Simo Taimela - Academia.edu (original) (raw)
Papers by Simo Taimela
Spine, 2013
Cross-sectional study in a subcohort of the 1986 Northern Finland Birth Cohort (n = 1987). To inv... more Cross-sectional study in a subcohort of the 1986 Northern Finland Birth Cohort (n = 1987). To investigate the role of environmental factors and LBP history in sciatica symptoms among Finnish young adults. History of low back pain (LBP), smoking, and male sex are associated with sciatica in adult populations. The role of the environmental determinants of sciatica has not been evaluated in populations consisting of only adolescents. Sciatic symptoms and environmental exposures were elicited by a mailed questionnaire and the associations were analyzed using multinomial logistic regression. Female sex was associated with severe sciatica at 18 years (OR, 3.9; 95% confidence interval (CI), 1.6-9.3). Both reported LBP at 16 years and LBP requiring consultation of a health care professional were associated with mild sciatica at 18 years (OR, 2.5; 95% CI, 1.3-4.9; and OR, 3.8; 95% CI, 1.2-11.9). In addition, LBP at 16 years requiring consultation of a health care professional was associated with severe sciatica at 18 years (OR, 5.0; 95% CI, 1.7-15.3). Smoking, obesity, physical workload, and level of physical activity were not associated with sciatica. Females reported sciatic pain more often than males. LBP at 16 years predicted sciatica at 18 years. 2.
Obstetrics and …, 2006
OBJECTIVETo investigate associations of physical activity and television viewing before and durin... more OBJECTIVETo investigate associations of physical activity and television viewing before and during pregnancy with risk of gestational diabetes mellitus (GDM) and abnormal glucose tolerance, the combination of GDM with less severe impaired glucose tolerance.METHODSWe assessed duration and intensity of physical activity and time spent viewing television both before and during pregnancy among 1,805 women enrolled in Project Viva, a cohort study in eastern Massachusetts. We identified 1,493 (83%) women with normal glucose tolerance and 312 (17%) with abnormal glucose tolerance, including 91 (5%) with GDM based on clinical glucose tolerance test results.RESULTSAfter adjustment for age, race or ethnicity, history of GDM, family history of diabetes, and prepregnancy body mass index, our data suggest that women who engaged in any vigorous physical activity in the year before pregnancy experienced a reduced risk of GDM (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.33–0.95) and abnormal glucose tolerance (OR 0.76, 95% CI 0.57–1.00). Women who reported vigorous activity before pregnancy and light-to-moderate or vigorous activity during pregnancy appeared to have a lower risk of both GDM (OR 0.49, 95% CI 0.24–1.01) and abnormal glucose tolerance (OR 0.70, 95% CI 0.49–1.01) compared with women reporting these activities in neither time period. Walking and total physical activity provided modest benefits. We observed no association of television viewing before or during pregnancy with risk of GDM or abnormal glucose tolerance.CONCLUSIONPhysical activity, especially vigorous activity before pregnancy and at least light-to-moderate activity during pregnancy, may reduce risk for abnormal glucose tolerance and GDM.
† Abstract Objective. To investigate how self-reported muscu- loskeletal pain and health-related ... more † Abstract Objective. To investigate how self-reported muscu- loskeletal pain and health-related quality of life (HRQoL) are associated among young adults. Design and Setting. The study population consisted of a subgroup of the Northern Finland Birth Cohort 1986 at the age of 19 (N = 874), who completed the 15-dimensional (15D) HRQoL questionnaire (score 0 to 1) and answered questions about six-month period prevalence of musculoskeletal pain in neck, shoulder, low back, and peripheral location. Results. Half of the males and one third of the females reported a 15D score of at least 0.98 and were selected as the reference group in the multino- mial logistic regression analysis. Young adults who reported multiple pains had significantly lower 15D scores than those reporting pain in only one loca- tion or no pain at all. After adjustments for other health problems, psychosocial distress, parental occupation, and the young adults' own employment status, the reporting of single musculoskeletal pain odds ratio (OR) 2.6 and multiple pains (ORs up to 11.9) among females, and multiple pains (ORs up to 4.6) among males were associated with a 15D score of 0.94 or less. Conclusions. The number of involved sites of self- reported musculoskeletal pain was associated with the level of reduction in HRQoL among young adults.
BMC Medical Research Methodology, 2021
Background The results of clinical trials should be assessed for both statistical significance an... more Background The results of clinical trials should be assessed for both statistical significance and importance of observed effects to patients. Minimal important difference (MID) is a threshold denoting a difference that is important to patients. Patient acceptable symptom state (PASS) is a threshold above which patients feel well. Objective To determine MID and PASS for common outcome instruments in patients with subacromial pain syndrome (SAPS). Methods We used data from the FIMPACT trial, a randomised controlled trial of treatment for SAPS that included 193 patients. The outcomes were shoulder pain at rest and on arm activity, both measured with the 0–100 mm visual analogue scale (VAS), the Constant-Murley score (CS), and the Simple Shoulder Test (SST). The transition question was a five-point global rating of change. We used three anchor-based methods to determine the MID for improvement: the receiver operating characteristic (ROC) curve, the mean difference of change and the mea...
BMC Musculoskeletal Disorders
Background Arthroscopic subacromial decompression is one of the most commonly performed shoulder ... more Background Arthroscopic subacromial decompression is one of the most commonly performed shoulder surgeries in the world. It is performed to treat patients with suspected shoulder impingement syndrome, i.e., subacromial pain syndrome. Only few studies have specifically assessed return-to-work rates after subacromial decompression surgery. All existing evidence comes from open, unblinded study designs and this lack of blinding introduces the potential for bias. We assessed return to work and its predictors in patients with shoulder impingement syndrome in a secondary analysis of a placebo-surgery controlled trial. Methods One hundred eighty-four patients in a randomised trial had undergone arthroscopic subacromial decompression (n = 57), diagnostic arthroscopy, a placebo surgical intervention, (n = 59), or exercise therapy (n = 68). We assessed return to work, defined as having returned to work for at least two follow-up visits by the primary 24-month time point, work status at 24 and...
JAMA
IMPORTANCE Humeral shaft fractures traditionally have been treated nonsurgically, but there has b... more IMPORTANCE Humeral shaft fractures traditionally have been treated nonsurgically, but there has been a steady increase in the rate of surgery over the past 2 decades without high-quality evidence to justify the trend. OBJECTIVE To compare the effectiveness of surgical treatment with open reduction and internal plate fixation to nonsurgical treatment with functional bracing in the treatment of closed humeral shaft fractures. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted at 2 university hospital trauma centers in Finland, enrollment between November 2012 and January 2018 with a final follow-up of January 2019. A total of 82 adult patients with closed, unilateral, displaced humeral shaft fracture met criteria for inclusion. Patients were excluded if they had cognitive disabilities preventing them from following the protocol or had multimorbidity or multiple trauma. INTERVENTIONS Patients were randomly assigned to surgical treatment with open reduction and internal plate fixation (n = 38) or to nonsurgical treatment with functional bracing (n = 44). MAIN OUTCOME AND MEASURE The primary outcome was Disabilities of Arm, Shoulder and Hand (DASH) score at 12 months (range, 0 to 100 points, 0 denotes no disability and 100 extreme disability; minimal clinically important difference, 10 points). RESULTS Among 82 patients who were randomized (mean age, 48.9 years; 38 women [46%]; 44 men [54%]), 78 (95%) completed the trial. Thirteen (30%) of the patients assigned to functional bracing underwent surgery during the 12-month follow-up period to promote healing of the fracture. At 12 months, the mean DASH score was 8.9 (95% CI, 4.2 to 13.6) in the surgery group and 12.0 (95% CI, 7.7 to 16.4) in the bracing group (between-group difference, −3.1 points; 95% CI, −9.6 to 3.3; P = .34). Eleven patients (25%) allocated to functional bracing developed fracture nonunion. Three patients (8%) allocated to surgery developed a temporary radial nerve palsy. CONCLUSIONS AND RELEVANCE Among patients with closed humeral shaft fracture, internal fixation surgery, compared with nonoperative functional bracing, did not significantly improve functional outcomes at 12 months. However, the substantial amount of treatment crossover from nonoperative to surgical treatment should be considered when interpreting the trial results.
BMJ Open
IntroductionChronic subdural haematomas (CSDHs) are one of the most common neurosurgical conditio... more IntroductionChronic subdural haematomas (CSDHs) are one of the most common neurosurgical conditions. The goal of surgery is to alleviate symptoms and minimise the risk of symptomatic recurrences. In the past, reoperation rates as high as 20%–30% were described for CSDH recurrences. However, following the introduction of subdural drainage, reoperation rates dropped to approximately 10%. The standard surgical technique includes burr-hole craniostomy, followed by intraoperative irrigation and placement of subdural drainage. Yet, the role of intraoperative irrigation has not been established. If there is no difference in recurrence rates between intraoperative irrigation and no irrigation, CSDH surgery could be carried out faster and more safely by omitting the step of irrigation. The aim of this multicentre randomised controlled trial is to study whether no intraoperative irrigation and subdural drainage results in non-inferior outcome compared with intraoperative irrigation and subdur...
JAMA, 2020
Importance Humeral shaft fractures traditionally have been treated nonsurgically, but there has b... more Importance Humeral shaft fractures traditionally have been treated nonsurgically, but there has been a steady increase in the rate of surgery over the past 2 decades without high-quality evidence to justify the trend. Objective To compare the effectiveness of surgical treatment with open reduction and internal plate fixation to nonsurgical treatment with functional bracing in the treatment of closed humeral shaft fractures. Design, Setting, and Participants Randomized clinical trial conducted at 2 university hospital trauma centers in Finland, enrollment between November 2012 and January 2018 with a final follow-up of January 2019. A total of 82 adult patients with closed, unilateral, displaced humeral shaft fracture met criteria for inclusion. Patients were excluded if they had cognitive disabilities preventing them from following the protocol or had multimorbidity or multiple trauma. Interventions Patients were randomly assigned to surgical treatment with open reduction and intern...
Background: Work disability (WD) is a medico-legal concept that refers to disability benefits (DB... more Background: Work disability (WD) is a medico-legal concept that refers to disability benefits (DB) granted due to diseases. We assessed whether subjective cognitive complaints (SCC)-presenting as self-rated difficulties of concentration, memory, clear thinking and decision making-predict permanent WD in knowledge-intensive occupations. Methods: We combined the SCC questionnaire results with reliable registry data on the DBs of 7,161 professional/managerial employees (46% females). We excluded employees who were on longterm sickness absence (SA) or had received a DB at baseline. The exposure variable was the presence of SCC. Age and SA before the questionnaire as a proxy measure of general health were treated as confounders and the analyses were conducted by gender. The outcome variable was a granted DB. The cumulative incidence function illustrates the difference between SCC categories, and the Fine-Gray model estimates the predictors of WD during the eight-year follow-up. Results: The most common primary reasons for permanent WD were mental (36%) and musculoskeletal (20%) disorders. SCC predicted DB in both genders when controlling for age and prior SA. Hazard ratios were 2.9 with a 95% confidence interval 1.4-6.0 for the females and 3.7 (1.8-7.9) for the males. After eight years, 3.1% of the females and 2.8% of the males in the abnormal SCC category had received a DB, while the respective figures in the reference category were 1.9% and 1.0%. Conclusion: Subjective cognitive complaints predict permanent WD in knowledge-intensive occupations among professional/managerial employees. This finding has implications for supporting work ability among employees with cognitively demanding tasks.
International Archives of Occupational and Environmental Health
Purpose Work disability (WD) as a medico-legal concept refers to disability benefits (DB) that ar... more Purpose Work disability (WD) as a medico-legal concept refers to disability benefits (DB) that are granted due to diseases that permanently reduce work ability. We studied whether an occupational healthcare instrument for the prediction of sickness absence (SA) risk—a health risk appraisal (HRA)—also predicts permanent WD. Methods HRA results were combined with registry data on DB of 22,023 employees from different industry sectors. We analysed how the HRA risk categories predict DB and considered occupational group, gender, age, and prior SA as confounding variables. Cumulative incidence function illustrates the difference between the HRA risk categories, and the Fine–Gray model estimates the predictors of WD during 6-year follow-up. Results The most common primary reasons for permanent WD were musculoskeletal (39%) and mental disorders (21%). Self-reported health problems in the HRA, labelled as “WD risk factors”, predicted DB when controlling for age and prior SA. Hazard ratios w...
BMJ Open
ObjectivesTo study whether self-reported health problems predict sickness absence (SA) from work ... more ObjectivesTo study whether self-reported health problems predict sickness absence (SA) from work in employees from different industries.MethodsThe results of a health risk appraisal (HRA) were combined with archival data of SA of 21 608 employees (59% female, 56% clerical). Exposure variables were self-reported health problems, labelled as ‘work disability (WD) risk factors’ in the HRA, presence of problems with occupational well-being and obesity. Age, socioeconomic grading and the number of SA days 12 months before the survey were treated as confounders. The outcome measure was accumulated SA days during 12-month follow-up. Data were analysed separately for males and females. A Hurdle model with negative binomial response was used to analyse zero-inflated count data of SA.ResultsThe HRA results predicted the number of accumulated SA days during the 12-month follow-up, regardless of occupational group and gender. The ratio of means of SA days varied between 2.7 and 4.0 among those ...
Scandinavian Journal of Medicine & Science in Sports, 2017
The relationship between different sport activities and lumbar intervertebral disc degeneration (... more The relationship between different sport activities and lumbar intervertebral disc degeneration (DD) is largely unknown. We evaluated whether adolescent participation in different sports is associated with lumbar DD in a population-based birth cohort of young adults. A total of 558 young adults (325 females and 233 males) underwent magnetic resonance imaging (MRI, 1.5-T scanner). A DD sum score, based on the Pfirrmann grading, was calculated for all lumbar levels. The sum score was categorized into no DD, 1, 2, or at least 3. Participation in different sport activities was self-reported by postal surveys at 16, 18 and 19 years and three groups were formed based on participation frequency in eleven sports: 1) highly active (at least twice a week), 2) moderately active (2 to 4 times a month), and 3) inactive (maximum once a month). Cumulative odds ratios (COR) and their 95% confidence intervals (CI) were obtained for each sport by ordinal logistic regression, adjusting for gender, body mass index, age, socioeconomic status, smoking, and other sports. Highly active participation in jogging/running and swimming was associated with a higher DD sum score (COR 3.0; 95% CI 1.4-6.3 and 5.0; 1.7-15.2, respectively) compared to inactive participation, whereas highly active participation in skating showed low COR. In conclusion, running and swimming at least twice a week in early adulthood are potentially associated with lumbar DD. Follow-up studies with MRI are needed to show whether frequent exposure to running or swimming has further effect on the integrity of lumbar intervertebral discs. This article is protected by copyright. All rights reserved.
Europa Medicophysica, Mar 1, 2004
Musculoskeletal disorders of which low back pain (LBP) accounts for more than 50% are now the mos... more Musculoskeletal disorders of which low back pain (LBP) accounts for more than 50% are now the most common cause of chronic incapacity in industrialized countries. The traditional approach in looking for the reason (etiology) for musculoskeletal disorders is to search structural failures but, in most cases, it is difficult to find an explicit reason for back pain. Many scientists now consider spine disorders as multifactorial, bio-psycho-social problems. Pain has clear effects on motor control. Therefore, LBP can also induce changes in neuromuscular control and motor performance, i.e., causing various functional deficits. Another feature, which deserves special consideration with reference to back problems, concerns the numerous psychological factors, which are involved in mediating the relationships between physical impairment, pain and disability. The new scientific knowledge on functional deficits is increasingly being transferred to clinical applications, where the aim is to reverse them with physical rehabilitation. As a result of the recognition of the behavioral (psychological) problems with LBP, psychological, behavioral and educational interventions are commonly combined with the physical rehabilitation for LBP also. Basically, functional rehabilitation includes systematic quantification of both the physical function and psychological factors, which drive the therapeutic process. The exercises used in the functional rehabilitation usually revolve around the treatment of the spine as a functional unit. Thus many programs for functional rehabilitation use rehabilitation equipment (iso-inertial/isokinetic) by properly trained physiotherapists. However, some centers use regular fitness equipment or aerobics-type exercises. Furthermore, some relaxation and ergonomic exercises are typically proposed, and psychological support provided along the treatment. There exists both an outpatient and an inpatient functional rehabilitation
Medicine Amp Science in Sports Amp Exercise, Jun 30, 1994
Spine, 2013
Cross-sectional study in a subcohort of the 1986 Northern Finland Birth Cohort (n = 1987). To inv... more Cross-sectional study in a subcohort of the 1986 Northern Finland Birth Cohort (n = 1987). To investigate the role of environmental factors and LBP history in sciatica symptoms among Finnish young adults. History of low back pain (LBP), smoking, and male sex are associated with sciatica in adult populations. The role of the environmental determinants of sciatica has not been evaluated in populations consisting of only adolescents. Sciatic symptoms and environmental exposures were elicited by a mailed questionnaire and the associations were analyzed using multinomial logistic regression. Female sex was associated with severe sciatica at 18 years (OR, 3.9; 95% confidence interval (CI), 1.6-9.3). Both reported LBP at 16 years and LBP requiring consultation of a health care professional were associated with mild sciatica at 18 years (OR, 2.5; 95% CI, 1.3-4.9; and OR, 3.8; 95% CI, 1.2-11.9). In addition, LBP at 16 years requiring consultation of a health care professional was associated with severe sciatica at 18 years (OR, 5.0; 95% CI, 1.7-15.3). Smoking, obesity, physical workload, and level of physical activity were not associated with sciatica. Females reported sciatic pain more often than males. LBP at 16 years predicted sciatica at 18 years. 2.
Obstetrics and …, 2006
OBJECTIVETo investigate associations of physical activity and television viewing before and durin... more OBJECTIVETo investigate associations of physical activity and television viewing before and during pregnancy with risk of gestational diabetes mellitus (GDM) and abnormal glucose tolerance, the combination of GDM with less severe impaired glucose tolerance.METHODSWe assessed duration and intensity of physical activity and time spent viewing television both before and during pregnancy among 1,805 women enrolled in Project Viva, a cohort study in eastern Massachusetts. We identified 1,493 (83%) women with normal glucose tolerance and 312 (17%) with abnormal glucose tolerance, including 91 (5%) with GDM based on clinical glucose tolerance test results.RESULTSAfter adjustment for age, race or ethnicity, history of GDM, family history of diabetes, and prepregnancy body mass index, our data suggest that women who engaged in any vigorous physical activity in the year before pregnancy experienced a reduced risk of GDM (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.33–0.95) and abnormal glucose tolerance (OR 0.76, 95% CI 0.57–1.00). Women who reported vigorous activity before pregnancy and light-to-moderate or vigorous activity during pregnancy appeared to have a lower risk of both GDM (OR 0.49, 95% CI 0.24–1.01) and abnormal glucose tolerance (OR 0.70, 95% CI 0.49–1.01) compared with women reporting these activities in neither time period. Walking and total physical activity provided modest benefits. We observed no association of television viewing before or during pregnancy with risk of GDM or abnormal glucose tolerance.CONCLUSIONPhysical activity, especially vigorous activity before pregnancy and at least light-to-moderate activity during pregnancy, may reduce risk for abnormal glucose tolerance and GDM.
† Abstract Objective. To investigate how self-reported muscu- loskeletal pain and health-related ... more † Abstract Objective. To investigate how self-reported muscu- loskeletal pain and health-related quality of life (HRQoL) are associated among young adults. Design and Setting. The study population consisted of a subgroup of the Northern Finland Birth Cohort 1986 at the age of 19 (N = 874), who completed the 15-dimensional (15D) HRQoL questionnaire (score 0 to 1) and answered questions about six-month period prevalence of musculoskeletal pain in neck, shoulder, low back, and peripheral location. Results. Half of the males and one third of the females reported a 15D score of at least 0.98 and were selected as the reference group in the multino- mial logistic regression analysis. Young adults who reported multiple pains had significantly lower 15D scores than those reporting pain in only one loca- tion or no pain at all. After adjustments for other health problems, psychosocial distress, parental occupation, and the young adults' own employment status, the reporting of single musculoskeletal pain odds ratio (OR) 2.6 and multiple pains (ORs up to 11.9) among females, and multiple pains (ORs up to 4.6) among males were associated with a 15D score of 0.94 or less. Conclusions. The number of involved sites of self- reported musculoskeletal pain was associated with the level of reduction in HRQoL among young adults.
BMC Medical Research Methodology, 2021
Background The results of clinical trials should be assessed for both statistical significance an... more Background The results of clinical trials should be assessed for both statistical significance and importance of observed effects to patients. Minimal important difference (MID) is a threshold denoting a difference that is important to patients. Patient acceptable symptom state (PASS) is a threshold above which patients feel well. Objective To determine MID and PASS for common outcome instruments in patients with subacromial pain syndrome (SAPS). Methods We used data from the FIMPACT trial, a randomised controlled trial of treatment for SAPS that included 193 patients. The outcomes were shoulder pain at rest and on arm activity, both measured with the 0–100 mm visual analogue scale (VAS), the Constant-Murley score (CS), and the Simple Shoulder Test (SST). The transition question was a five-point global rating of change. We used three anchor-based methods to determine the MID for improvement: the receiver operating characteristic (ROC) curve, the mean difference of change and the mea...
BMC Musculoskeletal Disorders
Background Arthroscopic subacromial decompression is one of the most commonly performed shoulder ... more Background Arthroscopic subacromial decompression is one of the most commonly performed shoulder surgeries in the world. It is performed to treat patients with suspected shoulder impingement syndrome, i.e., subacromial pain syndrome. Only few studies have specifically assessed return-to-work rates after subacromial decompression surgery. All existing evidence comes from open, unblinded study designs and this lack of blinding introduces the potential for bias. We assessed return to work and its predictors in patients with shoulder impingement syndrome in a secondary analysis of a placebo-surgery controlled trial. Methods One hundred eighty-four patients in a randomised trial had undergone arthroscopic subacromial decompression (n = 57), diagnostic arthroscopy, a placebo surgical intervention, (n = 59), or exercise therapy (n = 68). We assessed return to work, defined as having returned to work for at least two follow-up visits by the primary 24-month time point, work status at 24 and...
JAMA
IMPORTANCE Humeral shaft fractures traditionally have been treated nonsurgically, but there has b... more IMPORTANCE Humeral shaft fractures traditionally have been treated nonsurgically, but there has been a steady increase in the rate of surgery over the past 2 decades without high-quality evidence to justify the trend. OBJECTIVE To compare the effectiveness of surgical treatment with open reduction and internal plate fixation to nonsurgical treatment with functional bracing in the treatment of closed humeral shaft fractures. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted at 2 university hospital trauma centers in Finland, enrollment between November 2012 and January 2018 with a final follow-up of January 2019. A total of 82 adult patients with closed, unilateral, displaced humeral shaft fracture met criteria for inclusion. Patients were excluded if they had cognitive disabilities preventing them from following the protocol or had multimorbidity or multiple trauma. INTERVENTIONS Patients were randomly assigned to surgical treatment with open reduction and internal plate fixation (n = 38) or to nonsurgical treatment with functional bracing (n = 44). MAIN OUTCOME AND MEASURE The primary outcome was Disabilities of Arm, Shoulder and Hand (DASH) score at 12 months (range, 0 to 100 points, 0 denotes no disability and 100 extreme disability; minimal clinically important difference, 10 points). RESULTS Among 82 patients who were randomized (mean age, 48.9 years; 38 women [46%]; 44 men [54%]), 78 (95%) completed the trial. Thirteen (30%) of the patients assigned to functional bracing underwent surgery during the 12-month follow-up period to promote healing of the fracture. At 12 months, the mean DASH score was 8.9 (95% CI, 4.2 to 13.6) in the surgery group and 12.0 (95% CI, 7.7 to 16.4) in the bracing group (between-group difference, −3.1 points; 95% CI, −9.6 to 3.3; P = .34). Eleven patients (25%) allocated to functional bracing developed fracture nonunion. Three patients (8%) allocated to surgery developed a temporary radial nerve palsy. CONCLUSIONS AND RELEVANCE Among patients with closed humeral shaft fracture, internal fixation surgery, compared with nonoperative functional bracing, did not significantly improve functional outcomes at 12 months. However, the substantial amount of treatment crossover from nonoperative to surgical treatment should be considered when interpreting the trial results.
BMJ Open
IntroductionChronic subdural haematomas (CSDHs) are one of the most common neurosurgical conditio... more IntroductionChronic subdural haematomas (CSDHs) are one of the most common neurosurgical conditions. The goal of surgery is to alleviate symptoms and minimise the risk of symptomatic recurrences. In the past, reoperation rates as high as 20%–30% were described for CSDH recurrences. However, following the introduction of subdural drainage, reoperation rates dropped to approximately 10%. The standard surgical technique includes burr-hole craniostomy, followed by intraoperative irrigation and placement of subdural drainage. Yet, the role of intraoperative irrigation has not been established. If there is no difference in recurrence rates between intraoperative irrigation and no irrigation, CSDH surgery could be carried out faster and more safely by omitting the step of irrigation. The aim of this multicentre randomised controlled trial is to study whether no intraoperative irrigation and subdural drainage results in non-inferior outcome compared with intraoperative irrigation and subdur...
JAMA, 2020
Importance Humeral shaft fractures traditionally have been treated nonsurgically, but there has b... more Importance Humeral shaft fractures traditionally have been treated nonsurgically, but there has been a steady increase in the rate of surgery over the past 2 decades without high-quality evidence to justify the trend. Objective To compare the effectiveness of surgical treatment with open reduction and internal plate fixation to nonsurgical treatment with functional bracing in the treatment of closed humeral shaft fractures. Design, Setting, and Participants Randomized clinical trial conducted at 2 university hospital trauma centers in Finland, enrollment between November 2012 and January 2018 with a final follow-up of January 2019. A total of 82 adult patients with closed, unilateral, displaced humeral shaft fracture met criteria for inclusion. Patients were excluded if they had cognitive disabilities preventing them from following the protocol or had multimorbidity or multiple trauma. Interventions Patients were randomly assigned to surgical treatment with open reduction and intern...
Background: Work disability (WD) is a medico-legal concept that refers to disability benefits (DB... more Background: Work disability (WD) is a medico-legal concept that refers to disability benefits (DB) granted due to diseases. We assessed whether subjective cognitive complaints (SCC)-presenting as self-rated difficulties of concentration, memory, clear thinking and decision making-predict permanent WD in knowledge-intensive occupations. Methods: We combined the SCC questionnaire results with reliable registry data on the DBs of 7,161 professional/managerial employees (46% females). We excluded employees who were on longterm sickness absence (SA) or had received a DB at baseline. The exposure variable was the presence of SCC. Age and SA before the questionnaire as a proxy measure of general health were treated as confounders and the analyses were conducted by gender. The outcome variable was a granted DB. The cumulative incidence function illustrates the difference between SCC categories, and the Fine-Gray model estimates the predictors of WD during the eight-year follow-up. Results: The most common primary reasons for permanent WD were mental (36%) and musculoskeletal (20%) disorders. SCC predicted DB in both genders when controlling for age and prior SA. Hazard ratios were 2.9 with a 95% confidence interval 1.4-6.0 for the females and 3.7 (1.8-7.9) for the males. After eight years, 3.1% of the females and 2.8% of the males in the abnormal SCC category had received a DB, while the respective figures in the reference category were 1.9% and 1.0%. Conclusion: Subjective cognitive complaints predict permanent WD in knowledge-intensive occupations among professional/managerial employees. This finding has implications for supporting work ability among employees with cognitively demanding tasks.
International Archives of Occupational and Environmental Health
Purpose Work disability (WD) as a medico-legal concept refers to disability benefits (DB) that ar... more Purpose Work disability (WD) as a medico-legal concept refers to disability benefits (DB) that are granted due to diseases that permanently reduce work ability. We studied whether an occupational healthcare instrument for the prediction of sickness absence (SA) risk—a health risk appraisal (HRA)—also predicts permanent WD. Methods HRA results were combined with registry data on DB of 22,023 employees from different industry sectors. We analysed how the HRA risk categories predict DB and considered occupational group, gender, age, and prior SA as confounding variables. Cumulative incidence function illustrates the difference between the HRA risk categories, and the Fine–Gray model estimates the predictors of WD during 6-year follow-up. Results The most common primary reasons for permanent WD were musculoskeletal (39%) and mental disorders (21%). Self-reported health problems in the HRA, labelled as “WD risk factors”, predicted DB when controlling for age and prior SA. Hazard ratios w...
BMJ Open
ObjectivesTo study whether self-reported health problems predict sickness absence (SA) from work ... more ObjectivesTo study whether self-reported health problems predict sickness absence (SA) from work in employees from different industries.MethodsThe results of a health risk appraisal (HRA) were combined with archival data of SA of 21 608 employees (59% female, 56% clerical). Exposure variables were self-reported health problems, labelled as ‘work disability (WD) risk factors’ in the HRA, presence of problems with occupational well-being and obesity. Age, socioeconomic grading and the number of SA days 12 months before the survey were treated as confounders. The outcome measure was accumulated SA days during 12-month follow-up. Data were analysed separately for males and females. A Hurdle model with negative binomial response was used to analyse zero-inflated count data of SA.ResultsThe HRA results predicted the number of accumulated SA days during the 12-month follow-up, regardless of occupational group and gender. The ratio of means of SA days varied between 2.7 and 4.0 among those ...
Scandinavian Journal of Medicine & Science in Sports, 2017
The relationship between different sport activities and lumbar intervertebral disc degeneration (... more The relationship between different sport activities and lumbar intervertebral disc degeneration (DD) is largely unknown. We evaluated whether adolescent participation in different sports is associated with lumbar DD in a population-based birth cohort of young adults. A total of 558 young adults (325 females and 233 males) underwent magnetic resonance imaging (MRI, 1.5-T scanner). A DD sum score, based on the Pfirrmann grading, was calculated for all lumbar levels. The sum score was categorized into no DD, 1, 2, or at least 3. Participation in different sport activities was self-reported by postal surveys at 16, 18 and 19 years and three groups were formed based on participation frequency in eleven sports: 1) highly active (at least twice a week), 2) moderately active (2 to 4 times a month), and 3) inactive (maximum once a month). Cumulative odds ratios (COR) and their 95% confidence intervals (CI) were obtained for each sport by ordinal logistic regression, adjusting for gender, body mass index, age, socioeconomic status, smoking, and other sports. Highly active participation in jogging/running and swimming was associated with a higher DD sum score (COR 3.0; 95% CI 1.4-6.3 and 5.0; 1.7-15.2, respectively) compared to inactive participation, whereas highly active participation in skating showed low COR. In conclusion, running and swimming at least twice a week in early adulthood are potentially associated with lumbar DD. Follow-up studies with MRI are needed to show whether frequent exposure to running or swimming has further effect on the integrity of lumbar intervertebral discs. This article is protected by copyright. All rights reserved.
Europa Medicophysica, Mar 1, 2004
Musculoskeletal disorders of which low back pain (LBP) accounts for more than 50% are now the mos... more Musculoskeletal disorders of which low back pain (LBP) accounts for more than 50% are now the most common cause of chronic incapacity in industrialized countries. The traditional approach in looking for the reason (etiology) for musculoskeletal disorders is to search structural failures but, in most cases, it is difficult to find an explicit reason for back pain. Many scientists now consider spine disorders as multifactorial, bio-psycho-social problems. Pain has clear effects on motor control. Therefore, LBP can also induce changes in neuromuscular control and motor performance, i.e., causing various functional deficits. Another feature, which deserves special consideration with reference to back problems, concerns the numerous psychological factors, which are involved in mediating the relationships between physical impairment, pain and disability. The new scientific knowledge on functional deficits is increasingly being transferred to clinical applications, where the aim is to reverse them with physical rehabilitation. As a result of the recognition of the behavioral (psychological) problems with LBP, psychological, behavioral and educational interventions are commonly combined with the physical rehabilitation for LBP also. Basically, functional rehabilitation includes systematic quantification of both the physical function and psychological factors, which drive the therapeutic process. The exercises used in the functional rehabilitation usually revolve around the treatment of the spine as a functional unit. Thus many programs for functional rehabilitation use rehabilitation equipment (iso-inertial/isokinetic) by properly trained physiotherapists. However, some centers use regular fitness equipment or aerobics-type exercises. Furthermore, some relaxation and ergonomic exercises are typically proposed, and psychological support provided along the treatment. There exists both an outpatient and an inpatient functional rehabilitation
Medicine Amp Science in Sports Amp Exercise, Jun 30, 1994