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Biomedical subjects

H Alaranta

Publications and source records attributed to H Alaranta.

At least 37 records · Page 2Linked to original sources
PubMed1995

Severe sciatica: a 13-year follow-up of 342 patients.

This study involved 342 patients hospitalized because of severe, persistent sciatica suggestive of a lumbar intervertebral disc herniation. After standard clinical evaluation, EMG and myelography, 220 patients underwent lumbar discectomy. The remaining 122 patients were treated conservatively. Follow-up examinations were arranged after 1, 5 and 13 years. The study focused on the rehabilitation outcome in general and differences in outcome between the two treatment groups. Several indicators showed a rather poor outcome for sciatica patients during the 13-year follow-up period. In the operated group 16% had been re-operated because of lumbar disc herniation. True recurrence of herniation (same level and side) occurred in 8%. In the conservatively treated group 14% had undergone spinal surgery. Nearly 70% of the patients still reported sciatica. Self-assessed levels of low back pain were "no change/worse" for 19% in the operated group and for 44% in the conservatively treated group. In both the study groups, nearly 40% of the subjects had retired on disability pensions.

Activities of Daily Living↗
PubMed1995

Good muscle performance does not compensate instability symptoms in chronic anterior cruciate ligament deficiency.

A total of 167 patients with documented anterior cruciate ligament deficiency was examined preoperatively with laxity and isokinetic muscle strength measurements. Functional evaluation with Lysholm knee and Tegner activity level scores were done. Antero-posterior (AP) knee laxity correlated negatively with Tegner activity level (NS), and insignificantly with Lysholm knee score. A marginal correlation was found between the Lysholm score and muscle strength. Patients were divided into four groups depending on whether their AP laxity was greater or less than 20 mm and whether their quadriceps strength was greater or less than 85% of their control knee. No difference in the Lysholm or Tegner scores between the groups was observed. As a conclusion it seems that even a relatively good muscle performance does not compensate severe instability symptoms.

Adolescent↗
PubMed1995

Cardiovascular functional disorder and stress among patients having neck-shoulder symptoms.

OBJECTIVES: To investigate if autonomic nervous system function, reflected in cardiovascular variables, among patients with neck-shoulder symptoms (tension neck group (T)) differed from that in a symptom free control group (C), and to establish its relation with pain and psychological stress. METHODS: Twelve women with tension neck and nine controls in secretarial jobs were studied. They underwent an orthostatic test, deep breathing test, Valsalva manoeuvre, isometric handgrip test, and muscular endurance test. Pain was measured using visual analogue scales, and psychological stress by the Modified Somatic Perception Questionnaire (MSPQ). Plasma endothelin-1 (ET-1) was measured using high pressure liquid chromatography and radioimmunoassay. RESULTS: Signs of psychological stress were significantly (p < 0.001) more common in group T than in group C. Mean resting heart rate in group T (77.8 (SE 2.9) beats/min; range 64-100) was significantly greater than that in group C (63.8 (3.1) beats/min; range 52-80) (p < 0.01). In the orthostatic test, the overall changes in R-R intervals during the first 40 heart beats after standing up and during seven minutes of testing differed significantly between the groups (p < 0.001, < 0.05, respectively). The increase in diastolic blood pressure in the three minute isometric handgrip test was significantly less in group T (19.4 (3.5) mm Hg; range -5 to 35) than in group C (30 (3.4) mm Hg; range 15-50) (p < 0.05). The MSPQ score in the study group (n = 21) correlated positively with resting heart rate (r = 0.462, p < 0.05) and negatively with increase in diastolic blood pressure (r = -0.514, p < 0.05). Plasma concentrations of ET-1 did not differ between the groups. CONCLUSION: Increased sympathetic activity was found among patients having neck-shoulder symptoms. Local mechanisms may have influenced the cardiovascular changes observed during isometric testing in these patients.

Adult↗
PubMed1995

Lower limb amputees in Southern Finland.

The purpose of this study was to look at the current epidemiological trends of lower limb amputees in 1992 in the area of Southern Finland with 1.2 million inhabitants. Similar data was collected earlier in 1984-85 and 1989. The amputation incidence was found to be 27.4 per 100,000 inhabitants. The trans-tibial/trans-femoral ratio was 0.78. The percentage of prosthetic fitting among patients undergoing unilateral trans-tibial amputation was 68% and the corresponding figure among the trans-femoral patients was 35%. The epidemiological data showed an improvement on that found 8 years earlier although the overall age structure is shifting upwards.

Adult↗
PubMed1994

Isokinetic and non-dynamometric tests in low back pain patients related to pain and disability index.

STUDY DESIGN: This study compared isokinetic and non-dynamometric tests for their correlation with subjective low back pain symptoms. METHODS: A total of 185 patients with chronic low back pain were examined. RESULTS: The repetitive arch-up and sit-up tests correlated significantly with pain and disability (Million index) both in men and women (r ranged from -0.39 to -0.46; P < 0.001). In women, the isokinetic trunk flexion and extension tests and the non-dynamometric tests correlated equally well with the Million index. In men, the isokinetic flexion and extension tests had weaker correlations. Overall, the isokinetic lifting tests showed lower correlations than did the isokinetic trunk extension tests. In the isokinetic flexion and extension tests, fast testing speeds (120 degrees/sec and 150 degrees/sec) correlated somewhat better with the subjective symptoms than did the lowest speed (30 degrees/sec). CONCLUSIONS: The non-dynamometric tests are still useful in clinical practice in spite of the development of more accurate muscle strength evaluation methods.

Adult↗
PubMed1994

Intensive physical and psychosocial training program for patients with chronic low back pain. A controlled clinical trial.

STUDY DESIGN: The authors conducted a controlled clinical trial with 1-year follow-up to define the effectiveness of an intensive physical and psychosocial training program on patients with low back pain. SUMMARY OF BACKGROUND DATA: The intervention group included 152 patients (mean age 40.5 yr, Million index 45.1/100), and the reference group included 141 patients (mean age 40.4 yr, Million-index 44.5/100). METHODS: The progressive intervention program consisted of intensive physical training and psychosocial activation. The outcomes were physical and psychosocial measures, the pain and disability index (Million), sick leaves, and occupational handicap. RESULTS: The intervention was more efficient with respect to physical measures and pain and disability index. There were only mild or no differences in changes between the study groups in psychologic variables, sick leaves, or retirement. CONCLUSIONS: The intervention program could improve physical disability, but to improve occupational handicap, activities of the whole society (social legislation, labor market policy) are needed.

Absenteeism↗
PubMed1994

Anthropometric measurements and the incidence of low back pain in a cohort of pubertal children.

STUDY DESIGN: The authors studied the anthropometric measurements to predict low back pain (LBP) in a cohort of growing adolescents. SUMMARY OF BACKGROUND DATA: The cohort consisted of all the fourth-grade school children of the western school district of Helsinki, Finland, in the spring of 1986. They were examined annually from the mean age of 11.8 to 13.8 years. METHODS: The forward bending test, measurements of total arm length, pelvic equilibrium, and spinal pantographs were carried out by the same physiatrist. A standardized pain questionnaire presented at the final examination obtained the history of LBP. Of the original cohort of 1060 children, those 859 (408 girls and 451 boys) who participated in all the examinations and had not had LBP until the age of 12.8 years were included in this study. RESULTS: The 1-year (from 12.8 to 13.8 years) incidence of LBP was 18.4% in girls and 16.9% in boys. Trunk asymmetry measured by the forward bending test and sitting height were significant determinants of the incidence of LBP. In the whole cohort, the odds ratio (OR) of trunk asymmetry adjusted for all the other risk determinants was 1.19 and its confidence interval (CI) was 1.00-1.39 per one standard deviation increase of the trunk hump. In the multivariate analysis comprising both sexes, OR per one standard deviation increase of sitting height was 1.24, (95% CI 1.03-1.46). In boys, standing height (OR 1.40, 95% CI 1.13-1.65, per one standard deviation) and sitting height (OR 1.35, 95% CI 1.09-1.63, per one standard deviation) were positively associated with the risk of LBP. These associations were not significant in girls. CONCLUSIONS: Sitting height and trunk asymmetry may contribute to LBP in pubertal children. The role of anthropometric characteristics seems, however, modest.

Adolescent↗
PubMed1994

Long-term results of primary scalenotomy in the treatment of thoracic outlet syndrome.

A total of 107 patients with thoracic outlet syndrome were reviewed an average of 4.1 years (range 2-11 years) after primary scalenotomy. The sample included 86 women and 21 men, and the mean age at surgery was 41.9 years (range 16-59 years). The three most disturbing pre-operative symptoms were pain at rest (87%), numbness (66%) and lack of power (55%). The post-operative success rate diminished from 71% 1 month after operation to 63% at follow-up. The retirement frequency increased from 6% up to 33% during the follow-up time. It was highest among factory workers at 60%. Of the patients older than 45 years at surgery, 68% were retired at follow-up. The importance of careful selection for operation is emphasized, and also the need to consider vocational rehabilitation before resorting to surgical treatment of thoracic outlet syndrome. We recommend surgical treatment for this disabling disorder, especially for younger patients with clear evidence of thoracic outlet syndrome who are engaged in occupations demanding little repetitive work. The best results have occurred in this group.

Adolescent↗
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↗
PubMed1994

Evaluating the outcome of vocational rehabilitation.

This paper presents an analysis of studies in which vocational rehabilitation was followed up during the 1980s and early 1990s. Its purpose is to clarify the outcome of vocational rehabilitation as well as the factors predicting that outcome. In these follow-up studies the variables by which the outcome is measured are closely linked with the subjects' employment opportunities, and are basically the same as those applied in earlier follow-up studies. Because of the study designs it is difficult to make any generalizations concerning the results. Little attention has been paid to the evaluation of psychological adaptation in most of these studies. Also, follow-up studies generally have not taken into account the employment situation. Whether those who have had rehabilitation are able to find employment depends essentially on employers' policies towards the handicapped and the disabled.

Female↗
PubMed1994

Correlation between neurological leg deficits and reaction time of upper limbs among low-back pain patients.

The purpose of the study was to examine how neurological deficits of the leg, i.e. sensory deficit, deficient reflexes and muscular weakness, correlate with reaction times of upper limbs in a group with chronic low-back pain. Thirty-two patients were studied. Three sets of measurements of simple reaction time and choice reaction time of upper limbs were conducted at one-week intervals. Neurological deficits of the leg were recorded by a physician and the subjects answered a questionnaire about the severity of their low-back symptoms (Oswestry's index). We also defined a neurological index which reflected the total sum of the three types of leg deficits experienced by each of the subjects. Sensory deficit of the leg and the neurological index correlated strongly with slower reaction times of upper limbs, while the other two neurological deficits did not reach a level of significance. Sensory deficits of the leg seem to be an indicator of much greater motor disability than has been thought so far. The motor disability not only appears distally from the lumbar radicular damage caused for example by an intervertebral herniation, it also seems to relate to psychomotor reaction more generally, even on upper limbs.

Adult↗
PubMed1994

Knee disorders in carpet and floor layers and painters. Part I. Isometric knee extension and flexion torques.

Knee morbidity, knee extension torque and knee flexion torque were examined among 168 actively working carpet and floor layers and 146 painters. The study included a questionnaire concerning knee disorders and knee symptoms, a clinical examination of the knees and measurement of isometric knee extension and flexion torque. Knee accidents were reported more frequently by carpet and floor layers than by painters. Tenderness of the knees was noted to an equal extent in the two groups. Knee extension torques gradually decreased by increasing age among carpet and floor layers, but not among painters. Body weight and thigh girth were not related to age among carpet and floor layers, but gradually increased with age among painters. Analysis of covariance showed that the torques were most consistently related to thigh girth and age. In addition, the right knee extension torque was related to occupation and tenderness of the patellofemoral joint; the left knee extension torque was related to the knee pain index. These results suggest that occupational kneeling and internal derangement of the knee affect thigh muscles among actively working house builders.

Adult↗