Reliability and Validity of The Finnish Version of The Boston Carpal Tunnel Questionnaire among Surgically Treated Carpal Tunnel Syndrome Patients

BACKGROUND AND AIMS

The Boston Carpal Tunnel Questionnaire is the most commonly used outcome measure in the assessment of carpal tunnel syndrome. The purpose of this study was to translate the original Boston Carpal Tunnel Questionnaire into Finnish and validate its psychometric properties.

MATERIALS AND METHODS

We translated and culturally adapted the Boston Carpal Tunnel Questionnaire into Finnish. Subsequently, 193 patients completed the Finnish version of the Boston Carpal Tunnel Questionnaire, 6-Item CTS Symptoms Scale, and EuroQol 5 Dimensions 12 months after carpal tunnel release. The Boston Carpal Tunnel Questionnaire was re-administered after a 2-week interval. We calculated construct validity, internal consistency, test-retest reliability, and coefficient of repeatability. We also examined floor and ceiling effects.

RESULTS

The cross-cultural adaptation required only minor modifications to the questions. Both subscales of the Boston Carpal Tunnel Questionnaire (Symptom Severity Scale and Functional Status Scale) correlated significantly with the CTS-6 and EuroQol 5 Dimensions, indicating good construct validity. The Cronbach's alpha was 0.93 for both the Symptom Severity Scale and Functional Status Scale, indicating high internal consistency. Test-retest reliability was excellent, with an intraclass correlation coefficient greater than 0.8 for both scales. The coefficient of repeatability was 0.80 for the Symptom Severity Scale and 0.68 for the Functional Status Scale. We observed a floor effect in the Functional Status Scale in 28% of participants.

CONCLUSION

Our study shows that the present Finnish version of the Boston Carpal Tunnel Questionnaire is reliable and valid for the evaluation of symptom severity and functional status among surgically treated carpal tunnel syndrome patients. However, owing to the floor effect, the Functional Status Score may have limited ability to detect differences in patients with good post-operative outcomes.

Effect of total knee replacement surgery and postoperative 12 month home exercise program on gait parameters

OBJECTIVE

To evaluate the effects of surgery and a postoperative progressive home exercise program on gait parameters among individuals operated with total knee arthroplasty.

DESIGN

Single blinded randomized controlled trial.

SUBJECTS

108 patients (84 females, 24 males, mean age 69 years).

INTERVENTIONS

Patients were equally randomized into an exercise group (EG) and control group (CG). The 12-months progressive home exercise program starting two months postoperatively was compared to usual care.

METHODS

Gait analysis was performed using the Gaitrite electronic walkway system. In addition, knee extension and flexion strength were measured by a dynamometer preoperatively, and pain on visual analog scale (VAS) at two months and 14 months postoperatively.

RESULTS

At the 12-month follow-up, maximal gait velocity (p=0.006), cadence (p=0.003) and stance time (p=0.039) showed a greater increase among EG than CG. All the other gait parameters improved among both groups, but with not statistically discernible difference between groups. Weak correlations were found between changes in maximal gait velocity and the knee extension (r=-0.31, p=0.002), flexion strength (r=0.28, p=0.004) and pain during loading (r=-0.27, p=0.005) values.

CONCLUSION

The intervention produced statistically significant changes in maximal gait velocity, cadence and stance times in the exercise group compared to controls. Although the average change was small it is of importance that biggest changes occurred in those with low performance.

Effect of strength training in addition to general exercise in the rehabilitation of patients with non-specific neck pain. A randomized clinical trial

BACKGROUND

The optimal type of exercise protocol in the physical rehabilitation of non-specific neck pain has not yet been established. Furthermore, the role of fear-avoidance belief in the maintenance of pain and disability has been highlighted. Research indicates that exercise may be a means to reduce fear-avoidance belief, but evidence is scarce.

AIM

To compare the effect of two different exercise programs on pain, strength and fear-avoidance belief.

DESIGN

Randomized clinical trial.

SETTING

A specialized outpatient hospital clinic in Denmark.

POPULATION

Twenty-three men and 60 women on sick leave due to non-specific neck pain.

METHODS

Participants were randomized to either general physical activity (GPA group) or GPA and additional strength training of the neck and shoulder (SST group). The primary outcome was pain intensity. Secondary outcomes were muscle strength of the neck and shoulder and fear-avoidance belief.

RESULTS

Pain was significantly reduced within groups with a median of -1 (IQR: -3 to 0, P<0.001) in the SST group and -1 (IQR: -4 to 1, P=0.046) in the GPA group. The difference between groups was not significant. Changes in strength did not differ between groups. Both groups experienced significant increases in neck flexion strength of 14.7 N (IQR: -1 to 28.4, P=0. 001) in the SST group and 6.9 N (IQR: -4.9 to18.6, P=0.014) in the GPA group. Furthermore, the SST group achieved an increase of 18.6 N (IQR: -2.6 to 69.7, P=0.005) in neck extension. Fear-avoidance beliefs improved with 6 (IQR: 3 to 12, P<0.001) in the SST group, while the GPA group improved with 3 (IQR: 0 to 8, P=0.004). This between-group difference was significant (P=0.046).

CONCLUSION AND REHABILITATION IMPACT

This study indicates that in rehabilitation of subjects severely disabled by non-specific neck pain, there is no additional improvement on pain or muscle strength when neck exercises are given as a home-based program with a minimum of supervision. However, strength training of the painful muscles seems to be effective in decreasing fear-avoidance beliefs.

The Glanville fritillary genome retains an ancient karyotype and reveals selective chromosomal fusions in Lepidoptera

Previous studies have reported that chromosome synteny in Lepidoptera has been well conserved, yet the number of haploid chromosomes varies widely from 5 to 223. Here we report the genome (393 Mb) of the Glanville fritillary butterfly (Melitaea cinxia; Nymphalidae), a widely recognized model species in metapopulation biology and eco-evolutionary research, which has the putative ancestral karyotype of n=31. Using a phylogenetic analyses of Nymphalidae and of other Lepidoptera, combined with orthologue-level comparisons of chromosomes, we conclude that the ancestral lepidopteran karyotype has been n=31 for at least 140 My. We show that fusion chromosomes have retained the ancestral chromosome segments and very few rearrangements have occurred across the fusion sites. The same, shortest ancestral chromosomes have independently participated in fusion events in species with smaller karyotypes. The short chromosomes have higher rearrangement rate than long ones. These characteristics highlight distinctive features of the evolutionary dynamics of butterflies and moths.

Butterflies and moths (Lepidoptera) vary in chromosome number. Here, the authors sequence the genome of the Glanville fritillary butterfly, Melitaea cinxia, show it has the ancestral lepidopteran karyotype and provide insight into how chromosomal fusions have shaped karyotype evolution in butterflies and moths.

Exercise therapy is evidence-based treatment of shoulder impingement syndrome. Current practice or recommendation only

BACKGROUND

Subacromial impingement syndrome is the most common indication for shoulder operation. However, exercise therapy for the conservative treatment is recommended in the first instance.

AIM

To evaluate the implementation of exercise therapy in impingement syndrome.

DESIGN

Retrospective study using structured postal questionnaire and data collected from hospital archive.

METHODS

A total of 104 consecutive patients who had undergone shoulder surgery due to impingement syndrome. Patients were asked about therapy modalities that they had received before and after the operation as well as pain (VAS) and functional impairment (ASES) at one-year follow-up.

RESULTS

Before surgery 49% of patients had not received advice for shoulder muscle exercises. After operation all patients had received mobility exercises, but one quarter of patients still reported that they had not received instructions about shoulder strength exercises. At the follow-up the means of the ASES index was 85 and use of NSAID had decreased by 75%. However, 15% of patients had moderate functional impairment (ASES under 60).

CONCLUSION

About half of patients reported that they had not received advice for rotator cuff exercise therapy before surgery even though with it surgery would probably have been avoided in many cases. Although symptoms in most patients had decreased after operation, several patients still suffered from pain and decreased function. Still several patients had not received advice for shoulder strengthening exercises that are important to recovery.

CLINICAL REHABILITATION IMPACT

The adherence to the current recommendations about exercise therapy is insufficient in clinical practice. Thus we recommend that it should be monitored in all institutions in which shoulder pain is treated.

Normalized N50 assembly metric using gap-restricted co-linear chaining

Background

For the development of genome assembly tools, some comprehensive and efficiently computable validation measures are required to assess the quality of the assembly. The mostly used N50 measure summarizes the assembly results by the length of the scaffold (or contig) overlapping the midpoint of the length-order concatenation of scaffolds (contigs). Especially for scaffold assemblies it is non-trivial to combine a correctness measure to the N50 values, and the current methods for doing this are rather involved.

Results

We propose a simple but rigorous normalized N50 assembly metric that combines N50 with such a correctness measure; assembly is split into as many parts as necessary to align each part to the reference. For scalability, we first compute maximal local approximate matches between scaffolds and reference in distributed manner, and then proceed with co-linear chaining to find a global alignment. Best alignment is removed from the scaffold and the process is iterated with the remaining scaffold content in order to split the scaffold into correctly aligning parts. The proposed normalized N50 metric is then the N50 value computed for the final correctly aligning parts. As a side result of independent interest, we show how to modify co-linear chaining to restrict gaps to produce a more sensible global alignment.

Conclusions

We propose and implement a comprehensive and efficient approach to compute a metric that summarizes scaffold assembly correctness and length. Our implementation can be downloaded from http://www.cs.helsinki.fi/group/scaffold/normalizedN50/.

Fast scaffolding with small independent mixed integer programs

Motivation: Assembling genomes from short read data has become increasingly popular, but the problem remains computationally challenging especially for larger genomes. We study the scaffolding phase of sequence assembly where preassembled contigs are ordered based on mate pair data.

Results: We present MIP Scaffolder that divides the scaffolding problem into smaller subproblems and solves these with mixed integer programming. The scaffolding problem can be represented as a graph and the biconnected components of this graph can be solved independently. We present a technique for restricting the size of these subproblems so that they can be solved accurately with mixed integer programming. We compare MIP Scaffolder to two state of the art methods, SOPRA and SSPACE. MIP Scaffolder is fast and produces better or as good scaffolds as its competitors on large genomes.

Availability: The source code of MIP Scaffolder is freely available at http://www.cs.helsinki.fi/u/lmsalmel/mip-scaffolder/.

Contact:leena.salmela@cs.helsinki.fi

Stability of the upper neck during isometric neck exercises in rheumatoid arthritis patients with atlantoaxial disorders

OBJECTIVE

To study the effect of isometric neck strength exercises on upper cervical stability in patients with rheumatoid arthritis (RA).

METHODS

Twenty patients with a mean (SD) age of 58 (9) years and duration of RA of 27 (10) years volunteered for the study. Lateral radiographs of the cervical spine were taken to measure the current atlantoaxial distance (AAD) in flexion and extension. Maximal isometric neck flexion and extension strength values were measured by a dynamometer. Thereafter, AADs were measured from radiographs taken at 80-90% resistance of maximal strength.

RESULTS

According to the full flexion radiographs at baseline, the patients were classified into three groups: eight patients without anterior atlantoaxial subluxation (aAAS) [AAD = 2.1 (2-3) mm], seven with unstable aAAS [AAD = 6.6 (5-8) mm], and five with stable aAAS [AAD = 5.5 (5-7) mm]. During resisted flexion the AAD decreased by 5 (3-7) mm (p<0.001) in the unstable aAAS group, while in the other two groups the changes were minor. During resisted extension the AAD increased by 3 (2-6) mm (p<0.001) in the cases with unstable aAAS only.

CONCLUSION

Isometric exercising towards flexion decreases the AAD in cases with unstable aAAS. Submaximal loading of the neck extensors by pushing the back of the head against the resistance even in the neutral position of the cervical spine leads to a decrease in the width of the cervical spine canal and is not recommended in unstable aAAS.

Neck muscle training in the treatment of chronic neck pain: a three-year follow-up study

AIM

The objective of the trial was to evaluate whether the positive results achieved with a one-year training regimen in patients with chronic nonspecific neck pain would have long-standing effects.

METHODS

A follow-up study of two neck muscle training groups after a randomized controlled study was carried out. One-hundred and eighteen women included were those who had performed neck strength and endurance exercises in a previous randomised controlled trial. The primary outcome measures were neck pain measured by the visual analogue scale and disability indices. Isometric neck strength, range of motion (ROM) and pressure pain threshold (PPT) were measured and training frequency for the previous month elicited by a questionnaire.

RESULTS

At the 3-year follow-up, neck pain and the disability indices showed no statistically discernible change compared to the situation at the 12-month follow-up. Also, gains in neck strength, ROM and PPT achieved during the training year were largely maintained. However, adherence to the specific home training program faltered considerably.

CONCLUSION

The improvements achieved through long-term training were maintained at the 3-year follow-up. Since a 12-month exercise programme shows a long-term effect, exercise may not need to be performed regularly for the remainder of the subject's life.

Physical exercises and functional rehabilitation for the management of chronic neck pain

Despite chronic neck pain being so common in the population, few randomized studies have evaluated exercise methods in treating the neck disorders. The aim of this review was to reassess the effectiveness of different exercise methods in relieving pain and improving disability in patients with chronic nonspecific neck pain. Ten randomized controlled or comparative high-quality trials were included in a more detailed analysis using patient-oriented primary outcome measures (e.g., patient's rated pain and disability) as well as pressure pain threshold and functional outcomes (neck strength and range of motion). Findings revealed moderate evidence supporting the effectiveness of both long-term dynamic as well as isometric resistance exercises of the neck and shoulder musculature for chronic or frequent neck disorders. Findings revealed no evidence supporting the long-term effectiveness of postural and proprioceptive exercises or other very low intensity exercises. Clinicians are encouraged to consider these findings and incorporate them into their practice when planning the treatment of patients with chronic neck disorders.

Cervical muscle strength measurement in two groups of elite Greco-Roman and free style wrestlers and a group of non-athletic subjects

BACKGROUND

Free style and Greco-Roman are two types of wrestling. [figure: see text]

OBJECTIVES

The aim of this study was to examine the maximal isometric strength of cervical extension (ISCE) and the maximal isometric strength of cervical flexion (ISCF) in two groups of elite wrestlers and a group of non-athletic subjects.

METHODS

Fourteen elite Greco-Roman wrestlers (aged 19-25 years), 16 elite free style wrestlers (aged 18-25 years), and 16 non-athletic subjects (aged 18-25 years) participated in this study. All wrestlers competed at international level with the Iranian national team. Maximum voluntary contractions (MVC) of cervical extensor and flexor muscles were measured using a custom made device. The ratios of ISCE to weight (ISCE/weight), ISCF to weight (ISCF/weight), and ISCF to ISCE (ISCF/ISCE) were calculated for group comparisons. Pearson product moment test was used to estimate correlation between maximal isometric strength measurements and anthropometric variables. A one way analysis of variance was computed to compare ISCE/weight, ISCF/weight, and ISCF/ISCE among groups.

RESULTS

There was significant correlation between maximum cervical extension and flexion strengths and weight in all groups (p<0.05, n = 46). The ratios of cervical muscle strengths to weight were significantly higher in wrestlers than in non-athletic subjects (p<0.00). Greco-Roman wrestlers appeared to be stronger than free style wrestlers following comparison of all ratios.

CONCLUSIONS

Neck muscle force measurements may be a useful test for athletes in combat sports like wrestling. They can be applied to identify the weakness of a group of muscles in the neck area and to devise a proper training program.

Muscle strength, pain, and disease activity explain individual subdimensions of the Health Assessment Questionnaire disability index, especially in women with rheumatoid arthritis

OBJECTIVE

To study the extent to which muscle strength and performance, pain, and disease activity are associated with the total Health Assessment Questionnaire (HAQ) disability index and its subdimensions in male and female patients with rheumatoid arthritis.

METHODS

HAQ for functional capacity was completed by 135 patients with rheumatoid arthritis referred for orthopaedic surgery (74% women; mean (SD) age 62 (10) years; disease duration 19 (13) years, 70% positive for rheumatoid factor). Knee extension, trunk extension and flexion, grip strength, walking speed, and sit-to-stand test were measured to mirror physical function. Radiographs of hands and feet, pain, and the modified 28 joint disease activity score (DAS28) were also assessed.

RESULTS

Mean total HAQ was 1.08 (0.68) in women and 0.67 (0.70) in men (p = 0.0031). Women had greater disability than men in five of the eight subdimensions of the HAQ. Grip strength was 48%, knee extension strength 46%, trunk extension strength 54%, and trunk flexion strength 43% lower in women than in men. Knee extension strength was inversely correlated with walking time (r = -0.63 (95% confidence interval, -0.73 to -0.51)) and with sit-to-stand test (r = -0.47 (-0.60 to -0.31)). In an ordered logistic regression analysis in female rheumatoid patients, DAS28, pain, knee extension strength, and grip strength were associated with the total HAQ disability index.

CONCLUSIONS

Women reported greater disability than men both in the total HAQ and in the majority of its eight subdimensions. In addition to disease activity and pain, muscle strength has a major impact on disability especially in female rheumatoid patients.

Pain and joint mobility explain individual subdimensions of the health assessment questionnaire (HAQ) disability index in patients with rheumatoid arthritis

OBJECTIVE

To explore the associations between individual subdimensions of the health assessment questionnaire (HAQ) and clinical variables in patients with rheumatoid arthritis.

METHODS

304 patients with rheumatoid arthritis (73% female, mean (SD) age, 58 (13) years; disease duration 6 (9) years, 69% rheumatoid factor positive) completed the HAQ for functional capacity (0-3) and a 100 mm visual analogue scale for pain. Grip strength, range of motion of the large joints, Larsen score for radiographic damage of hand and foot joints, and the number of tender and swollen joints were recorded. A logit regression model was used to study associations between subdimensions of the HAQ and other variables.

RESULTS

Mean (range) total HAQ score was 0.92 (0 to 2.88) and varied from 0.73 to 1.04 in the subdimensions. Disability was lowest in the "walking" and highest in the "reach" subdimension. Pain was an explanatory variable in all individual subdimensions. Decreased grip strength, limitation of shoulder and wrist motion, and a larger number of swollen and tender joints in the upper extremities were related to several subdimensions. A higher pain score and swollen joint count in the upper extremities, decreased grip strength, and limited motion of wrist, shoulder, and knee joints explained increased disability (higher total HAQ scores).

CONCLUSIONS

In patients with rheumatoid arthritis, pain and range of movements of joints have the greatest impact on individual subdimensions of the HAQ. Extent of radiographic damage in peripheral joints and the number of swollen and tender joints are of lesser importance for function.

Tranexamic acid (Cyklokapron) reduces perioperative blood loss associated with total knee arthroplasty

In this prospective, randomized, double-blind study, we have investigated the effect of an antifibrinolytic agent, tranexamic acid (Cyklokapron), on blood loss and transfusion requirements associated with total knee arthroplasty. Twenty-nine patients were allocated randomly to receive either tranexamic acid 15 mg kg-1 or an equal volume of placebo a few minutes before a tourniquet was deflated. Blood loss during surgery, in the recovery room and on the surgical ward was recorded, together with the number of units of blood transfused in hospital. Mean blood loss during surgery was 428 (SD 254) ml in the tranexamic acid group (n = 15) compared with 415 (244) ml in the placebo group (n = 13). In the recovery room the tranexamic acid group lost 127 (95) ml and the placebo group 576 (245) ml (P < 0.001). On the ward the respective volumes were 293 (200) ml and 558 (293) ml (P < 0.01). Total blood loss was 847 (356) ml in the tranexamic acid group and 1549 (574) ml in the placebo group (P < 0.001). During the hospital stay the treatment group received 1.5 (1.3) units of blood compared with 3.3 (1.8) in the control group (P < 0.005). Two patients in the placebo group experienced a thrombotic complication compared with none in the treatment group. We conclude that tranexamic acid reduced perioperative blood loss and transfusion requirements associated with total knee arthroplasty.

Clinical use of neck isometric strength measurement in rehabilitation

The purpose of this study was to evaluate for diagnostic purposes the isometric strength of the neck flexor and extensor muscles in 56 patients with neck and shoulder pain and to quantify the effect of a specific rehabilitation program. An isometric measurement protocol was performed at the beginning and at the end of a 3-week rehabilitation program that included physiotherapy, stretching, aerobic exercises, and circuit training to improve arm, shoulder, and neck muscle strength. In the beginning, mean neck flexor muscle isometric strength was 83N (+/- 48 SD) and extensor muscle strength 158N (+/- 76 SD), whereas after rehabilitation the strength measurements were 117N (+/- 43 SD) and 207N (+/- 84 SD) respectively. There was a significant increase in the ability to push forward and backward, which correlated with the lessening of neck pain and disability found at the end of the program (p < .05). Isometric strength measurement is a useful and practical method of objectively showing a functional improvement in response to rehabilitation.

Digital tissue compliance meter

Tissue compliance measurements were used for documentation of soft tissue consistency and made possible the diagnosis of muscle spasm and the effects of treatment. We have developed a new digital electronic operated tissue compliance meter to quantify the soft tissue hardness and resistance more objectively than the conventional hand-held mechanical tissue compliance meters. The ranges of measurements were able to perform to a maximum depth of 50 millimeters from the body surface with maximal load of 4000 grams. In lateral epicondylitis was demonstrated the effect of treatment by increase of total work (area).