Objectives: This study aims to investigate the relationship between postural changes detected in ankylosing spondylitis (AS) vertebrae and clinicaland demographic characteristics of patients using a three-dimensional ultrasonic system.Patients and methods: A total of 44 AS patients (36 males, 8 females; mean age 39.1±9.8 years; range, 18 to 63 years) and 44 healthy volunteers(36 males, 8 females; mean age 38.4±9.4 years; range, 18 to 65 years) were included. Clinical, demographic, and laboratory data were recorded. Spinalposture analysis was performed using a Zebris CMS20 three-dimensional ultrasonic system.Results: Thoracic kyphosis angle was significantly higher in the AS group (45.4±12.8°) than in the control group (36.9±7.7°) (p=0.001). Lumbarlordosis angle was significantly lower in the AS group (20.7±10.6°) than in the control group (28±8.2°) (p=0.002). There were no significant differencesin total trunk inclination or sacral angles (p>0.05). Increase in thoracolumbar length at maximum spinal flexion and decrease in thoracolumbar lengthat maximum spinal extension were significantly lower in the AS group (p<0.05). A negative correlation was found between the thoracic kyphosisangle and length increase in spine flexure as well as chest expansion. Thoracic kyphosis angle had a statistically significantly positive correlation withage at onset of symptoms and tragus-wall distance (p<0.05).Conclusion: Significant changes were observed in spinal posture in patients with AS. In addition, significant correlations were found betweendynamic postural changes and spinal mobility. We think that postural evaluation and follow-up should be carried out with other parameters.Awareness of AS patients about postural changes should be increased, and proper exercise treatment should be applied.
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LALE ALTAN İNCEOĞLU , Reyhan ÇELİKER,
İLKER ERCAN ,
MURAT BİRTANE ,
KENAN AKGÜN ,
COŞKUN ZATERİ ,
NURETTİN TAŞTEKİN ,
AYLİN REZVANİ ,
İLKNUR AKTAŞ ,
ŞENAY ÖZDOLAP ÇOBAN ,
ERBİL DURSUN ,
NİGAR DURSUN ,
SELDA SARIKAYA
Objective: The objective of this study was to test the reliability and validity of the Turkish version of theFibromyalgia Participation Questionnaire (FPQ).Methods: One hundred and eighty-four female patients with fibromyalgia syndrome were includedin the study. All patients filled out the Turkish FPQ (FPQ-T) questionnaire, which was obtained bytranslation from German according to the guideline for the process of cross-cultural adaptation Thepatients filled out the revised Fibromyalgia Impact Questionnaire (FIQ) and reevaluated the FPQ-Ttwo hours later. Internal consistency reliability of the FPQ-T was assessed by calculating the “if itemdeleted” using Cronbach’s alpha and the “item-total correction” coefficient for each item of the ques-tionnaire. The consistency of the subscales and the correlation of the test-retest values were assessed.The test-retest values were compared using the Wilcoxon test. Criterion validity was measured usingFIQ scales by Spearman’s rank correlation coefficient.Results: For internal reliability, Cronbach’s alpha coefficient was calculated as 0.957 for nonworkingpatients and 0.958 for working patients. Cronbach’s alpha values of 0.939, 0.871, and 0.914 were ob-tained for daily, social, and work life, respectively. Correlation coefficients were 0.888 for daily life, 0.859for social life, and 0.901 overall in the nonworking group versus 0.896 the in working group. The com-parison of scores obtained from test-retest measurements showed no significant difference exceptfor Item 3. The correlation of the symptom severity score (SSS) and the FPQ-T was r=0.385 (p<0.001)and r=0.390 (p<0.001) for the nonworking and working subgroups, respectively. The evaluation ofconstruct validity showed a significant correlation between the SSS and FPQ-T.Conclusion: The results of our study showed that the FPQ-T is reliable and valid for assessing participa-tion and social functioning in fibromyalgia patients in Turkish society.
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ŞEBNEM ATAMAN , İsmihan SUNAR, Gürkan YILMAZ,
HATİCE BODUR ,
KEMAL NAS , Fikriye Figen AYHAN,
ÖZGÜR AKGÜL ,
AYŞEN AKINCI ,
ZÜHAL ALTAY ,
MURAT BİRTANE , Derya SOY BUĞDAYCI, Erhan ÇAPKIN,
REMZİ ÇEVİK , Yeşim Garip ÇİMEN, M. Tuncay DURUÖZ,
ATİLLA HALİL ELHAN ,
GÜLCAN GÜRER ,
CAHİT KAÇAR ,
AYHAN KAMANLI , Ece KAPTANOĞLU, Taciser KAYA, Hilal KOCABAŞ,
ÖMER KURU ,
MELTEM ALKAN MELİKOĞLU , Sumru ÖZEL,
AYLİN REZVANİ ,
İLHAN SEZER , Fatma GÜL YURDAKUL
Objectives: This study aims to report the assessment of the Turkish League Against Rheumatism (TLAR) expert panel on the compliance and adaptation of the European League Against Rheumatism (EULAR) 2016 recommendations for the management of rheumatoid arthritis (RA) in Turkey. Patients and methods: The EULAR 2016 recommendations for the treatment of RA were voted by 27 specialists experienced in this field with regard to participation rate for each recommendation and significance of items. Afterwards, each recommendation was brought forward for discussion and any alteration gaining ≥70% approval was accepted. Also, Turkish version of each item was rearranged. Last version of the recommendations was then revoted to determine the level of agreement. Levels of agreement of the two voting rounds were compared with Wilcoxon signed-rank test. In case of significant difference, the item with higher level of agreement was accepted. In case of no difference, the changed item was selected.Results: Four overarching principles and 12 recommendations were assessed among which three overarching principles and one recommendation were changed. The changed overarching principles emphasized the importance of physical medicine and rehabilitation specialists as well as rheumatologists for the care of RA patients in Turkey. An alteration was made in the eighth recommendation on treatment of active RA patients with unfavorable prognostic indicators after failure of three conventional disease modifying anti-rheumatic drugs. Remaining principles were accepted as the same although some alterations were suggested but could not find adequate support to reach significance. Conclusion: Expert opinion of the TLAR for the treatment of RA was composed for practices in Turkish rheumatology and/or physical medicine and rehabilitation clinics.
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HATİCE BODUR , Fatma GÜL YURDAKUL,
ŞEBNEM ATAMAN , Yeşim GARİP,
KEMAL NAS , Fikriye Figen AYHAN,
ÖZGÜR AKGÜL ,
AYŞEN AKINCI ,
ZÜHAL ALTAY ,
MURAT BİRTANE , Derya SOY BUĞDAYCI, Erhan ÇAPKIN,
REMZİ ÇEVİK ,
MEHMET TUNCAY DURUÖZ ,
GÜLCAN GÜRER ,
CAHİT KAÇAR ,
AYHAN KAMANLI , Taciser KAYA, Hilal KOCABAŞ,
ÖMER KURU , Ece KAPTANOĞLU,
MELTEM ALKAN MELİKOĞLU , Erhan ÖZDEMİREL, Sumru ÖZEL,
AYLİN REZVANİ ,
İLHAN SEZER , İsmihan SUNAR,
TUFAN GÜRKAN YILMAZ
Objectives: This study aims to update 2011 Turkish League Against Rheumatism SpondyloArthritis Recommendations, and to compose a national expert opinion on management of axial spondyloarthritis under guidance of current guidelines, and implantation and dissemination of these international guidelines into our clinical practice. Materials and methods: A scientific committee of 28 experts consisting of 14 rheumatologists and 14 physical medicine and rehabilitation specialists (one of them also has an immunology PhD) was formed. The recommendations, systematic reviews, and meta-analyses including pharmacologic and non-pharmacologic treatment were scrutinized paying special attention with convenient key words. The draft of Turkish League Against Rheumatism opinion whose roof consisted of international treatment recommendations, particularly the Assessment of SpondyloArthritis International Society/European League Against Rheumatism recommendations was composed. Assessment of level of agreement with opinions by task force members was established through the Delphi technique. Voting using a numerical rating scale assessed the strength of each recommendation. Results: Panel compromised on five basic principles and 13 recommendations including pharmacological and nonpharmacological methods. All of the recommendations had adequate strength. Conclusion: Turkish League Against Rheumatism expert opinion for the management of axial spondyloArthritis was developed based on scientific evidence. These recommendations will be updated regularly in accordance with current developments.
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Amaç: Kronik obstrüktif akciğer hastalığı önemli bir sağlık problemidir. Biz bu çalışmada kronik obstrüktif akciğer hastalığı olan hastalarda üst ekstremite egzersizleri ve yardımcı solunum kaslarına eklenen nöromuskuler elektrik stimülasyonu tedavisinin, arteriyel kan gazı, kalp atım hızı ve yaşam kalitesine olumlu etkisini araştırmayı amaçladık. Gereç ve Yöntemler: Göğüs hastalıkları uzmanı tarafından evre 4 şiddetli kronik obstrüktif akciğer hastalığı tanısı konulan yoğun bakım ihtiyacı olan otuz hasta çalışmaya dahil edildi. Bu hastalar kontrol ve tedavi grubu olarak her biri on beş hasta içeren eşit sayıda iki gruba ayrıldı. Her iki gruba dört hafta boyunca yardımsız üst ekstremite egzersiz programı ve sadece bir gruba on gün boyunca yardımcı solunum kaslarına nöromuskuler elektrik stimulasyonu tedavisi verildi. Arteriyel kan gazı değerlendirmesi, kalp tepe atım hızı ve solunum sıklığı kaydedildi. Yaşam kalitesini değerlendirmek için St. Georges Solunum anketi ve Kısa form 36 uygulandı. Fonksiyonel kapasite fonksiyonel bağımsızlık indeksi kullanılarak ölçüldü. Hastaların değerlendirilmesi başlangıç, 8. gün, 15. gün ve 30. günde yapıldı. Bulgular: Kalp tepe atım hızı, dakikalık solunum sıklığı, fonksiyonel bağımsızlık puanı egzersiz ve nöromuskuler elektrik stimülasyonu birlikte uygulanmış grupta istatistiksel olarak anlamlı olarak düzelmiş bulundu. Sonuç: Bu çalışma kısa dönemde kardiyorespiratuvar sistem üzerine tedavi edici egzersiz üzerine eklenen nöromuskuler egzersiz programının olumlu etkisi olduğunu göstermiştir. Anahtar Kelimeler:
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Chronic obstructive pulmonary disease is a major public health problem. In the present study, we aimed to investigate the possible effects of upper extremity exercises and neuromuscular electrical stimulation therapy applied to auxiliary respiratory muscles on arterial blood gases, blood pressure, heart rate values, and quality of life in patients with chronic obstructive pulmonary disease. Material and Methods: Thirty patients who were diagnosed with stage 4 severe chronic obstructive pulmonary disease by a pulmonologist and who needed intensive care were included in the study. The patients were equally allocated into two groups containing 15 patients each: control and intervention. Both groups were given an unassisted upper extremity exercise program for four weeks, and only one group was given neuromuscular electrical stimulation on auxiliary respiratory muscles for 10 days. Arterial blood gas measurements, peak heart rate, and breathing frequency were recorded. St. Georges Respiratory Questionnaire and short form-36 were performed for the evaluation of the quality of life. Functional capacity was determined by functional independent measurement. Evaluations of the patients were performed on the 1st, 8th, 15th, and 30th days of the study. Results: There were statistically significant improvements in peak heart rate, breathing frequency per minute, and functional independency scores in the group where exercise and neuromuscular electrical stimulation had been concomitantly applied (p<0.05). Conclusion: This study revealed positive effects of neuromuscular electrical stimulation in addition with therapeutic exercises on the cardiorespiratory system in the short run.
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ŞEBNEM ATAMAN , Zühre SÜRMELİ SARI, İsmihan SUNAR, Erhan ÖZDEMİREL, Ayşen AKINCI, Hatice BODUR,
ÖZGÜR AKGÜL ,
LALE ALTAN İNCEOĞLU , Zuhal ALTAY, Figen AYHAN,
MURAT BİRTANE , Derya BUĞDAYCI SOY, Erhan ÇAPKIN,
AYŞE BEYHAN LALE CERRAHOĞLU ,
MEHMET TUNCAY DURUÖZ , Rezzan GÜNAYDIN,
ZAFER GÜNENDİ , Gülcan GÜRER,
AJDA BAL HASTÜRK , Cahit KAÇAR, Ece KAPTANOĞLU, Taciser KAYA, Hilal KOCABAŞ, Nurdan KOTEVOĞLU,
KEMAL NAS , Aylin REZVANİ, Nesrin ŞEN,
ÖMER FARUK ŞENDUR , Peyman YALÇIN
Objectives: This study aims to report Turkish League Against Rheumatism s assessment on the compliance of European League Against Rheumatism 2013 treatment recommendations for rheumatoid arthritis with practices in Turkish rheumatology clinics and adaptations for Turkey. Patients and methods: Members of Turkish League Against Rheumatism and one rheumatoid arthritis patient voted for the 2013 recommendations of the European League Against Rheumatism for treatment of rheumatoid arthritis in two sessions. An item was changed and voted again only if at least 70% of participants wanted a change. Strength of recommendations was calculated for the items. Strength of recommendations for the changed items in the first and second voting rounds was compared by Wilcoxon signed-rank test. In case of significant difference, the item with higher strength of recommendation was accepted. In case of no difference, the changed item was selected. Results: Three overarching principles and fourteen recommendations were assessed among which the three overarching principles were changed emphasizing the importance of physiatrists as well as rheumatologists for taking care of the patients. Third item was changed by adding composite indices for assessing disease activity. In the ninth recommendation, rituximab was suggested as a first line drug independent of situations like latent tuberculosis or lymphoma, etc. In the 11th recommendation, unlike European League Against Rheumatism, our committee did not suggest any thought about tofacitinib, as then it had not been approved in Turkey. Remaining principles were accepted as the same. Conclusion: Expert opinion of Turkish League Against Rheumatism for treatment of rheumatoid arthritis patients was formed for practices in Turkish clinics. Conflict of Interest The authors declared no conflicts of interest with respect to the authorship and/or publication of this article. Financial Disclosure The authors received no financial support for the research and/or authorship of this article.
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Amaç: Diabetes mellituslu hastalarda ayak problemleri ve beraberindeki ülserasyonlar, morbidite ve kalıcı disabilitenin en önemli nedenidir. Ülserasyon için önemli risk faktörlerinden biri ayaktaki basınç değişiklikleridir. Biz bu çalışmada, tip 2 diabetli hastalarda taban basıncı ve hastalık süresi arasındaki ilişkinin varlığını tanımlamaya çalıştık. Gereç ve Yöntemler: Bu çalışmada 84 diabetik hastanın 168 ayağı değerlendirildi. Yaş, ağırlık, boy ve vücut kitle indeksi gibi demografk özellikler kaydedildi. Hastalar 10 yıldan az (Grup 1) veya fazla (Grup 2) hastalık süresine göre ayrıldı. Statik ve dinamik pedografk değerlendirme her hastada uygulandı ve sonuçlar gruplar arasında karşılaştırıldı. Bulgular: Statik pedobarografk değerlendirmede Grup 1deki hastaların sol ön ayak taban basıncı ortalama değeri anlamlı yüksekti (p<0,05). Biz sol ayak pik falanks basınçlarını anlamlı yüksek (p<0,05) bulmamıza karşın, sağ ayak taban temas alanı dinamik pedobarografk değerlendirmede Grup 1 hastalarda anlamlı düşüktü (p<0,05). Sonuç: Taban temas alanı azalması ve yürüme sırasında ön ayak pik basıncı 10 yıldan fazla hastalık süresi olan tip 2 diabetik hastalarda artmıştır.
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Meningiomlar; araknoid hücrelerden köken alan, tipik olarak selim karakterde, yavaş büyüyen tümörlerdir. Tüm meningiomlar içerisinde spinal meningiomlar %12 sıklıkta görülmektedir. Genellikle yavaş büyüme eğiliminde olmaları ve bulundukları bölgeye göre farklı semptom oluşturmaları nedeniyle semptomların başlamasıyla tanı konulması arasında geçen süre değişkendir. Manyetik rezonans (MR) görüntüleme öncesinde bazı spinal meningiomlu olguların lomber disk hernisi veya diz cerrahisi geçirdikleri bildirilmiştir. Burada 67 yaşında uzun süredir bel ağrısı ve alt ekstremitede ilerleyici kas gücü kaybı olan, lomber spinal stenoz tanısıyla opere edildikten sonra dorsal meningiom tanısı alan bir hastayı sunduk. Ameliyat sonrası tarafımıza başvuran hastayı rehabilitasyon amacıyla servisimizde takip ettik.
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