Biomedical subjects

H Hurri

Publications and source records attributed to H Hurri.

At least 19 recordsLinked to original sources

PubMed1999

Mechanisms explaining the association between low back trouble and deficits in information processing. A controlled study with follow-up.

STUDY DESIGN: A controlled study with a 6-month follow-up period. OBJECTIVES: To find an explanation for the association between impairment in information processing, i.e., slow reaction times, and chronic low back trouble. SUMMARY OF BACKGROUND DATA: Low back trouble, chronic pain in general, and depression have been associated with impaired cognitive functions and slow reaction times. It is a common phenomenon that the preferred hand performs better than the nonpreferred hand in motor tasks. The authors hypothesized that chronic low back trouble hampers the functioning of short-term memory in a way that leads the preferred hand to loose its advantage over the nonpreferred hand, but that the advantage would be restored during the rehabilitation. METHODS: Sixty-one healthy control subjects and 68 patients with low back trouble participated in the study. Reaction times for the preferred and nonpreferred upper limbs were tested. A multiway analysis of covariance was used to examine the group, handedness, and rehabilitation effects on reaction times. The hypothesis was specifically tested with a third-degree interaction: group-handedness-rehabilitation. RESULTS: A significant interaction among group, handedness, and rehabilitation was found (P = 0.05). At the beginning, the reaction times for the preferred hand were faster among the control subjects (P = 0.001), but not among the patients with low back trouble (P = 0.62). After the rehabilitation, the preferred hand was faster both among the control subjects (P = 0.001) and the patients with low back trouble (P = 0.0002). During the rehabilitation, back pain, psychological distress, and general disability decreased significantly among the patients with chronic low back trouble. CONCLUSIONS: The results support the hypothesis that chronic low back trouble (i.e., pain, psychological distress, and general disability) hampers the functioning of short-term memory, which results in decreased speed of information processing among patients with chronic low back trouble.

Adult↗

PubMed1998

One-footed and externally disturbed two-footed postural control in patients with chronic low back pain and healthy control subjects. A controlled study with follow-up.

STUDY DESIGN: A study of postural control during one-footed and externally disturbed two-footed stance among healthy control subjects and patients with chronic low back pain at the beginning of a functional back restoration program and 6 months later at follow-up examination. OBJECTIVES: To study postural control cross-sectionally among control subjects and patients with low back pain, and to evaluate the effects of functional restoration on the postural control parameters in a follow-up examination. SUMMARY OF BACKGROUND DATA: Deficits of motor skills and coordination have been reported in association with musculoskeletal disorders. It has been found that patients with chronic low back pain have impaired psychomotor control, but the impairment is reversible with successful low back rehabilitation. It is insufficiently known how functional activation and intensive physical training affect postural control. METHODS: Sixty-one healthy volunteers (32 men, 29 women) and altogether 99 patients with low back pain participated in the study. Sixty-eight patients (33 men, 35 women) had moderate and 31 (18 men, 13 women) had severe low back pain. Postural stability was measured with a force platform. In two-footed stance, vibration stimulation on calf and back muscles was used to disturb the balance. Center point of force-velocity (cm/sec), average position shift in anteroposterior direction (cm), and maximal position shift in lateral direction (cm) were used as the parameters. RESULTS: Reliability of all tests was acceptable. Center point of force-velocity was the most sensitive parameter and the one-footed measurement the most sensitivetest for evaluating postural stability. At the beginning, the patients with severe low back pain had poorer one-footed postural control compared with the control subjects (P = 0.0003). The subgroup of patients with moderate low back pain participated in the restoration program. The outcome of the restoration program was considered good if the disability because of low back pain (Oswestry index) decreased during the restoration program and poor if the disability increased or did not change. The one-footed postural stability remained primarily at the same level as the initial results in the control and good outcome groups, but became significantly poorer in the poor outcome group. The difference between poor outcome and control groups was statistically significant (P = 0.04). CONCLUSIONS: Impaired postural stability seems to be one factor in multidimensional symptomatology of patients with chronic low back trouble. Postural stability is easily disturbed in case of impairment in strength, coordination, or effective coupling of muscles in the lumbar and pelvic area. Patients with chronic low back pain seem to experience impairment in these functions, which should be taken into consideration when back rehabilitation programs are planned.

Adult↗

PubMed1998

Psychomotor speed in chronic low-back pain patients and healthy controls: construct validity and clinical significance of the measure.

The effect of ethanol on reaction times was studied in 5 healthy men to test the construct validity of the measure. Reaction times were studied among 61 healthy controls and 99 patients with chronic low-back pain (68 moderate and 31 severe) to evaluate the diagnostic value of reaction time measurements. Analysis of receiver operating characteristics was used to calculate the discriminative power of the reaction time measurements. The severity of low-back pain was associated with slow reaction times but the diagnostic value of a single reaction time measurement was low due to insufficient sensitivity. In conclusion, even though many patients with low-back pain suffer from central impairment of motor function, a single reaction time measurement is not usable in evaluation of the severity of low-back pain.

Adult↗

PubMed1998

Lumbar spinal stenosis: assessment of long-term outcome 12 years after operative and conservative treatment.

The present study focuses on the long-term prognosis of radiographically verified stenosis of the lower lumbar spine. The purpose here was to describe the outcome 12 years after radiographic diagnosis of spinal stenosis and to identify factors predicting disability after operative or conservative treatment. Data were compiled on 75 patients (43 men and 32 women) with changes in functional myelography diagnostic for spinal stenosis. Their mean age at the interview 12 years later was 61 years. The sagittal diameter of the dural sac was measured from baseline myelographs at all intervertebral levels and was corrected for magnification. In the interview, subjective outcome assessment was obtained with a structured questionnaire, and the low-back disorder was scored using the Oswestry disability index. The sagittal diameter of the dural sac was severely stenotic (<7.0 mm) in 32 patients (26 operated), and moderately stenotic (7.0-10.5 mm) in 43 patients (31 operated). The severity of the stenosis significantly predicted disability, even when the effects of age, sex, therapy regimen, and body mass index were adjusted for. For moderate and severe stenosis, the adjusted mean Oswestry indices were 28.4 and 39.1, respectively (p = 0.01). Therapy as such (operative versus nonoperative) did not significantly correlate with later disability. The radiographic severity of lumbar spinal stenosis predicts disability independently of therapy regimen. Randomized clinical trials are needed to establish the indications for surgical and conservative treatment. Radiographic severity of the stenosis should be considered as an effect-modifying or confounding factor in clinical trials and other studies focusing on the outcome of lumbar spinal stenosis.

Aged↗

PubMed1997

Arm motion speed and risk of neck pain. A preliminary communication.

STUDY DESIGN: A sample of 486 Helsinki City Council workers, 35 to 54 years of age, was examined twice at a 1-year interval. OBJECTIVES: To investigate the speed of repetitive arm motion for its ability to predict neck pain. SUMMARY OF BACKGROUND DATA: Psychomotor factors have been suggested to play a role in the etiology of spinal disorders. It was hypothesized that motor skills, as reflected by arm motion speed, could provide protection against neck pain. METHODS: Both the baseline and follow-up examinations consisted of a questionnaire on the history of neck pain and of a number of tests, including arm motion speed and static and dynamic strength of the upper extremities. RESULTS: Of the 124 men and women who reported not having had neck pain during the 1 year before the baseline examination, 23 (19%) reported neck pain on reexamination. The incidence of neck pain was significantly higher both in the least and most rapid quintiles of arm motion speed than in the medium quintiles. This association was not confounded by age, sex, smoking, physical activity at work or at leisure, psychological distress score, or strength measures of the upper extremities, although these factors were significant covariates of the arm motion speed at baseline. When adjusted for these factors, the odds ratios of neck pain in the most and least rapid quintiles of arm motion speed were 8.68 (95% confidence interval 1.85-40.75) and 9.57 (95% confidence interval 2.21-41.52) respectively, compared with the medium quintiles. CONCLUSIONS: These results suggest that people with either very slow or very rapid arm motion speed may have an increased risk of neck pain. The etiology of neck pain is probably different on these two occasions.

Adult↗

PubMed1997

Low synthesis rate of type I procollagen is normalized during active back rehabilitation.

STUDY DESIGN: Open, prospective trial with patients participating in an active back restoration program. OBJECTIVES: To compare the concentrations of biochemical indicators of Type I and III collagen synthesis and Type I collagen degradation in the serum of patients with chronic low back pain and healthy control subjects and to evaluate the effect of active back rehabilitation based on vigorous exercise on collagen metabolism. SUMMARY OF BACKGROUND DATA: The aim of active back rehabilitation is to restore the physical function of low back pain patients falling into the so-called "deconditioning syndrome." The changes in functional muscle strength measurements during the restoration rehabilitation program always depend on motivation, learning phenomena, and fear of pain and injury, so that even more objective ways of showing changes in physical activity are needed. METHODS: Specific radioimmunoassays for the amino-terminal (PINP) and carboxy-terminal (PICP) propeptides of Type I procollagen, the amino-terminal propeptide of Type III procollagen (PIIINP), and the cross-linked carboxy-terminal telopeptide of Type I collagen (ICTP) were used for serum samples obtained from 41 patients before, during, and after an active back restoration program and from 16 age- and sex-matched healthy control subjects. RESULTS: The circulating concentrations of PINP and PICP were initially lower in the patients ([mean +/- SD] 35.3 +/- 12.5 micrograms/L and 119.0 +/- 32.6 micrograms/L, respectively) than in the control subjects (47.9 +/- 18.0 micrograms/L and 136.7 +/- 47.7 micrograms/L, respectively; P < 0.05 for PINP). Toward the end of the active back rehabilitation program, both PINP and PICP increased in the patients (P < 0.001 for the increase between the initial level and the end of rehabilitation). There was a significant difference in the time courses of these changes, with the circulating PICP concentration increasing earlier than that of PINP. In the intervention group, the PIIINP concentration also increased (P < 0.01), whereas the ICTP concentration remained unchanged, with a tendency to decrease. No changes occurred in the control subjects. CONCLUSIONS: Active back rehabilitation based on vigorous exercise increases. Type I collagen synthesis in patients with chronic low back pain; this may provide a means of objectively verifying the effects of such rehabilitation.

Adult↗

PubMed1997

Relationships between spinal mobility, physical performance tests, pain intensity and disability assessments in chronic low back pain patients.

Correlations between the Oswestry Disability Questionnaire (ODQ), the Pain Disability Index (PDI), PDI subscales PDI factor 1 (PDI 1), PDI factor 2 (PDI 2) and visual analogue scale (VAS) pain intensity on the one hand and spine range of motion measures and static and dynamic functional performance tests on the other, were studied in 52 chronic low back pain patients. Comparable groups of male and female patients were studied. A moderately significant (p < 0.01) inverse correlation was observed between the ODQ and rotation to the left even after correction for age, but not when men and women were studied separately. A significant (r = -0.480, p < 0.001) inverse correlation was observed between the repeated squatting test and pain intensity and in men both pain intensity and disability correlated (r = -0.607, p < 0.001) with this particular test. Only for the women were there moderately significant (p < 0.01) inverse correlations between disability assessments and all the physical performance tests with the exception of the static back muscle test. In the women only the isometric lifting test showed a moderately significant inverse correlation (r = -0.504, p < 0.01) with pain intensity. Such apparent gender differences in the overlap between physical performance tests and self-report disability assessments and pain intensity may be clinically relevant. The results will, however, require confirmation on larger groups of chronic low back pain patients.

Adult↗

PubMed1997

Comparison of trunk strength measurements between two different isokinetic devices used at clinical settings.

Intradevice reliability of isokinetic trunk strength measurements has been studied frequently, but no evidence is available on interdevice reliability. This motivated the present study, in which two isokinetic devices, the Ariel 5000 and Lido Multi-Joint II, were compared in a sample of 41 subjects (20 healthy and 21 low back pain subjects). The measurements were made in a random order with both machines. The results showed that the two isokinetic machines gave quite different results in trunk flexion-extension strength measurements. A statistically significant difference was present in the average peak torques between the two devices, with the exception of flexion at low angular velocity (60 degrees/s), and the correlations between the two measurements were low. The results were assumed to be more of a reflection of the interdevice variations (hardware and software, attachment of the subject) than of learning effects or other phenomena. We conclude that isokinetic trunk-muscle strength test results with the Ariel and Lido are device specific, and one cannot automatically compare results obtained from different devices with each other.

Adult↗

PubMed1996

Psychomotor speed and postural control in chronic low back pain patients A controlled follow-up study.

STUDY DESIGN: Psychomotor speed (reaction time) and postural control (center point of force velocity) among healthy control volunteers and patients with chronic low back pain (LBP) were studied at the beginning of an active, functional, restoration back rehabilitation program and 5 months after the program. OBJECTIVES: To study cross-sectionally reaction times and center points of force velocity among control volunteers and patients with low back pain, and to evaluate the effects of the restoration on these measures of motor function in a follow-up examination. SUMMARY OF BACKGROUND DATA: Deficits of motor skills and of coordination have been reported in association with musculoskeletal disorders, but one can only speculate about an association between proprioceptive dysfunction and low back disorders on the basis of the currently available data. METHODS: Sixty-one healthy control volunteers and 99 patients with low back pain-68 of these patients experienced moderate pain; 31 experienced severe pain-participated in the study. Reaction times for upper and lower limbs were tested with a system based on a microcomputer. Postural stability was measured with a vertical force platform. RESULTS: A consistent trend was found in which patients with low back pain had reaction times slower than these of control volunteers. Man with severe low back pain had significantly longer hand reaction times than men in the control group (P = 0.03). Women with severe low back pain also had poorer postural control than women with moderate low back pain (P = 0.02) and women in the control group (P = 0.04). Functional restoration seemed to have an effect on reaction times. The restoration was considered successful if the condition of a patient with a disability that had resulted from low back pain improved during the follow-up examination and unsuccessful if the disability worsened. Patients who experienced these results were identified in groups called "good" and "poor," respectively. Among men, the reaction times improved in the control group and "good" groups, but they became slower in the "poor" group. The difference between "good" and "poor" groups was significant (P = 0.008). Women in the "good" group achieved the most improved reaction times, and the difference between these women and the control women almost reached significance (P = 0.076). CONCLUSION: The results indicate that patients with chronic low back pain have impaired psychomotor speed and, among women, impaired postural control. Psychomotor speed improved during an active, functional, restoration back rehabilitation program.

Adult↗

PubMed1996

Functional and clinical results after anterior interbody lumbar fusion.

The functional and clinical results of anterior interbody lumbar fusion were assessed in 134 patients. Functional tests included spinal mobility and isokinetic trunk muscle strength measurements. The score rating system of the Japanese Orthopaedic association (JOA) and the Oswestry disability index were used for clinical evaluation. Functional results revealed decreased spinal flexibility when compared with normal values. A reduction in physical ability was also seen in the isokinetic trunk muscle measurements. Non-union seemed to have only little effect on the functional results. Patients under 20 years at operation had the best results, but beyond this threshold results did not vary with age. The JOA rating score was 25 or more in 50% of patients. The mean Oswestry disability index was 47.8 (range 1-82) preoperatively and 20 (range 0-68) at follow-up (P < 0.001), indicating a clear decrease in subjective disability. Solid fusion was seen in 107 patients (80%) at follow-up.

Adolescent↗

PubMed1996

Periprosthetic microvasculature in loosening of total hip replacement.

This study was performed to quantitate vascularity in periprosthetic tissues of loose total hip replacements (THRs), because most likely revascularization and endothelial cells are important for implant osseointegration and loosening. Interface and pseudocapsular tissue samples obtained from loose THRs were stained with an immunohistochemical labelling (ABC technique) for von Willebrand factor. Non-inflammatory synovial samples served as controls. The results were quantitated by morphometry using the Kontron image analysis system. Evaluation of the mean endothelial index (EI; positively stained area micron/mm2 of tissue) revealed that in the control samples synovium was better vascularized than was the case in the cellular areas of the periprosthetic pseudocapsule (P = 0.0008) and interface (P = 0.0004) of loose THRs. There was no significant difference between mean EI of cellular areas in the interface and that of the pseudocapsule (P = 0.24). In the interface the vascularity was irregular. Vascular injury and decreased blood supply seem to occur at the implant-host interface, which may be one of the reasons for insufficient implant osseointegration and loosening.

Aged↗

PubMed1996

Isokinetic performance capacity of trunk muscles. Part I: The effect of repetition on measurement of isokinetic performance capacity of trunk muscles among healthy controls and two different groups of low-back pain patients.

The aim of this investigation was to assess the reproducibility of the isokinetic trunk muscle performance measurement among patients with different degrees of low-back pain. Twenty-two healthy volunteers, 20 patients with mild and 18 patients with severe low-back pain participated in isokinetic measurements. Lidoback isokinetic dynamometer was used. The measurements were performed with the subjects standing, using velocities of 60, 90 and 120 degrees/second. Five repetitions were performed at each velocity. All subjects were tested three times with a 1-week interval between the tests. Peak torque, average peak torque, coefficient of variation, total work done and peak torque to body weight ratio were calculated for each velocity for both flexion and extension. The results showed that in every measurement peak torque, average peak torque, peak torque to body weight ratio and total work done correlated with each other very strongly both in flexion and extension (r > or = 0.9). The average peak torques increased in further measurements. The change had a strong correlation with the severity of the back problem, which was evaluated by means of the Oswestry disability index. The critical value was found to be 20% in the Oswestry index: values above this meant big changes between measurements and values below this meant small changes between measurements.

Adult↗

PubMed1996

Isokinetic performance capacity of trunk muscles. Part II: Coefficient of variation in isokinetic measurement in maximal effort and in submaximal effort.

It has been claimed that with the aid of isokinetic trunk strength measuring devices it is possible to distinguish true muscular weakness from submaximal effort in the test. This proposition is based on the presumption that in the isokinetic trunk strength test identical performances can only be reproduced by maximal effort. The purpose of this study was to investigate whether it is possible to distinguish maximal effort from submaximal with the aid of the coefficient of variation (CV) in an isokinetic trunk muscle strength test. The study group included 35 (21 male and 14 female) subjects of whom 12 were healthy, 10 had a mild low-back pain and 13 had a more severe chronic low-back pain. The subjects performed five consecutive bendings both with maximal (100%) and submaximal (50%) efforts at a speed of 90 degrees/second. In maximal effort only healthy subjects reached an average level of CV close to 10% both in extension and in flexion. In the chronic low-back pain group the average CV was close to 20%. The difference in CV was statistically significant (p < 0.05-0.02) between the healthy and the chronic low-back pain subjects. In the submaximal effort all health groups had a CV of approximately 20% or more and no significant differences were found. The group of slightly variable measurements (CV = 11-20%) was remarkably large in both the maximal and submaximal effort. The results suggest that an effort with a CV of 11-20% cannot be classified as definitely submaximal or maximal. When the CV is less than 10% the effort can be fairly certainly classified as maximal.

Back↗

PubMed1995

Asymmetry of lumbar lateral flexion and treatment outcome in chronic low-back pain patients.

In a study on the treatment of chronic low-back pain (n = 456 patients; 58% men, 35-54 years of age), 3-month treatment outcome was assessed by back pain questionnaires and physical measurements including spinal and hip mobility and trunk muscle strength. Changes in differences between ranges of right and left lumbar lateral flexion and rotation of > 5 degrees from pretreatment to follow-up were recorded. A relative increase in left lumbar lateral flexion was associated with a better treatment outcome according to both back pain and physical performance (p < 0.05-0.001). With spinal rotation measurements no similar connections were observed. The results point to a connection between back pain and asymmetric spinal function, which may have pathogenetic and therapeutic significance.

Adult↗

PubMed1994

Relationship of the Pain Disability Index (PDI) and the Oswestry Disability Questionnaire (ODQ) with three dynamic physical tests in a group of patients with chronic low-back and leg pain.

OBJECTIVE: To determine the relationship between overall disability in daily activities, assessed with the Pain Disability Index (PDI) and the Oswestry Disability Questionnaire (ODQ), and impaired performance on three physical tests in patients with chronic low-back pain. DESIGN AND SUBJECTS: The PDI and ODQ were administered in a cross-sectional study, before beginning a back rehabilitation program, to 45 patients with low-back pain of > or = 3 months' duration, with or without radiation to the legs. All patients also performed repetitive sit-up, arch-up, and squatting tests. SETTING: Tertiary care center. RESULTS: Modestly significant (p < 0.05) or significant (p < 0.01) inverse correlations (Pearson's r = 0.30-0.41) were noted between the PDI and the ODQ and all three physical performance tests. When normative data were used, the correlation (Spearman's rs = -0.45) between PDI and the squatting test remained significant (p < 0.01), whereas it was modestly significant (rs = -0.33, p < 0.05) between the ODQ and squatting test and between the PDI and arch-up test (rs = -0.35, p < 0.05). Compared with patients presently working, those on sick leave had significantly higher scores on the PDI and ODQ (Wilcoxon's two-sample test: p < 0.001) and also significantly worse performance on all physical tests (p < 0.001). CONCLUSIONS: The PDI and ODQ, as measures of self-perceived disability, and impaired performance on repetitive squatting, arch-up, and sit-up tests, as measures of physical capability, show some overlap in low-back-pain patients. Both types of disability measures are clearly influenced by the patient's work status.

Adult↗

PubMed1994

Subjective benefits of energy storing prostheses.

The energy storing (ES) prosthesis has been used in the Prosthetic Foundation's workshop since 1987. Subjective responses from 168 amputees (141 trans-tibial and 27 trans-femoral) fitted with the ES prosthesis were analysed. Ratings were generally favourable in comparison with those for conventional prostheses. The most pronounced advantages of the new prosthesis as shown by the ratings were in walking uphill or swift walking. The younger amputees had more benefit than the older ones. High body weight decreased the benefit of the ES prosthesis. The ES prosthesis does not seem to provide any major advantage for the less active amputee whose movements are mainly indoors.

Adult↗

PubMed1994

Flexibility of the spine: normative values of goniometric and tape measurements.

A sample of 508 male and female white-collar and blue-collar employees aged 35 to 54 years were examined clinically to determine the reliability of spinal flexibility measurements using inclinometers and a tape measure, and to determine the normal values of cervical sagittal movements, lateral flexion, lumbar flexion and extension, trunk rotation and sidebending. Spinal flexibility decreased with advancing age, particularly among the blue-collar workers. Male predominance was observed in lumbar flexion and rotation and female predominance in cervical flexion-extension-movement. Spinal flexibility was negatively related to the experience of disabling pain. The strongest connections were between cervical flexion-extension-movement and neck pain, and between trunk sidebending and low back pain during the preceding year. The interobserver reliabilities were found to be generally good for all these measurements, and trunk sidebending showed the highest reliability coefficients. The intraobserver reproducibility (checked at a one-year interval) was acceptable only for cervical flexion-extension movement, cervical sidebending and trunk sidebending.

Adult↗

PubMed1994

Non-dynamometric trunk performance tests: reliability and normative data.

A sample of 508 male and female white-collar and blue-collar employees aged 35 to 54 years was evaluated clinically to determine the reliability of repetitive sit-ups, repetitive arch-ups, repetitive squatting, and static back endurance tests, to determine the normal values of these tests and to detect determinants for trunk muscle performance. All of the given tests had fairly good or even excellent test-retest reliability. Muscular performance capacity decreased with advancing age, particularly among blue-collar workers. Men showed greater muscle endurance in all the muscle tests, and blue-collar workers lower values in all tests. The repetitive tests, in particular, showed reduced values in those with previous low-back pain. Normative values of back endurance, repetitive squatting, sit-up and arch-up tests for different age, sex and occupational groups are presented.

Adult↗