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A Malmivaara

Publications and source records attributed to A Malmivaara.

17 recordsLinked to original sources
PubMed1998

Outcome measures for low back pain research. A proposal for standardized use.

STUDY DESIGN: An international group of back pain researchers considered recommendations for standardized measures in clinical outcomes research in patients with back pain. OBJECTIVES: To promote more standardization of outcome measurement in clinical trials and other types of outcomes research, including meta-analyses, cost-effectiveness analyses, and multicenter studies. SUMMARY OF BACKGROUND DATA: Better standardization of outcome measurement would facilitate comparison of results among studies, and more complete reporting of relevant outcomes. Because back pain is rarely fatal or completely cured, outcome assessment is complex and involves multiple dimensions. These include symptoms, function, general well-being, work disability, and satisfaction with care. METHODS: The panel considered several factors in recommending a standard battery of outcome measures. These included reliability, validity, responsiveness, and practicality of the measures. In addition, compatibility with widely used and promoted batteries such, as the American Academy of Orthopaedic Surgeons Lumbar Cluster were considered to minimize the need for changes when these instruments are used. RESULTS: First, a six-item set was proposed, which is sufficiently brief that it could be used in routine care settings for quality improvement and for research purposes. An expanded outcome set, which would provide more precise measurement for research purposes, includes measures of severity and frequency of symptoms, either the Roland or the Oswestry Disability Scale, either the SF-12 or the EuroQol measure of general health status, a question about satisfaction with symptoms, three types of "disability days," and an optional single item on overall satisfaction with medical care. CONCLUSION: Standardized measurement of outcomes would facilitate scientific advances in clinical care. A short, 6-item questionnaire and a somewhat expanded, more precise battery of questionnaires can be recommended. Although many considerations support such recommendations, more data on responsiveness and the minimally important change in scores are needed for most of the instruments.

Clinical Trials as Topic↗
PubMed1998

Standardized physical examination protocol for low back disorders: feasibility of use and validity of symptoms and signs.

A standardized examination protocol was developed for the assessment of low back disorders in primary care. The protocol was found feasible in the occupational health service setting. The interexaminer repeatability between an occupational physician and an occupational physiotherapist was good for most items. The predictive validity of different symptoms and signs was investigated with regard to future sick leaves due to low back disorders. Relief of pain when lying, severe trouble at work caused by pain, continuous pain, and pain in the leg or numbness or diminished sensitivity in the foot predicted sick leaves. Of physical signs, pain in the low back or buttock during lateral flexion and a side difference > or = 20 degrees in the straight-leg-raising angle were predictors for sick leaves. The predictive validity of the protocol items should be tested in another patient population before conclusions can be drawn concerning the external validity of our results.

Adult↗
PubMed1995

The treatment of acute low back pain--bed rest, exercises, or ordinary activity?

BACKGROUND: Bed rest and back-extension exercises are often prescribed for patients with acute low back pain, but the effectiveness of these two competing treatments remains controversial. METHODS: We conducted a controlled trial among employees of the city of Helsinki, Finland, who presented to an occupational health care center with acute, nonspecific low back pain. The patients were randomly assigned to one of three treatments: bed rest for two days (67 patients), back-mobilizing exercises (52 patients), or the continuation of ordinary activities as tolerated (the control group; 67 patients). Outcomes and costs were assessed after 3 and 12 weeks. RESULTS: After 3 and 12 weeks, the patients in the control group had better recovery than those prescribed either bed rest or exercises. There were statistically significant differences favoring the control group in the duration of pain, pain intensity, lumbar flexion, ability to work as measured subjectively, the Oswestry back-disability index, and number of days absent from work. Recovery was slowest among the patients assigned to bed rest. The overall costs of care did not differ significantly among the three groups. CONCLUSIONS: Among patients with acute low back pain, continuing ordinary activities within the limits permitted by the pain leads to more rapid recovery than either bed rest or back-mobilizing exercises.

Activities of Daily Living↗
PubMed1995

Lumbar spine in Marfan syndrome.

Lumbar spine radiographs of 28 patients with Marfan syndrome and a gender and age-matched control group were evaluated for scoliosis and morphologic changes of the L2, L3, and L4 vertebrae. No patient or control subject had any serious low back problems. The Marfan patients showed a high incidence of scoliosis (64%). The incidence of lumbosacral transitional vertebra was also high (18%). The end plates of the vertebral bodies in the Marfan patients were more biconcave than in the control group. In addition, the transverse processes were longer in relation to the vertebral body width in the Marfan group than in the controls. These findings indicate that biconcave vertebral bodies can be added to the list of skeletal manifestations of the Marfan syndrome, and Marfan syndrome to the list of differential diagnoses for biconcave vertebrae ("codfish vertebrae").

Adult↗
PubMed1995

Rheumatoid factor and HLA antigens in wrist tenosynovitis and humeral epicondylitis.

A matched case-referent study was undertaken to assess whether rheumatoid factor (RF) is associated with repeating tenosynovitis or peritendinitis and whether HLA-B27 predisposes to epicondylitis. The study subjects consisted of 25 workers in manually strenuous jobs with a history of at least two episodes of tenosynovitis or peritendinitis in the wrist or forearm, or humeral epicondylitis, and their matched referents. The latex agglutination test was positive in seven of the 23 cases with tenosynovitis and in one of the referents (p = 0.03). The corresponding figures for IgM-RF by enzyme immunoassay were ten and two, respectively (p = 0.008). HLA-B27 antigen was found in five of the 13 workers with epicondylitis and in one worker with no such history (p = 0.13). It is possible that RF-positive repeating tenosynovitis represents an incomplete form of rheumatoid disease.

Case-Control Studies↗
PubMed1993

Risk factors for injurious falls leading to hospitalization or death in a cohort of 19,500 adults.

Falls are the most common cause of nonfatal injuries and a major cause of injury death. In order to identify risk factors for injuries from falls, 19,518 persons aged 20-92 years from four regions of Finland were examined and followed up from between 1973 and 1977 to 1984 for 8 to 11 years by identifying hospital admissions or deaths due to fall injuries. During 187,405 person-years, 628 injuries from falls were documented. The risk for injuries from falls was significantly and independently of other factors associated with alcohol intake in all age and sex groups. After adjustment for all the other risk determinants, the relative risks (RR) (95% confidence intervals (CI)) in persons with monthly ethanol intake of 100-499 g, 500-999 g, and > or = 1,000 g were 1.43 (1.13-1.82), 2.32 (1.71-3.17), and 3.05 (2.05-4.55), respectively, compared with abstainers. Body mass index (kg/m2) > or = 30 was associated with an increased risk among women aged < 45 years (RR = 2.8, 95% CI 1.28-5.89), whereas in persons aged > or = 65 years it seemed to be a protective factor both among men (RR = 0.3, 95% CI 0.06-1.19) and women (RR = 0.5, 95% CI 0.30-0.76). Also single marital status, smoking, heavy physical activity during leisure time, use of psychopharmacologic agents, diabetes mellitus, and cardiovascular diseases other than stroke were found to carry independent predictive significance in at least one subgroup of sex and age. In conclusion, alcohol consumption, relative weight, and use of psychopharmacologic agents were seen to be the most relevant risk determinants. Intervention trials based on the predictive factors and on high-risk groups are needed.

Accidental Falls↗
PubMed1989

[Back pain].

Explore the source record for details and available documents.

Back Pain↗
PubMed1987

The value of the axial view in assessing discograms. An experimental study with cadavers.

The clinical value of discography is controversial. An axial view of a discogram such as could be obtained with CT scans should increase the structural information regarding disc pathology, and clarify the relationship to disease of the facet joints as well. To evaluate this concept, 103 intervertebral levels in 23 cadaver specimens were studied by anteroposterior, lateral, and axial roentgenographic views. From these three views, a new classification for interpreting discograms was developed. The correlations between the three different views were good, confirming the potential value of CT axial views. However, in one fourth of the discs there were pathologic anatomic findings that could be seen only in the axial views. There were more severe osteoarthritic changes in the right than the left facet joint, and a discrepancy between facet arthritis and disc disease was also noted.

Adult↗
PubMed1987

Plain radiographic, discographic, and direct observations of Schmorl's nodes in the thoracolumbar junctional region of the cadaveric spine.

The perceivability of Schmorl's nodes in plain radiographs and discograms in the thoracolumbar junctional region (T10-L1) of the cadaveric spine was assessed by comparing the radiologic measurements with bone measurements. Schmorl's nodes in bone specimens were encountered in 19 of 24 spines studied. They were more than two times as common between vertebrae T10-11 and T11-12 as between T12 and L1 (P less than 0.01). When the areas of actual Schmorl's nodes exceeded 0.5 cm2 (corresponding to an aperture with a diameter of 0.8 cm), 47% of the nodes were seen in plain lateral radiographs and 68% in discograms. When the area measured 0.5 cm2 or less, only 24% could be perceived in plain lateral radiographs and 23% in discograms. The clinical significance of Schmorl's nodes remains uncertain as long as they are difficult to detect in vivo.

Adult↗
PubMed1987

Facet joint orientation, facet and costovertebral joint osteoarthrosis, disc degeneration, vertebral body osteophytosis, and Schmorl's nodes in the thoracolumbar junctional region of cadaveric spines.

The disc degeneration in the thoracolumbar junctional region (T10-L1) of 37 male cadaveric spines was recorded with the use of discography. From 24 of these spines the facet joint orientation and degenerative findings of the facet and costovertebral joints, vertebral bodies (osteophytosis) and discs, and Schmorl's nodes were recorded directly from bones. At T11-12, the most common site for the transitional zone between thoracic and lumbar facet type, there was a marked variation in the orientation of facets. The occurrence of degenerative findings and Schmorl's nodes at the three levels in the region differed. At T10-11, disc degeneration, vertebral body osteophytosis, and Schmorl's nodes were most common (anterior degeneration). At T12-L1, facet and costovertebral joint degeneration were dominant (posterior degeneration). At T11-12, disc degeneration, vertebral body osteophytosis, Schmorl's nodes, and facet and costovertebral joint degeneration all occurred (anterior and posterior degeneration). The results point to a pathoanatomic association between degenerative changes and facet orientation.

Adult↗
PubMedDate not supplied

Radiographic vs. direct measurements of the spinal canal of the thoracolumbar junctional region (T10-L1) of the spine.

Midsagittal diameter (MSD) and interpedicular distance (IPD) in the thoracolumbar junctional region (T10-L1) of 24 male cadaveric spines were measured both from radiographs and directly from bones after removal of the soft tissues in order to assess the accuracy of plain radiographs. In addition surface areas of the vertebral canals were measured also from bone samples. It was found that the mean difference between bone and radiographic measurements in the IPD on different vertebral levels was 1.0 mm (r = 0.98). The MSD was a more difficult measurement, but the correlation coefficient was still 0.70, the mean difference being 0.7 mm or less. The sum of the MSD and IPD showed good relationship with the cross sectional area of the spinal canal, and the correlation coefficient was 0.77 (P less than 0.001).

Adult↗
PubMedDate not supplied

Disc degeneration in the thoracolumbar junctional region. Evaluation by radiography and discography in autopsy.

Disc dimensions and lengths of spondylophytes in the thoracolumbar junctional region (T 10-L 1) of 37 male cadaveric spines were measured from conventional radiographs. The disc degeneration was assessed by discography. The surface areas of the spondylophytes at vertebral body margins were recorded directly from the bones of 24 of the spines. Disc degeneration and the largest spondylophytes at corresponding levels measured from radiographs were related at T10-11 and at T11-12 (r = 0.41 and r = 0.43; p less than 0.01), but not at T12-L1 (r = 0.14). In the individual discs, however, only large spondylophytes in radiographs (actual length over 4 mm) were related to signs of disc degeneration. In addition, 'traction spurs' and Scheuermann's changes were more often associated with severe disc degeneration than 'claw-type' spondylophytes. The intervertebral disc space height correlated poorly with disc degeneration except, to some extent, at T11-12. Thus, the assessment of disc degeneration from conventional radiographs seems unreliable at this region of the spine.

Adult↗