Aim: To compare the Disease Activity Score with 28 joint (DAS28) using erythrocyte sedimentation rate (ESR) (DAS28-ESR) and DAS28 using C-reactive protein (CRP) (DAS28-CRP) with thresholds validated for DAS28-ESR in Turkish patients with rheumatoid arthritis.Method: The DAS28 data of 112 patients with rheumatoid arthritis followed in a local outpatient clinic were used. First, the correlation between DAS28-CRP and DAS28-ESR and the correlation between their unique components ([0.36 9 In (CRP + 1) + 0.96] and [0.70 9 In (ESR)]) were analyzed. Second, a Bland-Altman plot was constructed for the evaluation of the level of agreement between DAS28-CRP and DAS28-ESR. Lastly, the agreement between these two methods was analyzed by j coefficient.Results: Although there was a strong correlation between DAS28-CRP and DAS28-ESR, the correlation between their unique components was fair. Although more than 95% of the point data fall between the upper and lower bounds of the limit of agreement, the percentage error (46%) was higher than the acceptable proportion of 30%. The j coefficient of agreement between DAS28-ESR and DAS28-CRP with validated thresholds for DAS28-ESR was 0.42, which was close to the lower boundary for moderate agreement. Conclusion:The results of this study demonstrated that there is discordance between DAS28-ESR and DAS28-CRP with the validated thresholds for DAS28-ESR. Using the DAS28-CRP with threshold values validated for DAS28-ESR may lead to errors in the determination of disease activity and therefore may lead to errors in the management of patients with rheumatoid arthritis.
Objective Loss of proprioception and balance disorders are commonly observed in patients with knee osteoarthritis. In this study, we aimed to investigate the effects of balance and proprioception exercises in patients with knee osteoarthritis. Design A single-center randomized trial with three parallel arms. Setting A tertiary health care facility in Turkey. Participants Female patients with knee osteoarthritis aged 40–70 years. Interventions Ten-week exercise program in Biodex training, classical balance training and isometric strengthening groups. Main measures Dynamic balance (overall stability index and the modified Clinical Test of Sensory Interaction and Balance), pain (visual analogue scale), physical function (30-s chair stand test and 40-meter fast-paced walk test) and quality of life (Knee Injury and Osteoarthritis Outcome Score). Results Eighty-nine patients enrolled in the study. The Biodex training group, the classical training group, and the control group had overall stability index values of 1.0 ± 0.07, 1.4 ± 0.07 and 1.4 ± 0.07, and the Modified Clinical Test of Sensory Interaction and Balance – Condition-3 values of 0.7 ± 0.04, 0.9 ± 0.04 and 0.9 ± 0.04 respectively, at the end of treatment. In terms of pain scores on movement, each group showed significant improvement compared to their baseline, and the classical balance training group had better scores than the control group. No other significant difference was found between the groups. Physical function and quality of life outcomes showed significant main effects only in the time factor. Conclusions Balance and proprioception exercises may have positive effects on dynamic balance and pain. The effects on physical function and quality of life should be investigated in further studies with larger sample.
Objective: To determine the effects of Kinesio taping on pain, functional performance, range of motion, and postural stability in patients with knee osteoarthritis. Study Design: Randomised double-blind controlled trial.
Background It has been suggested that spinal manipulation may alter sensorimotor integration in the central nervous system and therefore may be used to treat central sensitization syndromes. Objective To investigate the effectiveness of spinal manipulation in addition to pharmacological treatment in patients with fibromyalgia. Design A single‐center, randomized, and placebo‐controlled trial with three parallel arms Setting Outpatient clinics at a tertiary health care facility. Participants Female patients aged 18‐55 years receiving pharmacological treatment. Interventions Spinal manipulation, sham manipulation, and control groups. Patients in the spinal manipulation group received high‐velocity low‐amplitude manipulation treatment twice a week for 3 weeks. Patients in the sham group received an application that was very similar to the active treatment but was not expected to have any real therapeutic effect. Patients in the control group continued to receive pharmacological therapy. Main Outcome Measures The primary outcome, pain score (visual analog scale), and secondary outcomes, pressure pain threshold (PPT), Revised Fibromyalgia Impact Questionnaire (FIQR), Widespread Pain Index (WPI), and Fibromyalgia Severity Score (FSS) were measured before, 1 month, and 3 months after randomization. Results Sixty patients with a mean age of 41.7 years (SD = 8.0) were enrolled in the study. A mixed‐design repeated analysis of covariance was used to test the data. At 1 month after randomization, pain scores did not differ between groups. At 3 months after randomization, the spinal manipulation group had a significantly lower pain score (adjusted mean = 4.3 cm, SE: 0.4) than the control group (adjusted mean = 6.8 cm, SE: 0.4) and the sham manipulation group (adjusted mean = 5.7 cm, SE: 0.4). PPT did not differ between groups at any time point. FIQR, WPI, and FSS showed some improvement 1 or 3 months after randomization in favor of the spinal manipulation group. Conclusions Spinal manipulation used in addition to pharmacological treatment in young/middle‐aged female patients with fibromyalgia could be an effective treatment for pain, disease severity, and functionality.
Background: Chronic heel pain with plantar fasciitis is relatively common and can affect adults of all ages regardless of an active or sedentary lifestyle. The purpose of the present study was to evaluate the effectiveness of corticosteroid injection (CSI), extracorporeal shock wave therapy (ESWT), and radiofrequency thermal lesioning (RTL) treatments in chronic plantar heel pain that has been unresponsive to other conservative treatments. Methods: We retrospectively analyzed the results of 217 patients treated with CSI ( n = 73), ESWT ( n = 75), and RTL ( n = 69). The treatment efficacy and pain intensity, as measured using the visual analog scale, were recorded and compared at the 6-month follow-up. Results: Pain intensity decreased significantly in all patients. However, it decreased significantly more in the CSI and RTL groups than in the ESWT group ( P < .001). Age, sex, body mass index, calcaneal spur presence, and symptom duration were similar among 3 groups ( P > .05). No complications were noted after the CSI, ESWT, or RTL sessions. Conclusion: CSI, ESWT, and RTL successfully treated chronic plantar heel pain that did not respond to other conservative treatments; however, CSI and RTL yielded better therapeutic outcomes. Level of Evidence: Level III, retrospective comparative study.
Background Lymphedema is defined as the abnormal accumulation of interstitial fluid and fibro-adipose tissues resulting from injury, infection, or congenital abnormalities of the lymphatic system. The gold standard approach in the treatment of lymphedema is Complete Decongestive Therapy and it has many components that require practical knowledge and skills. YouTube can be a useful tool to provide these skills to healthcare professionals and patients. The aim of this study was to examine the videos about lymphedema rehabilitation on YouTube and analyze their technical features, sources, contents, educational value and reliability. Methods The YouTube database was searched using the “lymphedema rehabilitation”, “lymphedema treatment”, “complete decongestive therapy”, “lymphedema massage”, and “lymphedema exercises” keywords. Two reviewers (Physical medicine and rehabilitation specialist) assessed videos for educational quality using a Global Quality Scale (GQS). To evaluate the reliability the 5-point Discern scale was used. Results A total of 90 videos, which met the inclusion criteria were included in the analysis. The mean duration of the videos was 8.9 ± 10.5 min. The mean number of daily views was 22.7 ± 47.1 for a day. The majority of the videos were created to inform patients (57.8%).The uploaders were mostly private healthcare institutions or healthcare professionals (65.6%). Information providers were lymphedema therapists mostly (63.3%). Manual lymphatic drainage was observed to stand out as the most mentioned lymphedema rehabilitation component on YouTube. The mean of reliability and GQS scores of the videos were 2.2 ± 1.0 and 2.7 ± 1.0, respectively. Conclusions The biggest obstacle for YouTube to be an excellent source of information is that it hosts large volumes of uncontrolled and low-quality data. When Youtube content related to lymphedema rehabilitation was examined, it was observed that many videos were quite insufficient and incomplete even though there were useful videos. If careful controlling measures are implemented and if medical videos aim to meet reliability and GQS criteria, YouTube can become an effective and useful source of information for lymphedema rehabilitation.
ÖzetPelvik kosta normal kemik dokusuna bitişik yumuşak dokuda nadir görülen anomalili kemik gelişimidir. Sıklıkla asemptomatiktir ve rastlantısal olarak tanı konulur. Posttravmatik hasar ve pelvisin avülsiyon hasarından ayırt etmek açısından tanınması önemlidir. Bu olgu sunumunda, kliniğimize kalçada ağrı yakınması ile başvuran iki hastada, direkt grafi ile saptanmış olan pelvik kostayı sunmaktayız. Hastalardan birinde, pelvik kosta ile aynı tarafta femoroasetabular impingement sendromu da bulunması, hastanın ağrı yakınmasını açıklayabilir olması açısından önemlidir. Anahtar Kelimeler: Pelvik kitle, kosta, ilium, femoroasetabular impingement, manyetik rezonans görüntüleme, radyografi AbstractPelvic digit is an unusual developmental anomaly in which bone develops in soft tissues adjacent to normal skeletal bone. It is an asymptomatic entity that is usually discovered incidentally. The importance of recognizing pelvic digit is in distinguishing it from post-traumatic ossification and avulsion injuries of the pelvis. We report pelvic digits discovered in plain films of two patients who presented with hip pain. One patient has accompanying femoroacetabular impingement on the same side, which may explain the presence of hip pain.
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