The effect of vitamin D treatment on quality of life in patients with fibromyalgia

BACKGROUND

Fibromyalgia is a syndrome characterized by chronic widespread pain accompanied by fatigue, disrupted sleep quality, cognitive impairments, subjective soft tissue swelling, and somatic symptoms. There are conflicting results in the literature regarding the prevalence of vitamin D deficiency in fibromyalgia patients and the reduction of symptoms after supplementation.

AIMS

Our study aims to evaluate the effectiveness and reliability of vitamin D supplementation in patients diagnosed with fibromyalgia.

METHODS

In our cross-sectional clinical study, 180 female patients aged 18 to 65 diagnosed with fibromyalgia according to the 2010 American College of Rheumatology Diagnostic Criteria were included. Oral vitamin D3 replacement of 50,000 IU was administered for 12 weeks. Patients' Fibromyalgia Impact Questionnaire (FIQ)and Visual Analogue Scale (VAS) scores were evaluated before and after the study.

RESULTS

Significant differences were observed in the FIQ scores of the 180 fibromyalgia patients before and after vitamin D supplementation (p < 0.05). There was also a significant improvement in VAS scores (p < 0.01). A negative correlation between vitamin D and VAS as well as FIQ scores was found in the study.

CONCLUSION

We determined that vitamin D deficiency is significantly more prevalent in patients diagnosed with fibromyalgia. Vitamin D supplementation was observed to have a positive effect on quality of life and reduction of pain.

Self-Reported Medication Adherence in Patients With Ankylosing Spondylitis: The Role of Illness Perception and Medication Beliefs

Objectives

This study aims to investigate medication adherence in Turkish patients with ankylosing spondylitis (AS) and analyze the related factors for non-adherence.

Patients and methods

Ninety-nine patients with AS (60 males, 39 females; mean age 41.3±8.4 years; range, 18 to 66 years) were included in the study. Sociodemographic and clinical data were collected. Disease activity (Bath Ankylosing Spondylitis Disease Activity Index, C-reactive protein, and erythrocyte sedimentation rate), functional status (Bath Ankylosing Spondylitis Functional Index), spinal pain and fatigue (visual analog scale), quality of life (Ankylosing Spondylitis Quality of Life), and depression and anxiety (Hospital Anxiety and Depression Scale) were evaluated. Adherence to anti-rheumatic drugs was elicited using the Compliance Questionnaire on Rheumatology (CQR). Medication beliefs were assessed using the Beliefs about Medicines Questionnaire (BMQ), and illness perception using the Brief Illness Perception Questionnaire (B-IPQ).

Results

Non-adherence was reported in 64 patients (64.6%). No significant relationship between demographic, clinical, or psychological factors and adherence was found, except for disease duration (p=0.031). High B-IPQ treatment follow-up, illness coherence, and BMQ-Specific necessity scores were associated with good adherence (p=0.007, p=0.039, and p=0.002, respectively). BMQ-General overuse and harm scores showed an inverse correlation with the CQR score (p=0.005 r=-0.278; p=0.029 r=-0.219, respectively). Longer disease duration [odds ratio (OR): 0.98, 95% confidence interval (CI): 0.97-0.99] and higher B-IPQ item-1 score regarding the effect of the illness on the individual's life (OR: 0.58, 95% CI: 0.42- 0.81) were important predictors of low adherence.

Conclusion

Nearly three out of five AS patients were identified as at risk for non-adherence with the CQR. Medication adherence is influenced by the patient’s beliefs about medicines and illness perceptions, and these may be key targets for future interventions to improve medication adherence.

Reliability and validity of the Turkish version of Activities-specific Balance Confidence scale in symptomatic knee osteoarthritis

BACKGROUND

Activities-specific Balance Confidence (ABC) scale is a well known tool to evaluate the functional balance. Balance impairment may accompany to knee osteoarthritis.

OBJECTIVE

The aim was to investigate the reliability and validity of the Turkish version of ABC in knee osteoarthritis.

METHODS

Forty-nine patients with knee osteoarthritis were included. All the participants were evaluated by ABC and Berg Balance Scale (BBS). Knee Injury and Osteoarthritis Outcome Score (KOOS) was used for the assessment of the knee related condition.

RESULTS

Mean age was 64.7 ± 9.2. Eighty-five percent was women. Mean ABC score was 53.5% and BBS score was 40. Interclass correlation coefficient was 0.95. There was a statistically significant positive correlation between the test-retest results (t= 1.90, p= 0.063). Correlation coefficient was high (p= 0.001, r= 0.953). Cronbach's alpha was 0.97. There was a significant positive correlation between ABC-T and BBS, the symptoms, daily living activities and quality of life subscales of KOOS (r= 0.555, p< 0.001; r= 0.424, r= 0.379, r= 0.621, p< 0.01). ABC-T correlated negatively with the radiological severity (r = -0.316, p< 0.05).

CONCLUSIONS

ABC-T is a reproducible test with excellent internal consistency and construct validity in knee osteoarthritis. Balance confidence was moderate and related with the symptoms, daily living activities, disease severity and quality of life.

Quality of life and related factors in degenerative lumbar spinal stenosis: A controlled study

OBJECTIVE

The purpose of this study was to compare the quality of life of patients with lumbar spinal stenosis (LSS) with that of the controls' and to investigate the factors related with the quality of life in LSS.

METHODS

Fifty-four patients with LSS were included in the study whose diagnosis were made by clinically and magnetic resonance imaging (MRI). Control group consisted of age and sex matched 54 individuals. Both of the patient and control groups were evaluated with the Short Form-36 (SF-36) health survey and Hospital Anxiety Depression Scale (HADS). The Oswestry Pain and Disability Index (ODI) was used for the assessment of the disability.

RESULTS

SF-36 scores in the LSS group was lower than that of the controls'. There was a significantly positive correlation between the SF-36 scores and walking distance in LSS group. A moderately negative correlation was found between the SF-36 and the ODI, HADS anxiety and depression scores. There was a significantly positive correlation between the ODI and the HADS anxiety and depression scores. HADS anxiety and depression scores in the patient group were significantly higher than that of the controls'.

CONCLUSIONS

As a result, quality of life was decreased in subjects with LSS. The factors related with the quality of life were the walking distance, severity of the disability and emotional status in LSS.

Gait speed and related factors in Parkinson's disease

[Purpose] The aim of this study was to investigate the relationship between gait speed and various factors in ambulatory patients with idiopathic Parkinson’s disease. [Subjects] Fifty ambulatory patients with idiopathic Parkinson’s disease who were admitted to an outpatient clinic were included in this cross-sectional study. [Methods] The Hoehn and Yahr Scale was used for measurement of the disease severity. Gait speed was measured by the 10-Meter Walk Test. Mobility status was assessed by Timed Up and Go Test. The Hospital Anxiety and Depression Scale was used for evaluation of emotional state. Cognitive status was examined with the Mini-Mental State Examination. The Downton Index was used for fall risk assessment. Balance was evaluated with the Berg Balance Scale. Comorbidity was measured with the Cumulative Illness Rating Scale. The 36-Item Short Form Health Survey was completed for measurement of quality of life. [Results] The mean age was 66.7 (47–83) years. Twenty-eight (56%) patients were men. Gait speed was correlated positively with height, male gender, Mini-Mental Examination score, Berg Balance Scale score and physical summary scores of the 36-Item Short Form Health Survey. On the other hand, there was a negative correlation between gait speed and age, disease severity, TUG time, Downton Index, fear of falling, previous falls and the anxiety and depression scores of the Hospital Anxiety and Depression Scale. There was no correlation between gait speed and comorbidity. [Conclusion] The factors related with the slower gait speed are, elder age, clinically advanced disease, poor mobility, fear of falling, falling history, higher falling risk, and mood disorder.

The effect of neuromuscular electrical stimulation on functional status and quality of life after knee arthroplasty: a randomized controlled study

[Purpose] The aim of this study was to investigate the effect of the addition of NMES to the post-TKA rehabilitation protocol on the functional status and quality of life of the patients. [Subjects and Methods] Patients were randomized into an exercise (control) and electrical stimulation (NMES) group. A home exercise program was prescribed for the control group. For the neuromuscular stimulation group 30 minute electrical stimulation applied to the vastus medialis muscle 5 days a week for 4 to 6 weeks. VAS, the timed up and go test, WOMAC and SF-36 scores were evaluated preoperatively and postoperatively at the first month and the third month of the follow-up period. [Results] Both the NMES group had 30 patients each, with 2 and 1 male patients respectively. The comparisons of WOMAC results at month 1 revealed that pain, stiffness, and total scores of the NMES group was significantly better than those of control group at the first and third months. Significantly better physical function and SF-36 subscales, except mental health, were found for the NMES group at the first month of follow-up. [Conclusion] The inclusion of the neuromuscular electrical stimulation program after knee arthroplasty was more effective at providing rapid improvements in knee pain, walking distance and quality of life.

Reliability and validity of the Turkish version of spinal cord lesion-related coping strategies

OBJECTIVE

Spinal Cord Lesion-Related Coping Strategies Questionnaire (SCL CSQ) is a specific test that is developed for evaluating the coping strategies of the persons with spinal cord injury (SCI). The aim of this study was to evaluate the reliability and validity of the Turkish version of SCL CSQ (SCL CSQ-T) in persons with SCI.

METHODS

One hundred persons with SCI were included in the study. All participants were evaluated with SCL CSQ-T and Brief Coping Styles Inventory (BCSI) at the baseline. SCL CSQ-T was repeated twice in 15 days. American Spinal Injury Association Impairment Scale and Functional Independence Measurement were used for the evaluation of the neurological loss severity and functional status. Emotional status was assessed by Hospital Anxiety and Depression Scale (HADS). Internal consistency reliability, test-retest reliability and construct validity of SCL CSQ-T were evaluated.

RESULTS

Intraclass correlation coefficients of the SCL CSQ-T were between 0.51-0.86. Cronbach's alpha values and test-retest reliability of the acceptance, fighting spirit and social reliance subscales were good. Three factors were found in exploratory factor analysis. There was a positive correlation between the subscales of SCL CSQ-T. There was a statistically significant positive correlation between acceptance strategy of SCL CSQ-T and self-confidence and optimism of BCSI. The fighting spirit strategy positively correlated with self-confidence and optimistic strategies. The social reliance strategy positively correlated with helplessness and seeking social support. Coping strategies did not correlate with HADS.

CONCLUSION

The results of this study revealed good internal consistency reliability, test-retest reliability and concurrent validity of the SCL CSQ-T factors acceptance and fighting spirit in relation to general coping strategies. The coping strategy social reliance needs revisions.

Efficacy of supervised exercise combined with transcutaneous electrical nerve stimulation in women with fibromyalgia: a prospective controlled study

The aim of this study was to investigate the results of a supervised exercise with transcutaneous electrical nerve stimulation (TENS) in an exercise controlled study in women with fibromyalgia. Sixty-six women with fibromyalgia who admitted to the outpatient clinic of our hospital were randomized into two treatment groups. The patients in both groups participated in a supervised combined exercise program for 12 weeks. The women in first group had additional TENS in the first 3 weeks of the study. All subjects were analyzed at the baseline, at the end of the 3rd and 12th weeks. Outcome measures were tender point count (TPC), myalgic pain score (MPS), Fibromyalgia Impact Questionnaire (FIQ) and Short Form-36 (SF-36) Health Survey. Sixty women with fibromyalgia completed the study. The patients in both groups showed improvement in terms of TPC, MPS, FIQ, physical and mental summary scores and total scores of SF-36 at the end of the 3rd and 12th weeks. The improvement in MPS at the third week was higher in the first group (p = 0.01). But there was no difference in terms of the improvement in MPS between the groups at the end of the 12th week control (p = 0.87). There was no significant difference between the improvement in the other outcome parameters of the two groups. As a result, supervised exercise program was successful to improve the myalgic pain, functional status and quality of life in women with fibromyalgia. Exercises combined with TENS might be useful due to quick myalgic pain relief in the treatment of fibromyalgia in everyday practice.

Comparison of the coping strategies, anxiety, and depression in a group of Turkish spinal cord injured patients and their family caregivers in a rehabilitation center

BACKGROUND

Spinal cord injury (SCI) effects the emotional states and coping strategies of the patients and their families. The interesting point is the interaction between the emotional status and coping strategies.

AIM

The aim of this study was to investigate the coping strategies and emotional states of the individuals with SCI and their caregivers and to compare the results of the groups.

DESIGN

Cross-sectional

SETTING

Inpatient rehabilitation.

POPULATION

Thirty one patients with traumatic SCI and 31 family caregivers admitted to the inpatient rehabilitation were evaluated.

METHODS

The injury duration was ≤12 months. Coping strategies and emotional status of the participants were evaluated by Brief Ways of Coping Questionnaire and Hospital Anxiety and Depression Scale. ASIA impairment scale and Functional Independence Measurement (FIM) were used for the assessment of the lesion severity and functional status.

RESULTS

The most common coping strategies were self confidence and optimistic strategies both in the patient and caregiver groups. There was no statistically significant difference between the coping strategies and emotional status of the groups (P>0.05). A positive correlation was found between helplessness strategy and age in patients with SCI. Coping strategies did not show correlation with FIM. Anxiety in caregivers correlated negatively with SCI duration (P<0.05).

CONCLUSION

As a result, the coping strategies and emotional status in the SCI patients and family caregiver groups showed similarity.

CLINICAL REHABILITATION IMPACT

SCI patients and also their family caregivers must be evaluated in terms of coping strategies, anxiety and depression. The couples with maladaptive coping styles and emotional mood disorders might be supported with special interventions to help the adaptation to SCI and to improve the rehabilitation efficacy.

Relationship between bone turnover and bone density at the proximal femur in stroke patients

OBJECTIVE

To investigate the relationship between the rate of bone turnover and bone loss at the proximal femur in stroke patients.

METHODS

This study was performed between January 1, 2005 and August 31, 2006 at the Stroke Rehabilitation Unit, Istanbul Physical Medicine and Rehabilitation Training Hospital, Istanbul, Turkey. One hundred six patients who had a stroke for the first time were included in the study. The control group consisted of 33 age- and gender-matched healthy subjects. Bone mineral density (BMD) was measured at the proximal hip region by dual energy X-ray absorptiometry (DXA). Serum osteocalcin (OC) and C telopeptide of type 1 collagen (CTX) levels were measured. Barthel Index (BI) was used for the evaluation of daily activities. Ambulation status of the patients was recorded.

RESULTS

Mean age was 65.1 +/- 9.8 years in the patient group and 51% were male. Mean disease duration was 16.9 +/- 9.1 months. Mean BI score was 60.5 +/- 25.8 on admission. Femoral neck BMD values were 0.873 +/- 0.95 g/cm(2) and 0.816 +/- 0.180 g/cm(2) for control subjects and hemiplegic sides of the patient group, respectively. Femur total BMD values were 0.948 +/- 0.119 g/cm(2) and 0.872 +/- 0.187 g/cm(2) for control group and hemiplegic sides of the patients, respectively. Femoral neck and femur total BMD values in the hemiplegic side were lower than those of controls' (P < .05). There was no statistically significant difference between the proximal femur BMD values of the intact and hemiplegic sides. Negative correlation was found between the proximal femur BMD values of both the intact and hemiplegic sides, and serum OC and CTX levels. Bone resorption rate was higher among the patients with stroke; however, bone formation rate was normal in this group. Serum CTX levels showed correlation with ambulation status. Femoral neck BMD values on the intact side were lower in the patient group with disease duration of more than 1 year compared to those with shorter disease duration.

CONCLUSION

As a result of this study bone turnover was inversely correlated with bone density at the hip of both hemiplegic and intact sides in stroke patients. Evaluation of bone turnover might be helpful to predict bone loss and to find out the stroke patients with bone loss who can not be decided to begin antiresorptive treatment with bone density measurement.

Bone loss and bone turnover in acute and chronic spinal cord injured patients

OBJECTIVE

To investigate bone loss and the rate of bone turnover in individuals with spinal cord injury (SCI), and to compare the results with those healthy controls.

METHODS

This cross-sectional, controlled study was performed between January and December 2005, in the Istanbul Physical Medicine and Rehabilitation Training Hospital, Istanbul, Turkey. Forty-eight patients with SCI were included in the study. The control group consisted of 47 age and sex matched healthy subjects. Bone density was measured at the proximal hip region by dual-energy X-ray absorptiometry. Serum levels of osteocalcin (OC) and C telopeptide of type 1 collagen (CTX) were measured.

RESULTS

Femur neck and femur total bone mineral density values in the SCI patients and control group were 0.894 (0.188), 0.911 (0.185), and 0.994 (0.116), 1.063 (0.132) (p<0.03, p<0.000). Serum levels of OC and CTX were significantly increased in patients (p<0.015, p<0.000). Femur bone density in both neck and total regions showed a significant decrease in the SCI patients with longer injury duration (p<0.001, p<0.000). Serum CTX levels were markedly elevated in the first year of SCI. However, serum OC level showed no difference for the injury duration.

CONCLUSION

Significant bone loss was found at the proximal hip in SCI patients. Serum biochemical markers were also significantly higher in the patient group than the healthy controls. The bone density was lower in the long-standing SCI patients, although serum CTX levels were higher in the first 12 months after injury.