Test-retest reliability and comparability of paper and computer questionnaires for the Finnish version of the Tampa Scale of Kinesiophobia.

OBJECTIVES: To estimate the internal consistency, test-retest reliability and comparability of paper and computer versions of the Finnish version of the Tampa Scale of Kinesiophobia (TSK-FIN) among patients with chronic pain. In addition, patients' personal experiences of completing both versions of the TSK-FIN and preferences between these two methods of data collection were studied. DESIGN: Test-retest reliability study. Paper and computer versions of the TSK-FIN were completed twice on two consecutive days. PARTICIPANTS: The sample comprised 94 consecutive patients with chronic musculoskeletal pain participating in a pain management or individual rehabilitation programme. The group rehabilitation design consisted of physical and functional exercises, evaluation of the social situation, psychological assessment of pain-related stress factors, and personal pain management training in order to regain overall function and mitigate the inconvenience of pain and fear-avoidance behaviour. RESULTS: The mean TSK-FIN score was 37.1 [standard deviation (SD) 8.1] for the computer version and 35.3 (SD 7.9) for the paper version. The mean difference between the two versions was 1.9 (95% confidence interval 0.8 to 2.9). Test-retest reliability was 0.89 for the paper version and 0.88 for the computer version. Internal consistency was considered to be good for both versions. The intraclass correlation coefficient for comparability was 0.77 (95% confidence interval 0.66 to 0.85), indicating substantial reliability between the two methods. CONCLUSION: Both versions of the TSK-FIN demonstrated substantial intertest reliability, good test-retest reliability, good internal consistency and acceptable limits of agreement, suggesting their suitability for clinical use. However, subjects tended to score higher when using the computer version. As such, in an ideal situation, data should be collected in a similar manner throughout the course of rehabilitation or clinical research.

Assessment of chronic pain behaviour: reliability of the method and its relationship with perceived disability, physical impairment and function.

The aim of the present study was to develop a reliable assessment of pain behaviour performed during the execution of a range of functional assessment measures. For the initial reliability study 18 subjects (consecutive referrals) were assessed. Subjects were observed and videotaped during a variety of physical tasks and demonstrations of pain behaviour were recorded; the videotapes were scored by two independent observers on two occasions. The relationships between pain behaviour, distress and physical function and impairment were also investigated in a group of 51 patients with chronic back pain. Self-report of disability and pain intensity were assessed using the Finnish version of Oswestry disability questionnaire and the pain visual analogue scale (VAS). Depression and somatic perception were assessed using the modified Zung and modified somatic perception questionnaire. The Tampa scale for kinesiophobia was used to evaluate fear of movement and (re)injury. The results of the intra- and interobserver reliability study demonstrate good to excellent levels of agreement. The exception was facial expression (kappa 0.29), which was excluded from the final instrument. There was a strong correlation between pain behaviour and subjective pain report and disability (p < 0.01). The correlations between total pain behaviour and performance of physical function tasks is striking (p < 0.01). Subjective disability was analysed by means of multiple regression analysis. Pain measured on the VAS was the most important variable explaining 36% of the variance, pain behaviour and pain combined explained 48% of the variance for self reported disability. In conclusion, this functional videobased assessment of pain behaviour is a reliable measure of pain behaviour. The total scores for pain behaviour correlate with tasks that involve the back; tests involving upper limbs were not affected. This test is suitable for the assessment of those with pain problems specifically involving the back. Furthermore, in the group studied pain and pain behaviour were the two most important determinants of self-reported disability.

A novel inserter instrument (Crossbow) for installation of self-reinforced bioabsorbable arrows into meniscus tissue.

A novel inserter, Crossbow, was developed for arthroscopic installation of self-reinforced bioabsorbable meniscus arrows into meniscus tissue. The Crossbow comprises a reservoir cartridge for up to four arrows, a triggering mechanism, and an interchangeable (curved or straight) trocar for guiding and installation of an arrow. A randomized biomechanical study was carried out by installing 13-mm-long meniscus arrows into fresh porcine menisci with the Crossbow and with the standard manual inserter trocar system. The mean pull-out force for Crossbow-installed arrows was 56.8 +/- 14.2 N, and that for arrows installed with the manual system was 43.7 +/- 13.8 N; the difference was statistically significant. While Crossbow is easy and rapid to use and gives good grip of arrows into pig meniscus, it may be an attractive alternative instrument to treat bucket-handle lesions of the menisci arthroscopically.

Delusional parasitosis in the elderly: a review and report of six cases from northern Finland.

A patient with delusional parasitosis has a strong conviction of being infested with parasites: for example, lice or worms. Such a patient is not satisfied with assurances or test results that no parasites are present, but is so convinced that he or she will go as far as to bring the parasites in "matchboxes" to a physician. Subjectively worried, the patient may try to pick the parasites out of the skin, causing cutaneous lesions and even ulcerations. The condition is classified as a delusional/paranoid disorder, somatic type according to DSM-III-R. Not much is known epidemiologically of this rare disorder, which usually affects older women who often are isolated socially. Therapy is regarded as difficult, and a wide variety of treatment methods have been attempted. In this article six female cases are presented, showing that a typical patient is an elderly woman who has suffered losses or is socially isolated. These patients lack deeper psychiatric insight into their problem, so they are mostly in the care of nonpsychiatric physicians. Treatment with a low dose of high-potency neuroleptics combined sometimes with antidepressants appears to be effective. Reducing social isolation is also important.