Timo Pohjolainen

Mini-intervention for subacute low back pain: two-year follow-up and modifiers of effectiveness.

Study Design. Randomized controlled trial. Objectives. To Investigate the long-term effectiveness, costs, and effect modifiers of a mini-intervention, provided in addition to the usual care, and the incremental effect of a worksite visit for patients with subacute disabling low back pain (LBP). Summary of Background Data. A mini-intervention was earlier proved to be an effective treatment for subacute LBP. Whether the beneficial effect is sustained is not known. Furthermore, modifiers of a treatment effect are largely unknown. Methods. A total of 164 patients with subacute LBP randomized into a mini-intervention (A, n = 56), a mini-intervention plus a worksite visit (B, n = 51), or the usual care (C, n = 57). Mini-intervention consisted of a detailed assessment of the patients’ history, beliefs, and physical findings by a physician and a physiotherapist, followed by recommendations and advice. The usual care patients received the conventional care. Pain, disability, health-related quality of life, satisfaction with care, days on sick leave, and health care consumption and costs were measured during a 24-month follow-up. Thirteen candidate modifiers were tested for each outcome. Results. There were no differences between the three treatment arms regarding the intensity of pain, the perceived disability, or the health-related quality of life. However, mini-intervention decreased occurrence of daily (A vs., C, P = 0.01) and bothersome (A vs. C, P < 0.05) pain and increased treatment satisfaction. Costs resulting from LBP were lower in the intervention groups (A 4670 Euros, B 5990 Euros) than in C (C 9510 Euros) (A vs. C, P = 0.04; and B vs. C, not significant). The average number of days on sick leave was 30 in A, 45 in B, and 62 in C (A vs. C, P = 0.03; B vs. C, not significant). The perceived risk for not recovering was the strongest modifier of treatment effect. Mental and mental-physical workers in A and B were less often on sick leave than those in C. Conclusions. Mini-intervention is an effective treatment for subacute LBP. Despite lack of a significant effect on intensity of low back pain and perceived disability, mini-intervention, including proper recommendations and advice, according to the “active approach,” is able to reduce LBP-related costs. The perceived risk of not recovering was the strongest modifier of treatment effect. In alleviating pain, the intervention was most effective among the patients with a high perceived risk of not recovering.

Mini- Intervention for Subacute Low Back Pain. A Randomized Controlled Trial

Study Design. Randomized controlled trial. Objectives. To investigate the effectiveness and costs of a mini-intervention, provided in addition to the usual care, and the incremental effect of a work site visit for patients with subacute disabling low back pain. Summary of Background Data. There is lack of data on cost-effectiveness of brief interventions for patients with prolonged low back pain. Methods. A total of 164 patients with subacute low back pain were randomized to a mini-intervention group (A), a work site visit group (B), or a usual care group (C). Groups A (n = 56) and B (n = 51) underwent one assessment by a physician plus a physiotherapist. Group B received a work site visit in addition. Group C served as controls (n = 57) and was treated in municipal primary health care. All patients received a leaflet on back pain. Pain, disability, specific and generic health-related quality of life, satisfaction with care, days on sick leave, and use and costs of health care consumption were measured at 3-, 6-, and 12-month follow-ups. Results. During follow-up, fewer subjects had daily pain in Groups A and B than in Group C (Group A vs. Group C, P = 0.002; Group B vs. Group C, P = 0.030). In Group A, pain was less bothersome (Group A vs. Group C, P = 0.032) and interfered less with daily life (Group A vs. Group C, P = 0.040) than among controls. Average days on sick leave were 19 in Group A, 28 in Group B, and 41 in Group C (Group A vs. Group C, P = 0.019). Treatment satisfaction was better in the intervention groups than among the controls, and costs were lowest in the mini-intervention group. Conclusions. Mini-intervention reduced daily back pain symptoms and sickness absence, improved adaptation to pain and patient satisfaction among patients with subacute low back pain, without increasing health care costs. A work site visit did not increase effectiveness.

Effect of long‐term neck muscle training on pressure pain threshold: A randomized controlled trial

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.

Spondylodesis augmented by transpedicular fixation in the treatment of olisthetic and degenerative conditions of the lumbar spine.

Fifty-one patients having lumbar or lumbosacral posterolateral fusion with pedicle screw internal fixation were reviewed retrospectively two years after the fusion by an independent observer. In 44 patients, the underlying condition was lytic or degenerative spondylolisthesis. The internal device was removed one year after the fusion. The fusion rate was 94%. The subjective disability was assessed using the Oswestry disability index. The mean Oswestry score was 38% preoperatively, and 24% two years after the fusion. Preoperatively, only every fifth patient was able to work; two years postoperatively, almost 60% held jobs. Complications due to internal fixation were recorded in 57% of the cases. Most of these, such as screw breakage and screw loosening in the sacrum, were of no clinical importance. The use of internal fixation seems to enhance the fusion rate but is associated with more complications than posterolateral fusion without implants.

EFFECTS OF NECK MUSCLE TRAINING IN WOMEN WITH CHRONIC NECK PAIN: ONE-YEAR FOLLOW-UP STUDY

Exercises are commonly recommended for chronic neck pain, but evidence-based guidelines do not explain what types of exercise. The aim of this randomized study was to evaluate the rate of change in neck strength following high- and low-intensity neck muscle training and their effects on pain and disability. One hundred eighty women with chronic neck pain were randomized into a high-intensity strength training group (STG), local muscle endurance training group (ETG), or control group (CG). The neck training consisted of isometric exercises in the STG and dynamic exercises in the ETG. Both groups performed dynamic exercises for the upper extremities. Strength tests, neck pain, and disability indices were evaluated at the baseline, at the follow-ups after 2 and 6 months in the training groups, and after 12 months in all groups. In both groups the greatest gains in neck strength, as well as decrease in neck pain and disability, were achieved during the first 2 months. However, the improvements continued up to 12 months. The STG achieved the greatest strength gains at all follow-ups. The CG showed only minor changes, and significant differences were found in favor of the training groups in all measures. The change in neck pain and disability indices correlated with the isometric neck strength (r = −0.22 [-0.36 to - 0.08] to −0.36 [-0.49 to −0.23]). Neck and shoulder muscle training was shown to be an effective therapy for chronic neck pain, resulting in early improvement in both the strength tests and subjective measures. The results can be maintained and even improved with long-term training.

Decline in work disability caused by early rheumatoid arthritis: results from a nationwide Finnish register, 2000–8

Objectives To study whether the work disability (WD) rates in early rheumatoid arthritis (RA) have changed in Finland, where the treatment of RA has long been active but has intensified further since 2000. Methods All incident non-retired patients with RA of working age (18–64 years) in a nationwide register maintained by the Finnish Social Insurance Institution from 1 January 2000 to 31 December 2007 were identified. Patient cohorts were analysed in 2-year time periods (2000–1, 2002–3, 2004–5, 2006–7) and initial disease-modifying antirheumatic drugs (DMARDs) were elucidated from the drug purchase register. The incidence of continuous WD in the RA cohorts as well as in the entire Finnish population up to 31 December 2008 was analysed. Results A total of 7831 patients were identified (71% women, 61% rheumatoid factor-positive). Throughout the follow-up period the use of methotrexate and combination DMARDs as the initial treatment of early RA increased. During the first 2 years the incidence of RA-related continuous WD was 8.9%, 9.4%, 7.2% and 4.8% in the year cohorts, respectively (p<0.001 for linearity). Compared with the entire Finnish population, the age- and sex-stratified standardised incidence ratio of a WD pension due to any cause was 3.69, 3.34, 2.77 and 2.80 in the year cohorts, respectively (p<0.001 for linearity). Conclusions Since 2000 the frequency of continuous WD in early RA has declined in Finland. The present data allow no explanatory analysis but, at the same time, increasingly active treatment strategies have been introduced.

Survival after spinal cord injury in Finland

OBJECTIVE Mortality, cause of death and risk indicators for death among patients with traumatic spinal cord injury were investigated over a 30-year period. DESIGN A cross-sectional study with retrospective data. SUBJECTS All patients (n = 1647) aged 16 years and over who had sustained traumatic spinal cord injury during the period 1976-2005, who were admitted to Käpylä Rehabilitation Centre, Helsinki, Finland, participated in the study. METHODS Demographic and clinical data were collected from the registers of Käpylä Rehabilitation Centre. Cause-specific mortality was assessed using Statistics Finlands official cause-of-death register. RESULTS During the observation period (1976-2007) 419 patients died. The main causes of death were respiratory disease (28%), cardiovascular disease (21%), suicide (10%) and external causes (9.5%). The mean age at death was 55.5 years for men and 58.2 years for women. Ten-year survival was 97.9%. Mortality was significantly affected by age at onset of injury, neurological level and extent of lesion. Survival of traumatic spinal cord injury patients was approximately 50% that of the general population, and survival of the general population was 80% during the follow-up period. CONCLUSION These results support the need for improvements in long-term rehabilitative care and regular follow-up of patients with traumatic spinal cord injury. The importance of psychosocial follow-up services must be emphasized.

Anxiety and depression are independent predictors of quality of life of patients with chronic musculoskeletal pain

We examined the relative impact of baseline anxiety, depression and fear of movement on health related quality of life at 12-month follow-up after a multidisciplinary pain management programme. One hundred and eleven patients who had chronic musculoskeletal pain (mean age 45 years, 65% women) attended during 2003–2005 a multidisciplinary three-phase pain management programme with a total time frame of six to seven months, totalling 19 days. The Beck Anxiety Inventory was used to rate anxiety, the Beck Depression Inventory depression, the Tampa Scale of Kinesiophobia fear of movement. The generic 15D questionnaire was used to assess health related quality of life. Baseline data were collected at admission, follow-up data at 12 months. Mean health related quality of life increased significantly from baseline to 12-month follow-up. Anxiety at baseline predicted significant negative change in the health related quality of life, depression predicted significant positive change in the health related quality of life. Fear of movement did not predict any significant change in the health related quality of life. We concluded that patients with chronic musculoskeletal pain and mild to moderate depression benefit from a multidisciplinary pain management programme in contrast to anxious patients. The findings imply further research with bigger sample sizes, other than HRQoL outcome measures as well as with other groups of patients.

Alleviating loneliness among frail older people - findings from a randomised controlled trial

Loneliness among frail older people predicts increased use of health services, early institutionalisation and increased mortality. The objective of this study was to determine the effects of a new rehabilitation model on loneliness among frail older people. This randomized controlled multi-centre trial with a 12-month follow-up was implemented in Finland. A total of 708 community-dwelling people aged 65+ years with progressively decreasing functional capacity participated. Participants were randomly allocated to the intervention group (n = 343) or to the control group (n = 365). The intervention consisted of a network-based group rehabilitation programme designed for frail older people. A 0.9-fold decrease in the proportion of participants feeling lonely was observed in the intervention group and a 1.1-fold increase in the control group. The results suggest that a physically orientated rehabilitation programme may reduce emotional loneliness.

No increased mortality in incident cases of rheumatoid arthritis during the new millennium

Ample evidence shows that rheumatoid arthritis (RA) is associated with a shortened life expectancy, with indicators of severe disease and rheumatoid factor (RF) as risk factors.1,–,3 Early and aggressive treatment strategies over the past decade have resulted in more favourable functional and radiological outcomes, probably also having an impact on mortality. Methotrexate treatment has been associated with decreased preterm deaths.4 Some studies have found no difference in mortality between patients and the general population.5 6 To examine the present status in Finland, we used the national registry of the Social Insurance Institution, covering all residents, to identify all incident cases of RA with an index day between 1 January 2000 and 31 December 2007. The case definition was eligibility—for the first time during the lifetime—for special …