Objectives:This study aims to assess the effect of short-wave therapy (SWT) devices emitting radiofrequency (RF) waves on the proliferation rates of fibroblasts and neoplastic cells. Patients and methods:In this experimental study, fibroblasts cultured from sternal mesenchymal cells of a bypass surgery patient were enriched using stem cell techniques between January 2004 and February 2004. The K-562 and ML-1 neoplastic cell lines were prepared for analysis. Fibroblasts and neoplastic cell lines were exposed to 27.12 MHz short-waves at different energy levels. Continuous short-wave (CSW) was applied at 200 W power, and pulsed short-wave (PSW) was applied at three different mean powers: 1.6 W (PSW-1), 14.9 W (PSW-2), and 54 W (PSW-3). Fibroblast colonies were counted using inverted microscopy, and neoplastic cell proliferation rates were measured using enzyme-linked immunosorbent assay. All short-wave-exposed cells were compared to the controls with no exposure. Results:Short-waves increased the number of fibroblast colonies three- to four-fold across all power levels (1.6 W, 14.9 W, 54 W, and 200 W). They significantly increased K-562 cell proliferation only at 1.6 W and 54 W power levels (p=0.044 and p=0.004, respectively). In contrast, there was no significant increase in ML-1 cell proliferation at any power level tested (p>0.05). Conclusion:This study found that short-waves can boost fibroblast proliferation, potentially aiding tendon healing. However, it also had unpredictable proliferative effects on K-562 cells, as an inconsistent correlation with energy levels was observed. The ML-1 cells were not affected by short-waves, suggesting variability in tumor biology. These findings emphasize the need for precise dosing and personalized treatment strategies when using SWT devices.

OBJECTIVE:The aim of this study was to compare exercise, continuous short-wave diathermy (SWD) and intermittent SWD treatment modalities and to evaluate the effects of these treatments on chronic back pain and depression.METHODS:This study is an intervention trial which evaluated patients who applied to our clinic due to chronic low back pain between 2008-2009. The study group consisted of 90 patients between the ages of 40-65 who had had low back pain for more than 6 months. The patients were randomized into three groups. The first group received placebo short-wave diathermy, the second group received continuous short-wave diathermy, and the third group received pulsed short-wave diathermy. Pain was evaluated by Visual Analog Scale (VAS) and the Pain Disability Index (PDI).The Modified Oswestry Low Back Pain Disability Questionnaire Form was used for the measurement of functional deficiency and the Beck Depression Inventory (BDI) was used for the evaluation of depression.All scales were performed before the treatment, immediately after treatment and 3 months after treatment.RESULTS:Significant decreases in PDI and VAS scores were found in all groups (p<0.05 for each). Similarly, there was a significant improvement in all groups in terms of functional deficiency(p<0.001 for each), while no differences were found between groups (p = 0.895). In terms of BDI scores, there was no improvement in those receiving only exercise, while Group 2 and 3 had significant improvements (p <0.05). When groups were compared for BDI scores, no differences were found between any of the groups (p = 0.189).CONCLUSION:Continuous SWD treatment with exercise was found to be more effective in reducing pain in patients with chronic low back pain than other treatment modalities used in our study. Although there was no significant difference between the groups in terms of depressive mood, it was found that those receiving continuous and pulsed SWD treatment had significant improvements in depression as measured by the BDI.

BACKGROUND/AIMS This study aimed to determine the effects of back school therapy, a home exercise program, and shortwave diathermy treatment on the quality of life of patients with chronic low back pain. MATERIAL and METHODS In this interventional study, we evaluated 90 patients who were admitted to our clinic from 2006 to 2007 and had been followed-up for their low back pain complaints that had been present for at least 6 months. These patients were randomized into 3 groups after being subjected to back school therapy and home exercise programs. Placebo shortwave, continuous shortwave diathermy, and pulsed shortwave diathermy treatments were applied to these three groups, respectively. The Short form 36 (SF-36) was used to evaluate the quality of life of the study groups. RESULTS In this study, statistically significant recovery was achieved in all the three groups in terms of physical function, role limitations due to physical problems, and bodily pain criteria. Those who received the diathermy therapy had higher mean scores in terms of all the three criteria mentioned above. CONCLUSION Significant improvements were achieved within the study groups in terms of all the above-mentioned criteria, except for "role limitations due to emotional problems", as measured by SF-36. However, we could not find any significant difference between the groups in terms of the quality of life.

As a result of the current demographics, increased projections of osteoporosis (OP) and prevalence of the disease in Turkey, a panel of multidisciplinary experts developed a thorough review to assist clinicians in identifying OP and associated fracture risk patients, diagnosing the disease with the appropriate available diagnostic methods, classifying the disease, and initiating appropriate treatment. The panel expects to increase the awareness of this prevalent disease, decrease consequences of OP with corresponding cost savings and, ultimately, decrease the overall burden of OP and related fractures in Turkey. Background OP is not officially accepted as a chronic disease in Turkey despite the high prevalence and predicted increase in the following years. However, there are areas where the country is performing well, such as having a country-specific fracture risk assessment model, DXA access, and the uptake of FRAX. Additional efforts are required to decrease the existing treatment gap estimating 75-90% of patients do not receive pharmacological intervention for secondary prevention, and the diagnosis rate is around 25%. Methods A selected panel of Turkish experts in fields related to osteoporosis was provided with a series of relevant questions to address prior to the multi-day conference. Within this conference, each narrative was discussed and edited by the entire group, through numerous drafts and rounds of discussion until a consensus was achieved. Represented in the panel were a number of societies including The Turkish Osteoporosis Society, The Society of Endocrinology and Metabolism of Turkey (SEMT), and The Turkish Society of Physical Medicine and Rehabilitation. Results Standardized general guidelines to identify OP and related fractures and at-risk population in Turkey, which will enable clinicians to accurately and effectively diagnose the disease, treat the appropriate patients with available pharmacological and non-pharmacological treatments and decrease the burden of the disease. Conclusions This manuscript provides a review of the current state of OP and related fractures in Turkey. Moreover, this manuscript reviews current international guidelines and national studies and proposes a number of helpful country-specific classifications that can be used by healthcare providers caring for the at-risk population. Additionally, the panel proposes practical recommendations that should be implemented nationally in order to decrease the burden of OP and related fractures and effectively preventing the burden in future generations.

Although positive effect of kinesiotaping in reducing back pain in addition to exercise was observed in 6-week follow-up, no additional contribution to exercise was demonstrated in kyphosis angle and balance assessment. Instantaneous positive effect of taping was observed in kyphosis angle and static balance measurement using a SportKAT device measurements 30 min after taping. The present study aims to investigate whether kinesiotaping for posture correction in patients with osteoporosis-related increased kyphosis provides additional benefits to routine osteoporosis and balance exercises in reducing dorsal kyphosis angle, pain, and balance. A single-center, parallel-group randomized controlled trial with unblinded assessments at baseline, week 3, and week 6 and additional measures 30 min immediately after taping in intervention group only. Forty-two female osteoporotic patients with hyperkyphosis were enrolled and randomized into 2 groups. The intervention group received an exercise program plus 3 sessions of kinesiotaping over the upper back; the control group received only an exercise program. The primary outcome measure was dorsal kyphosis angle, measured using a digital inclinometer. Secondary outcome measures were pain assessed on a visual analog scale (VAS 0–10 cm) and balance assessed with the Berg Balance Scale and SportKAT device. The study was conducted on 22 patients with an average age of 64 ± 7.08 in the control group and 20 patients with an average age of 63.1 ± 8.8 in the treatment group. There was not a significant difference when dorsal kyphosis angle of the two groups was compared in terms of the change between the baseline and week 6. The mean change in the control group was 0.86 ± 2 while it was 0.70 ± 1.75 in the intervention group. No significant difference was detected between the groups in terms of balance measurements. Significant differences were seen in favor of the intervention group when the VAS pain scores of the two groups were compared in terms of the change between the baseline and week 3 (p < 0.001) and the baseline and week 6 (p < 0.001), while no such difference was identified when the changes between weeks 3 and 6 were compared between the two groups. A significant effect on dorsal kyphosis angle and balance was also shown in the treatment group 30 min after taping. Application of kinesiotaping may have short-term positive effects on pain, but is unlikely to have significant effects on kyphosis angle or balance for women with osteoporosis. Positive changes seen in kyphosis angle and balance 30 min after taping are short-lived.

Objectives This study aims to estimate the prevalence of rheumatoid arthritis (RA) and spondyloarthritis (SpA) in Turkey using the same telephone questionnaire developed for screening RA and SpA in France and used in Serbia and Lithuania. Material and methods The study was performed in two steps. In step I, the French questionnaire was translated into Turkish and validated through a group of 200 patients (80 males, 120 females; mean age 44.0±13.1 years; range 19 to 75 years) followed up at the rheumatology departments of University Hospitals in Antalya and Ankara. In step II, the validated Turkish questionnaire was administered face-to-face to randomly selected 4,012 subjects (1,670 males, 2,342 females; mean age 41.5±16.8 years; range 16 to 97 years) by trained general practitioners across the country, in 25 prov- inces for case detection. The subjects who were suspected of having RA or SpA in accordance with the questionnaire were invited to the nearest university hospital for rheumatologic examination in order to confirm the diagnosis. Results In step II, a total of 25 subjects (2 males, 23 females) were diagnosed as RA. The standardized RA prevalence for the general population of Turkey was calculated as 0.56% (95% confidence interval [CI]; 0.33-0.79), 0.10% (95% CI; -0.05-0.25) for males and 0.89% (95% CI; 0.51-1.27) for females. A total of 18 subjects (3 males, 15 females) were diagnosed as SpA. The standardized SpA prevalence for the general population of Turkey was 0.46% (95% CI; 0.25-0.67), 0.17% (95% CI; -0.03-0.37) for males and 0.65% (95% CI; 0.32-0.98) for females. The prevalence of RA was highest in the Northern region (2.00%) and the prevalence of SpA was highest in the Central region (1.49%). Conclusion The prevalences of RA and SpA in Turkey are close to each other and there are significant inter-regional variations in prevalences of both RA and SpA.

Introduction: The aim of this study was to investigate the effect of posture support corset (kypho-orthosis) on balance, quality of life, and dorsal kyphosis angle in patients with kyphosis due to osteoporosis.Materials and Method: Twenty-nine patients were randomized into two groups. One group (n=14) was given the conventional osteoporosis exercises, and the other group (n=15) was given the kypho-orthosis in addition to these exercises. Kyphosis angle and height were measured. Evaluations were done by Kinesthetic Ability Trainer device, single foot balance test, Timed Up & Go Test, Berg Balance Scale, Quality of Life Questionnaire of the European Foundation for Osteoporosis at baseline, and after one and three months.Results: In both groups, a significant improvement was found after treatment in terms of values measured by Timed Up & Go Test, Berg Balance Scale, right and left foot balance test, the physical and mental functional dimensions of quality of life and dorsal kyphosis angle. A significant difference was found in height at three months in the corset group.Conclusion: Using kypho-orthosis does not provide additional benefit to the exercise program on balance, dorsal kyphosis angle and the quality of life; but it contributes to height increase by providing the patients with a more vertical posture.

Objectives: This study aims to identify the frequency of clinical risk factors associated with osteoporosis in postmenopausal women.Patients and methods: In this cross-sectional, observational, multicenter study, a total of 730 postmenopausal women were assessed for risk factors associated with osteoporosis. The assessment included a standardized questionnaire which recorded the following clinical risk factors: family and personal histories of fractures, prolonged immobilization, sun exposure, lifelong sedentary lifestyle, smoking history, low calcium intake in childhood and adulthood, excessive caffeine intake, high sodium intake, inadequate protein intake, number of pregnancies, age at menopause, the presence of premature menopause, primary and secondary amenorrhea, medical conditions, and chronic use of prescription drugs.Results: The most frequent clinical risk factors for osteoporosis were inadequate sun exposure (53.3%), current sedentary lifestyle (52.9%), low calcium intake in adulthood (45.1%) and childhood (41.9%), and sedentary lifestyle in adolescence (27.9%). A total of 707 patients (96.5%) described more than one risk factor, while 74.3% of the patients reported one clinical risk factor at least for secondary osteoporosis.Conclusion: Adequate sun exposure and proper intake of dietary calcium beginning in childhood combined with lifelong daily physical activity may play a role in preventing osteoporosis in postmenopausal women. In addition, physicians should be aware of the high probability of secondary osteoporosis in this patient group.

Objective: Osteoporosis is an important health problem with regard to morbidity, mortality, and negative effects on quality of life as well as health-related costs. Distal radius fracture is one of the most frequent fractures and it has been shown to be associated with an increased risk of further fractures. Awareness and treatment of osteoporosis is important to prevent further fractures in patients with osteoporosis. The aim of this study was to evaluate the awareness of osteoporosis and related factors in distal radius fracture patients. Materials and Methods: A total of 120 low-energy distal radius fracture patients aged 45 years and over were included in the study. A questionnaire was applied in all patients after they gave their consent. Results: In our patients 40.8% had awareness about osteoporosis, and 59.2% did not. About the educational levels 47.5% of patients were not able to read and write or were primary school graduates, 52.5% were secondary or high school graduates. Awareness of osteoporosis was positively correlated with education. With regard to sources of information, 50% of patients reported physicians as the main source of information. Conclusion: We demonstrated that the level of awareness of osteoporosis is associated with educational level in distal radius fracture patients. Awareness of osteoporosis and thus to begin treatment earlier is important to prevent further fractures in distal radius fracture patients. Turk J Phys Med Rehab 2013;59:52-6.

A candidate identification questionnaire (CIQ) was tested to determine its predictive value for patient-reported satisfaction in patients switched from once-weekly or once-daily treatment with a bisphosphonate to once-monthly dosing. This was a prospective, open-label, multicenter international study in patients with postmenopausal osteoporosis who had been receiving once-daily or once-weekly alendronate or risendronate for at least 3 months. Patients completed a CIQ, then commenced 150 mg monthly ibandronate for 6 months. Patients completed the Osteoporosis Patient Satisfaction Questionnaire (OPSAT-QTM) at baseline for 6 months. Scores were converted to composite satisfaction scores (CSS, scale 0-100). Totally 677 patients completed a CIQ, 645 were enrolled in the treatment phase and comprised the intent-to-treat (ITT) population, and 630 completed the study. In the ITT population, 68.1% patients answered “yes” to one or more CIQ questions. OPSAT-Q scores increased for the convenience, quality of life and overall satisfaction domains (p scores for the side effects domains were significant (p preferred the once-monthly dosing schedule and 563 patients (90.7%) found it more convenient. The most common adverse events were dyspepsia (1.9%), nausea (1.1%), and upper abdominal pain (0.9%). Patients are likely to prefer treatment with monthly ibandronate to a weekly or monthly bisphosphonate irrespective of their stated preference before switching treatment.

Aim: The purpose of this multicenter descriptive study is to determine the preferences of physiatrists in our country for anti-osteoporotic drugs in patients with primary and secondary osteoporosis.Materials and Methods: This study was carried out in 10 provinces of Turkey. The diagnosis of osteoporosis was based on World Health Organization criteria using dual-energy x-ray absorptiometry. Patients with a spine and/or hip T-score <=-2.5 were considered as osteoporotic. 714 patients over 18 years old with primary or secondary osteoporosis were included in the study. In addition to socio-demographic characteristics and chronic use of medications and/or additional systemic diseases that cause secondary osteoporosis were questioned and antiosteoporotic drugs that are recommended by their physicians were recorded.Results: The physicians' preferred vitamin D and calcium as the prior treatment both in primary and secondary osteoporosis. The most commonly used anti-osteoporotic agent was alendronate from the biphosphonate group. It was followed by ibandronate, risedronate, strontium ranelate, calcitonin, zoledronate, raloxifene, parathyroid hormone (PTH) and hormone replacement therapy (HRT) in the primary osteoporosis and risedronate, ibandronate, calcitonin, strontium ranelate, zoledronate, PTH, HRT and raloxifene in the secondary osteoporosis, respectively.Conclusion: The physician should choose the most suitable treatment for the patient based on fracture risk, medical history, previous treatments for osteoporosis, concomitant diseases, treatment-induced risks and benefits, and the relation between financial cost and potential benefit.

Aim: BONCURE (Bonviva for Current Bisphosphonate Users Regional European Trial), aimed to evaluate patient preference with monthly ibandronate in women with postmenopausal osteoporosis who previously received daily or weekly alendronate or risendronate.Materials and Methods: This prospective, open-label study consisted of two sequential stages, Part A (screening) and Part B (treatment). Patients enrolled into Part A completed the Candidate Identification Questionnaire (CIQ). In Part B, after completing the Osteoporosis Patient Satisfaction Questionnaire (OPSATQ), patients received monthly oral ibandronate 150 mg for 6 months. Following treatment, patients completed the OPSAT-Q and Preference Questionnaire.Results: A total of 223 patients (mean age, 63.7 +/- 9.51 years) were enrolled in Part A from Turkey. Among them, 103 (46.2%) answered "YES" to at least one CIQ question. The mean composite OPSAT-Q domain scores increased for convenience (mean change, 15.3 +/- 17.7 points), quality of life (10.4 +/- 20.4 points), overall satisfaction (11.9 +/- 22.7 points), and side effects (3.3 +/- 18.8 points). At month 6, 177 subjects (92.7%) preferred once-monthly dosing schedule and 99.0% were compliant (>= 80%) with study treatment. Thirty (15.6%) subjects experienced mild to moderate adverse events, mostly gastrointestinal.Conclusion: Postmenopausal women with osteoporosis prefer and are more satisfied and compliant with monthly dosing of ibandronate than daily or weekly bisphosphonate treatment. (Turkish Journal of Osteoporosis 2012; 18: 1-7)

Introduction: The aim of the present study is to investigate the factors,affecting osteoporosis and subclinical vertebral fracture in patients with peripheral arterial disease(PAD).Materials and Method: Eighty patients over 45 years of age with a diagnosis of PAD and without a history of osteoporosis were included in the study. The patients were queried in terms of demographic characteristics,calcium intake and physical activity. BMD was measured by a dual energy X-ray absorbsiometer (DEXA). The loss of vertebral height was determined. PAD was staged according to Fontaine's classification. Serum calcium,phosphorus,alkaline phosphatase, 25(OH)D, parathormone, homocysteine and B12 levels were measured and thyroid,renal and hepatic function tests were performed.Results: According to the DEXA measurements, 19.17% (14)of the patients had osteoporosis while 63.01%(46) of them had osteopenia. Of the patients 28(36.70%)and 8(10.12%) had grade 1 and grade 2 vertebral fractures, respectively. Radiologically confirmed vertebral fractures were not present in 43(53.2%) patients. No significant relation was found between the stage of the PAD, BMD and t scores (p>0.05). On the other hand,subclinical vertebral fractures significantly correlated with the stage of the disease and the weakness symptom (p<0.05).Conclusion: The stage of the disease showed no correlation with osteoporosis,but correlated with the grade of subclinical vertebral fracture. Thus, this group of patients should be investigated for osteoporosis and evaluated both with BMD measurement and direct radiography.

Atamaz FC, Durmaz B, Baydar M, Demircioglu OY, Iyiyapici A, Kuran B, Oncel S, Sendur OF. Comparison of the efficacy of transcutaneous electrical nerve stimulation, interferential currents, and shortwave diathermy in knee osteoarthritis: a double-blind, randomized, controlled, multi-center study. Arch Phys Med Rehabil 2012;93:748-56.Objective: To compare the effectiveness of transcutaneous electrical nerve stimulation (TENS), interferential currents (IFCs), and shortwave diathermy (SWD) against each other and sham intervention with exercise training and education as a multimodal package.Design: A double-blind, randomized, controlled, multicenter trial.Setting: Departments of physical medicine and rehabilitation in 4 centers.Participants: Patients (N=203) with knee osteoarthritis (OA).Interventions: The patients were randomized by the principal center into the following 6 treatment groups: TENS sham, TENS, IFCs sham, IFCs, SWD sham, and SWD. All interventions were applied 5 times a week for 3 weeks. In addition, exercises and an education program were given. The exercises were carried out as part of a home-based training program after 3 weeks' supervised group exercise.Main Outcome Measures: Primary outcome was a visual analog scale (0-100mm) to assess knee pain. Other outcome measures were time to walk a distance of 15m, range of motion, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Nottingham Health Profile, and paracetamol intake (in grams).Results: We found a significant decrease in all assessment parameters (P<.05), without a significant difference among the groups except WOMAC stiffness score and range of motion. However, the intake of paracetamol was significantly lower in each treatment group when compared with the sham groups at 3 months (P<.05). Also, the patients in the IFCs group used a lower amount of paracetamol at 6 months (P<.05) in comparison with the IFCs sham group.Conclusions: Although all groups showed significant improvements, we can suggest that the use of physical therapy agents in knee OA provided additional benefits in improving pain because paracetamol intake was significantly higher in the patients who were treated with 3 sham interventions in addition to exercise and education.

Objective: The purpose of this study was to research the presence of osteoporosis and Subclinical Vertebral Fracture (SVF) in patients with a fracture of the distal end of the radius (FDER). Metarials and Methods: The patients over 45 years of age who presented with a FDER following a trauma and not evaluated for osteoporosis after FDER were included in the study Calcium intake of the subjects was assessed using the European Vertebral Osteoporosis Study (EVOS) Questionnaire and the physical activity level was evaluated. Dual Energy X-ray Absorptiometry (DXA) measurements and thoracic and lumbar spine radiographs were performed for detecting SVE Vertebral height loss was assessed according to Genant's classification. In order to determine the secondary causes of osteoporosis, biochemical tests were done. Results: The average age of 42 patients included in the study was 59.26 +/- 9.19; and the average body mass index was 26.33 +/- 3.21. 21 patients were diagnosed as having osteoporosis and 14 patients were detected to have SW. The average number of the fractures was 0.82 +/- 1.33 (0-4) and the fracture grade was 1. The average score of physical activities was found to be 12.43 +/- 5.31 and the calcium score was 9.65 +/- 3.34. The rate of patients who did not have osteoporosis according to DXA, however demonstrated SVF was reported to be 11.9%. When the patients with and without SVF were compared, no significant difference was not found with regard to demographical characteristics and biochemical indicators. Conclusion: FDERs are frequent osteoporotic fractures and are also accepted as a predictor of hip and vertebral fractures associated with higher level of morbidity and mortality. SVF may be present in patients with FDER even if the diagnosis of osteoporosis is not established by DXA. Turk J Phys Med Rehab 2012;58:220-4.

Osteoarthritis is the most common form of arthritis. Current treatment of osteoarthritis includes nonpharmacologic and pharmacologic modalities. Balneotherapy (or spa therapy) for patients with osteoarthritis is one of the oldest forms of nonpharmacologic therapy. Balneotherapy methods include mineral baths, mud therapy, hydropinotherapy and inhalation therapy. In this review the effectiveness of balneotherapy in prevention and treatment of osteoarthritis is presented in the light of current knowledge.

Aim: The aim of this study was to investigate the relationship between vertebral fractures and spondylosis and bone mineral density in men older than 60 years. Material and Method: Thirty-two men with back and low back pain aged over 60 years were included into the study. Thoracic and lumbar spine radiographs were taken and, anterior, central and posterior heights of each vertebral body from T4 to L5 was measured and than the number of vertebral fractures was assessed. Osteophyte and disc scores were used for evaluation of spondylosis. Bone mineral density was measured by dual-energy-X-ray absorptiometry. Measurements were obtained from lumbar vertebrae and proximal femoral region. Results: Significant positive correlations were found between vertebral fracture and osteophyte score and bone mineral density of total femoral region. When osteophyte score and total femoral bone mineral density were taken into consideration, there were no significant correlations between other parameters and vertebral fracture. Significant positive correlations were observed between osteophyte score and bone mineral density and t scores of L1-4. Also there were significant positive correlations between disc score and both bone mineral density and t scores of L1-4. Significant positive correlation was also found between femoral bone density and body weight. Conclusion: Finally, lumbar bone mineral density increases with spinal degenerative changes, but the increase in bone mineral density can not prevent sub clinic vertebral fractures. Especially, in the men who have intensive spinal degenerative changes, the measurement of lumbar bone mineral density is not enough for determining the fracture risk. Measurement of femoral bone mineral density and evaluation of clinic risk factors are more important for determining the fracture risk. (From the World of Osteoporosis 2008;14:1-6)

Abstract Background/objective: To show the efficacy, safety, and tolerability of sildenafil in men with erectile dysfunction (ED) associated with complete or incomplete spinal cord injury (SCI) and to assess its effects onquality of life (Qol) using the Life-Satisfaction Check List. Methods: This was a placebo-controlled, multicenter, randomized, double-blind, flexible-dose, 2-way crossover study with a 2-week washout period between each phase. Patients with ED attributable to SCI(Sexual Health Inventory-Male score ≤21) received 50 to 100 mg sildenafil (n = 24) or placebo (n = 26). Results: Compared with placebo, sildenafil produced higher levels of successful sexual stimulation,intercourse success, satisfaction with sexual life and sexual relationship, erectile function, overall sexual satisfaction, and an improved Erectile Dysfunction Inventory of Treatment Satisfaction score, with no clinically relevant effects onvital signs. Sildenafil seemed more effective in patients with incomplete SCI than in those with complete SCI, producing significant improvements, compared with placebo, in a number of measures only in patients with incomplete SCI. All patients who expressed a preference selected sildenafil over placebo, although the drug had no effect on patient Qol. Sildenafil was well tolerated, with a profile comparable to that of placebo. Conclusions: Compared with placebo, treatment with oral sildenafil safelyand effectively improved erectile function in patients with ED attributable to SCI, especially in those with incomplete injury, and was theagent of choice in those who expressed a preference.