Christina H. Stenström

The safety of a resistive home exercise program in patients with recent onset active polymyositis or dermatomyositis

The objective was to investigate whether a 12-week resistive home exercise program in addition to conventional medical treatment could be safely performed regarding muscle inflammation, muscle function, and quality of life in patients with active polymyositis (PM) or dermatomyositis (DM). Eleven patients diagnosed with active PM or DM were included. Muscle biopsies and Magnetic Resonance Imaging (MRI) of the thighs were performed. Quality of life, function, and subjective global disease impact (SGDI) were assessed and creatine phosphokinase levels (CPK) were analysed. The patients exercised with the exercise program for 15 minutes and took a 15-minute walk five days a week for 12 weeks. After the exercise period there was no sign of increased muscle inflammation. The group showed significantly improved function and quality of life compared to the start of study. It seems that this exercise program safely can be employed in patients with active PM or DM, and we suggest that physical exercise should be included in the rehabilitation of these patients.The objective was to investigate whether a 12-week resistive home exercise program in addition to conventional medical treatment could be safely performed regarding muscle inflammation, muscle function, and quality of life in patients with active polymyositis (PM) or dermatomyositis (DM). Eleven patients diagnosed with active PM or DM were included. Muscle biopsies and Magnetic Resonance Imaging (MRI) of the thighs were performed. Quality of life, function, and subjective global disease impact (SGDI) were assessed and creatine phosphokinase levels (CPK) were analysed. The patients exercised with the exercise program for 15 minutes and took a 15-minute walk five days a week for 12 weeks. After the exercise period there was no sign of increased muscle inflammation. The group showed significantly improved function and quality of life compared to the start of study. It seems that this exercise program safely can be employed in patients with active PM or DM, and we suggest that physical exercise should be included in the rehabilitation of these patients.

Intensive dynamic training in water for rheumatoid arthritis functional class II : a long-term study of effects

The aim of the study was to assess the effects of once-weekly, intensive dynamic training in water of patients with Rheumatoid Arthritis (RA). Thirty patients with RA, functional class II, in a training group (TG) and 30 in a comparison group (CG) were assessed with respect to clinical, radiological and functional disease manifestations and psychosocial consequences before and after a four-year training period. After the training period the TG patients had significantly better grip strength and higher activity level, the latter maintained at two-year follow-up. There were significantly more CG patient admittances for acute hospital care during the training period. No other differences between the groups were found. Dynamic training at an intensive tempo does not seem, even in a long perspective, to lead to any undesirable consequences.

Functional and psychosocial consequences of disease and experience of pain and exertion in a group of rheumatic patients considered for active training. Result of a survey in Bollnäs Medical District. I.

The purpose of this study was to select and describe a group of RA patients within a defined area who had, on clinical grounds, been considered for active training. The material consisted of 69 patients with classical or definite RA. It comprised half of the RA patients known to the clinic. The patients were assessed by means of a questionnaire, functional tests with rating of activity-induced pain, a cycling-test with rating of perceived exertion, and an interview by a psychologist. Subjective disease consequences were pain and stiffness. 38% of the patients never or seldom exercised. 72% wished to increase their activity but were prevented by pain. The functional tests indicated slow performance and considerable pain in activities of daily life. The interview disclosed above all, a low degree of self-confidence. Generalized pain and functional impairment correlated slightly with psychosocial factors. The results of the study indicate the need for active training as one strategy to alleviate pain and to maintain functional capacity in RA patients.

Variability of forces applied by experienced physiotherapists during provocation of the sacroiliac joint

OBJECTIVE To evaluate the distribution of total force vector and force components intended for the right and left sacroiliac joint, respectively, during pain-provocation sacroiliac joint tests. DESIGN Two force plates, each capable of sensing three orthogonal forces, were used in a descriptive study to assess force. BACKGROUND Studies evaluating the reliability of sacroiliac joint tests have revealed conflicting results and to our knowledge, no studies have evaluated the distribution of forces and their variations. METHODS Fifteen physiotherapists, experienced in musculoskeletal therapy, performed the distraction test and pressure on apex sacralis on the same healthy person on two occasions. RESULTS In both tests, the total force vector was less on the force plate closer to the physiotherapist. The vertical force component dominated and was considerably greater than the lateral (examined person supine/prone). The caudal/cranial force component was small. Systematic differences were found for the total force vector and for the lateral and vertical force components between occasions and/or between the force plates. CONCLUSIONS The consistency of total force vector and force components was incomplete within and between physiotherapists and between occasions. Relevance. The results indicate that forces have to be investigated as the questions still arise of whether the variation in force distribution has any importance in pain response, whether force registration could be a useful pain evaluation instrument, and whether force registration could be a step towards standardising pain-provocation sacroiliac joint tests.

Force and time recording for validating the sacroiliac distraction test.

OBJECTIVE The present aim was to investigate whether applied force and time interval of force exposure during the sacroiliac distraction test could discriminate subjects with sacroiliitis pain from healthy subjects. DESIGN The study was a methodological one using force plates sensing three orthogonal forces. BACKGROUND Studies evaluating the validity of sacroiliac joint tests show conflicting results. To our knowledge, no previous studies have evaluated force recording combined with pain reports. METHODS Eleven subjects with sacroiliitis and 11 healthy subjects were examined with distraction test once by each of three physiotherapists. The subjects indicated any pain by pressing a button giving a mark in the data collection. RESULTS The magnitude of the total force vector was significantly smaller (P<0.05) and the time interval was significantly shorter (P<0.05) in the sacroiliitis group, although almost 20 s could elapse before pain was provoked. The sensitivity of the test was 0.55 calculated for all physiotherapists involved, and varied between them, range 0.55-0.82. The specificity was 1.0. CONCLUSIONS The results support the advantage of force and time recording during the distraction test as a technique for evaluating pain. Further investigation is needed on whether the velocity of force application, the ability to maintain the same pressure and the bilateral distribution of force on the sacroiliac joints influence the sensitivity. RELEVANCE There is a need for objective evaluation methods in manual tests that are easy to perform. Recording force and its time interval may be a step towards standardising pain-provocation sacroiliac joint tests.

Effects of Staff Training in Natural Mobility: A Long-term Follow-up

The aim of this study was to evaluate the effects of a half-day course in Natural Mobility, which is an interactive instruction method in patient-transfer. A physiotherapist communicates her tacit knowledge to caregivers, who learn how to understand and improve verbal and non-verbal communication to get patients move themselves. Two hundred and twelve caregivers responded to three questionnaires before the course and 4-5 months and one year after the course respectively. The questions ad dressed the number of transfer methods the staff used, whether they changed their use of methods, how the strain of work was affected, and how satisfied they were with their way of assisting patient-transfer. The results showed that sixty-eight percent had changed their use of methods and the change remained one year after the course. The strain experienced was significantly reduced 4-5 months after the course and this reduction was retained one year later. Work satisfaction showed a significant increase; which was retained one year after the course. The changes in working habits were few, but retained, and comments indicated that the treatment of the patients had changed. Natural Mobility training appears to be a useful complement to the patient-transfer methods used today, by involving physiotherapists tacit knowledge in the training of health care staff.

Physical activity and pain among patients with rheumatoid arthritis – A cognitive approach

The objective of this study was to describe relationships between physical activity and beliefs about pain, beliefs about fear-avoidance and health locus of control (HLoC), and to describe relations between pain and the same three variables. Ninety-five patients were investigated using the Physical Activity Index; pain intensity on a VAS; the Pain and Impairment Relationship Scale (PAIRS); the modified Fear-avoidance Beliefs Questionnaire (mFABQ); and the Multidimensional Health Locus of Control Scales, form C (MHLC-C). Logistic regression models were used to calculate odds ratios (OR). Low levels of physical activity, moderate pain intensity, relatively strong beliefs in relations between pain and functioning, moderate fear-avoidance of physical activity, and attribution of HLoC mainly to health professionals were found. Self-reported physical activity was not significantly related to the outcome of PAIRS, mFABQ or MHLC-C. The odds for high-intensity pain was sevenfold (OR=7.09) with high PAIRS scores compared to low and threefold (OR=3.26) with high mFABQ scores compared to low. Our results suggest that pain in rheumatoid arthritis is related to strong beliefs in a relationship between pain and functioning and to high fear-avoidance beliefs, while physical activity does not seem to be related to those factors. HLoC is related to neither pain nor physical activity.

Reliability and validity of a Swedish version of the Revised Leeds Disability Questionnaire for patients with ankylosing spondylitis.

The aim of the study was to investigate the reliability and the validity of a Swedish version of the Revised Leeds Disability Questionnaire (RLDQ). Forty-two patients, 36 men and 6 women, median age 52.5 years, median symptom duration 24 years, with spondylarthropathy were assessed with the RLDQ, three questions on the content of the questionnaire, and range-of-motion measures. The results indicated satisfactory test-retest stability and internal consistency, and only minor internal redundancy. RLDQ items were generally considered relevant and suggested additions were similar to items already included in the questionnaire. Patients with low disability scores tended to be older and have better joint mobility than those with higher scores. Physiotherapists observed and scored disability significantly higher than patients. Correlations between subscores of the RLDQ and range-of-motion measures were in the main weak. In conclusion the Swedish version of the RLDQ may be considered as reliable and valid.The aim of the study was to investigate the reliability and the validity of a Swedish version of the Revised Leeds Disability Questionnaire (RLDQ). Forty-two patients, 36 men and 6 women, median age 52.5 years, median symptom duration 24 years, with spondylarthropathy were assessed with the RLDQ, three questions on the content of the questionnaire, and range-of-motion measures. The results indicated satisfactory test-retest stability and internal consistency, and only minor internal redundancy. RLDQ items were generally considered relevant and suggested additions were similar to items already included in the questionnaire. Patients with low disability scores tended to be older and have better joint mobility than those with higher scores. Physiotherapists observed and scored disability significantly higher than patients. Correlations between subscores of the RLDQ and range-of-motion measures were in the main weak. In conclusion the Swedish version of the RLDQ may be considered as reliable and valid.

Sensory and affective components of pain as recorded with the Pain-O-Meter (POM) among children with acute and chronic pain

Aim: To explore the usefulness of the Pain‐O‐Meter sensory and affective words scale (POM‐WDS) with regard to whether children aged 6–16 who suffer from chronic and acute pain know the words and what words they chose to describe their pain. Methods: Sixty‐one children participated, mean age 11 y, suffering from acute pain (n=25) and pain associated with juvenile idiopathic arthritis (JIA, n=36). Children rated their pain intensity on the POM‐VAS (visual analogue scale, 0–10 cm). Thereafter, children were asked whether each sensory and affective word on the POM‐WDS was known to them, and whether each word described their pain experience. Results: Seventeen out of 23 words were known to at least 70% of the sample. The least recognized word was grinding. Children age 6–16 knew fewer words than the adolescents. Age was a significant determinant for whether the children knew the words grinding (odds ratio (OR) 20.08, p<0.01), gnawing (OR 5.92, p < 0.05), unbearable (OR 8.02, p<0.05), and excruciating (OR 20.17, p<0.001). Terrible (OR 33.3, p<0.05), aching (OR 44.5, p<0.05) and sore (OR 5.4, p<0.05) were selected more often by children with acute pain than with JIA.