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This study was conducted to determine the characteristics of health and physical function that are associated with not starting strength and balance training (SBT). The study population consisted of 339 community-dwelling individuals (75–98 years, 72% female). As part of a population-based intervention study they received comprehensive geriatric assessment, physical activity counseling, and had the opportunity to take part in SBT at the gym once a week. Compared with the SBT-adopters, the nonadopters (n = 157, 46%) were older and less physically active, had more comorbidities and lower cognitive abilities, more often had sedative load of drugs or were at the risk of malnutrition, had lower grip strength and more instrumental activities of daily living (IADL) difficulties, and displayed weaker performance in Berg Balance Scale and Timed Up and Go assessments. In multivariate models, higher age, impaired cognition, and lower grip strength were independently associated with nonadoption. In the future, more individually-tailored interventions are needed to overcome the factors that prevent exercise initiation.
Background. The aim of the present study was to compare one-year-follow-up data on disability and health-related quality of life (HRQoL) between spinal fusion patients and age- and sex-matched general population. Methods. The data on fusion patients were collected prospectively using a spinal fusion data base in two Finnish hospitals. A general population sample matched for age, sex and residential area was drawn from the Finnish Population Register. All participants completed a questionnaire and the main outcome measures were the Oswestry Disability Index (ODI) and the Short Form-36 questionnaire (SF-36). Results. Altogether 252 (69% females) fusion patients and 682 (67% females) population sample subjects participated in the study. In general population the mean ODI was 15 (SD 17) in females and 9 (SD 13) in males. The corresponding preoperative ODI values were 47 (SD16) and 40 (SD 15) and one year follow-up values 22 (SD 17) and 23 (SD 20). In both sexes the ODI decreased significantly after surgery but remained higher than in the general population, p < 0.001. The physical component summary score (PCS) of the SF-36 was lower in the patients than general population sample both preoperatively and at one-year follow-up (p < 0.001). The mental component summary score (MCS) was lower preoperatively (p < 0.001), but reached the general population level after one year in both men (p = 0.42) and women (p = 0.61). Conclusions. Disability and HRQoL improved significantly after spinal fusion surgery during a one- year follow-up. However, the patients did not reach the level of the general population in the ODI or in the physical component of HRQoL at that time, although in the mental component the difference disappeared.
Purpose: To establish if visual feedback and force requirements influence SICI. Methods: SICI was assessed from 10 healthy adults (5 males and 5 females aged between 21 and 35 years) in three submaximal isometric elbow flexion torque levels [5, 20, and 40% of maximal voluntary contraction (MVC)] and with two tasks differing in terms of visual feedback. Single-pulse and paired-pulse motor-evoked potentials (MEPs), supramaximal M-wave, and background surface electromyogram (sEMG) were recorded from the biceps brachii muscle. Results: Repeated measures MANOVA was used for statistical analyses. Background sEMG did not differ between tasks (F = 0.4, P = 0.68) nor was task × torque level interaction observed (F = 1.2, P = 0.32), whereas background sEMG increased with increasing torque levels (P = 0.001). SICI did not differ between tasks (F = 0.9, P = 0.43) and no task × torque level interaction was observed (F = 2.3, P = 0.08). However, less SICI was observed at 40% MVC compared to the 5 and 20% MVC torque levels (P = 0.01–0.001). Conclusion: SICI was not altered by performing the same task with differing visual feedback. However, SICI decreased with increasing submaximal torque providing further evidence that SICI is one mechanism of modulating cortical excitability and plays a role in force gradation.
ObjectiveaaTo evaluate changes in the strength and mechanical properties of neck muscles and disability in patients with cervical dystonia (CD) during a 12-week period following botulinum neurotoxin (BoNT) injections. MethodsaaEight patients with CD volunteered for this prospective clinical cohort study. Patients had received BoNT injections regularly in neck muscles at three-month intervals for several years. Maximal isometric neck strength was measured by a dynamometer, and the mechanical properties of the splenius capitis were evaluated using two myotonometers. Clinical assessment was performed using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) before and at 2, 4, 8, and 12 weeks after the BoNT injections. ResultsaaMean maximal isometric neck strength at two weeks after the BoNT injections decreased by 28% in extension, 25% in rotation of the affected side and 17% in flexion. At four weeks, muscle stiffness of the affected side decreased by 17% and tension decreased by 6%. At eight weeks, the muscle elasticity on the affected side increased by 12%. At two weeks after the BoNT injections, the TWSTRS-severity and TWSTRS-total scores decreased by 4.3 and 6.4, respectively. The strength, muscle mechanical properties and TWSTRS scores returned to baseline values at 12 weeks. ConclusionsaaAlthough maximal neck strength and muscle tone decreased after BoNT injections, the disability improved. The changes observed after BoNT injections were temporary and returned to pre-injection levels within twelve weeks. Despite having a possible negative effect on function and decreasing neck strength, the BoNT injections improved the patients reported disability.
Objective: To determine the intensity and volume of therapeutic exercises during a standard 13-day inpatient neck rehabilitation course in relation to overall physical activity in rehabilitation and everyday life. Design: Cross-sectional study. Methods: Subjects (n=19; 16 women and 3 men; mean age 48.6 years, standard deviation (SD) 6.6) with chronic nonspecific neck pain were recruited from two inpatient neck rehabilitation courses. Intensity and volume of therapeutic exercises and physical activity were measured in metabolic equivalents (METs) with an objective measurement device and all-time recall questionnaire. Maximum oxygen uptake was determined in METs (METc) by direct maximal cycle ergometer. Results: Subjects’ mean METc was 7.2 METs (SD 1.4) or 25.3 ml/kg/min (SD 4.8). Intensity of all therapeutic exercises was 1.9 METs or 27 %METc (SD 5.1) and volume 7.7 MET-hours/week. Intensity of specific neck and shoulder exercises was 2.0 METs or 28 %METc (SD 5.4) and volume 2.5 MET-hours/week. In addition, subjects were more active in everyday life than in inpatient rehabilitation. Conclusion: The therapeutic exercise dose failed to reach previously reported target values for pain relief. The dose of therapeutic exercises and confounding physical activity should be carefully controlled in pain rehabilitation programmes.
Abstract. Background: The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) is one of the most widely used shoulder outcome tools in clinical work and in scientific studies. However, it has not been validated in the Finnish language. The aims of this study were to cross-culturally adapt the ASES to the Finnish language and to study the psychometric properties of the self-report section of the ASES. Methods: A total of 105 patients with shoulder symptoms answered the questionnaires of the ASES, a single disability question, the Simple Shoulder Test (SST), and the Short-Form 36 Health Survey (SF-36). The reliability of the ASES questionnaire was studied using a test-retest procedure at 2-week intervals. Psychometric assessment was performed by testing the construct validity, internal consistency, the criterion validity, and the convergent validity of the ASES. Results: The reproducibility and internal consistency of the ASES were 0.83 (95% CI 0.70 to 0.90) and 0.88 (95% Cl 0.84 to 0.91). There were no significant differences between the diagnostic groups in the pain scores from the ASES, and the function score was significantly higher in the instability group compared to the other groups. The convergent validity of the ASES correlated with the SST, r = 0.73 (p < 0.001); the single disability question, r =-0.74(p<0.001);and the Physical Component Score of the SF-36, r = 0.57 (p < 0.001). Conclusions: The Finnish version of the ASES proved to be a reliable and valid tool for assessing shoulder disabilities in patients with different shoulder diagnoses, including rotator cuff disease, instability, and osteoarthritis.
Purpose: To validate the activities and participation components of The International Classification of Functioning, Disability and Health (ICF). Methods: In this cross-sectional study, 113 Finnish community-dwelling persons with MS were assessed using a semi-structured interview provided by the Canadian Occupational Performance Measure (COPM) to capture participants’ self-perceived problems in everyday activities and participation. Problems were linked to the ICF categories. Results: Participants identified 527 of the most important occupational performance problems. They covered all chapters of the ICF Activities and Participation components. Forty-one categories out of a total 53 ICF activities and participation categories of the Comprehensive ICF Core Set and four out of five categories of the Brief ICF Core Set were reported on by the participants. The most common category in this sample, ‘d920 Recreation and leisure’ (145 problems/27.5%), is not included in the Brief ICF Core Set. Conclusions: Most, but not all, ICF activities and participation categories of the ICF Core Sets for MS could be confirmed from the perspective of persons with MS. It is worth considering to add category ‘d920 Recreation and leisure’ to the Brief ICF Core Set.
Background and Aims: Vision is an important prerequisite for balance control and mobility. The role of objectively measured visual functions has been previously studied but less is known about associations of functional vision. That refers to selfperceived vision-based ability to perform daily activities. The aim was to investigate the relationship between functional vision and balance and mobility performance in a community-based sample of older adults. Methods: This study is part of a Geriatric Multidisciplinary Strategy for the Good Care of the Elderly project (GeMS). Participants (576) aged 76 to 100 years (mean age 81 years, 70% women) were interviewed using a seven-item functional vision questionnaire (VF-7). Balance and mobility were measured by the Berg balance scale (BBS), timed up and go (TUG), chair stand test, and maximal walking speed. In addition self-reported fear of falling, depressive symptoms (15-item Geriatric Depression Scale), cognition (Mini Mental State Examination) and physical activity (Grimby) were assessed. In the analysis, participants were classified into poor, moderate, or good functional vision groups. Results The poor functional vision group (n=95) had more comorbidities, depressed mood, cognition decline, fear of falling, and reduced physical activity compared to participants with moderate (n=222) or good functional vision (n=259). Participants with poor functional vision performed worse on all balance and mobility tests. After adjusting for gender, age, chronic conditions, and cognition, the linearity remained statistically significant between functional vision and BBS (p=0.013), TUG (p=0.010), 3 and maximal walking speed (p=0.008), but not between functional vision and chair stand (p=0.069). Conclusion Poor functional vision is related to weaker balance and mobility performance in community-dwelling older adults. This highlights the importance of widespread assessment of health, including functional vision, to prevent balance impairment and maintain independent mobility among older population.
Purpose The aim of this 10-year follow-up study was to determine changes in health-related quality of life (HRQoL) over time among ambulatory persons with MS (PwMS) at the baseline using generic and disease-specific instruments. Methods Of 109 independently walking PwMS included in a population-based study in 2002, 77 (70.6 %) were re-assessed in 2012. HRQoL was captured using the 36-Item Short Form Survey Instrument (RAND-36), 15D instrument (15D), and the Multiple Sclerosis Quality of Life-54 (MSQOL-54). Repeated-measures ANOVA and effect size (ES) calculations (Cohen’s d) were used in the statistical analysis. Results The RAND-36 physical health composite score (p = 0.003, ES = 0.26) and 15D total score (p = 0.012, ES = 0.25) declined from the baseline levels. In particular, lower scores were observed on the RAND-36 scales of physical functioning (p = 0.001, ES = 0.27), pain (p = 0.020, ES = 0.25), and general health perceptions (p = 0.002, ES = 0.36), on the MSQOL-54 scales of physical functioning (p = 0.001, ES = 0.27), pain (p = 0.040, ES = 0.21), sexual functioning (p = 0.003, ES = 0.43), and satisfaction with sexual functioning (p = 0.012, ES = 0.38), and in the 15D dimensions of mobility (p = 0.004, ES = 0.31) and sexual functioning (p ≤ 0.001, ES = 0.59). Improvement was observed on the RAND-36 scale of social functioning (p = 0.049, ES = 0.25). The other composite scores, scales, and dimensions remained unchanged. Conclusion The results of this study suggest that ambulatory PwMS at baseline reported reduced HRQoL in physical functioning after a 10-year follow-up period, while emotional well-being was maintained and social functioning improved. The scores in the other HRQoL dimensions and scales remained unchanged. More long-term population-based studies are needed to precisely determine the development of HRQoL among PwMS.
Objective: To determine the effects of physiotherapy interventions on balance in people with multiple sclerosis. Data sources: A systematic literature search was conducted in Medline, Cinahl, Embase, PEDro, both electronically and by manual search up to March 2011. Study selection: Randomized controlled trials of physiotherapy interventions in people with multiple sclerosis, with an outcome measure linked to the International Classification of Functioning, Disability and Health (ICF) category of “Changing and maintaining body position”, were included. Data extraction: The quality of studies was determined by the van Tulder criteria. Meta-analyses were performed in subgroups according to the intervention. Data synthesis: After screening 233 full-text papers, 11 studies were included in a qualitative analysis and 7 in a metaanalysis. The methodological quality of the studies ranged from poor to moderate. Low evidence was found for the efficacy of specific balance exercises, physical therapy based on an individualized problem-solving approach, and resistance and aerobic exercises on improving balance among ambulatory people with multiple sclerosis. Conclusion: These findings indicate small, but significant, effects of physiotherapy on balance in people with multiple sclerosis who have a mild to moderate level of disability. However, evidence for severely disabled people is lacking, and further research is needed.
Objective: To examine the effect of randomized controlled trials of walking training on walking and self-care in patients with stroke. Data sources: MEDLINE, CINAHL, Embase, PEDro, OTSeeker, Central, and manual search to the end of August 2012. Study selection: English, Finnish, Swedish, or German language walking training randomized controlled trials for patients over 18 years of age with stroke. Data synthesis: The meta-analyses included 38 randomized controlled trials from 44 reports. There was high evidence that in the subacute stage of stroke, specific walking training resulted in improved walking speed and distance compared with traditional walking training of the same intensity. In the chronic stage, walking training resulted in increased walking speed and walking distance compared with no/placebo treatment, and increased walking speed compared with overall physiotherapy. On average, 24 training sessions for 7 weeks were needed. Conclusion: Walking training improves walking capacity and, to some extent, self-care in different stages of stroke, but the training frequency should be fairly high.
Terveysalan työharjoittelun toteutumista on arvosteltu siitä, että oppilaitokset panostavat entistä vähemmän työharjoittelun ohjaukseen ja harjoittelupaikkojen kanssa tehtävään yhteistyöhön. Harjoittelussa perinteiset työtavat ja vallitseva työkulttuuri siirretään kritiikittömästi opiskelijoille. Koulun antamat tiedot ja harjoittelupaikan edellyttämät taidot eivät kohtaa. Artikkelissa luodaan näkymiä uudenlaiseen työssäoppimiseen tehostamalla koulun ja työpaikkojen välistä yhteistyötä.
Objective: To systematically summarize the literature on: (i) the course of pain and physical functioning; and (ii) predictors of deterioration of pain and physical functioning in patients with osteoarthritis of the hip. Methods: A literature search was conducted in PubMed, CINAHL, Embase, PsychINFO and SPORTDiscus up to July 2015. Meta-analyses and qualitative data syntheses were performed. Results: Eleven of the 15 included studies were of high quality. With regard to the course of pain and physical functioning, high heterogeneity was found across studies (I2 >71%) and within study populations (reflected by large standard deviations of change scores). Therefore, the course of pain and physical functioning was interpreted to be indistinct. Clinical characteristics (higher comorbidity count and presence of knee osteoarthritis), health behaviour factors (no supervised exercise and physical inactivity) and socio-demographics (lower education) were found to predict deterioration of pain (weak evidence). Higher comorbidity count and lower vitality were found to predict deterioration of physical functioning (strong evidence). For several other predictive factors weak evidence was found (e.g. bilateral hip pain, increase in hip pain (change), bilateral knee pain, presence of knee osteoarthritis). Conclusion: Because of high heterogeneity across studies and within study populations, no conclusions can be drawn with regard to the course of pain and physical functioning. Several clinical characteristics, health behaviours and psychosocial factors prognosticate deterioration of pain and physical functioning. These findings may guide future research aimed at the identification of subgroups of patients with hip osteoarthritis.
The aim of this article is to investigate students’ narratives about their professional development process. This research brings new kind of knowledge to continuing learning, developing education and planning the curriculum in physiotherapy education. The European Qualification Framework (EQF) defines learning competences in education; qualitative research has a narrative approach. The material consists of eight voluntarily participating physiotherapy students’ portfolios written during their whole study time. The longitudinal data describes them as learners and their development process. The major findings are four main episodes in professional development: the previous studies, a new way of learning, understanding the physiotherapy and becoming professional in physiotherapy. Three story models were found: the story of the development of an autonomous learner, the story of the development in becoming a member of the physiotherapy community and the story of the development of a critical developer. In conclusion, four steps in the physiotherapy students’ professional development were formed. The model helps understand the students’ concepts about their professional development. Students need theoretical knowledge and practical skills to build their professional development. Reflecting learning and instructed practice are important for professional development in healthcare. Learning is connected to action, context and culture where information is collected and used.
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.
Background Patient-reported outcomes (PROs) are widely accepted measures for evaluating outcomes of surgical interventions. As patient-reported information is stored in electronic health records, it is essential that there are valid electronic PRO (ePRO) instruments available for clinicians and researchers. The aim of this study was to evaluate the validity of electronic versions of five widely used foot and ankle specific PRO instruments. Methods Altogether 111 consecutive elective foot/ankle surgery patients were invited face-to-face to participate in this study. Patients completed electronic versions of the Foot and Ankle Ability Measure (FAAM), the Foot and Ankle Outcome Score (FAOS), the modified Lower Extremity Function Scale (LEFS), the Manchester-Oxford Foot Questionnaire (MOXFQ), and the Visual Analogue Scale Foot and Ankle (VAS-FA) on the day of elective foot and/or ankle surgery. Construct validity, coverage, and targeting of the scales were assessed. Results Based on general and predefined thresholds, construct validity, coverage, and targeting of the ePRO versions of the FAAM, the FAOS, the MOXFQ, and the VAS-FA were acceptable. Major issues arose with score distribution and convergent validity of the modified LEFS instrument. Conclusions The ePRO versions of the FAAM, the FAOS, the MOXFQ, and the VAS-FA provide valid scores for foot and ankle patients. However, our findings do not support the use of the modified LEFS as an electronic outcome measure for patients with orthopedic foot and/or ankle pathologies.
Jos liikunta olisi pilleri, se todennäköisesti olisi maailman myydyin lääke, koska sillä on niin paljon positiivisia vaikutuksia hyvinvointiimme. Fysioterapeutteina olemme tottuneet käyttämään terapeuttista harjoittelua työkaluna esimerkiksi korjaamaan asentoa, parantamaan fyysistä toimintakykyä, kuntoa ja yleistä terveyttä. Sekin on monille tuttua, että harjoittelu voi toimia kivunlievittäjänä esimerkiksi jännevaivoissa ja että se ennaltaehkäisee monia kroonisia sairauksia. Säännöllisen harjoittelun vaikutusten lista myös psyykkisen toimintakykymme kannalta on pitkä, sillä kehoa ja mieltä ei voida harjoittelunkaan suhteen erottaa toisistaan. Vaikutukset ulottuvat vähintäänkin emotionaaliseen hyvinvointiin, kognitiiviseen ongelmanratkaisu- ja ajattelukykyyn, muistiin, stressinsietokykyyn, mielialaan, ahdistuneisuuteen, minä-pystyvyyskäsitykseen sekä resilienssiin.
Background: This study aimed to explore how students in a physiotherapy bachelor program acquire awareness of their own movement quality and form conceptions of movement quality. Methods: The study was designed as an elective course, implementing Basic Body Awareness Therapy principles. The participants were six PT students. Two data sets – students’ diaries and reflective group interviews – were collected, one a week before the course ended, and one on its completion. Phenomenographic research methodology was used to transcribe and analyze the data. Results: Three descriptive categories emerged reflecting the PT students’ conceptions of movement quality phenomenon as a widening process: I: Coming into contact with movement experiences, II: Variety of movement qualities, and III: Movement quality as professional development. Within these, two critical aspects, Acceptance of own movement quality and Reflective reasoning based on own experiences of being in movement to gain quality, were identified, indicating aspects of pedagogical importance in deepening PT students’ understanding of the movement quality phenomenon. Conclusion: The three categories reflect the PT students’ variety, widening views on movement quality. The findings elucidate movement awareness learning, by being in movement, indicating a direction for future research on students’ learning of movement quality conceptions within physiotherapy education.
Background: The Knee Injury and Osteoarthritis Outcome Score (KOOS) is a commonly used knee assessment and outcome tool in both clinical work and research. However, it has not been formally translated and validated in Finnish. The purpose of this study was to translate and culturally adapt the KOOS questionnaire into Finnish and to determine its validity and reliability among Finnish middle-aged patients with knee injuries. Methods: KOOS was translated and culturally adapted from English into Finnish. Subsequently, 59 patients with knee injuries completed the Finnish version of KOOS, Western Ontario and McMaster Osteoarthritis Index (WOMAC), Short-Form 36 Health Survey (SF-36) and Numeric Pain Rating Scale (Pain-NRS). The same KOOS questionnaire was re-administered 2 weeks later. Psychometric assessment of the Finnish KOOS was performed by testing its construct validity and reliability by using internal consistency, test-retest reliability and measurement error. The floor and ceiling effects were also examined. Results: The cross-cultural adaptation revealed only minor cultural differences and was well received by the patients. For construct validity, high to moderate Spearman’s Correlation Coefficients were found between the KOOS subscales and the WOMAC, SF-36, and Pain-NRS subscales. The Cronbach’s alpha was from 0.79 to 0.96 for all subscales indicating acceptable internal consistency. The test-retest reliability was good to excellent, with Intraclass Correlation Coefficients ranging from 0.73 to 0.86 for all KOOS subscales. The minimal detectable change ranged from 17 to 34 on an individual level and from 2 to 4 on a group level. No floor or ceiling effects were observed. Conclusion: This study yielded an appropriately translated and culturally adapted Finnish version of KOOS which demonstrated good validity and reliability. Our data indicate that the Finnish version of KOOS is suitable for assessment of the knee status of Finnish patients with different knee complaints. Further studies are needed to evaluate the predictive ability of KOOS in the Finnish population.
Objective: Our aim was to investigate the relation between radiograph-based subchondral bone structure and cartilage composition assessed with delayed gadolinium enhanced magnetic resonance imaging of cartilage (dGEMRIC) and T2 relaxation time. Design: Ninety-three postmenopausal women (KellgreneLawrence grade 0: n ¼ 13, 1: n ¼ 26, 2: n ¼ 54) were included. Radiograph-based bone structure was assessed using entropy of the Laplacian-based image (ELap) and local binary patterns (ELBP), homogeneity indices of the local angles (HIAngles,mean, HIAngles,Perp, HIAngles,Paral), and horizontal (FDHor) and vertical fractal dimensions (FDVer). Mean dGEMRIC index and T2 relaxation time of tibial cartilage were calculated to estimate cartilage composition. Results: HIAngles,mean (rs ¼ 0.22) and HIAngles,Paral (rs ¼ 0.24) in medial subchondral bone were related (P < 0.05) to dGEMRIC index of the medial tibial cartilage. ELap (rs ¼ 0.23), FDHor,0.34 mm (r ¼ 0.21) and FDVer,0.68 mm (r ¼ 0.24) in medial subchondral bone were related (P < 0.05) to T2 relaxation time values of the medial tibial cartilage. FDHor at different scales in lateral subchondral bone were related (P < 0.01) to dGEMRIC index (r ¼ 0.29e0.41) and T2 values of lateral tibial cartilage (r ¼ 0.28 to 0.36). FDVer at larger scales were related (P < 0.05) to dGEMRIC index (r ¼ 0.24e0.25) and T2 values of lateral tibial cartilage (r ¼ 0.21). HIAngles,Paral (r ¼ 0.25) and FDVer,0.68 mm (rs ¼ 0.22) in the lateral tibial trabecular bone were related (P < 0.05) to dGEMRIC index of the lateral tibial cartilage. Conclusion: Our results support the presumption that several tissues are affected in the early osteoarthritis (OA). Furthermore, they indicate that the detailed analysis of radiographs may serve as a complementary imaging tool for OA studies.
Background and aims: There is a growing body of evidence, that pain is common at school age. Less is known about the repeatability of pain questionnaires for children. This study aimed to assess the test-retest repeatability of the Finnish version of the electronic pain questionnaire for school-aged children. Methods: Primary (n = 79) and lower secondary (n = 127) schoolchildren aged 10–15 years from two schools from the Jyväskylä region of Finland, filled in an electronic questionnaire twice in an interval of 2 weeks. It captured the frequency of pain symptoms with a five-point Likert-scale questionnaire covering nine areas of the body for the last 3 months. The intraclass correlation coefficient (ICC) values 0.40–0.59 reflected fair and 0.60–0.74 good repeatability. Results: The highest prevalences of pain were in the head (29%) and neck and shoulder (NS) (23%) areas. ICC values showed good repeatability for questions about pain frequency in the head, NS and lower extremities. In primary school, these values were good in the lower extremities and fair in NS, lower back and the head. In lower secondary school, the ICC values were good in NS and the head, fair in the stomach and lower extremities. Conclusions: This electronic questionnaire was an acceptably repeatable indicator to measure the frequency of pain in the most prevalent pain areas: the head and NS. Implications: It is important to be aware of the impact of health-related outcomes on children’s ability to be successful in their lives. With the help of a simple electronic questionnaire, it is possible to cost-effectively capture, for example, the prevalence and frequency of pain during the school hours. The identification of children’s pain symptoms accurately provides more possibilities to prevent and to minimize the chronic pain among schoolchildren.
Objective: We aim to compare the rate of revisions for adjacent segment disease (ASD) after lumbar spine fusion (LSF) surgery between patients with isthmic spondylolisthesis (IS) and degenerative lumbar spine disorders (DLSD). Summary of Background Data: ASD is a major reason for late reoperations after LSF surgery. Several risk factors are linked to the progression of ASD, but the understanding of the underlying mechanisms is imperfect. If IS infrequently becomes complicated with ASD, it would emphasize the role of the ongoing degenerative process in spine in the development of ASD. Methods: 365 consecutive patients that underwent elective LSF surgery were followed up for an average of 9.7 years. Surgical indications were classified into 1) IS (n=64), 2) DLSD (spinal stenosis with or without spondylolisthesis) (n=222), and 3) other reasons (deformities, postoperative conditions after decompression surgery, posttraumatic conditions) (n=79). All spinal reoperations were collected from hospital records. Rates of revisions for ASD were determined using Kaplan-Meier methods. Results: Altogether, 65 (17.8%) patients were reoperated for ASD. The incidences of revisions for ASD in subgroups were 1) 4.8% (95% CI: 1.6 to 22.1%); 2) 20.5% (95% CI: 15.6 to 26.7%); 3) 20.6% (95% CI: 12.9 to 31.9%). After adjusting the groups by age, sex, fusion length, and the level of the caudal end of fusion, when comparing with IS group, the other groups had significantly higher hazard ratios (HR) for the revision for ASD [2) HR (95% CI) 3.92 (1.10 to 13.96), p=0.035], [3) HR (95% CI) of 4.27 (1.11 to 15.54), p=0.036]. Conclusions: Among patients with IS, the incidence of revisions for ASD was less than a 4th of that with DLSD. Efforts to prevent the acceleration of the degenerative process at the adjacent level of fusion are most important with DLSD.
Study Design: Cross-sectional study. Introduction: There is a lack of information on the measurement properties of patient-reported upperextremity instruments and their association to health-related quality of life (HRQoL). Purpose of the Study: This study aimed to examine and compare the measurement properties andconstruct validity of the Disabilities of Arm, Shoulder, and Hand (DASH) Instrument and the MichiganHand Questionnaire (MHQ) using a heterogeneous sample of patients with hand and wrist problems. Methods: Two hundredfifty consecutive patients visiting a general orthopedic outpatient clinic due tovarious hand/wrist problems were invited to participate in the study. A total of 193 (77%) participantsprovided sufficient patient-reported outcome data and were included in the analysis. Participantscompleted the DASH, the MHQ, the EQ-5D-3L, and pain on a visual analog scale instruments. Grip andkey pinch forces were measured. Scale targeting, relatedness of demographics, and construct validity ofthe DASH and the MHQ were assessed. Results: Both the DASH and the MHQ had good targeting, but the DASH had wider coverage. Theconvergence between the DASH and the MHQ was high. The DASH was more closely related to HRQoLthan the MHQ in terms of EQ-5D scores. Discussion: The DASH instrument appeared to measure hand function and disability from a perspective ofHRQoL superior to the MHQ among patients with heterogeneous hand and wrist complaints. Conclusion: The DASH performs well in measuring the HRQoL-related hand outcomes while the MHQmight be more specific for the affected hand.
Study Design. A prospective clinical study to test and adapt a Finnish version of the Scoliosis Research Society 30 (SRS-30) questionnaire. Objective. To perform cross-cultural adaptation and evaluate the validity of the adapted Finnish version of the SRS-30 questionnaire. Summary of Background Data: The SRS-30 questionnaire has proved to be a valid instrument in evaluating health-related quality of life (HRQoL) in adolescent and adult population with spine deformities in the United States. Multinational availability requires cross-cultural and linguistic adaptation and validation of the instrument. Methods. The SRS-30 was translated into Finnish using accepted methods for translation of quality-of-life questionnaires. A total of 274 adult patients with degenerative radiographic sagittal spinal disorder answered the questionnaire with sociodemographic data, RAND-36, Oswestry disability index, DEPS depression scale, and Visual Analog Scale (VAS) back and leg pain scales within 2 weeks’ interval. The cohort included patients with and without previous spine surgery. Internal consistency and validity were tested with Cronbach α, intraclass correlation (ICC), standard error of measurement, and Spearman’s correlation coefficient with 95% confidence intervals (CI). Results. The internal consistency of SRS-30 was good in both surgery and nonsurgery groups, with Cronbach α 0.853 (95% CI, 0.670 to 0.960) and 0.885 (95% CI, 0.854 to 0.911), respectively. The test-retest reproducibility ICC of the SRS-30 total and subscore domains of patients with stable symptoms was 0.905 (95% CI, 0.870 to 0.930) and 0.904 (95% CI, 0.871 to 0.929), respectively. The questionnaire had discriminative validity in the pain, self-image, and satisfaction with management domains compared with other questionnaires. Conclusions. The SRS-30 questionnaire proved to be valid and applicable in evaluating HRQoL in Finnish adult spinal deformity patients. It has 2 domains related to deformity that are not covered by other generally used questionnaires.
Study Design. A prospective cohort study. Objective. This study evaluated the cumulative reoperation rate and indications for reoperation following instrumented lumbar spine fusion (LSF). Summary of Background Data. LSF reduces disability and improves health-related quality of life for patients with several spinal disorders. The rate of instrumented LSF has drastically increased over the last few decades. The increased incidence of LSF, however, has led to increased reoperation rates. Methods. The data are based on the prospective LSF database of Tampere University Hospital that includes all elective indications for LSF surgery. A total of 433 consecutive patients (64% women, mean age 62 years) who underwent LSF in Tampere University Hospital between 2008 and 2011 were evaluated and indications for reoperations were rechecked from patient records and radiographs. The most common diagnosis for the primary surgery was degenerative spondylolisthesis and the mean follow-up time was 3.9 years. The cumulative incidence of reoperations and the ‘‘time to event’’ survival rate was calculated by Kaplan-Meier analysis. Results. By the end of 2013, 81 patients had undergone at least one reoperation. The cumulative reoperation rate at 2 years was 12.5% (95% confidence interval: 95% CI: 9.7–16.0) and at 4 years was 19.3% (95% CI: 15.6–23.8). The most common pathology leading to reoperation was adjacent segment pathology with a cumulative reoperation rate of 8.7% (95% CI: 6.1–12.5) at 4 years. The corresponding rates for early and late instrumentation failure were 4.4% (95% CI: 2.7–7.0) and 2.9% (95% CI: 1.9–7.1), respectively, and for acute complications, 2.5% (95% CI: 1.4–4.5). Conclusion. Although previous studies reported that early results of spinal fusion are promising, one in five patients required reoperation within 4 years after surgery. Patients and surgeons should be aware of the reoperation rates when planning fusion surgery. Key words: adjacent segment, complications, instrumented lumbar spine fusion, pathology, reoperation. Level of Evidence: 4 Spine 2018;43:295–301
Competent educators are needed to ensure that social and healthcare professionals are effective and highly competent. However, there is too little evidence‐based knowledge of current and required enhancements of educators' competences in this field. The aim of this study was to describe social and healthcare educators’ perceptions of their competence in education. The study had a qualitative design, based on interviews with educators and rooted in critical realism. Forty‐eight participants were recruited from seven universities of applied sciences and two vocational colleges in Finland, with the assistance of contact persons nominated by the institutions. The inclusion criterion for participation was employment by an educational institution as a part‐time or full‐time, social and/or healthcare educator. Data were collected in the period February–April 2018. The participants were interviewed in 16 focus groups with two to five participants per group. The acquired data were subjected to inductive content analysis, which yielded 506 open codes, 48 sub‐categories, nine categories and one main category. The educators’ competence was defined as a multidimensional construct, including categories of educators’ competences in practicing as an educator, subject, ethics, pedagogy, management and organisation, innovation and development, collaboration, handling cultural and linguistic diversity, and continuous professional development. Educators recognised the need for developing competence in innovation to meet rapid changes in a competitive and increasingly global sociopolitical environment. Enhancement of adaptability to rapid changes was recognised as a necessity. The findings have social value in identifying requirements to improve social and healthcare educators' competence by helping educational leadership to improve educational standards, construct a continuous education framework and create national and/or international curricula for teacher education degree programs to enhance the quality of education. We also suggest that educational leadership needs to establish, maintain and strengthen collaborative strategies to provide effective, adaptable support systems, involving educators and students, in their working practices.
Conceptual discussions related to clinical reasoning and decision making have evolved over the years from biomedical to incorporating more holistic approach to reasoning. Empirical studies exploring clinical reasoning and decision making in physiotherapy practice have mostly focused on aspects of managing persons with low back pain, such as exercise prescription, education and communicating diagnosis. There is a paucity of studies exploring decision making in whiplash‐associated disorder (WAD); thus, the aim of this study was to explore the physiotherapists' lived experiences of decision making related to treating persons with WAD. A qualitative research design based on hermeneutic phenomenological methodology was used in this study. Five participants (physiotherapists) were purposefully recruited, and data are collected via semistructured interviews, which were recorded and transcribed verbatim. Interpretative phenomenological analysis (IPA) was used as a method for analysing the data. Emergent, superordinate and master themes emerged from the data to illuminate the lived experiences under exploration. Three master themes were identified: (1) sense of collaboration; (2) sense of being out of control; and (3) sense of emotional engagement (subthemes: feeling of satisfaction and feelings of distress and uncertainty). A sense of collaboration revealed varied meaning related to the role of persons receiving care, suggesting a lack of conceptual clarity related to shared‐decision making. A perceived loss of a sense of being in control was related to experienced emotions, such as feelings of distress and uncertainty. The findings of this study highlight the importance of providing space for reflection and mentoring in the workplace.
Purpose To examine the relationship between leisure-time physical activity (LTPA) and ability to meet different work requirements among adult working men with or without current depressive symptoms. Methods We measured LTPA with the long version of the International Physical Activity Questionnaire (IPAQ). The Work Ability Index (WAI) and Beck Depression Inventory (BDI) were used to assess the work ability and depression of 921 Finnish employed male volunteers. Participants were divided into three groups according to the WAI for their work requirements: mental (MENT), physical (PHYS), and an equal amount of mental and physical work (BTH). Results When adjusted for age, BMI and employment years, there was a significant difference in weekly LTPA between WAI groups {p = 0.003, [F (2902) = 5.58]}, but not for depression. It appeared that participants with depressive symptoms scored lower WAI in each group regardless of LTPA. In addition, a linear relationship was found between higher LTPA and WAI in nondepressed workers in the PHYS [p = 0.011, β = 0.10 (95% CI 0.03–0.18)] and BTH [p = 0.027, β = 0.19 (95% CI 0.03–0.34)] groups. Among workers with depressive symptoms, similar linearity was found in BTH [p = 0.003, β = 0.20 (95% CI 0.03–0.55)]. In group-wise comparison, work requirements {p = 0.001, [F (2902) = 11.2]} and depressive symptoms {p < 0.001, [F (1902) = 177.0]} related with lower WAI. Conclusion Depressive symptoms were associated with lower work ability regardless of the job description. Therefore, higher levels of weekly LTPA was linked with better work ability among nondepressed working men. Workers with depressive symptoms in jobs that require extensive mental or physical work might need more than exercise to improve work ability.
Introduction The construct validity of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) has previously been questioned. The purpose of this study was to evaluate the measurement properties of the Finnish version of the DASH for assessing disability in patients with hand complaints using Rasch Measurement Theory. Methods A cohort of 193 patients with typical hand and wrist complaints were recruited at a surgery outpatient clinic. The DASH scores were analysed using the Rasch model for differential item functioning, unidimensionality, fit statistics, item residual correlation, coverage/targeting and reliability. Results In the original DASH questionnaire, the item response thresholds were disordered for 2 of 30 of the items. The item fit was poor for 9 of 30 of the items. Unidimensionality was not supported. There was substantial residual correlation between 87 pairs of items. Item reduction (chi square 95, degrees of freedom 50, p < 0.001) and constructing two testlets led to unidimensionality (chi square 0.64, degrees of freedom 4, p = 0.96). Person separation index was 0.95. The testlets had good fit with no differential item functioning towards age or gender. Conclusion Unidimensionality of the original Finnish version of the DASH was not supported, meaning the questionnaire seems to gauge traits other than disability alone. Hence, the clinician must be careful when trying to measure change in patients’ scores. Item reduction or the creation of testlets did not lead to good alternatives for the original Finnish DASH. Differential item functioning showed that the original Finnish scale exhibits minor response bias by age in one item. The original Finnish DASH covers different levels of ability well among typical hand surgery patients.
Background The Foot and Ankle Outcome Score (FAOS) is one of the most frequently used patient-reported outcome measures for foot and ankle conditions. The aim is to test the structural validity of the Finnish version of the FAOS using Rasch Measurement Theory. Methods FAOS scores were obtained from 218 consecutive patients who received operative treatment for foot and ankle conditions. The FAOS data were fitted into the Rasch model and person separation index (PSI) calculated. Results All the five subscales provided good coverage and targeting. Three subscales presented unidimensional structure. After testlet formation, all subscales were unidimensional. All subscales showed sufficient fit to the Rasch model. PSI ranged from 0.73 to 0.94 for the subscales. Conclusions The Finnish version of the FAOS shows acceptable structural validity for assessing complaints among orthopaedic foot and ankle patients.
Objectives: To evaluate the association of thoracic spine (TS) posture and mobility with TS pain. Methods: Participants with TS pain reported maximum, average, and night pain in TS area, and pain summary score was calculated. Upright and sitting TS postures were evaluated by inspection. TS posture and mobility (flexion and extension) were recorded using an inclinometer and a tape measure, respectively. Correlations between posture and mobility assessments were calculated using Spearman rank correlation, the association of TS posture and mobility with TS pain by logistic regression analysis. Results: The participants’ (n = 73, 52 females, age range 22–56) TS pain duration was 12 weeks on average. The correlations for measurements of TS posture and flexion mobility were higher than correlations of other TS measurements being between 0.53 and 0.82. Decreased extension mobility of the upper (from 1st to 6th TS segments; Th1–Th6) TS was associated with higher worst pain (OR 1.04, 95% CI 1.00–1.07) and whole TS with pain sum score (OR 1.05, 95% CI 1.01– 1.08). Less kyphotic whole TS was associated with lower pain sum score (OR 0.96, 95% CI 0.92– 1.00). Greater flexion mobility of upper and lower (Th6–Th12) TS were associated with lower pain sum score (OR 0.96, 95% CI 0.91–1.00, and OR 0.96, 95% CI 0.91–1.00, respectively). Conclusions: Reduced thoracic extension mobility was associated with higher pain scores and the greater flexion mobility with lower pain scores. Future research is warranted to evaluate if treatments geared toward TS extension mobility improvements would result in lower TS pain.
Background: The identification of risk factors for sports injuries is essential before injury prevention strategies can be planned. Hypothesis: Previous acute knee injury and lower perceived knee function measured by Knee injury and Osteoarthritis Outcome Score (KOOS) will increase the risk of acute knee injury in youth team-sports athletes. Study Design: Prospective cohort study. Level of Evidence: Level 3. Methods: At baseline, youth (≤21 years old) male and female basketball and floorball athletes completed a questionnaire on previous acute knee injuries and perceived knee function (KOOS). A total of 211 male and 183 female athletes were followed for an acute knee injury up to 3 years. Unadjusted and adjusted Cox regression models were used in risk factor analyses. Results: In male athletes, previous acute knee injury and lower KOOS Pain, Activities of Daily Living, Sport and Recreation, and knee-related Quality of Life subscale scores increased the risk of acute knee injury in the unadjusted analyses. Adjusted analyses for male injuries were not performed because of low number of acute knee injuries (n = 18). In female athletes, previous acute knee injury increased the risk of acute knee injury when adjusted for athletes’ age and body mass index (hazard ratio, 2.6 [95% CI, 1.3-5.2]). In female athletes, none of the KOOS subscale scores were associated with the increased risk of acute knee injury in the adjusted analyses. Conclusion: Previous acute knee injury was associated with the risk of new acute knee injury in youth male and female athletes. In youth male athletes, additionally, lower perceived knee function in 4 out of 5 KOOS subscale scores were associated with the increased risk of new acute knee injury. Clinical Relevance: The treatment and rehabilitation of the present acute knee injury and secondary prevention of reinjury should be emphasized in youth team-sports athletes.
Aim To evaluate the activity of knee stabilizing muscles while using custom-made biomechanical footwear (BF) and to compare it when walking barefoot and with a knee brace (Unloader®). Methods Seventeen healthy working-aged (mean age: 28 years; standard deviation: 8 years) individuals participated. The knee brace was worn on the right knee and BF in both legs. Surface electromyography (sEMG) data was recorded bilaterally from vastus medialis (VM), semitendinosus (ST), tibialis anterior (TA) and lateral gastrocnemius (LG) muscles during walking, and repeated-measures ANOVA with a post-hoc t-test was used to determine differences between the different walking modalities (barefoot, brace and BF). Results Averaged sEMG was significantly higher when walking with BF than barefoot or knee brace in ST and LG muscles. It was significantly lower when walking with the brace compared to barefoot in the right and left ST, LG and TA muscles. Analysis of the ensemble-averaged sEMG profiles showed earlier activation of TA muscles when walking with BF compared to other walking modalities. Conclusion BF produced greater activation in evaluated lower leg muscles compared to barefoot walking. Thus BF may have an exercise effect in rehabilitation and further studies about its effectiveness are warranted.
Clinical practice guidelines recommend a biopsychosocial approach for the management of musculoskeletal pain conditions, but physiotherapists have reported feeling inadequately trained and lacking in confidence to deal with psychosocial issues. Although a growing number of studies is exploring physiotherapists’ perceptions of biopsychosocial training, the results have not been synthesized. Therefore, the aim of this systematic review and metasynthesis of qualitative studies was to explore physiotherapists’ perceptions of learning and implementing a biopsychosocial intervention to treat musculoskeletal pain conditions. A search of the electronic databases: MEDLINE, EMBASE, CINAHL, ERIC, PsycInfo, SportDiscus and Sociological abstracts identified eligible studies. We included full text qualitative and mixed methodology studies published in English which investigated physiotherapists’ perceptions of learning and implementing biopsychosocial interventions. Twelve studies involving 113 participants met the inclusion criteria and a thematic synthesis was conducted. The quality of the included studies was appraised using the Clinical Appraisal Screening Program. Four main themes emerged from the data: changed understanding and practice, professional benefits, clinical challenges and learning requirements. The results of this study indicate that even though the physiotherapists reported a shift towards more biopsychosocial and person-centered approaches, the training interventions did not sufficiently help them feel confident in delivering all the aspects. Planning future implementation interventions and training physiotherapists through a biopsychosocial approach should focus on adequate training and individualized mentoring related to psychosocial factors, and discussion of role boundaries, patient expectations and organizational factors such as time constraints and referral pathways.
Background: The thoracic spine (TS) has been neglected in the study of the spine despite its essential role in the stability and posture of the entire spinal complex. Therefore, there is an inevitable need to investigate the reproducibility of different thoracic spinal posture measures used in subjects with TS pain. Methods: Thirty-two subjects (16 females and 16 males, mean age 39 years) were evaluated by two physiotherapists on the same day to gauge inter-rater reliability and on two consecutive days to gauge intra-rater reliability. TS posture was assessed by observation, and thoracic spine mobility was measured by manual assessment of segmental flexion and extension mobility in a seated position. Additionally, posterior-to-anterior accessory mobility in a prone position was assessed manually. Moreover, cervicothoracic flexion in a seated position, thoracic posture, and thoracic flexion and extension mobility in a standing position were assessed with a tape measure, and flexion and extension mobility in a seated position and TS posture in seated and standing positions were measured with an inclinometer. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), mean difference (MD), Bland-Altman (B&A) plot features and coefficient of repeatability (CR) were calculated. Results: The mean and standard deviation (SD) of the duration of TS pain was 22 (SD 45) months, with the intensity of pain being rated at 27 (SD 21) mm on a visual analogue scale (VAS). Intra-rater reliability was very strong (ICC ≥ 0.80) for the evaluation of seated and standing upper TS posture, standing whole TS posture and seated lower TS posture with an inclinometer. Moreover, TS posture evaluation with a measuring tape, posture inspection in a seated position, and manual assessment of segmental extension were found to have very strong intra-rater reliability. Inter-rater reliability was very strong for inclinometer measurements of standing and seated upper TS posture as well as standing whole TS posture. Conclusion: Intra-rater reliability was higher than inter-rater reliability in most of the evaluated measurements. Overall, posture measurements with an inclinometer were more reliable than mobility measurements with the same instrument. The manual assessments can be used reliably when same evaluator performs the examination.
Background and purpose: Educators’ ethical competence is of crucial importance for developing students’ ethical thinking. Previous studies describe educators’ ethical codes and principles. This article aims to widen the understanding of health- and social care educators’ ethical competence in relation to core values and ethos. Theoretical background and key concepts: The study is based on the didactics of caring science and theoretically links the concepts ethos and competence. Methods: Data material was collected from nine educational units for healthcare and social service in Finland. In total 16 semi-structured focus group interviews with 48 participants were conducted. The interviews were analysed with a thematic analysis according to Braun and Clarke. Ethical considerations: The study is approved by the Declaration of Helsinki, the legislation regarding personal data and the General Data Protection Regulation. The study received ethical permission from the University of Jyväskylä. Informed consent was obtained from all the educational units and participants in the study. Findings: The findings are presented based on three general patterns, an ethical basic motive, an ethical bearing and ethical actions. Subthemes are Humane view of students as unique individuals with individual learning, Bearing of tactfulness and firmness, Bearing of perceptiveness and accessibility, Bearing of satisfaction and joy over student learning, Valuing bearing towards each oneself and colleagues, Ability to interact and flexibility, Collegiality and a supportive work community and Educators as role models and inspirators. Conclusion: Educators’ personal and professional ethos is crucial to student learning, personal growth and ethical reasoning. Therefore, it is important to further develop educators’ training regarding ethical competence.
The development of digital solutions is becoming increasingly important in facing global challenges. Therefore, research on this topic is important in taking into account cardiac patients’ experiences of the rehabilitation process for the design of digital counseling solutions. The aim of the present qualitative study was to explore the different meanings that patients give to the rehabilitation process using a Glaserian grounded theory (GT) approach. Qualitative interviews were conducted with 30 participants from a rehabilitation center in Finland. The findings indicated a “complex trust-building process” core category comprising five categories of trust-building in rehabilitation: feeling that one has hit rock bottom, facing and coping in a crosscurrent, understanding together as a peer group, moving toward a healthier lifestyle with technology, and finding self-awareness. The complex process of trust-building involved interactions among emotion, cognition, and acceptance and support processes. Therefore, digital rehabilitation should be incorporated into counseling based on patients’ psychosocial, physical and emotional needs to help patients become aware of their own feelings and thoughts during the rehabilitation process.
Future social‐ and health‐care educators will be required to have versatile competence in educating professionals that reflects both the constantly changing health‐care environment and delivery of high‐quality patient care. Continuing professional development can be defined as a process that aims to increase educators' competence and well‐being, along with the effectiveness of an organisation. This study aimed to describe educators' continuing professional development and clarify the contribution of continuing education. The research applied a qualitative approach as only limited information about social‐ and health‐care educators' professional development currently exists.’ Data were collected by group interviews of 35 experienced social‐ and health‐care educators from six institutions of higher education and two vocational schools across Finland. An inductive content analysis yielded 39 subcategories, 11 categories and three main categories, namely, educators' approaches for developing professional competence, barriers to continuing education, and educators' continuing education needs. The educators reported that they maintain and develop their competence in versatile ways; for example, continuing professional development takes place through both formal continuing education and informal collaboration at daily work. Regarding barriers to continuing education, the educators most often cited the lack of planning and a lack of resources, for example, scheduling and financial factors. The continuing education needs of social‐ and health‐care educators are highly individual and should not only reflect organisational goals. The fact that this study only included experienced educators can be considered a limitation, as a sample that also included novice educators may have yielded different perceptions of continuing education and professional development. The results of the research can be utilised when designing the continuing professional development of educators at the individual, group or organisational level.
Background and Aims: Michigan Hand Outcomes Questionnaire is a widely used patient-reported outcome measure in hand surgery. The aim of this study was to translate and validate the Michigan Hand Outcomes Questionnaire into Finnish for Finnish patients with hand problems following international standards and guidelines. Material and Methods: The original English Michigan Hand Outcomes Questionnaire was translated into Finnish. Altogether, 115 patients completed the Finnish Michigan Hand Outcomes Questionnaire, and reference outcomes: Disabilities of the Arm and Shoulder, EQ-5D 3L and pain intensity on a visual analog scale. Grip and key pinch forces were measured. After 1–2 weeks, 63 patients completed the Finnish Michigan Hand Outcomes Questionnaire the second time. The Michigan Hand Outcomes Questionnaire was analyzed for internal consistency, repeatability, correlations with the reference outcomes, and factor analysis. Results: Cronbach’s alpha ranged from 0.90 to 0.97 in all the Michigan Hand Outcomes Questionnaire subscales, showing high internal consistency. The intraclass correlation coefficient showed good to excellent test–retest reliability ranging from 0.66 to 0.91 in all the Michigan Hand Outcomes Questionnaire subscales. In factor analysis, the structure with six subscales was not confirmed. All the subscales correlated with Disabilities of the Arm and Shoulder score, and five subscales correlated with EQ-5D index. Conclusion: The Finnish version of the Michigan Hand Outcomes Questionnaire showed similar properties compared to the original English version and thus can be used as patient-reported outcome measure for Finnish patients with hand problems.
Aim The purpose of the study was to identify and describe the characteristic profiles of evidence-based practice competence of educators in the social, health and rehabilitation sectors and to establish relevant background factors. Design This study was carried out as a descriptive cross-sectional study. Methods Data were collected from social, health and rehabilitation sector educators working in the 21 Finnish universities of applied sciences and seven vocational colleges (n = 422; N = 2,330). A self-assessment instrument measuring evidence-based practice competence was used. Competence profiles were formed using a K-cluster grouping analysis. Results Three distinct competence profiles were identified and delineated. Most educators feel that they can guide students' critical thinking and are able to seek and produce scientific knowledge. Evidence-based practice competence was explained by background factors such as year of graduation (for higher degree), level of education, job title, current employer and current field of work.
Kuntoutuksen ja kasvatuksen yhteistoiminnan on pitkään kuvattu olevan murrosvaiheessa, jossa yksilöasiantuntijuuteen perustuvista toimintamalleista pyritään kohti yhteistoimintaa ja lapsen arjessa tapahtuvaa kuntoutusta. Yhteistoimijuudella pyritään tuen oikea-aikaiseen tarjoamiseen lapselle siten, että siitä hyötyy koko varhaiskasvatusyhteisö. Tutkimustehtävänä oli kuvata ammattilaisten sekä lasten vanhempien käsityksiä yhteistoimijuudesta varhaiskasvatuksen yhteistoiminnassa. Aineisto kerättiin yksilöhaastatteluina (n = 10) osana kehittämishanketta varhaiskasvatusympäristössä, jossa oli pidempään toiminut yhteisöllinen puheterapeutti ja hankkeen ajan myös toimintaterapeutti. Aineisto kerättiin ja analysoitiin fenomenografisella menetelmällä. Käsitykset yhteistoimijuudesta jakaantuivat neljään hierarkkisesti laajenevaan kuvauskategoriaan: tiedon jakaminen, eri näkökulmien yhdistely, yhteistä päämäärää kohti työskentely ja yhdessä arjessa toimiminen. Kategorioiden välisiä kriittisiä eroja tarkasteltiin kolmen sisällöllisesti varioivan teeman kautta: toimijoiden roolit, yhteistoiminnan eri muodot ja lopputulos. Tutkimuksen tulokset mukailevat aiempaa tutkimustietoa yhteistoimijuudesta ja terapeuttisesta yhteistoiminnasta, mutta tuovat esiin vanhempien ja ammattilaisten laadullisesti erilaisia käsityksiä yhteistoimijuudesta. Varhaiskasvatuksen yhteistoiminnassa tarvitaan uudenlaisia kasvatusta ja kuntoutusta yhdistäviä toimintatapoja ja malleja, sekä erityisesti vanhempien roolin ja toimijuuden vahvistamista.
Background: Overweight and obesity are major problems worldwide, and they lead to an increased risk for several diseases. The use of technology in the treatment of obesity is promising, but in the existing literature, there is considerable uncertainty regarding its efficacy. In this review, we included web- and mobile-based weight loss interventions that were implemented remotely in rehabilitation settings. Objective: The aim of this systematic review is to study the effectiveness of physical activity-promoting web- and mobile-based distance weight loss interventions in rehabilitation settings on body composition in comparison with control groups that did not use technology. Methods: Studies were searched from 9 databases. The inclusion criteria were as follows: population: age 18-65 years; intervention: physical activity-promoting web- and mobile-based distance weight loss interventions; comparison: control groups without the use of technology; outcome: changes in BMI, waist circumference, or body fat percentage; study design: randomized controlled trial. The quality of the studies was assessed by 2 researchers. Meta-analysis was performed, and we also conducted a meta-regression analysis to evaluate the factors associated with the changes in body composition outcomes if statistical heterogeneity was observed. Results: The meta-analysis included 30 studies. The mean quality of the studies was 7 of 13 (SD 1.9; range 3-10). A statistically significant difference was observed in BMI (mean difference [MD] 0.83, 95% CI 0.51-1.15 kg/m2; P<.001), waist circumference (MD 2.45, 95% CI 1.83-3.07 cm; P<.001), and body fat percentage (MD 1.07%, 95% CI 0.74%-1.41%; P<.001) in favor of the weight loss groups using web- or mobile-based interventions. Meta-regression analyses found an association between personal feedback and BMI (P=.04), but other factors did not play a role in explaining statistical heterogeneity. Conclusions: Web- and mobile-based distance weight loss interventions significantly reduced BMI, waist circumference, and body fat percentage. Future studies should focus on the comparability of the intervention content. Future studies are needed to better understand weight loss and identify which components are essential in achieving it. Trial Registration: PROSPERO CRD42016035831; https://tinyurl.com/7c93tvd4
In these times of precision and personalized medicine, profiling patients to identify their needs is crucial to providing the best and most cost-effective treatment. In this study, we used urine metabolomics to explore the characterization of older adults with hip fractures and to explore the forecasting of patient outcomes. Overnight urine specimens were collected from 33 patients (mean age 80 ± 8 years) after hip fracture surgery during their stay at a rehabilitation hospital. The specimens were analyzed with 1H NMR spectroscopy. We performed a metabolomics study regarding assessments of frailty status, Functional Independence Measure (FIM), and Short Physical Performance Battery (SPPB). The main metabolic variations concerned 10 identified metabolites: paracetamol derivatives (4 peaks: 2.15 ppm; 2.16 ppm; 7.13 ppm and 7.15 ppm); hippuric acid; acetate; acetone; dimethylamine; glycine; alanine; lactate; valine; TMAO. At baseline, the urinary levels of these metabolites were significantly higher (i) in frail compared with non-frail patients, (ii) in persons with poorer FIM scores, and (iii) in persons with poorer compared SPPB scores. Our findings suggested that patients with increased levels of urine metabolites associated with metabolic, inflammatory, and renal disorders presented clear signs of frailty, impaired functional independence, and poor physical performance. Metabolomics could be a valuable tool to further characterize older adults, especially after major medical events.
Introduction and aim: Cultural differences have significant impacts on classroom behaviours and communication in teaching. The aim of this study is to explore social and healthcare educators’ cultural competence in transcultural education. Methodology: Data was collected from semi-structured focus group interviews at universities of applied sciences and vocational colleges. Inductive content analysis was used in the analysis process. Results: Educators’ cultural competence in transcultural education emerges as generic categories: transcultural education, educatorship and ethical attitudes, and underpins by the sub-categories: language and linguistics, different learning styles, integrating multicultural students, cultural knowledge and sensitivity, collaborating and cooperating, self-awareness and openness, and respecting and caring. Conclusion: Cultural competence represents a core competence for social-and health care educators. Educators need to know students’ background, master different learning styles, be flexible in their pedagogical approaches and have an open and ethical attitude.
Peer mentoring is commonly used for didactical and learning purposes. In this study we examine peer group mentoring in the university context. The aim is to promote understanding of peer group mentoring based on a meta-analysis of two primary studies: teacher students and teacher group tutors. As a result, three core categories were found: 1) Individual’s participation in the group, 2) Professional development with others and 3) Community enabling sharing and development. These were hierarchically organized and there are critical aspects placed in between the core categories. Professional and personal experiences intertwine to enhance participants’ self-understanding and professional development.