USABILITY OF WORLD HEALTH ORGANIZATION DISABILITY ASSESSMENT SCHEDULE IN CHRONIC TRAUMATIC BRAIN INJURY

Objectives: To investigate functioning measured with the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0) in patients with mild, moderate and severe traumatic brain injury, and to compare patients' experiences with assessments made by their significant others and by consultant neurologists.Methods: A total of 112 consecutive patients with traumatic brain injury (29 mild, 43 moderate, 40 severe) and their significant others completed a 12-item WHODAS 2.0 survey. A neurologist assessed functioning with the International Classification of Functioning, Disability and Health minimal generic set.Results: The total patient and proxy WHODAS 2.0 sum score was rated as severe, and impairments in household tasks, learning, community life, emotional functions, concentrating, dealing with strangers, maintaining friendships, and working ability as around moderate in all 3 severity groups. In standing, walking, washing, and dressing oneself the reported impairments increased from mild in mild traumatic brain injury to moderate in severe traumatic brain injury. A neurologist rated the overall functioning, working ability, and motor activities most impaired in severe traumatic brain injury, while there were no between-group differences in energy and drive functions and emotional functions.Conclusion: Patients with chronic traumatic brain injury perceive a diversity of significant difficulties in activities and participation irrespective of the severity of the injury. We recommend assessing disability in traumatic brain injury with the short and understandable WHODAS 2.0 scale, when planning client-oriented services

Use of pain medication before and after inpatient musculoskeletal rehabilitation: longitudinal analysis of a nationwide cohort

The objective of this study was to identify subgroups among the participants in inpatient multidisciplinary musculoskeletal rehabilitation based on the differences in the shapes of trajectories of pain medication consumption during the 9 years around the time of intervention. A register-based study among 4578 public sector employees was conducted. Group-based trajectory analysis was done on the purchase of prescribed pain medications during the 9 years around the time of rehabilitation. The participants were on an average 50.7 (SD=6.6) years of age, and 2955 (86%) were women. Average yearly purchase of pain medications increased during the follow-up period from 73.4 (SD=193.0) to 163.3 (SD=295.7) defined daily doses. The analysis suggested six-cluster model. The shapes of the trajectories of three clusters did not show any steep slopes, one trajectory demonstrated nonstop rising through the entire follow-up, and one trajectory was closed to the trajectory average of medication use. One trajectory (11% of the sample) demonstrated a steep growth before the intervention and steep drop after it. When comparing this cluster with all other clusters combined, odds ratios were 0.40 [95% confidence interval (CI): 0.19-0.85] for age group (older vs. younger), 0.78 (95% CI: 0.61-1.01) for sex (women vs. men), and 1.44 (95% CI: 1.09-1.90) for occupational status (lower vs. higher). In other words, the participants belonged to this cluster were younger employees with a lower occupational grade. It seems that younger employees in manual jobs benefitted of the studied multidisciplinary musculoskeletal rehabilitation the most, especially when the timing of intervention is bounded to the substantial rise of pain severity

The World Health Organization Disability Assessment Schedule (WHODAS 2.0) and the WHO Minimal Generic Set of Domains of Functioning and Health versus Conventional Instruments in subacute stroke

Objective: To compare short generic International Classification of Functioning, Disability and Health (ICF)-based measures of functioning with traditional measures of stroke severity and dependence in subacute stroke.Methods: In this cross-sectional study patients with stroke (n = 195) and their significant others completed the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0) at discharge from rehabilitation. A neurologist assessed functioning with the 7-item World Health Organization (WHO) Minimal Generic Set of domains of functioning and health. These scores were compared with assessments of severity of stroke (National Institutes of Health Stroke Scale; NIHSS) and dependence (modified Rankin Scale; mRS; and Functional Independence Measure; FIM).Results: From mild to severe stroke, increasing disability was found in single items and sum scores of WHODAS and the WHO Minimal Generic Set. Although proxies rated 6 out of the 12 separate WHODAS functions more impaired than did the patients, correlations between the different measures (proxy- and patient-WHODAS, the WHO Minimal Generic Set, mRS, NIHSS and FIM total and sub-scores) were strong to very strong, except for moderate correlations between patient-WHODAS, and NIHSS or FIM cognitive sub-score.Conclusion: Despite their brevity, both generic ICF-based tools were useful in finding disabilities for patient- and family-centred goal-setting and service-planning after subacute rehabilitation

Confirmatory Factor Analysis of the Finnish Job Content Questionnaire (JCQ) in 590 Professional Musicians

Background: Poorly functioning work environments may lead to dissatisfaction for the employees and financial loss for the employers. The Job Content Questionnaire (JCQ) was designed to measure social and psychological characteristics of work environments. Objective: To investigate the factor construct of the Finnish 14-item version of JCQ when applied to professional orchestra musicians.Methods: In a cross-sectional survey, the questionnaire was sent by mail to 1550 orchestra musicians and students. 630 responses were received. Full data were available for 590 respondents (response rate 38%). The questionnaire also contained questions on demographics, job satisfaction, health status, health behaviors, and intensity of playing music. Confirmatory factor analysis of the 2-factor model of JCQ was conducted.Results: Of the 5 estimates, JCQ items in the "job demand" construct, the "conflicting demands" (question 5) explained most of the total variance in this construct (79%) demonstrating almost perfect correlation of 0.63. In the construct of "job control," "repetitive work" (question 10) demonstrated a perfect correlation index of 0.84 and the items "little decision freedom" (question 14) and "allows own decisions" (question 6) showed substantial correlations of 0.77 and 0.65.Conclusion: The 2-factor model of the Finnish 14-item version of JCQ proposed in this study fitted well into the observed data. The "conflicting demands," "repetitive work," "little decision freedom," and "allows own decisions" items demonstrated the strongest correlations with latent factors suggesting that in a population similar to the studied one, especially these items should be taken into account when observed in the response of a population

Treatment of Displaced Olecranon Fractures: A Systematic Review

Background and Aims:The incidence of olecranon fractures is rising. Displaced fractures are usually operated either by tension band wiring or plate fixation. The aim of this review is to evaluate the best current evidence on the management of displaced olecranon fractures.Materials and Methods:Randomized controlled trials were systematically gathered in May 2018 from CENTRAL, MEDLINE, Embase, CINAHL, Scopus, and PEDro databases. The methodological quality of articles was assessed according to the Cochrane Collaboration’s domain-based framework. Prospero database registration number: CRD42018096650.Results:Of 1518 identified records, finally, 5 were relevant. Four trials were found on tension band wiring: two compared tension band wiring with plate fixation (n = 108), one compared plate fixation with an olecranon memory connector (n = 40), and one trial compared tension band wiring with a modified tension band wiring called Cable Pin System (n = 62). In addition, one trial compared operative and conservative treatment in elderly (n = 19). The risk of bias was considered low in two and high in three of the trials. The follow-up time was 5–36 months, and outcome measures varied from patient-rated and physician-rated measures to radiological outcomes. In the analysis, there was no difference between tension band wiring and plate fixation. The data were insufficient for further quantitative analysis.Conclusion:No differences were found in clinical or patient-rated outcome measures between the two most frequent fixation methods (tension band wiring and plate fixation) of displaced olecranon fractures. Current data are not sufficient to evaluate other treatment methods; however, conservative treatment might serve as an option for selected patients in the elderly population.</div

Quantification of sEMG signals for automated muscle fatigue detection using nonlinear SVM

Fatigue is a multidimensional and subjective concept and is a complex phenomenon including various causes, mechanisms and forms of manifestation. Thus, it is crucial to delineate the different levels and to quantify selfperceived fatigue. The aim of this study was to introduce a method for automatic quantification and detection of muscle fatigue using surface EMG signals. Thus, sEMG signals from right sternocleidomastoid muscle of 9 healthy female subjects were recorded during neck flexion endurance test in Quaem hospital. Then six features in time, frequency and time- scale domains were extracted from signals. After dimensionality estimation and reduction, the SVM classifier was applied to the resulted feature vector. Then, the performance of linear SVM and nonlinear SVM with RBF kernel and the effect of show that the best accuracy is achieved using RBF kernel SVM with features using LLE criterion, were RMS, ZC and AIF. These results suggest that the selected features contained some information that could be used by nonlinear SVM with RBF kernel to best discriminate between fatigue and nonfatigue stages.    </p

Does perceived work ability improve after a multidisciplinary preventive program in a population with no severe medical problems? The Finnish Public Sector Study.

OBJECTIVES: This study examines the short- and long-term effects of a multidisciplinary preventive program on perceived work ability in a population with no severe medical problems. METHODS: Altogether 859 public sector employees who participated in the program in 1997-2005 and their 2426 propensity-score-matched controls were studied prospectively. Propensity scores for probability of being granted participation in the program were calculated based on the data on health, health-risk behaviors, and work-related characteristics that were gathered from repeat responses to a survey, national health registers, and employers' records. Mean scores of perceived work ability (PWA) and prevalence ratios (PR) of suboptimal PWA were calculated after a short-term (mean 1.7 years, up to 4.6 years) and a long-term (mean 5.8 years, up to 9.2 years) follow-up. RESULTS: No beneficial effects were observed with respect to work ability. In comparison to controls, the participants' risk of suboptimal PWA was actually slightly higher after both the short-term [PR 1.23, 95% confidence interval (95% CI) 1.10-1.39] and long-term (PR 1.18, 95% CI 1.06-1.31) follow-ups. CONCLUSIONS: These data suggest that the vocationally oriented multidisciplinary preventive program was ineffective in improving work ability among participants with no severe medical problems.</p

Validity and internal consistency of the thoracic outlet syndrome index for patients with thoracic outlet syndrome

Background: No validated scales exist specifically for measuring quality of life (QoL) and functioning level in patients with thoracic outlet syndrome (TOS). This cross-sectional survey examined whether some items adopted from validated QoL scales could be suitable for patients with TOS.Methods: To find an optimal thoracic outlet syndrome index (TOSI), a panel of 14 specialists experienced in treating TOS independently evaluated the relevance of 19 items adopted from scales used in other upper-extremity syndromes. After undergoing surgery for TOS, 52 patients rated the relevance of those items found by experts to be relevant. Content validity was measured by a content validity index, content validity ratio, and modified κ. The internal consistency of 15 retained items was assessed with the Cronbach α, and its construct validity was assessed by an exploratory factor analysis.Results: Of the 19 items, 15 were considered relevant for TOS by the panelists, with an overall test content validity index of 0.93. The internal consistency of these 15 items was excellent. The exploratory factor analysis accompanied by a parallel analysis confirmed the uni-dimensionality of the TOSI. All 15 items that the panelists considered relevant were also items that the patients marked with scores over 7 points on an 11-point scale of relevance.Conclusion: The internally consistent, face- and content-valid TOSI scale is proposed for use in evaluating specifically the QoL in TOS patients, as well as improving future longitudinal studies comparing functioning before and after interventions or spontaneous recovery in TOS patients.</p