Objectives: This study aims to investigate the effects of extracorporeal shock wave therapy (ESWT) on pain, sleep, fatigue, disability, depression, and quality of life (QoL) in patients with myofascial pain syndrome (MPS). Patients and methods: Between March 2018 and September 2018, a total of 94 patients (16 males, 78 females; mean age 44.2±11.94 years; range, 19 to 74 years) with the diagnosis of MPS were included in the study. The patients were divided into two groups. The treatment group consisted of 49 patients and a total of seven sessions of high-energy flux density ESWT (H-ESWT) (0.26 mJ/mm 2) were given with three days interval. The control group consisted of 45 patients and the treatment of hot pack, transcutaneous electrical nerve stimulation, and ultrasound was given for five days for two weeks. At baseline and one month after treatment, the visual analog scale (VAS), Short Form-36 (SF-36), Pittsburgh Sleep Quality Index (PSQI), Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale, Neck Disability Index (NDI), and Beck Depression Inventory (BDI) scores were compared between the groups. Results: There were no statistically significant differences in the age, sex, demographic characteristics, and baseline VAS, SF-36, NDI, BDI, FACIT, and PSQI scores between the groups (p>0.05). In the ESWT group, there was a statistically significant decrease in the VAS, SF-36, NDI, BDI, FACIT, and PSQI scores after treatment compared to the baseline scores, while only the SF-36 subscale scores were statistically significantly higher (p<0.05). There was a statistically significant correlation between the VAS and SF-36 scores and the BDI, NDI, FACIT and PSQI scores after the treatment. Conclusion: Our study results suggest that H-ESWT is more effective than traditional physical therapy methods on pain, QoL, sleep, fatigue, depression, and disability in patients with MPS.

Objectives: This study aims to assess the effects of isokinetic quadriceps and hamstring strengthening exercises on balance, proprioception, and physical function in patients with moderate-to-severe knee osteoarthritis and moderate fall risk. Patients and methods: Between November 2011 and December 2012, a total of 39 participants (30 females, 9 males; mean age 61.7±8.6 years; range, 18 to 79 years) with Grade 2 or 3 knee osteoarthritis according to the Kellgren-Lawrence radiographic grading system and moderate risk of fall with active knee pain were included in this study. All participants received isokinetic quadriceps and hamstring strengthening exercises for six weeks. Pre-treatment quadriceps and hamstring muscle strength (peak torque and total work value) and quadriceps to hamstring muscle strength ratio at angular velocities of 60°/sec and 180°/sec, range of motion (ROM), average proprioceptive errors at 15-45° and 30-60°, the Berg Balance Scale (BBS) scores, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscale scores, the Visual Analog Scale (VAS) scores, and physical function tests results were compared with the post-treatment results. The correlations of pre-and post-treatment BBS and average proprioceptive error at 15-45° and 30-60° changes to other pre-and post-treatment clinical measurements changes were calculated. Results: Post-treatment quadriceps and hamstring muscle strength at angular velocities of 60°/sec and 180°/sec and quadriceps to hamstring muscle strength ratios at angular velocity of 60°/sec, ROM, average proprioceptive errors at 15-45° and 30-60°, BBS scores, WOMAC subscale scores, VAS scores, and physical function tests significantly improved compared to the pre-treatment results (p<0.001). Statistically significant correlations were found between the pre-and post-treatment BBS score changes and pre-and post-treatment VAS (p=0.015), WOMAC-Pain (p=0.017), WOMAC-Physical Function (p=0.005) scores and Timed Up and Go Test (p=0.036) scores. Conclusion: Inclusion of isokinetic quadriceps and hamstring strengthening exercises into the rehabilitation programs for the patients with knee osteoarthritis may improve the quality of life and contribute to the decreased risk of fall.

Background: Osteoarthritis is the most prevalent form of joint disease, and the most common location is the knee. Objectives: The aim of this study was to determine the effect of acupuncture treatment and physiotherapy on pain, physical function, and quality of life (QOL) in patients with knee osteoarthritis (KOA). Study Design: This study was a prospective, randomized, controlled clinical trial. Settings: The research took place in the interventional pain unit of a tertiary center in a university hospital. Methods: One hundred patients with KOA were randomly divided into the acupuncture group and the physiotherapy group. Both treatments were given in 12 sessions over 6 weeks. Thirteen acupuncture points were selected for the knee. Local points were GB34, SP10, SP9, ST36, ST35, ST34, EX-LE2, EXLE5, EXLE4, and distal (distant) points were defined as KI3, SP6, LI4, and ST41. The Visual Analog Scale (VAS) was used to measure pain intensity. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the 36-Item Short Form Health Survey (SF-36) were used to determine functional status and health-related QOL, respectively. All patients were evaluated at baseline, after the last treatment, and at the 12-week follow-up period. Results: There was no statistically significant difference between the acupuncture group and physiotherapy group in terms of pain, total WOMAC, and SF-36 levels at baseline, after treatment, and at the 12th week after treatment (P > 0.05). Both treatments significantly improved functional status (acupuncture, from 63.8 ± 20.81 to 53.72 ± 19.43; and physiotherapy, from 59.04 ± 21.49 to 52.28 ± 19.54; P < 0.05) and decreased the level of pain assessed by VAS (acupuncture, from 8.32 ± 1.61 to 5.54 ± 2.34; and physiotherapy, from 7.86 ± 1.9 to 5.68 ± 2.42; P < 0.05) at the 12-week follow-up of the study. There was no adverse advent related to therapeutic methods. Limitations: Sham or placebo control groups are lacking in this study. Conclusions: The acupuncture and physiotherapy performed twice weekly for 6 weeks have similar effects with regard to pain, functional status, and QOL. There were no significant differences between the acupuncture and physiotherapy groups in relief of pain, improved functional status, and QOL in the treatment of KOA. Both acupuncture and physiotherapy treatments were found to yield significantly superior results when compared with baseline values. Key words: Knee osteoarthritis, acupuncture, physiotherapy, randomized clinical trial