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J V Viitanen

Publications and source records attributed to J V Viitanen.

17 recordsLinked to original sources
PubMed2002

Functional long-term changes in patients with spondylarthropathy.

The objective of the study was to determine the long-term functional outcome of chronic spondylarthropathy (SpA) when measured by various functional indices. This information is important in the planning of long-term intervention studies and selection of the best follow-up methods. The study group consisted of 65 patients (21 women and 44 men) with SpA. Their mean age was 49 years and the mean age from diagnosis was 12 years. They completed several questionnaires (developed for the evaluation of functional capacity or the state of health of patients with SpA) at the beginning of the study and 3 years later. The questionnaires were: the Bath Ankylosing Spondylitis Functional Index (BASFI), the Dougados Functional Index (DFI), the Health Assessment Questionnaire for Spondylarthropathies (HAQ-S), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Patient Global Assessment (BAS-G) and Stiffness-VAS (on a visual analogue scale). We also asked the patients to inform us if something had occurred in their lives during the follow-up that might have affected their health. Most of the indices (BASFI, DFI, BASDAI, BAS-G and Stiffness-VAS, but not HAQ-S) showed a statistically significant reduction in the functional capacity or state of health of the patients during the follow-up. Many factors occurring during the 3-year period may have influenced the results of the indices. The natural course of the functional capacity of patients with SpA appears to be one of impairment, when evaluated using these indices. Our experience also showed that it is very difficult to separate any effect of a single treatment intervention (e.g. rehabilitation) in a long-term follow-up study, as so many interfering factors, e.g. life events and health-related factors, may affect the follow-up population over several years.

Activities of Daily Living↗
PubMed2001

Functional changes in patients with spondylarthropathy. A controlled trial of the effects of short-term rehabilitation and 3-year follow-up.

A cohort of 25 patients with spondylarthropathy (SpA) participated in a 3-year follow-up study of functional changes before and after an intensive 3-week inpatient course. They answered questions in the following functional status/disability indices: Bath ankylosing spondylitis functional index (BASFI), Dougados functional index (DFI), health assessment questionnaire for spondylarthropathy (HAQ-S), Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis patient global assessment (BAS-G), and horizontal visual analogue scale for stiffness (stiffness VAS) before and after the course and 3 years later by mail. A control group of 18 consecutive SpA patients from the waiting list for an inpatient course filled in the same questionnaires as study patients 3 months before entry and again 3 weeks later at home without rehabilitation. During the waiting time for the inpatient course, control group global assessments (BASDAI, BAS-G, and stiffness-VAS) worsened slightly, and BASFI but not HAQ-S and DFI scores remained unchanged in the 3 weeks without treatment. The results of the 25 study patients showed small and not significant improvements in all functional index scores (BASFI -0.5 points, DFI -1.1, and HAQ-S 0.17), whereas improvements were significant in BAS-DAI, BAS-G, and stiffness-VAS (-13 mm, 13 mm, and -11 mm, respectively) after the 3-week inpatient course. At 3-year follow-up, these small changes had disappeared and the changes were not significant. The global indices and BASFI worsened slightly (0.4) from baseline results, while DFI was slightly better (-0.4) and HAQ-S remained at the post-treatment level after 3 years. Thus, BASFI was the most sensitive to changes, whereas DFI and HAQ-S were relatively insensitive. All six indices correlated highly significantly with each other (ICC 0.53-0.94). The natural course of spondylarthropathy leads to progression of functional impairments, which seems to be preventable with intensive rehabilitation, at least in the short term. Among the three functional indices, BASFI seems to be the most sensitive tool.

Disability Evaluation↗
PubMed2001

Feasibility of fitness tests in subjects with chronic pain (fibromyalgia): discordance between cycling and 2-km walking tests.

Altogether, 69 out of 98 fibromyalgia (FMS) patients who attended a 2-week multidisciplinary inpatient course and a 1-week control period 3 months later completed 2-km walking tests and stepwise-increased cycling tests at entry and after 3 months. The purpose was to compare the feasibility of the two fitness tests for assessment of FMS patients. The results showed a substantially lower fitness level in the results of the 2-km walking test than in the cycling test in the same patients: mean maximum VO2 was 28.5 ml/kg per min vs 34.6 ml/kg per min, respectively. At entry and after the 3-month training period, the correlations between the two tests were very poor, i.e., with Spearman's r coefficients of 0.37 and 0.34, respectively (P < 0.01), intraclass correlation coefficients (ICC) 0.20 (95% CI -0.29 to 0.50) and 0.47 (95% CI 0.15 to 0.67), reliability coefficients (alpha) 0.54 and 0.47, and Kendal-T coefficients 0.32 and 0.41 for ordinal correlation of the test results. The results did not correlate with pain, which remained at initial levels for the 3 months of follow-up. Principally, these tests should both measure the same property, i.e., the fitness of fibromyalgia syndrome (FMS) patients, but the results differed substantially. The 2-km walking test showed a markedly lower fitness level than the cycling test in the same patients. The primary explanation for this difference might be difficulties in controlling test performance. especially in walking. The 2-km walking test would not appear recommendable for subjects with chronic pain syndrome, e.g., fibromyalgia.

Adult↗
PubMed2000

Evaluation of the Finnish versions of the functional indices BASFI and DFI in spondylarthropathy.

The aim of the study was to compare and evaluate the usefulness of Finnish versions of two functional indices used in spondylarthropathies. Seventy consecutive inpatients with different kinds of spondylarthropathies filled in self-administered questionnaires: the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Dougados Functional Index for spondylarthropathies (DFI). Cronbach's alpha as a coefficient of internal consistency was analysed for BASFI and DFI. Test-retest reliability was evaluated in 30 patients. For validity the functional indices were compared with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), erythrocyte sedimentation rate (ESR), spinal movement measures of chest expansion (CE), Schober S1 test and occiput-to-wall distance (OWD), and radiological changes in the lumbar spine (RTGLS) and sacroiliac joints (RTGSI). The reproducibility of the indices BASFI and DFI was good; the intraclass correlation coefficient (ICC) for reliability was 0.99 and 0.98, and the coefficient of internal consistency (Cronbach's alpha) was 0.94 for both BASFI and DFI. The functional indices correlated well with each other, r = 0.85 (95% CI 0.78-0.90). Validity in terms of correlation coefficients between disease activity index BASDAI and functional indices BASFI and DFI was 0.74 (95% CI 0.60-0.84) and 0.69 (95% CI 0.53-0.80), respectively. BASFI and DFI correlated with spinal mobility measurements and RTGLS, but DFI did not correlate with RTGSI. Neither BASFI nor DFI correlated with ESR and disease duration, and only DFI correlated with age. In conclusion, BASFI and DFI are reliable and valid for Finnish inpatients with spondylarthropathies. It is important to know that cultural differences do not reduce the usefulness of these indices.

Adult↗
PubMed2000

Clinical assessment of spinal mobility measurements in ankylosing spondylitis: a compact set for follow-up and trials?

Different spinal ranges of motion (ROM) were measured and the results of 17 repeated tests correlated with spinal radiological changes in 52 male patients with ankylosing spondylitis (AS). Both Schober tests and measurements of lumbar and cervical rotations (TRi, TR, CR, CRt) and lateral flexions (LFLf, LFLx, CLFLt, CLFLm), together with thoracolumbar flexion (ThFL), cervical flexion-extension measurements (CFL, CExt), and tragus - wall and occiput - wall distances (OWD,TWD), showed significant correlations with detailed radiological spinal changes. Cervical rotation (CRm, CRt) and flexion (CFLm) correlated only with cervical changes, and thoracolumbar rotation as assessed by instrument (TRi) correlated only weakly with lumbar changes, while chin-chest distance (CCD) and chest expansion (CE) showed no correlation. Inter- and intratester reliability was good in all tests (the intraclass correlation coefficients ranged from 0.84 to 0.98). Three new tape methods for measuring thoracolumbar and cervical rotations and cervical lateral flexion also proved to be valid and reliable, as did the Schober-S1 modification. We conclude that the thoracolumbar segment (Schober), whole (ThFL) and lateral (LFL) flexions and rotation (TR), and chest expansion (CE) (after careful standardisation) together with cervical rotation (CR), extension (CExt) and/or lateral flexion (CLFL) comprise the set of mobility tests for the follow-up and assessment of disease progression in AS. On the other hand, cervical (forward) flexion (CFL), chin-chest distance (CCD) and an instrument method for thoracolumbar rotation (TRi) are not approaches to be recommended.

Adult↗
PubMed2000

Sensitivity to change of mobility tests; effect of short term intensive physiotherapy and exercise on spinal, hip, and shoulder measurements in spondyloarthropathy.

OBJECTIVE: To assess the sensitivity to change of 13 spinal, shoulder, and hip measurements and determine correlation between age, disease duration, and radiologic findings in ankylosing spondylitis (AS) and other spondyloarthropathies (SpA). METHODS: We assessed 112 patients with various types of SpA as changes before and after an intensive inpatient course. RESULTS: The most sensitive spinal measurements were finger to floor distance, chest expansion. thoracolumbar rotation (TLR), and lateral flexion, in that order. Cervical rotation, lateral flexion, and intermalleolar distance might also be useful in short term clinical trials, while the Schober tests, thoracolumbar flexion, and occiput-wall distance were not sufficiently sensitive. Hip internal rotation (HRi), shoulder flexion, and abduction measurements were also sensitive, though possibly more suitable for patients with articular symptoms. TLR and HRi were the only measurements that correlated markedly with disease duration, but not with age. Changes in the measurements correlated significantly with radiological spinal changes. CONCLUSION: Finger to floor distance, TLR, and thoracolumbar lateral flexion were the most sensitive to detect improvements in short term clinical trials, while the Schober test, thoracolumbar flexion, and occiput-wall distance were insensitive.

Adult↗
PubMed1999

Assessment of thoracolumbar rotation in ankylosing spondylitis: a simple tape method.

Results of a 'new' method for thoracolumbar rotation by tape (TRPav), simple instrumental rotation (TRi), the modified Schober test and thoracolumbar flexion (ThFL) were correlated with radiological changes in patients with ankylosing spondylitis (AS). TRPav showed a significant radiological correlation (Ls-r: 0.38; Th-r: 0.31), while the instrument method (TRi) did not; both the Schober test and ThFL, again, correlated fairly highly (Ls-r: 0.71, 0.62; Th-r: 0.49, 0.42). Both inter- and intratester reliability of the tests was good (Bland and Altman plots). Thoracolumbar rotation is one of the three principal levels of spinal motion and seems to be less affected by age. TRPav proved a valid and reliable method for measuring thoracolumbar rotation and clinically is a non-invasive, quick and easy complement to AS measurement methodologies.

Adult↗
PubMed1998

Neck mobility assessment in ankylosing spondylitis: a clinical study of nine measurements including new tape methods for cervical rotation and lateral flexion.

The objective was to carry out a clinical assessment of different cervical mobility measurements in ankylosing spondylitis (AS), including two new tape methods for measuring cervical rotation and lateral bending. A range of cervical movements was measured in 52 consecutive male AS patients and the results correlated with detailed radiological changes in the whole spine and sacroiliac joints. Occiput- and tragus-to-wall distance (OWD/TWD), cervical rotation (CR) and lateral flexion (CLF) using a Myrin inclinometer (My) and a tape method (t), cervical flexion-extension (CFl-CExt/My) motion and chin chest distance (CCD) measurements were taken and repeated (test-retest). The results showed a highly significant correlation of all measurements with cervical radiological changes, except for CCD, and also those of OWD/TWD with lumbar changes. CLF and CExt also correlated significantly with lumbar changes, other measurements did not, and only TWD and CExt correlated with thoracic changes. All measurements showed good reliability, intra-class correlation coefficients (ICC) ranging from 0.89 to 0.98. Occiput- or tragus-to-wall distance, cervical extension and lateral flexion proved to be valid and reliable measurements in AS, but cervical rotation also appeared to be a clinically relevant method. Cervical lateral flexion is a recommendable measurement for clinical trials in AS. The two new tape methods for measuring cervical rotation and lateral bending were as valid and reliable as the inclinometer method (Myrin), but also quick and easy. Chin-to-chest distance was not among the most valid tests in AS.

Adult↗
PubMed1995

Correlation between mobility restrictions and radiologic changes in ankylosing spondylitis.

STUDY DESIGN: In 151 adult patients with ankylosing spondylitis who participated in an inpatient rehabilitation program of 3-4 weeks, 10 different range of motion (ROM) values were measured, and their lumbar spine and sacroiliac joints were radiographed. OBJECTIVES: To determine whether a correlation obtained between restriction of ROM and progression of radiologic findings in ankylosing spondylitis, together with a high enough reliability level in measurements. SUMMARY OF BACKGROUND DATA: A significant correlation was observed between the restriction of eight ROMs: the Schober test, thoracolumbar rotation, thoracolumbar flexion, cervical rotation, occiput-wall distance, chin-chest distance, chest expansion, finger-floor distance, and overall radiologic changes in both lumbar spine and sacroiliac joints; straight leg raise did not correlate, and vital capacity only with sacroiliac joint changes. Spearman's correlation coefficients for ROMs were slightly higher to lumbar spine changes than to sacroiliac joint changes. A corresponding correlation was also observed between spinal mobility restrictions and six detailed changes in lumbar roentgenogram: syndesmophytes, apophyseal arthritis, sclerotic anterior borders of vertebrae, straightened anterior surface of vertebrae, and ossification of interspinous and anterior longitudinal ligaments. Other detailed lumbar spine findings did not correlate. As assessed by erythrocyte sedimentation rate values the disease activity increased in the course of radiologic progression, decreasing again, however, to the end stage. METHODS: Conventional methods with a tape and (Myrin) inclinometer were used to measure thoracolumbar flexion, cervical rotation, occiput-wall distance, chin-chest distance, finger-floor distance, chest expansion, vital capacity, and straight leg raise. In addition, a new method of thoracolumbar rotation and a new modification of the Schober test were introduced. Thirty-nine patients were randomized for a reliability assessment using repeated measurements of ROMs. Radiologic changes were evaluated (in a masked fashion) using the method of Dale and Vinje. RESULTS: The reliability of all ROMs was good (except for interrater intraclass correlation coefficients of chest expansion: 0.53). CONCLUSIONS: The clear correlation between radiologic sacroiliac joint and lumbar spine progression and eight ROMs showed that these are useful noninvasive measurements of disease progression and severity in ankylosing spondylitis that can be used in daily practice.

Adult↗
PubMed1995

Fifteen months' follow-up of intensive inpatient physiotherapy and exercise in ankylosing spondylitis.

Long-term effects of three or four-week inpatient physiotherapy and exercise courses were studied in 141 adult patients with ankylosing spondylitis (AS). Eight cervical and thoracolumbar range of motion (ROM) measurements and straight leg raise test, vital capacity (VC) and fitness index were measured at the beginning and end of an intensive course and 15 months later. All nine mobility measurements, vital capacity and fitness index were significantly improved after the course. Fifteen months later only chest expansion and vital capacity had significantly deteriorated from the baseline, while CR, FFD and fitness index were still significantly better. Disease duration did not influence treatment results. We conclude that it is possible by means of intensive rehabilitation courses to prevent for more than one year deterioration of spinal function and fitness in AS patients irrespective of disease duration.

Activities of Daily Living↗
PubMed1995

Age and spinal mobility in ankylosing spondylitis.

Mobility measurements of spine, chest, hips, and shoulder in 73 adult males with ankylosing spondylitis (AS) were correlated with the duration of disease. Several mobility tests showed a significant correlation with the duration of AS, but after adjustment for age, only rotation of the thoracolumbar spine maintained a highly significant correlation. It is concluded that age has a strong effect on the mobility tests. Rotation of the thoracolumbar spine seems to be a valid measure for AS-specific changes.

Adult↗
PubMed1995

The relative value of spinal and thoracic mobility measurements in ankylosing spondylitis.

The relative value of nine spinal and thoracic mobility measurements was investigated in 73 male patients with ankylosing spondylitis (AS). The value of a test was obtained by the relative ranks of validity, reliability and sensitivity to change. Validity was determined as age-adjusted correlation of the test result with AS-specific radiological changes in the lumbar spine. Reliability was determined as inter-observer error. Sensitivity to change was determined as change in test result during an intensive rehabilitation course. The five most valuable tests were rotation of the thoracolumbar spine (TR), finger-to-floor distance (FFD), the Schober test, thoracolumbar flexion and occiput-to-wall distance. Of these, FFD had high reliability and sensitivity ranks, but poor correlation with AS-specific spinal changes. TR had high validity and sensitivity ranks, and improvement of the measurement technology would probably result in a superior test for the follow-up of AS. Chest expansion and vital capacity had low ranks in all comparisons.

Adult↗
PubMed1993

Thoracolumbar rotation in ankylosing spondylitis. A new noninvasive measurement method.

Thoracolumbar rotation was measured by a noninvasive method in 135 patients with ankylosing spondylitis. The mean of the total rotation from the level of the xiphisternum to S1 was 45.2 degrees, which is approximately half of that in healthy subjects measured by comparable methods. Rotation had a significant negative correlation with the duration of the disease and with the radiologic degree of lumbar spine involvement, but not with the degree of radiologic sacroiliitis. Reproducibility of the method was good. Measurement of thoracolumbar rotation is seldom used in the assessment of ankylosing spondylitis, and merits further evaluation.

Female↗
PubMed1993

Pain intensity in patients with fibromyalgia and rheumatoid arthritis.

Three times daily continuously during a three-week inpatient rehabilitation course a visual analogue scale (VAS) was used in the assessment of pain intensity in 20 female patients with primary fibromyalgia (PF) and 20 female patients with rheumatoid arthritis (RA). The pain intensity in PF patients was constantly twice as high as in RA patients. The effect of the rehabilitation course on pain intensity, as assessed by linear regression analysis, was significantly higher in RA than in PF (p < 0.001). In comparison of the first and the last two days, the pain intensity decreased significantly (P < 0.01) in RA, but not in PF. The patients with PF were more depressive than the RA patients, but a positive correlation between depression score and pain intensity was found only in RA patients. Depression was not able to explain the high pain intensity in PF patients. Continuous monitoring of pain by VAS seems to be a useful tool for assessing changes in pain intensity in patients with rheumatic disorders.

Adult↗
PubMed1992

Effect of physiotherapy on spinal mobility in ankylosing spondylitis.

The efficacy of intensive inpatient physiotherapy was retrospectively analysed in 505 adult patients with ankylosing spondylitis (AS). Eight different measures of thoracic and spinal mobility were collected from the patients' medical records. Recovery in terms of the following measures was 7 to 37% when results after rehabilitation were compared to those taken before: thoracolumbar flexibility (TLF) 15%, the Schober test 12.4%, occiput to wall distance (OWD) 30.8%, cervical rotation 22.6%, chin to chest distance (CCD) 21.7%, finger to floor distance (FFD) 36.6%, chest expansion (CE) 31.3%, vital capacity (VC) 7.4%. Changes in all measures were statistically significant (p less than 0.001). OWD, CE and FFD showed greatest improvement. The average increase in CE was about 1 cm in both sexes and the average increase in VC200 ml in men and 270 ml in women, which indicates improvement in ventilatory capacity. Mobility in the majority of patients improved, though in 2 to 8% range of motion (ROM) deteriorated during the course.

Adult↗