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

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

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 15D 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 15D 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 15D 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 rehabilitationMeasurement 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.Peer reviewe

Effectiveness of 12 months' intensive training after rotator cuff repair

This study examined the effectiveness of intensive shoulder strength training on disability, health-related quality of life (HRQoL) and shoulder function in patients who had undergone rotator cuff repair (RCR). In addition, the self- report section of the American Shoulder and Elbow Surgeons Standardized Assessment Form (ASES) was cross-culturally adapted to the Finnish language and the psychometric properties of the Finnish version were assessed. Patients with a rotator cuff tear (aged 41-62 years) were randomized into an exercise group (EG, n=35) or a usual care group (UCG, n=32) after RCR. Disability was assessed with ASES questionnaire and quality of life with Short- Form 36 Health Survey (SF-36) preoperatively and at two months, 12 months and three years after surgery. Shoulder function was evaluated by measuring range of motion (ROM) and muscle strength at two and 12 months after surgery. The strength training intervention began two months after surgery and lasted 12 months. The EG were given instructions on a home-based shoulder muscle strengthening programme, while the UCG received ordinary postoperative instructions. The reliability of the ASES questionnaire was assessed. Preoperatively, the RCR patients with high functional disability of the shoulder demonstrated low HRQoL. After the 12-month intervention, no between-group differences were observed in any of the outcomes. The mean (SD) ASES score improved from 74 (14) by 21 points (95% CI, 16 to 26, p < 0.001) in the EG and from 70 (18) by 25 points (95% CI, 20 to 31, p < 0.001) in the UCG. Both groups maintained their post-intervention ASES score levels throughout the three-year follow-up. The Finnish version of the ASES proved to be a reliable and valid shoulder-specific measurement tool. These results suggest that the majority of the patients achieved good re- covery during one year. The additional exercise intervention did not benefit patients with a rotator cuff tear

Enhanced rehabilitation guidance after arthroscopic capsulolabral repair of the shoulder : a randomized controlled trial

Objective: To compare the effects of a 12-month home-based exercise program to usual care in patients after arthroscopic capsulolabral repair of the shoulder. Design: Randomized controlled trial. Setting: Outpatient physical and rehabilitation medicine clinic. Subjects: Forty-five patients (mean age: 35 years; standard deviation (SD): 10 years) who underwent arthroscopic capsulolabral repair due to labral lesion were randomized into an exercise group (EG) or a control group (CG). Intervention: The EG received a 12-month home-based additional exercise program with four physiotherapy follow-up visits, while the CG received standard postoperative exercise instructions. Main measures: Self-reported shoulder disability was assessed with the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) and quality of life with the Short-Form (SF)-36 Health Survey. The function of the operated shoulder was evaluated with strength and range of motion measurements. Results: No between-group differences were observed in any of the outcomes at the follow-up. Mean ASES score improved by 16 (95% confidence interval (CI): 10–23) points from the baseline 78 (SD: 17) in the EG and 13 (95% CI: 7–19) points from the baseline 79 (SD: 17) in the CG. Both groups achieved a significant improvement in the dimensions of Physical Functioning, Role-Physical, and Bodily Pain of the SF-36 and in every aspect of strength and range of motion measures. In EG, exercise adherence was moderate (52%) during the first six months and poor (22%) during the last six months. Conclusion: Home-based additional exercises with four outpatient follow-up visits did not improve outcome after arthroscopic capsular repair of the shoulder.peerReviewe

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); healthrelated 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.peerReviewe

Quality of life and disability: can they be improved by active postoperative rehabilitation after spinal fusion surgery in patients with spondylolisthesis? A randomised controlled trial with 12-month follow-up

Purpose The aim of the study was to investigate the effectiveness of the postoperative 12-month exercise program compared to usual care on disability and health-related quality of life (HRQoL) in patients after lumbar spine fusion surgery (LSF). Methods Altogether, 98 patients with isthmic (31) or degenerative (67) spondylolisthesis were randomised to exercise therapy group (EG) (n = 48) or usual care group (UCG) (n = 50) 3 months after LSF. EG patients had home-based progressive strength and aerobic training program for 12 months. UCG patients received only oral and written instructions of exercises. Oswestry Disability Index (ODI) and HRQoL (RAND-36) were evaluated at the time of randomization, at the end of the intervention and 1 year after intervention. Results The mean ODI score decreased from 24 (12) to 18 (14) in the EG and from 18 (12) to 13 (11) in the UCG during intervention (between-groups p = 0.69). At 1-year follow-up, 25 % of the EG and 28 % of the UCG had an ODI score ≥20. No between-group differences in HRQoL change were found at any time point. The mean (95 % CI) physical functioning dimension of the HRQoL improved by 10.0 (4.6–15.3) in the EG and by 7.8 (2.5–13.0) in the UCG. In addition, the role physical score improved by 20.0 (7.7–32.3) in the EG and by 16.4 (4.4–28.4) in the UCG during the intervention. Conclusions The exercise intervention did not have an impact on disability or HRQoL beyond the improvement achieved by usual care. However, disability remained at least moderate in considerable proportion of patients.peerReviewe

Tukimalli työhönpaluuseen selkäleikkauksen jälkeen:asiakasohjaajana työterveyshuolto

Tiivistelmä Lähtökohdat: Kokeilussa Keski-Suomessa integroitiin työterveyshuolto muuhun sosiaali- ja terveydenhuoltoon potilaiden jatkohoidossa selkäleikkauksen jälkeen. Menetelmät: Työterveyshuolto arvioi potilaan työkyvyn ja teki työhönpaluusuunnitelman kahdessa viikossa. Hoitoa, kuntoutusta ja työpaikan toimia koordinoi vastuullinen asiakasohjaaja. Tulokset: Potilaiden sairauspoissaolot lyhenivät 78:sta 38 päivään verrattuna kahden sairaanhoitopiirin lukuihin v. 1998 ja 2013. Yhteistyö toimi, mutta tiedonkulussa oli ongelmia. Kelan päivärahakorvauksia säästyi keskimäärin 2 280 €/potilas. Päätelmät: Yhteistyö ja työterveyshuollon koordinointi nopeuttivat merkittävästi potilaiden paluuta työhön työkykyisinä.Abstract Background: As a trial scheme of the Hospital District of Central Finland, in spring 2017 a project was started to operationally integrate occupational health care with other health care services and social benefits. The aim was to shorten return-to-work (RTW) periods. The project was funded and steered by the Finnish Ministry of Social Affairs and Health and was supported and implemented with the backing of various stakeholders. Methods:The investigational group consisted of patients who had undergone back surgery (M51.1) and patients suffering from chronic back pain (M54) who were temporarily unable to work. After an operation or treatment, orthopaedists or physiatrists did not put patients on 2 to 3 months’ sick leave as usual. Instead, within two weeks the patients were referred to occupational health care. The case manager thereafter took care of the necessary support for returning patients to work as soon as possible. The outcome of this case management model was assessed on the basis of the change in the length of the return-to-work period. Results: The main qualitative change was the way in which the patients were examined and advised with regard to returning to work two weeks after their discharge from hospital. As main quantitative result, instead of the previous recovery periods of 78 days, patients now returned to work in 38 days. If these outcomes are assessed on the basis of the average benefits per patient from the Social Insurance Institution, the cost saving per patient was 2280 euros. Conclusions: As a new model for integration of occupational health care with the rest of health care and social benefits, case management requires the definition of shared targets and the operational commitment of various actors. If these conditions are fulfilled, the return-to-work periods of both surgical and chronic back pain patients could be significantly shortened and costs of income subsidies reduced

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.peerReviewe