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Background Approximately 80% of all proximal humeral fractures (PHFs) are non-displaced or minimally displaced fractures, which can be treated with conservative treatment. This study investigated the effect of interferential current (IFC) added to orthopedic rehabilitation on shoulder function, pain, and disability in patients with PHF. Methods This study was a prospective, double-blind, randomized, placebo-controlled conducted in physical medicine and rehabilitation outpatient clinic. Thirty-five patients were randomly separated into the IFC group ( n  = 18) and the sham group ( n  = 17). The orthopedic rehabilitation program was applied to all patients by the same physiotherapist three times a week for four weeks. Patients in the IFC group received the intervention for 20 minutes 3 times a week before the exercise. The same pads were performed for the sham group, but no electrical stimulation was applied. Constant-Murley score (CMS) for shoulder function, visual analog scale (VAS) activity pain, disabilities of the arm, shoulder, and hand (DASH) score, and paracetamol intake were recorded post-treatment, at 6 weeks and 18 weeks post-treatment. Results The demographic and fracture characteristics were not different between the groups. Significant differences were observed in the IFC and sham group in intragroup comparisons of total CMS, VAS activity pain, DASH score, and paracetamol intake over time ( p  < 0.001). Significant improvement over time was valid for all pairwise comparisons in both groups. However, no significant differences were detected between the IFC and sham group. Conclusion IFC added to orthopedic rehabilitation could not appear to be an electrotherapy modality that could potentially benefit shoulder function and disability in patients with PHF.

Of those, three used cluster sampling,3-5 one intended to reach the entire population living in the study area20 and one did not mention how the sampling procedure was managed.19 Four of those studies were held mainly in coastal urban areas,3-5,19 not taking into consideration the hinterland and rural areas. [...]our study had the advantage of covering both urban and rural areas and also inland Turkey. In doing so, we aimed to capture all the individuals intended to be involved in the study. [...]despite being less costly than face-to-face surveys, telephone surveys might result in lower response rates.21 Our study indicates a prevalence of 0.56% for RA adjusted for the general population aged 16 or over. [...]58% of the individuals involved in our study were females whereas the national census performed in 2000 showed that females constituted 50% of Turkey's population. [...]our study showed that a northsouth gradient of RA across Europe might not exist, compared to the prevalence reported from Northern European countries.12,28 However, a north-south gradient of RA might exist in Turkey.

The symptoms are often intermittent and affect target joints (distal and proximal interphalangeal joints, index and middle metacarpophalangeal joints, and thumb base), and the Heberden's nodes, Bouchard's nodes and bony enlargement are the clinical hallmarks of hand OA.6 Radiographic evaluation is widely used to evaluate the structural damage of hand OA. [...]the evidence for the relationship between radiographic hand OA and hand function ranges from none to moderate.9 Symptomatic hand OA is associated with weak grip strength and impaired hand function, and it seems to be mediated by pain.4,10,11 Furthermore, Heberden's and Bouchard's nodes can affect hand function and lead to poor cosmesis.10,12 In the present study, we aimed to determine the clinical, functional, and radiological features of hand OA and to evaluate their relationships in different geographic samples of the Turkish population. The demographic and clinical characteristics of the patients, body mass index (BMI), and dominant hand finger ratio (second to fourth finger length) were evaluated. [...]DHI scores were found to be significantly higher in patients with Bouchard nodes in the fourth finger of the right hand (p = 0.016) and the third (p = 0.033) and fourth fingers (p=0.024) of the left hand.

The incidence of intervertebral disc degeneration (IDD) is 10% in the patients at age 50 but increases up to 60% around 70 years of age.4 These degenerative changes in the lumbar spine are a major etiological factor in the development of LBP and disability in the elderly population.5 Intervertebral disc degeneration is strongly related to LBP, and while it is asymptomatic in most cases, it may give rise to sciatalgia in some cases and to spinal stenosis in the long term, which is an important cause of pain and disability particularly in elderly patients.6-7 The clinical picture in LS patients include discomfort in the lower back, radiating leg pain, and neurogenic intermittent claudication (NIC).8 Lumbar spondylosis diagnosis is made by clinical examination and imaging methods. Detection of degenerative changes in the lumbar X-rays, such as osteophytes, intervertebral narrowing, and subchondral sclerosis, support the diagnosis.9 Magnetic resonance imaging (MRI) is the best imaging tool for the assessment of detailed structural changes in the spinal canal, the ligaments, the discs, and the nerve roots.10 However, in studies examining MRI findings in asymptomatic individuals, it was reported that a significant proportion of patients had bulging, annular tears, facet arthropathies, and it was emphasized that degenerative changes increased with age.11 Weiner et al.12 have pointed to the excessive diagnostic tests in elderly patients with LBP and emphasized unnecessary employment of MRI in most of the patients, which contributed substantially to the increased health costs. Visual Analog Scale (VAS) values for pain during the day (at rest and with movement) and at night, presence of radiating pain, Roland Morris disability questionnaire (RMDQ) for functional status evaluation, straight leg raise test (SLRT) for sciatalgia, deep tendon reflexes (DTRs; as hypoactive, normal, or hyperactive), NIC findings, and motor strength and sensory loss were recorded. According to the MRI reports, 245 (76.8%) had disc hernia, 285 (89.3%) had IDD, 149 (46.7%) had root compression, 256 (80.3%) had osteophytes, and 119 (37.3%) showed SS findings (Table 2).

We investigated the correlation of bone mineral density (BMD) with risk factors and laboratory parameters (e.g., markers of bone turnover, biochemical indicators, and hormonal factors) in males without secondary osteoporosis. A total of 105 males were divided into two groups: Group 1 (n: 52) <60 years, and Group 2 (n:53) ≥ 60 years. The subjects were evaluated for risk factors (European Vertebral Osteoporosis Study (EVOS) and BMD) and for biochemical (i.e., blood calcium, blood phosphorus, urinary calcium/phosphorus, creatinine clearance, osteocalcin, and deoxypyridinoline) and hormonal markers (follicle-stimulating hormone [FSH], luteinizing hormone [LH], free testosterone [fT], and parathyroid [PTH]) of bone mineral metabolism. In Group 1, no significant relationship was observed between risk factors for both lumbar and femoral neck BMDs and risk factors and laboratory parameters (p>0.05). On the other hand, we observed in Group 2 a significant positive correlation between lumbar BMD and BMI, BMI at 25 years of age, and fT; in the same group, a negative correlation between lumbar BMD and deoxypyridinoline (p<0.05) was seen. We saw a significant positive correlation between femoral neck BMD and BMI, BMI at 25 years of age, and daily activities of life in Group 2. In addition, we saw a negative correlation between femoral neck BMD and height difference, fT, LH, and deoxypyridinoline in Group 2 (p<0.05). Risk factors for male osteoporosis were multifactorial: demographic and clinical data (difference of height, BMI, physical activity) together with biochemical and hormonal data (deoxypyridinoline, fT, LH) were significant, and most of the risk factors analyzed were related to bone loss in the proximal femur.

In a Turkish League Against Rheumatism (TLAR) project, evidence-based recommendations for the management of knee osteoarthritis (OA) was developed for the first time in our country in 2012 (TLAR-2012). In accordance with developing medical knowledge and scientific evidence, recommendations were updated. The committee was composed of 22 physical medicine and rehabilitation specialists (4 have rheumatology subspeciality also) and an orthopaedic surgeon. Systematic literature search were applied on Pubmed, Embase, Cochrane and Turkish Medical Index for the dates between January the 1st 2012 and January the 29th of 2015. The articles were assessed for quality and classified according to hierarchy for the level of evidence, and the selected ones sent to committee members electronically. They were asked to develop new recommendations. In the meeting in 2015, the format of the recommendations was decided to be patient-based and considering the grade and the severity of the disease. By the discussion of the each item under the light of new evidences, the final recommendations were developed. Each item was voted electronically on a 10-cm visual analogue scale (VAS) and the strength of recommendation (SoR) was calculated. In the light of evidences, totally 11 titles of recommendations were developed; the first 7 were applicable to each patient in every stages of the disease, remaining were for defined specific clinical situations. The mean SoR value of the recommendations was between 7.44 and 9.93. TLAR-2012 recommendations were updated in a new format. We think that, present recommendations will be beneficial for the physicians who manage, as well as the patients who suffer from the disease.

Purpose To compare the effects of home-based and hospital-based exercise programs on exercise capacity, quality of life, psychological symptoms, and hemodynamic parameters in heart failure (HF) patients. Methods Seventy-four patients were randomized into either a hospital-based exercise (Group 1) or a home-based exercise (Group 2) group. Prior to and after the 8-week rehabilitation program, the two groups were compared with respect to their functional capacity [maximal oxygen uptake (pVO 2 ) and 6-min walk test (6MWT)], quality of life (Medical Outcomes Study and the 36-item Short Form Survey, SF-36), psychological symptoms [Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory], and hemodynamic parameters [(left ventricular diastolic diameter in diastole, left ventricular diameter in systole, Mitral Early diastolic peak flow velocity ( E )/late diastolic peak flow velocity ( A ), Mitral E/Mitral early peak velocity ( E m ), Tei index, right ventricular systolic peak velocity ( S m ), tricuspid annular plane systolic excursion, systolic pulmonary arterial pressure (SPAP), and left and right ventricular ejection fraction (LVEF and RVEF)]. Results After the exercise programs, significant improvement was observed in pVO 2 , 6MWT and subscales of physical function, general health, and vitality of SF 36, as well as BDI and LVEF in both groups ( P  < 0.05). A comparison of the two exercise groups revealed no significant differences between them regarding the analyzed variables ( P  > 0.05). Conclusion Both the hospital-based and home-based exercise groups improved significantly in functional capacity, quality of life, depression symptoms, and LVEF. Based on these results, we believe that physicians can recommend home-based exercise under strict supervision for stable HF patients. However, additional research should be conducted in this area.

Objective: To investigate and compare the impact of hospital and home exercise programmes on aerobic capacity, fatigue, and quality of life in patients with post-polio syndrome. Design: A prospective, randomized controlled trial. Setting: Department of Physical Medicine and Rehabilitation, University Hospital. Subjects: Thirty-two patients were divided into two groups for either hospital- or home-based aerobic exercise programme. Main outcome measures: Patients were assessed before and after the rehabilitation programme, with respect to functional capacity (pVo2), fatigue (Fatigue Severity Scale, Fatigue Impact Scale) and quality of life (Nottingham Heath Profile). Results: After the exercise programme, improvement was observed in the hospital exercise group compared to a pre-exercise period in all Nottingham Heath Profile scores (except sleep scores), pVo2, Fatigue Severity Scale and Fatigue Impact Scale (cognitive, physical, psychosocial, total) (P<0.05). In contrast, in the home exercise group a decrease was observed in pVo2 scores after the rehabilitation programme, compared to a pre-rehabilitation period (P<0.05). In addition, a significant improvement was observed in the home exercise group after the rehabilitation programme in all parameters excluding Fatigue Impact Scale—physical, Fatigue Impact Scale—psychosocial, and Nottingham Heath Profile—sleep (P<0.05). When the two exercise groups were compared, improvement was observed in the hospital exercise group compared to the home exercise group in pVo2 and Fatigue Severity Scale—total, Fatigue Impact Scale—physical, Fatigue Impact Scale—psychosocial, Fatigue Impact Scale—total, and Nottingham Heath Profile—energy scores (P<0.05). Conclusion: Fatigue and quality of life were both improved in the home and hospital exercise groups. An increase was also found in the functional capacity in the hospital exercise group. A regular exercise programme is beneficial to patients with post-polio syndrome.

Purpose To investigate the association between C421T polymorphism within exon 4, C575T polymorphism within exon 6 of the RANK gene and bone mineral density (BMD) variations in postmenopausal Turkish women. Methods One hundred seventy-eight postmenopausal women (patients = 100 and controls = 78) who applied to Ege University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, for osteoporosis examination were analyzed. BMDs of the lumbar spine and femoral sites were measured. Patient and control groups were established based on their T-score values being above and/or below −1. After venous blood sampling, C421T and C575T polymorphisms of the RANK gene were assessed through PCR process following DNA extraction. Results Genotype frequencies for the C421T and C575T polymorphisms were compared between the control group and the patient group. No significant difference was detected between the two groups for both polymorphisms. There was also no significant difference between the control and patient groups in terms of the combined genotype ( p  = 0.752) and the combined haplotype analysis of the C421T and C575T polymorphisms ( p  = 0.723). In the control and patient groups separately, no significant differences in BMD values either at the femoral sites or at the lumbar spine were detected between the combined genotypes of the two polymorphisms. Conclusions The genotypes, combined genotypes and allele frequencies of C421T and C575T polymorphisms of the RANK gene have not been found to be associated with BMD in Turkish women. Further studies including both sexes and more cases are required.

Aim To evaluate the effects of home- and hospital-exercise programs on exercise capacity and chronotropic variables in patients with heart transplantation. Methods Forty patients were randomized into two groups either hospital- or home-based exercise program. The patients were compared, before and after the rehabilitation program, with respect to maximal oxygen uptake (pVO 2 ), chronotropic variables [heart rate reserve (HRR e ), heart rate recovery (HRR 1 ), and chronotropic response index (CRI)] and Duke Treadmill Score (DTS). Results Hospital-based exercise group has shown a significant recovery in post-exercise pVO 2 (pre-exercise 16.73 ± 3.9 ml/kg/min, post-exercise 19.53 ± 3.89 ml/kg/min, P  = 0.002) and DTS (pre-exercise 4.74 ± 1.17, post-exercise 5.61 ± 1.11, P  = 0.002). A significant recovery in favor of the hospital-based exercise group was found in HRR e (pre-exercise 26.9 ± 14.6, post-exercise 34.6 ± 14.6, P  = 0.01). No significant change was observed in HRR 1 (pre-exercise −1.38 ± 1.04, post-exercise −1.21 ± 1.89, P  = 0.49) and CRI (pre-exercise 0.44 ± 0.23, post-exercise 0.48 ± 0.20, P  = 0.15) in hospital-based exercise group. No significant change was observed in any parameters of home-based group ( P  > 0.05). Conclusion A significant recovery was observed both in the functional capacity and the chronotropic response in hospital-based exercise program. Exercise programs that are planned to be performed under supervision in rehabilitation units are useful for the patients with heart transplant in terms of the exercise capacity and chronotropic variables.