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Amaç: Pulmoner arteriyel hipertansiyon hastalarında, hastalığın erken dönemlerinde semptomlar eforla ortaya çıkarken, hastalığın ileri evrelerinde dinlenme durumunda da gözlenebilir. Pulmoner arteriyel hipertansiyon hastaları için optimize edilmiş tıbbi tedavi bulunmasına rağmen, çoğu pulmoner arteriyel hipertansiyon hastası düşük egzersiz kapasitesi ve yaşam kalitesinden şikayetçidir. Pulmoner arteriyel hipertansiyon tedavi parametrelerinden biri pulmoner rehabilitasyondur. Pulmoner rehabilitasyon multidisipliner bir yaklaşımdır. Pulmoner arteriyel hipertansiyon için en önemli bileşeni fizyoterapi programıdır. Kişiye özel fizyoterapi programları egzersiz eğitimi, solunum kas eğitimi, hasta eğitimi bileşenlerinden oluşmaktadır. Solunum kas kuvveti eğitimi daha çok spesifik olarak inspiratuar kas eğitimi şeklinde uygulanmaktadır. Pulmoner arteriyel hipertansiyonlu hastalar için inspiratuar kas eğitimi uygulamasının genel etkilerini araştıran ve konu alan çalışma sayısı azdır. Bu çalışmanın amacı “Pulmoner arteriyel hipertansiyonlu hastalarda inspiratuar kas eğitimi hastanın fonksiyonel egzersiz kapasitesini ve yaşam kalitesini arttırmada etkili midir?” sorusunu cevaplamaktır. Yöntemler: Ocak 2022 tarihinden önce PubMed, Web of Science, Cochrane Library, Springer Link olmak üzere dört ana veri tabanında arama yapıldı. Arama son 5 yılda yayınlanan randomize kontrollü prospektif çalışmalar olacak şekilde sınırlandırıldı. Bulgular: Pulmoner arteriyel hipertansiyonlu hastalarda inspiratuar kas eğitimi uygulanan çalışmalar dahil edildi. Tam metinler okunduktan sonra dahil edilme kriterlerine uygun iki çalışma bulundu. Bu yayınların tümü randomize kontrollü prospektif çalışmalardı. Sonuç: Çalışmalar incelendiğinde, pulmoner arteriyel hipertansiyonlu hastalarda inspiratuar kas eğitimi uygulamasının, fonksiyonel egzersiz kapasitesini ve inspiratuar kas kuvvetini arttırdığı ancak yaşam kalitesini arttırmadaki etkinliğinin belirsiz olduğu sonucuna varıldı.

Purpose: In this study, it was aimed to investigate whether physical activity level depends on exercise perception and body awareness. Methods: A total of 116 people between the ages of 18-25 years who did not have any diseasepreventing physical activity participated in the study. Using a face-to-face questionnaire and inquiry methods, participants were evaluated with Body Awareness Questionnaire (BAQ), Exercise Benefits/Barriers Scale (EBBS), and International Physical Activity Questionnaire-Short Form (IPAQ-SF). Results: The mean age and body mass index of the participants were 20.38 years and 21.86 kg / m2. In IPAQ-SF scores, 28.4% of the participants were at the low activity level, 40.5% were at the medium activity level and 31% were at the high activity level. There was a weak correlation (r

This editorial discusses how the rehabilitation field has transformed as a result of COVID-19.

Bronşektazi; bronşların anormal, kalıcı ve geri dönüşü olmayan dilatasyonu ile karakterize klinik olarak öksürük, balgam üretimi ve tekrarlayan solunum yolu enfeksiyonlarına neden olan kronik inflamatuar bir akciğer hastalığıdır. Bronşektazinin altta yatan birçok nedeni vardır. Bronşektazide pulmoner rehabilitasyon; egzersiz eğitimi, hava yolu temizleme teknikleri, kas-iskelet sistemine yönelik yaklaşımlar, solunum işini azaltmaya dayalı teknikler ve hasta eğitimini içermektedir. Bronşektazili hastalara kişiselleştirilmiş pulmoner rehabilitasyon programları planlanıp uygulanması yaşam kalitesini ve fiziksel kapasiteyi artırmak açısından oldukça değerlidir. Rehabilitasyonun uzun vadeli sonuçları ile ilgili daha fazla çalışmaya ihtiyaç vardır. Geleneksel pulmoner rehabilitasyon programlarının bronşektazi için optimize edilmesi gerekmektedir.

The aims of this study were to evaluate the optical properties of flowable and injectable composites after polishing, such as translucency (translucency parameter [TP], TP

Telesağlığın bir alt bileşeni olan telerehabilitasyon, rehabilitasyon hizmetlerinin hasta ile sağlık hizmeti sağlayıcısı arasında iletişim ve bilgi teknolojisi yoluyla sunulması olarak tanımlanmaktadır. Fizyoterapi ve rehabilitasyon alanında telerehabilitasyon; pulmoner, kardiyak, ortopedik, nörolojik, onkolojik hastalıkların rehabilitasyonu gibi çok çeşitli alanlarda uygulanabilmektedir. Sosyal izolasyon süreçleri, transfer problemleri, klinikte karşılanamayan iş yükleri gibi nedenlerle alternatif rehabilitasyon yöntemlerinden biri olan telerehabilitasyonun kullanımı hızla yaygınlaşmıştır. Bu derlemenin amacı rehabilitasyon alanlarına göre sıklıkla çalışılan patolojilerde yapılan telerehabilitasyon çalışmalarını incelemektir.

Our aim in this study is to reveal the frequency of febrile seizures in patients with Familial Mediterranean Fever and Periodic Fever, Aphthous stomatitis, Pharyngitis, cervical Adenitis syndrome and to compare it to normal population.Patients with Familial Mediterranean Fever and Periodic Fever, Aphthous stomatitis, Pharyngitis, cervical Adenitis syndrome, who were diagnosed accord- ing to Turkish pediatric Familial Mediterranean Fever diagnostic criteria and Marshall criteria, were enrolled to the study. A form containing questions about febrile seizures history was pre- pared for Familial Mediterranean Fever and Periodic Fever, Aphthous stomatitis, Pharyngitis, cervical Adenitis syndrome patients. Demographic data and febrile seizures history of Periodic Fever, Aphthous stomatitis, Pharyngitis, cervical Adenitis patients were obtained by calling the parents by phone. Familial Mediterranean Fever patients were randomly selected during their routine follow-up. The frequency of febrile seizures in both disease groups was compared with the prevalence of previous febrile seizures studies in the general population in Turkey.A total of 417 Familial Mediterranean Fever and 152 Periodic Fever, Aphthous stomati- tis, Pharyngitis, cervical Adenitis subjects were recruited to the study. The frequency of febrile seizures in Familial Mediterranean Fever and Periodic Fever, Aphthous stomatitis, Pharyngitis, cervical Adenitis syndrome was similar (8.4% vs. 8.6%; P.05). The frequency of febrile seizures in Familial Mediterranean Fever and Periodic Fever, Aphthous stomatitis, Pharyngitis, cervical Adenitis syndrome patients was found to be significantly higher than the frequency in general population (8.4% vs. 4.4%) [P.0001, OR: 1.99 (CI: 1.4-2.8)]; (8.6% vs. 4.4%) [P.01, OR: 2.03 (CI: 1.1-3.6)], respectively.The frequency of febrile seizures in patients with Familial Mediterranean Fever and Periodic Fever, Aphthous stomatitis, Pharyngitis, cervical Adenitis syndrome was found to be significantly higher than in the general population. This increased frequency of febrile seizures in both periodic syndromes seems to be a result of recurrent fever.

Sarkoidozlu bireylerde; egzersiz intoleransı ve kas zayıflığı gibi yaşam kalitesini etkileyen semptomların sıklıkla görülmesi nedeniyle bireylere mümkün olduğunca aktif ve katılımcı bir yaşam sürmeleri önerilmektedir. Sarkoidozun karmaşıklığı ve çoklu sistem tutulumu potansiyeli göz önüne alındığında, rehabilitasyon veya fiziksel egzersiz programları da dahil olmak hastaya yönelik terapötik yaklaşımın kapsamlı ve bireyselleştirilmiş olması gerekmektedir. Sarkoidozlu bireylerin bu heterojenliği, standart pulmoner rehabilitasyon programının modifikasyonunu gerektirebilir. Bütün bu bilgilerden yola çıkarak sarkoidozlu bireylerde optimal bir egzersiz programının (egzersiz türleri, yoğunluklar, sıklık ve süre) tanımlanması için daha geniş kapsamlı çalışmalara ihtiyaç vardır.

Bu çalışmanın amacı Türkiye’deki Fizyoterapi önlisans programlarının incelenmesi ve müfredat analizinin yapılmasıdır. ‘TC Ölçme, Seçme ve Yerleştirme Merkezi (ÖSYM)’ ve ‘Yüksek Öğretim Kurulu (YÖK)’ web sayfaları taranarak ülkemizde kurulmuş olan devlet ve vakıf üniversitelerindeki fizyoterapi önlisans programları irdelenmiştir. Fizyoterapi programlarına öğrenci aldıkları tarih, 2013 ve 2018 kontenjan sayıları, öğretim elemanı sayıları, ders müfredatları incelenmiş ve veriler yüzde ve oranlar şeklinde dökümante edilmiştir. Yaptığımız veri taramasında, Fizyoterapi ön lisans programlarının 38’ inin ( %42,6) 2013 yılı ve öncesinde, 58’inin (57,4%) 2013 sonrasında açıldığı görülmektedir. Bu okullardaki kontenjan sayıları 2013 yılında 1605, 2018 yılında 5827’dir. 2018 yılı öğretim elemanı sayısı 26 (25,7%) okulda 2 ve altındayken, Fizyoterapist öğretim elemanı sayısı 51 (50,5%) okulda 2 ve altındadır. Ders müfredatları incelendiğinde ise ölçme değerlendirme derslerinin %64,4 okulda ve rehabilitasyon derslerinin %79,2 okulda olduğu belirlenmiştir. Çalışmamızdan elde ettiğimiz sonuçlara göre Türkiye’de Fizyoterapi teknikerliği ön lisans programlarında yetersiz öğretim elemanı sayıları ve program müfredatlarında da standardizasyon eksikliği bulunmaktadır. Programın meslek tanımına uygun olarak düzenlenmesi ve öğretim elemanı sayılarının arttırılması gerektiğini düşünüyoruz

Background The Bronchoscopic Lung Volume Reduction (BLVR) is recommended in patients with severe Chronic Obstructive Pulmonary Disease (COPD) who are still symptomatic and have hyperinflation despite having received optimal medical therapy and Pulmonary Rehabilitation (PR). However, the small number of PR centers is insufficient to compensate for the need for existing hospital-based PR programs. Objective This article aimed to compare between hospital-based and home-based PR programs in terms of effectiveness on BLVR candidates. Methods This study is a prospective, controlled, nonrandomized clinical trial. Stable COPD patients who were referred to our PR clinic prior to BLVR were recruited consecutively. Patients were evaluated in two groups, hospital-based PR (Group 1) or home-based PR (Group 2). Both groups were admitted to the recommended PR for eight weeks. Pulmonary function tests, modified Medical Research Council (mMRC) dyspnea scale, COPD Assessment Test (CAT) and the 6-min walk distance (6MWD) were assessed for each patient before and after PR. Results A total of 67 patients were enrolled in the study. The max. age was 79 years and min. age was 49 years, with 65(±7.45) as a mean ±SD. Improvements in the mMRC and CAT scores after PR in both groups were significant and a similar level. Whereas, 6MWD was only significantly increased in Group 1. Conclusions This study, demonstrated that both home-based and hospital-based PR provided significant and similar improvements in the mMRC and CAT scores but 6MWD was only significantly increased in the hospital-based PR. Since 6MWD after PR plays a major role in BLVR eligibility, our findings suggest that hospital-based PR may be the most appropriate method for BLVR candidates.

OBJECTIVES: Lung transplantation (LTx) candidates have severe exercise intolerance. This makes it difficult for them to complete the field tests used to determine the exercise capacity of patients. Therefore, there is a need for alternative tests that require less effort. We aimed to investigate the use of short-timed performance tests instead of 6-minute walk test (6MWT) in the determination of exercise capacity in LTx. MATERIALS AND METHODS: A total of 63 LTx candidates were included in the study. Ten-meter walking speed test (10MWT), 5-times sit-to-stand test (5XSST), 6MWT were performed at one-hour intervals within the same day, and by the same physiotherapist in all patients. Maximal inspiratory (MIP) and expiratory pressure (MEP), peripheral muscle strengths, pulmonary function tests, and body mass index (BMI) were recorded for each patient. RESULTS: The subjects’ baseline mean 6-minute walking distance (6MWD) was 336m, 5XSST time was 11.59 sec, and 10MWT time was 8.45sec. There was a negative and moderate correlation between 6MWD and 10MWT (p

Bronşektazi, kronik inflamasyon ve enfeksiyonun bronş duvarlarında oluşturduğu hasara bağlı olarak bir veya birden fazla bronşta meydana gelen dilatasyon ve harabiyet ile karakterize kronik bir akciğer hastalığıdır. Hastalığın yönetiminde pulmoner rehabilitasyon önemli bir yer tutmaktadır. Hastalık yönetimine ilişkin çalışmaların çoğu yetişkin grubu kapsamaktadır. Bu doğrultuda çalışmanın amacı, pediatrik ve adolesan bronşektazili hastalarda pulmoner rehabilitasyonun etkinliğini araştırmaktır. PubMed, Cochrane Library, PEDro ve TRDizin veri tabanları Aralık 2021’e kadar arandı. Pediatrik, adolesan bronşektazi hastalarında pulmoner rehabilitasyon, hava yolu temizleme teknikleri ve egzersiz içerikli tedaviler uygulanan ya da rehabilitasyona katkı sağlayacağı düşünülen çalışmalar dahil edildi. Toplamda 161 makale bulundu. Tam metinler okunduktan sonra belirlenen dahil edilme kriterlerini karşılayan 7 çalışma seçildi. Pediatrik ve adolesan bronşektazili hastalarda pulmoner rehabilitasyonun etkisiyle hastalık semptomları azaltılıp yaşam kalitesi arttırılabilir. Gelecekteki çalışmalarla pediatrik ve adolesan bronşektazili gruba yönelik fiziksel aktivite ve egzersiz önerileri fikir birliğinden ziyade kanıta dayalı olarak verilebilir.

Financial performances of commercial banks are commonly determined with various multi-criteria decision-making (MCDM) models. For example, Analytic Hierarchy Process (AHP) method is one of the most widely used MCDM approaches in the formation of performance measurement models. In this study, a hybrid model is developed with the usage of AHP and Design of Experiments (DOE) to obtain overall financial performance scores by combining performance scores at the financial ratios for 18 Turkish commercial banks and their rankings within the commercial banking sector. In obtaining performance scores of the banks at the financial ratios the rationing process is used. In the applied rationing process, three different thresholds (quartiles: Q(1), Q(2), and Q(3)) are determined for each financial ratio. In the paper, the results of the proposed hybrid model are compared with the results of the AHP approach to determine its advantages over the usage of the AHP approach alone. The comparisons show that the hybrid model provides statistically similar but more robust performance scores and ranking results.

Objectives The aim of the present study was to compare the home-based pulmonary rehabilitation (PR) with the hospital-based PR with respect to exercise compliance rates and efficiency of therapy in stable chronic obstructive pulmonary disease (COPD). Materials and methods Patients with stable severe and very severe COPD who were admitted consequently to our PR clinic were prospectively included in the study. Patients who completed the home-based PR for at least 4 days/week for 2 months as recommended were classified as the study group. Patients who completed the hospital-based PR in our clinic before the present study were classified as the control group. Results Thirty-five patients were included in the home-based PR, but 10 patients were incompatible with the exercise training, and four patients were out of follow-up. Twenty-one patients successfully completed the home-based PR (study group), and compliance rate was 60%. Thirty-seven patients previously underwent the hospital-based PR, and 25 patients completed the exercise program (control group); thus, their compliance rate was 67%. There was no difference between the two groups with respect to treatment compliance rates. The significant improvement in six-minute walking distance, modified Medical Research Council dyspnea, and COPD Assessment Test scores were observed after PR in both groups, and there was no difference with respect to the levels of improvement. Conclusion The present study showed that approximately two-thirds of patients with COPD successfully completed the home-based PR, and that this program also provided similar benefits with respect to the quality of life and exercise capacity compared with the hospital-based PR.

Objectives We aimed to investigate the effects of pulmonary rehabilitation (PR) on the level of physical activity (PA) and the general clinical status in adult patients with non-cystic fibrosis bronchiectasis. Materials and methods The patients were included prospectively in the study and followed a home-based PR program for 2 months comprising breathing exercises, training in chest hygiene techniques, peripheral muscle strengthening training, and self-walking. The outcomes measurements were the following: 6-minute walking distance, pulmonary function test, peripheral and respiratory muscle strength measurements, International Physical Activity Questionnaire (IPAQ), Saint George Respiratory Questionnaire, and modified Medical Research Council dyspnea scores. Results Of the total 25 patients included in the study, six were excluded due to follow-up and adherence problems. A comparison of the outcome measures recorded before and after PR showed statistically significant improvements in the IPAQ total (p=0.015) and walking scores (p=0.011). While the proportion of patients in the low PA category was 73% (n=14) prior to PR, this rate decreased to 42% (n=8) post-PR. The proportion of patients in the moderate PA category was 26% (n=5) prior to PR and increased to 52% (n=10) post-PR. While positive improvements were seen in all clinically monitored parameters, aside from spirometric values, these changes did not reach a statistically significant level. Conclusion The majority of patients with bronchiectasis have a low level of PA. PR ensures positive improvements in the level of PA and general physical clinical status of such patients.

Objective: Pulmonary rehabilitation(PR) is mandatory before bronchoscopic lung volume reduction (BLVR). But there is a limited data about its efficiancy on post-BLVR process. We aimed to investigate the effect of mached control groups receiving and not receiving Preop-PR on post-BLVR lung functions and exercise capacity. Methods: The data of patients who underwent BLVR were retrospectively analyzed. The patients were categorized as PR group(n:52) and Non-PR group(n:37). The PR program included aerobic and strengthening training for 2 months. Respiratory functions (TLC:Total lung capacity, RV:Residual volume; FEV1:Expiratory volume in 1 second; FVC:Forced vital capacity) and exercise capacity (6MWD:6-minute walking distance) of the groups were compared in 6-months period. Results: When baseline values of the groups were analyzed, all respiratory parameters and 6MWD were similar except for RV / TLC, FEV1% and FVC%. In the PR group, there was a significant improvement in FVC (p=.005), FVC%, (p=.000) and 6MWD (p=028) after the preop-PR. Drop-out rates were 50% in the PR and 92% in the Non-PR group in 6th months. When comparing baseline-first month data, there was a statistically significant improvement in all parameters of the PR group except RV / TLC(p =.321) and FVC(p=099). Considering that there are too many drop outs in the Non-PR group, this was similar in the baseline-3rd month data comparison. Conclusion: Preop-PR improves exercise capacity and respiratory functions. Respiratory functions of the patients who received PR at 6-month follow-ups were better. It was found that patient groups receiving PR had more compliance with follow-up.

BACKGROUND Although similar factors play a role in both PTA and anemia in patients with CKD, additional risk factors exist in the pathogenesis of PTA. The present study aimed at comparing anemia and inflammation-related parameters between RTx recipients and CKD patients and elucidating the risk factors of PTA. METHODS This single-centered, cross-sectional study consisted of 68 participants: 48 were in the RTx group and 20 were in the CKD group. The CKD patients were comparable to the RTx recipients in terms of age, gender, and eGFR. Serum levels of EPO, hepcidin, and IL-6 were measured by enzyme-linked immunosorbent assays. The ratio of EPO/Hb was calculated to estimate endogenous EPO resistance. RESULTS The prevalence of anemia was 46% in the RTx group and 30% in the CKD group (P = .23). RTx recipients had significantly lower Hb (P = .04), higher EPO (P

CONTEXT: Although pulmonary rehabilitation (PR) is increasingly used in patients with chronic obstructive pulmonary disease (COPD), the factors affecting the gains obtained from PR are still not clear. AIMS: We aimed to investigate the effect of body mass index (BMI) on PR outcomes in COPD. SETTINGS AND DESIGN: The study was a retrospective–descriptive study. SUBJECTS AND METHODS: Patients with BMI of 18.5–25 kg/m2 were referred to as Group 1 (n = 15) and patients with BMI ≥25 kg/m2 as Group 2 (n = 17). All patients received PR for 8 weeks. Six-min walking distance (6MWD), forced expiratory volume in 1-s, forced vital capacity (FVC), carbon monoxide diffusing capacity (DLCO), maximal inspiratory pressure (MIP), modified Medical Research Council dyspnea scale (mMRC), and COPD assessment test (CAT) scores were compared. STATISTICAL ANALYSIS USED: Paired t-test, Wilcoxon rank, and Mann–Whitney-U test were used for statistical analysis. RESULTS: Thirty-two patients were included in the study. Baseline parameters were similar except 6MWD. Following PR, 6MWD, mMRC, and CAT scores were significantly improved in both the groups (P < 0.05). A significant difference was found in favor of Group 1 for FVC (P = 0.039) and MIP (P = 0.018), while no difference was detected in DLCO. CONCLUSIONS: In this study, PR yielded similar gains between COPD patients with high BMI and those with normal BMI in terms of exercise capacity, dyspnea, and disease symptom severity. The only additional gains were achieved in the respiratory functions of patients with normal weight. All COPD patients should be referred to PR, regardless of the BMI, taking into account the resulting PR gains.

We reviewed the medical records of patients with periodic fever, aphthosis, pharyngitis, and adenitis (PFAPA) to investigate the clinical course, treatment response, and association with MEFV gene mutation. Familial Mediterranean fever should be considered in patients with PFAPA who do not respond to adenotonsillectomy.

Aim Left atrioventricular (AV) valve regurgitation is the most serious residual lesion after surgical correction of atrioventricular septal defect (AVSD). Despite improvements in surgical techniques, left AV valve regurgitation continues to be the most serious problem after surgery. In this study, it was aimed to investigate the risk factors of the left AV valve regurgitation by evaluating clinical and echocardiographic findings of patients with AVSD, retrospectively. Material and methods In this study, 78 patients were enrolled. Preoperative echocardiographic findings, operation data, postoperative echocardiography findings were recorded. Results Fifteen patients (19%) were partial, 26 patients (33%) were intermediate and 37 patients (47%) were complete type. Forty-seven patients (60.3%) were female and 25 patients (32%) had Down’s syndrome. The median age at diagnosis was 6 months ranged from one day to 12 years. The median age at operation was 10 months (3–180 months) and the median weight at operation was 6.8 kg (4–49 kg). The total follow-up was a median of 103 months (28 days-268 months). In patients with partial AVSD, there was no significant difference in left AV valve regurgitation in the first, postoperative and last echocardiography (p> 0.05). In patients with intermediate and complete AVSD, left AV valve regurgitation was higher in the final echocardiography than in the first echocardiography (p = 0.007 and p = 0.01, respectively). According to the univariate analysis; age, gender, the presence of Down syndrome, operation type, annuloplasty, and pulmonary hypertension were not associated with moderate or severe left AV regurgitation after surgical repair (p> 0.05). Left AV valve regurgitation in the first echocardiographic examination was found to be the only predictor of left AV valve regurgitation in the last echocardiographic examination (p=0.001). There was only one patient who was reoperated for severe left AV valve regurgitation. Conclusion The most important postoperative problem in patients with AVSD is left AV valve regurgitation. Left AV valve regurgitation in the first echocardiographic examination was found as a potential risk factor on left AV valve regurgitation.

Aim: We aimed to investigate the relationship between functional exercise capacity level and muscle strength and lung functions in the lung transplantation (LTx) candidates.Materials and Methods: Twenty-five patients who were referred to our hospital for the pre-transplantation pulmonary rehabilitation program were included in the study. Patients were divided into 2 groups according to the 6-min walk test walking distance (Group1: 6MWD, Amaç: Çalışmamızda akciğer nakil adaylarında fonksiyonel egzersiz kapasitesi seviyesinin, periferik kas gücü ve solunum fonksiyonları ile olan ilişkisini incelemeyi amaçladık.Gereç ve Yöntem: Hastanemiz pulmoner rehabilitasyon merkezinde, akciğer nakli öncesi rehabilitasyon programına alınması için refere edilen 25 hasta çalışmaya dahil edildi. Hastalar 6 -dakika yürüyüş testi yürüme mesafelerine (6DYM) göre 2 gruba ayrıldı (Grup1: 6DYM

Amaç: Hastabakım vericileri hakkında yapılan çalışmalar çoğunlukla psikolojik etkilenimlerüzerinedir. Bakım verenlerin ortopedik etkilenimleri dikkate alınmamaktadır. Çalışmamızınamacı hastalara bakmakla yükümlü aile bireylerinin ortopedik etkilenimlerininve bu etkilenim miktarının hasta yakını bakım yüküne etkisinin incelenmesidir.Yöntemler:Palyatif bakım servisinde yatmakta olan hastaların, primer bakımlarını en aziki ay süredir üstlenen yakınları çalışmaya dahil edildi. Çalışma sonuçölçümleri: Oswestry boyun ağrısı sorgulaması, kol omuz el dizabilite anketi(DASH),Western Ontario ve McMaster osteoartrit indeksi (WOMAC), Short Form 36(SF36) yaşam kalitesi anketi, uluslararası fiziksel aktivite anketi (IPAQ),Zarit Bakım yük ölçeği (ZBY), beck depresyon anketi (BDA).Bulgular:Çalışmamız ortalama 50 yaşında, çoğunluğu kadın (%81), evli (%76) ve ev hanımı(%59) olan kırk iki bakım vericinin yer aldığı kesitsel bir çalışmadır.Ortalama DASH skoru 18.82 iken, Oswestry skoru 22.18 idi. IPAQ total skora göreolgular fiziksel olarak aktif kategorisindeydi (10145 MET). Bütün SF-36 altgrupları normatif değerlerle karşılaştırıldığında istatistiksel olarak anlamlıderecede düşüktü (p> 0,05). Total bakım yükü skoru 38.64 idi. ZBY, DASH (r =0,479), WOMAC (r = 0,453), Oswestry (r = 0,645), pekçok SF-36 alt grubu ve BDAile koreleydi (p, Objective: The studies on caregivers focus more on their psychological impact. The caregivers’ orthopedic problems are not taken into consideration. We aimed to determine the orthopedic problems of the patient family caregivers and to examine the relationship with burden of care.Methods: Caregivers of palliative care who look after the patient recieving palliative care at least two months were included in the study. The outcome measurements: Oswestry neck pain questionnaire,arm shoulder hand disability questionnaire (DASH), Western Ontario and McMaster osteoarthritis index (WOMAC), Short Form 36 (SF-36), International Physical Activity Questionnaire (IPAQ), Zarit Burden Interview (ZBI) and BECK depression inventory (BDI).Results: A cross-sectional study was carried our with fourty-two caregivers who averaged 50 years, were mostly female (81%), married (76%) and housewife (59%). Mean DASH score was 18.82, while Oswestry score was 22.18. According to the IPAQ total score, the cases were in the physically active category (10145 MET). In all SF36 subgroup, there was a statistically insignificant decrease compared to normative values (p> 0,05). Total burden score was 38,64. The ZBI correlated with DASH (r = 0,479), WOMAC (r = 0,453), Oswestry (r = 0,645) many SF36 subgroups (p

Objectives: Lung transplantation is the last treatment option when conservative treatment is not effective in individuals with terminal stage lung disease. Dyspnea is the primary symptom affecting quality of life in these patients. In our study, the effects of Pulmonary Rehabilitation (PR) on dyspnea and factors related with dyspnea were investigated in lung transplant candidates. Methods: Patients who were in the lung transplant waiting list and completed the 3-month PR program were included in the study. Study result measurements: 6-minute walk test distance (6MWD), lung functions (FEV1, FVC), respiratory muscle strength (MIP, MEP), quadriceps femoris muscle strength as measured by digital dynanometer, hand grip force measured by hand dinanometer (HG) and modified Modified Medical Research Council (mMRC) dyspnea scale. Results: A total of 47 patients were included in the study. After PR, 6MWD (p < 0.0001), MIP (p < 0.0001), MEP (p < 0.0001), HG (p < 0.0001) and mMRC (p < 0.0001) improvements were detected. There was no statistically significant relationship between the decrease in mMRC and the amount of change occurring in other outcome measurements (p > 0.05). Conclusions: According to the results of our study, PR has a positive effect on exercise capacity, peripheral and respiratory muscle strength and dyspnea in lung transplant candidates. But there was no relationship between these positive developments and dyspnea. There is a need for studies investigating the effects of different clinical features on rehabilitation outcomes.

BACKGROUND: Pulmonary rehabilitation (PR) has been shown to be effective on exercise capacity and dyspnea in lung transplantation (LTx) candidates. In this study, we aimed to investigate the efficacy of PR and to compare the outcomes in LTx candidates with obstructive and restrictive lung diseases. METHODS: Between January 2013 and May 2018, medical data of 86 patients who were on the waiting list for LTx were retrospectively analyzed. The patients were divided into two groups based on the diagnosis as obstructive patients (Group 1) and restrictive patients (Group 2). Six-minute walking test (6MWT), the Borg scale, and the modified Medical Research Council dyspnea scores were analyzed. RESULTS: A total of 65 patients completed the 8-week PR protocol (n = 42 in Group 1 and n = 23 in Group 2). Irrespective of the initial diagnosis, there was a significant (P < 0.05) improvement in the 6MWT distance in both groups without any statistically significant difference between the groups (Group 1, 299 m [42–548] vs. 377 m [84–561], mean increase 78 m, P < 0.001; Group 2, 337 m [70–525] vs. 396 m [139–621], mean increase 59 m, P = 0.002; Δ, P = 0.476). The effect of PR on dyspnea was significantly improved in both groups, whereas there were no differences between groups. CONCLUSION: PR has a positive effect on exercise capacity and dyspnea in patients with both obstructive and restrictive lung diseases who are on the waiting list for LTx. Our study results suggest that PR is effective in LTx candidates, irrespective of the initial diagnosis.

CONTEXT: Although pulmonary rehabilitation (PR) has become a preoperative standard practice, the fact that studies do not include groups of patients who do not receive preoperative PR restricts to introduce the real benefit of the rehabilitation process in lung transplantation (LTx). AIMS: We aimed to investigate the effect of preoperative PR before LTx on postoperative period. SETTINGS AND DESIGN: Retrospective, parallel design. SUBJECTS AND METHODS: Between March 2012 and October 2014, medical records of patients who underwent LTx were analyzed. There were two parallel groups. (1) Study group (n = 15) included the patients with received preoperative PR for at least 8 weeks. (2) Control group (n = 12) included the patients with underwent LTx without preoperative PR as appropriate donor was found. Time to intubation, length of intensive care unit (ICU) stay, and postoperative early mortality were evaluated. STATISTICAL ANALYSIS USED: Shapiro–Wilk, Fisher' exact test, Mann–Whitney U-test, Wilcoxon rank test. RESULTS: A total of 27 patients with LTx surgery, whose mean age was 40.6 (11.4) and 40% of females were included in the study. There were no significant differences in demographic characteristics between two groups, except the age (P = 0.005). The study group intubation time (2 [0–7] days) was shorter than control group (3 [1–12] days) (P = 0.02). There was no significant difference in the length of ICU stay postoperatively (P = 0.19) and postoperative early mortality rate (P = 0.65). CONCLUSIONS: Our study results suggest that preoperative PR may shorten time to intubation in patients undergoing LTx. Therefore, referral of LTx to PR centers and preoperative PR is of utmost importance for postoperative LTx.

Objectives The aim of this study was to evaluate the effect of comprehensive, 8-week outpatient pulmonary rehabilitation (PR) programme consisting of 60-min sessions twice a week under supervision on dyspnea and exercise capacity of patients who were lung transplantation (LTx) candidates. Materials and methods Between March 2012 and December 2014, medical data of 23 patients on the waiting list for LTx who were referred to our PR unit and completed 16-session outpatient under direct supervision were retrospectively analyzed. Data on exercise capacity as assessed by 6-minute walking test (6MWT) and the rate of perceived dyspnea as assessed by the Borg scale and Medical Research Council (MRC) dyspnea scale were recorded. Results Of 23 patients 57% were males; the mean age was 35±10 (range: 16-48) years. Four patients were operated early, as an appropriate donor was available. Diagnosis was as follows: bronchiectasis (n=10, 44%), silicosis (n=7, 30%), sarcoidosis (n=2, 9%), idiopathic pulmonary fibrosis (n=1, 4%), chronic obstructive pulmonary disease (n=1, 4%), and others (n=2, 9%). At the end of the program, there was a significant improvement (median: 60 m) in 6MWT scores (360 [70-254] m vs. 300 [139-489] m; p=0.018). In addition, a clinical improvement was observed in Borg (p=0.000) and MRC scores (p=0.008). Conclusion Our study results suggest that 8-week outpatient PR programme consisting of training twice a week is effective to decrease perceived dyspnea and to improve exercise capacity in patients who are on the waiting list for LTx.

Amaç: Çalışmamızın amacı torokotomi sonrası yoğun bakımünitesinde yatmakta olan hastalarda erken dönemde uygulanan fizyoterapininhemodinamik etkilerinin belirlenmesidir.Gereç ve Yöntemler: Torokotomi yapılan ve cerrahi yoğunbakımda 24 saatlerini tamamlayan hastalar çalışmaya dahil edildi. Hastalarasolunum egzersizleri, insentif spirometre çalışması, destekli öksürme vemobilizasyon içerikli fizyoterapi programı, cerrahi yoğun bakım ünitesindeuygulandı. Hastaların tedavi öncesinde, sonrasında ve 5 dakikatoparlanmalarının ardından sistolik (SKB) ve diastolik kan basınçları (DKB),kalp hızı (KH) ve oksijen saturasyonları (SpO2) kaydedildi. Ağrı seviyeleri ise vizüel analogskalası (VAS, 0-10) kullanılarak değerlendirildi.Bulgular: Yirmiikisi (%30) kadın, 50 (%70)’si erkek, yaş ortalaması59 olan 72 hasta çalışmaya alındı. Tedavi öncesi ve sonrası karşılaştırılmasında DKB’de yükselme (p=,006),tedavi sonrası ve 5 dakika toparlanma karşılaştırılmasında KH’de düşme(p=,008), tedavi öncesi ve 5 dakika toparlanma karşılaştırmasında ise KH’dekidüşme (p=,026) ve DKB’deki yükselme (p=,014) istatistiksel olarak anlamlıydı.Meydana gelen hemodinamik değişimler fizyolojik limitler içindeydi.Sonuç: Çalışmamızdanelde edilen sonuçlara göre cerrahi yoğun bakım ünitesinde uygulanan erken dönemfizyoterapi güvenlidir. Fizyolojik yanıtları gözlemlemek ve hasta güvenliğinisağlamak amacıyla fizyoterapi sırasında hemodinamik parametreler süreklimonitorize edilmelidir., Aim: To determine the haemodynamic effects of early physiotherapyprogramme in intensive care unit after thoracotomy.Materials and Methods: The patients whounderwent torocotomy and completed 24 hours in surgical intensive care unit wereincluded in the study. The physiotherapy program consisted of breathingexercises, incentive spirometer tarining, assisted coughing and mobilizationwere applied in surgical intensive care unit. The systolic (SBP) and diastolicblood pressure (DBP), heart rate (HR) and oxygen saturation (SpO2)were recorded before, during and after the treatment for 5 minutes. Pain level was assessed withVisual Analogue Scale (VAS, 0–10).Results: Seventy-two patients whowere 22 (30%) of female, 50 (70%) of male and mean age was 72 (mean age 59) were included in the study. The increasein DBP (p = .006) in the comparison of before and after treatment, the decreasein HR in the comparasion of after treatment and 5-minutes recovery (p = .008), the decrease in HR (p = .026) andincrease in DBP (p = .014) in the comparasion of pre-treatment and 5-minuterecovery were statistically significant. The hemodynamic changes were withinthe physiological limits.Discussion and Conclusion: According to the resultsof our study, early physiotherapy applied in surgical intensive care unit issafe. Hemodynamic parameters should be monitored continuously duringphysiotherapy to monitor physiological responses and ensure patient safety.

28th International Congress of the European-Respiratory-Society (ERS) -- SEP 15-19, 2018 -- Paris, FRANCE WOS: 000455567100490 Background: This study was planned with the consideration that Inspiratory Muscle Training (IMT) would contribute to the improvement of exercise capacity, dyspnea perception and lung functions by increasing respiratory muscle strength. Methods: This was designed as a prospective, randomized, double-blind study, and included 34 LTx candidates. The patients were randomly divided into two groups (PR plus IMT Group=PRIMT; Standard PR Group=SPR). All patients underwent a 3-month hospital based PR with or without IMT. Study outcomes: exercise capacity (6MWD), respiratory muscle strength (MIP, MEP), dyspnea perception (mMRC), Pulmonary Functions (FEV1, FVC, DLCO, DLCO/VA). Results: It was found that PRIMT group had much more significant increase in 6MWD (104m, p=0,03) and MIP (p=0,001) than the SPR group. Although both groups demonstrated a statistically significant decrease in the mMRC dyspnea score, no significant differences were found between the groups (p = 0.075). In all pulmonary functions, there was a slight increase in the PRIMT group (not statistically significant) and a decrease tendency in the SPR group after treatment. When comparing the delta values of the groups, a significant difference was found in favor of the PRIMT in DLCO / VA (%) (p = 0.02). Conclusion: A greater increase in exercise capacity and respiratory muscle strength was observed in the PRIMT group. The normally expected decline in respiratory function due to advanced lung disease was prevented. Our study showed that the IMT increased the benefits provided by PR. These gains obtained in the preoperative period will also be an advantage in the postoperative period. European Respiratory Society

Background Transitional care is a purposeful, planed movement of adolescence and young adults with chronic condition from childhood- to adult-oriented health care systems. Well-organised, systematic transitional health care is of high importance for providing the continuous medical treatment and for reaching optimal outcomes. Up to date, there is no unique, consensus-based model for patients’ transition from childhood- to adult oriented health care centres in Turkey. Objectives We aimed to assess the transitional care among patients with juvenile onset rheumatologic disease in referral tertiary centre in Turkey. Methods The transitional policlinic is held once per month at the department for paediatric rheumatology, consisting of 2 adult and 4 paediatric rheumatologist. A total of 147 patients have undergone the transitional care in the time period from May 2014 to December 2017. Patient s were called by telephone, by two different investigators (EP, OK). Thirty-three (22%) patients were not reached and 17 (11%) of theme were excluded from the study due to short post-transitional period ( Results A total of 147 patients (79 (54%) females) underwent transition process and 97 of them were included in the study. There was no statistically significant difference between different patients groups regarding the age of transition. The education levels of patients were as following: university 60 (61.9%), high-school 21 (21.6%), middle-school 13 (13.4%), primary school 3 (3.1%). Majority of patients was single at the time of study (79 (81.4%) patients) while only 18 (18.6%) patients were married; half of them being child owner. At the time of study, 44 (30%) patients were employed and mean age at employment was 19.06±3.1 years. Most of patients had health insurance at the time of study (94 (96.9%)). Seventy-one (73.2%) patients continued their regular follow up at adult department while 26 (25.8%) patients discontinued medical treatment. The most common reasons for cessation of follow up were the work/school absence (20 (76.9%)), followed by patients’ personal reasons (2 (7.6%)) and dissatisfaction with adult clinic services (4 (15.5%)). Most of patients reported satisfaction with transition process: 96 (99%). Conclusions This is the first Turkish model of transitional care among patients with chronic rheumatic disease. Well-organised transitional health care is of crucial importance for the continuous and optimal health care of adolescents and young adults with chronic rheumatic disease. Further studies with higher number of patients would reveal the relevance of described transitional care model. Reference [1] - Foster HE, Minden K, Clemente D, et al. EULAR/PReS standards and recommendations for the transitional care of young people with juvenile-onset rheumatic diseases. Ann Rheum Dis. 2017;76:639–646. Disclosure of Interest None declared

Objective: To investigate whether inspiratory muscle training would contribute to the improvement of exercise capacity, dyspnea perception and respiratory functions in lung transplantation candidates. Design: Prospective randomized controlled trial. Setting: Pulmonary Rehabilitation center. Subjects: A total of 34 patients with severe lung disease requiring lung transplantation were randomly allocated to either pulmonary rehabilitation plus inspiratory muscle training group (PR + IMT group, n = 17) or pulmonary rehabilitation group (PR group, n = 17) before any lung transplantation operation. Methods: All patients underwent supervised pulmonary rehabilitation program on two days per week for three months. The PR + IMT group received inspiratory muscle training in addition to the standard pulmonary rehabilitation program. The 6-minute walk test, maximal inspiratory pressure, modified Medical Research Concile dyspnea scores and spirometric parameters were measured for each patient. Results: The PR + IMT group had statistically significantly increased in walking distance (100 m, P = 0.03), maximum inspiratory pressure (26 cmH2O, P = 0.001) and alveolar volume ratio of carbonmonoxide diffusion capacity (9%, P = 0.02) than PR group. Although both groups demonstrated a statistically significant decrease in the dyspnea score, no significant differences were found between the groups ( P = 0.075). There was no change in spirometric variables in both groups. Conclusion: A greater increase in exercise capacity was observed in the PR + IMT group. Our study showed that inspiratory muscle training improved exercise capacity even further and increased the benefits provided by pulmonary rehabilitation.

BACKGROUND: This study aims to investigate the effects of shortterm intense pulmonary rehabilitation on respiratory function in patients with lung cancer who were defined as inoperable due to insufficient pulmonary reserve. METHODS: A total of 25 patients (24 males, 1 female; mean age 62 years; range, 50 to 72 years) who were histologically diagnosed as non-small cell lung carcinoma, considered functionally inoperable due to high risk of an estimated postoperative complication, and suitable for surgical resection according to tumor stage were included in the study. Patients received chest physiotherapy, self-walking and inspiratory muscle training for two weeks. The forced expiratory volume in one second, forced vital capacity, modified Medical Research Council dyspnea scale, six-minute walking distance, maximal inspiratory and expiratory pressures for respiratory muscle strength measurements, and predicted peak maximal oxygen consumption were examined. RESULTS: After pulmonary rehabilitation, there was statistically significant improvement in the six-minute walking distance (53 m, p

The frequency and success rates of lung transplant in patients with end-stage lung disease are increasing. In our study, we investigated the effects of preoperative pulmonary rehabilitation on pulmonary function, exercise capacity, and quality of life in patients who are candidates for lung transplant.This prospective study included 39 consecutive patients who were candidates for lung transplant. All patients underwent preoperative pulmonary rehabilitation for at least 3 weeks.Our patient group included 25 male and 14 female patients with a mean age of 36 years (range, 15 -68 y). Although no significant improvement was shown in the forced expiratory volume in 1 second after pulmonary rehabilitation, significant improvements were observed in the Modified Medical Research Council dyspnea scores (P = .001) and 6-minute walk distance (P = .001). We also observed statistically significant improvements in the Short-Form 36 Quality of Life Questionnaire's physical function (P = .01) and emotional role (P = .02) subparameters. We also found a significant improvement in the Beck Depression Inventory score (P = .004). There was no correlation between Beck Depression Inventory scores before and after rehabilitation and 6-minute walk distance, Short-Form 36, and Modified Medical Research Council dyspnea scores.Our results suggest that preoperative pulmonary rehabilitation improves exercise capacity, reduces the sensation of dyspnea and muscle strength loss, and has a positive effect on the psychologic state of patients who are candidates for lung transplant.

Backround: Lung transplantation is the final treatment option in the end stage of certain lung diseases, once all possible conservative treatments have been exhausted. These patients9 physical activity levels and exercise capacities are low. In our study we aimed to investigate the effect of the Pulmonary Rehabilitation (PR) on physical activity and physical fitness levels . Material-Method: Twenty-one patients who were on the waiting list for lung transplantation and who did not have any disease that prevented them from exercising were included in the study. PR was administered 8 week, 2 times a week at the hospital, 3 times at home without supervision. Baseline and after rehabilitation; The 6-min walk test distance (6MWD), 10-meter walking time, 5-times sit-up test time, and the International Physical Activity Questionnaire Short Form (IPAQ-SF) scores were compared. Results: 11 male and 10 female patients were included in the study (age 36 (15-68), BMI: 19 (12,70-33,20)). According to pre and post PR values, there was a statistically significant increase in 10-meter walking time (p = 0,000), 5-time sitting time (p = 0,000) and 6MWD (p = 0,002). And also, there was a statistically significant increase in all IPAQ-SF subcategories (except the severe physical activity) and total score. Conclusion: Pulmonary rehabilitation increases exercise capacities, physical fitness and physical activity levels in lung transplantation candidates. Any eligible pulmonary transplant candidates should be directed to Pulmonary Rehabilitation regardless of the diagnosis and level of physical activity level.

Background: Patients candidate for lung transplantation (LT) are known to have severely limited exercise capacity. Dyspnoea is a commonly observed symptom in these patients. This study aims to determine exercice limiting factors associated with dyspnoea in LT candidates in order to optimize their Pulmonary Rehabilitation (PR) programs. Material ve Method: Twenty-one patients on the waiting list for lung transplantation (mean age: 36(15-68); Body Mass Index: 19(12-33)) who were referred to PR were included in the study. The pre-PR measured lung functions (FEV1, FVC), respiratory muscle strengths (MIP, MEP), six minute walking distance (6MWD), Modified Medical Research Council (mMRC) dyspnoea scores and Quadriceps femoris (QF) muscle strength (measured with a digital dynamometer) were statistically analysed. Results: Patients’ functional capacities were; 6MWD (m): 285±119, FEV1 (predicted %): 28,2±12,2, FVC (predicted%): 36,2±9,6, MIP: 67±25cmH2O, MEP: 113,4±46,4cmH2O, mMRC: 3,7±1,2, QF muscle strength: 34±11. Correlation analysis has shown 6MWD (r = -0,48), MIP (r = -0,51) and MEP (r = -0,48) values were inversely correlated with mMRC (p Conclusion: Dyspnoea was found to reduce the exercise capacity and to be significantly associated only with respiratory muscle strength rather than with lung functions and peripheral muscle strength in LT candidates. The importance of controlling dyspnoea should be emphasized in the pulmonary rehabilitation of LT patients.

Purpose: Exercise training in patients with obstructive sleep apnea (OSA) has received accelerated attention. The aim of the study was to investigate the effects of Tai Chi and Qigong exercises on OSA severity and daytime sleepiness. Methods: Forty five sedentary patients with mild to moderate untreated OSAS [30≥ Apnea–Hypopnea Index (AHI) ≥5] between the age of 30-65 and body mass index (BMI)≤35 (30,14±3,33kg/m2) were randomly divided into two groups. The training group (n=23) was performed to Tai Chi and Qigong (TCQ) exercise program under physiotherapist supervision for 1 hour for 12 weeks, 3 days / week, and home exercise program was given for 2 days. The control group (n = 22) received home exercise program for 12 weeks, 5 days / week. Patients were assessed before and following the12 week exercise program. OSA severity (AHI) were assessed with one night of laboratory polysomnography (PSG); daytime sleepiness with Epworth Sleepiness Scale (ESS). Results: There was no significant change in BMI (p>0,05) in groups. Compared with control group, TCQ exercise group resulted in a statistically significant AHI reduction (TCQ:19,32±7,24 to 13,55±7,78, control:19,07±6,13 to 20,87±11,30; p=0,002) as well as significant changes in ESS (TCQ:9,61±5,81to 5,65±3,59; control: 8,64±5,40 to 8,55±5,04; p=0,001). Conclusions: TCQ exercises may reduce the severity of sleep apnea independent of changes in BMI and improve daytime sleepiness in mild to moderate OSAS. These results have shown that TCQ exercises may be a useful adjunctive to conventional treatment in OSAS.