The effectiveness of "Dijital Steps" web based telerehabilitation system for patient with hindfoot pain: A randomised controlled trial.

OBJECTIVE: The aim of the study was to evaluate and compare effective therapeutic options for hindfoot pain, develop and investigate the effectiveness of tele-rehabilitation systems, and ensure patients perform their exercises and preventive measures regularly and accurately, while monitoring results. METHODS: Hindfoot pain (HP) patients (N = 77 with 120 feet) were admitted to this study and divided into two pathologies; Plantar Fasciitis and Achilles Tendinopathy. Patients in each pathology were randomized into three different rehabilitation programs-web-based telerehabilitation (PF-T & AT-T), -hands-on healing techniques combined with exercise (PF-C & AT-C)-unsupervised home exercise (PF-H & AT-H) program. Disability, activity restrictions, first-step pain, dorsiflexion-plantar flexion range of motion and kinesiophobia scores were recorded. The outcomes of the study groups were collected pre-post intervention (8thweek). Telerehabilitation system was developed via user-driven innovation and tested before using formally. RESULTS: Each group had significant improvements in pain, disability, functional status and kinesiophobia (p < 0.001). In terms of functional status, PF-C had a statistically significant difference from others (p < 0.001). There was no difference between the groups for the pain scores in both pathologies. (p > 0.001). However, web-based telerehabilitation (PF-T & AT-T) were found to be more effective on kinesiophobia compared to the other groups (p < 0.001). CONCLUSIONS: The presented web-based telerehabilitation system for management of hindfoot pain is an effective way and might be preferred instead of unsupervised home exercise specially for kinesiophobia. Additionally, Foot and ankle stretching and strengthening exercises protocols, myofascial releasing and mulligan concept manual therapy are effective modalities in terms of ROM, VISA-A, FAAM, FFI, TSK and VAS scores for hindfoot pain. The results indicated that three promised different rehabilitation protocols could be an effective strategy for HP.

The effect of neuromuscular and vestibular-ocular reflex training program on balance, isokinetic muscle strength and proprioception in people with chronic ankle instability.

OBJECTIVE: This study aimed to compare and investigate the effectiveness of neuromuscular exercise combined with vestibular-ocular reflex training and only neuromuscular exercise training on balance, isokinetic muscle strength, and proprioception in chronic ankle instability (CAI). METHOD: The study included 20 patients with unilateral CAI. The functional status was evaluated with the Foot and Ankle Ability Measure (FAAM). The star-excursion balance test was used for dynamic balance, and the joint position sense test assessed proprioception. Ankle concentric muscle strength was measured by an isokinetic dynamometer. The subjects were randomly divided into neuromuscular and vestibular-ocular reflex training (VOG, n = 10) and neuromuscular training group (NG, n = 10). Both rehabilitation protocols were applied for four weeks. RESULTS: Although VOG had higher means of all parameters, no superiority was found between the two groups in post-treatment results. However, the VOG significantly improved FAAM scores at the sixth-month follow-up than NG (P < .05). In the linear regression analysis, the post-treatment proprioception inversion-eversion for unstable side and FAAM- S were found to be independent factors of FAAM-S scores at the six months follow -up in VOG. Post-treatment isokinetic strength for inversion of unstable side (120 º /s) and FAAM- S were determined as predictor factors of FAAM- S scores at the six months follow -up (p < .05) in NG. CONCLUSION: The Neuromuscular combined with vestibular-ocular reflex training protocol effectively managed unilateral CAI. Furthermore, it may be considered an effective strategy for clinical outcomes for a long-term period in terms of functional status.

Extracorporeal Shockwave Therapy Versus Graston Instrument-Assisted Soft-Tissue Mobilization in Chronic Plantar Heel Pain: A Randomized Controlled Trial.

BACKGROUND: Although there are studies showing that extracorporeal shockwave therapy (ESWT) and instrument-assisted soft-tissue mobilization methods are effective in chronic plantar heel pain (CPHP) treatment, there is a need for studies comparing these techniques. We compared the effectiveness of ESWT versus instrument-assisted soft-tissue mobilization using Graston Technique (GT) instruments in addition to stretching exercises (SEs) in CPHP. METHODS: Sixty-nine patients were randomly assigned to three groups: ESWT+SEs (group 1), GT+SEs (group 2), and SEs only (control group) (ratio, 1:1:1). The SEs, twice daily for 8 weeks, were standard for all. Group 1 received low-intensity ESWT; in group 2, GT was the selected method. Visual analog scales (for initial step and activity pain), the Foot Function Index (FFI), the 12-item Short-Form Health Survey (SF-12), and the Tampa Scale for Kinesiophobia were used pretreatment, posttreatment, and at 8-week and 6-month follow-up. RESULTS: Visual analog scale and FFI scores improved posttreatment and during follow-up in all groups (P < .001). Although effect sizes were greater in groups 1 and 2 than in the control group in initial step pain posttreatment and at 8-week follow-up, group 2 had the highest effect size at 6 months. Mean SF-12 scores in groups 1 and 2 improved on the posttreatment assessment. Furthermore, group 2 showed significant improvements in FFI scores compared with the other groups at 6-month follow-up (F = 6.33; P = .003). CONCLUSIONS: Although ESWT+SEs and GT+SEs seem to have similar effects on initial step pain posttreatment and at 8-week follow-up, GT+SEs was found most effective for improving functional status at 6 months in the management of CPHP.

The effects of core stabilization training on dynamic balance and pulmonary parameters in patients with asthma.

BACKGROUND: In the literature, novel physiotherapy and rehabilitation approaches are getting significant attention as a way to cope with secondary complications in the management of asthma. OBJECTIVE: To investigate the effectiveness of core stabilization exercises combined with the Asthma Education Program (AEP) and breathing exercises in patients with asthma. METHODS: The study sample consists of 40 asthmatic patients (age 52.25 ± 11.51 years) who were randomly divided into a Training Group (TG) (n= 20) and a Control Group (CG) (n= 20). All subjects were included in the AEP, and both groups were trained in breathing retraining exercises (2 times/wk, 6-week duration in the clinic). The core stabilization exercise program was also applied in the TG. Respiratory muscle strength (maximum inspiratory and expiratory pressures), physical activity level (International Physical Activity Questionnaire Short Form (IPAQ)), health-related quality of life (Asthma Quality of Life Questionnaire (AQOL)), functional exercise capacity (six-minute walking test (6MWT)), and dynamic balance (Prokin PK200) were assessed before and after the interventions. RESULTS: The TG showed more significant improvements in MIP (ΔTG:4.55 cmH2O, ΔCG:0.95 cmH2O), IPAQ (ΔTG:334.15 MET-min/wk., ΔCG:99 MET-min/wk.), 6MWT (ΔTG:24.50 m, ΔCG:11.50 m), and dynamic balance sub-parameters compared to the mean difference between the initial assessment and after a 6-week intervention program, which included twelve exercise sessions (p< 0.01). CONCLUSIONS: The findings present greater improvements in inspiratory muscle strength, physical activity level, functional exercise capacity, and dynamic balance when core stabilization exercises are included in the pulmonary rehabilitation program for the management of asthma.

Outpatient vs Home Management Protocol Results for Plantar Fasciitis.

BACKGROUND: We compared the effectiveness of stretching and strengthening exercises combined with myofascial releasing and mobilization techniques to a stretching and strengthening only home program in plantar fasciitis (PF) management. METHOD: The study included 53 feet of 47 patients with plantar fasciitis (35 women / 12 men; mean age 48.9±11.2 years). Pain, disability, and activity restrictions were assessed by Foot Function Index (FFI), and first step pain was graded by visual analog scale (VAS). Ankle range of motion (ROM), gastrocnemius-soleus flexibility, proprioception, dynamic balance, and foot sensation were also considered. The patients were randomly divided into outpatient clinic treatment (Outpatient, n = 27 feet) and home rehabilitation groups (Home, n = 26 feet). Patient education was routine for all at the beginning of the management programs. In the Outpatient group, the foot-ankle-hip exercise program, myofascial releasing, and joint and soft tissue mobilization techniques were "hands on" at a clinic (twice a week for 8 weeks), whereas the Home group completed their home rehabilitation program on their own (8 weeks' duration with follow-ups every week). RESULTS: VAS, FFI, ROM, balance, proprioception, foot sense, and flexibility improved at the eighth week in both groups according to intragroup comparison (P < .05). When the 2 groups were compared, the results of plantar flexion range, balance, proprioception, foot sensation, flexibility, FFI, and VAS showed significant improvements in the Outpatient vs the Home group (P < .05). Also, the FFI and VAS scores at the sixth month were superior in the Outpatient group (P < .05). CONCLUSION: A combined supervised management protocol had superior clinical results in plantar fasciitis management. LEVEL OF EVIDENCE: Level II, comparative study.

Assessing selected quality of life factors of nursing home residents in Turkey.

As a result of improved public health and medical advances, not only has life expectancy among older people increased, but the importance of quality of life in terms of health in later life has also increased. The aim of this study was to investigate the relationship between socio-demographic factors, health-related behaviors, residents' satisfaction, and functional disability levels among elderly people living in nursing homes in Turkey using the World Health Organization's Quality of Life-BREF (WHOQOL-BREF). Data regarding socio-demographic characteristics, chronic health problems, health-related behaviors (smoking, alcohol consumption, physical activity, etc.) were collected from the study group (N=107) by a structured questionnaire during face-to-face interviews. Dependencies in activities of daily living (ADL) of the study group were also assessed using Katz's ADL index. The mean WHOQOL-BREF scores were significantly higher in participants who had independence in performing ADL (bathing, dressing, toileting, transfer, continence, feeding) (p<0.0001, p<0.0001, p<0.0001, p<0.001, p<0.0001, and p<0.001, respectively). It was found that WHOQOL-BREF scores were positively associated with having physical exercise habits and residents' satisfaction with nursing homes; being dependent in dressing were significant predictors of in the study (R(2): 0.38, p<0.003, p<0.0001, and p<0.0001, respectively). Residents' satisfaction from living nursing homes and participation in physical exercise were significant predictors of WHOQOL-BREF scores for those that participated in this study.

Factors affecting oral health habits among children with cerebral palsy: pilot study.

BACKGROUND: The aim of the present study was to investigate the factors affecting the oral health habits of children with spastic-type cerebral palsy (CP). METHODS: A total of 35 children with CP and their mothers were randomly selected for this cross-sectional study. Data regarding their sociodemographic characteristics and their oral health habits were collected during face-to-face interviews. RESULTS: Logistic regression analysis indicated that mothers' irregular brushing habits were a risk factor for their children's lack of regular brushing habits (odds ratio: 6.4, P = 0.048). Additionally, a significant association was observed between the mother's length of time between dental visits and the length of time between children's dental visits (R(2)= 0.11, P = 0.046). CONCLUSIONS: Mothers' oral health habits, including brushing habits and frequency of dental visits, are important factors in promoting healthy and beneficial oral health habits in children with CP in Turkey.

The links between health-related behaviors and life satisfaction in elderly individuals who prefer institutional living.

BACKGROUND: Life satisfaction among residents of institutions is becoming an important issue in a rapidly aging population. The aim of this cross-sectional study was to investigate the links between life satisfaction and health-related behaviors amongst functionally independent elderly people who prefer institutional living in Istanbul, Turkey. METHODS: The socio-demographic characteristics, health-related behaviors, leisure-time activities and fall histories of 133 residents of an institution in Istanbul were assessed by a structured questionnaire during face-to-face interviews. A validated life-satisfaction index questionnaire (LSI-A) was completed. RESULTS: The mean age of the study group was 73.9 +/- 8.0 (range 60-90 years). Within the group, 22.6% had never married and 14.3% had university degrees. The majority (71.4%) were in the low income bracket. The overall mean LSI-A score was 20.3 +/- 5.9. Participants who declared moderate/high income levels had a significantly higher mean LSI-A score than those in the low-income bracket (p = 0.009). Multivariate analysis of the data suggested that leisure-time activities and participation in regular physical activities are significant predictors of LSI-A scores (R2: 0.112; p = 0.005 and p = 0.02, respectively). CONCLUSION: The findings imply that regular physical activity and leisure-time activities are significantly related to life satisfaction among residents in institutions. Participation in physical activity and leisure-time activity programs may help to improve the life satisfaction of elderly people living in institutions.

Evaluation of life satisfaction index of the elderly people living in nursing homes.

The aim of our study was to evaluate the quality of life of the elderly living in nursing homes. A pool of 183 elderly people living in nursing homes were involved in the study. Data regarding the socio-demographic characteristics and life satisfaction index-A (LSI-A) of the participants were collected by means of a questionnaire during face-to-face interviews. The average LSI-A score of the whole group of participants was 25.26+/-5.51. When the mean LSI-A score of participants in relation to their independent variables was analyzed, no statistically significant differences were found for gender, socio-economic status or body mass indexes (BMI). However, the mean LSI-A score of those elderly people who spent some time in leisure activities was significantly higher than those who did not (p=0.03). In the stepwise linear regression analysis, the education level and place of residence were found to be the statistically significant independent predictors of LSI-A scores in the study group (p=0.05, p=0.001).