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Öğe An approach to lipedema: a literature review of current knowledge of an underestimated health problem(Springer, 2019) Tuğral, Alper; Bakar, YeşimLipedema, which has been known as an adipose tissue disorder characterized by abnormal fat deposition, mostly affects women. This condition can easily be ruled out regarding its diagnosis because it is commonly misdiagnosed as obesity. True diagnosing and optimal management of lipedema show a great importance. As patients suffer from lipedema, not only experiencing physical symptoms such as tenderness or a feeling of heaviness but also psychological symptoms such as anxiety, they cause negative influences on quality of life of a person with lipedema. This paper tries to review all aspects of lipedema from diagnosis to management and assessment options.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; Tuğral, Alper; Aribaş, Zeynep; Bakar, YeşimBackgroundDiminished 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 Comparison of a 12-week whole-body exergaming program on young adults: Differentiation in flexibility, muscle strength, reaction time, and walking speed between sexes(Sage Publications Inc, 2020) Bakar, Yeşim; Tuğral, Alper; Özel, Alp; Altuntaş, Yasin D.This study aimed to investigate the effects of exergaming on flexibility, muscle strength, reaction time, and walking speed of adults within sex differences. Fifty-four individuals participated in a 12-week exergaming program. Three 30-min sessions were conducted each week. Baseline and post-intervention assessments were done using the sit-and-reach and bend-over tests for flexibility, hand-held dynamometer for muscle strength, auditory and visual reaction time machine for reaction time, and 5-meter walk test for walking speed. There were no significant changes in the sit-and-reach, bend-over test, and auditory-visual reaction time for either gender (p> .05) with the intervention. Walking speed and muscle strength improved after exergaming in both sexes (p< .05). The study showed that the video gaming intervention led to significant and equal improvements in muscle strength and walking speed for both sexes; however, it had no impact on flexibility and auditory-visual reaction time.Öğe The effect of adjuvant radiotherapy on skin biophysical properties in patients with breast cancer at risk for breast lymphedema: A prospective study(Wiley, 2023) Tuğral, Alper; Akyol, Murat; Bakar, YeşimBreast cancer (BC) is the most common type of cancer among women. Radiotherapy (RT) is one of the main and primary treatment options for BC, especially in breast-conserving surgery (BCS). BC patients who underwent RT experience a wide range of symptoms, in which breast oedema and irritation of the skin take the lion's share. Breast oedema/lymphedema, which is also a prominent side effect after RT should be well determined in earlier settings due to the chronicity of lymphedema. Therefore, this study aimed to analyze the biophysical parameters of skin on the ipsilateral (IL) and contralateral (CL) sites via Tissue dielectric constant (TDC) and Transepidermal water loss (TEWL) methods in terms of oedema and skin barrier function (SBF). The following reference points before and after the RT were measured: (R1: Pectoralis muscle, R2: Upper breast, R3: Lower breast, R4: Lateral site of the thorax). A total of 24 BC patients (mean age and BMI: 52.78 +/- 9.85 years and 28.42 +/- 5.64 kg/m(2)) were evaluated. In the IL site, the SBF was not found significant in R1-R3, whereas significantly lower SBF was observed in R4 after RT (t = -3.361, p = 0.003). A significant increase in TDC was observed in R2 at the 5.0 mm depth (t = -2.500, p = 0.02). We suggest that a longer period of follow-up should be carefully carried out to track changes in terms of SBF and oedema in the irradiated breast. The increased need for early detection of changes associated with breast lymphedema can be achievable via noninvasive, safe, cheap, and easily repeatable devices.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 Potential Role of Smartphone Addiction on Sleep Quality and Perceived Neck Pain Among Undergraduate Physiotherapy Students: A Multicentered Cross-Sectional Study(2024) Tuğral, Alper; Tuğral, YağmurPurpose: This study aimed to analyze the possible associations between smartphone addiction, perceived neck pain, and sleep quality among undergraduate physiotherapy students. Material and Methods: Students were asked to fill out the Smartphone Addiction Scale (SAS), the Neck Bournemouth Questionnaire (NBQ), and the Pittsburgh Sleep Quality Index (PSQI) on the Google Forms platform, accessed online via a QR code. Results: 355 physiotherapy students were included in this study. Considering the threshold value of 5 in PSQI which is accepted as an indicator of poor sleep, 285 out of 355 students (80.3%) showed higher scores (mean:9.73±2.68) than this threshold. A structural equation model showed that the NBQ had a significant effect on the SAS (B= .223; p=.031), and the SAS, in turn, had a significant effect on the PSQI (B=.021; p=.003). It was shown that 7% of the association between the NBQ and the PSQI was explained by the SAS acting as a mediator. Conclusion: Smartphone addiction should be considered to prevent future potential musculoskeletal complaints as well as to preserve and improve the academic performance of students from the perspectives of the associations between sleep quality and perceived neck pain.Öğe Quality of life and somatic physical function of patients with colorectal cancer who underwent oxaliplatin-based systemic chemotherapy: a prospective study(Springer, 2024) Tuğral, Alper; Kebabçı, Eyup; Aribas, Zeynep; Akyol, Murat; Can, Aysegul; Bakar, YeşimintroductionThis 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) Tuğral, Alper; Akyol, Murat; Colakoglu, Oyku; Bakar, YeşimBreast 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) İsmailoğlu, Elif Günay; Özdemir, Kadirhan; Tuğral, Alper; Bakar, YeşimObjective: 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 Translation, reliability, and validation of the Turkish version of the Lymphedema Quality-of-Life tool in Turkish-speaking patients with lower limb Lymphedema(Elsevier Science Inc, 2019) Bakar, Yeşim; Tuğral, AlperThe aim of this study was to translate the original English version of the Lymph Quality-of-Life Questionnaire (LYMQoL) into Turkish language and test its reliability and validity in patients with lower limb lymphedema (LLL). A total of 119 patients (86 women and 33 men) with LLL were enrolled in this study. The Turkish version of the Nottingham Health Profile was used to evaluate the criterion validity of related domains in LYMQoL. The LYMQoL was performed after seven days to evaluate its test-retest reliability. Cronbach's alpha value was found to be 0.94 for internal consistency, and the intraclass correlation coefficient score for test-retest reliability was found to be 0.95. The intraclass correlation coefficient score of domains ranged between 0.83 and 0.92. For the criterion validity, functional aspects'' and symptoms'' domains moderately correlated significantly with the Nottingham Health Profile total score. Kappa values ranged from 0.356 to 0.715. According to the factor analysis, four factors that explain the 71% of the cumulative variance were found. In conclusion, this study indicates that the Turkish version of the LYMQoL is a reliable valid tool for the evaluation of disease-specific health-related quality of life in patients with LLL. It can be safely used in both clinical routine and research.Öğe Understanding changes in pulmonary function and functional status in breast cancer patients after systemic chemotherapy and radiotherapy: a prospective study(Bmc, 2024) Tuğral, Alper; Aribas, Zeynep; Akyol, Murat; Bakar, YeşimBackgroundRespiratory 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.Öğe View of Perceived Symptoms Associated with Chemotherapyinduced Peripheral Neuropathy in Patients with Breast Cancer: A Cross-sectional Study(2024) Tuğral, Alper; Akyol, MuratObjective: This cross-sectional study aimed to assess the perceived chemotherapy-induced peripheral neuropathy (CIPN) symptoms in patients with breast cancer who received taxane-based chemotherapy. Methods: A total of 74 patients with breast cancer who underwent taxane-based chemotherapy were screened and invited to participate in this study. Perceived symptoms of CIPN were assessed via the European Organization for Research and Treatment of Cancer-Chemotherapy Induced Peripheral Neuropathy (EORTC-CIPN20) questionnaire after the completion of systemic treatment within a month and a half. Sensory, motor, and autonomic subscale scores were calculated and analyzed for each patient. Results: This study included 52 patients with breast cancer. The mean total exposure dose was 2093.92±1266.22 mg. The rates of adjuvant and neoadjuvant chemotherapy were similar (n=25 vs. n=27). Most patients underwent breast-conserving surgery (65.4%). The types of chemotherapy regimen were combined anthracycline and paclitaxel (n=28), docetaxel (n=14), and combined anthracycline, pertuzumab, trastuzumab, and docetaxel (n=10). Patients who underwent modified radical mastectomy had significantly higher scores in the perceived symptoms of CIPN motor function subscale of EORTCCIPN20 (z=-2.838, p=0.005). The autonomic subscale of EORTC-CIPN20 was significantly correlated with age (r=-0.373, p=0.006) and with the total exposure dose of chemotherapy (r=0.295, p=0.034). Conclusion: The type of surgery, specifically MRM, which has been emphasized as a contributing factor to CIPN, should be taken into consideration for further potential deterioration. By this means, it is reasonable to state that not only ongoing monitoring of the CIPN is of utmost importance, but also potential contributors to the management of the CIPN are of great importance.
