The effect of cervical mobilization on joint position sense, balance and gait in patients with multiple sclerosis: a randomized crossover study

OBJECTIVE

To investigate the effect of cervical mobilization on joint position sense, balance and gait in multiple sclerosis (MS) patients.

METHODS

Sixteen MS patients received traditional rehabilitation and traditional rehabilitation+cervical mobilization treatments in different orders, 2 days a week for 4 weeks. For the cervical mobilization, joint traction and shifts with myofascial release techniques were applied. Joint position sense was evaluated from the bilateral knee and ankle joints with a digital goniometer, balanced with the Berg Balance Test (BBT), the Functional Reach Test, and gait with the Dynamic Gait Index (DGI) and the Timed 25-Foot Walk Test.

RESULTS

Improvements were determined in joint position sense, balance, gait with both treatment methods (p < 0.05). With the addition of cervical mobilization to traditional treatment, there was observed to be an increased effect carried over in knee joint position sense and BBT (p < 0.05). The BBT and DGI scores improved in the group applied with cervical mobilization following the washout period (p < 0.05).

CONCLUSIONS

Cervical mobilization could be effective in improving joint position sense, balance and gait, and accelerated improvements in a short time. The application of cervical mobilization could be a supportive treatment method to improve position sense, balance and gait in patients with MS.

Machine learning models for early prediction of mortality risk in patients with burns: A single center experience

Mortality rate is considered as the most important outcome measure for assessing the severity of burn injury. A scale or model that accurately predicts burn mortality can be useful to determine the clinical course of burn injuries, discuss treatment options and rehabilitation with patients and their families, and evaluate novel, innovative interventions for the injuries. This study aimed to use machine learning models to predict the mortality risk of patients with burns after their first admission to the center and to compare the performances of these models. Overall, 1064 patients hospitalized in burn intensive care and burn service units between 2016 and 2022 were included in the study. In total, 40 parameters, including demographic characteristics and biochemical parameters of all patients, were analyzed in the study. Furthermore, the dataset was randomly divided into two clusters with 70% of the data used for artificial neural networks (ANNs) training and 30% for model success testing. The ANN model proposed in this study showed high success across all machine learning methods tried in different variants, with an accuracy of 95.92% in the test set. Machine learning models can be used to predict the mortality risk of patients with burns. This study may help validate the use of machine learning models for applications in clinical practice. Conducting multicenter studies will further contribute to the literature.

Psychometric Testing of the Newborn Skin Assessment Attitude Scale in Neonatal ICU Nurses

OBJECTIVE

To develop a Newborn Skin Assessment Attitude Scale (NSAAS) for neonatal ICU (NICU) RNs.

METHODS

The study was conducted with 326 nurses working in NICUs in three cities in Turkey. The researchers evaluated the content and construct validity and reliability of the scale with item-total score correlation analysis, the test-retest method, and calculating the Cronbach α reliability coefficient.

RESULTS

The content validity index of the scale ranged between 0.87 and 1.00. Prior to exploratory factor analysis and confirmatory factor analysis, the Kaiser-Meyer-Olkin coefficient of the NSAAS was 0.976, and the Bartlett test of sphericity result was χ2 = 15,337.052 (P < .001). The scale was constructed with 35 items with factor loads greater than 0.40 and three subdimensions. Confirmatory factor analysis showed that the fit indices of the NSAAS were χ2/df = 3.57, root mean square error of approximation = 0.08, normed fit index = 0.98, non-normed fit index = 0.98, comparative fit index = 0.98, and standardized root mean square residual = 0.05. The overall reliability coefficient of the NSAAS was α = .978. The test-retest coefficients of correlation were r = 0.558 for the overall scale and r = 0.615, r = 0.504, and r = 0.598 for the Awareness, Practice, and Avoidance subdimensions, respectively. In addition, no statistically significant difference was observed when comparing the test-retest mean scores for the total scale and the subdimensions (P > .05).

CONCLUSIONS

The NSAAS can be reliably used for measuring NICU nurses' attitudes toward newborn skin assessment.

A content comparison of 4 commonly used adult upper limb amputee outcome measurements with application of the refinements of International Classification of Functioning, Disability, and Health linking rules

INTRODUCTION

The application of the refinements of linking rules to the outcome measurement methods provides an opportunity to obtain information concerning what the available instruments actually measure and how the instrument measures certain outcomes. The purpose of the study was to analyze the content of 4 commonly used upper limb amputee scales using the refined International Classification of Functioning, Disability, and Health (ICF) linking rules.

METHODS

The Upper Extremity Functional Status module of the Orthotics and Prosthetics User Survey (OPUS-UEFS), Trinity Amputation and Prosthesis Experience Scales, Southampton Hand Assessment Procedure (SHAP), and Quick Disability of the Arm, Shoulder, and Hand were analyzed by 2 health professionals for a content comparison based on ICF categories. The Kappa statistic was used to calculate the degree of agreement between 2 professionals.

RESULTS

The scale questions were linked with 43 different ICF codes in this study. Trinity Amputation and Prosthesis Experience Scale addresses all ICF domains. All items of SHAP and most items of OPUS-UEFS were linked to the activity-participation domain. Quick Disability of the Arm, Shoulder, and Hand items were linked with activity-participation and body function domains. The perspectives of OPUS-UEFS and SHAP are descriptive. The perspectives of Quick Disability of the Arm, Shoulder, and Hand were descriptive and appraisal. The perspectives of Trinity Amputation and Prosthesis Experience Scale subscales were descriptive, appraisal, and needs or dependency. Estimated kappa values ranged from 0.44 to 0.91 for ICF codes.

CONCLUSIONS

Most concepts in the scales were frequently linked to the activity-participation domain. We think that the results of this study will be a useful guide to clinicians and researchers in selecting relevant and appropriate outcome measurements for upper limb amputee rehabilitation.

Investigation of glucose, serum insulin levels, and insulin resistance in patients with major burn: a retrospective cross-sectional study

BACKGROUND

Many studies have reported that insulin resistance (IR) is present and persistent in patients with major burns; however, the evidence remains insufficient. This study was planned to investigate insulin levels and IR in the early post-traumatic period in patients with major burns and to determine the prevalence of IR after burn injury.

METHODS

This study included 68 patients. These patients were followed up once a week for 4 weeks after hospitalization. In the follow-up examinations, demographic and burn injury characteristics; HbA1c, procalcitonin serum glucose, and insulin levels; and IR were evaluated.

RESULTS

IR was seen in some weeks only in 25 of the 68 patients included in the study. Among all patients, IR was determined in only 11 (16.17%) patients from the 1st day of hospitalization until discharge. Patients with and without IR were evaluated as 2 groups, and their biochemical parameters were compared, and no significant difference was found between glucose and procalcitonin levels (P>0.05). Glucose levels were >100 mg/dL in the first few weeks in all patients who were followed up; however, they returned to the normal range in the following weeks.

CONCLUSION

In patients with IR, there was insufficient evidence to conclude that the condition persists. We believe that the HOMA-IR value is not directly related to burn injuries and that other additional pathologies may cause it during treatment.

Investigating the effects of appropriate fitting footwear on functional performance level, balance and fear of falling in older adults: A comparative-observational study

The aim of the study was to assess the characteristics of footwear altogether and to compare the effect of appropriate-fitting and ill-fitting footwear on functional performance, balance, and fear of falling (FoF) in older adults. Individuals who wore appropriate-fitting (n = 61) or ill-fitting footwear (n = 92) were enrolled in the study. Footwear was evaluated using the Footwear Assessment Scale (FAS). The participants were assessed using the Berg Balance Scale (BBS) for balance, the Timed Up and Go test for functional performance and the Activities-specific Balance Confidence scale for FoF. Tests were conducted twice for each individual with or without footwear. Differences between the groups were analyzed using the MANOVA for scores of balance, performance and fear of falling and Chi-squared test for homogeneity. The Paired t-test was used to compare test scores with or without footwear. It was concluded that appropriate-fitting footwear improves balance, reduces fear of falling and may affect functional performance positively. ClinicalTrials.gov No: NCT04151654.

Effects of Craniosacral Osteopathy in Patients with Peripheral Vestibular Pathology

INTRODUCTION

Vertigo appears as a result of a sudden neural activity imbalance of the vestibular system. The vertigo prevalence is higher in patients over 60 years of age compared to patients under 40 years of age.

OBJECTIVES

The purpose of this study was to analyze the effect of craniosacral osteopathy on dizziness and balance in individuals who have peripheral vestibular pathology.

METHODS

A total of 30 individuals, aged 24-50 years, participated in this study. Twenty-four of the participants were female (80%) and 6 were male (20%). The participants were separated into 2 groups, with 15 patients included in the cranial osteopathy treatment group (study group) and 15 patients included in the group that used dimenhydrinate (control group). The individuals were evaluated in terms of dizziness and balance. A visual analog scale was used to evaluate dizziness. Balance was evaluated using the Berg balance scale and the Activities-Specific Balance Confidence scale. The craniosacral treatment program was applied once per week for 6 sessions. All of the individuals included in this study were evaluated 3 times, i.e., prior to treatment, on the third week of treatment, and on the sixth week of treatment.

RESULTS

Significant improvement was noted within each group in terms of dizziness and balance (p < 0.05). When the groups were compared with each other, it was observed that craniosacral osteopathy was more effective than dimenhydrinate treatment for dizziness and balance (p < 0.05).

CONCLUSION

Craniosacral osteopathy is an effective treatment choice in individuals who have chronic peripheral vestibular pathology. In individuals who have resistant and chronic vestibular pathology, craniosacral osteopathy should be evaluated among the treatment choices.

Reliability and Validity of the Turkish Reintegration to Normal Living Index in Amputees

In our country, outcome measures are needed to evaluate the results of occupational therapy in amputees. This study aimed to cross-culturally adapt the Reintegration to Normal Living Index (RNLI) and to evaluate the reliability and validity of a Turkish version of the RNLI. The Turkish version of the RNLI was applied to 120 amputees. Cronbach's alpha coefficient and the intraclass correlation coefficient (ICC) were used to determine internal consistency and test-retest reliability, respectively. Criterion validity was assessed using Short Form 36 (SF-36). The Turkish version of the RNLI presented reliable results in repeated assessments (ICC = .88), and the internal consistency of the RNLI was high (Cronbach's α coefficient = .89). A statistically significant relationship was found between RNLI and SF-36 (p < .05). The Turkish RNLI is a reliable and valid tool to evaluate the level of reintegration to normal living for amputees.

The effects of early physiotherapy on biochemical parameters in major burn patients: A burn center's experience

BACKGROUND

This study sets out to investigate the effects of early physiotherapy on biochemical parameters in major burn patients.

METHODS

Ten women (50%) and 10 men (50%) aged 21-47 years old were included in this study. Participants were divided into two groups: the first group was the treatment group and the second group was the control group. In the treatment group, patients were admitted to the physiotherapy programme from the first day they have been hospitalised, in addition to their routine treatment (e.g. medical, surgery), for four days per week. The physiotherapy programme consisted of parameters, such as early mobilisation and ambulatory training, chest physiotherapy, and both active and passive normal joint movement exercises. The days of treatment were determined as of Tuesday, Wednesday, Thursday and Friday. Patients could not be treated on a Monday because that was surgery day. The control group consisted of patients who could not receive physiotherapy due to various reasons. All patients included in this study were evaluated weekly for six weeks after admission to the hospital. Parameters, such as demographic information, characteristics of burn injury, C-reactive protein, fibronectin, transferrin and prealbumin, were evaluated.

RESULTS

When the results obtained in this study were considered, there was a significant difference in favour of the treatment group for all biochemical parameters (p<0.05). From the second week, a significant increase was observed in prealbumin values in the treatment group (p<0.05). A significant increase was observed in fibronectin after the fourth week (p<0.05).

CONCLUSION

We believe that early physiotherapy should be included in the treatment in major burns. Early physiotherapy may reduce the effects of hypermetabolic response after major burns. There is a need for multi-centered and broader studies.

Developing a shoulder pain scale for wheelchair basketball players

BACKGROUND

Shoulder pain in wheelchair (WC) basketball players is common. Yet there was no scale to define shoulder pain.

OBJECTIVE

This study was performed to develop a shoulder pain scale for WC basketball players.

METHODS

A five-step procedure was followed: Identifying the feature, writing down the items and drafting the form, formulating the final form, pre-pilot-pilot implementation, and validity-reliability analyses. The final form of the scale consisted of 15 items about self-care and sport-specific activities.

RESULTS

External factor analysis showed that the scale had a two-factor structure which is "Shoulder Pain during Sports" and "Shoulder Pain during Self-care Activities". Pre-rotation results of factor analysis showed that if all of the items were loaded on the first factor, it would have an eigenvalue more than 7 times larger than the eigenvalue of the second factor. Therefore, it can be concluded that the scale can be used as a one-dimensional scale. The Cronbach's Alpha values were found to be 0.94 and 0.92 for the shoulder pain factor during sports and self-care activities, respectively. Total value was found to be 0.95. The corrected item-total correlation values were all above 0.60.

CONCLUSIONS

This newly developed valid, reliable scale allows assessment of the shoulder pain of WC basketball players.

Determination of the effects of playing soccer on physical fitness in individuals with transtibial amputation

BACKGROUND

The aim of this paper is to determine the effects of playing soccer on various components of physical performance such as body composition, muscular endurance, anaerobic power, flexibility, balance, and speed of individuals with transtibial amputation.

METHODS

Twelve amputee football players aged 26.67±7.76 years and twelve sedentary individuals aged 33±6.7 years were involved in this study. Body composition, and isotonic and isometric endurance of trunk muscles were assessed. Vertical jump test, sit-and-reach test, modified Thomas test, Berg Balance Scale, L test, and figure-of-eight walk (F8W) test were used to assess other physical fitness parameters.

RESULTS

The Body Mass Index, waist circumference and body fat percentages of the amputee soccer players were significantly lower than the sedentary amputees (P<0.05). The endurance of back extensors was significantly higher in the soccer group (119.33±47.15 s) than the endurance in the control group (26.25±15.96 s) (P<0.001). Subjects belonging to the soccer group had significantly higher anaerobic power than those in the control group (P<0.05). Flexibility, as assessed by the sit-and-reach test was significantly higher for the soccer group (P=0.002), whereas the modified Thomas test, which is also used to measure flexibility, indicated no significant difference among both groups (P>0.05). Balance was higher in the soccer group (P=0.023). The completion period of the F8W test was significantly lower in the soccer group (4.54±0.9 s) than in the control group (7.71±2.25 s) (P<0.001). No significant difference was observed in the numbers of steps measured during the F8W test (P=0.231).

CONCLUSIONS

This is the first study which investigates the effects of sports on the physical fitness of individuals with transtibial amputation with the inclusion of a control group. Overall findings present the benefits of participating in playing soccer on physical fitness parameters of amputees, but further studies with randomized controlled trials, with larger populations, and with other sport branches should be conducted to motivate all amputees to participate in sports.

Validity and reliability of the Turkish version of the Manchester-Oxford Foot Questionnaire for hallux valgus deformity evaluation

OBJECTIVE

The aim of this study was to evaluate the reliability and validity of the Turkish version of the Manchester-Oxford Foot Questionnaire (MOXFQ) in patients affected by hallux valgus in order to assess the accuracy of this cross-cultural adaption.

METHODS

Thirty female volunteers aged between 18 and 55 years were included in the study. Subjects with hallux valgus were asked to complete the MOXFQ and the Short-Form 36 Health Survey (SF-36). After receiving permission from the author, the MOXFQ was translated into Turkish twice and then back translated to English, after which its compatibility was evaluated. The Turkish version of the MOXFO was applied twice, 1-3 days apart, to the study subjects. Internal consistency and test-retest reliability were assessed using Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. Construct validity was assessed with the use of Spearman's rank correlation coefficient, using a priori hypothesized correlations with SF-36 domains.

RESULTS

Subjects achieved similar scores at the first and second administration of the questionnaire (<0.001). The internal consistency reliability was acceptable for all MOXFQ domains (pain, walking/standing, social interaction), with Cronbach's alpha coefficients ranging from 0.775 to 0.779. The assessment of test-retest reliability revealed satisfactory values, with ICCs ranging from 0.91 to 0.96. Construct validity was supported by the presence of all the hypothesized correlations, with SF-36 within its physical parameters.

CONCLUSION

The Turkish version of the MOXFQ is a valid and reliable tool for evaluating foot pain and functional status in patients affected by hallux valgus.

Cross cultural adaptation and reliability of the Turkish version of Amputee Body Image Scale (ABIS)

OBJECTIVES

The Amputee Body Image Scale (ABIS) is a self assessed questionnaire with 20 items created to measure body image perception of amputees. The questions assess how an individual perceives and feels about his or her body experience. But no Turkish version is available. The aim of this study was to cross-culturally adapt the ABIS for use with Turkish speaking lower limb amputees and to determine reliability.

METHODS

The sample consisted of 50 transtibial amputees. The mean age of the participants was 43.14, SD: 14.66. The ABIS has been filled by the patients for two times.

RESULTS

Internal consistency of the ABIS was very high (Cronbach alpha 0.834 for test and 0.842 for retest). The test-retest reliability was excellent for the ABIS (ICC = 0.939, 95% CI 0.895-0.965).

CONCLUSIONS

The Turkish version of the ABIS is a reliable instrument to assess body image in lower limb amputees.