Emine Esra Bilir

Objective: Extracorporeal shock wave therapy (ESWT) is a modern physical therapy modality used to treat musculoskeletal conditions. In this study, we aimed to assess the effectiveness of radial ESWT on pain, disability and depression in chronic non-radicular low back pain (LBP).Material and Methods: Sixty-nine patients with chronic nonradicular LBP were included in the study and randomized to two groups: rESWT (group 1) or sham ESWT (group 2). A total of 62 patients completed the study; the intervention group (n=30, mean age of 45.7±10.7 years) received rESWT, and the control group (n=32, mean age of 47.0±10.1 years) received sham ESWT. Outcome parameters included the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Hospital Anxiety and Depression Scale (HADS). The evolutions were made before treatment, after treatment, and 1st month after treatment.Results: Sixty-two patients completed the study (rESWT, n=30; sham ESWT, n=32). Pain intensity decreased significantly more in the rESWT group than in the sham group both immediately after treatment (VAS change: 2.9±1.3 vs. 1.8±1.4, p=0.002) and at 1-month follow-up (3.3±1.7 vs. 2.3±1.9, p=0.035). Functional disability also improved significantly more with rESWT (ODI change after treatment: 6.5 [4.0-12.0] vs. 2.0 [-2.0-3.5], p<0.001; at 1 month: 8.0 [0.0-12.5] vs. 0.0 [0.0-5.5], p=0.014). Although anxiety improved more in the rESWT group immediately after treatment (p=0.036), this difference was not maintained at 1 month (p=0.184). No significant between-group differences were observed in depression scores either after treatment (p=0.994) or at 1 month (p=0.177).Conclusion: rESWT appears to be an effective intervention for reducing pain and disability, with superior short-term outcomes compared to sham treatment. However, its effects on anxiety were transient, and no additional benefit was observed for depression. rESWT may be considered a safe and effective adjunctivetreatment for improving pain and function in this patient population.

Aim The purpose of this study was to evaluate the effectiveness of an individualized aerobic exercise program prescribed according to V̇O₂max measured by cardiopulmonary exercise testing (CPET) in a cardiac rehabilitation setting. Methods An observational case-control study. Thirty patients diagnosed with compensated Heart failure and functional capacity New York Heart Association 2-3 were included in the study. Participants underwent a CPET to determine aerobic capacity. Before and after the intervention, CPET and 6-Minute Walk Test (6MWT) for functional exercise capacity, the short form-36 health survey (SF-36) scale to assess quality of life, handgrip strength using a dynamometer for muscle strength, and the Hospital Anxiety and Depression Scale (HADS) were applied. Results The study included 30 patients, 85.7% of whom were male, with a mean age of 52.8 years. The CPET results before and after rehabilitation revealed changes in several parameters; however, only PETCO₂ and resting systolic blood pressure showed statistically significant changes. There were no significant differences in the VO₂ max, VE/VCO₂ slope (EQCO₂), O₂ pulse, or heart rate recovery (HRR) levels after treatment assessment. In the functional assessment, handgrip strength significantly increased (P = .001). The energy/fatigue and social functioning domains of the SF-36 significantly improved after rehabilitation (P = .032 and P = .024, respectively). There was no difference in anxiety or depression assessments (both P > .05). Conclusion A structured rehabilitation program featuring continuous moderate-intensity aerobic exercise significantly improves ventilatory efficiency, blood pressure control, peripheral muscle strength, and certain aspects of quality of life in heart failure patients.

Background: We aimed to investigate the efficacy of lumbar transforaminal epidural steroid injection therapy in patients with radicular low back pain that had not been alleviated by conservative management strategies. Methods: This study included 252 patients with radiculopathy due to lumbar disc herniation who failed conservative treatment. This is a retrospective cohort study. Participants (aged 18– 90) underwent C-arm fluoroscopy-guided transforaminal epidural steroid injections (TFESI) using a subpedicular approach. Pain severity and functional status were evaluated at baseline, 2 weeks, and 3 months post-procedure using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Statistical analysis focused on sociodemographic characteristics and longitudinal changes in VAS and ODI scores. Results: Out of 252 patients, 221 completed the full 3-month follow-up (mean age 54.5 ± 14.1 years; 57.5% female). The median symptom duration was 5 months, and the most frequent injection levels were L4-5 (51.1%) and L5-S1 (48.4%). Significant improvements were observed in both pain (VAS) and functional status (ODI) at the 2-week and 3-month months (p < 0.001). At the 3-month follow-up, treatment success (defined as > 50%improvement) was achieved in 64.3% of patients for pain at rest, 57.5% for pain during movement, and 74.2% for nocturnal pain. Additionally, 55.7% of patients demonstrated a significant reduction in disability according to ODI scores. Conclusion: TFESI is an effective non-operative treatment intervention that provides significant mid-term pain reduction and functional improvement in a substantial proportion of patients with lumbar radiculopathy. The low rate of surgical conversion suggests its value as a key alternative to surgery. Clinical Trials Number: NCT07538765.

Dear Editor, I read with great interest the randomized controlled trial comparing platelet-rich plasma (PRP) and corticosteroid injections (CSI) in the treatment of lateral epicondylitis. The authors’ report that PRP led to superior pain relief and functional outcomes at 6 months, highlighting its potential as a longer-lasting intervention compared to CSI. These findings are consistent with earlier studies. Peerbooms et al. and Gosens et al. demonstrated the long-term benefits of PRP over corticosteroids in controlled trials with 1- and 2-year follow-up, respectively [1,2]. More recently, Hohmann et al. confirmed in a systematic review and meta-analysis that while corticosteroids may provide faster symptom relief, PRP offers superior outcomes at 3 and 6 months [3]. In addition, cost-effectiveness analyses by Klifto et al. indicated that PRP is a more economically viable option in the long term for recalcitrant cases [4]. However, it is important to acknowledge that not all evidence favors PRP. Several well-conducted studies and meta-analyses have reported mixed or inconclusive results. For instance, Krogh et al. conducted a randomized, double-blind trial showing no significant difference between PRP and corticosteroids at 3-month follow-up [5]. Similarly, a systematic review by de Vos et al. found inconsistent evidence supporting PRP’s superiority, particularly in the short term [6]. These conflicting results may be attributed to variations in PRP preparation methods, patient selection, severity of tendinopathy, or differences in outcome measurement tools. The present study adds meaningful data from an Indian clinical setting, yet several limitations should be considered. The sample size is not specified, which limits statistical power. The lack of blinding introduces potential bias, and the single-center design restricts generalizability. In addition, no imaging modalities were used to objectively assess tendon healing, and critical parameters of PRP preparation (e.g., leukocyte content and platelet concentration) were not reported. The study also does not account for potential confounders such as occupational risk factors, physical activity levels, or post-injection rehabilitation compliance. Finally, the economic implications of PRP use were not addressed. In summary, this trial contributes to the ongoing debate over biologic versus pharmacologic treatments for lateral epicondylitis. While evidence increasingly supports the long-term benefits of PRP, further multicenter, blinded, and standardized trials are essential to clarify its role, particularly in light of existing studies reporting no superiority over corticosteroids.

Objectives: This study aims to investigate the incidence and associated risk factors of clavicle and humerus fractures and brachial plexus injuries (BPIs) secondary to birth trauma. Patients and methods: Between October 2019 and May 2023, a total of 556 newborns (300 males, 256 females; median age: 5 days; range, 0 to 5 days) with clavicle, humerus fractures, and BPIs secondary to birth trauma were retrospectively analyzed. The sex, Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) scores at 1 and 5 min, need for resuscitation, gestational week, mode of delivery, birth weight, birth length, and head circumference of the neonates were recorded. Concomitant BPI, evaluation specialty, and maternal characteristics were also noted. Results: A larger head circumference was associated with an increased risk of clavicle fractures (pConclusion: Our study results show that larger head circumference increases the risk of clavicle fractures and BPI. Higher birth weight and lower APGAR scores at 1 min also raise BPI incidence. Newborns with these risk factors should undergo a thorough evaluation.

Aim: Lateral epicondylitis is a clinical condition causing pain, sensitivity, functional disability in the elbow. The treatment approach is mostly conservative. We aimed to evaluate the effectiveness of kinesiologic tape versus epicondylitis orthosis in the treatment. Materials And Method: Eighty patients (51 female, 29 male; mean age 39.5+7.4) who were diagnosed lateral epicondylitis were enrolled to our study. Patients were randomly allocated two groups; epicondylitis orthosis and kinesiologic tape were applied group 1and group 2. Visual analog scale (VAS) for pain severity, goniometric measurement of range of motion for clinical assessment, disability assessment (arm, shoulder and hand problems questionnaire: QUICK DASH) for upper extremity function, SF-36 (ShortForm36) scale for quality-of-life assessment were used as used in the study. Results: Before treatment and 1th, 4th weeks variances of values were compared between groups. There were improvement in VAS scores, SF-36 PF(physical function) and MH(mental health) subgroups, QD FS and W subgroups scores of Group 2 was significantly higher than scores of Group 1 (p

Objective: Hemiplegic shoulder pain is one of the most common complications after stroke. High-intensity laser therapy is a new treatment option between conventional treatment strategies. We aimed to compare the effectiveness of conventional physical therapy agents and high-intensive laser therapy in this study. Material and Method: Randomized, case-control trial. Participants (n=43) were randomized into two groups. Group 1: high-intensive laser therapy (n=22), and group 2: conventional physical therapy (n=21), and additionally, therapeutic exercise programs were applied both groups. Patients were assessed before treatment and after treatment for clinical parameters with a visual analog scale, an arm motor ability test, functional independence measure scores, and modified ranking scores. Patients underwent sonographic diagnostic evaluation. Results: Sociodemographic characteristics and clinical data and ultrasonographic findings were similar between groups (p>0.05). In both groups, within-group comparisons showed a significant decrease in activity and nocturnal pain scores and a significant increase in arm motor ability test function and movement scores and functional independence measure scores (p