Katri Laimi

Return to work after traumatic brain injury: Systematic review

Abstract Objective: To evaluate the evidence on pre- and post-injury predictors of vocational outcome after traumatic brain injury (TBI). Literature selection and critical analysis: The search was conducted on PubMed and Central databases since 1990. A clinical question was formulated according to the PICO framework. Clinical relevance of the selected studies was evaluated following the GRADE framework. Main outcomes and results: The main outcome measures were employment status and return to work after TBI. Methodological quality of most of the relevant 12 controlled and 68 uncontrolled studies included in the review was estimated as very low. There was weak evidence that age, educational level, pre- and post-injury occupational status, severity of TBI, functional status, level of depression and anxiety, gender and race may be predictive for the vocational outcome after TBI. Conclusions and implications for further research: No strong evidence was found that vocational outcomes after TBI could be predicted or improved. There is a need for both experimental and observational well-conducted studies on this important subject. Researchers are strongly encouraged to use unified and standardized terms and scales in further studies. The authors suggest the International Classification of Functioning, Disability and Health (ICF) as the best tool available for this purpose.

Conservative treatment or surgery for shoulder impingement: systematic review and meta-analysis

Abstract Objective: To investigate the evidence on effectiveness of surgery for shoulder impingement compared with conservative treatment. Data sources: Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL and Science Citation Index databases were searched in March 2013 unrestricted by date or language. Study selection: Controlled randomized (RCT) or quasi-randomized clinical trials comparing surgery and conservative treatment of shoulder impingement were included. Data extraction: The methodological quality of each included trial was assessed according to the Cochrane Collaboration’s domain-based evaluation framework. Data synthesis: Of seven included RCTs, risk of systematic bias was considered to be low for two, high for four, and unclear for one RCT. The random-effect meta-analysis was conducted on four RCTs involving 347 subjects (173 surgically treated cases and 174 controls). There was no significant difference in changes in pain intensity between surgically and conservatively treated subjects (Hedges’s g = 0.01 in favor of conservative treatment, 95% CI −0.27 to 0.30). Conclusion: Based on the review of seven RCTs, the evidence on effectiveness of surgical or conservative treatment of shoulder impingement was found to be limited. There was, however, moderate evidence that surgical treatment is not more effective than active exercises on reducing pain intensity caused by shoulder impingement. Implications for Rehabilitation Based on the review of seven RCTs, the evidence on effectiveness of surgical or conservative treatment of shoulder impingement was found to be limited. There was moderate evidence that surgical treatment is not more effective than active exercises on reducing pain intensity caused by shoulder impingement. Because of surgery’s higher costs and susceptibility for complications compared with costs and risks of conservative treatment, conservative treatment can be recommended as a first choice of treatment of shoulder impingement in first or second grade.

Extracephalic tenderness and pressure pain threshold in children with headache

Background Sensitisation of the pain detection system has been suggested to be involved in the pathogenesis of recurrent headache. In adults, increased sensitivity to pain has been found in patients with chronic tension type headache. Children with migraine or with unspecific headache report non‐headache pains and interictal pericranial muscular tenderness more often than headache‐free children.

Outcome of headache frequency in adolescence

Only a few studies have been published of the outcome of adolescent headache (HA). The aim of this study was to examine the predictors of the outcome of headache frequency. A population-based sample of 13-year-olds with or without HA (N = 228) was followed to the age of 16 years. HA was classified on the basis of a face-to-face interview and clinical examination. The outcomes of monthly HA (>1/month) and non-frequent HA (0-1/month) were studied. Frequent use of analgesics, female gender and multiple non-headache pain predicted the persistence of monthly HA (>1/month). Significant predictors for worsening non-frequent HA (from 0 to 1/month to >1/month) were female gender, consistent migraine and high basic educational level of one parent. Adolescents frequently using analgesics constitute a risk group for a poor outcome of HA. Especially girls meeting this criterion should be considered a target group in the planning and implementing of preventive measures.

Force production and EMG activity of neck muscles in adolescent headache.

Purpose. This study compared the maximal force, EMG/force ratio and co-activation characteristics of the neck-shoulder muscles between 30 adolescents with migraine-type headache, 29 with tension-type headache, and 30 headache-free controls. Method. Force was measured with surface electromyography (EMG) from the cervical erector spinae (CES), the sternocleidomastoid (SCM) and trapezius muscles during the maximal isometric neck flexion, neck extension and shoulder flexion. Results. Girls with migraine-type headache had higher EMG/force ratios between the EMG of the left agonist SCM muscle and the corresponding maximal neck flexion (p = 0.030) and neck rotation force to the right side (p = 0.024) than the girls with tension-type headache. Migrainous girls had more co-activation of right antagonist CES muscle during maximal neck flexion force than the girls without headache (p = 0.015). Neck force production showed no significant differences between girls. Girls with tension-type headache displayed lower left shoulder flexion force than girls with migraine-type headache (p = 0.005) or with no headache (p = 0.005). In boys, no significant differences were observed. Conclusions. Girls with tension-type headache and migraine-type headache have differences in neuromuscular function in the neck-shoulder muscles. The data amplify our knowledge of the neck-shoulder muscle dysfunction in adolescent headache, and may encourage the use of specific rehabilitation methods in the management of different types of headache.

Neck flexor muscle fatigue in adolescents with headache – An electromyographic study

Background: Muscular disorders of the neck region may be of importance for the etiology of tension‐type headache. However, in adolescents, there are no data on the association between neck muscle fatigue and headache.

Are signs of temporomandibular disorders stable and predictable in adolescents with headache

The aim of the present study was to study changes in signs and symptoms of temporomandibular disorders (TMD) and factors predicting TMD signs in adolescents with and without headache. A population-based sample (n = 212) of 13-year-olds with and without headache was re-examined at the age of 16. The study included a questionnaire, face-to-face interview and somatic examination. In addition, a neurological examination, a muscle evaluation and a stomatognathic examination were performed. Significant changes were seen in TMD signs during the follow-up, but TMD signs at the end of the follow-up could not be predicted by baseline headache, sleeping difficulties, depression or muscle pain. TMD signs at the age of 16 were associated with female gender and muscle pain. We conclude that considerable changes in TMD signs occur in the follow-up of adolescents with and without headache. Headache-related TMD are not predictable in adolescents with and without headache.

Lumbar fusion compared with conservative treatment in patients with chronic low back pain: a meta-analysis.

We assess the effect of lumbar fusion (LF) in reducing disability among patients with chronic low back pain (CLBP) compared with conservative treatment and to weigh the clinical significance of this effect. We conducted a random-effect meta-analysis on the basis of a systematic review with research quality grading according to Grading of Recommendations Assessment, Development and Evaluation (GRADE). The studies included were retrieved from MEDLINE and Cochrane CENTRAL databases from 1990 till January 2013. Randomized or nonrandomized controlled studies were included if the study participants had a history of CLBP because of degenerative spinal diseases and had been treated with LF. A study was included if it compared LF with conservative treatment. The outcome measure was a change in the Oswestry Disability Index (ODI) score during a follow-up. The meta-analysis included data on 666 patients (402 cases) who participated in four randomized–controlled trials. The ODI score reduced in the LF and the control groups. The mean reduction in the ODI score in the follow-up of 1.5 years was −2.91 (95% confidence interval −6.66 to 0.84) in favor of LF. The difference between groups was statistically and clinically insignificant. Test for heterogeneity indicated that study imputation would favor LF but the imputed result would still be clinically insignificant with an estimated corrected reduction of ODI score of −5.51 (95% confidence interval −5.78 to −5.24). There is strong evidence that LF is not more effective than conservative treatment in reducing perceived disability because of CLBP among patients with degenerative spinal diseases. It is unlikely that further research on the subject would considerably affect this conclusion.

Neck muscles cross‐sectional area in adolescents with and without headache – MRI study

Background: Cervical musculature may play an important role in the genesis of tension‐type headache. However, there are no reports on a possible association between the morphometrical features of the neck flexion and extension muscles and adolescence headache.

Characteristics of neck pain associated with adolescent headache

The objective of the study was to find out what kind of neck pain (NP) is associated with headache (HA) and with various headache variables: frequency, type, intensity, disturbance, and relief with analgesics. A population-based sample of 12-year-olds with and without HA (n = 304) was followed for 4 years. At the age of 16 years, NP was evaluated on the basis of self-reported symptoms and a thorough physical examination of the neck region. Both self-reported and measured NP were associated with HA variables. Co-occurrent NP was found in adolescents with migraine as often as in those with tension-type HA. Especially, muscle pain and intensive, frequent NP were associated with disturbing HA unresponsive to analgesics. The study indicates that concomitant NP should be considered in adolescent HA sufferers, and a thorough cervical and muscle evaluation is recommended when planning the treatment of HA.