Kirsi Piitulainen

The relationship between functional disability and health-related quality of life in patients with a rotator cuff tear.

Purpose:To determine the relationship between functional disability and health-related quality of life (HRQoL) in rotator cuff tear (RCT) patients. Method:In 67 RCT patients (mean age, 54 years; 57% males), functional disability was self-reported with the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), HRQoL with the Short-Form 36 Health Survey (SF-36), and pain by visual analogue scale. ASES results were divided into tertiles (12–38, 39–51, and 52–82). Results:Mean ASES score was 48 (range, 12–82). Patients with the highest functional disability and highest pain level had the lowest HRQoL. For the highest, middle, and lowest ASES categories, respectively, mean SF-36 Physical Component Summary (PCS) scores were 35 SD 5, 36 SD 8, and 41 SD 6 (p< 0.001) (r = 0.47 for ASES vs. PCS; p< 0.001), and Mental Component Summary (MCS) scores were 50 SD 13, 56 SD 10, and 58 SD 8 (p = 0.011) (r = 0.37 for ASES vs. MCS; p= 0.003). Conclusions: Patients with higher functional disability had lower HRQoL. RCT extensively affects patients’ lives; therefore, capturing both generic and shoulder-specific measures of RCT problems is recommended. Implications for Rehabilitation Rotator cuff tears (RCTs) result from injury or degeneration, and tear prevalence increases with age. RCT causes disabling pain, decline in muscle strength and shoulder mobility. RCT patients with decreased functioning have impaired quality of life.

Disability and health-related quality of life in patients undergoing spinal fusion: a comparison with a general population sample

BackgroundThe aim of the present study was to compare one-year-follow-up data on disability and health-related quality of life (HRQoL) between spinal fusion patients and age- and sex-matched general population.MethodsThe data on fusion patients were collected prospectively using a spinal fusion data base in two Finnish hospitals. A general population sample matched for age, sex and residential area was drawn from the Finnish Population Register. All participants completed a questionnaire and the main outcome measures were the Oswestry Disability Index (ODI) and the Short Form-36 questionnaire (SF-36).ResultsAltogether 252 (69% females) fusion patients and 682 (67% females) population sample subjects participated in the study. In general population the mean ODI was 15 (SD 17) in females and 9 (SD 13) in males. The corresponding preoperative ODI values were 47 (SD16) and 40 (SD 15) and one year follow-up values 22 (SD 17) and 23 (SD 20). In both sexes the ODI decreased significantly after surgery but remained higher than in the general population, p < 0.001. The physical component summary score (PCS) of the SF-36 was lower in the patients than general population sample both preoperatively and at one-year follow-up (p < 0.001). The mental component summary score (MCS) was lower preoperatively (p < 0.001), but reached the general population level after one year in both men (p = 0.42) and women (p = 0.61).ConclusionsDisability and HRQoL improved significantly after spinal fusion surgery during a one- year follow-up. However, the patients did not reach the level of the general population in the ODI or in the physical component of HRQoL at that time, although in the mental component the difference disappeared.

Efficacy of a 12-month, monitored home exercise programme compared with normal care commencing 2 months after total knee arthroplasty: a randomized controlled trial

OBJECTIVE To evaluate the efficacy of a delayed home exercise programme compared with normal care after primary total knee arthroplasty. DESIGN Single-blind, prospective, randomized, controlled trial. PARTICIPANTS A total of 108 participants (61% females, mean age 69 years [standard deviation 8.7]), were randomized to a home-based exercise group (EG, n = 53) or to a control group (CG, n = 55). METHODS Two months post-operatively, the EG received a home exercise programme, while the CG received no additional guidance. The outcome measurements were: pain and disability, measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); health-related quality of life (HRQoL), measured using the Short Form-36 questionnaire (SF-36); maximal walking speed; isometric knee muscle strength; and the Timed Up and Go (TUG) test. Measurements were made at baseline and at 12 months thereafter. RESULTS At the 12-month follow-up, maximal walking speed (p < 0.001) and knee flexion strength (p = 0.009) were significantly greater in the EG. Both groups showed similar improvements in all of the WOMAC subscale scores, the SF-36 summary scores and the TUG time. CONCLUSION Home-based training was not superior to normal care with regard to pain, disability or HRQoL, but resulted in greater improvement in objectively measured physical performance.

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

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.

Reliability and validity of the Finnish version of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section

BackgroundThe 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.MethodsA 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.ResultsThe 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).ConclusionsThe 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.

Trunk Muscle Strength After Lumbar Spine Fusion: A 12-Month Follow-up

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.

Reliability and validity of the Finnish version of the prosthesis evaluation questionnaire

Abstract Background: Thus far there have been no specific patient-reported outcome instrument in Finnish for health-related quality of life (HRQoL) assessment after major lower extremity amputation and successful prosthesis fitting. Methods: The prosthesis evaluation questionnaire (PEQ) was translated and cross-culturally adapted into Finnish. Participants completed a questionnaire package including the Finnish version of the PEQ and the 15 D HRQoL instrument. Scales (n = 10) were tested for internal consistency, floor-ceiling effect, and reproducibility for which participants completed the PEQ twice within a 2-week interval. Validity was tested by estimating the correlation between the 15 D index and the scales. The authors included 122 participants who had completed the questionnaire on two separate occasions in the final analysis. Results: Mean scale scores of the 10 scales varied from 52 to 83. Cronbach’s alphas ranged from 0.67 to 0.96. The total score showed no floor-ceiling effect. Reproducibility of the scales was good (intraclass correlation coefficient, 0.78–0.87; coefficient of repeatability, 19–36). Significant correlations were observed between the 15 D index and the scales for ambulation, social burden, usefulness, and well-being. Conclusions: This study provided evidence of the reliability and validity of the Finnish version of the PEQ in assessing the HRQoL among major lower extremity amputated patients who have been fitted with prosthesis. Implications for rehabilitation Measurement of quality of life during rehabilitation can provide important information on patients’ well-being. The prosthesis evaluation questionnaire (PEQ) is a valid instrument for assessing health-related quality of life (HRQoL) after major lower extremity amputation. This study provided evidence of the reliability and validity of the Finnish version of the PEQ for assessing HRQoL among patient who have undergone major lower extremity amputation.

Patients Undergoing Lumbar Spine Fusion has Low Trunk Muscle Strength and Imbalance between Flexor and Extensor Muscles Preoperatively and still 1 Year after the Surgery

Introduction Lumbar spine fusion (LSF) may be performed in the treatment of several spinal disorders if conservative treatment fails. Decreased physical activity due to pain together with spinal fusion may cause muscle atrophy and therefore decrease the trunk muscle strength. Previously, the average trunk muscle strength in flexion and in extension were reported to be 564 and 629 N, respectively, in control population compared with those of 375 and 404 N in patients 2 months after disc herniation surgery (Häkkinen et al, 2003). In healthy people trunk extensor strength has been reported to be greater than flexor strength, that is, extensor/flexor strength ratio is more than 1 (Yahia et al, 2011). Objective The aim of the present study was to evaluate the influence of lumbar spine fusion to the flexion and extension strength of the trunk muscles at 1 year follow-up after the surgery. Material and Methods Altogether 195 patients (66% females, mean [SD] age 61 [12] years and body weight 78 [15] kg) undergoing instrumented LSF attended the present study. Indications for surgery were degenerative spondylolisthesis, spondylolysis, spinal stenosis, disc herniation or degeneration, postoperative conditions or scoliosis. The median (IQR) duration of preoperative back pain was 31 (18, 66) months. Isometric flexion and extension strength of the trunk muscles was measured using a strain-gauge dynamometer and back pain was measured using visual analogue scale (VAS 0–100 mm) preoperatively and at 1 year after surgery. Results Mean (SD) preoperative trunk flexion and extension strength levels were 295 (172) and 205 (144) N, respectively. A year after the surgery, mean (95% CI) trunk flexion strength increased by 69 (53–85) N (p < 0.001) and extension strength by 53 (37–70) N (p < 0.001). Mean (SD) preoperative extension/flexion strength ratio was 0.75 (0.38) and did not change during the follow-up. Flexion strength/body weight ratio increased from preoperative 0.38 (0.20) by 0.09 (0.07–0.11) and extension strength/body weight ratio from 0.27 (0.18) by 0.07 (0.05–0.09) (p < 0.001) 1 year after the surgery. Mean (SD) back pain VAS decreased from preoperative 63 (27) to 25 (26) mm at 1 year and pain intensity during flexion and extension strength measurements decreased from 41 (29) to 11(21) mm and from 55 (29) to 14 (25) mm, respectively (p < 0.001). No correlation between strength measurements and back pain was found at either time point. Conclusion The trunk muscle strength in patients with chronic back pain undergoing LSF is low. After LSF some improvement can be found, however, still 1 year after the surgery the trunk muscle strength remains low. Moreover, the flexion strength is better than extension strength, which is in contrast to results of healthy people in previous studies. Therefore, after the spinal fusion surgery the rehabilitation should aim at improving muscle strength and special attention should be paid to correct the imbalance between trunk flexion and extension muscles.