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    Assessment of voiding dysfunction in Parkinson's disease: Reliability and validity of the Turkish version of the Danish Prostate Symptom Score
    (Wiley, 2017) Akkoc, Yesim; Gok, Haydar; Karapolat, Hale; Ersoz, Murat; Sungur, Ulas; Koklu, Kurtulus; Alemdaroglu, Ebru; Tunc, Hakan; Acarer, Ahmet; Ozer, Inci Sule; Akbostanci, Cenk; Arli, Berna; Yoldas, Tahir Kurtulus
    AimsTo investigate the reliability and validity of the Turkish version of the Danish Prostate Symptom Score (Dan-PSS) questionnaire in patients with Parkinson's disease (PD) and to compare the burden of LUTS (Lower urinary tract symptoms) in men and women. MethodsFor analysis of test-retest reliability, the Turkish version of the Dan-PSS scale was developed using the back translation method, and it was administered on the day of admission and repeated 1 week after in 60 patients with PD. The OAB-q (Overactive Bladder Questionnaire) and PDQ-39 (Parkinson's Disease Questionnaire-39) were administered to 73 patients for validity analysis. ResultsBoth the internal consistency (Cronbach's alpha coefficient: 0.99-1.00) and the test-retest reliability (intraclass correlation coefficient: 0.99-1.00) of the Dan-PSS were found to be high in patients with PD. Although weak to moderate correlations were found between the subscales of the Dan-PSS and PDQ-39 (r: 0.20-0.42; P<0.05), a strong correlation was found with the OAB-q (r: 0.60-0.79; P<0.05). Nocturnal urination was the most frequent (93.2%), and bothersome (54.8%) symptom. The majority of the symptom and bother responses were similar in men and women. ConclusionsCurrent study shows that the Turkish version of the Dan-PSS questionnaire is an internally consistent, reliable, and valid scale for patients with PD. Therefore, it can be used to evaluate frequency and severity of LUTS in PD. LUTS are commonly seen in patients with PD in both sexes. It is suggested that all patients with PD should be referred for urological assessment.
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    The Awareness of Physicians and Allied Health Professionals about Cardiopulmonary Rehabilitation: A Cross-Sectional Survey Study
    (Aves, 2014) Sarikaya, Selda; Tur, Birkan Sonel; Kurtais, Yesim; Karapolat, Hale Uzumcugil; Soyupek, Feray; Hafiz, Meliha; Sarp, Umit; Cakit, Burcu Duyur; Demirsoy, Nesrin; Taskiran, Ozden Ozyemisci; Erdogdu, Deniz Dulgeroglu; Sutbeyaz, Serap Tomruk; Alemdaroglu, Ebru; Delialioglu, Sibel Unsal; Dogan, Asuman; Gokkaya, N. Kutay Ordu; Koseoglu, Fusun; Guzel, Rengin; Ayhan, F. Figen; Tuncay, Figen; Kulcu, Duygu Geler; Eksioglu, Emel
    Objective: Cardiopulmonary (CPR) programs were developed to improve and stabilize the physical, psychological, social, mental, professional, and economic conditions of patients with cardiovascular and pulmonary diseases. Although it is known that CPR reduces mortality and morbidity, it is not widely implemented as it is in Turkey. In this study, we aimed to determine the level of CPR awareness among physicians and allied health professionals. Material and Methods: This was a multi-center, cross-sectional survey study. The study included physicians, nurses, physiotherapists, and other allied health professionals who were informed about the survey and provided written consent to participate. Results: A total of 727 volunteers from 12 different centers were included in the study. Of the participants, 59.5% were physicians, 31.4% were nurses, 5.9% were physiotherapists, and 3.2% were other allied health professionals; 79.3% participants answered the question on if they have had any idea about CPR. Participants indicated that patients should be referred to cardiac pulmonary rehabilitation after a coronary artery bypass (83.8%), chronic obstructive pulmonary disease (83.2%), and cardiac valve surgery (38.9%). Only 40.1% of the survey participants provided information about CPR to patients, while 20.5% did not provide any information about CPR. Conclusion: This survey study determined that in centers where CPR could be implemented, health professionals have knowledge about CPR. If the study were conducted nationwide, the level of awareness might be even lower. Although it is an idea of CPR, the level of knowledge for this issue is not adequate. As the number of the CPR centers will increase, the knowledge of doctors and allied health professionals will advance.
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    Cross-sectional study of urinary problems in adults with cerebral palsy: awareness and impact on the quality of life
    (Springer-Verlag Italia Srl, 2017) Yildiz, Necmettin; Akkoc, Yesim; Ersoz, Murat; Gunduz, Berrin; Erhan, Belgin; Yesil, Hilal; Bardak, Ayse Nur; Ozdolap, Senay; Tunc, Hakan; Koklu, Kurtulus; Alemdaroglu, Ebru; Erden, Ender; Sungur, Ulas; Satir, Ozlem; Erdogan, Cagdas; Alkan, Hakan
    We aimed to assess the functional status, urinary problems, and awareness of these problems in adults with cerebral palsy (CP) and their relationship with the quality of life. One-hundred-seventeen adults with CP (53 women, 64 men) were included in this study. Subjects were asked to fill out a urological questionnaire which dealt with urinary symptoms, awareness of urinary problems, and pharmacological treatment they received. Subjects were also assessed with the Gross Motor Function Classification System (GMFCS), Functional Independence Measures (FIM), Functional Mobility Scale (FMS), and King's Health Questionnaire (KHQ). The mean age of the subjects was 25.3 +/- 7.8 years. Of the patients, 83.8% were currently unemployed, 95.7% were single, and 96.5% were living with family. Of the patients, 20.5% had experienced frequency, 38.5% had nocturia, 48.7% had urgency, and 36.8% had urge urinary incontinence. Approximately 80% of the patients did not refer to physician due to urinary problems, and 60% of patients were not recorded history about urinary problem by any physician. Urge urinary incontinence was statistically more frequent in females than males (54.7 and 21.9%,respectively, p < 0.05). Female patients had significantly higher KHQ incontinence impact, role limitation, physical limitation, emotion, incontinence severity measures, and symptom severity subgroup scores than male patients (p < 0.05). Urge urinary incontinence was most frequent (65.4%) in spastic quadriplegic CP (p < 0.05). All functional status scores (GMFCS, FIM-toilet transfer, and FMSs) were worse in spastic quadriplegic patients than other topographical involvement of CP (p < 0.0125). Although the urinary problems are common in adult with CP, it is yet an overlooked condition that could affect quality of life. Therefore, health care professionals, patients, and their caregivers should be aware of the increased risk of urinary problems in these patients.
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    An evaluation of bladder emptying methods and the effect of demographic and clinical factors on spontaneous voiding frequency in stroke patients
    (Springer, 2013) Ersoz, Murat; Erhan, Belgin; Akkoc, Yesim; Zinnuroglu, Murat; Yildiz, Necmettin; Gok, Haydar; Ozdolap, Senay; Tunc, Hakan; Kaya, Kurtulus; Alemdaroglu, Ebru; Susuzer, Sedat; Gunduz, Berrin; Bardak, Ayse Nur; Ozcan, Seda; Yesil, Hilal; Uygunol, Kursat; Konukcu, Sibel; Gunes, Nese; Ege, Ferhat
    In this study, the bladder emptying methods at different stages of the post-stroke period along with the effects of demographic and clinical parameters on spontaneous voiding frequency were investigated. The frequencies of bladder emptying methods at admission to the rehabilitation clinic, after neurourological and urodynamic assessment and at home after discharge were spontaneous voiding (SV) 51/99 (51.5 %), 62/99 (62.6 %), 73/99 (73.7 %), emptying without a urinary catheter + an external collector system (EWUC + ECS) 24/99 (24.2 %), 18/99 (18.2 %), 17/99 (17.2 %), intermittent catheterization (IC) 1/99 (1.0 %), 15/99 (15.2 %), 6/99 (6.1 %), indwelling urethral catheter (IUC) 23/99 (23.2 %), 4/99 (4.0 %) and 3/99 (3.0 %), respectively. Lower spontaneous voiding frequencies were observed in single-divorced and geriatric individuals (p < 0.05). The number of patients who modified the method at home was 2/62 for SV, 5/18 for EWUC + ECS, 9/15 for IC, and 2/4 for IUC. The majority of stroke patients were able to void spontaneously and the spontaneous voiding frequency increased at follow-up. The spontaneous voiding frequency was low in geriatric and single-divorced subgroups. The method in which the most changes occurred was IC.
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    Overactive bladder symptoms in patients with multiple sclerosis: Frequency, severity, diagnosis and treatment
    (Taylor & Francis Ltd, 2016) Akkoc, Yesim; Ersoz, Murat; Yuceyar, Nur; Tunc, Hakan; Koklu, Kurtulus; Yoldas, Tahir Kurtulus; Donmez, Ulku; Uzunkopru, Cihat; Alemdaroglu, Ebru; Bilen, Sule; Emre, Ufuk; Otzdolap, Senay; Tuncay, Elif; Yucesan, Canan; Gok, Haydar; Ercan, Merve Bahar; Uygunol, Kursat; Kocer, Belgin; Zinnuroglu, Murat
    Objective: To determine the frequency and severity as well as the diagnosis and treatment of overactive bladder problems in patients with multiple sclerosis (MS) followed up at five centers in Turkey. Design: Survey study. Setting: Outpatient tertiary clinics of physical medicine and rehabilitation and neurology. Participants: Consecutive MS patients scheduled for outpatient follow-up (n=309). Intervention: MS patients were asked to complete a questionnaire regarding the frequency and severity, as well as the diagnosis and treatment of their overactive bladder problems. Results: The mean age +/- SD was 39.3 +/- 10.6 years. Urinary urgency was the most common urinary symptom (62%), followed by frequency (50.4%), urge incontinence (44.7%) and nocturia (33%). Residual urine volume was measured using a portable ultrasound instrument in 13.3% of the patients and by catheterization in 16.2% of them. Urodynamic investigations and urinary tract ultrasound were performed on 26.5% and 35.3% of the patients, respectively. Anticholinergic medications were prescribed for 27.5% of the patients. Intermittent catheterization and indwelling catheterization were used on 8.1% and 1.9% of the patients, respectively. The overactive bladder symptom score (OABSS) was significantly higher in patients who had had residual urine measurement (P<0.001), upper urinary tract assessment by ultrasound (P<0.001), urodynamic assessment (P<0.001), admitted to a doctor for urinary symptoms (P<0.001), and current or past catheter use (P=0.002). Conclusion: Urgency was the most common urinary symptom followed by frequency, urge incontinence and nocturia in MS patients. The patients with lower OABSS had detailed urological assessments less frequently than the patients with higher OABSS.
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    Post-stroke lower urinary system dysfunction and its relation with functional and mental status: a multicenter cross-sectional study
    (Taylor & Francis Ltd, 2019) Akkoc, Yesim; Bardak, Ayse Nur; Ersoz, Murat; Yilmaz, Bilge; Yildiz, Necmettin; Erhan, Belgin; Tunc, Hakan; Koklu, Kurtulus; Alemdaroglu, Ebru; Dogan, Asuman; Ozisler, Zuhal; Koyuncu, Engin; Atalay, Nilgun Simsir; Gunduz, Berrin; Isik, Ridvan; Guler, Ayse; Sekizkardes, Merve; Demir, Yasin; Yasar, Evren; Sasmaz, Ezgi; Satir, Ozlem
    Background: Review of the literature clearly reveals that little is known about the association between functional and mental status, and Lower Urinary Tract Dysfunction (LUTD) in patients with stroke. Objective: The aim of this study was to assess functional and mental status in stroke patients and to identify possible associations with the prevalence, severity and bother of LUTD. Material and methods: This study was designed as a cross-sectional study and included 260 stroke patients enrolled from six different hospitals in Turkey. The patients were questioned using the Danish Prostatic Symptom Score (DAN-PSS) Questionnaire to evaluate LUTD, and evaluated using the Modified Barthel Index (MBI), Incontinence Quality of Life Questionnaire (I-QoL), and the Mini Mental State Examination (MMSE). Results: At least one LUTD finding was reported in 243 (93.5%) patients; the most commonly encountered complaint in these patients was nocturia (75.8%). The mean MBI, MMSE, and I-QoL scores were found to be significantly lower in LUTD (+) patients compared to LUTD (-) patients (p = 0.000, p = 0.005, and p < 0.01, respectively). Similarly all parameters (MBI, MMSE, and I-QoL scores) assessed were found to be significantly lower for patients with urinary incontinence than those without incontinence (p = 0.000, p = 0.000, and p < 0.01, respectively). Conclusion: LUTD is a common problem in patients with stroke. LUTD is associated with poorer cognitive and functional status and the quality of life in these patients. We, therefore, suggest that bladder dysfunction should not be overlooked during rehabilitation of stroke patients.
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    Which swallowing difficulty of food consistency is best predictor for oropharyngeal dysphagia risk in older person?
    (Springer, 2019) Umay, Ebru; Eyigor, Sibel; Karahan, Ali Yavuz; Keskin, Dilek; Karaca, Gulten; Unlu, Zeliha; Tikiz, Canan; Vural, Meltem; Aydeniz, Banu; Alemdaroglu, Ebru; Bilir, Emine Esra; Yaliman, Ayse; Sen, Ekin Ilke; Akaltun, Mazlum Serdar; Altindag, Ozlem; Keles, Betul Yavuz; Bilgilisoy, Meral; Ozcete, Zeynep Alev; Demirhan, Aylin; Gundogdu, Ibrahim
    Key summary pointsAimOur aim was to investigate which swallowing difficulty of food consistency in older people who did not have any disease that might affect swallowing functions, and which symptoms were most likely related to oropharyngeal dysphagia (OD) risk.FindingsWe have found that the eating/drinking difficulty of thick liquids was the highest predictive value with respect to OD risk and the eating difficulty of mixed content food had the highest diagnostic ratio.MessageThe present study reports that even in older person who do not go to the hospital with the complaints of swallowing difficulty, the difficulty of swallowing thick liquids and especially the mixed content food should be questioned. AbstractPurposeThe present study aimed to investigate which swallowing difficulty of food consistency in participants over 65years of age who did not have any disease that might affect swallowing functions, and which symptoms were most likely related to oropharyngeal dysphagia (OD).MethodsThe cross-sectional and multicenter study was conducted at 12 hospitals including 883 participants aged >= 65years who were fed orally and who were admitted to the physical medicine and rehabilitation outpatient clinics between September 2017 and December 2018. Demographic characteristics were recorded. Katz Daily Living Activities Index (KDLAI), swallowing-related quality of life scale (Swal-QoL) and 10-item Eating Assessment Tool (EAT-10) were used. The participants were asked the yes or no questions including swallowing difficulty of various types of food consistency with the face-to-face interview.ResultsParticipants were divided into two groups as normal swallowing (EAT-10<3 group) (n=639) and OD risk groups (EAT-10 >= 3 group) (n=244) according to the EAT-10 scores. While there was no difference related to number of teeth and KDLAI scores between groups (p=0.327 and p=0.221, respectively), the significant difference was found between groups in terms of yes/no questions and Swal-QoL scores (p<0.05). Receiver operating characteristic analysis revealed that eating difficulty of mixed content food provided maximum sensitivity (99%) and eating/drinking difficulty of thick liquid had maximum specificity (77%). The higher area under curve was in eating/drinking difficulty of thick liquid (0.891), and higher positive likelihood ratio (LR) was eating/drinking difficulty of thick liquid (4.26) as well as lower negative LR was eating difficulty of mixed content food (0.01). The higher diagnostic odds ratio was eating difficulty of mixed content food (367.0), and the higher posttest probability was eating/drinking difficulty of thick liquid (0.211).ConclusionWhile eating difficulty of hard solid food is the most common symptom in healthy participants over 65years of age, the eating difficulty of thick liquids is the highest predictive value related to oropharyngeal dysphagia risk. Also, the eating difficulty of mixed content food had the highest diagnostic ratio.