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Öğe Assessment of sensorimotor and strength related function of breast cancer patients during systemic drug therapy: a prospective observational study(Bmc, 2023) Tugral, Alper; Aribas, Zeynep; Akyol, Murat; Bakar, YesimBackground Chemotherapy is a well-known risk factor for sensorial and motor disturbances. Chemotherapy induced peripheral neuropathy (CIPN) which predominantly affects sensory nerves might cause a diminished fine motor function. This prospective observational study aimed to assess the sensorimotor functions of breast cancer patients before, during, and after chemotherapy.Methods A total of 56 breast cancer patients were evaluated at three different times as follows: T1 (before chemotherapy), T2 (middle chemotherapy), and T3 (completion of chemotherapy). Motor function was assessed with handgrip strength (HGS), peripheral muscle strength (PMS), and the Minnesota Manual Dexterity Test (MMDT). Semmes Weinstein Monofilament Test (SWMT) was performed to assess the sensory function. Fatigue was evaluated with the European Organization for Research and Treatment of Cancer Quality of Life Module Cancer Related Fatigue (EORTC-QLQ-FA12), respectively.Results HGS and MMDT were found significant (chi 2: 11.279, p = 0.004 and chi 2: 9.893, p = 0.007, respectively) whereas PMS was not found significant (F (2,110) = 1.914, p = 0.152). Pairwise comparisons with Bonferroni adjustments revealed that HGS was found significant between T1 and T3, while significant results were obtained between T1 and T2 as well as T2 and T3 in MMDT (p = 0.01 and p = 0.042). There were significant results in some reference points of SWMT, though they were not found after pairwise comparisons with Bonferroni adjustment (p > 0.05). Fatigue was found significantly increased from T1 through T3 (Median: 19.44 vs 27.77, z: -2.347, p = 0.019, Wilcoxon test).Conclusion Our study showed that decreased handgrip strength and fine motor function, as well as increased fatigue, are evident during the chemotherapy. SWMT can be an optional assessment in the context of tracking changes in cutaneous sensation during chemotherapy due to its non-invasive, cheap, and easily repeatable features among cancer patients. To preserve functional capacity as well as independence in daily living, precautions and follow up assessments during the systemic therapy process should be integrated as early as possible to prevent future deteriorations in daily life for patients who undergo chemotherapy.Öğe Assessment of the cardiorespiratory fitness and the quality of life of patients with breast cancer undergoing chemotherapy: a prospective study(Springer Japan Kk, 2023) Akyol, Murat; Tugral, Alper; Aribas, Zeynep; Bakar, YesimBackgroundDiminished cardiorespiratory fitness is a well-known side effect of chemotherapy as well as a risk factor for potential cardiovascular diseases among cancer patients. This study aimed to assess the potential effects of systemic adjuvant (ACT) or neoadjuvant (NACT) chemotherapy on cardiorespiratory fitness and quality of life (QoL) among breast cancer (BC) patients.MethodsDemographic data, cardiorespiratory fitness, health-related QoL domains were assessed with simple data form, six-minute walk test (6MWT), European Organization for Research and Treatment of Cancer quality of life module (EORTC-C30), and Functional Assessment of Cancer Therapy (FACT-B+), respectively. Time1 (T1, prior to chemotherapy), Time2 (T2; interim assessment), and Time3 (T3, final assessment) were set as assessment points.ResultsA total of 42 patients (32 ACT vs 10 ACT) completed all assessments. There were no significant differences of main effect of time and time*group interaction on total walked distance (TWD) after controlling for age and BMI (F(2,28) = 1.309, p = 0.286; F(2,28) = 1.444, p = 0.253). EORTC symptoms subscale was found to be correlated with EORTC and FACT-B+ physical function (PF) subscales (r = - 861, p < 0.001; r = - 0.877, p < 0.001) in T3. The EORTC PF subscale was found to be correlated with the TWD in the baseline (r = 0.411, p = 0.024).ConclusionsThis study showed that the effect of chemotherapy on diminished PF and remarkably increased symptom burden among BC patients. Yet, the type of chemotherapy had no effect on TWD regarding cardiorespiratory fitness. Monitoring potential functional decline regarding cardiorespiratory fitness can be performed via simple field tests such as 6MWT.Öğe Can Lymphatic Transport Impaired by Total Knee Arthroplasty be Managed with Manual Lymphatic Drainage?(Mary Ann Liebert, Inc, 2024) Cihan, Emine; Yildirim, Necmiye Un; Bakar, Yesim; Bilge, OnurObjective: It is known that particles released from the prosthesis due to wear after joint replacement surgery affect the lymphatic system. This study aimed to investigate the effect of the manual lymphatic drainage (MLD) technique on pain, edema, and blood lactate dehydrogenase (LDH) levels in the early period of lymphatic transport affected by total knee arthroplasty (TKA). Method: Twenty-four patients who underwent TKA were randomly allocated (control: 12; MLD: 12). Both groups received postoperative rehabilitation. The MLD group also received MLD in the first 3 days after surgery. Clinical assessment was undertaken on the third day and at the sixth week postoperatively. The Visual Analog Scale (VAS) was used for pain during activity, algometer measurements for pain threshold levels, and the Frustum method for leg volumes. The LDH was recorded using laboratory measurements. Results: A significant difference was found in the VAS activity-related pain scores of the groups according to the assessment time (MLD: chi(2) = 47.175; p = 0.000; control; chi(2) = 30.995; p < 0.000). The pain threshold significantly increased in the MLD group from postoperative day 2 (2nd day, 3rd day, 6th week, respectively; p = 0.015; p = 0.001; p < 0.000). Leg volume significantly decreased over time in both groups after surgery (p < 0.001); however, there was no significant difference between the groups (first-third postoperative days and sixth week; p = 0.192; p = 0.343; p = 0.453; p = 0.908, respectively). While the LDH significantly decreased after drainage in the MLD group (first-third postoperative days; p = 0.002; p = 0.005; p = 0.006, respectively), it increased with exercise in the control group, first day (p = 0.004) and second day (p = 0.019). Conclusions: MLD added to exercise therapy is more effective than exercise therapy alone in reducing the LDH level, a marker of pain and muscle damage, but is not effective for edema due to surgery.Öğe The Characteristics of Pain Tolerance in Patients Who Underwent Unilateral Breast Cancer Surgery: The Effect of Handedness and Surgical Site to Assess the Potential Musculoskeletal Symptoms and Function(Cig Media Group, Lp, 2022) Tugral, Alper; Bakar, Yesim; Akyol, MuratDiminished strength and altered musculoskeletal pain characteristics are well-known consequences of breast cancer treatment. This study aimed to assess myofascial pain and strength in breast cancer survivors (BCS). A total of 96 BCS were included. A Strength imbalance was prominent in BCS who underwent surgery in their nondominant site, while the pain tolerance was significantly lower in the surgical site. Background: Breast cancer survivors (BCS) usually experience musculoskeletal pain and strength imbalance between surgical and nonsurgical sites. Material and methods: This study aimed to assess the effect of handedness and surgical site on pain tolerance and upper extremity strength in BCS. A total of 96 female BCS (Mean age and BMI: 51.06 +/- 9.36 years and 27.77 +/- 3.75 kg/m(2)) were included in this study. BCS were categorized as DoS or NoS whether they had surgery on their dominant or nondominant site, respectively. Socio-demographic data, upper extremity strength, pain tolerance, and pain-related function measurements were performed by simple form, manual muscle tester, pain algometer, and Disabilities of Arm, Shoulder, and Hand's (DASH) pain subscale, respectively. Results: Pain tolerances were significantly lower in upper trapezius muscle region in the surgical site (t = -4,263, P <.001 and t = -2138, P = 0.037) while in the deltoid tuberosity, pain tolerance was significantly higher in surgical site (t = 2633, P = 0.011). Mean differences in strength in shoulder flexion and abduction were significantly lower in the DoS group compared to the NoS group (z = -3.166, P =.002 and z = -2.131, P =.033, respectively), whereas the pain subscale was significantly higher in the DoS (P =.013). Conclusion: Pain tolerance decreased in the upper trapezius muscle region on the surgical site irrespective of the handedness. However, in deltoid tuberosity, the effect of handedness was remarkable. Exercise programs should focus to establish a strength balance in nondominant surgery BCS since strength imbalance might be more prominent to affect them to take part in activities in daily living.Öğe The effect of complex decongestive physiotherapy applied with different compression pressures on skin and subcutaneous tissue thickness in individuals with breast cancer-related lymphedema: a double-blinded randomized comparison trial(Springer, 2023) Duygu-Yildiz, Elif; Bakar, Yesim; Hizal, MustafaPurposeThe aim of this study was to evaluate the effect of compression bandage applied with different pressures on the skin and subcutaneous thickness in individuals with breast cancer-related lymphedema (BCRL).Methods21 individuals with stage 2 unilateral BCRL participated in the study. Individuals were randomly allocated into two groups as low-pressure bandage (20-30 mmHg) (n: 11) and high-pressure bandage (45-55 mmHg) (n: 10). Skin and subcutaneous tissue thickness, extremity volume, sleep quality, treatment benefit, and comfort were evaluated by ultrasound from 6 reference points (as hand dorsum, wrist volar, forearm volar, arm volar, forearm dorsum, and arm dorsum), volumetric measurement, Pittsburgh Sleep Quality Index, Patient Benefit Index-Lymphedema, and visual analog scale, respectively. Complex decongestive physiotherapy was applied to both groups. Compression bandage was applied according to their group. Individuals were evaluated at the baseline, 1st session, 10th session, 20th session, and at 3-month follow-up.ResultsSkin thickness decreased significantly in the volar reference points of the extremity in the high-pressure bandage group (p = 0.004, p = 0.031, and p = 0.003). Subcutaneous tissue thickness significantly decreased at all reference points in the high-pressure bandage group (p < 0.05). In the low-pressure bandage group, skin thickness only decreased in the forearm dorsum and the arm dorsum (p = 0.002, p = 0.035) and subcutaneous tissue thickness changed for all points (p < 0.05) except for hand and arm dorsum (p = 0.064, p = 0.236). Edema decreased in a shorter time in the high-pressure bandage group (p < 0.001). No significant differences were found in sleep quality, treatment benefit, and comfort for both groups (p = 0.316, p = 0.300, and p = 0.557, respectively).ConclusionHigh pressure was more effective in reducing subcutaneous tissue thickness in the dorsum of hand and arm. The usage of high-pressure can be recommended especially in cases which have edema in the dorsum of hand and arm which is difficult to resolve. Also, high-pressure bandage can provide faster edema resolution and can be used in rapid volume reduction as desired. Treatment outcomes may improve with high-pressure bandage without any impairment in comfort, sleep quality, and treatment benefit.Öğe EMPATHY AND ATTITUDE UPON AN AGED BODY: SHORT TERM EFFECTS OF THE AGED SIMULATION SUIT AMONG UNDERGRADUATE PHYSIOTHERAPY STUDENTS(Dokuz Eylul Univ Inst Health Sciences, 2023) Ozdemir, Kadirhan; Tugral, Alper; Ismailoglu, Elif Gunay; Bakar, Yesim; Taskiran, Nihal; Onder, Hatice Erdem; Sari, DilekPurpose: When empathy and attitude levels of health professionals are high, patient compliance and satisfaction are increased. The purpose of this study was to assess the empathy and attitude levels of undergraduate physiotherapy students towards older people before and after wearing the aged simulation suit by performing pre-defined related scenarios.Material and Methods: The aged simulation suit was put on 63 students to complete the pre-defined scenarios, which included reading, eating, walking, and sitting to determine the experiences and emotions of students via semi-structured questions and interviews. The empathy and attitude levels were evaluated using the Jefferson Scale of Empathy-Health Professions Students (JSE-HPS) version and Kogan's Attitudes Towards Old People (KAOP) scales at baseline and immediately after performed scenarios.Results: The scores of the JSE-HPS and its sub-scales, including perspective-taking (p < 0.001) and compassionate care (p=0.008), were significantly improved, while standing in patient's shoes was significantly decreased after the intervention (p=0.005). KAOP positive items were found to be higher compared to the baseline results (p=0.040). Besides, 87.1% of the students stated that their behavior towards older people would change positively.Conclusion: Using aged simulation suits may be an effective educational technique that positively contributes to undergraduate physiotherapy students' attitudes and empathy.Öğe Examination of posture and balance in children with primary monosymptomatic nocturnal enuresis(Ios Press, 2023) Inal, Busra; Ozengin, Nuriye; Bakar, Yesim; Ankarali, Handan; Ozturk, YusufPURPOSE: This study aimed to examine symptom severity, posture, and balance of children with primary monosymptomatic nocturnal enuresis (PMNE) and compare to a healthy control group. METHODS: Thirty-five children with PMNE and 34 healthy children were included in this study. Physical and sociodemographic characteristics of the children were recorded. Symptom severity was assessed with a Vancouver Non-Neurogenic Lower Urinary Tract Dysfunction/Dysfunctional Elimination Syndrome Questionnaire (NLUTD/DES), a four-day bladder diary and a seven-day bowel diary. Standing postural alignment was assessed with the Spinal Mouse device, and the sensory integration of static balance and dynamic standing balance was assessed with the Biodex Balance System SD. RESULTS: Compared to healthy controls, children with PMNE demonstrated increased symptom severity (p = 0.001), increased upright lumbar lordosis (p = 0.018) and sacral-hip angles (p = 0.029), decreased static balance in the sensory condition of unstable surface with eyes closed (p = 0.001), and decreased mediolateral dynamic balance (p = 0.049). CONCLUSION: Children with PMNE demonstrate altered postural alignment, static and dynamic postural instability, and greater symptom severity on the Vancouver NLUTD/DES than age-matched controls.Öğe PERCEIVED EXERCISE BELIEFS AND BARRIERS AMONG BREAST CANCER SURVIVORS: A DESCRIPTIVE CROSS-SECTIONAL STUDY(2024) Tuğral, Alper; Bakar, Yesim; Akyol, MuratSince the importance of the benefit of physical activity and exercise has been understood especially for cancer patients, efforts are taken to assess belief in exercise to adapt patients to a more physically active environment to create a sustainable health outcome. Thus, this study aimed to assess exercise beliefs and barriers by using a validated metric tool (Exercise Beliefs/Barriers Scale-EBBS) to evaluate beliefs in exercise in breast cancer survivors (BCS). In addition, it was also aimed to assess the relationships among EBBS, sociodemographic, and clinical variables of BCS. A total of 112 BCS were screened and invited to participate in this study. Clinical (type of surgery, adjuvant treatments, etc.), demographic data (age, medication use, etc.), and total sitting time were collected through a simple data form and 7th of the International Physical Activity Questionnaire-Short Form (IPAQ-SF), respectively. All patients were requested to fill out EBBS.96 BCS completed this study. Weak but significant correlations were found between time spent after surgery and perceived belief (r=. -273, p=0.009), and perceived barriers (r=-.239, p=0.022), respectively. Perceived barriers were also significantly correlated with age (r=-.212, p=0.042). No significant effects of the type of breast surgery and axillary procedure as well as medications (Tamoxifen) on perceived beliefs and barriers were found. Factors should be thoroughly investigated to provide a sustainable exercise behavior among BCS. Older BCS should be thoroughly monitored to gain regular exercise behavior. This study also highlighted the emerging need for sensitive, specific, and focused tools to assess beliefs in exercise among the cancer population.Öğe Quality of life and somatic physical function of patients with colorectal cancer who underwent oxaliplatin-based systemic chemotherapy: a prospective study(Springer, 2024) Tugral, Alper; Kebabci, Eyup; Aribas, Zeynep; Akyol, Murat; Can, Aysegul; Bakar, YesimintroductionThis study aimed to study the potential effects of oxaliplatin-based chemotherapy on cardiorespiratory fitness, handgrip strength (HGS), body composition, and quality of life (QoL) of stages III-IV colorectal cancer (CRC) patients before the first cycle (T0) and after the last cycle of systemic adjuvant/neoadjuvant chemotherapy (T1).MethodsCardiorespiratory fitness, HGS, body composition, and QoL were evaluated with the six-minute walk test (6MWT), hydraulic hand dynamometer, body composition analyzer, and Functional Assessment of Cancer Therapy-Colon (FACT-C) questionnaire in both T0 and T1, respectively.ResultsTwenty-eight CRC patients were included in this study. The total walked distance (TWD) was found to be decreased from T0 to T1 (499.72 m vs. 488.56 m); however, this change was not significant (z = -.706, p = 0.48). Type of chemotherapy whether adjuvant or neoadjuvant also showed no significant effect on TWD (z = -.1.372, p = .17 vs z = -1.180, p = .238, respectively). The QoL was significantly decreased (T0 = 118.35 vs T1 = 110.77, t = 2.176,p = 0.05). The TWD was significantly correlated with the physical well-being (PWB) subscale of FACT-C (r = .64, p = 0.001) as well as with HGS (r = .46, p = .018) in T0. After controlling for age, type of chemotherapy, and type of regimen, the HGS did not show a significant difference from T0 to T1 (F(1,23) = 1.557, p = .22, eta p2 = .06). However, the effect of time x gender showed significant difference from T0 to T1 (F(1,23) = 4.906, p = .037, eta p2 = .17).ConclusionThis study showed the decreased QoL and physical well-being of CRC patients who underwent oxaliplatin-based treatment. In addition, the gender effect of decreased HGS should be considered further when planning an oncological rehabilitation program.Öğe Risk Profiling of Breast Cancer-Related Lymphedema (BCRL) in Patients With Breast Cancer Via Using Body Composition and Tissue Dielectric Constant (TDC) Method: A Cross-Sectional Study(Cig Media Group, Lp, 2024) Tugral, Alper; Akyol, Murat; Colakoglu, Oyku; Bakar, YesimBreast cancer-related lymphedema (BCRL) is one of the most fearsome side effects of breast cancer treatment. Higher body mass index (BMI) is a well-known risk factor for BCRL. A total of 72 patients were included. The fat mass was significantly and linearly correlated with dielectric ratios which might be indicative of preclinical Background: Breast Cancer-Related Lymphedema (BCRL) is one of the most prominent long-term side effects of breast cancer (BC) treatment. Although an increased BMI is a well-recognized risk factor for BCRL, there is a lack of knowledge regarding the potential associations between body composition and the risk of BCRL. Therefore, this study aimed to analyze the BCRL risk profiles of surgically operated BC patients via body composition and the Tissue Dielectric Constant (TDC) method, respectively. Methods: A total of 72 patients were included. Patients' risk for BCRL was assessed with Moisture MeterD (Delfin, Finland) in 4 different probes each has unique penetration depths from 0.5 (10 mm) to 5.0 (55 mm) at both upper extremities. The body composition was analyzed with Tanita-BC-420 (TANITA, Japan). Comparing the dielectric values of extremities and proportioning to one another as TDC ratio (at-risk side/unaffected side) was used to profile BCRL risk. Results: TDC values of the thorax reference point were significantly higher in all four probes on the at-risk side ( P < .05). TDC ratios in the forearm and Thorax points were significantly correlated with fat mass (r = 0.256, P = .030; r = 0.269, P = .022) as well as with visceral fat rating (VFR) (r = 0.340, P = .003; r = 0.466, P < .001). Conclusion: This study highlights the need for further care and investigation in the assessment and prediction of BCRL by considering body composition. Since the risk reduction of BCRL can be maximized by considering the individual features, we can conclude that patients with higher body fat irrespective of the BMI should be followed up regularly.Öğe Sleep quality and sedentary behavior among cancer survivors: is there a possible link?(2024) Tuğral, Alper; Bakar, Yesim; Akyol, MuratPurpose: Disrupted sleep patterns can be frequent in cancer survivors not only during treatment but also during survival. This study aimed to analyze the possible link between sleep quality and sedentary behavior among cancer patients. Methods: Demographic and clinical information was obtained through an assessment form. Sleep quality and physical inactivity level were assessed by the Pittsburgh Sleep Quality Index (PSQI) and Sedentary Behavior Questionnaire (SBQ), respectively. This cross-sectional study was conducted between April and June 2023 in the Medical Oncology unit of Izmir Bakırçay University Faculty of Medicine. Results: This study was completed with a total of 80 patients with most of the types of cancer being breast (n=55). The mean PSQI score was 7.68±4.02. SBQ scores were 8.16±3.90, and 6.85±3.86 hours on weekdays and weekends, respectively. No significant association was observed between PSQI and SBQ total scores (p>.05). Age was correlated with sleep disturbances (r=-.24, p=0.03), daytime dysfunction (r=-.34, p=0.002), and first item of SBQ (watching TV) both on weekdays (r=.35, p=0.001) and weekends (r=.38, p=0.001), respectively. Conclusion: This study showed that there was no significant relationship between sedentary behavior and sleep quality among cancer patients, however, the remarkable rate of poor sleep quality was evident in this sample. However, it might be reasonable to suggest that the increased screen time especially for older cancer patients due to significant associations between screen time and age, should be well managed while sleep hygiene and daytime dysfunction should be considered further among younger cancer survivors.Öğe The Reliability, Validityand Cross-Cultural Adaptation of Turkish Version of Jefferson Scale of Empathy for Health Professions Students(Marmara Univ, Inst Health Sciences, 2024) Ismailoglu, Elif Gunay; Ozdemir, Kadirhan; Tugral, Alper; Bakar, YesimObjective: The study is aimed to study for the reliability, validity, and cross-cultural adaptation of the Turkish version of the Jefferson Scale of Empathy for undergraduate health profession students (JSE-HPS). Methods: Cultural adaptation of JSE-HPS was carried out in 5 stages according to the protocol of Beaton et al.JSE-HPS was administered to students who educated in the departments of Physiotherapy and Rehabilitation, Nursing and Health Management. The reliability of JSE-HPS was evaluated by internal consistency and test -retest analysis using Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. Criterion validity assessed by comparing the scores of JSE-HPS and Emphatic Tendency Scale (ETS). An analysis of construct validity was carried out by exploratory and confirmatory factor analysis. Results: The exploratory factor analysis revealed the presence of three factors that explain 44.68% of the total variance and that correspond to the dimensions of the original scale. Following factor structures were obtained as Perspective taking, Compassionate care and Standing in patient's shoes. Turkish version of JSE-HPS total score were significantly correlated with the ETS total score (r=0.187, p=.005). The Cronbach's Alpha internal consistency coefficient was found alpha = .793. The test -retest reliability coefficient was 0.86. The confirmatory factor analysis verified a good fit of the model (chi 2/df = 1.776). Conclusion: The Turkish version of JSE-HPS is a valid and reliable scale for evaluating empathy levels of undergraduate health professions students.Öğe Understanding changes in pulmonary function and functional status in breast cancer patients after systemic chemotherapy and radiotherapy: a prospective study(Bmc, 2024) Tugral, Alper; Aribas, Zeynep; Akyol, Murat; Bakar, YesimBackgroundRespiratory complications in breast cancer (BC) patients after chemotherapy (CT) and radiotherapy (RT) have been well acquainted and these complications should be investigated to prevent secondary problems and/or improve BC patients' clinical outcomes. Therefore, this study aimed to assess the potential acute effect of systemic chemotherapy and radiotherapy on respiratory function and functional status of patients with breast cancer.MethodsA total of 25 BC patients who were candidates for systemic chemotherapy and radiotherapy were recruited after oncological examination and included in this study. Respiratory function and functional status were assessed with the Pulmonary Function Test (PFT) and the Six-Minute Walk Test (6MWT), respectively. Patients were assessed before CT (c0), after CT (c1), and after RT (r1).Results25 BC patients were assessed in c0 and c1 while only 15 out of 25 patients (60%) were assessed in r1. The actual values of Forced vital capacity (FVC) (t = 2.338, p =.028), Forced expiratory volume in 1s (FEV1 (t = 2.708, p =.012), and the forced expiratory flow of between 25% and 75% of vital capacity (FEF25-75%) (t = 2.200, p =.038) were found significantly different after systemic CT. Inspiratory (MIP) and expiratory (MEP) muscle strength also did not show a significant change from c0 to c1. A significant effect of the type of surgery was found (Wilks' lambda, F [1, 19] = 6.561, p =.019, eta p2 = 0.25) between c0 and c1 in actual FVC value. The main effect of time was found significant in FVC (F [2, 28] = 4.840, p =.016, eta p2 = 0.25) from c0 to r1. Pairwise comparisons with Bonferroni correction showed that there was a significant difference between c0 and r1 (p =.037).DiscussionThe present study showed decreased FVC and FEV1 actual values and percent predicted rates from baseline to the completion of treatment. Since the interactional effect of the type of surgery was significant, we suggest that clinical and demographic factors such as age should be considered when interpreting the early changes in PFT. In addition, the significant linear trend of decreasing in some specific outcomes in respiratory function also highlighted the need for continuous monitoring of potential respiratory problems in patients with BC from baseline to the completion of chemotherapy and radiotherapy.
