Turkish Journal of Physical Medicine and Rehabilitation最新文献

Objectives: This study aims to investigate the effects of swimming exercise on arthritis severity, radiological joint damage, and leptinrelated molecular changes in experimental rheumatoid arthritis (RA) in rats.

Materials and methods: A total of 30 male Wistar rats were randomly assigned to three groups (n=10 per group): Control, Arthritis, and Exercise + Arthritis. Experimental arthritis was induced by a single intradermal injection of Complete Freund's Adjuvant (CFA). The Exercise + Arthritis group underwent a six-week swimming protocol (1 h/day, five days/week), beginning two weeks before arthritis induction and continuing thereafter. Arthritis severity was assessed by visual scoring, radiological analysis, and histopathological evaluation. Plasma concentrations of leptin and matrix metalloproteinases (MMP-1, MMP-3, MMP-8, MMP-13) were measured using enzyme-linked immunosorbent assay (ELISA), and leptin receptor expression in paw tissues was analyzed immunohistochemically.

Results: The Exercise + Arthritis group exhibited significantly lower visual arthritis scores (p=0.002), reduced ankle swelling (p<0.001), and decreased cartilage and bone damage radiologically (p=0.045) compared to the Arthritis group. Histopathological evaluation revealed that swimming exercise markedly attenuated inflammatory cell infiltration, pannus formation, and bone resorption. Although plasma leptin and MMP levels did not differ between the groups (p>0.05), leptin receptor expression, considered to be associated with joint damage, was found to be significantly lower in the Exercise + Arthritis group (p=0.009). Swimming exercise reduced arthritis severity and joint damage.

Conclusion: Moderate-intensity swimming exerts protective, anti-inflammatory effects in experimental RA by reducing inflammation and preserving joint structure in rats, possibly through modulating leptin receptor expression and inflammatory pathways. Although regular swimming may serve as a useful adjunct to slow disease progression and joint damage in RA in rats, the translational relevance of these results remains uncertain in humans.

Objectives: This study aims to investigate the incidence and associated risk factors of clavicle and humerus fractures and brachial plexus injuries (BPIs) secondary to birth trauma.

Patients and methods: Between October 2019 and May 2023, a total of 556 newborns (300 males, 256 females; median age: 5 days; range, 0 to 5 days) with clavicle, humerus fractures, and BPIs secondary to birth trauma were retrospectively analyzed. The sex, Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) scores at 1 and 5 min, need for resuscitation, gestational week, mode of delivery, birth weight, birth length, and head circumference of the neonates were recorded. Concomitant BPI, evaluation specialty, and maternal characteristics were also noted.

Results: A larger head circumference was associated with an increased risk of clavicle fractures (p<0.001, odds ratio [OR]=1.681). High birth weight (p<0.01, OR=1.001), larger head circumference (p<0.001, OR=1.523), and lower APGAR score at 1 min (p=0.018, OR=0.605) were associated with BPI risk. Fractures were mainly evaluated by orthopedists, while BPI was primarily assessed by physical medicine and rehabilitation and pediatric neurology specialists (p<0.001). Neonatal physicians most frequently requested consultations from orthopedics for fractures and rehabilitation or neurology for BPI (p<0.001).

Conclusion: Our study results show that larger head circumference increases the risk of clavicle fractures and BPI. Higher birth weight and lower APGAR scores at 1 min also raise BPI incidence. Newborns with these risk factors should undergo a thorough evaluation.

Objectives: This study aims to investigate the effects of myofascial release therapy (MRT) added to standard physical therapy and rehabilitation practices on neck pain, trigger point (TP) numbers, pressure pain threshold (PPT), cervical joint range of motion (ROM), neck disability and quality of life in patients with cervical myofascial pain syndrome (MPS).

Patients and methods: This prospective, randomized-controlled trial included a total of 60 patients (8 males, 52 females; mean age: 41.6±12.5 years; range, 20 to 65 years) aged between 18 and 65 years who reported neck pain persisting for over one month and satisfied the Travell and Simons criteria for MPS diagnosis between December 2021 and September 2022. The patients in Group 1 (n=30) underwent a standard physical therapy program. Patients in Group 2 (n=30) additionally underwent MRT three days a week. Before and on Day 15 after treatment, patients' pain was evaluated by Visual Analog Scale (VAS), TP numbers by palpation, PPTs by pressure algometer, cervical ROM by goniometer, disability by Neck Disability Index (NDI), quality of life by Nottingham Health Profile (NHP).

Results: The VAS scores, TP numbers, PPTs, cervical ROM values, NDI, and NHP scores exhibited a significant improvement posttreatment compared to pretreatment in both groups (p<0.001). Considering the changes after treatment, in Group 2, the changes of VAS-movement, VAS-rest, TP numbers, PPTs, cervical ROMs, NDI, NHP scores were significantly higher than Group 1 (p≤0.05 for all).

Conclusion: In patients with neck pain due to cervical MPS, MRT provides positive effects on pain, TP numbers, PPT measurements, cervical ROM, neck disability, and quality of life. The MRT appears to be an effective treatment for cervical MPS as it is non-invasive, easy to apply, inexpensive, and has a low side effect profile.

Objectives: This study aims to investigate differences in occupational balance and quality of life between mothers of children with acquired brain injury (ABI) and healthy children.

Patients and methods: Forty mothers (mean age: 37.6±7.8 years; range, 24 to 52 years) of children with ABI (27 males, 13 females; mean age: 9.6±4.7 years; range, 2 to 16 years) and 40 mothers (mean age: 42.1±7.1 years; range, 32 to 58 years) of healthy children participated in the cross-sectional experimental study between May 2022 and December 2022. The occupational balance levels of the mothers in the study and control group were evaluated with the Occupational Balance Questionnaire 11-T, and the quality of life of the mothers was evaluated with the Nottingham Health Profile.

Results: Total Occupational Balance Questionnaire 11-T scores and items "having sufficient things to do during a regular week," "balance between doing things for others and for oneself," "balance between work, home, family, leisure, rest, and sleep," "having sufficient time for doing obligatory occupations," "balance between physical, social, mental, and restful occupations," "balance between energy-giving/energy-taking activities," and "satisfaction with time spent in rest, recovery, and sleep" were found to be statistically significantly lower in the mothers of children with ABI compared to the control group. The Nottingham Health Profile scores were found to be statistically significantly lower for the mothers of children with ABI compared to the control group.

Conclusion: The study revealed that the occupational balance and quality of life of mothers of children with ABI were adversely affected. In the rehabilitation process of children with ABI, the focus should be on the mother's occupational balance as well as the functional status of the children.

Objectives: This study aimed to assess the prevalence of shoulder soft tissue injuries and evaluate character of impact of functional limitations on sports practice in overhead competitive athletes.

Patients and methods: The prospective, observational cohort study using a mixed-method approach was conducted between the 2019 and 2022 sports seasons. The study evaluated the medical history, including clinical data such as pain, and medical records of 237 competitive overhead athletes (152 males, 85 females; mean age: 26.6±5.8 years; range, 18 to 30 years). Physical examination included assessment of shoulder range of motion, shoulder muscle strength and functional testing. The diagnosis was confirmed by magnetic resonance imaging. Functional limitation to athletes' sports practice were evaluated using patient-reported outcome measures [Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow Score].

Results: Shoulder injuries were documented in 65, representing nearly one-third of observed athletes. Subacromial impingement syndrome was the most common shoulder injury in each individual sport, followed by partial rotator cuff (RTC) tears. The KJOC data showed the highest functional limitation in the athletes with RTC partial tears. There was a significant relationship between shoulder dysfunction and RTC muscle imbalance, which could be a cause of the RTC partial tears.

Conclusion: Subacromial impingement syndrome is the most common shoulder injury in studied overhead competitive athletes. Functional limitations are most pronounced in athletes with RTC partial tears, and they are associated with RTC muscles' imbalance. Consideration of the study results can substantially help medical staff during in-season management of functional limitations associated with shoulder pain, as well as in the prevention of disorders caused by imbalance of the RTC muscles in overhead athletes.

Objectives: This study aims to determine the Turkish validity and reliability of the Composite Autonomic Symptom Score (COMPASS-31) in patients with fibromyalgia.

Patients and methods: The study included 117 patients (113 females, 4 males; mean age: 43.0±11.0 years; range, 20 to 61 years) diagnosed with fibromyalgia between November 2021 and February 2023. The COMPASS-31, Revised Fibromyalgia Impact Questionnaire (FIQR), and the 36-item Short-Form Health Survey (SF-36) were used to collect data. The reliability of the scale was tested with internal consistency and test-retest reliability, and the validity was determined with construct validity. For test-retest reliability, 31 individuals (27 females, 4 males; mean age: 42.0±10.0 years; range, 21 to 60 years) were reassessed after one week. To establish the construct validity of COMPASS-31, its correlation with FIQR and SF-36 was assessed.

Results: Cronbach's alpha value was 0.912, and the intraclass correlation coefficient was 0.838, indicating high reliability and internal consistency. According to the construct validity analysis, COMPASS-31 showed a good positive correlation with FIQR (r=0.451, p<0.001), and good negative correlations were observed between COMPASS-31 and vitality, mental health, and general health subscales of SF-36 (r=-0.402, p>0.001; r=-0.404, p<0.001; r=-0.455, p<0.001).

Conclusion: The Turkish version of the COMPASS-31 is valid and reliable to assess autonomic symptoms in patients with fibromyalgia.

Objectives: This study aims to compare ozone with the commonly used methylprednisolone in experimental facial paralysis and to investigate whether combining ozone with methylprednisolone provides additional benefits over methylprednisolone alone.

Materials and methods: The prospective randomized controlled animal study was conducted between November 2023 and January 2024. Thirty-two male Sprague-Dawley rats (mean weight: 300±30 g; range, 270 to 330 g; mean age: 8±1 weeks) with experimentally induced facial nerve injury were divided into five subgroups: control, paralyzed, methylprednisolone (2 mg/kg/day, intramuscular), ozone (1.1 mg/kg/day, intraperitoneal), and combination (ozone+methylprednisolone). Treatments were administered for 14 days. Functional, histologic, and immunohistochemical examinations were made.

Results: Posttreatment comparison of treatment groups showed that whisker movements (p=0.001) and total clinic scores (p=0.023) were significantly higher in the combination group compared to the ozone group. In histologic analysis, vascular congestion was significantly lower in the methylprednisolone group than in the ozone group (p=0.012). On the other hand, apoptosis levels, indicating cell death in the facial nerve, were significantly lower in the combination group compared to the methylprednisolone (p=0.016) and ozone (p=0.036) groups.

Conclusion: The combination of methylprednisolone and ozone lead to the most favorable functional and cellular outcomes. Further studies are required to confirm the benefits of ozone therapy for human facial paralysis, understand the molecular mechanisms behind its effectiveness, and determine the optimal doses for combined treatment.

Objectives: This study aims to investigate mercaptoalbumin and non-mercaptoalbumin (HNA%) levels in the serum of patients with idiopathic carpal tunnel syndrome (CTS) and to explore the correlation between serum HNA% and symptom severity, functional status, electrophysiological findings (EPFs), median nerve cross-sectional area (MNCSA) measured by ultrasound, and vitamin D levels.

Patients and methods: Between April 2022 and November 2023, this prospective, case-controlled study included a total of 47 patients diagnosed with bilateral CTS (6 males, 41 females; mean age: 45.4±9.0 years; range, 25 to 60 years) and 34 healthy controls (4 males, 30 females; mean age: 42.5±10.8 years; range, 27 to 60 years) were included. Evaluation parameters included pain as measured by Visual Analog Scale (VAS), pinch grip strength (kg), Boston Carpal Tunnel Questionnaire (BCTQ), EPF, MNCSA by ultrasonography (mm² ), mercaptoalbumin and non-mercaptoalbumin ratio in serum (HNA%=HNA /Total albumin ×100) and 25(OH)D.

Results: The MNCSA was significantly higher in patients with CTS than healthy controls (p<0.001). The HNA% was significantly higher and 25(OH)D levels were significantly lower in patients with CTS than in healthy controls (p<0.001 and p=0.003, respectively). The HNA% was positively correlated symptom severity score (SSS) and functional status score (FSS) (r=0.396, p=0.006; r=0.29, p=0.042, respectively), and negatively correlated with 25(OH)D (r=-0.320, p=0.028). There was no relationship between HNA% and EPF and MNCSA.

Conclusion: Our study results suggest that HNA% may be a new biomarker of oxidative stress in CTS. There is a relationship between HNA% and symptom severity, functional status, and low vitamin D levels.

Objectives: The aim of this study was to investigate the effect of robot-assisted arm training and recreational activities in addition to a conventional rehabilitation program on upper extremity functions.

Patients and methods: The three-arm, randomized controlled study was conducted between July 2017 and March 2019. Forty-five patients (25 males, 20 females; mean age: 65.7±8.3 years; range, 40 to 75 years) were randomized into three groups. The first group underwent a conventional rehabilitation program. The second group underwent a conventional rehabilitation program + robot-assisted arm training. The third group underwent conventional rehabilitation + robot-assisted arm training + recreational activities. Before and after the rehabilitation program, handgrip strength, pinch strength, nine-hole peg test, Frenchay arm test, Unified Parkinson's Disease Rating Scale (UPDRS), Parkinson's Disease Questionnaire-39 (PDQ-39), rapid alternating movements, fine finger movements, Disabilities of the Arm, Shoulder, and Hand, and Fatigue Severity Scale were investigated.

Results: In the first and second group, success was achieved in UPDRS mentation, behavior and mood, activities of daily living, motor examination subscales, PDQ-39 total score, emotional well-being, and activities of daily living subscales. Handgrip strength and nine-hole peg test performance also improved significantly. Tip pinch strength, fine finger movements test, and Frenchay arm test showed greater improvement in the third group.

Conclusion: Activities of daily living, upper extremity motor function, muscle strength, mental and emotional well-being improved in patients with Parkinson disease treated with robot-assisted arm in addition to conventional rehabilitation. Hand fine motor skills were improved in patients who attended to recreational activities in addition to conventional rehabilitation and robot-assisted arm training.