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Ankylosing spondylitis (AS) is a chronic inflammatory disease which effects cervical posture of patients. The aim of this study was to evaluate AS patients according to the degree of cervical disorder and was evaluate them electrophysiologically, functionality, and disease parameters. Our study comprised 64 AS patients and 30 healthy controls. The head posture of patients was evaluated by craniovertebral angle (CVA) measurement. Nerve conduction of bilateral median, radial, ulnar, and medial antebrachial cutaneous (MAC) nerves were studied in all patients. The most important nerve conduction differences in AS patients who have severe forward head posture (FHP) were decrease in sensory nerve action potential (SNAP) amplitude and compound muscle action potential amplitudes of median nerves, a decrease in the SNAP amplitude of ulnar nerves, a delay in the F response latency of ulnar nerves, and prolongation in the SNAP latency of the MAC nerve. The FHP disorder that develops in AS patients may have electro physiological effects, similar to those of thoracic outlet syndrome In addition, the functional status of these patients is worsened as severity of FHP increases.

Objective: A residential environment refers to the physical and social characteristics in a neighbourhood. The physical characteristics include interior housing qualities, exterior neighbourhood characteristics, and the accessibility of essential facilities and services outside the neighbourhood. Older adults especially may be vulnerable to the negative impacts of the residential environment. The aim of this study is to elucidate the problems ageing people face in their neighbourhoods, buildings and public areas. Methods: The study group consisted of a total of 1,001 people over the age of 65 who were admitted to physical medicine and rehabilitation clinics in Turkey and consented to participate. A questionnaire covering demographic, social and environmental information was used. Results: Of the study group, 58.6% was living in an apartment building, but only 23.6% of these buildings had an elevator, and the stairs were inconvenient in 46.7% of the buildings. Only 49% of the elderly people went for a walk regularly. The most frequent complaint about the hospitals, community health centres and other public areas was the inappropriate restroom conditions. Eighty-six percent of the study group were not members of an organization, a foundation or a group, and 73.6% did not have personal hobbies. Conclusions: The layouts of buildings and surroundings are inappropriate for older people, and the opportunities for them to participate in social activities are limited. Health and social programmes and governmental and local policies for older people are needed, and public awareness about this issue should be raised.

Objectives: To compare the effectiveness of the Leeds Assessment of Neuropathic Symptoms and Signs Scale (LANSS) to the painDETECT questionnaire (PD-Q) in Carpal Tunnel Syndrome (CTS), and determine if there are any differences between hand related functions in the 2 questionnaires. Methods: This prospective clinical trial was conducted from April to July 2014. Ninety patients with a positive Tinel or Phalen sign were recruited. Hands were evaluated by electromyography and grouped according to mild, moderate or severe involvement. Neuropathic pain was analysed by the LANSS and the PD-Q; hand functions were evaluated by the Duruoz Hand Index (DHI), Semmes Weinstein monofilaments and grip strength. Results: Electromyographic findings revealed 32.9% of hands had mild, 61.8% had moderate and 5.3% had severe CTS. There was a correlation between the LANSS scores and the Visual Analogue Scale (VAS) pain, while the PD-Q scores were correlated with the VAS pain, DHI and Semmes Weinstein Monofilaments (SWM). Comparison of the hand related parameters of the questionnaires showed there was a statistically significant difference between the 2 groups with respect to the DHI and SWM tests in the PD-Q. However, there was no difference in the LANSS. Conclusion: Although there was a significant correlation between the LANSS and PD-Q scores, the PD-Q scores revealed better correlation coefficients in VAS pain, DHI scores and SWM tests. In conclusion, the PD-Q seems to be better than the LANSS both in neuropathic pain and in detecting functions related to hand abilities.

WOS: 000406937200005 PubMed: 27080048 Purpose: In this study, we aimed to describe the sociodemographic characteristics of caregivers of patients in a geriatric unit and to clarify the relationship between caregiver burden and specific clinical variables in the patients and the characteristics of the caregivers. Design: Cross-sectional multicenter study. Methods: One hundred twenty-three patients and 123 caregiver dyads, with mean ages of 72.5 +/- 7.7 years and 51 +/- 14.7 years, respectively, were included. The functional, psychological, and cognitive statuses of the patients were determined, and the sociodemographic characteristics of the caregivers as well as the type and duration of caregiving were recorded. Caregivers completed the Caregiver Burden Inventory (CBI) to measure the perceived burden of care. Most patients were female and generally lived with their family. Findings: Most of the caregivers were family members (90%), female (73.2%), primary school graduates (52.8%), and first-degree relatives (73.1%). The average CBI score was 33, and the highest CBI subscores were for time, developmental, and physical burdens. Caregiver burden correlated with the patient's ambulatory, psychological, and cognitive status and with the caregiver's age, gender, income level, and duration of caregiving. Conclusions: We have highlighted the relationship between caregiver and patient characteristics in a cohort of elderly Turkish patients with neurological and musculoskeletal disorders. In particular, we have highlighted the heavy caregiver burden in a developing country. Clinical Relevance: Our results may guide the nurses to understand the requirements of caregivers and to help them find suitable resources that would meet their needs to cope with their burden.

Objective: To evaluate the effect of rheumatoid arthritis (RA) on strength, dexterity, coordination and functional status of the hand and to determine the relation with magnetic resonance imaging (MRI) findings. Materials and Methods: Thirty eight patients with RA and thirty three controls were included in the study. There were five drop-outs in RA group. Pain was assessed by visual analog scale. Painful and swollen joints of the dominant hand were recorded. Hand deformities of the patients were noted. Hand grip strength and pinch strength of the dominant hand were evaluated. Hand disability was assessed by Duruoz hand index (DHI) and the Purdue pegboard test was used for assessment of coordination and dexterity. MRI of the dominant wrist and hand was performed in RA group. MRI scans were evaluated for synovitis, tenosynovitis, bone erosion and bone edema. Results: Demographic characteristics were similar between groups. While DHI scores were significantly higher (p=0.000), Purdue pegboard test scores were significantly lower in RA group in comparison to control group (p=0.000). Bone edema and synovitis scores were significantly higher in patients with longer disease duration (p=0.025, p=0,006 respectively). There were significant negative correlation between grip strength, pinch strength subgroups and tenosynovitis scores (p=0.001, p=0,001). When the Purdue pegboard scores were lower, tenosynovitis scores were significantly higher (p=0.019, p=0,013, p=0,043). There was a significant positive correlation between DHI score and tenosynovitis score (p=0.003). Conclusion: This study showed that RA has significant negative impact on hand function and dexterity and the parameters used in the evaluation of hand function are mainly associated with tenosynovitis scores. Since tenosynovitis is a common pathology in RA, MRI can be used as a supportive method in early diagnosis of tenosynovitis and may be useful in identification of patients requiring aggressive treatment.

Most women are unaware of the risk factors for osteoporosis (OP). In an effort to prevent the development of OP, women need to have a raised awareness on this issue. The aims of this study were to determine any differences in the level of awareness and knowledge about OP between pre- and postmenopausal women.Three hundred and six women who presented to the outpatient clinic of the Physical Medicine and Rehabilitation Department were included into the study. Demographic characteristics of the subjects were recorded. The participants were interviewed via an OP awareness questionnaire, which was designed to determine their knowledge of OP and risk factors.The mean ages of the 126 pre- and 180 postmenopausal women were 41.3 ± 5.9 and 58.9 ± 8.1 years, respectively. Thirty-two percent of premenopausal and 51% of postmenopausal women had heard about OP (p0.001), but the mean scores of OP knowledge according to the OP questionnaire were not different between the groups (p0.05). Both pre- and postmenopausal women with a higher level of education demonstrated better knowledge of OP based on their awareness questionnaire score (p0.001).Although half of the pre- and postmenopausal women reported having some awareness of OP, their level of knowledge was poor, particularly with regard to the risk factors associated with the condition and its complications. Having information about the risks of OP and a better understanding of the health beliefs of those at risk are important, as both may play a major role in influencing an individual's OP-preventing behaviors.

b>Objective: The aim of this study was to determine the frequency of fibromyalgia (FM) in patients on Peritoneal Dialysis (PD) and to investigate its impact on the quality of life of that population. Methods: A hundred and twenty four patients with end stage renal disease who had undergone PD, and a control group of 54 age and sex-matched healthy volunteers were included to the study. Demographic characteristics including age, sex, disease and dialysis duration were recorded. Fibromyalgia Impact Questionnaire (FIQ) and Nottingham Health Profile (NHP) were also measured. Results: The mean age of the patients (68 female, 56 male) and control subjects (36 female, 18 male) were 43.5 ± 13.4 and 41.2 ± 9.2 years respectively. The prevalence of FM in the PD patients and controls were determined as 9.7% (12 patients) and 11.1% (6 controls) respectively and were found to be similar (p = 0.983). The mean score of sub- groups of NHP except pain and emotion subgroups, were significantly higher in PD patients than in the control group. The mean FIQ levels, the scores of all the subgroups of NHP except the social subgroup were significantly higher in PD patients with FM than in those without FM. Conclusion: In conclusion although the prevalence of FM appears to be similar in PD patients and control subjects, the functional disability is common and quality of life is worse in PD patients with FM than in patients without FM. Detection and treatment of FM may lead to improvement in the quality of life of PD patients with this syndrome.

Background There have been few studies in the literature evaluating the effect of Behcet's disease (BD) on tendons. Thus, we planned to search for the involvement of hand and foot tendons in BD by using ultrasonography and to determine the relation of tendon involvement with clinical measurements. Methods The study consisted of 33 randomly selected BD patients and 36 voluntary healthy controls matched by age and body mass index. Sonographic evaluations were performed from hands (flexor digitorum superficialis (2–5), flexor digitorum profundus (2–5), flexor carpi radialis) and Achilles tendons of the nondominant extremities using an 8–10 MHz linear array probe. Grip strength and crepitation were also measured on the nondominant side. Results Mean hand and foot tendon thickness values of BD patients were significantly higher than in control group ( p = 0.00). Disease duration, age, and presence of crepitation were not correlated with tendon thickness in the BD group (all p values >0.05). Grip strength values were lower in the BD group than in control group but the difference was not statistically significant ( p = 0.344). Grip strength values were not correlated with hand tendon thicknesses in BD groups (all p values >0.05). Conclusion Because tendons tears and thicknesses are associated with inflammation, awareness of tendon pathologies is very important in rheumatic diseases. It would be of value to investigate this relationship in future studies in order to determine if this increment in tendon thickness is an indicator of disease activity and affects prognosis. The physician should be on alert about tendon involvement even if the patient has no complaints.

The aim of this study was to investigate the relationship between estrogen deficiency and hand functions with the evaluation of the depression state at the same time. Randomized selected 35 postmenopausal women (n = 35, mean age; 46.6 ± 2.8 years), 30 premenopausal controls (n = 30, mean age; 45.4 ± 2.7 years) were included in this study. The hand grip strength (JAMAR), the pinch strength and manual dexterity (Purdue peg-board test) were evaluated as hand functions by the same investigator. The DASH score (Disability of Arm, Shoulder and Hand) and the Beck Depression score were determined in each patient. The hand grip strength and manual dexterity were better in premenopausal women than postmenopausal ones. The lower level of estrogen was associated with decreased manual dexterity, increased disability and increased depression. There was no association between estrogen defiency and hand grip strength but we found a correlation between depression score and hand grip strength. Depression has been decreased hand grip/pinch strength and dexterity. We need prospective long term trials about the effect of estrogens on the hand functions and

WOS: 000357419000017, Frailty is one of the geriatric syndromes and has an important relationship with mortality and morbidity. The aim of this study is to present the characteristics, prevalence, and related factors of frailty in older adults in our country. The study included 1126 individuals over 65 years of age from 13 centers. Frailty was evaluated using the Fried Frailty criteria, and patients were grouped as "frail," "pre-frail," and "non-frail." Nutritional status was assessed with "Mini Nutritional Test," psychological status with the "Center for Epidemiological Studies Depression Scale-CES-D," and additional diseases with the "Charlson Comorbidity index." Approximately 66.5 % of the participants were between 65 and 74 years of age and 65.7 % were women. Some 39.2 and 43.3 % of the participants were rated as frail and pre-frail, respectively. The multinomial logistic regression analysis was used to determine the factors associated with frailty. It was observed that age, female gender, low education level, being a housewife, living with the family, being sedentary, presence of an additional disease, using 4 or more drugs/ day, avoiding to go outside, at least one visit to any emergency department within the past year, hospitalization within the past year, non-functional ambulation, and malnutrition increased the risk of frailty (p

Background Diabetes mellitus (DM) is a chronic condition which can effect different systems of the body Objectives In this study we aimed to determine the impairments in hand and upper extremity functions, pain and quality of life in diabetic patients. Methods Fifty diabetic patients who attended to physical medicine and rehabilitation outpatient clinics were evaluated. The patients fasting blood glucose levels, hemoglobin A1 C levels, body mass indexes were detected; existing hand deformities were noted; evaluations of hand strength was made by hand grip strength, hand pain by VAS, hand skills by purdue pegboard test and nerve involvement by semmes weinstein monofilaments (SWM). For upper extremity functions Disabilities of Arm Shoulder and Hand scores (DASH) and for quality of life Nottingham Health profile (NHP) test were selected. Results The mean age of the patients were 62,76±10,99 years. Among our DM patients only 4 patients had normal weight, 14 were over weight, 29 were obese and 4 had morbid obesity. The mean valueof fasting blood gucose was 145,2 and that of HbA1 c was 7,64. In hand evaluations we found trigger finger and dupuytren contracture in 10,6%, restricted hand mobility in 3,4%,crepitation of hand tendons in 55,3% and carpal tunnel syndrome in 38,3%. SWM median nerve mean values were 3,64±0,68 and that of ulnar nerve was 3,77±0,83.In correlation analysis we found hand pain by VAS correlated all evaluation parameters except purdue pegboard test. SWM scores correlated with all subgroups of NHP, purdue pegboard test and hand pain by VAS. DASH scores correlated with HbA1 c levels, abdominal circumference, grip strength and SWM evaluations. Conclusions In our diabetic patients we found nearly all patients were obese or overweight; had problems both in hand functions and median - ulnar nerves. Involvement of the nerves leads to problems in quality of life and fine skills of hands. Additional upper extremity impairments increase their pain and disability. As a result we suggest the patients to have a strict glucose control for a better life standard. Disclosure of Interest None declared

We aimed to investigate the effect of hand osteoarthritis (HOA) on hand strength, dexterity, and upper extremity functional scores, as well as to determine the relation of radiological severity of HOA with these parameters.Sixty patients and 40 controls were enrolled in the study. The presence of hand pain, nodes, and tenderness in hand joints was determined. Grip and pinch strengths were measured by Jamar dynamometer and pinch meter, dexterity was assessed by Purdue pegboard test, and upper extremity function was determined by disabilities of arm, shoulder and hand (DASH) test. Hand radiographs were evaluated according to the Kallman grading scale.The mean age of the patients and control subjects were 58.9 ± 4.8 and 56.6 ± 5.8 years, respectively. The level of hand pain and tenderness, and the number of nodes were significantly higher in the patient group than in control subjects. The mean grip and pinch strengths were lower in the patient group,: however, the difference was significant only in left lateral and left three chuck pinch. In hand dexterity, all scores except Purdue 1 were significantly lower in the patient group. In the functional evaluation DASH outcome, questionnaire scores of the patient and control groups were 48.3 ± 26.3 and 39.5 ± 23.5, respectively (p 0.05). In the patient group, Kallman scores indicating radiological severity were found to be correlated with age, DASH scores, grip and pinch strengths, and Purdue scores (except Purdue assembly). Pain by visual analog scale was significantly higher in the patient group and correlated significantly with DASH scores.In patients with HOA, using standardized tests for evaluations may not be adequate. The determination of grip-pinch strength, dexterity and functional disability will lead to a clearer definition of the needs of the patients and will likely increase the gains from the rehabilitation programs.

There are a number of studies that have evaluated the relationship between fibromyalgia (FM) and vitamin D deficiency with conflicting results. The aim of this study was to assess vitamin D deficiency in patients with FM and to evaluate the relationship with the common symptoms of FM and levels of serum vitamin D. Forty premenopausal female fibromyalgia patients and 40 age- and sex-matched control subjects were included in the study. The demographic characteristics of all subjects, including age, sex, and body mass index, were recorded. The number of tender points was recorded, and the intensity of the widespread pain of the subjects was measured by the visual analog scale. The activities of daily living component of the Fibromyalgia Impact Questionnaire (FIQ-ADL), was used to assess physical functional capacity. Serum vitamin D was measured in both groups, and vitamin D levels37.5 nmol/L were accepted as vitamin D deficiency. The vitamin D levels and clinical and laboratory characteristics of the patient and control groups were comparatively analyzed. The relationship between vitamin D levels and clinical findings of the FM patients were also determined. The mean age was 41.23 ± 4.8 and 39.48 ± 4.08 years for the patient and control groups, respectively. The pain intensity, number of tender points, and FIQ-ADL scores were higher in FM patients than in control subjects. The mean levels of vitamin D in the patient and control groups were determined to be 31.97 ± 15.50 and 28.97 ± 13.31 nmol/L, respectively (p.05). The incidence of vitamin D deficiency was similar between the patient and control groups (67.5% vs. 70%). Vitamin D levels significantly correlated with pain intensity (r = -0.653; p = .001) and FIQ-ADL scores in the FM group (r = -0.344; p = .030). In conclusion, the results of this study indicate that deficiency of vitamin D is not more common in premenopausal female patients with FM than in control subjects without FM. However, the association between pain and vitamin D levels in FM patients emphasizes that hypovitaminosis of vitamin D in the FM syndrome may have an augmenting impact on pain intensity and functional status. Future studies are needed to show the effect of vitamin D supplementation in the reduction of pain intensity and disability in patients suffering from this chronic condition.

Purpose The aims of this study were to evaluate the effects of demographic and clinical determinants on pain and to investigate the possible risk factors that disrupt QoL. Materials and methods The design of this research was a prospective study performed in tertiary care hospital-based physical medicine and rehabilitation departments. A comprehensive geriatric pain assessment (Geriatric Pain Scale, GPS) and health-related quality of life (HR-QOL) assessment (Nottingham Health Profile, NHP) were performed. Results Of the 275 patients, 76% were female and 59.6% were older than 70 years of age. Two hundred seventy four patients (99.7%) had various levels of pain. The mean age of the patent group was 72.77 ± 5.7 (min: 65, max: 96) years. The overall GPS was 60.41 ± 22 (min: 0, max: 99.9), and the total NHP score was 49.01 ± 22.4 (min: 0, max: 100). Correlation analyses showed that for the total GPS score, female gender, lower education, and economic status were significant determinants of higher levels of pain. The multiple linear regression analysis showed that the NHP, GPS, Self-Reported Disability Index (SRDI), and Geriatric Depression Scale (GDS) were significant determinants of poorer HR-QOL. Conclusions There was a high prevalence of pain and being female, having low income, having low social support, having a higher rate of disability with related multiple comorbidities, and depression as related factors of HR-QOL. Strengthening these negative predictors of HR-QOL might enhance the efficiency of pain therapies in this population.

Amaç: Bu çalışmada amaç, Fiziksel Tıp ve Rehabilitasyon (FTR) polik liniklerine başvuran geriatrik hastaların demografik ve klinik özelliklerini belirlemek, bu klinik ve demografik özelliklerin, yaş, cinsiyet ve öğrenim düzeylerine göre farklılıklarını ortaya çıkarmaktı. Gereç ve Yöntem: Çok merkezli çalışma kapsamına 20 FTR polikliniğine başvuran 65 yaş üzeri toplam 820 hasta alındı. Demografik verilerin yanın da; yakınmaları, hastalıkları, ağrı düzeyleri, kullandıkları ilaçlar, alışkanlıkları ve tıbbi durumları kaydedildi. Yaş, cinsiyet ve öğrenim düzeyinin yakın malar, hastalıklar ve alışkanlıklar üzerindeki etkisi araştırıldı. Bulgular: Hastaların yaş ortalaması 71,7±5,5 yıl idi. %16,7’si tek başına yaşıyordu, %61,7’si ev hanımı idi. %86'sının bir veya daha fazla komorbid hastalığı mevcuttu; en sık hipertansiyon (HT) daha sonra mide ve kalp hastalıkları görülmekte idi. En sık yakınma nedenleri sıklığı sırasıyla eklem ağrısı, halsizlik-yorgunluk, yaygın vücut ağrısıydı. Günde yutulan ilaç sayısı ortalama 4,02±0,9 (ortanca 4), VAS'a göre ağrı ortalaması 5,1±1,3 (ortan ca 5) olarak belirlendi. %16,5’nin düşme öyküsü mevcuttu. %30,1’i yürüyüş yapıyor ve sadece %15,4’ü ev içinde egzersiz yapıyordu. Omurga deformitesi, omurga ağrısı, idrar kaçırma, görme sorunu, yutma güçlüğü, duymada azalma, denge ve diş sorunu 75 yaşın üzerindekilerde istatistiksel açıdan anlamlı olarak daha fazla görülmekteydi. Sonuç: FTR polikliniklerinde hastaların çoğunluğunu yaşlı popülasyon oluş turmaktadır. İleri yaş grubunda komorbid hastalıkların varlığı, kullanılan ilaç sayısının fazla olması, osteoporoz ve düşme sıklığının artması, FTR heki minin hem medikal tedavi planlama aşamasında ve hem de rehabilitasyon programı hazırlarken dikkatli davranmasını gerektirmektedir. İleri yaş grubunun günlük yaşamlarında bağımsız ve daha aktif olabilmesi için sadece kas-iskelet yakınmaları değil, bütün organ sistemleri değerlendiril erek kapsamlı ve çok yönlü bir geriatrik rehabilitasyon programı düzenlen melidir. Türk Fiz Tıp Rehab Derg 2011;57:143-9., Aim: The aim of this study was to define the demographic and clinical characteristics of geriatric patients who referred to physical medicine and rehabilitation (PMR) outpatient clinics and to detect the differences between these characteristics in regard to age, sex and education level. Materials and Methods: 820 patients over 65 years old who attended 20 outpatient clinics were included in the study. In addition to demographic data, the complaints, comorbid diseases, pain levels, drugs being used, exercise and medical status of the patients were recorded. The effects of age, sex and education level on complaints, comorbid diseases and exercise habits were investigated. Results: The mean age of the patients was 71.7±5.5 years. 16.7% were living alone, 61.7% were housewives. 86% of the patients had one or more comorbid diseases - hypertension, gastric problems and heart disease were mostly encountered. The most common complaints were joint pain, fatigue and widespread body pain. The average number of pills taken per day was 4.02±0.9 (median 4), and the VAS pain score was 5.1±1.3 (median 5.0). History of falling was present in 16.5% of patients. 30.1% were routinely walking and 15.4% were performing exercise at home. In patients over 75 years, vertebral pain and deformity, urinary incontinence, eye problem, difficulty in swallowing, decrease in hearing, as well as balance and teeth problems were significantly more frequent than in younger subjects. Conclusion: Aged population constitutes most of the PMR outpatient clinic patients. Considering comorbid diseases, high number of daily taken drugs and falls, PMR specialist should be cautious in prescribing drugs and planning rehabilitation programme. For independence in activities of daily living in this age group, besides the musculoskeletal system, all other systems should be evaluated and a comprehensive geriatric rehabilitation programme should be constructed. Turk J Phys Med Rehab 2011;57:143-9.

Background: Myofascial pain syndrome (MPS) is characterized by myofascial trigger points in a palpable taut band of skeletal muscle. Objective: We aimed to investigate serum trace elements, vitamin B12, folic acid levels and their correlations with clinical findings and functional status in patients with MPS. Methods: Thirty eight patients with at least one trigger point located on shoulder muscles, and at least 6 months duration, were included in this study. The demographic data, disease duration of patients were noted. Serum copper, zinc, magnesium and iron levels, vitamin B12 and folic acid levels were measured. Visual analogue scale (VAS) was implemented to estimate daily severity of pain. Pain pressure threshold of subjects and control groups were assessed by using Fischer's tissue compliancemeter. The Turkish version of the Beck Depression Inventory (BDI) was administered for the presence of any depressive disorder. Results: The mean age of patients in MPS group and control group were 33.1 and 37.8 years respectively. Serum levels of zinc (p < 0.006) were significantly decreased in patients with MPS. VAS, total myalgic and BDI scores of patients were significantly higher than the control group (Respectively p < 0.000, p < 0.012, p < 0.000). Association between TMS and magnesium, vitamin B12 levels was found statistically significant. BDI score correlated significantly with the serum zinc level (r: 0.548, p < 0.001) and VAS in patients with MPS (r:0.641, p < 0.000). Conclusion: According to the results of this study, it was asserted that trace elements, vitamins may play an important role in the pathophysiology of MPS and psychological factors may also have additional effect.

To the best of our knowledge, there is no study in the English literature about the usefulness of ultrasound therapy in degenerative hip osteoarthritis. The aim of this study was to examine its short- and long-term efficacy in patients with primary hip osteoarthritis with regard to pain, functional status, and quality of life (QoL). Forty-five patients with primary hip osteoarthritis were enrolled into the study. Demographic and clinical characteristics including age, sex, duration of disease, and pain on activity and at rest using visual analogue scale (VAS) were recorded. Functional status was determined by a 15-m timed walking test and Western Ontario McMaster Osteoarthritis Questionnaire. QoL was determined by the Short Form-36 survey (SF-36). Each patient was randomly assigned to either group I (standard physical therapy including hot pack and exercise program), group II (sham ultrasound in addition to standard physical therapy), or group III (ultrasound and standard physical therapy). The main outcome measures of the treatment were pain intensity by VAS; functional status measurements that were evaluated at baseline, at the end of the therapies, and at the first and third month of follow-up; and QoL scores that were determined at baseline and at the end of the first and third months. Twelve male and 33 female patients (mean age, 65.3 ± 6.7 years; mean disease duration, 2.5 ± 1.7 years) were included in the study. There were no differences between the groups regarding demographic variables on entry to the study. There were 15 patients in each group. Pain and functional outcome measures were determined to have improved significantly in all of the groups at the end of the therapies, but these improvements continued at the end of the first and third months only in group III (p < 0.001) The physical subscores of SF-36 were improved at the end of the first month and were maintained at the end of the third month only in patients receiving additional ultrasound therapy (group III, p < 0.001), while mental subscores of SF-36 did not change significantly in any group. In conclusion, addition of therapeutic ultrasound to the traditional physical therapy showed a longitudinal positive effect on pain, functional status, and physical QoL in patients with hip osteoarthritis. The use of therapeutic ultrasound in the treatment of hip osteoarthritis should be encouraged, and it seems worthy to continue with large clinical trials on ultrasound in order to standardize the treatment modality in this patient group.

Background Enhancing quality of life (QoL) in older adults with physical limitations is a significant challenge for healthcare providers. One of the first steps to improving quality of life in older adults with osteoarthritis (OA) is developing a better understanding of the set of factors that coexist and influence QoL. Objectives To determine the predictors of disease-specific QoL in a sample of knee and hip OA in a tertiary care hospital and to evaluate physical activity, mental health, social functioning and social support components of OA-specific-QoL questionnaire in addition to score of pain, ESR, CRP, x-ray, and co-morbid conditions. Methods A cross-sectional, methodological exploration from an inpatient sample (N=100) of adults (mean age: 64.51±8.78, 83 female) with OA of the knee (N=78) and hip (N=22) according to the ACR- clinic and radiograhic knee OA or hip OA classification criteria was performed. Clinical, laboratory and radiographic datas were analysed using SPSS15.0. The osteoarthritis knee and hip quality of life questionnaire (OAKHQOL) consisting of 43 items in five dimensions and three independent items were fullfilled by patients (1). Results Means of pain-VAS scores at rest and movement were moderately high (5.14 and 6.64). Twenty patients were in stage I, 36 patients were stage II, 30 patients were in stage III and remaining 14 patients were in stage IV OA according to the Kellgren-Lawrence system. All of the patients were overweight or obese. Related comorbidities were common such as 48 hypertensive, and 33 diabetic.Lineer regression analyses showed that mental health ( R 2 =0.668, p =.000), pain ( R 2 =0.591, p =.000), and vehichle-transfer difficulties ( R 2 =0.572, p =.000) were the most important predictors for OA-specific-QOL. Conclusions The findings of this study provide a foundation or targeted interventions to improve QoL and the importance of mental health older adults with OA of the knee and hip. The individual problem solving including both mental and physical approaches may help these patients to improve OA-specific-QoL. Mental health and cognitive approaches should be incorporated to OA management. References Rat AC, Coste J, Pouchot J, Baumann M, Spitz E, Retel-Rude N, Le Quintrec JS, Dumont-Fischer D, Guillemin F. OAKHQOL: a new instrument to measure quality of life in knee and hip osteoarthritis. J Clin Epidemiol. 2005 Jan;58(1):47-55. Disclosure of Interest None declared

Background Carpal tunnel syndrome (CTS) is an entrapment neuropathy of the median nerve and can cause neuropathic pain and functional decrease in hand functions. Objectives The aim of this study was to compare the effectivity of Leeds assessment of neuropathic symptoms and signs scale (LANSS) with pain detect questionnaire (PDQ) in CTS and their relations with hand functions. Methods The patients were selected among the patients who admitted to physical medicine and rehabilitation outpatient clinics and the selection criteria was to have positive Tinel or Phalen sign and paresthesia in hand. 157 hands of 90 patients were evaluated by electromyography and grouped as mild, moderate or severe involvement. Neuropathic pain was analysed by LANNS and PDQ; hand functions by Duruoz hand index (DHI); sensory evaluations by Semmes Weinstein monofilaments (SWM) and grip strength by Jamar dynamometer. Results EMG findings revealed 30.4% of hands had mild, 66.5% had moderate and 2.5% had severe CTS. In statistical evaluations in order to have a homogenous group, we have chosen the moderate CTS group. LANSS scores correlated with DHI, Jamar scores (p and r values were 0.032, 0.209; 0.010, -0.250 respectively. PDQ scores correlated with VAS score, DHI, Jamar, SWM (p and r values were 0.001, 0.314; 0.000, 0.346; 0.005, -0.270; 0.000, 0.391). The correlation coefficient between LANSS and PDQ was p: 0.000; r: 0.324. Conclusions Though there is a significant correlation between LANSS and PDQ scores, PDQ scores revealed better correlation coefficients in DHI and Jamar scores and additional correlations were determined in VAS scores and SWM values.In conclusion we think PDQ presents finer results then LANNS. Disclosure of Interest None declared

Background Anti-CCP antibodies are known to be related to more erosive disease in rheumatoid arthritis (RA). In recent years these antibodies are found to be increased in chronic obstructive pulmonary disease, liver disease, autoinflammatory diseases and cigarette smoking as well. Objectives In this study we searched whether additional factors such as lung, thyroid, liver problems and smoking had any contribution to anti-CCP levels in RA patients. Methods One hundred and thirteen RA patients who followed up in our rheumatology outpatient clinics participated in the study. In addition to demographic features, pulmonary function test results, anti thyroglobulin (anti TG ab) and anti thyro peroxidase (anti TPO ab) antibodies, hepatitis markers, erythrocyte sedimentation rate (ESR), C- reactive protein, rheumatiod factor (RF) and anti- CCP levels were evaluated. Results Mean values of the parameters were as follows: age of the patients: 54.76±11.56; disease duration: 10.9±7.2 years, forced expiratory volume 1: 79.5±21.33, forced vital capacity: 81.85±16.73. Levels of anti TG ab was high in 9.7% and that of anti TPO ab was high in 18.6% of the patients. 10% of the patients were Hepatitis B carrier. 72.6% of the patients were smoking cigarette. We divide the patients into 2 groups according to anti- CCP levels (higher or lower then 60 units). We found statistical significant difference in anti TG ab levels (p: 0.04), RF levels (p: 0.00) and ESR (p: 0.001). Conclusions It is well known that RF and ESR levels are related with anti- CCP levels, in addition to these we found anti TG antibodies could also increase anti -CCP levels. It is necessary to make studies with larger samples for more precise decisions. Disclosure of Interest None declared

Reliable and valid evaluation of hand strength is important for determining the effectivity of treatment strategies and it is accepted that grip and pinch strength provide an objective index for the functional integrity of upper extremity. This study was designed to evaluate the grip and pinch strength differences between sides for the right and left handed population.The study included 128 right and 21 left hand dominant volunteers. Grip strength of the participants were measured by using a Jamar dynamometer. Pulp pinch strength measurements were performed by manual pinchmeter.When the study group was totally evaluated, a statistically significant difference was found between the grip and pinch strengths of dominant and nondominant hands in favour of the dominant hand. For further information we grouped 149 participants as right and left handed and investigated the number of subjects with stronger nondominant hand for each group. The percentage of stronger nondominant hand grip was 10.93% and 33.33% for right and left handed groups respectively. The results were less significant for pinch strength with 28.12% and 28.57% for right and left handed subjects respectively.We concluded that the dominant hand is significantly stronger in right handed subjects but no such significant difference between sides could be documented for left handed people.

Background Temporomandibular joint disorders are common and lead to functional disability not only in temporomandibular joint but also in teeth, soft tissues and components of mastication. Patients with temporomandibular joint (TMJ) disorders report symptoms which include jaw and neck pain, headache and clicking or grating within the joint. Pharmacotherapy, physical therapy modalities, injection and exercise are all used for the treatment of TMJ disorders however no therapies have been shown to be uniquely superior for the treatment of pain or oral dysfunction in this chronic syndrome. Objectives The aim of this study was to evaluate the comparative effects of physical therapy and injection therapy along with the exercises in a group of patients with TMJ disorders. Methods Fourty nine patients with a mean age 37.57±15.14 years were recruited to the study. Patients were evaluated for complaints and clinical findings and then randomly allocated to three treatment groups. All patients got education and learned TMJ exercises to perform as home exercise program. The patients in the first group (n=17) received pharmacotherapy (non-steroidal anti-inflammatory drugs for a duration of 10 days with anti-inflammatory doses), the second group (n=15) received physical therapy comprising superficial local heat and TENS for 10 sessions; the third group (n=17) received hyaluronic acid injection to TMJ. The main outcome measures were pain at rest and movement of jaw assessed by VAS; and mouth opening distance. Oral health impact profile (OHIP-14) was used in all patients to assess people’s perceptions of the social impact of oral disorders on their well-being. All the measurements were performed at baseline, at the end of therapies, one month and three months after therapies. Results Fourteen men and 35 women were completed the study. All patients reported to perform their home exercise program twice a day. Pain by VAS in rest and movement of jaw decreased in all patient groups (5.9±1.4 vs 5.6±1.9 vs 6.2±2.2; 1.1±0.9 vs 1.4±1.1 vs 2.5±1.6 respectively) but the most significant improvement was observed in the injection group than in other groups at first and third months (p 0.05). Conclusions Our results indicated that all of the treatments including pharmacotherapy, physiotherapy, hyaluronic acid injection therapy improved the patients’ pain and functional status at the end of the therapies but hyaluronic acid injection treatment to TMJ were found to be more efficacious and long lasting in regard to pain, than in other therapies. Further studies are needed to confirm our results in larger groups of patients suffering from TMJ disorders. Disclosure of Interest None Declared