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    The agreement between three classification systems used to grade the severity of lymphedema in patients with upper and lower extremity lymphedema: A retrospective study
    (Taylor & Francis Inc, 2022) Sahinoglu, Ertan; Ergin, Gulbin; Karadibak, Didem
    Background: Several classification systems are used to grade the severity of lymphedema. Their agreement with each other has not been reported. Objective: To evaluate the agreement between the American Physical Therapy Association (APTA) criteria, the criteria of Ramos et al., and the International Society of Lymphology (ISL) criteria in patients with upper and lower extremity lymphedema. Methods: A total of 156 patients (63 and 93 patients with upper and lower extremity lymphedema, respectively) were included. The circumference measurements and limb volume were measured. The severity of lymphedema of the patients was classified as mild, moderate, and severe lymphedema using the APTA criteria, the criteria of Ramos et al., and the ISL criteria. The agreement between the classification systems was assessed with Krippendorff's alpha. Results: An acceptable and poor agreement were found between the criteria in upper (Krippendorff's alpha > 0.667) and lower extremity lymphedema (Krippendorff's alpha < 0.667), respectively. In pairwise comparisons, an acceptable agreement was found among each comparison in upper extremity lymphedema (Krippendorff's alpha > 0.667), and a poor agreement was found among each comparison in lower extremity lymphedema (Krippendorff's alpha < 0.667) except between the APTA criteria and the criteria of Ramos et al (Krippendorff's alpha > 0.667). Conclusions: Patients with upper extremity lymphedema classified according to these criteria can be assumed to be samples of the same population; however, patients with lower extremity lymphedema graded according to the ISL criteria may be included in a different classification when they grade with the APTA criteria and the criteria of Ramos et al.
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    Effect of exercise interventions in adults with cancer receiving palliative care: a systematic review and meta-analysis
    (Springer, 2023) Tanriverdi, Aylin; Kahraman, Buse Ozcan; Ergin, Gulbin; Karadibak, Didem; Savci, Sema
    PurposePrevious publications showed the effectiveness of exercise in adults with cancer receiving palliative care, but evidence for palliative care research on exercise is lacking. The purpose is to examine the effects of an exercise intervention on exercise capacity, physical function, and patient-reported outcome measures in adults with cancer receiving palliative care.MethodsWe searched databases including EMBASE, PubMed, and Web of Science from inception until 2021. We used the Cochrane criteria to assess the risk of bias within studies. Using RevMan, mean difference (MD) and 95% confidence intervals or standardized mean difference (SMD) and 95% confidence intervals were calculated.ResultsA total of 14 studies and 1034 adults with cancer receiving palliative care are included in this systematic review and meta-analysis. Half of the studies were deemed to have high risk of bias. All of the interventions used aerobic and/or resistance exercises. The results indicated that exercise interventions significantly improved exercise capacity (mean difference: 46.89; 95% confidence interval: 4.51 to 89.26; Z = 2.17; P = 0.03), pain (standardized mean difference: - 0.29; 95% confidence interval: - 0.54 to - 0.03; Z = 2.18; P = 0.03), fatigue (standardized mean difference: - 0.48; 95% confidence interval: - 0.83 to - 0.12; Z = 2.66; P = 0.008), and quality of life (standardized mean difference: 0.23; 95% confidence interval: 0.02 to 0.43; Z = 2.12; P = 0.03).ConclusionExercise training, with aerobic exercise, resistance exercise, or combined aerobic and resistance exercise, helps to maintain or improve exercise capacity, pain, fatigue, and quality of life in adults with cancer receiving palliative care.
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    The efficacy of change in limb volume on functional mobility, health-related quality of life, social appearance anxiety, and depression in patients with lower extremity lymphedema
    (Sage Publications Inc, 2022) Sahinoglu, Ertan; Ergin, Gulbin; Karadibak, Didem
    Objectives This study aims to investigate the impact of change in limb volume on the levels of functional mobility, health-related quality of life, social appearance anxiety, and depression before and after complex decongestive physiotherapy in patients with lower extremity lymphedema. Method Twenty-seven patients with unilateral lower extremity lymphedema were included. The treatment period was 20 sessions. The outcome measures were the limb volume, the Timed Up and Go test, the Short Form-36, the Social Appearance Anxiety Scale, and the Beck Depression Inventory. Results A statistically significant decrease in the limb volume (p < 0.001) and statistically significant improvements in the Timed Up and Go test performance (p < 0.001), the Short Form-36 Physical Component Summary score (p < 0.01), the Social Appearance Anxiety Scale score (p < 0.001), and the Beck Depression Inventory score (p < 0.001) were found. No statistically significant difference was found on the Short Form-36 Mental Component Summary score (p > 0.05). Conclusion The decrease in the limb volume improves the functional mobility, physical health-related quality of life, social appearance anxiety, and depression in patients with lower extremity lymphedema, but not the mental health-related quality of life.
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    Reliability, Concurrent Validity, and Minimal Detectable Change of a Smartphone Application for Measuring Thoracic Kyphosis
    (Marmara Univ, Inst Health Sciences, 2023) Sahinoglu, Ertan; Ergin, Gulbin; Bakirhan, Serkan; Unver, Bayram
    Objective: To assess the intra - and inter-rater reliability and concurrent validity, and to estimate minimal detectable change of a smartphone application for measuring thoracic kyphosis angle. Methods: A total of 80 healthy university students were evaluated. Two raters measured the thoracic kyphosis angle using a digital inclinometer and the smartphone application. Intra - and inter-rater reliability were assessed using the intraclass correlation coefficient (ICC) with 95% confidence interval. The standard error of measurement (SEM) and the minimal detectable change at the 95% confidence level (MDC95) were also calculated. The concurrent validity between the digital inclinometer and the smartphone application was assessed by the linear regression analysis and Bland and Altman's 95% limits of agreement method. Results: The intra - and inter-rater reliability were excellent for the digital inclinometer and the smartphone application (ICC > 0.75). The SEM values for the digital inclinometer and the smartphone application were close together. The MDC95 values for the smartphone application were 5.11 and 6.30 degrees, and 9.02 degrees for intra - and inter-rater, respectively. The digital inclinometer and the smartphone application showed a positive correlation (R-2 = 0.85). The Bland-Altman plot showed a good agreement between the instruments. Conclusion: The smartphone application used in this study is a cost-effective, practical, reliable, and valid instrument for measuring the thoracic kyphosis angle. More than 9 degrees in the value of the thoracic kyphosis angle measured by the smartphone application can be considered as a true change.