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    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, Yesim
    Background 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.
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    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, Murat
    Diminished 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.
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    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, Mustafa
    PurposeThe 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.
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    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, Dilek
    Purpose: 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.
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    Examination of posture and balance in children with primary monosymptomatic nocturnal enuresis
    (Ios Press, 2023) Inal, Busra; Ozengin, Nuriye; Bakar, Yesim; Ankarali, Handan; Ozturk, Yusuf
    PURPOSE: 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.
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    PERCEIVED EXERCISE BELIEFS AND BARRIERS AMONG BREAST CANCER SURVIVORS: A DESCRIPTIVE CROSS-SECTIONAL STUDY
    (2024) Tuğral, Alper; Bakar, Yesim; Akyol, Murat
    Since 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.
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    Sleep quality and sedentary behavior among cancer survivors: is there a possible link?
    (2024) Tuğral, Alper; Bakar, Yesim; Akyol, Murat
    Purpose: 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.