Neck Pain in Adolescent Headache Sufferers. A Cohort Study of Schoolchildren

Although neck pain (NP) and headache (HA) are often concomitant in adolescents, few data exist on the association of NP with HA in this age group. The aim of the study was to examine the association of concomitant NP with adolescent HA and with the outcome of HA. The associations of self-reported NP, physical findings of the neck and disc degeneration of the cervical spine with adolescent HA were studied. This study is part of a population-based follow-up study of 12-year-old children (N 1135/1409) with and without HA. A sample of adolescents (N = 304) was followed to the age of 16 years. At the age of 17 years, 69 of them participated in a magnetic resonance imaging (MRI) study of the cervical spine. During the follow-up from 13 to 16 years of age, changes in both HA type and frequency were common. A poor outcome of HA was associated with NP interfering with daily activities at the age of 13 years. The changes in HA type were not predictable by NP. At the age of 16 years, local and referred palpation pain of the neck muscles, self-reported NP and NP intensity were associated with HA, and especially with disturbing HA unresponsive to analgesics. The association of NP with HA was not determined by HA type. Mild degenerative changes of the cervical spine were common but did not contribute to headache. HA in adolescence is often episodic, and prevention and treatment of NP could be important in the prevention of future chronic adult HA.Niskakipu päänsärkyisillä nuorilla – koululaisten seurantatutkimus Vaikka niskakipu ja päänsärky esiintyvät nuorilla usein samanaikaisesti, tutkimustietoa niiden yhteydestä on vähän. Tutkimuksen tarkoituksena oli selvittää niskakivun yhteyttä nuoren päänsärkyyn ja päänsäryn ennusteeseen. Tutkittiin niskaoireiden, mitatun niskakivun ja kaularangan välilevyrappeuman yhteyttä nuoren päänsärkyyn. Tämä tutkimus on osa väestöpohjaista 12-vuotiaiden päänsärkyisten ja päänsäryttömien lasten (N 1135/1409) seurantatutkimusta. Osaa nuorista (N = 304) seurattiin 16 vuoden ikään. 17-vuotiaina heistä 69 osallistui kaularangan magneettitutkimukseen. Päänsärkytyypin ja esiintymistiheyden muutos oli yleistä 13-16-vuotiaana. Päänsäryn paheneminen oli todennäköisempää, jos 13-vuotiaan päänsärkyyn liittyi päivittäistä toimintaa haittaava niskakipu. Niskakipu ei selittänyt päänsärkytyypin muutosta. 16-vuotiaana niskalihasten paikallisella ja päähän säteilevällä painoarkuudella, nuoren raportoimalla niskakivulla ja niskakivun voimakkuudella oli yhteys päänsärkyyn, erityisesti haittaavaan päänsärkyyn, joka ei helpottunut särkylääkkeiden avulla. Niskakivulla ei ollut yhteyttä päänsärkytyyppiin. Lievät kaularangan rappeumamuutokset olivat yleisiä, mutta ne eivät liittyneet päänsärkyyn. Nuoren päänsärky on usein ajoittaista, ja nuoren niskakivun ehkäisy ja hoito saattaa olla tärkeää ehkäistäessä tulevaa aikuisen kroonista päänsärkyä.Siirretty Doriast

How well the ICF concepts of functioning, capacity and performance are known amongst the Finnish specialists in physical and rehabilitation medicine?

Purpose: To investigate how well Finnish specialists in physical and rehabilitation medicine (PRM) are familiar with ICF-based concepts of functioning, capacity, and performance. &nbsp; &nbsp; Methods: In February 2013, the 5-minute survey was conducted amongst participants at the annual meeting of the Finnish Society of PRM. The 54 participants (response rate 81%) were asked to define the difference between concepts of functioning and capacity/performance. They were also asked to give some examples of medical tests related to these concepts. Two independent researchers evaluated the responses basing on appropriate definitions presented by ICF and researchers own experience. Results: &nbsp; Of respondents, 83% were able to define the concept of functioning accordingly to the ICF framework as a complex relationship between health condition and contextual factors. Instead, only 24% were capable to describe concept of capacity/performance as an ability to execute single tasks in a standard or current environment. Of respondents, 40% emphasized the physical dimension of performance. Over 80% of respondents suggested at least one test for assessment of the level of performance, but only 57% introduced an example of tests for measuring limitation of functioning. Conclusions: The ICF-based concepts of functioning and performance were not widely used amongst Finnish physicians specialized in PRM even if the responses to survey reflected the biopsychosocial way of understanding the functioning. &nbsp; The ICF-based concepts of functioning and performance were not widely used amongst Finnish physicians specialized in PRM even if the responses to survey reflected the biopsychosocial way of understanding the functioning. The ICF-based concepts of functioning and performance were not widely used amongst Finnish physicians specialized in PRM even if the responses to survey reflected the biopsychosocial way of understanding the functioning. </strong

Pre- and Postintervention Factor Structure of Functional Independence Measure in Patients with Spinal Cord Injury

Objective. To evaluate the factor structure of Functional Independence Measure (FIM (R)) scale amongst people with spinal cord injury (SCI). Methods. This was a retrospective, register-based cohort study on 155 rehabilitants with SCI. FIM was assessed at the beginning and at the end of multidisciplinary inpatient rehabilitation. The internal consistency of the FIM was assessed with Cronbach's alpha and exploratory factor analysis was employed to approximate the construct structure of FIM. Results. The internal consistency demonstrated high Cronbach's alpha of 0.95 to 0.96. For both pre- and postintervention assessments, the exploratory factor analysis resulted in 3-factor structures. Except for two items ("walking or using a wheelchair" and "expression"), the structures of the identified three factors remained the same from the beginning to the end of rehabilitation. The loadings of all items were sufficient, exceeding 0.3. Both pre- and postintervention chi-square tests showed significant p values < 0.0001. The "motor" domain was divided into two factors with this 2-factor structure enduring through the intervention period. Conclusions. Amongst rehabilitants with SCI, FIM failed to demonstrate unidimensionality. Instead, it showed a 3-factor structure that fluctuated only little depending on the timing of measurement. Additionally, when measured separately, also motor score was 2-dimensional, not 1-dimensional. Using a total or subscale FIM, scores seem to be unjustified in the studied population

Utility of the World Health Organization Disability Assessment Schedule and the World Health Organization minimal generic set of domains of functioning and health in spinal cord injury

Objective: To compare easy-to-use International Classification of Functioning, Disability and Health (ICF)-based measures of functioning with the level and severity of spinal cord injury.Methods: Cross-sectional study. Patients (n = 142) and their significant others completed the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0) questionnaire. A physician at the university hospital outpatient clinic assessed functioning with the 7-item World Health Organization (WHO) minimal generic set.Results: The patient and proxy WHODAS sum score was rated severe with decreasing severity in groups with complete and partial tetraplegia and paraplegia, respectively. Working ability was rated most severely impaired in the tetraplegic groups. Between-group differences were also found in mobility, household tasks, and self-care. Mobility was found to be associated with lesion severity; life activities, participation and friendships with lesion level; and self-care and WHODAS sum score with both lesion severity and level. Depending on the level and severity of spinal cord injury, a moderate to strong correlation was found between the sum scores of the 2 tools, and mostly very strong correlations between patient and proxy assessments of functioning.Conclusion: Both generic ICF-based tools, despite their briefness, seemed to be useful as they were able to differentiate various levels and severities of spinal cord injury. We recommend using the 12-item WHODAS 2.0 when planning individualized services for patients with spinal cord injury

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

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&#39;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&#39;s g&thinsp;=&thinsp;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&#39;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.</p

Psychometric properties of 12-item self-administered World Health Organization disability assessment schedule 2.0 (WHODAS 2.0) among general population and people with non-acute physical causes of disability - systematic review

Objective: WHODAS 2.0 is a unified scale to measuring disability across diseases, countries, and cultures. The objective was to explore the available evidence on the psychometric properties of 12-item self-administered WHODAS 2.0 among a general population and people with non-acute physical causes of disability.Methods: Five databases Medline, Embase, Web of Science, Scopus, and PsycINFO were searched for papers related to the validity, reliability, responsiveness, minimal clinically important difference or minimal detectable change of 12-item self-administered WHODAS 2.0. In order to avoid missing any potentially relevant studies, the search clauses were left as generic as possible and the refining search was conducted manually. As the review was focusing on chronic physical disorders and general adult population, major psychiatric diagnoses, acute traumas, other acute conditions (e.g., postpartum or pregnancy), hearing loss, progressive neurological disorders, and age Results: The 14 out of 191 observational studies were considered relevant. The sample sizes varied from 80 up to 31,251 participants. Great diversity was observed in the participants’ health problems. The Cronbach’s alpha was high – up to 0.96. The correlations between WHODAS 2.0 and other disability scales were high. Substantial floor without ceiling effect was reported by two studies. Exploratory factor analysis resulted in a multidimensional structure – up to five factors. The discriminative ability and test–retest reliability of the scale was good.Conclusions: It seems, that the 12-item self-administered WHODAS 2.0 is internally consistent and a reliable scale demonstrating overall good correlation with other measures of disability. However, it appears that it is a multidimensional scale and its total score may represent different combinations of several contributing factors. Thus, the 12-item WHODAS 2.0 can be more reliable when creating a person’s functional profile formed by the 12 individual item scores instead of a single total sum.</p

Comparing disability between traumatic brain injury and spinal cord injury using the 12-item WHODAS 2.0 and the WHO minimal generic data set covering functioning and health

Objective: To compare disability between two patient groups using short validated tools based on International Classification of Functioning, Disability and Health (ICF).Design: Cross-sectional study.Setting: University hospital specialist outpatient clinic.Subjects: A total of 94 patients with traumatic brain injury and 59 with spinal cord injury.Main measures: Disability evaluated using self-reported and proxy 12-item WHODAS 2.0 (World Health Organization Disability Assessment Schedule), and physician-rated WHO minimal generic data set covering functioning and health.Results: The two measures used showed severe but very different disabilities in these patient groups. Disability was assessed worse by physicians in the spinal cord injury population (sum 15.8 vs. 12.7, P = 0.0001), whereas disability assessed by the patients did not differ significantly between the two groups (sum 18.4 vs. 21.2). Further analysis revealed that in patients with “high disability” (the minimal generic data set score ⩾15), self-reported functioning was more severely impaired in the traumatic brain injury group compared to the spinal cord injury group (29.7 vs. 21.4, P Conclusion: Both generic measures were able to detect severe disability but also to detect differences between two patient populations with different underlying diagnoses.</p

Short- and long-term changes in perceived work ability after interdisciplinary rehabilitation of chronic musculoskeletal disorders: prospective cohort study among 854 rehabilitants

Objective: To investigate the changes in rehabilitants&rsquo; perceived work ability after rehabilitation for chronic musculoskeletal disorders with respect to the baseline characteristics. Design: &nbsp; Prospective cohort study based on register and repeated survey data. Setting: &nbsp; Public sector employees in ten towns and five hospital districts. Subjects: &nbsp; A total of 854 employees who participated in the rehabilitation programme owing to common chronic musculoskeletal disorders between 1997 and 2009. Interventions: &nbsp; Interdisciplinary, biopsychosocial, inpatient rehabilitation programme targeting people of working age with common chronic musculoskeletal disorders. The programme was executed in different rehabilitation centres across the country and funded by the Social Insurance Institution of Finland. Main measures: &nbsp; Differences in perceived work ability level before and after rehabilitation. Data were derived from repeated surveys on average 2.1 years before rehabilitation, and 1.5 years (short-term follow-up) and 6.0 years (long-term follow-up) after rehabilitation. Results: &nbsp; Before the rehabilitation, perceived work ability was 7.13 (SD 1.84) among the rehabilitants and 7.27 (SD 1.72) in the matched reference population. Among rehabilitants, this figure decreased by 0.82 (95% confidence interval &ndash;0.98 to &minus;0.67) in the short-term and by 1.26 (95% confidence interval &ndash;1.45 to &minus;1.07) in the long-term follow-up. Only slight differences in steepness of this deterioration were observed between subgroups, created based on the participants&rsquo; baseline characteristics. Conclusions: Perceived work ability of participants, in an interdisciplinary biopsychosocial rehabilitation programme for common musculoskeletal disorders, deteriorated regardless of any studied pretreatment characteristics. The improvement of work ability may be an unrealistic goal for participants in this type of rehabilitation. &nbsp; Perceived work ability of participants, in an interdisciplinary biopsychosocial rehabilitation programme for common musculoskeletal disorders, deteriorated regardless of any studied pretreatment characteristics. The improvement of work ability may be an unrealistic goal for participants in this type of rehabilitation.</p