Antti Mal - Academia.edu (original) (raw)

Papers by Antti Mal

International Workshop on Model Checking of Software, 2000

Study Design. Systematic review. Objective. To assess the effectiveness of radiofre- quency dener... more Study Design. Systematic review. Objective. To assess the effectiveness of radiofre- quency denervation for the treatment of musculoskeletal pain disorders. Summary of Background Data. There is a lack of ef- fective treatment for chronic zygapophysial joint pain and discogenic pain. Radiofrequency denervation appears to be an emerging technology, with substantial variation in its use. Methods. Original articles for this review

European Journal of Vascular and Endovascular Surgery, 2009

Spine, Jan 15, 2007

Critical appraisal of the literature. The objective of this study was to assess if results of bac... more Critical appraisal of the literature. The objective of this study was to assess if results of back pain trials are statistically significant and clinically important. There seems to be a discrepancy between conclusions reported by authors and actual results of randomized controlled trials. Little attention has been paid to the problem of over-reporting of conclusions. All 43 trials of the Cochrane review on exercise therapy for low back pain were included. Descriptive analyses were conducted. Eighteen trials reported positive conclusions in favor of exercise. Only six of the 43 studies showed both clinically important and statistically significant differences in favor of the exercise groups on function, and 4 on pain. It seems that many conclusions of studies of exercise therapy for chronic low back pain have been based on statistical significance of results rather than on clinical importance and, consequently, may have been too positive. Authors of trials should report not only sta...

Spine, Jan 15, 2006

A randomized trial. To evaluate the effectiveness of a semi-intensive multidisciplinary rehabilit... more A randomized trial. To evaluate the effectiveness of a semi-intensive multidisciplinary rehabilitation for patients with chronic low back pain in an outpatient setting. Systematic reviews have shown that there is strong evidence that intensive multidisciplinary treatment (>100 hours), which includes functional restoration, improves function among chronic patients with low back pain, and moderate evidence that it reduces pain but contradictory evidence regarding improvement of working ability. However, there is paucity of data whether semi-intensive outpatient multidisciplinary rehabilitation in groups is more effective than individual physiotherapy. A total of 120 women employed as healthcare and social care professionals with nonspecific chronic low back pain were recruited from two occupational healthcare centers. The patients were randomized into two intervention programs. Multidisciplinary rehabilitation (n = 59) was conducted in groups and comprised of physical training, wor...

Scandinavian journal of work, environment & health, 2002

This study attempted to determine the feasibility and utility of methods used in evidence-based m... more This study attempted to determine the feasibility and utility of methods used in evidence-based medicine for some common questions in the practice of occupational medicine. The following clinical questions were generated that were representative of the type of problems encountered by occupational health physicians: is work a cause of health problems and is impaired health a cause of diminished work capacity for a specific job? Answers were generated according to the method used in evidence-based medicine by formulating an answerable question, searching the literature, critically appraising the results, and applying the results to the clinical question. Answers were found to all the questions in a reasonable amount of time. The searches revealed a need for more systematic reviews and studies that use work-related health outcomes like return to work. However, there is more evidence available in Medline than is generally assumed by occupational health physicians. Using this evidence le...

Spine, 2000

A systematic review of randomized controlled trials was performed. Exercise therapy is a widely u... more A systematic review of randomized controlled trials was performed. Exercise therapy is a widely used treatment for low back pain. To evaluate the effectiveness of exercise therapy for low back pain with regard to pain intensity, functional status, overall improvement, and return to work. The Cochrane Controlled Trials Register, Medline, Embase, PsycLIT, and reference lists of articles were searched. Randomized trials testing all types of exercise therapy for subjects with nonspecific low back pain with or without radiation into the legs were included. Two reviewers independently extracted data and assessed trial quality. Because trials were considered heterogeneous with regard to study populations, interventions, and outcomes, it was decided not to perform a meta-analysis, but to summarize the results using a rating system of four levels of evidence: strong, moderate, limited, or none. In this review, 39 trials were identified. There is strong evidence that exercise therapy is not m...

Occupational and Environmental Medicine, 2008

The Laryngoscope, 2009

To assess the effectiveness and adverse effects of radiofrequency ablation (RFA) of soft palate (... more To assess the effectiveness and adverse effects of radiofrequency ablation (RFA) of soft palate (SP) in snoring. Systematic search of electronic databases. Only articles published in peer-reviewed journals were evaluated. Included were controlled or prospective studies with at least 10 adults (> or =18 years of age) without moderate/severe obstructive sleep apnea. Of the 159 articles identified, 30 met the inclusion criteria: two randomized controlled trials (RCT), four clinical controlled trials, and 24 prospective uncontrolled studies. The only placebo controlled RCT indicated SP RFA to be superior compared to placebo. The other RCT, comparing different radiofrequency ablation generators, showed no evidence of differences in snoring treatment efficacy, and only minor differences in patient discomfort. In two of the controlled trials snoring relief obtained by SP RFA was comparable, and in three of them associated with less postoperative pain than other interventions. Radiologic results were contradictory with some trials reporting significant changes of the upper airways, whereas others did not. Neither long-term side effects nor major adverse events have been reported after. The review provides evidence that SP RFA is an intervention causing less postoperative pain than others, and the risk of adverse effects for the patient seems to be small. It may reduce symptoms of snoring, at least in the short term. However, most of the published SP RFA literature is based on observational studies with a short follow-up time, which precludes solid conclusions about the effectiveness of the procedure. Laryngoscope, 2009.

Spine, 2003

Descriptive prognostic study. To identify outcome determinants of subacute low back pain. The fac... more Descriptive prognostic study. To identify outcome determinants of subacute low back pain. The factors predicting recovery from prolonged back pain among working adults are largely unknown. One hundred sixty-four employed patients with subacute (duration of pain 4-12 weeks) daily low back pain were recruited from primary health care to a randomized study. Data on potential predictive factors were collected before randomization. In multiple regressions using repeated measures analysis, the treatment received was adjusted when determining the impact of the predictive factors. Dependent outcome variables used were pain, perceived functional disability, generic health-related quality of life, satisfaction with care, days on sick leave, use of health care, and costs of health care consumption measured, at 3-, 6-, and 12-month follow-ups. Age and intensity of pain at baseline predicted most of the outcomes. The perceived risk of not recovering was a stronger determinant of outcome than gender, education, or self-rated health status (which did not have any predictive value) or body mass index, expectations of treatment effect, satisfaction with work, or the presence of radicular symptoms below the knee (only slight predictive value). The only factors predicting the duration of sick leave were the duration of sick leave at baseline and the type of occupation. Age and intensity of pain are the strongest predictors of outcome. Accumulation of days on sick leave is predicted by the duration of sick leave at entry and the type of work, but not by pain, perceived disability, or satisfaction with work.

Spine, 2006

Prospective randomized controlled trial. To assess effectiveness of microdiscectomy in lumbar dis... more Prospective randomized controlled trial. To assess effectiveness of microdiscectomy in lumbar disc herniation patients with 6 to 12 weeks of symptoms but no absolute indication for surgery. There is limited evidence in favor of discectomy for prolonged symptoms of lumbar disc herniation. However, only one randomized trial has directly compared discectomy with conservative treatment. Fifty-six patients (age range, 20-50 years) with a lumbar disc herniation, clinical findings of nerve root compression, and radicular pain lasting 6 to 12 weeks were randomized to microdiscectomy or conservative management. Fifty patients (89%) were available at the 2-year follow-up. Leg pain intensity was the primary outcome measure. There were no clinically significant differences between the groups in leg or back pain intensity, subjective disability, or health-related quality of life over the 2-year follow-up, although discectomy seemed to be associated with a more rapid initial recovery. In a subgroup analysis, discectomy was superior to conservative treatment when the herniation was at L4-L5. Lumbar microdiscectomy offered only modest short-term benefits in patients with sciatica due to disc extrusion or sequester. Spinal level of the herniation may be an important factor modifying effectiveness of surgery, but this hypothesis needs verification.

International Workshop on Model Checking of Software, 2000

Study Design. Systematic review. Objective. To assess the effectiveness of radiofre- quency dener... more Study Design. Systematic review. Objective. To assess the effectiveness of radiofre- quency denervation for the treatment of musculoskeletal pain disorders. Summary of Background Data. There is a lack of ef- fective treatment for chronic zygapophysial joint pain and discogenic pain. Radiofrequency denervation appears to be an emerging technology, with substantial variation in its use. Methods. Original articles for this review

European Journal of Vascular and Endovascular Surgery, 2009

Spine, Jan 15, 2007

Critical appraisal of the literature. The objective of this study was to assess if results of bac... more Critical appraisal of the literature. The objective of this study was to assess if results of back pain trials are statistically significant and clinically important. There seems to be a discrepancy between conclusions reported by authors and actual results of randomized controlled trials. Little attention has been paid to the problem of over-reporting of conclusions. All 43 trials of the Cochrane review on exercise therapy for low back pain were included. Descriptive analyses were conducted. Eighteen trials reported positive conclusions in favor of exercise. Only six of the 43 studies showed both clinically important and statistically significant differences in favor of the exercise groups on function, and 4 on pain. It seems that many conclusions of studies of exercise therapy for chronic low back pain have been based on statistical significance of results rather than on clinical importance and, consequently, may have been too positive. Authors of trials should report not only sta...

Spine, Jan 15, 2006

A randomized trial. To evaluate the effectiveness of a semi-intensive multidisciplinary rehabilit... more A randomized trial. To evaluate the effectiveness of a semi-intensive multidisciplinary rehabilitation for patients with chronic low back pain in an outpatient setting. Systematic reviews have shown that there is strong evidence that intensive multidisciplinary treatment (>100 hours), which includes functional restoration, improves function among chronic patients with low back pain, and moderate evidence that it reduces pain but contradictory evidence regarding improvement of working ability. However, there is paucity of data whether semi-intensive outpatient multidisciplinary rehabilitation in groups is more effective than individual physiotherapy. A total of 120 women employed as healthcare and social care professionals with nonspecific chronic low back pain were recruited from two occupational healthcare centers. The patients were randomized into two intervention programs. Multidisciplinary rehabilitation (n = 59) was conducted in groups and comprised of physical training, wor...

Scandinavian journal of work, environment & health, 2002

This study attempted to determine the feasibility and utility of methods used in evidence-based m... more This study attempted to determine the feasibility and utility of methods used in evidence-based medicine for some common questions in the practice of occupational medicine. The following clinical questions were generated that were representative of the type of problems encountered by occupational health physicians: is work a cause of health problems and is impaired health a cause of diminished work capacity for a specific job? Answers were generated according to the method used in evidence-based medicine by formulating an answerable question, searching the literature, critically appraising the results, and applying the results to the clinical question. Answers were found to all the questions in a reasonable amount of time. The searches revealed a need for more systematic reviews and studies that use work-related health outcomes like return to work. However, there is more evidence available in Medline than is generally assumed by occupational health physicians. Using this evidence le...

Spine, 2000

A systematic review of randomized controlled trials was performed. Exercise therapy is a widely u... more A systematic review of randomized controlled trials was performed. Exercise therapy is a widely used treatment for low back pain. To evaluate the effectiveness of exercise therapy for low back pain with regard to pain intensity, functional status, overall improvement, and return to work. The Cochrane Controlled Trials Register, Medline, Embase, PsycLIT, and reference lists of articles were searched. Randomized trials testing all types of exercise therapy for subjects with nonspecific low back pain with or without radiation into the legs were included. Two reviewers independently extracted data and assessed trial quality. Because trials were considered heterogeneous with regard to study populations, interventions, and outcomes, it was decided not to perform a meta-analysis, but to summarize the results using a rating system of four levels of evidence: strong, moderate, limited, or none. In this review, 39 trials were identified. There is strong evidence that exercise therapy is not m...

Occupational and Environmental Medicine, 2008

The Laryngoscope, 2009

To assess the effectiveness and adverse effects of radiofrequency ablation (RFA) of soft palate (... more To assess the effectiveness and adverse effects of radiofrequency ablation (RFA) of soft palate (SP) in snoring. Systematic search of electronic databases. Only articles published in peer-reviewed journals were evaluated. Included were controlled or prospective studies with at least 10 adults (> or =18 years of age) without moderate/severe obstructive sleep apnea. Of the 159 articles identified, 30 met the inclusion criteria: two randomized controlled trials (RCT), four clinical controlled trials, and 24 prospective uncontrolled studies. The only placebo controlled RCT indicated SP RFA to be superior compared to placebo. The other RCT, comparing different radiofrequency ablation generators, showed no evidence of differences in snoring treatment efficacy, and only minor differences in patient discomfort. In two of the controlled trials snoring relief obtained by SP RFA was comparable, and in three of them associated with less postoperative pain than other interventions. Radiologic results were contradictory with some trials reporting significant changes of the upper airways, whereas others did not. Neither long-term side effects nor major adverse events have been reported after. The review provides evidence that SP RFA is an intervention causing less postoperative pain than others, and the risk of adverse effects for the patient seems to be small. It may reduce symptoms of snoring, at least in the short term. However, most of the published SP RFA literature is based on observational studies with a short follow-up time, which precludes solid conclusions about the effectiveness of the procedure. Laryngoscope, 2009.

Spine, 2003

Descriptive prognostic study. To identify outcome determinants of subacute low back pain. The fac... more Descriptive prognostic study. To identify outcome determinants of subacute low back pain. The factors predicting recovery from prolonged back pain among working adults are largely unknown. One hundred sixty-four employed patients with subacute (duration of pain 4-12 weeks) daily low back pain were recruited from primary health care to a randomized study. Data on potential predictive factors were collected before randomization. In multiple regressions using repeated measures analysis, the treatment received was adjusted when determining the impact of the predictive factors. Dependent outcome variables used were pain, perceived functional disability, generic health-related quality of life, satisfaction with care, days on sick leave, use of health care, and costs of health care consumption measured, at 3-, 6-, and 12-month follow-ups. Age and intensity of pain at baseline predicted most of the outcomes. The perceived risk of not recovering was a stronger determinant of outcome than gender, education, or self-rated health status (which did not have any predictive value) or body mass index, expectations of treatment effect, satisfaction with work, or the presence of radicular symptoms below the knee (only slight predictive value). The only factors predicting the duration of sick leave were the duration of sick leave at baseline and the type of occupation. Age and intensity of pain are the strongest predictors of outcome. Accumulation of days on sick leave is predicted by the duration of sick leave at entry and the type of work, but not by pain, perceived disability, or satisfaction with work.

Spine, 2006

Prospective randomized controlled trial. To assess effectiveness of microdiscectomy in lumbar dis... more Prospective randomized controlled trial. To assess effectiveness of microdiscectomy in lumbar disc herniation patients with 6 to 12 weeks of symptoms but no absolute indication for surgery. There is limited evidence in favor of discectomy for prolonged symptoms of lumbar disc herniation. However, only one randomized trial has directly compared discectomy with conservative treatment. Fifty-six patients (age range, 20-50 years) with a lumbar disc herniation, clinical findings of nerve root compression, and radicular pain lasting 6 to 12 weeks were randomized to microdiscectomy or conservative management. Fifty patients (89%) were available at the 2-year follow-up. Leg pain intensity was the primary outcome measure. There were no clinically significant differences between the groups in leg or back pain intensity, subjective disability, or health-related quality of life over the 2-year follow-up, although discectomy seemed to be associated with a more rapid initial recovery. In a subgroup analysis, discectomy was superior to conservative treatment when the herniation was at L4-L5. Lumbar microdiscectomy offered only modest short-term benefits in patients with sciatica due to disc extrusion or sequester. Spinal level of the herniation may be an important factor modifying effectiveness of surgery, but this hypothesis needs verification.