Frailty prevalence and related factors in the older adult-FrailTURK Project.

Frailty is one of the geriatric syndromes and has an important relationship with mortality and morbidity. The aim of this study is to present the characteristics, prevalence, and related factors of frailty in older adults in our country. The study included 1126 individuals over 65 years of age from 13 centers. Frailty was evaluated using the Fried Frailty criteria, and patients were grouped as "frail," "pre-frail," and "non-frail." Nutritional status was assessed with "Mini Nutritional Test," psychological status with the "Center for Epidemiological Studies Depression Scale-CES-D," and additional diseases with the "Charlson Comorbidity index." Approximately 66.5 % of the participants were between 65 and 74 years of age and 65.7 % were women. Some 39.2 and 43.3 % of the participants were rated as frail and pre-frail, respectively. The multinomial logistic regression analysis was used to determine the factors associated with frailty. It was observed that age, female gender, low education level, being a housewife, living with the family, being sedentary, presence of an additional disease, using 4 or more drugs/day, avoiding to go outside, at least one visit to any emergency department within the past year, hospitalization within the past year, non-functional ambulation, and malnutrition increased the risk of frailty (p < 0.05). Establishing the factors associated with frailty is highly important for both clinical practice and national economy. This is the first study on this subject in our country and will provide guidance in determining treatment strategies.

Quality of life and related factors in degenerative lumbar spinal stenosis: A controlled study.

OBJECTIVE: The purpose of this study was to compare the quality of life of patients with lumbar spinal stenosis (LSS) with that of the controls' and to investigate the factors related with the quality of life in LSS. METHODS: Fifty-four patients with LSS were included in the study whose diagnosis were made by clinically and magnetic resonance imaging (MRI). Control group consisted of age and sex matched 54 individuals. Both of the patient and control groups were evaluated with the Short Form-36 (SF-36) health survey and Hospital Anxiety Depression Scale (HADS). The Oswestry Pain and Disability Index (ODI) was used for the assessment of the disability. RESULTS: SF-36 scores in the LSS group was lower than that of the controls'. There was a significantly positive correlation between the SF-36 scores and walking distance in LSS group. A moderately negative correlation was found between the SF-36 and the ODI, HADS anxiety and depression scores. There was a significantly positive correlation between the ODI and the HADS anxiety and depression scores. HADS anxiety and depression scores in the patient group were significantly higher than that of the controls'. CONCLUSIONS: As a result, quality of life was decreased in subjects with LSS. The factors related with the quality of life were the walking distance, severity of the disability and emotional status in LSS.

The effects of using the Internet on the health-related quality of life in people with spinal cord injury: a controlled study.

STUDY DESIGN: Prospective cohort study. OBJECTIVES: To compare the health-related quality of life (HRQoL) in people with spinal cord injury (SCI) who use the Internet versus those who don't and with a control group of able-bodied individuals. To investigate the frequency of Internet usage before and after injury. To evaluate the differences in terms of demographic features of both groups, analyze the variation in the Internet usage pattern of people with SCI before and after the injury. SETTING: Istanbul, Turkey. METHODS: A total of 60 people with SCI (38 Internet users, 22 nonusers) were included in the study. The control group consisted of 33 healthy persons of similar age and sex. The HRQoL was evaluated with the SF-36 Health Survey. RESULTS: The scores of all the subscales of the SF-36, except vitality, were significantly lower in people with SCI than those of the controls'. The bodily pain subscale and physical component scores were found to be significantly higher in people with SCI using the Internet than the nonuser group with SCI (P<0.05). The Internet usage frequency increased significantly in people with SCI after injury (P<0.05). A significant correlation was found between time since injury and Internet use (r=0.365, P=0.007). CONCLUSION: Although HRQoL scores were lower in people with an SCI, the physical status component score was better in the Internet user SCI group. As there is a significant increase in the time spent online after injury, the Internet could be an effective modality to contact and educate people with an SCI.

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.

Comparison of the coping strategies, anxiety, and depression in a group of Turkish spinal cord injured patients and their family caregivers in a rehabilitation center.

BACKGROUND: Spinal cord injury (SCI) effects the emotional states and coping strategies of the patients and their families. The interesting point is the interaction between the emotional status and coping strategies. AIM: The aim of this study was to investigate the coping strategies and emotional states of the individuals with SCI and their caregivers and to compare the results of the groups. DESIGN: Cross-sectional SETTING: Inpatient rehabilitation. POPULATION: Thirty one patients with traumatic SCI and 31 family caregivers admitted to the inpatient rehabilitation were evaluated. METHODS: The injury duration was ≤12 months. Coping strategies and emotional status of the participants were evaluated by Brief Ways of Coping Questionnaire and Hospital Anxiety and Depression Scale. ASIA impairment scale and Functional Independence Measurement (FIM) were used for the assessment of the lesion severity and functional status. RESULTS: The most common coping strategies were self confidence and optimistic strategies both in the patient and caregiver groups. There was no statistically significant difference between the coping strategies and emotional status of the groups (P>0.05). A positive correlation was found between helplessness strategy and age in patients with SCI. Coping strategies did not show correlation with FIM. Anxiety in caregivers correlated negatively with SCI duration (P<0.05). CONCLUSION: As a result, the coping strategies and emotional status in the SCI patients and family caregiver groups showed similarity. CLINICAL REHABILITATION IMPACT: SCI patients and also their family caregivers must be evaluated in terms of coping strategies, anxiety and depression. The couples with maladaptive coping styles and emotional mood disorders might be supported with special interventions to help the adaptation to SCI and to improve the rehabilitation efficacy.

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.

Osteoporosis after spinal cord injury.

Immobilisation secondary to spinal cord injury (SCI) is associated with marked and rapid atrophy of trabecular bone. The purpose of this study was to evaluate bone mineral density (BMD) in both the upper and lower extremities following SCI sustained for various lengths of time and to correlate the BMD to the level of the lesion, time from injury, spasticity and serum calcium, phosphorus and alkaline phosphatase (ALP) levels. A study was undertaken in 41 SCI patients with a mean age of 35.8 +/- 12.7 years. A significant difference in BMD between upper and lower extremities of the paraplegics were found. BMD of upper and lower extremities were similar in tetraplegies. The BMD values were significantly different when the upper extremity scores of paraplegics and tetraplegics were compared but BMD scores of the lower extremities were similar in the two groups. The decrease in BMD was less in the spastic patients when compared to the flaccid group. There was a positive correlation between time from injury and the degree of BMD deficit in the paralysed areas. In the whole group of patients a significant positive correlation was found between the duration of SCI and serum ALP levels.

Calcitonin and calcium combined therapy in osteoporosis: effects on vertebra trabecular bone density.

Calcitonin is a hormone produced by the parafollicular cells of the thyroid gland. Like calcium salts, calcitonin acts by reducing bone resorption. In this study, 26 osteoporotic patients were given 100 IU salmon calcitonin for 10 days and, thereafter, 100 IU calcitonin every other day for 80 days combined with 1000 mg/day calcium salts. Prior to and after the combined therapy, the mean trabecular bone densities from the levels of thoracic 12 and lumbar 1 and 2 were obtained and routine thoracic and lumbar radiography performed. Combined calcitonin and calcium therapy for 3 months produced significant increases in vertebra trabecular bone density. The evaluation of the trabecular bone density and the number of non-traumatic compression fractures in 26 osteoporotic patients prior to the therapy did not indicate any close relationship between them. It is concluded that, in addition to other factors reported previously, microtraumas during daily activities have some effect on the incidence of fractures.