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Ylinen J, Pasanen T, Heinonen A, Kivistö H, Kautiainen H, Multanen J. Trunk muscle activation of core stabilization exercises in subjects with and without chronic low back pain. J Back Musculoskelet Rehabil 2024:BMR230043. [PMID: 38250755 DOI: 10.3233/bmr-230043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND Weakness and atrophy in trunk muscles have been associated with chronic low back pain (CLBP). OBJECTIVE This study aimed to identify isometric exercises resulting the highest trunk muscle activity for individuals with and without CLBP. METHODS Fourteen males with CLBP and 15 healthy age-matched healthy subjects were recruited for this study. Muscle activity during maximal voluntary isometric contraction (MVIC) was measured for a comparative reference with surface electromyography (sEMG) from six trunk muscles. Thereafter maximum EMG amplitude values were measured during eleven trunk stability exercises. The maximal EMG activity in each exercise relative to the MVICs was analyzed using generalizing estimating equations (GEE) models with the unstructured correlation structure. RESULTS The GEE models showed statistically significant differences in muscle activity between exercises within both groups (p< 0.001), with no significant differences between groups (p> 0.05). The highest muscle activity was achieved with the hip flexion machine for multifidus, side pull with a resistance band for lumbar extensors, side and single-arm cable pull exercises for thoracic extensors, rotary plank and the hip flexion machine for abdominal. CONCLUSION This study found five isometric trunk exercises that exhibited highest muscle activity depending on muscle tested, with no significant difference between individuals with and without CLBP.
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Affiliation(s)
- Jari Ylinen
- Department of Physical Medicine and Rehabilitation, NOVA, Central Hospital of Central Finland, Jyväskylä, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Tero Pasanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Ari Heinonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Heikki Kivistö
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Hannu Kautiainen
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Juhani Multanen
- Department of Physical Medicine and Rehabilitation, NOVA, Central Hospital of Central Finland, Jyväskylä, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Kilpikoski S, Häkkinen AH, Repo JP, Kyrölä K, Multanen J, Kankaanpää M, Vainionpää A, Takala EP, Kautiainen H, Ylinen J. The McKenzie Method versus guideline-based advice in the treatment of sciatica: 24-month outcomes of a randomised clinical trial. Clin Rehabil 2024; 38:72-84. [PMID: 37605454 DOI: 10.1177/02692155231196393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
OBJECTIVE To compare the effectiveness of a McKenzie Method intervention in patients with sciatica with guideline-based patient education. DESIGN Multi-centre, assessor-blinded, parallel-group, randomised trial. SETTING Two tertiary hospitals providing operative spinal care. SUBJECTS Sciatica patients with magnetic resonance imaging-confirmed lumbar disc herniation compressing a nerve root. INTERVENTIONS The McKenzie group received specific back exercises for seven visits combined with an educational book, and the Control group received a single session of self-management guidance according to usual practices. MAIN MEASURES The primary outcome was the number of surgical operations. Secondary outcomes were pain measured using the Visual Analogue Scale, disability using the Oswestry Disability Index and health-related quality of life using a RAND-36 questionnaire at baseline and 24-month follow-up. RESULTS Altogether 66 patients, mean age of 43 years, of which 50% were females with long-lasting sciatica, mean 16 weeks, were randomised to two groups. Nineteen patients (29%) had surgery. There was no significant difference in surgery rates between the groups. Back and leg pain decreased, and disability improved in both groups. Health-related quality of life improved in six dimensions out of eight in both groups. There were no significant between-group changes in the patient-reported outcomes at the follow-up. CONCLUSIONS Multiple sessions of McKenzie-based back exercises with a McKenzie-specific patient's educational book produced effects equal to guideline-based advice at long-term follow-up. However, the power of these results is diminished due to the small patient population and confounding factors.
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Affiliation(s)
- Sinikka Kilpikoski
- Department of Physical Medicine and Rehabilitation, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Arja H Häkkinen
- Department of Physical Medicine and Rehabilitation, Jyväskylä Central Hospital, Jyväskylä, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jussi P Repo
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Kati Kyrölä
- Orthopaedics and Traumatology, Hospital NOVA, Central Finland Health Care District, Jyväskylä, Finland
| | - Juhani Multanen
- Department of Physical Medicine and Rehabilitation, Jyväskylä Central Hospital, Jyväskylä, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Markku Kankaanpää
- Department of Rehabilitation and Psychosocial Support, Tampere University Hospital, Tampere, Finland
| | - Aki Vainionpää
- Department of Rehabilitation, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Esa-Pekka Takala
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Jyväskylä Central Hospital, Jyväskylä, Finland
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Rinne M, Garam S, Kukkonen-Harjula K, Tokola K, Häkkinen A, Ylinen J, Nikander R. Response to the letter to the editor by Treleaven et al., May 14, 2023. Clin Rehabil 2023; 37:1575-1576. [PMID: 37408318 DOI: 10.1177/02692155231185469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Affiliation(s)
- Marjo Rinne
- Health Promotion Research, UKK Institute for Health Promotion Research, Tampere, Finland
| | - Sanna Garam
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
| | | | - Kari Tokola
- Health Promotion Research, UKK Institute for Health Promotion Research, Tampere, Finland
| | - Arja Häkkinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Riku Nikander
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland
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Rinne M, Garam S, Kukkonen-Harjula K, Tokola K, Häkkinen A, Ylinen J, Nikander R. Neck-Shoulder Region Training for Chronic Headache in Women: A Randomized Controlled Trial. Clin Rehabil 2023; 37:1322-1331. [PMID: 37097883 PMCID: PMC10426253 DOI: 10.1177/02692155231170687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 03/29/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVES We investigated whether a specific exercise program for the neck-shoulder region reduces headache intensity, frequency, and duration, and how it influences neck disability among women with chronic headache compared to a control group. DESIGN Two-center randomized controlled trial. SUBJECTS 116 working-age women. INTERVENTION The exercise group (n = 57) performed a home-based program with six progressive exercise modules, over 6 months. The control group (n = 59) underwent six placebo-dosed transcutaneous electrical nerve stimulation sessions. Both groups performed stretching exercises. MAIN MEASURES The primary outcome was pain intensity of headache, assessed using the Numeric Pain Rating Scale. Secondary outcomes were frequency and duration of weekly headaches, and neck disability assessed using the Neck Disability Index. Generalized linear mixed models were used. RESULTS Mean pain intensity at baseline was 4.7 (95% CI 4.4 to 5.0) in the exercise group and 4.8 (4.5 to 5.1) in the control group. After 6 months the decrease was slight with no between-group difference. Headache frequency decreased from 4.5 (3.9 to 5.1) to 2.4 (1.8 to 3.0) days/week in the exercise group, and from 4.4 (3.6 to 5.1) to 3.0 (2.4 to 3.6) in the control group (between-group p = 0.017). Headache duration decreased in both groups, with no between-group difference. Greater improvement in the Neck Disability Index was found in the exercise group (between-group change -1.6 [95% CI -3.1 to -0.2] points). CONCLUSION The progressive exercise program almost halved headache frequency. The exercise program could be recommended as one treatment option for women with chronic headache.
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Affiliation(s)
- Marjo Rinne
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Sanna Garam
- School of Rehabilitation and Examination, Metropolia University of Applied Sciences, Helsinki, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | | | - Kari Tokola
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Arja Häkkinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Department of Physical Medicine and Rehabilitation, Central Hospital of Central Finland and Central Finland Wellbeing Services County, Jyväskylä, Finland
| | - Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Central Hospital of Central Finland and Central Finland Wellbeing Services County, Jyväskylä, Finland
| | - Riku Nikander
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Department of Physical Medicine and Rehabilitation, Central Hospital of Central Finland and Central Finland Wellbeing Services County, Jyväskylä, Finland
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Kilpikoski S, Suominen EN, Repo JP, Häkkinen AH, Kyrölä K, Kautiainen H, Ylinen J. Comparison of magnetic resonance imaging findings among sciatica patients classified as centralizers or non-centralizers. J Man Manip Ther 2023; 31:358-367. [PMID: 36756675 PMCID: PMC10566442 DOI: 10.1080/10669817.2023.2174555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 01/22/2023] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVE To compare if the degenerative findings from MRI differ between the sciatica patients classified as centralizers (CEN) and non-centralizers (Non-CEN) according to the McKenzie Method of mechanical diagnosis and therapy. STUDY DESIGN A cross-sectional study. METHODS Patients (N = 100) referred to a spine clinic of a single tertiary hospital for specialist consultation for sciatica. The McKenzie-based assessment was performed by the mechanical diagnosis and therapy-trained physiotherapists. Clinical data and prevalence of lumbar MRI findings were compared between the groups. RESULTS There was no significant difference in leg pain intensity between the groups. The Non-CEN had significantly more intense back pain, mean 56 (SD 30) and were more disabled 44 (SD 15) compared to the CEN mean 41 (SD 25) and mean 31 (11), measured with a visual analogue scale (0-100), and the Oswestry Disability Index (0-100), respectively. The CEN had more severe degenerative findings on MRI than the Non-CEN: vertebral end-plate changes were 63% and 43%; mean Pfirrmann's disc degeneration lumbar summary score was 12.8, and 10.6; and severity score of total damage was 12.0 and 10.1, respectively. There were differences neither in disc contour changes nor nerve root stenosis on MRI. CONCLUSIONS Sciatica patients classified as non-centralizers had significantly more severe back pain, and were significantly more disabled than centralizers, who instead had more severe degenerative findings on MRI. Thus, classification to non-centralizers by the McKenzie method seems not predict higher incidence of degenerative findings on MRI compared to centralizers.
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Affiliation(s)
- Sinikka Kilpikoski
- Department of Physical and Rehabilitation Medicine, Centra’ Finland Health Care District Hospital, Jyvaskyla, Finland
| | | | - Jussi P Repo
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Arja H Häkkinen
- Faculty of Health Sciences, Univeristy of Jyväskylä, Jyväskylä, Finland
| | - Kati Kyrölä
- Consultant Surgeon Orthopaedics and Traumatology, Docent. Chief Orthopaedic Surgeon, Hospital NOVA, Central Finland Health Care District, Jyvaskyla, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Helsinki, Finland
| | - Jari Ylinen
- Department of Physical and Rehabilitation Medicine, Centra’ Finland Health Care District Hospital, Jyvaskyla, Finland
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Cederqvist S, Flinkkilä T, Ylinen J, Kautiainen H, Tuominen A, Kiviranta I, Paloneva J. Response to: 'Correspondence on 'Non-surgical and surgical treatments for rotator cuff disease: a pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation'' by Randelli et al. Ann Rheum Dis 2023; 82:e103. [PMID: 33536163 DOI: 10.1136/annrheumdis-2020-219782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/23/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Sanna Cederqvist
- Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Tapio Flinkkilä
- Department of Orthopedics and Traumatology, Oulu University Hospital, Oulu, Finland
| | - Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyvaskyla, Central Finland, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
- Research Center, Folkhälsan, Helsinki, Finland
| | - Antti Tuominen
- Department of Surgery, Central Finland Hospital Nova, Jyvaskyla, Finland
| | - Ilkka Kiviranta
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
- Department of Orthopedics and Traumatology, University of Helsinki, Helsinki, Finland
| | - Juha Paloneva
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Kyrölä K, Hiltunen S, Uimonen MM, Ylinen J, Häkkinen A, Repo JP. Psychometric Properties of the Scoliosis Research Society Questionnaire (Version 22r) Domains Among Adults With Spinal Deformity: A Rasch Measurement Theory Analysis. Neurospine 2022; 19:422-433. [PMID: 35577333 PMCID: PMC9260537 DOI: 10.14245/ns.2143354.677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/10/2022] [Indexed: 11/24/2022] Open
Abstract
Objective Adult spinal deformity (ASD) have lower health-related quality of life (HRQoL) compared to the general population. Applying Rasch measurement theory (RMT), this study tested the revised Scoliosis Research Society-22 (SRS-22r) HRQoL instrument among symptomatic adult patients with degenerative spinal disorders and varying degrees of ASD.
Methods SRS-22r data from 637 outpatient spine clinic patients with degenerative spine conditions were investigated for unidimensionality, item/scale fit, differential item functioning (DIF), scale coverage/targeting, and person separation index (PSI) using RMT.
Results Unidimensionality of the SRS-22r was not supported for either the total score or for 3 of its 5 domains. Item fit was acceptable for 11/22 items. The individual domains showed good coverage despite the degree of structural disorders. Ordered thresholds were achieved by merging response categories in some of the items. DIF towards age or sex was found in 11/22 items and in some domain items. The PSI exceeded 0.7 for the SRS-22r total score.
Conclusion The individual domain scores of the SRS-22r perform better than the total score providing good coverage and targeting among patients with ASD. Refinements of items and domains may improve the structural validity of the instrument to meet the criteria for measuring ASD patients, even when multidimensionality persists.
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Affiliation(s)
- Kati Kyrölä
- Department of Surgery, Central Finland Healthcare District, Jyväskylä, Finland
- Corresponding Author Kati Kyrölä Department of Orthopaedics, Central Finland Healthcare District, Hospital Nova, Hoitajantie 3, 40620 Jyväskylä, Finland
| | - Susanna Hiltunen
- Department of Surgery, Central Finland Healthcare District, Jyväskylä, Finland
- Department of Orthopaedics, Kuopio University Hospital, Kuopio, Finland
| | - Mikko M. Uimonen
- Department of Surgery, Central Finland Healthcare District, Jyväskylä, Finland
| | - Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Central Finland Healthcare District, Jyväskylä, Finland
| | - Arja Häkkinen
- Department of Physical Medicine and Rehabilitation, Central Finland Healthcare District, Jyväskylä, Finland
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jussi P. Repo
- Department of Surgery, Central Finland Healthcare District, Jyväskylä, Finland
- Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Disease, Tampere University Hospital, Tampere, Finland
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Määttä J, Takatalo J, Leinonen T, Pienimäki T, Ylinen J, Häkkinen A. Lower thoracic spine extension mobility is associated with higher intensity of thoracic spine pain. J Man Manip Ther 2022; 30:300-308. [PMID: 35257630 PMCID: PMC9487940 DOI: 10.1080/10669817.2022.2047270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives To evaluate the association of thoracic spine (TS) posture and mobility with TS pain. Methods Participants with TS pain reported maximum, average, and night pain in TS area, and pain summary score was calculated. Upright and sitting TS postures were evaluated by inspection. TS posture and mobility (flexion and extension) were recorded using an inclinometer and a tape measure, respectively. Correlations between posture and mobility assessments were calculated using Spearman rank correlation, the association of TS posture and mobility with TS pain by logistic regression analysis. Results The participants’ (n = 73, 52 females, age range 22–56) TS pain duration was 12 weeks on average. The correlations for measurements of TS posture and flexion mobility were higher than correlations of other TS measurements being between 0.53 and 0.82. Decreased extension mobility of the upper (from 1st to 6th TS segments; Th1–Th6) TS was associated with higher worst pain (OR 1.04, 95% CI 1.00–1.07) and whole TS with pain sum score (OR 1.05, 95% CI 1.01–1.08). Less kyphotic whole TS was associated with lower pain sum score (OR 0.96, 95% CI 0.92–1.00). Greater flexion mobility of upper and lower (Th6–Th12) TS were associated with lower pain sum score (OR 0.96, 95% CI 0.91–1.00, and OR 0.96, 95% CI 0.91–1.00, respectively). Conclusions Reduced thoracic extension mobility was associated with higher pain scores and the greater flexion mobility with lower pain scores. Future research is warranted to evaluate if treatments geared toward TS extension mobility improvements would result in lower TS pain.
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Affiliation(s)
- Juhani Määttä
- Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Loisto Terveys, Oulu, Finland
| | - Jani Takatalo
- Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Loisto Terveys, Oulu, Finland.,Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Tero Leinonen
- Loisto Terveys, Oulu, Finland.,Fysios Oulu, Oulu, Finland
| | - Tuomo Pienimäki
- Department of Physical and Rehabilitation Medicine, University of Oulu, Oulu, Finland
| | - Jari Ylinen
- Central Hospital of Central Finland, Jyväskylä, Finland
| | - Arja Häkkinen
- Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Central Hospital of Central Finland, Jyväskylä, Finland
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Multanen J, Häkkinen A, Kautiainen H, Ylinen J. Associations of neck muscle strength and cervical spine mobility with future neck pain and disability: a prospective 16-year study. BMC Musculoskelet Disord 2021; 22:911. [PMID: 34715847 PMCID: PMC8556991 DOI: 10.1186/s12891-021-04807-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background Neck pain has been associated with weaker neck muscle strength and decreased cervical spine range of motion. However, whether neck muscle strength or cervical spine mobility predict later neck disability has not been demonstrated. In this 16-year prospective study, we investigated whether neck muscle strength and cervical spine mobility are associated with future neck pain and related disability in women pain-free at baseline. Methods Maximal isometric neck muscle strength and passive range of motion (PROM) of the cervical spine of 220 women (mean age 40, standard deviation (SD) 12 years) were measured at baseline between 2000 and 2002. We conducted a postal survey 16 years later to determine whether any subjects had experienced neck pain and related disability. Linear regression analysis adjusted for age and body mass index was used to determine to what extent baseline neck strength and PROM values were associated with future neck pain and related disability assessed using the Neck Disability Index (NDI). Results The regression analysis Beta coefficient remained below 0.1 for all the neck strength and PROM values, indicating no association between neck pain and related disability. Of the 149 (68%) responders, mean NDI was lowest (3.3, SD 3.8) in participants who had experienced no neck pain (n = 50), second lowest (7.7, SD 7.1) in those who had experienced occasional neck pain (n = 94), and highest (19.6, SD 22.0) in those who had experienced chronic neck pain (n = 5). Conclusions This 16-year prospective study found no evidence for an association between either neck muscle strength or mobility and the occurrence in later life of neck pain and disability. Therefore, screening healthy subjects for weaker neck muscle strength or poorer cervical spine mobility cannot be recommended for preventive purposes.
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Affiliation(s)
- Juhani Multanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland. .,Department of Physical Medicine and Rehabilitation, Central Finland Hospital, Jyväskylä, Finland.
| | - Arja Häkkinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Department of Physical Medicine and Rehabilitation, Central Finland Hospital, Jyväskylä, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.,Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Central Finland Hospital, Jyväskylä, Finland
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10
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Abstract
BACKGROUND The Depression Scale (DEPS) is a commonly used screening tool for major depression in studies investigating low back pain, yet it has not been validated for patients with back-specific problems. OBJECTIVE To assess the psychometric properties of the DEPS in patients with degenerative spinal disease. METHODS Six hundred and thirty-seven patients with a degenerative spinal disease completed the DEPS instrument. The Rasch Measurement Theory was applied to analyze the measurement properties of the DEPS. The main hypothesis-driven approach was whether the DEPS would meet relevant psychometric criteria for assessing depressive symptoms among patients with degenerative spinal disease. RESULTS The Mean (SD) DEPS score was 9.2 (6.6). Scale minimum or maximum points among participants were 2.4% and 0.8%, respectively. Cronbach's alpha for internal consistency was 0.92. Person Separation Index for reliability was 0.88. All items had ordered thresholds and seven of the 10 items had good item fit. Unidimensionality of the DEPS was supported (proportion of significant t-tests, 4.5%). CONCLUSIONS This study supports the validity of the DEPS for screening depressive symptoms in patients with degenerative spinal disease.
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Affiliation(s)
- Kati Kyrölä
- Department of Surgery, Central Finland Health Care District Hospital, Jyväskylä, Finland
| | - Arja H Häkkinen
- Department of Physical Medicine and Rehabilitation, Central Finland Health Care District Hospital, Jyväskylä, Finland.,Department of Sports and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Central Finland Health Care District Hospital, Jyväskylä, Finland
| | - Jussi P Repo
- Department of Surgery, Central Finland Health Care District Hospital, Jyväskylä, Finland
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11
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Cederqvist S, Flinkkilä T, Sormaala M, Ylinen J, Kautiainen H, Irmola T, Lehtokangas H, Liukkonen J, Pamilo K, Ridanpää T, Sirniö K, Leppilahti J, Kiviranta I, Paloneva J. Non-surgical and surgical treatments for rotator cuff disease: a pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation. Ann Rheum Dis 2021; 80:796-802. [PMID: 33272959 PMCID: PMC8142425 DOI: 10.1136/annrheumdis-2020-219099] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Rotator cuff disease (RCD) causes prolonged shoulder pain and disability in adults. RCD is a continuum ranging from tendinopathy to full-thickness tendon tear. Recent studies have shown that subacromial decompression and non-surgical treatments provide equivalent results in RCD without a full-thickness tendon lesion. However, the importance of surgery for full-thickness tendon tears remains unclear. METHODS In a pragmatic, randomised, controlled trial, 417 patients with subacromial pain underwent 3-month initial rehabilitation and MRI arthrography (MRA) for the diagnosis of RCD. Of these, 190 shoulders remained symptomatic and were randomised to non-surgical or surgical treatments. The primary outcomes were the mean changes in the Visual Analogue Scale for pain and the Constant Murley Score for shoulder function at the 2-year follow-up. RESULTS At the 2-year follow-up, both non-surgical and surgical treatments for RCD reduced pain and improved shoulder function. The scores differed between groups by 4 (95% CI -3 to 10, p=0.25) for pain and 3.4 (95% CI -0.4 to 7.1, p=0.077) for function. Among patients with full-thickness ruptures, the reduction in pain (13, 95% CI 5 to 22, p=0.002) and improvement in function (7.0, 95% CI 1.8 to 12.2, p=0.008) favoured surgery. CONCLUSIONS Non-surgical and surgical treatments for RCD provided equivalent improvements in pain and function. Therefore, we recommend non-surgical treatment as the primary choice for patients with RCD. However, surgery yielded superior improvement in pain and function for full-thickness rotator cuff rupture. Therefore, rotator cuff repair may be suggested after failed non-surgical treatment. TRIAL REGISTRATION DETAILS ClinicalTrials.gov, NCT00695981 and NCT00637013.
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Affiliation(s)
- Sanna Cederqvist
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Tapio Flinkkilä
- Department of Surgery, Division of Orthopaedic and Trauma Surgery, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Markus Sormaala
- Department of Radiology, Helsinki University Hospital, Helsinki, Finland
| | - Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
| | - Hannu Kautiainen
- Research Center, Folkhälsan, Helsinki, Finland
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Tero Irmola
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Heidi Lehtokangas
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juho Liukkonen
- Department of Emergency Medicine, Central Finland Central Hospital, Jyväskylä, Finland
| | - Konsta Pamilo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Tero Ridanpää
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Kai Sirniö
- Department of Surgery, Division of Orthopaedic and Trauma Surgery, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Juhana Leppilahti
- Department of Surgery, Division of Orthopaedic and Trauma Surgery, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Ilkka Kiviranta
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
- Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland
| | - Juha Paloneva
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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12
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Multanen J, Uimonen MM, Repo JP, Häkkinen A, Ylinen J. Use of conservative therapy before and after surgery for carpal tunnel syndrome. BMC Musculoskelet Disord 2021; 22:484. [PMID: 34039330 PMCID: PMC8157685 DOI: 10.1186/s12891-021-04378-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Conservative therapies are typically offered to individuals who experience mild or intermittent symptoms of carpal tunnel syndrome (CTS) or postoperatively to subjects who have undergone carpal tunnel release. Although long-term studies report mostly positive results for carpal tunnel release, knowledge on the need for conservative treatments following surgery is scarce. The aim of this retrospective cohort study was to examine the use of conservative therapies before and after carpal tunnel releasing surgery. Methods Of 528 patients who underwent carpal tunnel release surgery in the study hospital during the study period, 259 provided sufficiently completed questionnaires (response rate 49 %). The patients completed a questionnaire battery including a sociodemographic, medical history and symptom questionnaire, the Boston Carpal Tunnel Syndrome Questionnaire, 6-item CTS symptoms scale and EuroQoL 5D. Frequencies of conservative therapies pre- and postoperatively were calculated. Association between Pain VAS and satisfaction with treatment were examined in patient groups according to the use of conservative therapies. Results Of all patients, 41 (16 %) reported receiving only preoperative, 18 (7 %) reported receiving only postoperative, 157 (60 %) reported receiving both pre- and postoperative conservative therapies and 43 (17 %) did not receive any therapies. Preoperative use of conservative therapies was more common in females than males (82 % vs. 64 %; p = 0.002), but postoperatively no significant gender difference was observed. The patients who received conservative therapies were younger than non-users in both the preoperative (median age 59 vs. 66; p < 0.001) and postoperative (59 vs. 66; p = 0.04) phases. The patients reported high satisfaction with their treatment and simultaneous improvement in Pain VAS scores. Those receiving conservative therapies only preoperatively reported the highest satisfaction. Conclusions While the use of conservative therapies decreased after surgery, a large proportion of the patients received these adjunct interventions. Patients reported high satisfaction with their treatment one year post surgery. Pain outcome seems to be closely related to satisfaction with treatment. Level of Evidence Level III.
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Affiliation(s)
- Juhani Multanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland. .,Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland.
| | - Mikko M Uimonen
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Jussi P Repo
- Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Arja Häkkinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
| | - Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
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13
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Ylinen J, Pennanen A, Weir A, Häkkinen A, Multanen J. Effect of biomechanical footwear on upper and lower leg muscle activity in comparison with knee brace and normal walking. J Electromyogr Kinesiol 2021; 57:102528. [PMID: 33647872 DOI: 10.1016/j.jelekin.2021.102528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/27/2020] [Accepted: 01/20/2021] [Indexed: 11/29/2022] Open
Abstract
AIM To evaluate the activity of knee stabilizing muscles while using custom-made biomechanical footwear (BF) and to compare it when walking barefoot and with a knee brace (Unloader®). METHODS Seventeen healthy working-aged (mean age: 29 years; standard deviation: 8 years) individuals participated. The knee brace was worn on the right knee and BF in both legs. Surface electromyography (sEMG) data was recorded bilaterally from vastus medialis (VM), semitendinosus (ST), tibialis anterior (TA) and lateral gastrocnemius (LG) muscles during walking, and repeated-measures ANOVA with a post-hoc t-test was used to determine differences between the different walking modalities (barefoot, brace and BF). RESULTS Averaged sEMG was significantly higher when walking with BF than barefoot or knee brace in the ST muscles, in the right LG, and left TA muscle. It was significantly lower when walking with the brace compared to barefoot in the right ST and LG muscles, and left TA muscle. Analysis of the ensemble-averaged sEMG profiles showed earlier activation of TA muscles when walking with BF compared to other walking modalities. CONCLUSION BF produced greater activation in evaluated lower leg muscles compared to barefoot walking. Thus BF may have an exercise effect in rehabilitation and further studies about its effectiveness are warranted.
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Affiliation(s)
- Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland.
| | - Antti Pennanen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland.
| | - Adam Weir
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands; Aspetar Sports Groin Pain Centre, Aspetar Orthopaedic and Sports Hospital, Doha, Qatar; Sport Medicine and Exercise Clinic Haarlem (SBK), Haarlem, the Netherlands
| | - Arja Häkkinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland; Faculty of Sport and Health Sciences, University of Jyväskylä, Finland.
| | - Juhani Multanen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland; Faculty of Sport and Health Sciences, University of Jyväskylä, Finland.
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14
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Multanen J, Ylinen J, Karjalainen T, Ikonen J, Häkkinen A, Repo JP. Structural validity of the Boston Carpal Tunnel Questionnaire and its short version, the 6-Item CTS symptoms scale: a Rasch analysis one year after surgery. BMC Musculoskelet Disord 2020; 21:609. [PMID: 32919457 PMCID: PMC7488577 DOI: 10.1186/s12891-020-03626-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/02/2020] [Indexed: 11/24/2022] Open
Abstract
Background The Boston Carpal Tunnel Questionnaire (BCTQ) and its shorter version, the Six-Item Carpal Tunnel Symptoms Scale (CTS-6), are widely used for assessing function and/or symptoms in patients with carpal tunnel syndrome. This study examined the structural validity of the BCTQ and CTS-6 among patients who had undergone surgery for treatment of carpal tunnel syndrome. Methods The data for this cross-sectional analysis were obtained from 217 adult patients who had undergone carpal tunnel release surgery 1 year earlier. All patients completed the CTS-6, Symptom Severity Scale (SSS) and Functional Status Scale (FSS) of the BCTQ at 12 months after surgery. The Rasch Measurement Theory (RMT) was applied to investigate the unidimensionality, residual correlation, differential item functioning, scale coverage/targeting, and person separation of the CTS-6, SSS and FSS of the BCTQ. Results The FSS showed unidimensionality and good scale and item fit. All items showed ordered response category thresholds. Eight of the FSS items displayed differential item functioning favoring age or gender. The multidimensional structure of the CTS-6 was absorbed by creating a testlet for frequency of symptoms or testlets for pain and numbness. The testlets supported unidimensionality in the BCTQ SSS. One item in the CTS-6 and two items in the BCTQ SSS showed differential item functioning favoring age or gender. Four items in the BCTQ SSS and two items in the CTS-6 exhibited disordered response category thresholds. Merging of the relevant response categories led to ordered response category thresholds. The person separation indices were 0.73, 0.86 and 0.77 for the CTS-6, BCTQ SSS and FSS, respectively. Conclusions Based on the RMT analysis, the CTS-6 has superior psychometric properties compared to the BCTQ SSS in surgically treated patients. The CTS-6 might be more accurate when separated into item sets measuring pain or numbness. The FSS of the BCTQ has acceptable construct validity, although gender differences at some ages were observed in responses.
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Affiliation(s)
- Juhani Multanen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland. .,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
| | - Teemu Karjalainen
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Joona Ikonen
- Department of Hand Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Arja Häkkinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland.,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jussi P Repo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
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15
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Takatalo J, Ylinen J, Pienimäki T, Häkkinen A. Intra- and inter-rater reliability of thoracic spine mobility and posture assessments in subjects with thoracic spine pain. BMC Musculoskelet Disord 2020; 21:529. [PMID: 32778081 PMCID: PMC7418198 DOI: 10.1186/s12891-020-03551-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 07/31/2020] [Indexed: 11/17/2022] Open
Abstract
Background The thoracic spine (TS) has been neglected in the study of the spine despite its essential role in the stability and posture of the entire spinal complex. Therefore, there is an inevitable need to investigate the reproducibility of different thoracic spinal posture measures used in subjects with TS pain. Methods Thirty-two subjects (16 females and 16 males, mean age 39 years) were evaluated by two physiotherapists on the same day to gauge inter-rater reliability and on two consecutive days to gauge intra-rater reliability. TS posture was assessed by observation, and thoracic spine mobility was measured by manual assessment of segmental flexion and extension mobility in a seated position. Additionally, posterior-to-anterior accessory mobility in a prone position was assessed manually. Moreover, cervicothoracic flexion in a seated position, thoracic posture, and thoracic flexion and extension mobility in a standing position were assessed with a tape measure, and flexion and extension mobility in a seated position and TS posture in seated and standing positions were measured with an inclinometer. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), mean difference (MD), Bland-Altman (B&A) plot features and coefficient of repeatability (CR) were calculated. Results The mean and standard deviation (SD) of the duration of TS pain was 22 (SD 45) months, with the intensity of pain being rated at 27 (SD 21) mm on a visual analogue scale (VAS). Intra-rater reliability was very strong (ICC ≥ 0.80) for the evaluation of seated and standing upper TS posture, standing whole TS posture and seated lower TS posture with an inclinometer. Moreover, TS posture evaluation with a measuring tape, posture inspection in a seated position, and manual assessment of segmental extension were found to have very strong intra-rater reliability. Inter-rater reliability was very strong for inclinometer measurements of standing and seated upper TS posture as well as standing whole TS posture. Conclusion Intra-rater reliability was higher than inter-rater reliability in most of the evaluated measurements. Overall, posture measurements with an inclinometer were more reliable than mobility measurements with the same instrument. The manual assessments can be used reliably when same evaluator performs the examination. Trial registration Clinical Trials, NCT01884818. Registered 24 June 2013, https://clinicaltrials.gov/ct2/show/NCT01884818?cond=thoracic+spine&cntry=FI&rank=1
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Affiliation(s)
- Jani Takatalo
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyväskylä, Finland. .,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
| | - Jari Ylinen
- Central Finland Central Hospital, Jyväskylä, Finland
| | - Tuomo Pienimäki
- The Social Insurance Institution of Finland, Helsinki, Finland
| | - Arja Häkkinen
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyväskylä, Finland.,Central Finland Central Hospital, Jyväskylä, Finland
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16
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Multanen J, Kiuru P, Piitulainen K, Ylinen J, Paloneva J, Häkkinen A. Enhanced rehabilitation guidance after arthroscopic capsulolabral repair of the shoulder: a randomized controlled trial. Clin Rehabil 2020; 34:890-900. [PMID: 32380852 PMCID: PMC7350199 DOI: 10.1177/0269215520919472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To compare the effects of a 12-month home-based exercise program to usual care in patients after arthroscopic capsulolabral repair of the shoulder. Design: Randomized controlled trial. Setting: Outpatient physical and rehabilitation medicine clinic. Subjects: Forty-five patients (mean age: 35 years; standard deviation (SD): 10 years) who underwent arthroscopic capsulolabral repair due to labral lesion were randomized into an exercise group (EG) or a control group (CG). Intervention: The EG received a 12-month home-based additional exercise program with four physiotherapy follow-up visits, while the CG received standard postoperative exercise instructions. Main measures: Self-reported shoulder disability was assessed with the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) and quality of life with the Short-Form (SF)-36 Health Survey. The function of the operated shoulder was evaluated with strength and range of motion measurements. Results: No between-group differences were observed in any of the outcomes at the follow-up. Mean ASES score improved by 16 (95% confidence interval (CI): 10–23) points from the baseline 78 (SD: 17) in the EG and 13 (95% CI: 7–19) points from the baseline 79 (SD: 17) in the CG. Both groups achieved a significant improvement in the dimensions of Physical Functioning, Role-Physical, and Bodily Pain of the SF-36 and in every aspect of strength and range of motion measures. In EG, exercise adherence was moderate (52%) during the first six months and poor (22%) during the last six months. Conclusion: Home-based additional exercises with four outpatient follow-up visits did not improve outcome after arthroscopic capsular repair of the shoulder.
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Affiliation(s)
- Juhani Multanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Department of Physical Medicine and Rehabilitation, Central Finland Hospital District, Jyväskylä, Finland
| | - Pauli Kiuru
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Kirsi Piitulainen
- Department of Physical Medicine and Rehabilitation, Central Finland Hospital District, Jyväskylä, Finland
| | - Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Central Finland Hospital District, Jyväskylä, Finland
| | - Juha Paloneva
- Department of Surgery, Central Finland Hospital District, Jyväskylä, Finland.,School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Arja Häkkinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Department of Physical Medicine and Rehabilitation, Central Finland Hospital District, Jyväskylä, Finland
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17
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Multanen J, Ylinen J, Karjalainen T, Kautiainen H, Repo JP, Häkkinen A. Reliability and Validity of The Finnish Version of The Boston Carpal Tunnel Questionnaire among Surgically Treated Carpal Tunnel Syndrome Patients. Scand J Surg 2019; 109:343-350. [PMID: 31132964 DOI: 10.1177/1457496919851607] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS The Boston Carpal Tunnel Questionnaire is the most commonly used outcome measure in the assessment of carpal tunnel syndrome. The purpose of this study was to translate the original Boston Carpal Tunnel Questionnaire into Finnish and validate its psychometric properties. MATERIALS AND METHODS We translated and culturally adapted the Boston Carpal Tunnel Questionnaire into Finnish. Subsequently, 193 patients completed the Finnish version of the Boston Carpal Tunnel Questionnaire, 6-Item CTS Symptoms Scale, and EuroQol 5 Dimensions 12 months after carpal tunnel release. The Boston Carpal Tunnel Questionnaire was re-administered after a 2-week interval. We calculated construct validity, internal consistency, test-retest reliability, and coefficient of repeatability. We also examined floor and ceiling effects. RESULTS The cross-cultural adaptation required only minor modifications to the questions. Both subscales of the Boston Carpal Tunnel Questionnaire (Symptom Severity Scale and Functional Status Scale) correlated significantly with the CTS-6 and EuroQol 5 Dimensions, indicating good construct validity. The Cronbach's alpha was 0.93 for both the Symptom Severity Scale and Functional Status Scale, indicating high internal consistency. Test-retest reliability was excellent, with an intraclass correlation coefficient greater than 0.8 for both scales. The coefficient of repeatability was 0.80 for the Symptom Severity Scale and 0.68 for the Functional Status Scale. We observed a floor effect in the Functional Status Scale in 28% of participants. CONCLUSION Our study shows that the present Finnish version of the Boston Carpal Tunnel Questionnaire is reliable and valid for the evaluation of symptom severity and functional status among surgically treated carpal tunnel syndrome patients. However, owing to the floor effect, the Functional Status Score may have limited ability to detect differences in patients with good post-operative outcomes.
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Affiliation(s)
- J Multanen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
| | - J Ylinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
| | - T Karjalainen
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - H Kautiainen
- Department of General Practice, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - J P Repo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - A Häkkinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland.,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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18
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Kyrölä K, Häkkinen AH, Ylinen J, Repo JP. Further validation of the Scoliosis Research Society (SRS-30) questionnaire among adult patients with degenerative spinal disorder. Disabil Rehabil 2019; 43:98-103. [PMID: 31106613 DOI: 10.1080/09638288.2019.1616327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The Scoliosis Research Society (SRS-30) questionnaire proved valid in measuring health-related quality of life (HRQoL) in adult patients with spinal deformity or degenerative disease. This study further assesses the validity of the SRS-30 by comparing its results with other HRQoL instruments, such as Oswestry disability index (ODI) and the RAND-36, among unselected adult patients with degenerative spinal disorder. MATERIALS AND METHODS 628 consecutive patients completed the SRS-30, the ODI, the pain visual analog scale (VAS), and RAND-36 questionnaires. Using a 9 mm minimal important difference threshold of the VAS, patients were divided into three groups of symptom location: back pain (n = 226), lower extremity pain (n = 161), and combination of both (n = 241). Statistical and illustrative tests using beta coefficients, Rasch measurement analytics, and score distributions were used for analysis. RESULTS The SRS-30 functioned well for all three subgroups. There were small differences in convergent validity of the SRS-30 compared to the ODI and the RAND-36 between the three subgroups. The SRS-30 performed similarly in different pain groups independent of age, gender, or deformity severity. The scale displayed good coverage and targeting for all three subgroups. CONCLUSIONS The SRS-30 proved to provide valid HRQoL scores for all adult patients with degenerative spinal disorders. Implications for Rehabilitation Degenerative spinal conditions associated with spinal deformities are common in patients over 60 years. Low back pain is globally the leading cause of disability. The applicability of the Scoliosis Research Society (SRS-30) questionnaire has not been tested in relation to different pain origins. The SRS-30 proved to provide valid health-related quality of life assessment among patients with degenerative spinal disease independent of pain location. The SRS-30 questionnaire can be used to assess the level of disability and rehabilitation of patients with degenerative spinal disease.
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Affiliation(s)
- Kati Kyrölä
- Department of Orthopaedics and Traumatology, Central Finland Health Care District, Jyväskylä, Finland
| | - Arja H Häkkinen
- Department of Physical Medicine and Rehabilitation, Central Finland Health Care District, Jyväskylä, Finland.,Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Central Finland Health Care District, Jyväskylä, Finland
| | - Jussi P Repo
- Department of Orthopaedics and Traumatology, Central Finland Health Care District, Jyväskylä, Finland
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19
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Ilves OE, Neva MH, Häkkinen K, Dekker J, Kraemer WJ, Tarnanen S, Kyrölä K, Ylinen J, Piitulainen K, Järvenpää S, Kaistila T, Häkkinen A. Trunk Muscle Strength After Lumbar Spine Fusion: A 12-Month Follow-up. Neurospine 2018; 16:332-338. [PMID: 30653909 PMCID: PMC6603846 DOI: 10.14245/ns.1836136.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/06/2018] [Indexed: 11/21/2022] Open
Abstract
Objective The aim of this study was to investigate changes in trunk muscle strength 12 months after lumbar spine fusion (LSF) compared to preoperative strength.
Methods A total of 194 patients (mean±standard deviation [SD] age, 61±21 years) who underwent LSF participated in this prospective longitudinal study. Physical measurements of the participants were made before surgery and 12 months postoperatively. Isometric trunk extension and flexion strength was measured using a strain-gauge dynamometer in the standing position. Strength changes were calculated. Regression analysis was performed to explore which factors predicted strength levels at 12 months postoperatively.
Results The preoperative mean±SD extension strength was 205±144 N, which increased to 258±142 N (p<0.001) at the 12-month follow-up. Flexion strength increased from 295±172 N to 364±164 N (p<0.001). The preoperative extension/flexion strength ratio was 0.75±0.38 and remained similar (0.73±0.26) at 12 months postoperatively (p=0.39).
Conclusion Although trunk muscle strength increased by 26% for extension and 23% for flexion at the 12-month postoperative follow-up, both values remained objectively low. In addition, flexion strength remained higher than extension strength, which indicates an imbalance between those muscle groups. Age, severe back pain, and low trunk muscle strength before surgery predicted low trunk muscle strength at 1 year after spinal fusion.
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Affiliation(s)
- Outi Elina Ilves
- Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Marko Henrik Neva
- Department of Orthopedics and Trauma, Tampere University Hospital, Tampere, Finland
| | - Keijo Häkkinen
- Biology of Physical Activity, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Joost Dekker
- Departments of Rehabilitation Medicine and Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - William J Kraemer
- Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Sami Tarnanen
- Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Kati Kyrölä
- Department of Orthopedics and Traumatology, Central Finland Health Care District, Jyväskylä, Finland
| | - Jari Ylinen
- Department of Orthopedics and Trauma, Tampere University Hospital, Tampere, Finland.,Department of Physical Medicine and Rehabilitation, Central Finland Health Care District, Jyväskylä, Finland
| | - Kirsi Piitulainen
- Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Department of Physical Medicine and Rehabilitation, Central Finland Health Care District, Jyväskylä, Finland
| | - Salme Järvenpää
- Department of Physical Medicine and Rehabilitation, Central Finland Health Care District, Jyväskylä, Finland
| | - Tiina Kaistila
- Department of Orthopedics and Trauma, Tampere University Hospital, Tampere, Finland
| | - Arja Häkkinen
- Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Department of Physical Medicine and Rehabilitation, Central Finland Health Care District, Jyväskylä, Finland
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20
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Multanen J, Häkkinen A, Heikkinen P, Kautiainen H, Mustalampi S, Ylinen J. Pulsed electromagnetic field therapy in the treatment of pain and other symptoms in fibromyalgia: A randomized controlled study. Bioelectromagnetics 2018; 39:405-413. [PMID: 29709070 DOI: 10.1002/bem.22127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 03/12/2018] [Indexed: 11/09/2022]
Abstract
Low-energy pulsed electromagnetic field (PEMF) therapy has been suggested as a promising therapy to increase microcirculation, which is of great concern in patients with fibromyalgia. This study evaluated the effectiveness of PEMF therapy on the treatment of fibromyalgia. A group of 108 women with fibromyalgia were allocated to a 12-week treatment period with an active Bio-Electro-Magnetic-Energy-Regulation (BEMER) device and a similar treatment period with an inactive device. Each patient received active and sham treatments in a random order. Pain and stiffness were assessed on a visual analog scale (VAS, scale 0-100 mm), and functional status was assessed by the Fibromyalgia Impact Questionnaire (FIQ). Mean VAS pain scores before the active and sham treatment periods were 66 (SD 22) and 63 (SD 22), respectively. After treatment periods, mean VAS pain scores had decreased significantly in active treatment, -12, 95% CI [-18, -6], and in sham treatment, -11, 95% CI [-17, -5]. Similarly, the decrease in stiffness and FIQ index after both treatments was statistically significant. However, per-protocol analysis showed no differences between active and sham treatments at any of the outcomes. This study demonstrated that low-energy PEMF therapy was not efficient in reducing pain and stiffness or in improving functioning in women with fibromyalgia. Bioelectromagnetics. 39:405-413, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Juhani Multanen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
| | - Arja Häkkinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland.,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Pauli Heikkinen
- Department of Physics, University of Jyväskylä, Jyväskylä, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.,Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Sirpa Mustalampi
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
| | - Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
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Kyrölä K, Repo J, Mecklin JP, Ylinen J, Kautiainen H, Häkkinen A. Spinopelvic Changes Based on the Simplified SRS-Schwab Adult Spinal Deformity Classification: Relationships With Disability and Health-Related Quality of Life in Adult Patients With Prolonged Degenerative Spinal Disorders. Spine (Phila Pa 1976) 2018; 43:497-502. [PMID: 28767623 DOI: 10.1097/brs.0000000000002370] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional, observational study. OBJECTIVE To study the occurrence of sagittal malalignment, the adaptability of a simplified sagittal modifiers grading of the Scoliosis Research Society (SRS)-Schwab adult spinal deformity (ASD) classification, and the deformity-specific SRS questionnaire version 30 (SRS-30) in an unselected adult cohort with symptomatic degenerative spinal disorders. SUMMARY OF BACKGROUND DATA The sagittal modifiers of the SRS-Schwab ASD classification correlate with health-related quality of life (HRQoL) measures in patients with ASD. The deformities and disabilities caused by sagittal malalignment in patients with common degenerative spinal disorders of multiple etiologies are rarely studied. A simplified and categorizing version of the SRS-Schwab ASD classification in relation to the Oswestry Disability Index (ODI) and the SRS-30 outcomes has not yet been developed. METHODS We recruited 874 consecutive patients with degenerative spinal disorders between March 2013 and February 2014. Full spine radiographs were taken and the patients divided into sagittal deformity severity groups: mild or none, moderate, and marked deformity. Participants completed the ODI, SRS-30, and a general health questionnaire. RESULTS We included 637 patients in the analysis. The severity of sagittal deformity was mild or none in 407 (63.9%) patients, moderate in 159 (25.0%), and marked in 71 (11.1%). Linearity across the modifier grades and deformity classes was found for ODI total score (P = 0.033), and the function/activity (P = 0.004) and self-image/appearance (P = 0.030) domains of the SRS-30. Age, body mass index, duration of symptoms, and the use of painkillers increased while physical activity, working, and educational status decreased significantly with deformity severity. CONCLUSION Sagittal spinopelvic malalignment is significantly related to deterioration of the ODI and the SRS-30 in symptomatic adults with degenerative spinal disorders. The SRS-Schwab classification sagittal modifiers categorized into three groups is a practical tool to detect various clinically significant grades of deformity in a cohort with no recognized ASD. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Kati Kyrölä
- Department of Orthopaedics and Traumatology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Jussi Repo
- Department of Orthopaedics and Traumatology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Jukka-Pekka Mecklin
- Department of Education and Science, Central Finland Health Care District, Jyväskylä, Finland.,Department of Surgery, University of Eastern Finland, Jyväskylä, Finland
| | - Jari Ylinen
- Department of Physical Rehabilitation, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Hannu Kautiainen
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Arja Häkkinen
- Department of Physical Rehabilitation, Central Hospital of Central Finland, Jyväskylä, Finland.,Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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22
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Ilves O, Häkkinen A, Dekker J, Wahlman M, Tarnanen S, Pekkanen L, Ylinen J, Kautiainen H, Neva M. Effectiveness of postoperative home-exercise compared with usual care on kinesiophobia and physical activity in spondylolisthesis: A randomized controlled trial. J Rehabil Med 2017; 49:751-757. [PMID: 28862315 DOI: 10.2340/16501977-2268] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To study the effectiveness of a 12-month exercise therapy on kinesiophobia and physical activity in patients with spondylolisthesis after lumbar spine fusion. DESIGN Randomized controlled trial. SUBJECTS Patients (n = 98) with spondylolisthesis who had undergone lumbar spine fusion. METHODS All patients (mean age 59 years) had received lumbar spine fusion surgery and identical postoperative instructions. Three months postoperatively, they were randomized into an exercise group (n = 48) or usual care group (n = 50). The exercise group received 12-month progressive home-based training with regular booster sessions, and the usual care group a single session of physiotherapy instruction. Kinesiophobia was assessed with the Tampa Scale for Kinesiophobia (TSK) and physical activity by the International Physical Activity Questionnaire (IPAQ) preoperatively, 3 months after lumbar spine fusion, and at the end of the 12-month intervention. RESULTS Before the intervention, the median (first quartile; third quartile) of TSK was 32.5 (29.0; 37.0) in the exercise group and 30.0 (25.8; 36.0) in the usual care group, changing to 30.0 (25; 36) in the exercise group and to 30.5 (24; 36.3) in the usual care group (between-group p = 0.17). IPAQ metabolic equivalent minutes per week increased from 1,863 (1,040; 3,042) to 3,190 (1,634; 6,485) in the exercise group and from 2,569 (1,501; 4,075) to 3,590 (1,634; 6,484) in the usual care group (between-group p = 0.92). CONCLUSION Progressive 12-month home-exercise starting 3 months postoperatively was not superior to usual care in decreasing kinesiophobia or increasing physical activity in spondylolisthesis.
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Affiliation(s)
- Outi Ilves
- Department of Health Sciences, University of Jyvaskyla, 40014 Jyvaskyla, Finland.
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23
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Ylinen J, Salo P, Järvenpää S, Häkkinen A, Nikander R. Isometric endurance test of the cervical flexor muscles – Reliability and normative reference values. J Bodyw Mov Ther 2017; 21:637-641. [DOI: 10.1016/j.jbmt.2017.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 02/06/2017] [Accepted: 02/23/2017] [Indexed: 11/17/2022]
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Heikkilä A, Sevander-Kreus N, Häkkinen A, Vuorenmaa M, Salo P, Konsta P, Ylinen J. Effect of total knee replacement surgery and postoperative 12 month home exercise program on gait parameters. Gait Posture 2017; 53:92-97. [PMID: 28119232 DOI: 10.1016/j.gaitpost.2017.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/06/2016] [Accepted: 01/03/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the effects of surgery and a postoperative progressive home exercise program on gait parameters among individuals operated with total knee arthroplasty. DESIGN Single blinded randomized controlled trial. SUBJECTS 108 patients (84 females, 24 males, mean age 69 years). INTERVENTIONS Patients were equally randomized into an exercise group (EG) and control group (CG). The 12-months progressive home exercise program starting two months postoperatively was compared to usual care. METHODS Gait analysis was performed using the Gaitrite electronic walkway system. In addition, knee extension and flexion strength were measured by a dynamometer preoperatively, and pain on visual analog scale (VAS) at two months and 14 months postoperatively. RESULTS At the 12-month follow-up, maximal gait velocity (p=0.006), cadence (p=0.003) and stance time (p=0.039) showed a greater increase among EG than CG. All the other gait parameters improved among both groups, but with not statistically discernible difference between groups. Weak correlations were found between changes in maximal gait velocity and the knee extension (r=-0.31, p=0.002), flexion strength (r=0.28, p=0.004) and pain during loading (r=-0.27, p=0.005) values. CONCLUSION The intervention produced statistically significant changes in maximal gait velocity, cadence and stance times in the exercise group compared to controls. Although the average change was small it is of importance that biggest changes occurred in those with low performance.
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Affiliation(s)
- A Heikkilä
- Department of Health Sciences, University of Jyväskylä, Keskussairaalantie 4, 40620 Jyväskylä, Finland; Department of Orthopaedic Surgery, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland.
| | - N Sevander-Kreus
- Department of Health Sciences, University of Jyväskylä, Keskussairaalantie 4, 40620 Jyväskylä, Finland; Department of Orthopaedic Surgery, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland.
| | - A Häkkinen
- Department of Health Sciences, University of Jyväskylä, Keskussairaalantie 4, 40620 Jyväskylä, Finland; Department of Physical and Rehabilitation Medicine, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland; Department of Orthopaedic Surgery, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland.
| | - M Vuorenmaa
- Department of Physical and Rehabilitation Medicine, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland; Department of Orthopaedic Surgery, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland.
| | - Petr Salo
- Department of Physical and Rehabilitation Medicine, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland; Department of Orthopaedic Surgery, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland.
| | - P Konsta
- Department of Physical and Rehabilitation Medicine, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland; Department of Orthopaedic Surgery, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland.
| | - J Ylinen
- Department of Physical and Rehabilitation Medicine, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland; Department of Orthopaedic Surgery, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland.
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25
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Mustalampi S, Ylinen J, Korniloff K, Weir A, Häkkinen A. Reduced Neck Muscle Strength and Altered Muscle Mechanical Properties in Cervical Dystonia Following Botulinum Neurotoxin Injections: A Prospective Study. J Mov Disord 2016; 9:44-9. [PMID: 26828215 PMCID: PMC4734985 DOI: 10.14802/jmd.15035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/23/2015] [Accepted: 11/10/2015] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate changes in the strength and mechanical properties of neck muscles and disability in patients with cervical dystonia (CD) during a 12-week period following botulinum neurotoxin (BoNT) injections. Methods Eight patients with CD volunteered for this prospective clinical cohort study. Patients had received BoNT injections regularly in neck muscles at three-month intervals for several years. Maximal isometric neck strength was measured by a dynamometer, and the mechanical properties of the splenius capitis were evaluated using two myotonometers. Clinical assessment was performed using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) before and at 2, 4, 8, and 12 weeks after the BoNT injections. Results Mean maximal isometric neck strength at two weeks after the BoNT injections decreased by 28% in extension, 25% in rotation of the affected side and 17% in flexion. At four weeks, muscle stiffness of the affected side decreased by 17% and tension decreased by 6%. At eight weeks, the muscle elasticity on the affected side increased by 12%. At two weeks after the BoNT injections, the TWSTRS-severity and TWSTRS-total scores decreased by 4.3 and 6.4, respectively. The strength, muscle mechanical properties and TWSTRS scores returned to baseline values at 12 weeks. Conclusions Although maximal neck strength and muscle tone decreased after BoNT injections, the disability improved. The changes observed after BoNT injections were temporary and returned to pre-injection levels within twelve weeks. Despite having a possible negative effect on function and decreasing neck strength, the BoNT injections improved the patients reported disability.
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Affiliation(s)
- Sirpa Mustalampi
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
| | - Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
| | | | - Adam Weir
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Arja Häkkinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland ; Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Paloneva J, Lepola V, Äärimaa V, Joukainen A, Ylinen J, Mattila VM. Increasing incidence of rotator cuff repairs--A nationwide registry study in Finland. BMC Musculoskelet Disord 2015; 16:189. [PMID: 26265152 PMCID: PMC4531533 DOI: 10.1186/s12891-015-0639-6] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 07/16/2015] [Indexed: 12/12/2022] Open
Abstract
Background Rotator cuff repair incidence rates have reportedly increased in the United States and England. Here we analyzed nationwide data relating to rotator cuff repairs recorded in the Finnish National Hospital Discharge Register (NHDR). Methods The NHDR was reviewed to identify adult patients who underwent rotator cuff repair between 1998 and 2011. Incidence rates per 105 person-years were calculated using the annual adult population size. Results During the 14-year time period, 50,646 rotator cuff repairs were performed on subjects aged 18 years or older. The incidence of rotator cuff repair showed an almost linear increase of 204 %, from 44 per 105 person-years in 1998 to 131 per 105 person-years in 2011. The most common concomitant procedure was acromioplasty, which was performed in approximately 40 % of rotator cuff repairs in 2011. Other common concomitant procedures included tenodesis (7 %) and tenotomy (6 %) of the long head of the biceps tendon, and resection of the acromioclavicular joint (3 %). Conclusions This nationwide analysis revealed a remarkable increase in the incidence of rotator cuff repair from 1998 to 2011 in Finland. This progress can be questioned, since there are not convincing data of the superiority of the operative treatment over non-operative management in all rotator cuff tears.
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Affiliation(s)
- Juha Paloneva
- Department of Surgery, Central Finland Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland.
| | - Vesa Lepola
- Division of Orthopedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland.
| | - Ville Äärimaa
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland.
| | - Antti Joukainen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland.
| | - Jari Ylinen
- Department of Physical and Rehabilitation Medicine, Central Finland Hospital, Jyväskylä, Finland.
| | - Ville M Mattila
- Division of Orthopedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland. .,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Division of Orthopedics and Biotechnology, Karolinska Institutet and Department of Orthopedics at Karolinska University Hospital Huddinge, Sweden, and Department of Orthopedics, Tampere University Hospital, Tampere, Finland.
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27
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Salpakoski A, Kallinen M, Kiviranta I, Alen M, Portegijs E, Jämsen E, Ylinen J, Rantanen T, Sipilä S. Type of surgery is associated with pain and walking difficulties among older people with previous hip fracture. Geriatr Gerontol Int 2015; 16:754-61. [PMID: 26178923 DOI: 10.1111/ggi.12552] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2015] [Indexed: 12/21/2022]
Abstract
AIM The aim was to assess the level of lower body pain among people with previous femoral neck fracture, and whether the type of surgery was associated with pain and physical function a mean of 2 years after surgery. METHODS The study included 115 community-dwelling older adults aged 60 years and older with previous femoral neck fracture, and 31 reference subjects without previous lower limb injuries. A total of 30 patients had internal fixation surgery, 70 had hemiarthroplasty and 15 had total hip replacement. All patients had surgery in the same hospital and received typical inpatient rehabilitation. From 1.6 months to 7.5 years after the fracture, the patients underwent examination including clinical evaluation, measurements of pain in the lower body (visual analog scale), physical function (maximal walking speed, Timed Up & Go, Berg Balance Scale) and self-reported walking difficulties. RESULTS Hip fracture patients reported more pain (81 ± 88 mm) compared with the reference group (25 ± 39 mm, P = 0.004). Patients with internal fixation reported significantly more pain than the other study groups. Significantly more patients with internal fixation (53%) reported walking difficulties compared with patients who had hemiarthroplasty (29%, P = 0.028) or total hip replacement (13%, P = 0.018). No significant difference was observed in performance-based physical function between the fracture groups, but participants in the reference group had better physical function than any of the fracture groups. CONCLUSIONS Hip fracture patients treated with internal fixation experienced more pain and walking difficulties than the hemiarthroplasty and total hip replacement groups. Different types of surgical fixation might require different rehabilitation and pain management strategies after hip fracture. Geriatr Gerontol Int 2015; ●●: ●●-●●.
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Affiliation(s)
- Anu Salpakoski
- Research and Development, Mikkeli University of Applied Sciences, Mikkeli, Finland.,Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Mauri Kallinen
- Department of Medical Rehabilitation, Oulu University Hospital, Oulu, Finland
| | - Ilkka Kiviranta
- Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markku Alen
- Department of Medical Rehabilitation, Oulu University Hospital, Oulu, Finland.,Institute of Health Sciences, University of Oulu, Oulu, Finland
| | - Erja Portegijs
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Esa Jämsen
- Service Line of General Practice and Geriatrics, Hatanpää Hospital, Tampere, Finland
| | - Jari Ylinen
- Department of Physical and Rehabilitation Medicine, Central Finland Central Hospital, Jyväskylä, Finland
| | - Taina Rantanen
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Sarianna Sipilä
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Takatalo J, Häkkinen A, Järvenpää S, Ylinen J. Repeatability of a computer-controlled posterior to anterior vertebral stiffness in subjects with thoracic spine pain. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
BACKGROUND AND PURPOSE An increased incidence rate of acromioplasty has been reported; we analyzed data from the Finnish National Hospital Discharge Register. PATIENTS AND METHODS During the 14-year study period (1998-2011), 68,877 acromioplasties without rotator cuff repair were performed on subjects aged 18 years or older. RESULTS The incidence of acromioplasty increased by 117% from 75 to 163 per 10(5) person years between 1998 and 2007. The highest incidence was observed in 2007, after which the incidence rate decreased by 20% to 131 per 10(5) person years in 2011. The incidence declined even more at non-profit public hospitals from 2007 to 2011. In contrast, it continued to rise at profit-based private orthopedic clinics. INTERPRETATION We propose that this change in clinical practice is due to accumulating high-quality scientific evidence that shows no difference in outcome between acromioplasty and non-surgical interventions for rotator cuff disease with subacromial impingement syndrome. However, the exact cause of the declining incidence cannot be defined based solely on a registry study. Interestingly, this change was not observed at private clinics, where the number of operations increased steadily from 2007 to 2011.
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Affiliation(s)
- Juha Paloneva
- Department of Surgery, Central Finland Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland
| | - Vesa Lepola
- Division of Orthopedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jari Ylinen
- Department of Physical and Rehabilitation Medicine, Central Finland Hospital
| | - Ville Äärimaa
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
| | - Ville M Mattila
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Division of Orthopedics and Biotechnology, Karolinska Institutet and Department of Orthopedics at Karolinska University Hospital Huddinge, Sweden, and Department of Orthopedics, Tampere University, Finland
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Rolving N, Christiansen DH, Andersen LL, Skotte J, Ylinen J, Jensen OK, Nielsen CV, Jensen C. Effect of strength training in addition to general exercise in the rehabilitation of patients with non-specific neck pain. A randomized clinical trial. Eur J Phys Rehabil Med 2014; 50:617-626. [PMID: 24955503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND The optimal type of exercise protocol in the physical rehabilitation of non-specific neck pain has not yet been established. Furthermore, the role of fear-avoidance belief in the maintenance of pain and disability has been highlighted. Research indicates that exercise may be a means to reduce fear-avoidance belief, but evidence is scarce. AIM To compare the effect of two different exercise programs on pain, strength and fear-avoidance belief. DESIGN Randomized clinical trial. SETTING A specialized outpatient hospital clinic in Denmark. POPULATION Twenty-three men and 60 women on sick leave due to non-specific neck pain. METHODS Participants were randomized to either general physical activity (GPA group) or GPA and additional strength training of the neck and shoulder (SST group). The primary outcome was pain intensity. Secondary outcomes were muscle strength of the neck and shoulder and fear-avoidance belief. RESULTS Pain was significantly reduced within groups with a median of -1 (IQR: -3 to 0, P<0.001) in the SST group and -1 (IQR: -4 to 1, P=0.046) in the GPA group. The difference between groups was not significant. Changes in strength did not differ between groups. Both groups experienced significant increases in neck flexion strength of 14.7 N (IQR: -1 to 28.4, P=0. 001) in the SST group and 6.9 N (IQR: -4.9 to18.6, P=0.014) in the GPA group. Furthermore, the SST group achieved an increase of 18.6 N (IQR: -2.6 to 69.7, P=0.005) in neck extension. Fear-avoidance beliefs improved with 6 (IQR: 3 to 12, P<0.001) in the SST group, while the GPA group improved with 3 (IQR: 0 to 8, P=0.004). This between-group difference was significant (P=0.046). CONCLUSION AND REHABILITATION IMPACT This study indicates that in rehabilitation of subjects severely disabled by non-specific neck pain, there is no additional improvement on pain or muscle strength when neck exercises are given as a home-based program with a minimum of supervision. However, strength training of the painful muscles seems to be effective in decreasing fear-avoidance beliefs.
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Affiliation(s)
- N Rolving
- Department of Physiotherapy and Occupational Therapy Aarhus University Hospital, Aarhus, Denmark -
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31
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Piitulainen K, Häkkinen A, Salo P, Kautiainen H, Ylinen J. Does adding a 12-month exercise programme to usual care after a rotator cuff repair effect disability and quality of life at 12 months? A randomized controlled trial. Clin Rehabil 2014; 29:447-56. [DOI: 10.1177/0269215514547598] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 07/21/2014] [Indexed: 01/27/2023]
Abstract
Objective: To compare a 12-month home-based exercise programme with usual care for disability and health-related quality of life after rotator cuff repair. Design: Randomized controlled trial. Setting: Outpatient physical and rehabilitation medicine clinic. Subjects: Consecutive patients ( n = 67, mean age 54 years) who underwent rotator cuff repairs were randomized into an experimental group (EG) or a usual care group (UCG). Interventions: The UCG received ordinary postoperative instructions, while the EG were given advice and instructions on a shoulder muscle strengthening programme to be undertaken at home. Main measures: Disability was assessed with the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and quality of life with the Short-Form 36 Health Survey (SF-36). Results: At the follow-up, no between-group differences were observed in any of the outcomes. The mean (SD) ASES score improved by 21 points (95% CI, 16 to 26, p < 0.001) in the EG from the baseline 74 (14) and by 25 points (95% CI, 20 to 31, p < 0.001) in the UCG from the baseline 70 (18). Both groups exhibited significant improvements ( p < 0.001) in the SF-36 physical component score. In the UCG, improvements were observed in the Social Functioning ( p = 0.034) and Role Emotional ( p = 0.003) dimensions. In the EG, 57% of the patients completed the exercises twice weekly for the first six months, after which training adherence declined. Conclusions: The home exercise programme and usual care were equally effective in improving disability and quality of life after rotator cuff repair. The extra time involved in teaching the home exercise programme is not warranted.
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Affiliation(s)
- Kirsi Piitulainen
- Department of Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland
- Department of Physical Medicine and Rehabilitation, Central Finland Health Care District, Jyvaskyla, Finland
| | - Arja Häkkinen
- Department of Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland
- Department of Physical Medicine and Rehabilitation, Central Finland Health Care District, Jyvaskyla, Finland
| | - Petri Salo
- Department of Physical Medicine and Rehabilitation, Central Finland Health Care District, Jyvaskyla, Finland
| | - Hannu Kautiainen
- Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland
- Department of General Practice, University of Helsinki, Helsinki, Finland
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Central Finland Health Care District, Jyvaskyla, Finland
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Piitulainen K, Paloneva J, Ylinen J, Kautiainen H, Häkkinen A. Reliability and validity of the Finnish version of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section. BMC Musculoskelet Disord 2014; 15:272. [PMID: 25112412 PMCID: PMC4243510 DOI: 10.1186/1471-2474-15-272] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 08/04/2014] [Indexed: 11/11/2022] Open
Abstract
Background The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) is one of the most widely used shoulder outcome tools in clinical work and in scientific studies. However, it has not been validated in the Finnish language. The aims of this study were to cross-culturally adapt the ASES to the Finnish language and to study the psychometric properties of the self-report section of the ASES. Methods A total of 105 patients with shoulder symptoms answered the questionnaires of the ASES, a single disability question, the Simple Shoulder Test (SST), and the Short-Form 36 Health Survey (SF-36). The reliability of the ASES questionnaire was studied using a test-retest procedure at 2-week intervals. Psychometric assessment was performed by testing the construct validity, internal consistency, the criterion validity, and the convergent validity of the ASES. Results The reproducibility and internal consistency of the ASES were 0.83 (95% CI 0.70 to 0.90) and 0.88 (95% Cl 0.84 to 0.91). There were no significant differences between the diagnostic groups in the pain scores from the ASES, and the function score was significantly higher in the instability group compared to the other groups. The convergent validity of the ASES correlated with the SST, r = 0.73 (p < 0.001); the single disability question, r = -0.74 (p < 0.001); and the Physical Component Score of the SF-36, r = 0.57 (p < 0.001). Conclusions The Finnish version of the ASES proved to be a reliable and valid tool for assessing shoulder disabilities in patients with different shoulder diagnoses, including rotator cuff disease, instability, and osteoarthritis. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-272) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kirsi Piitulainen
- Department of Health Sciences, University of Jyvaskyla, PL 35, 40014 Jyvaskyla, Finland.
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Tarnanen SP, Neva MH, Häkkinen K, Kankaanpää M, Ylinen J, Kraemer WJ, Newton RU, Häkkinen A. Neutral Spine Control Exercises in Rehabilitation After Lumbar Spine Fusion. J Strength Cond Res 2014; 28:2018-25. [DOI: 10.1519/jsc.0000000000000334] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Vuorenmaa M, Ylinen J, Piitulainen K, Salo P, Kautiainen H, Pesola M, Häkkinen A. Efficacy of a 12-month, monitored home exercise programme compared with normal care commencing 2 months after total knee arthroplasty: A randomized controlled trial. J Rehabil Med 2014; 46:166-72. [DOI: 10.2340/16501977-1242] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ylinen J, Vuorenmaa M, Paloneva J, Kiviranta I, Kautiainen H, Oikari M, Häkkinen A. Exercise therapy is evidence-based treatment of shoulder impingement syndrome. Current practice or recommendation only. Eur J Phys Rehabil Med 2013; 49:499-505. [PMID: 23480979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Subacromial impingement syndrome is the most common indication for shoulder operation. However, exercise therapy for the conservative treatment is recommended in the first instance. AIM To evaluate the implementation of exercise therapy in impingement syndrome. DESIGN Retrospective study using structured postal questionnaire and data collected from hospital archive. METHODS A total of 104 consecutive patients who had undergone shoulder surgery due to impingement syndrome. Patients were asked about therapy modalities that they had received before and after the operation as well as pain (VAS) and functional impairment (ASES) at one-year follow-up. RESULTS Before surgery 49% of patients had not received advice for shoulder muscle exercises. After operation all patients had received mobility exercises, but one quarter of patients still reported that they had not received instructions about shoulder strength exercises. At the follow-up the means of the ASES index was 85 and use of NSAID had decreased by 75%. However, 15% of patients had moderate functional impairment (ASES under 60). CONCLUSION About half of patients reported that they had not received advice for rotator cuff exercise therapy before surgery even though with it surgery would probably have been avoided in many cases. Although symptoms in most patients had decreased after operation, several patients still suffered from pain and decreased function. Still several patients had not received advice for shoulder strengthening exercises that are important to recovery. CLINICAL REHABILITATION IMPACT The adherence to the current recommendations about exercise therapy is insufficient in clinical practice. Thus we recommend that it should be monitored in all institutions in which shoulder pain is treated.
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Affiliation(s)
- J Ylinen
- Department of Physical and Rehabilitation Medicine Jyväskylä Central Hospital, Jyväskylä, Finland -
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Mustalampi S, Häkkinen A, Kautiainen H, Weir A, Ylinen J. Responsiveness of Muscle Tone Characteristics to Progressive Force Production. J Strength Cond Res 2013; 27:159-65. [DOI: 10.1519/jsc.0b013e3182518023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mustalampi S, Ylinen J, Kautiainen H, Weir A, Häkkinen A. Acute effects of cold pack on mechanical properties of the quadriceps muscle in healthy subjects. Phys Ther Sport 2012; 13:265-9. [PMID: 23068904 DOI: 10.1016/j.ptsp.2012.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 01/31/2012] [Accepted: 02/07/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To examine the effects of local cooling on mechanical properties of the quadriceps muscle in healthy subjects. SUBJECTS Thirty-nine healthy subjects (27 women, 12 men, mean age 39, range 20-62) volunteered. METHODS A cold gel pack was applied to the quadriceps muscle for 20 min. Properties were quantified by analyzing the frequency (tension), decrement (elasticity) and stiffness of damped oscillations and the compliance of the muscle before, immediately after and after 15-min after cooling. RESULTS The largest responses immediately after cooling were seen in the oscillation decrement parameter, 7.9 (3.7-12.1) %, and in the compliance parameter, -7.5 (-9.8 to -5.3) %. Responses in the oscillation frequency, 6.5 (2.3-10.6) %, and stiffness parameters, 4.0 (0.8-7.1) %, were also statistically significant. The compliance still showed a -6.1 (-7.7 to -4.5) % decrease after the 15 min recovery phase, while no remaining alteration was found in the oscillation parameters. CONCLUSION The quadriceps muscle became tenser, stiffer, and less elastic as a result of cooling, and the mechanical properties were not fully recovered after 15 min. Careful warming-up is suggested after cooling to enable normalization of mechanical properties of the muscle and to avoid injuries.
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Affiliation(s)
- Sirpa Mustalampi
- Department of Physical Medicine and Rehabilitation, Jyvaskyla Central Hospital, Keskussairaalantie 19, 40620 Jyvaskyla, Finland.
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Affiliation(s)
- J Khan
- Department of Surgery, Vaasa Central Hospital, Vaasa, Finland.
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Tarnanen S, Neva MH, Kautiainen H, Ylinen J, Pekkanen L, Kaistila T, Vuorenmaa M, Häkkinen A. The early changes in trunk muscle strength and disability following lumbar spine fusion. Disabil Rehabil 2012; 35:134-9. [PMID: 22671313 DOI: 10.3109/09638288.2012.690496] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To analyze trunk muscle function pre- and postoperatively in patients undergoing lumbar spine fusion. Associations between changes in trunk muscle strength and disability were also studied. METHOD A total of 114 patients undergoing lumbar spine fusion participated in the study. The flexion and extension strength of the trunk was measured preoperatively and 3 months after surgery using a strain-gauge dynamometer. Disability and pain during the past week was evaluated with the Oswestry disability index (ODI) and visual analog scale (VAS), respectively. RESULTS Preoperative trunk extension and flexion strength levels were 319 N and 436 N in males, respectively, and 160 N and 214 N in females, respectively. In females 3 months postoperatively, the trunk extension strength increased by 39 N (p < 0.001) and flexion by 38N (p < 0.001), whereas it remained unchanged in males. The preoperative extension/flexion strength ratio was 0.79 in females and 0.76 in males. Three months postoperatively, the strength ratio decreased to 0.66 in males (p = 0.02). The mean ODI improved by 47% and back pain decreased by 65% (both p < 0.001). The changes in the ODI correlated with changes in trunk extension (r = -0.38) and flexion (r = -0.43) strength. CONCLUSIONS Patients undergoing lumbar spine fusion had low trunk muscle strength and strength imbalance. Back fusion surgery leads to considerable relief of pain and disability, but patients still have low trunk extension and flexion strength levels 3 months postoperatively. Therefore, there is need for a proper progressive strength training protocols to normalize back function.
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Affiliation(s)
- Sami Tarnanen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
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Piitulainen K, Ylinen J, Kautiainen H, Häkkinen A. The relationship between functional disability and health-related quality of life in patients with a rotator cuff tear. Disabil Rehabil 2012; 34:2071-5. [DOI: 10.3109/09638288.2012.670363] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Salo P, Ylönen-Käyrä N, Häkkinen A, Kautiainen H, Mälkiä E, Ylinen J. Effects of long-term home-based exercise on health-related quality of life in patients with chronic neck pain: A randomized study with a 1-year follow-up. Disabil Rehabil 2012; 34:1971-7. [DOI: 10.3109/09638288.2012.665128] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ylinen J, Takala EP, Kautiainen H, Nykänen M, Häkkinen A, Pohjolainen T, Karppi SL, Airaksinen O. Association of neck pain, disability and neck pain during maximal effort with neck muscle strength and range of movement in women with chronic non-specific neck pain. Eur J Pain 2012; 8:473-8. [PMID: 15324778 DOI: 10.1016/j.ejpain.2003.11.005] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2003] [Accepted: 11/11/2003] [Indexed: 11/28/2022]
Abstract
Several studies have reported lower neck muscle strength in patients with chronic neck pain compared to healthy controls. The aim of the present study was to evaluate the association between the severity of neck pain and disability with neck strength and range of movement in women suffering from chronic neck pain. One hundred and seventy-nine female office workers with chronic neck pain were selected to the study. The outcome was assessed by the self-rating questionnaires on neck pain (visual analogue scale, Vernon's disability index, Neck pain and disability index) and by measures of the passive range of movement (ROM) and maximal isometric neck muscle strength. No statistically significant correlation was found between perceived neck pain and the disability indices and the maximal isometric neck strength and ROM measures. However, the pain values reported during the strength tests were inversely correlated with the results of strength tests (r=-0.24 to -0.46), showing that pain was associated with decreased force production. About two-thirds of the patients felt pain during test efforts. Pain may prevent full effort during strength tests and hence the production of maximal force. Thus in patients with chronic neck pain the results do not always describe true maximal strength, but rather the patients' ability to bear strain, which may be considerably influenced by their painful condition. The results of the present study suggest that rehabilitation in cases of chronic neck pain should aim at raising tolerance to mechanical strain.
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Affiliation(s)
- Jari Ylinen
- Department of Physical and Rehabilitation Medicine, Jyväskylä Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland.
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Ylinen J, Takala EP, Kautiainen H, Nykänen M, Häkkinen A, Pohjolainen T, Karppi SL, Airaksinen O. Effect of long-term neck muscle training on pressure pain threshold: A randomized controlled trial. Eur J Pain 2012; 9:673-81. [PMID: 16246820 DOI: 10.1016/j.ejpain.2005.01.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2004] [Accepted: 01/04/2005] [Indexed: 11/19/2022]
Abstract
Muscle tenderness has been measured in several studies to evaluate effectiveness of treatment methods, but only short-term results have been reported so far. The aim of the present study was to evaluate the long-term effects of two different muscle training methods on the pressure pain threshold of neck muscles in women with neck pain. Altogether 180 woman with chronic, non-specific neck pain were randomized into three groups: neck muscle endurance training, neck muscle strength training and control groups. The main outcome measures included pressure pain threshold measurement at six muscle sites and on the sternum. Neck pain was assessed by a visual analogue scale (VAS). At the 12-month follow-up statistically significantly higher pressure pain threshold values were obtained in both training groups at all muscle sites compared to the baseline, while no significant change occurred in the controls. Significantly higher changes in pressure pain threshold were detected at all six sites in the strength training group and at four out of six sites in the endurance training group compared to the control group. This is the first study to show an increase in pressure pain thresholds as a result of long-term muscle training. A decrease in neck pain was associated with reduced pressure pain sensitivity in neck muscles, showing that the pressure pain threshold may be a useful outcome measure of the effectiveness of neck muscle rehabilitation.
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Affiliation(s)
- Jari Ylinen
- Department of Physical and Rehabilitation Medicine, Jyväskylä Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland.
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Paloneva J, Oikari M, Ylinen J, Ingalsuo M, Ilkka K, Ilkka K. [Structured electronic consultation letter for shoulder disorders]. Duodecim 2012; 128:1585-1591. [PMID: 22970610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Referral to a specialist has a significant influence on management of the patient and costs associated with the treatments. However, development and research of the process by which patients are referred has been almost neglected. Expectations considering the purpose, contents, and timing of the referral of the consulting physician and the consultant do not always meet. A structured, electronic consultation letter was developed to respond this need. Functionality and interactivity are the key elements of the referral, including (1) an electronic referral letter to a specialist, (2) interactive education in clinical examination and management of shoulder disorders, and (3) an instrument of clinical examination and documentation of shoulder disorders.
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Affiliation(s)
- Juha Paloneva
- Keski-Suomen keskussairaala, traumatologian osasto, kirurgian klinikka
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Oikari M, Häkkinen A, Kautiainen H, Pesola M, Ylinen J, Vanhala M. [Referrals of knee osteoarthritis patients to orthopedic surgery]. Duodecim 2012; 128:1593-1599. [PMID: 22970611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Due to large volume of knee osteoarthritis referrals and increasing waiting times, the contents of referrals and patient's pathways were analyzed in the Jyväskylä Central Hospital. METHODS The referral contents of 171 knee osteoarthritis patients referred to the orthopedic outpatient clinic were screened, and the post-referral treatment decisions were pulled from the medical records. OUTCOME Most of the referrals had information about the diagnosis (90%), pain (88%) and symptom duration (80%). The least frequently mentioned were BMI (3%) and the implementation of conservative treatment (7%). During the specialist visit following the referral, 62% of the patients ended up in operative and 38% in conservative treatment. There was no connection between the referral contents and the line of treatment chosen. CONCLUSIONS Conservative treatment of knee osteoarthritis should be optimized prior to referral to specialist care.
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Affiliation(s)
- Marjo Oikari
- Keski-Suomen keskussairaala, fysiatrian poliklinikka, KYS
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Vuorenmaa M, Häkkinen A, Paloneva J, Kiviranta I, Kautiainen H, Marjo O, Ylinen J. [Implementation of preoperative physiotherapy and recovery after shoulder impingement surgery]. Duodecim 2011; 127:935-940. [PMID: 21648167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Subacromial impingement syndrome is a common orthopedic condition. METHODS Patients operated due to shoulder impingement (n=104) were sent a questionnaire inquiring rehabilitation procedures before and after surgery, pain and shoulder function. RESULTS Response rate was 68%, mean age of the patients was 53 years. Before surgery, 50% of the patients had received physiotherapy. The symptoms disappeared after surgery in the majority of the patients. However, 13% of the patients had significant shoulder pain (VAS over 30 mm) one year postoperatively and 15% had considerable functional deficit. CONCLUSIONS To avoid unnecessary operations for shoulder impingement proper conservative treatment must be provided before surgery.
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Affiliation(s)
- Mirja Vuorenmaa
- Keski-Suomen keskussairaala, yleislääketieteen yksikkö ja ORTON Invalidisäätiö
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Häkkinen A, Borg H, Kautiainen H, Anttila E, Häkkinen K, Ylinen J, Kiviranta I. Muscle strength and range of movement deficits 1 year after hip resurfacing surgery using posterior approach. Disabil Rehabil 2010; 32:483-91. [DOI: 10.3109/09638280903171451] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ylinen J, Nikander R, Nykänen M, Kautiainen H, Häkkinen A. Effect of neck exercises on cervicogenic headache: A randomized controlled trial. J Rehabil Med 2010; 42:344-9. [DOI: 10.2340/16501977-0527] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Borg H, Kiviranta I, Anttila E, Häkkinen K, Ylinen J, Kautiainen H, Häkkinen A. External rotation strength deficit after hip resurfacing surgery. Disabil Rehabil 2009; 31:865-70. [DOI: 10.1080/09638280802355387] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ylinen J, Kankainen T, Kautiainen H, Rezasoltani A, Kuukkanen T, Häkkinen A. Effect of stretching on hamstring muscle compliance. J Rehabil Med 2009; 41:80-4. [DOI: 10.2340/16501977-0283] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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