[Show abstract][Hide abstract] ABSTRACT: Background:
Deterioration associated with aging in the erect posture and balance to change the location of the center increased the rate of fall in older age is one of the reasons. Loss of muscle strength is one of the major factors affecting the posture. In this prospective, randomized and controlled study, it was aimed to investigate the effectiveness of strengthening postural muscles through electrostimulation or by applying biofeedback exercises with static posturography in patients aged 60 years and over with balance disorder.
Patients aged between 60-80 years, who applied to Istanbul Faculty of Medicine Physical Medicine and Rehabilitation Department outpatient clinic and had been diagnosed with balance disorder using the Timed Up and Go (TUG) test, were included. 250 patients were screened, from them 67 patients were enrolled and 57 of them completed the study.Patients were randomized to three groups. The patients in Tetrax® group (TG) group (n:18) participated in a 15-minute exercise with Tetrax® which consisted of 15 minutes exercise session 3 times weekly for 4 weeks. The patients in EG group (n:19) received an electrostimulation program of postural muscles of 40 minutes per session 3 times weekly for 4 weeks. Patients in the control group (n:20) did 6-week balance exercises which were performed by other groups as well. 48 out of 57 patients attended the 6th-month control. As determinants of balance status Timed Up and Go Test (TUG), Berg Balance Scale (BBS) and Fall Index measured by Tetrax® were calculated at baseline, 1-month and 6-month follw up assesments. The patient's quality of life was assesed by Turkish version of World Health Organisation Quality of Life Questionnaire in Older Adults (WHOQOL-OLD.TR) at baseline and 6-month follow up assesments.
TUG values in both EG and TG decreased significantly between baseline assesment and 1-month (mean differences for TG: -4,00 ± 1,309 and EG -2,588 ± 1,839 p= 0,002 for the each of groups) and baseline assesment and 6-month (mean differences for TG: -2,933± 1,223 and EG -2,058 ± 1,477 p= 0,003 for the each of groups). A significant increase was determined in BBS values between baseline and 1-month (mean differences for TG: 4.000 ± 2,360 and EG: 3,529 ± 2,672 p= 0,031 for the each of groups). Fall Index (FI) measured by Tetrax® decreased between baseline assesment and 1-month (p= 0,185), and 6-month (p= 0,086) respectively, also between 1-month and 6-month follow up assesments (p= 0,627), but all of them were not significant changes. In all three groups the quality of life (p= 0,951) improved. Exercises conducted with Tetrax® were more effective than electrostimulation of postural muscles in increasing TUG values and decreasing BBS values.
Even though applying electrostimulation to postural muscles affected patients positively compared to pre-treatment, exercises performed with Tetrax® were more effective than the electrostimulation protocol to postural muscles in reducing balance disorder and this well-being continued even in the 6th month.
Journal of Back and Musculoskeletal Rehabilitation 09/2015; DOI:10.3233/BMR-150611 · 0.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background and objectives:
Measurement of the femoral cartilage thickness by using in-vivo musculoskeletal ultrasonography (MSUS) has been previously shown to be a valid and reliable method in previous studies; however, to our best notice, normative data has not been provided before in the healthy population.The aim of our study was to provide normative data regarding femoral cartilage thicknesses of healthy individuals with collaborative use of MSUS.
This is across-sectional study run at Physical and Rehabilitation Medicine Departments of 18 Secondary and Tertiary Centers in Turkey. 1544 healthy volunteers (aged between 25-40 years) were recruited within the collaboration of TURK-MUSCULUS (Turkish Musculoskeletal Ultrasonography Study Group). Subjects who had a body mass index value of less than 30 and who did not have signs and symptoms of any degenerative/inflammatory arthritis or other rheumatic diseases, history of knee trauma and previous knee surgery were enrolled. Ultrasonographic measurements were performed axially from the suprapatellar window by using linear probes while subjects' knees were in maximum flexion. Three (mid-point) measurements were taken from both knees (lateral condyle, intercondylar area, medial condyle).
A total of 2876 knees (of 817 M, 621 F subjects) were taken into analysis after exclusion of inappropriate images. Mean cartilage thicknesses were significantly lower in females than males (all p< 0.001). Thickness values negatively correlated with age; negatively (females) and positively (males) correlated with smoking. Men who regularly exercised had thicker cartilage than who did not exercise (all p < 0.05). Increased age (in both sexes) and absence of exercise (males) were found to be risk factors for decreased cartilage thicknesses.
Further data pertaining to other countries would be interesting to uncover whether ethnic differences also affect cartilage thickness. Collaborative use of MSUS seems to be promising in this regard.
Journal of Back and Musculoskeletal Rehabilitation 11/2013; 27(2). DOI:10.3233/BMR-130441 · 0.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Osteoarthritis is the most common age-related degenerative joint disease. It affects all the joints containing hyaline cartilage. Knee osteoarthritis is the most cumbersome in terms of prevalence and disability. The aim of this study to evaluate the efficacy of intra-articular hyaluronic acid in patients with knee osteoarthritis with regard to joint pain and function, as well as patient satisfaction, assessed at one month and at one year, and by age group.
In this prospective randomised study, 172 patients who were diagnosed knee OA and who received three consecutive intra-articular injections of HA weekly were included. Patients 65 years of age or older were accepted as the "elderly group", and those under 65 were accepted as the "middle-aged group". Clinical evaluations of efficacy and safety were conducted at the beginning of the study, one month after the third injection, and one year after the third injection.
In the two groups, the intragroup analysis revealed significant improvements following injection when compared with preinjection values. According to the last followup controls (after 12 months) in the middle-aged group, VAS activity pain, VAS rest pain, WOMAC physical function, and WOMAC pain values were found to be statistically lower when compared with pre-injection values. In the elderly group, no statistically significant differences were found between pre-injection and after 12 months.
We can conclude that intra-articular joint HA injections are effective in both young and old patients with OA with regard to pain and functional status over a short-term period. Further, HA injections in patients younger than 65 years can be planned for a one-year period.
The Open Rheumatology Journal 07/2013; 7(1):38-41. DOI:10.2174/1874312901307010038
[Show abstract][Hide abstract] ABSTRACT: Background and objectives:
To test the hypothesis that dry needling is more effective than sham dry needling in relieving myofascial pain of the temporomandibular muscles.
Material and method:
Fifty-two subjects with established myofascial trigger points were randomized into two groups; study group (N: 26) and placebo group (N: 26). Dry needling was applied using acupuncture needles. Sham dry needling was applied to the placebo group. Pain pressure threshold was measured with pressure algometry, pain intensity was rated using a 10-cm visual analog scale (VAS) and the unassisted jaw opening without pain measurement was performed. Evaluations were done by a physician blinded to the data.
Of 52 patients assigned, 50 completed the study. Mean algometric values were significantly higher in the study group when compared to the placebo group (p values being less than 0.05). There were no differences between the two groups in terms of VAS and unassisted jaw-opening without pain values.
Dry needling appears to be an effective treatment method in relieving the pain and tenderness of myofascial trigger points.
Journal of Back and Musculoskeletal Rehabilitation 12/2012; 25(4):285-290. DOI:10.3233/BMR-2012-0338 · 0.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: (i) To compare individuals with self-reported bruxism and non-bruxist individuals in terms of maximal bite force (MBF) and temporomandibular joint (TMJ) primary assessment parameters and (ii) to examine the relationship between MBF and tooth wear in these subjects.
Twenty-nine bruxist subjects and 29 healthy controls were enrolled. MBF measurements were carried out by the use of bite force recorder. Tooth wear indices, maximal mouth opening, maximal lateral excursions and maximal protrusions were measured for every subject.
MBF and tooth wear index scores were significantly higher in bruxists (p values <0.05) compared to non-bruxists. MBF and tooth wear index scores were found to be significantly correlated in the bruxist group (r=0.79, p=0.00). Less significant correlation was observed in the non-bruxist group (r=0.38, p=0.04). No differences in masticatory clinical examination parameters were identified between the groups.
This study is the first to show that MBF can increase in bruxist individuals and that the increase in MBF are correlated with tooth wear in bruxist subjects. Further studies regarding the possible role of MBF in bruxism are to be done.
[Show abstract][Hide abstract] ABSTRACT: Objective
Vertigo is a common clinical problem, particularly in older people. Benign paroxysmal positional vertigo (BPPV) is one of the most frequent causes of vertigo. It may be dangerous, especially in older individuals, because unsteadiness associated with BPPV can lead to falls. We aimed to investigate therapeutic effects of canalith repositioning maneuvers in patient with BPPV.
Patients complaining of vertigo referred to our Physical Medicine Outpatient Clinic for vestibular rehabilitation.
26 patients (14 male, 12 female) were studied; mean age was 52.5 ± 6.5 year (range 35–65), and mean symptom duration was 9.5 ± 20 months (range 0.25–96).
Detailed clinical examination, tests, and imaging studies were performed to exclude other possible diseases that may cause vertigo. Previous falls from the onset of symptoms were recorded. The Dix–Hallpike test for posterior and anterior semicircular canals (SCC) BPPV, and the supine roll test for horizontal SCC BPPV were performed. In all patients, the Epley maneuver (canalith repositioning maneuver, CRM) was performed initially. The Semont (liberatory) maneuver was performed in those patients who showed no signs of improvement with the Epley maneuver. Patients were followed up during 3 months.
All patients were diagnosed as having posterior SCC BPPV. Eight patients described immediate relief of their vertigo following the first maneuver. Ten days later 16 patients (61.5%) showed complete relief from vertigo. The Epley maneuver was repeated in five patients who showed moderate improvement with the first maneuver. Five patients with little or no improvement following the Epley maneuver undertook the Semont maneuver (liberatory maneuver): complete relief from vertigo was found in two. Patients were followed up during 3 months. No recurrence was observed in any patients during the study period. After 3 months, six patients still had the symptoms of BPPV but to a lesser degree.
Our results indicate that BPPV can be diagnosed easily and treated using a simple maneuver. On the basis of patient history and the Dix–Hallpike test it seems to be unnecessary to perform other diagnostic examinations routinely before trying CRM. Diagnosis and appropriate therapy is important for the prevention of further complications.
[Show abstract][Hide abstract] ABSTRACT: For symptomatic relief of low back pain, non-steroidal antiinflammatory drugs (NSAIDs) and analgesics are often in used in
combination with muscle relaxants. However adverse effects, especially sedation, limit the use of some muscle relaxants. Thiocolchicoside
(TCC) is a non-sedating muscle relaxant that has been shown to be safe and effective as monotherapy in the treatment of this
problem. The present study was carried out to determine if the combination of thiocolchicoside and standard treatment is more
effective than standard treatment alone.
Ninety-three Turkish centers recruited adults presenting with acute and subacute low back pain. Each physician included four
patients. Patients were randomized to receive either a NSAID or an analgesic for 5 to 7 days (referred to as “standard treatment”)
or standard treatment plus 8 mg TCC (Muscoril) twice daily for 5 to 7 days. On inclusion and again on day 7, low back pain
was evaluated with a visual analogue scale (VAS) and disability was evaluated with the Roland-Morris disability questionnaire.
Pain and disability were evaluated again on day 31.
A total of 155 patients were randomized to receive standard treatment alone and 174 received standardtreatment and TCC. The
vast majority (98.2%) of the patients received a NSAID as standard treatment. The mean VAS and disability questionnaire scores
of the two groups were equivalent at inclusion. At day 7, patients in both groups were improved but patients receiving TCC
had significantly less pain (p<0.003) and disability (p=0.0005) than patients on standard treatment alone; this was also true at day 31. (p<0.005 and p=0.0005, respectively). The addition of TCC to NSAID standard treatment resulted more effective for the symptomatic treatment
of low back pain than the NSAID alone. In addition, the combination was well tolerated and produced no more adverse effects
than the NSAID alone.
Journal of Orthopaedics and Traumatology 01/2002; 3(2):103-108. DOI:10.1007/s101950200036