Реконструкция системы электроснабжения ОАО "Гомельский химический завод" в связи с заменой технологического оборудования цеха сложно-смешанных минеральных удобрений

Objective The purposes of this study were to examine whether any differences in function and health exist between patients with cervical radiculopathy (CR) due to disk disease scheduled for surgery and patients with chronic whiplash-associated disorders (WADs) and to compare measures of patients' physical function with those obtained from healthy volunteers. Methods This is a cross-sectional study of patients with CR (n = 198) and patients with chronic WAD (n = 215). Patient data were compared with raw data previously obtained from healthy people. Physical measures included cervical active range of motion, neck muscle endurance, and hand grip strength. Self-rated measures included pain intensity (visual analog scale), neck disability (Neck Disability Index), self-efficacy (Self-Efficacy Scale), and health-related quality of life (EuroQol 5-dimensional self-classifier). Results Patient groups exhibited significantly lower performance than the healthy group in all physical measures (P < .0005) except for neck muscle endurance in flexion for women (P > .09). There was a general trend toward worse results in the CR group than the WAD group, with significant differences in neck active range of motion, left hand strength for women, pain intensity, Neck Disability Index, EuroQol 5-dimensional self-classifier, and Self-Efficacy Scale (P < .0001). Conclusions Patients had worse values than healthy individuals in almost all physical measures. There was a trend toward worse results for CR than WAD patients

Short- and long-term effects of exercise on neck muscle function in cervical radiculopathy:A randomized clinical trial

OBJECTIVE: To compare short- and long-term changes in neck muscle endurance, electromyography measures of neck muscle activation and fatigue and ratings of fatigue and pain after neck-specific training or physical activity in people with cervical radiculopathy.DESIGN: Randomized clinical trial.SUBJECTS/PATIENTS: Seventy-five patients with cervical radiculopathy.METHODS: Patients underwent neck-specific training in combination with a cognitive behavioural approach or prescribed physical activity over a period of 14 weeks. Immediately after the intervention and 12 months later, surface electromyography was recorded from neck flexor and extensor muscles during neck endurance tests. Time to task failure, amplitude and median frequency of the electromyography signal, and subjective fatigue and pain ratings were analysed in 50 patients who completed at least one follow-up.RESULTS: A significant increase in neck flexor endurance time was observed for both groups at 14 weeks compared with baseline and this was maintained at the 12-month follow-up (p &lt; 0.005). No change was identified for the slope of the median frequency. For the neck-specific training group, splenius capitis was less active during neck flexion at both follow-ups (p &lt; 0.01), indicating reduced muscle co-activation.CONCLUSION: Both specific and general exercise increased neck flexor endurance, but neck-specific training only reduced co-activation of antagonist muscles during sustained neck flexion.</p

Probing the mechanisms underpinning recovery in post‐surgical patients with cervical radiculopathy using Bayesian networks

Background Rehabilitation approaches should be based on an understanding of the mechanisms underpinning functional recovery. Yet, the mediators that drive an improvement in post‐surgical pain‐related disability in individuals with cervical radiculopathy (CR) are unknown. The aim of the present study is to use Bayesian networks (BN) to learn the probabilistic relationships between physical and psychological factors, and pain-related disability in CR. Methods We analysed a prospective cohort dataset of 201 post‐surgical individuals with CR. In all, 15 variables were used to build a BN model: age, sex, neck muscle endurance, neck range of motion, neck proprioception, hand grip strength, self-efficacy, catastrophizing, depression, somatic perception, arm pain intensity, neck pain intensity and disability. Results A one point increase in a change of self‐efficacy at 6 months was associated with a 0.09 point decrease in a change in disability at 12 months (t = −64.09, p < .001). Two pathways led to a change in disability: a direct path leading from a change in self-efficacy at 6 months to disability, and an indirect path which was mediated by neck and arm pain intensity changes at 6 and 12 months. Conclusions This is the first study to apply BN modelling to understand the mechanisms of recovery in post‐surgical individuals with CR. Improvements in pain‐related disability was directly and indirectly driven by changes in self‐efficacy levels. The present study provides potentially modifiable mediators that could be the target of future intervention trials. BN models could increase the precision of treatment and outcome assessment of individuals with CR. Significance Using Bayesian Network modelling, we found that changes in self-efficacy levels at 6-month post-surgery directly and indirectly influenced the change in disability in individuals with CR. A mechanistic understanding of recovery provides potentially modifiable mediators that could be the target of future intervention trials

Lumbar muscle fatigue : Analysis of electromyography, endurance time and subjective factors in patients with lumbar disc herniation and healthy subjects

The overall aim of the thesis was to investigate the relation between objectively and subjectively assessed lumbar muscle fatigue and subjective factors in patients with lumbar disc herniation and in healthy subjects. Eighty healthy subjects and 43 patients undergoing surgery for lumbar disc herniation and selected consecutively for the study participated. Muscle fatigue in the lower back was assessed during a modified Sorensen test, an isometric prone holding test for the back extensors against gravity and until exhaustion, or a staircase protocol (20%, 40%, 60%, and 80% of maximum voluntary contraction). Concomitantly, EMG was detected from the lumbar extensor muscles and subjects rated their perceived fatigue - and the patients also their pain - on a Borg CR- 10 scale. Recovery was assessed after the modified Sorensen test during 5-second contractions at 1-5 minutes of recovery then examined using an exponential time dependence model. To measure activity, participation, self-efficacy and health, the patients also filled in questionnaires. The reliability of the modified Sorensen test was also assessed. The modified Sorensen test with concomitant measures of EMG provided useful reliability (ICC>0.60) for evaluation purposes. Borg scale ratings correlated highly (r>0.7) with endurance time. The EMG median frequency slopes correlated low-to-moderately (r<0.54). At Borg rating 3 (moderate fatigu'), 5 (strong fatigue), and 7 (very strong fatigue), the medians of median frequency and endurance time had changed by 28-37%, 48-69%, 63-89% at each time respectively. This relation can be used in clinical testing where maximum endurance tests are unsuitable: a fixed time performance until Borg rating 5 may be used. That healthy women's back muscles were more fatigue-resistant than healthy men's was shown in a smaller median frequency decrease. However the opposite was indicated for patients with lumbar disc herniation. Elimination of pain due to surgery reduced muscle fatigue with respect to a smaller median frequency decrease but not enough to increase endurance time. Patients could not fatigue their muscles as much as healthy subjects could, as shown by significantly shorter endurance time and smaller median frequency decrease than healthy subjects. The applicability of the exponential time dependence model was excellent to all healthy subjects except three. Of the patients, only 14 had an exponential recovery process both before and after surgery indicating that the recovery process had been impaired due to the disc herniation. Measurements of fatigue and recovery were associated with activity limitations, participation restrictions, self-efficacy and health in patients with lumbar disc herniation. These interactions were seen by correlation coefficients of 0.53-0.95 between endurance time and some of the questionnaire answers, especially for women. Patients with non-significant fatigue and an impaired recovery process scored significantly worse on the questionnaires than those with both fatigue and non-impaired recovery

Neck-specific training with a cognitive behavioural approach compared with prescribed physical activity in patients with cervical radiculopathy : a protocol of a prospective randomised clinical trial

Background: Patients with cervical radiculopathy often have neck- and arm pain, neurological changes, activity limitations and difficulties in returning to work. Most patients are not candidates for surgery but are often treated with different conservative approaches and may be sick-listed for long periods. The purpose of the current study is to compare the effectiveness of neck- specific training versus prescribed physical activity. Methods/Design: The current protocol is a two armed intervention randomised clinical trial comparing the outcomes of patients receiving neck specific training or prescribed physical activity. A total of 144 patients with cervical radiculopathy will be randomly allocated to either of the two interventions. The interventions will be delivered by experienced physiotherapists and last 14 weeks. The primary outcome variable is neck- and arm pain intensity measured with a Visual Analogue Scale accompanied with secondary outcome measures of impairments and subjective health measurements collected before intervention and at 3, 6, 12 and 24 months after base-line assessment. Discussion: We anticipate that the results of this study will provide evidence to support recommendations as to the effectiveness of conservative interventions for patients with cervical radiculopathy.Funding Agencies|Swedish Government through the Karolinska Institute; Swedish National School of Research Education in Health Care Sciences; Strategic Research Programme in Care Sciences; Stockholm County Council Funding ALF Medicine</p

Using the cervical range of motion (CROM) device to assess head repositioning accuracy in individuals with cervical radiculopathy in comparison to neck- healthy individuals

This study had two purposes: to compare head repositioning accuracy (HRA) using the cervical range of motion (CROM) device between individuals with cervical radiculopathy caused by disc disease (CDD; n = 71) and neck- healthy individuals (n = 173); and to evaluate the test–retest reliability of the CROM device in individuals with CDD, and criterion validity between the CROM device and a laser in neck-healthy individuals, with quantification of measurement errors. Parameters of reliability and validity were expressed with intra- class- correlation coefficients (ICCs), and measurement errors with standard error of measurement (SEM) and Bland Altman limits of agreement. HRA (Mdn, IQR) differed significantly between individuals with CDD and neck- healthy individuals after rotation right 2.7° (6.0), 1.7° (2.7); and rotation left 2.7° (3.3), 1.3° (2.7) (p &lt; = 0.021); 31% of individuals with CDD were classified as having impairment in HRA. The test–retest reliability of the CROM device in individuals with CDD showed ICCs of 0.79- 0.85, and SEMs of 1.4°- 2°. The criterion validity between the CROM device and the laser in neck-healthy individuals showed ICCs of 0.43- 0.91 and SEMs of 0.8°- 1.3°. The results support the use of the CROM device for quantifying HRA impairment in individuals with CDD in clinical practice; however, criterion validity between the CROM device and a laser in neck-healthy individuals was questionable. HRA impairment in individuals with CDD may be important to consider during rehabilitation and evaluated with the criterion established with the CROM device in neck-healthy individuals.Funding Agencies|Swedish Research Council||Swedish Society of Medicine||Medical Research Council of Southeast Sweden||</p