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    Atrial Fibrillation Impact Questionnaire (AFImpact): Validity and reliability of the Turkish version
    (Aves, 2021) Zeren, Melih; Demir, Rengin; Karcı, Makbule; Yiğit, Zerrin; Uzunhasan, Işıl; Gürses, Hülya Nilgün
    Objective: Guidelines recommend measuring and addressing health-related quality of life in the management of atrial fibrillation (AF); however, a disease-specific questionnaire is lacking for the Turkish language. Our aim was to translate and adapt the Atrial Fibrillation Impact Questionnaire (AFImpact) into Turkish and to explore its psychometric properties. Methods: This cross-sectional study was conducted in two phases, including the translation and cultural adaptation of AFImpact into Turkish language and the analysis of psychometric properties of the translated questionnaire. 98 patients diagnosed with AF were evaluated using the Turkish version of AFImpact, Short Form-36 (SF-36) and Pittsburg Sleep Quality Index (PSQI). Reliability, validity, and factor structure of the Turkish version of AFImpact was explored. Results: Cronbach's alpha coefficients for vitality, emotional distress, and sleep domains of AFImpact was 0.956, 0.955, and 0.819, respectively, indicating good-to-excellent internal consistency. No significant difference was detected between the initial and retest scores, and intraclass correlation coefficients of each domain varied between 0.991 and 0.996, indicating excellent test-retest reliability. Each domain of AFImpact highly correlated with similar domains of SF-36 and PSQI, having correlation coefficients between -0.484 and -0.699. AFImpact was able to discriminate between the patients in different functional classes, confirming know-groups validity. Factor analysis revealed AFImpact had the same factorial structure as the original questionnaire. Conclusion: The Turkish version of AFImpact is a valid and reliable questionnaire for evaluating health-related quality of life in patients with AF.
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    Cut-off values of 6-min walk test and sit-to-stand test for determining symptom burden in atrial fibrillation
    (Springer London Ltd, 2022) Zeren, Melih; Karcı, Makbule; Demir, Rengin; Gürses, Hülya Nilgün; Oktay, Veysel; Uzunhasan, Işıl; Yiğit, Zerrin
    Background Since symptomatology is a major predictor of quality of life and an endpoint for the management of atrial fibrillation (AF), practical approaches for objectively interpreting symptom burden and functional impairment are needed. Aims We aimed to provide cut-off values for two frequently used field tests to be able to objectively interpret symptom burden in atrial fibrillation. Methods One hundred twenty-five patients with AF were evaluated with European Heart Rhythm Association (EHRA) score, 6-min walk test (6MWT), 30 s sit-to-stand test (30 s-STST), Short-Form 36 (SF-36), International Physical Activity Questionnaire-Short Form (IPAQ-SF), and spirometry. Patients with EHRA 1 were classified as asymptomatic, and those with EHRA 2-4 as symptomatic. Cut-off values of 6MWT and 30 s-STST for discriminating between these patients were calculated. Results The optimal cut-off value was 450 m for 6MWT (sensitivity: 0.71; specificity of 0.79) and 11 repetitions for 30 s-STST (sensitivity 0.77; specificity of 0.70). Area under ROC curve was 0.75 for both tests (p < 0.001). Discriminative properties of the two tests were similar, and they were significantly correlated (r = 0.58; p < 0.001). Subgroup analysis revealed patients below cut-off values also had worse outcomes in SF-36, IPAQ-SF, and spirometry. Conclusions In patients with AF, walking < 450 m in 6MWT or performing < 11 repetitions in 30 s-STST indicates increased symptom burden, as well as impaired exercise capacity, quality of life, physical activity participation, and pulmonary function. These cut-off values may help identifying patients who may require adjustments in their routine treatment or who may benefit from additional rehabilitative approaches.
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    Do pulmonary and extrapulmonary features differ among cystic fibrosis, primary ciliary dyskinesia, and healthy children?
    (Wiley, 2020) Denizoğlu Kulli, Hilal; Gürses, Hülya Nilgün; Zeren, Melih; Üçgün, Hikmet; Çakır, Erkan
    Background Primary ciliary dyskinesia (PCD) is generally likened to cystic fibrosis (CF) due to similarities in impaired mucociliary clearance and some other symptoms. The aim of our study was to investigate pulmonary and extrapulmonary characteristics of children with CF and PCD since no studies have addressed respiratory muscle strength in children with PCD and to compare the results to those obtained from healthy age-matched controls. Methods Pulmonary and extrapulmonary characteristics were assessed by 6-min walk test, spirometry, maximum inspiratory and expiratory pressure measurements, and knee extensor strength test in the children with CF, PCD, and healthy controls. Results Children with PCD and CF had similar PFT results, except forced expiratory flow between 25% and 75% of vital capacity (FEF25-75) which was lower in PCD (p = .04). Maximum inspiratory pressure (MIP) value was lower in the children with CF compared with the healthy controls (p = .016), MEP value of the children with PCD was worse than those with CF and healthy controls (p = .013 and p = .013), respectively. 6-min walk test (6MWT) distance of the children with CF was lower than their healthy counterparts (p = .003). Knee extensor muscle strength differed among the children with PCD, CF, and healthy control groups, but post hoc test failed to show statistical significance (p = .010). Conclusion Children with CF and PCD had some impairments in pulmonary functions, respiratory muscle strength, functional capacity, and peripheral muscle strength compared with healthy children. However, the unique characteristics of each disease should be considered during physiotherapy assessment and treatment. The clinicians may especially focus on the respiratory and peripheral muscle strength of the children with PCD.
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    Does the effect of comprehensive respiratory physiotherapy home-program differ in children with cystic fibrosis and non-cystic fibrosis bronchiectasis?
    (Springer, 2022) Gürses, Hülya Nilgün; Üçgün, Hikmet; Zeren, Melih; Denizoğlu Külli, Hilal; Çakır, Erkan
    Bronchiectasis is a form of airway damage as a consequence of endobronchial infection and inflammation and may be present in different diseases. The underlying aetiologies include both cystic fibrosis (CF) and a group of non-cystic fibrosis diseases (NCFB) such as immunodeficiency, primary ciliary dyskinesia, or severe pulmonary infection. Although children with CF and non-cystic fibrosis bronchiectasis (NCFB) have many similar clinical features, their responses to exercise may be different. The aim of this study was to compare the efficacy of a comprehensive respiratory physiotherapy (CRP) home-program in children with CF and NCFB. Thirty children with CF and thirty children with NCFB were included in the study. Both groups performed the CRP home-program twice daily for 8 weeks. Pulmonary function, exercise capacity, and respiratory and peripheral muscle strength were assessed at baseline and after 8 weeks of training. Both groups experienced significant improvements in pulmonary function, exercise capacity, and respiratory and peripheral muscle strength (p < 0.001). Maximum expiratory pressure, exercise capacity, and peripheral muscle strength were further improved in NCFB group compared to CF (p < 0.05); however, there was a great variability in the improvements for each variable. Conclusion: CRP is beneficial both for children with CF and NCFB and adherence to the program was high in both groups.
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    Effect of gender and physical activity level on sit-to-stand test performance among young adults
    (2020) Gürses, Hülya Nilgün; Külli, Hilal Denizoğlu; Durgut, Elif; Zeren, Melih
    Objective: Our study aimed to determine the sit-to-stand (STS)test performance and physical activity levels of young adults andinvestigate the relationship of STS tests with gender and physicalactivity levels.Methods: Sixty volunteers randomly performed the 5×STS,10sSTS, 30sSTS and 60sSTS tests. Fatigue was rated using theBorg category ratio scale. Physical activity level and weekly energyexpenditure of volunteers were calculated using the InternationalPhysical Activity Questionnaire.Results: The 5×STS, 10sSTS, 30sSTS and 60sSTS test scoreswere statistically different between genders (p=0.004; p=0.002;p=0.000; p=0.000, respectively). Fatigue levels after STS testsdid not show any difference between genders (p=0.636; p=0.295;p=0.888; p=0.150, respectively). Weekly energy expenditures werepositively correlated with STS tests except 5×STS test (r=?0.458,p=0.000; r=0.427, p=0.001; r=0.606, p=0.000; r=0.545, p=0.000,respectively). All STS tests had significant differences betweenparticipants with moderate or high physical activity level (p=0.016;p=0.007; p=0.000; p=0.000, respectively).Conclusion: Our study shows that STS tests scores correlate togender and physical activity levels in young adults.
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    Postural stability and fall risk in patients with obstructive sleep apnea: a cross-sectional study
    (Springer Heidelberg, 2021) Yılmaz Gökmen, Gülhan; Gürses, Hülya Nilgün; Zeren, Melih; Özyılmaz Semiramis; Kansu, Abdullah; Akkoyunlu, Muhammed Emin
    Purpose Nocturnal hypoxia and daytime sleepiness resulting from fragmented sleep may impair the ability of postural stability in subjects with OSA. This study investigates the effect of disease severity on postural stability and whether or not it poses a fall risk in individuals with obstructive sleep apnea (OSA). Methods Forty-nine patients with OSA diagnosed by all-night polysomnography (apnea-hypopnea index (AHI) >= 5) and aged 51.4 +/- 7.2 years were included in the study. The patients were divided into two groups as severe OSA (AHI >= 30, n = 24) and non-severe OSA (5 <= AHI <= 30, n = 25). All patients were subjected to testing for postural stability (PS), limits of stability (LOST), and the stability index for fall risk (fall risk SI) with the Biodex Balance System (R). Daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS). Biodex measurements and daytime sleepiness were compared between severe and non-severe OSA groups. Univariate analysis was conducted to explore if AHI, ESS score, lowest SaO(2) (%), sleep stages (%), or total arousal index predict postural stability scores. Results Overall and anterior-posterior PS indices were higher in the severe OSA group (p < 0.05). Dynamic PS and fall risk indices did not differ between groups. AHI and lowest SaO(2) (%) were found to be an independent predictor for both overall PS (r = 0.300 and r = 0.286, respectively) and fall risk SI (r = 0.296 and r = 0.374, respectively), whereas stage N1 (%) and stage N3 (%) were an independent predictor for overall LOST score (r = -0.328 and r = 0.298, respectively) (p < 0.05). Conclusion Static postural stability of individuals with severe OSA is worse than those with non-severe OSA. Static postural stability worsens, and fall risk increases as AHI increases and the lowest SaO(2) decreases in individuals with OSA. On the other hand, dynamic postural stability worsens as stage N1 (%) sleep increases and stage N3 (%) sleep decreases. While nocturnal hypoxia indicators such as AHI and lowest SaO(2) are associated with static postural stability, sleep structure-related variables are associated with dynamic stability. Including postural stability assessments in the clinical practice for OSA may help addressing workplace accidents or tendency to fall.
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    Sit-to-stand test in children with bronchiectasis: Does it measure functional exercise capacity?
    (Mosby-Elsevier, 2020) Zeren, Melih; Gürses, Hülya Nilgün; Kulli, Hilal Denizoğlu; Üçgün, Hikmet; Çakır, Erkan
    Background: Similar to six-minute walk test (6MWT), sit-to-stand test (STST) is a self-paced test which elicits sub-maximal effort; therefore, it is suggested as an alternative measurement for functional exercise capacity in various pulmonary conditions including COPD and cystic fibrosis. We aimed to investigate the association between 30-second STST (30s-STST) and 6MWT in both children with bronchiectasis (BE) and their healthy counterparts, as well as exploring cardiorespiratory burden and discriminative properties of both tests. Methods: Sixty children (6 to 18-year-old) diagnosed with non-cystic fibrosis BE and 20 age-matched healthy controls were included. Both groups performed 30s-STST and 6MWT. Test results, and heart rate, SpO(2) and dyspnea responses to tests were recorded. Results: Univariate analysis revealed that 30s-STST was able to explain 52% of variance in 6MWT (r = 0.718, p<0.001) in BE group, whereas 20% of variance in healthy controls (r = 0.453, p = 0.045). 6MWT elicited higher changes in heart rate and dyspnea level compared to 30s-STST, indicating it was more physically demanding. Both 30s-STST (21.65 +/- 5.28 vs 26.55 +/- 3.56 repetitions) and 6MWT (538 +/- 85 vs 596 +/- 54 m) were significantly lower in BE group compared to healthy controls (p<0.01). Receiver operating characteristic (ROC) curve analysis revealed an area under the ROC curve (UAC) of 0.765 for 30s-STST and 0.693 for 6MWT in identifying the individuals with or without BE (p<0.05). Comparison between AUCs of 30s-STST and 6MWT yielded no significant difference (p = 0.466), indicating both tests had similar discriminative properties. Conclusions: 30s-STST is found to be a valid alternative measurement for functional exercise capacity in chil-dren with BE. (c) 2020 Elsevier Inc. All rights reserved.
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    Validity and reliability of the Turkish version of breathlessness beliefs questionnaire
    (Taylor & Francis Inc, 2022) Gürses, Hülya Nilgün; Saka, Seda; Zeren, Melih; Bayram, Mehmet
    Background Dyspnea is often the main symptom that limits exercise; however, the vicious cycle of dyspnea limiting exercise participation is also an important contributor to the reduced exercise capacity. Objective The aim of our study was to investigate the reliability and validity of Turkish Breathlessness Beliefs Questionnaire (BBQ) in patients with Chronic Obstructive Pulmonary Diseases (COPD). Methods Seventy-seven COPD patients were included in the study. Sociodemographic and physical characteristics were recorded. Turkish version of BBQ, Saint George Respiratory Questionnaire (SGRQ) and Hospital Anxiety and Depression Scale (HADS) were applied. Second evaluation of BBQ was conducted via telephone calls with no drop-outs. Reliability of the questionnaire was explored by calculating the internal consistency and test-retest analysis. Construct validity was assessed calculating correlation coefficients of BBQ with HADS and SGRQ scores. Known group validity was also explored. Results Cronbach alpha coefficients for total score of BBQ were 0.78, indicating that the questionnaire has 'good' internal consistency. Initial and test-retest BBQ total scores were 41.42 +/- 6.47 and 41.18 +/- 6.24, respectively. Intra-class correlation coefficients (ICC2,1) values of BBQ and its sub-scales varied between 0.973 and 0.983, indicating strong test-retest reliability. Correlation coefficient between BBQ total and SGRQ-Activity (0.619) was highest among the variables of interest, followed by BBQ total and SGRQ total (0.611). There was a significant correlation between BBQ total and HADS (0.390). One-way analysis of variance revealed that BBQ total and BBQ-Activity Avoidance scores were significantly differ in disease stages. Conclusion Turkish version of BBQ was found to be a valid and reliable tool for measuring dysfunctional beliefs related to the dyspnea in patients with COPD.