGROUND: Studies have emphasized the importance of the presence of myofascial trigger points (MTrPs) in patients with rotator cuff pathologies and the high frequency of MTrPs in rotator cuff muscles. OBJECTIVE: Evaluate the effectiveness of the treatment of active MTrPs in patients with rotator cuff pathologies. METHODS: Fifty-three patients with rotator cuff tear were randomized into two groups. All patients received the same standard conservative treatment twice a week for 6 weeks. Patients in Group 1 additionally received ischemic compression (IC) of MTrPs. Pain, range of motion (ROM), function, and anxiety and depression were assessed. MTrPs in rotator cuff muscles were assessed manually, and the number of MTrPs on the shoulder complex was counted. RESULTS: There were no significant differences between the groups in terms of changes in resting/activity/night pain, ROM, function, or anxiety and depression (p> 0.05). Pain scores improved only in Group 1. However, the total number of MTrPs was significantly decreased in Group 1 (p= 0.001). CONCLUSION: A six-week course of IC helps treat active MTrPs. A standard conservative treatment program reduced pain and increased function; the addition of MTrP treatment did not improve clinical outcomes in patients with rotator cuff pathologies.

The Turkish version of the pregnancy physical activity questionnaire: cross-cultural adaptation, reliability, and validity.

[Purpose] The aim of this study was to translate the Pregnancy Physical Activity Questionnaire, adapt it for use with Turkish subjects and determine its reliability and validity. [Subjects and Methods] The Pregnancy Physical Activity Questionnaire was translated into Turkish and administered twice at 7-14-day intervals to pregnant women to assess the test-retest reliability. Cronbach's α was used for internal consistency, and the inter-rater correlation coefficient was used to calculate the test-retest reliability. The Turkish Short Form 36 Health Survey (SF-36) and the International Physical Activity Questionnaire were used to estimate validity. [Results] The internal consistency during the first and third trimesters of pregnancy was excellent, with Cronbach's α values of 0.93 and 0.95, respectively. The mean interval between the two assessments was 11.1 ± 2.1 days. The correlation coefficient between the total activity measured by the Turkish version of the Pregnancy Physical Activity Questionnaire and the International Physical Activity Questionnaire estimates of the total metabolic equivalent were fair to poor during the first, second, and third trimesters of pregnancy (r = 0.17, r = 0.17, r = 0.21, respectively). The Turkish version of the Pregnancy Physical Activity Questionnaire showed fair correlations with the Short Form 36 Health Survey physical component score (r = -0.30) and mental component score (r = -0.37) for the first trimester of pregnancy. [Conclusion] The Turkish version of the Pregnancy Physical Activity Questionnaire was found to be reliable and valid for assessing a pregnant woman's physical activity.

Benefits of short-term structured exercise in non-overweight women with polycystic ovary syndrome: a prospective randomized controlled study.

[Purpose] The short-term effects of structured exercise on the anthropometric, cardiovascular, and metabolic parameters of non-overweight women diagnosed with polycystic ovary syndrome were evaluated. [Subjects and Methods] Thirty women with a diagnosis of polycystic ovary syndrome were prospectively randomized to either a control group (n=16) or a training group (n=14) for a period of 8 weeks. Anthropometric, cardiovascular, and metabolic parameters and hormone levels were measured and compared before and after the intervention. [Results] Waist and hip measurements (anthropometric parameters); diastolic blood pressure; respiratory rate (cardiovascular parameters); levels of low-density lipoprotein cholesterol, total cholesterol, fasting glucose, and fasting insulin; and the homeostasis model assessment of insulin resistance index (metabolic parameters) were significantly lower in the training group after 8 weeks of exercise compared to the baseline values. After exercise, the training group had significantly higher oxygen consumption and high-density lipoprotein levels and significantly shorter menstrual cycle intervals. The corresponding values for controls did not significantly differ between the start and end of the 8-week experiment. [Conclusion] Short-term regular exercise programs can lead to improvements in anthropometric, cardiovascular, and metabolic parameters of non-overweight women with polycystic ovary syndrome.

Association of physical activity level with depression, anxiety, and quality of life in children with type 1 diabetes mellitus.

BACKGROUND: Children with type 1 diabetes mellitus (T1DM) have low physical activity levels and are at high risk for psychosocial morbidities, including depression, heightened anxiety and low health-related quality of life (HRQoL). OBJECTIVE: The aim of this study was to assess the associations of physical activity level with depression, anxiety, and HRQoL in children with T1DM. SUBJECTS AND METHODS: A cross-sectional study design, including children with T1DM aged between 8 and 12 years and healthy controls, was used. Physical activity (PA) level was assessed with the Physical Activity Questionnaire for Older Children (PAQ-C). Anxiety was screened by The Screen for Anxiety Related Emotional Disorders (SCARED) questionnaire. Depressive symptoms were evaluated using the Children's Depression Inventory (CDI). Quality of life was assessed with the The Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0). RESULTS: Forty-seven T1DM and 55 healthy children were included with mean ages of 9.87±1.63 and 9.56±1.60 years, respectively. The T1DM group had significantly higher depression and anxiety score (p<0.05) and lower HRQoL-child self-report score (p<0.05, for all) compared with the control group. Significant associations were found between PAQ-C and PedsQL 4.0 (p<0.05), between SCARED and PedsQL 4.0 (p<0.05), and between HbA1c and PedsQL 4.0 (p<0.05) in children with T1DM. CONCLUSIONS: The result of our study suggested that only HRQoL was related to physical activity, anxiety and HbA1c in children with T1DM.

Reliability and responsiveness of algometry for measuring pressure pain threshold in patients with knee osteoarthritis.

[Purpose] This study aimed to establish the intrarater reliability and responsiveness of a clinically available algometer in patients with knee osteoarthritis as well as to determine the minimum-detectable-change and standard error of measurement of testing to facilitate clinical interpretation of temporal changes. [Subjects] Seventy-three patients with knee osteoarthritis were included. [Methods] Pressure pain threshold measured by algometry was evaluated 3 times at 2-min intervals over 2 clinically relevant sites-mediolateral to the medial femoral tubercle (distal) and lateral to the medial malleolus (local)-on the same day. Intrarater reliability was estimated by intraclass correlation coefficients. The minimum-detectable-change and standard error of measurement were calculated. As a measure of responsiveness, the effect size was calculated for the results at baseline and after treatment. [Results] The intrarater reliability was almost perfect (intraclass correlation coefficient = 0.93-0.97). The standard error of measurement and minimum-detectable-change were 0.70-0.66 and 1.62-1.53, respectively. The pressure pain threshold over the distal site was inadequately responsive in knee osteoarthritis, but the local site was responsive. The effect size was 0.70. [Conclusion] Algometry is reliable and responsive to assess measures of pressure pain threshold for evaluating pain patients with knee osteoarthritis.

Do stages of menopause affect the outcomes of pelvic floor muscle training?

OBJECTIVE: The purpose of our study is to determine whether there is a difference in pelvic floor muscle strength attributable to pelvic floor muscle training conducted during different stages of menopause. METHODS: One hundred twenty-two women with stress urinary incontinence and mixed urinary incontinence were included in this prospective controlled study. The participants included in this study were separated into three groups according to the Stages of Reproductive Aging Workshop staging system as follows: group 1 (n = 41): stages -3 and -2; group 2 (n = 32): stages +1 and -1; and group 3 (n = 30): stage +2. All three groups were provided an individual home exercise program throughout the 12-week study. Pelvic floor muscle strength before and after the 12-week treatment was measured in all participants (using the PERFECT [power, endurance, number of repetitions, and number of fast (1-s) contractions; every contraction is timed] scheme, perineometry, transabdominal ultrasound, Brink scale, pad test, and stop test). Data were analyzed using analysis of variance. RESULTS: There were no statistically significant differences in pre-exercise training pelvic floor muscle strength parameters among the three groups. After 12 weeks, there were statistically significant increases in PERFECT scheme, Brink scale, perineometry, and ultrasound values. In contrast, there were significant decreases in stop test and 1-hour pad test values observed in the three groups (P = 0.001, dependent t test). In comparison with the other groups, group 1 demonstrated statistically significant improvements in the following postexercise training parameters: power, repetition, speed, Brink vertical displacement, and stop test. The lowest increase was observed in group 2 (P < 0.05). CONCLUSIONS: Strength increase can be achieved at all stages of menopause with pelvic floor muscle training, but the rates of increase vary according to the menopausal stage of the participants. Women in the late menopausal transition and early menopause are least responsive to pelvic floor muscle strength training. Further studies in this field are needed.

Clinical implication of latent myofascial trigger point.

Myofascial trigger points (MTrPs) are hyperirritable points located within a taut band of skeletal muscle or fascia, which cause referred pain, local tenderness and autonomic changes when compressed. There are fundamental differences between the effects produced by the two basic types of MTrPs (active and latent). Active trigger points (ATrPs) usually produce referred pain and tenderness. In contrast, latent trigger points (LTrPs) are foci of hyperirritability in a taut band of muscle, which are clinically associated with a local twitch response, tenderness and/or referred pain upon manual examination. LTrPs may be found in many pain-free skeletal muscles and may be "activated" and converted to ATrPs by continuous detrimental stimuli. ATrPs can be inactivated by different treatment strategies; however, they never fully disappear but rather convert to the latent form. Therefore, the diagnosis and treatment of LTrPs is important. This review highlights the clinical implication of LTrPs.