Turkish Journal of Physical Medicine and Rehabilitation最新文献

Objectives: This study aimed to examine effects of core stabilization and aerobic exercises on lumbar stabilizer muscles and diaphragm motility in individuals with chronic low back pain (CLBP).

Patients and methods: Fifty-one patients (19 males, 32 females; mean age: 32.7±8.8 years; range, 20 to 60 years) with CLBP were included in this randomized controlled trial between March 2021 and May 2022. The patients were divided into three groups: the core group, the aerobic group, and the control group. Conventional treatments (hotpack, transcutaneous electrical nerve stimulation, ultrasound, and McKenzie exercises) were applied to all three patient groups. The core group received core stabilization exercises, and the aerobic group received aerobic exercises. The control group received only conventional treatments. Exercises were continued for six weeks. All patients were assessed through the Beck Depression Inventory (BDI), Visual Analog Scale (VAS), Roland Morris Disability Questionnaire (RMDQ), and Nottingham Health Profile (NHP). Trunk flexor and extensor strength, as well as trunk flexor and back extensor endurance, was examined. Structural features of the multifidus (MF), transversus abdominis (TrA), external oblique (EO), internal oblique (IO), and diaphragm muscles, as well as diaphragm motility, were evaluated with ultrasound imaging. All measurements were repeated before and after six weeks of treatment.

Results: In all groups, post-treatment values of VAS rest/activity, trunk flexor endurance, back extensor endurance, trunk flexor/extensor muscle strength, BDI, RMDQ and, NHP scores improved significantly compared to pre-treatment (p=0.001). Resting and contraction thicknesses of TrA, MF, EO, and IO muscles increased significantly in both the core (p=0.001/0.001, p=0.001/0.002, p=0.001/0.001, and p=0.001/0.001, respectively) and aerobic groups (p=0.001/0.013, p=0.002/0.020, p=0.001/0.004, and p=0.001/0.010, respectively), while the control group did not show any significant difference (p=0.229/0.064, p=0.052/0.102, p=0.069/0.449, and p=0.094/0.146, respectively). After treatment, all groups showed significant increments in end-expiratory thickness (p=0.001), end-inspiratory thickness (p=0.001), motility of diaphragm during normal breathing (control, p=0.003; core, p=0.001; aerobic, p=0.001), and deep breathing (control, p=0.007; core, p=0.001; aerobic, p=0.001).

Conclusion: While aerobic and core stabilization exercises provided significant improvements in individuals with CLBP, the core stabilization group showed the best improvement in all parameters. Accordingly, the necessity of aerobic and core stabilization exercises in treatment programs comes to the fore in individuals with CLBP.

Objectives: This study aims to investigate the efficacy of epidermis dermis fascia (EDF) kinesiotaping (KT) technique on pain intensity, number of active trigger points (TrPs), cervical range of motion (ROM) angles, and disability levels in patients with myofascial pain syndrome (MPS) on upper trapezius (UT) muscle.

Patients and methods: Between January 2019 and January 2020, a total of 180 patients (21 males, 159 females; mean age: 35.9±9.0 years; range, 18 to 56 years) with MPS were included. The patients were randomized into either KT with EDF technique (Group 1) or sham KT (Group 2). Outcome measures were Visual Analog Scale (VAS) pain score, number of active TrPs, cervical ROM angles, and Neck Pain Disability Scale (NPDS).

Results: Both groups improved in terms of all outcome parameters except for cervical flexion and extension angles in Group 2. The VAS pain scores significantly decreased in Group 1 (p<0.0001) significantly improved in Group 1. Cervical left (p=0.001) and right (p<0.0001) lateral flexion angles significantly improved in Group 2. There was no significant difference between the groups regarding cervical ROM angles.

Conclusion: Our study results suggest that KT with the EDF technique is an effective method in reducing pain and number of active TrPs, improving disability and cervical ROM angles.

Objectives: This study aims to evaluate and compare the therapeutic effectiveness of static dry needling (S-DN), dynamic dry needling (D-DN), and a combined technique (CT) for managing myofascial pain syndrome (MPS).

Patients and methods: Between January 1, 2023 and April 15, 2023, a total of 38 patients (9 males, 29 females; mean age: 40.5±12.7 years; range, 22 to 63 years) with MPS who experienced neck pain for less than six months and had at least one painful myofascial trigger point in the trapezius, rhomboids, or levator scapula muscle were included in the study. The patients were divided into three groups: D-DN, S-DN, and CT. Measurements included the Visual Analog Scale (VAS), range of motion (ROM), Neck Disability Index (NDI), and the European Quality of Life 5 Dimensions 3 Level Version (EQ5D3L). All measurements were made at baseline (T0), after the first treatment session (T1), after the final session (T2), and one-month post-treatment (T3).

Results: The group treated with S-DN showed less significant improvement in ROM scores compared to other treatment methods. Both the D-DN and S-DN groups showed decreased VAS scores at rest and during motion across all time points, compared to the CT group. The NDI scores decreased in all groups, while the EQ5D3L scores exhibited no variations between groups or across any time point irrespective of the treatment method employed.

Conclusion: Our study results suggest that all three methods are effective in treating MPS, with D-DN potentially being the preferred method over S-DN and CT due to its time efficiency.

Objectives: The study aimed to compare the effects of separate and simultaneous application of Tecar therapy and low-level laser therapy on neurological symptoms of type 2 diabetic patients.

Patients and methods: In this randomized control trial conducted between November 2021 and February 2022, 45 patients (30 females, 15 males; mean age: 65.7±7.6 years; range, 51 to 76 years) with type 2 diabetes and peripheral sensory neuropathy of the lower limbs were randomly divided into three groups: Tecar + sham laser (n=15), Tecar + laser (n=15), and laser + sham Tecar (n=15). Outcome measures for both right and left limbs included tibial motor nerve conduction velocity (MNCV), sural nerve amplitude, sole sensation, and ankle-brachial index (ABI) measured before and after 10 sessions and after a three-month follow-up.

Results: In intergroup comparison, the Tecar + laser group significantly improved compared to the laser + sham Tecar group in terms of tibial MNCV in both limbs after 10 sessions and all measured outcomes after three months (p<0.05). In addition, comparison between the Tecar + laser and Tecar + sham laser groups for tibial MNCV (p=0.021 for the right limb and p=0.002 for the left limb) and ABI (p=0.001 for the right limb and p=0.002 for the left limb) in both limbs after three months was significant. In the intragroup comparison, a significant improvement was found in the laser + sham Tecar group for sole sensation (p<0.001) and ABI (p<0.001) of both limbs after three months compared to before the interventions, whereas in the other two groups, significant improvements were found in all four outcomes.

Conclusion: A significant increase was found in neurological outcomes in all three groups after 10 sessions. Moreover, the use of combined Tecar therapy and laser compared to Tecar or laser alone could lead to a more lasting effect in improving the sensory symptoms of type 2 diabetic patients with peripheral neuropathy of the lower limbs.

Stroke is the second most common cause of mortality and disability worldwide. Most of the patients cannot regain their walking ability after a stroke. Impaired gait and mobility negatively affect the activities of daily living and quality of life of stroke survivors. Restoring gait and mobility are the most important targets of the rehabilitation approaches. Advances in computers and engineering have enabled robotics to be used in many areas of rehabilitation medicine. One of them is gait training. High-intensity, repetitive task training is crucial for neural plasticity and motor learning. Robot-assisted gait training may be a promising method leading to functional recovery in patients with stroke. In this review, the efficacy of robot-assisted gait training in stroke rehabilitation is discussed in light of current literature.

Post-stroke hemichorea-hemiballismus (HCHB) typically manifests as hyperkinetic movements contralateral to the lesion, but rarely occurs ipsilaterally. In this article, we present a rare case who initially presented with left hemiparesis and developed right HCHB after right basal ganglia hemorrhage. To facilitate motor recovery in the left hemiparesis, we applied low-frequency repetitive transcranial magnetic stimulation (rTMS) over the left primary motor cortex. Unexpectedly, the right HCHB was significantly reduced after four weeks of therapy. Post-treatment perfusion imaging showed increased cerebral blood flow in the left middle cerebral artery territory. In conclusion, low-frequency rTMS may be considered an alternative therapy for post-stroke HCHB.

Objectives: This study aims to compare the effectiveness of intra-articular and peri-articular dextrose prolotherapy (DPT) in patients with knee osteoarthritis (KOA) without effusion.

Patients and methods: Between August 2018 and November 2018, a total of 51 participants including 27 cases (12 males, 15 females; mean age: 55.7±5.2 years; range, 38 to 70 years) in Group A and 24 cases (9 males, 15 females; mean age: 54.7±4.6 years; range, 38 to 70 years) in Group B were recruited. Group A received intra-articular DPT, while Group B received peri-articular DPT. Treatment was administered two times with two-week intervals. The Visual Analog Scale (VAS), Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Oxford Knee Scale (OKS) questionnaires were filled at baseline, and four and eight weeks after first injection.

Results: At four and eight weeks, the VAS, OKS, and WOMAC scores improved from baseline in both groups. There was no significant difference in the WOMAC and OKS scores between two methods. The VAS scores showed superiority of intra-articular method (p<0.05).

Conclusion: Both peri-articular and intra-articular DPT were effective in patients with KOA. There was no superiority in terms of functional improvement between two groups. However, intra-articular prolotherapy was more effective in decreasing pain in these patients.

Objectives: The aim of this study was to investigate the etiological and clinical characteristics of pediatric patients with severe acquired brain injury and their effects on rehabilitation outcomes.

Patients and methods: A total of 67 pediatric patients (39 males, 28 females; mean age: 9.7±4.8 years; range, 3 to 18 years) who were hospitalized due to severe acquired brain injury between March 2020 and October 2021 were retrospectively analyzed. The patients were classified in five different groups according to the etiology: traumatic brain injury, anoxic brain injury (ABI), cerebrovascular accident, encephalitis, and brain tumors. The time of brain injury, etiology, length of stay in the intensive care unit, additional injuries, presence of operation, nutritional status, history of tracheotomy, duration of rehabilitation and complications were recorded. The factors affecting the difference between the Functional Ambulation Classification (FAC) scores of the patients before and after rehabilitation were evaluated.

Results: The mean time since injury was 83.04±57.29 days and the mean duration of rehabilitation was 55.37±37.15 days. Statistically significant improvements were found in all the groups in the functional levels and FAC scores after rehabilitation. In the inter-group comparisons, the ABI group showed statistically less improvement than the other groups. The functional level of the patients before rehabilitation, etiology and the presence of fecal incontinence were statistically significant factors that affected the change in FAC scores (p=0.043, p=0.049, p=0.048, and p=0.035, respectively).

Conclusion: Our study results show that rehabilitation yields in positive outcomes even in patients with severely acquired brain injury in the pediatric age group.

Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis. While it is commonly associated with lung involvement, it can affect other parts of the body. Approximately 10% of extrapulmonary tuberculosis cases involve bone and joint manifestations. Apart from the spine, the most commonly affected joints are the knee, hip, and ankle joints. Joint involvement can present as a slowly progressive and chronic monoarthritis. In this study, we presented a 63-year-old male patient who was diagnosed with primary tuberculosis tenosynovitis, a rare condition that can be easily confused with many clinical conditions, despite the absence of any infectious focus. In conclusion, Mycobacterium tuberculosis can involve joints, acting as an exceptional mimicker. Therefore, this pathogen should always be considered in the differential diagnosis and management of patients with arthritis.

Objectives: This study aims to investigate the effectiveness of Rocabado exercises in patients with rheumatoid arthritis (RA) in remission with temporomandibular joint (TMJ) involvement.

Patients and methods: Between May 2023 and July 2023, a total of 42 patients (4 males, 38 females; mean age: 47.8±13.9 years; range, 21 to 73 years) were included in this single-center, single-blind, randomized-controlled study. Only the RA patients in remission for at least three months, with TMJ complaints and who had TMJ involvement detected by magnetic resonance imaging (MRI) were included. The patients were randomized into the Rocabado exercise group (n=21) and standard TMJ exercise group (n=21). The home-based exercise programs for both groups continued for six weeks. A Visual Analog Scale (VAS) was used to evaluate pain. The TMJ examination findings were recorded. The maximum interincisal distances were measured. To evaluate the quality of life, the patients were asked to fill the Turkish Oral Health Impact Profile-14 (OHIP-14).

Results: Demographic and baseline characteristics were similar between the groups. Standard TMJ exercises group showed an improvement only for OHIP-14 after treatment. Rocabado exercises group showed a statistically significant improvement for interincisal distance, OHIP-14, VAS pain, number of patients with limited mouth opening, TMJ pain with palpation, and pterygoid pain with palpation after treatment.

Conclusion: Our study results indicate that Rocabado exercises may be effective in RA patients with TMJ involvement in relieving pain and improving the quality of life due to oral health.