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    Clinical Effects of Additional Platelet-Rich Plasma Application to Exercise Therapy in Patients with Subacromial Impingement Syndrome: A Double-Blind Randomized Controlled Trial
    (Sage Publications Inc, 2024) Ziroglu, Nezih; Sahbaz, Yasemin
    Background: Exercise therapy (ET) is the main and initial treatment modality for treating subacromial impingement syndrome (SIS). The isolated or combined use of platelet-rich plasma (PRP) applications in treating SIS is increasing and promising. A comparison was made on the effectiveness of ET alone and in combination with PRP on pain, functionality, and quality of life (QoL) in patients with SIS. Purposes/Hypothesis: The purposes of this study were to (1) investigate the possible positive effects of PRP injections combined with ET in treating SIS on pain, functionality, and QoL and (2) propose an alternative treatment protocol. It was hypothesized that the group receiving PRP applications in addition to ET would have a better QoL due to less pain and higher functionality 6 months after treatment. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Volunteer patients diagnosed with SIS were included based on history and physical examination findings. All participants underwent magnetic resonance imaging to confirm the diagnosis and exclude possible accompanying pathologies. The patients were randomly divided into 2 groups. The first group underwent ET at home for 8 weeks (ET group), and the second group received the same ET program and an additional 2 PRP injections, at the beginning of the study and the end of the fourth week (PRP group). Patients were evaluated initially and 6 months after the treatment using the visual analog scale (VAS) for pain score, Constant-Murley Score (CMS), and the 36-Item Short Form Health Survey (SF-36). The Kolmogorov-Smirnov test determined the conformity of the data to a normal distribution, chi-square analysis was used to compare categorical variables between groups, and the Mann-Whitney U test was used to compare continuous and intergroup variables. Intragroup changes before and after treatment were evaluated with the Wilcoxon signed-rank test. P < .05 was considered statistically significant. Results: A total of 67 patients were initially enrolled; 5 were excluded and 6 were lost to follow-up (1 because of a COVID diagnosis). Thus, 56 patients (56 shoulders) were included for analysis. There were 28 patients in the ET group and 28 patients in the PRP group. There were no statistical differences between groups regarding participant characteristics and clinical evaluations before treatment. A statistically significant improvement was observed in pain (VAS subgroups), functionality (CMS subgroups), and QoL (SF-36 subgroups) evaluations of patients in both the ET and the PRP groups compared with before the treatment and 6 months after treatment (P < .05). At the 6-month posttreatment evaluation, the PRP group was statistically significantly superior to isolated ET in terms of VAS rest (P = .001) and night (P = .004) scores. This superiority was also in favor of the PRP group in flexion strength (P = .001), abduction strength (P = .046), and abduction degree (P = .041) measurements. There was no significant difference between ET and PRP groups regarding VAS activity, CMS, and SF-36 scores (P > .05) at 6 months. Conclusion: Our study showed that both isolated ET and additional PRP application to ET are effective methods in SIS treatment regarding pain, function, and QoL. Combining ET with PRP was superior in reducing pain and improving abduction degree and strength.
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    A COMPARISON OF THE EFFECTS OF CONVENTIONAL ULTRASOUND AND HIGH POWER PAIN THRESHOLD ULTRASOUND ON FROZEN SHOULDER
    (Turkey Assoc Physiotherapists, 2019) Sahbaz, Yasemin; Tunali, Ayse Nur; Cakmak Reyhan, Aycan
    Purpose: Frozen shoulder is a disease characterized by severe disruption of quality of life, pain and progressive limitation of movement. The purpose of this study was to compare the effects of the high power pain threshold ultrasound (HPPT-US) and conventional ultrasound (C-US) on shoulder pain, the range of motion (ROM) and upper extremity functionality in frozen shoulder patients. Methods: Twenty voluntary patients (10 women, 10 men) with frozen shoulder were randomly divided into two groups. The treatment duration of both groups was 14 sessions and treatment program consists of Transcutaneous Electrical Nerve Stimulation, Cold Pack, Neuromuscular Electrical Stimulation, and exercise training. In addition to the standard treatment programs, the HPPT-US was applied to the study group, and the C-US was administered to the control group for five minutes. All patients were evaluated three times before treatment, seventh session, and 14th session. The shoulder pain intensity was assessed with Visual Analogue Scale (VAS), joint range of motion (ROM) using Goniometric Measurement, and functional status with Disabilities of the Arm, Shoulder. Hand (DASH). Results: There were significant differences in ROM, VAS, and DASH scores in both groups (p<0.05). There was no significant difference between the groups when the intra-group changes were calculated by taking the difference between the scores obtained before and after treatment (p>0.05). Conclusion: The patients with frozen shoulder benefited from both treatment programs, however, HPPT-US had no advantage over C-US.
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    Cross-cultural Adaptation, Reliability, and Validity of the Turkish Version of the American Orthopedic Foot and Ankle Society (AOFAS) Midfoot Scale
    (Galenos Publ House, 2024) Ziroglu, Nezih; Sahbaz, Yasemin; Koluman, Alican; Birinci, Tansu; Ciftci, Mehmet Utku; Baca, Emre
    Objective: The American Orthopedic Foot and Ankle Association (AOFAS) Midfoot scale is one of the most popular outcome measures for evaluating midfoot pathologies. We aimed to obtain a valid and reliable Turkish translation of the AOFAS Midfoot scale. Methods: Fifty-seven patients with midfoot pathologies were included, and the mean age was 38.47 +/- 12.54. To appraise construct validity, correlations were applied with the visual analog scale (VAS), the Turkish version of the foot and ankle ability scale (FAAM), and the 12-item short form health survey. Results: The AOFAS Midfoot-Turkish scale had adequate internal consistency (alpha=0.75) and test-retest reliability [intraclass correlation coefficient (ICC)2,1=0.86 2,1 =0.86 for function, and ICC2,1=0.95 2,1 =0.95 for total score]. The AOFAS Midfoot-Turkish scale total score had a moderate to strong correlation with VAS activity and FAAM-ADL, FAAM-Sports, and PCS-12 (rho=-0.69, p=0.001; rho=0.88, p=0.001, r=0.86, p=0.001, and r= 0.68, p=0.001, respectively). The lowest correlation was found between the AOFAS Midfoot-Turkish and the MCS-12 (rho=0.37, p=0.004). Conclusion: The Turkish version of the AOFAS Midfoot scale is a reliable and valid outcome measurement instrument that can be used to evaluate Turkish-speaking individuals with various midfoot pathologies, especially Lisfranc injuries.
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    The Effectiveness of Neuromuscular Electrical Stimulation in Patients With Subacromial Impingement Syndrome A Randomized Controlled Study
    (Lippincott Williams & Wilkins, 2023) Karaaslan, Yasemin; Sahbaz, Yasemin; Dogan, Dildade Dilek; Ziroglu, Nezih; Altun, Suleyman; Mutlu, Ebru Kaya
    ObjectiveThe aim of the study is to compare the effects of exercise training plus neuromuscular electrical stimulation with exercise training alone on shoulder function, pain, range of motion, and muscle strength in patients with subacromial impingement syndrome.DesignPatients were randomly divided into groups of exercise training (n = 24) and exercise training + neuromuscular electrical stimulation (n = 24). Shoulder function was evaluated with the Disabilities of the Arm, Shoulder and Hand Questionnaire, pain level was assessed with a visual analog scale, range of motion was measured with a goniometer, and muscle strength was assessed with a handheld dynamometer baseline and at the end of treatment (week 8).ResultsIn both groups, shoulder function, range of motion, and muscle strength (except flexion muscle strength in the exercise training group) increased, while pain decreased (P < 0.05). Compared with the exercise training group, visual analog scale-activity and visual analog scale-night decreased more, and external-rotation range of motion and whole muscle strength increased more in the exercise training + neuromuscular electrical stimulation group (P < 0.05). On the other hand, the effect sizes were medium to large for both groups.ConclusionsThe addition of neuromuscular electrical stimulation treatment to exercise training did not improve shoulder function, which is the primary outcome, more than exercise training alone, but increased muscle strength and range of motion (external-rotation only) and decreased pain (activity-night), which are the secondary outcomes.