Skin closUre in carPal tunnEl Release (SUPER): protocol for a blinded randomised controlled trial comparing absorbable and non-absorbable sutures in carpal tunnel release.

INTRODUCTION: Carpal tunnel syndrome is a common disorder affecting a substantial portion of the general population. Surgical intervention is often deemed necessary, with the median nerve release being one of the most frequent operations. Optimising all the aspects of this procedure can enhance patient satisfaction with the treatment. METHODS AND ANALYSIS: We aim to determine the differences in the aesthetic outcome of the scar as well as the pain experienced during the healing process between the use of absorbable and non-absorbable sutures. The primary outcome measure will be the patients' subjective satisfaction with the aesthetic appearance of the scar 1 year after the operation. Secondary outcomes will include a similar evaluation of the aesthetics performed by a blinded outcome assessor, as well as pain experienced by the patients during the 2 weeks postoperatively. The severity and improvement of the patients' symptoms will also be measured by a Finnish version of the Boston Carpal Tunnel Questionnaire. Costs will be evaluated for both groups. Safety of the wound closure will be followed and reported. ETHICS AND DISSEMINATION: This protocol was approved by the Research Ethics Committee of the Northern Savo Hospital District (2319/2021). The trial will be conducted in accordance with the principles of Good Clinical Practice and the Declaration of Helsinki. The results will be disseminated through publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT05503719.

Body composition, balance, functional capacity and falls in older women.

BACKGROUND: The aim of this study was to examine the association of body composition, muscle strength, balance, and functional capacity on falls and fall injuries among community-dwelling older women. METHODS: The study comprised of a 2-year randomized controlled trial involving 914 women with an average age of 76.5 (SD = 3.3) years at baseline. The women were assigned to exercise intervention (n = 457) and control groups (n = 457). Clinical measurements were conducted at baseline, 12 months and 24 months. RESULTS: During the 2-year follow up, total of 546 women (59.7%) sustained a fall. The total number of falls was 1380 and out of these, 550 (40%) of falls were non-injurious and 745 (54%) were injurious. Higher femoral neck bone mineral density (BMD) was associated with a higher overall risk of falls [RR = 2.55 (95% CI = 1.70-3.84, p < 0.001)], but was a protective factor for severe fall injuries [RR = 0.03 (95% CI = 0.003-0.035, p < 0.01)]. Slower Timed Up and Go (TUG) was associated with an increased overall risk of falls [RR = 1.07 (95% CI = 1.05-1.10, p < 0.001)] and injuries requiring medical attention [RR = 1.10 (95% CI = 1.02-1.19, p = 0.02)]. Longer single leg standing time was a protective factor for falls [RR = 0.99 (95% CI = 0.99-1.00, p < 0.01)] and overall injurious falls [RR = 0.99 (95% CI = 0.99-1.00, p = 0.02)]. CONCLUSION: For postmenopausal women with higher femoral neck BMD appear to sustain more falls, but have a lower risk of severe fall injuries. Better TUG and single leg standing time predict lower risk of falls and fall injuries.

The diagnostic cut-off points for components of sarcopenia in Finnish Caucasian women: A retrospective cross-sectional study.

Objectives: To determine the diagnostic cut-off values of components for sarcopenia in Caucasian women. Methods: The present retrospective cross-sectional study based on the REFERENCE sample included 400 healthy women aged 20 to 40 years, and the OSTPRE sample included 344 women aged 63 to 75. The subjects of the OSTPRE population were re-measured five and ten years later after the baseline. Both samples underwent grip strength (GS), quadriceps strength (QS), and total-body DXA (TB-DXA) measurements, from which Relative Skeletal Muscle Mass Index (RSMI) was calculated. Results: In the REFERENCE population, the -1 SD / -2 SD cut-off points were for RSMI 5.8 kg/m2 / 5.1 kg/m2, for GS 32.0 kg / 26.4 kg, and for QS 39.8 kg / 29.8 kg. The prevalence of under -2 SD distributions in REFERENCE were: RSMI 1.8%, GS 1.3%, and QS 2.0%, and in OSTPRE (15/20/25 years measurements): RSMI 1.2 %/1.9 %/0.5 %, GS 52.2%/42.3%/48.8%, and QS 47.4%/55.2%/not available. The distributions of GS and QS were statistically significantly different between REFERENCE and all OSTPRE measurement points (p<0.001 in Chi-squared). Conclusions: The diagnostic cut-offs for components of sarcopenia are RSMI 5.1 kg/m2, grip strength 26.4 kg, and quadriceps strength 29.8 kg in Finnish Caucasian women.

Protocol for a double-blinded randomised controlled trial investigating the use of adjunct bicarbonate in carpal tunnel release: a single-centre study.

INTRODUCTION: This study aims to compare the effectiveness of buffered and non-buffered long-acting local anaesthetics in pain relief during and after carpal tunnel release (CTR) surgery. Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. Surgical treatment of CTS, CTR, is the most common hand surgical operation. CTR is usually performed under local anaesthesia, the application of which is often the most painful event during the procedure. One important aspect of patient satisfaction is adequate pain management during and after CTR. Long-acting local anaesthetics provide good postoperative pain control. Adjunct bicarbonate has been shown to reduce pain during injection of local anaesthetic and to prolong its analgesic effect. To date, no published randomised controlled trial has compared buffered to non-buffered long-acting local anaesthetic during CTR. METHODS AND ANALYSIS: The study will randomly assign 116 patients with CTS to receive buffered or non-buffered mixtures of lidocaine and bupivacaine with epinephrine before CTR. The primary outcome is overall pain experienced during the injection of local anaesthetic, assessed with the Visual Analogue Scale. The secondary outcomes are pain intensity from the injection and during CTR, use of painkillers and pain intensity every 4 hours until third postoperative night, symptom severity and functional status preoperatively and at 3 months after surgery, and patient-rated outcome measures at 3 months after surgery. ETHICS AND DISSEMINATION: This protocol was approved by the Research Ethics Committee of the Northern Savo Hospital District (2311/2021). The study will be performed according to the principles of good clinical practice and the Declaration of Helsinki. The results are expected to be presented in an international hand surgical conference and the manuscript to be sent to a hand surgery-orientated peer-reviewed journal during 2024. TRIAL REGISTRATION NUMBER: This study is registered to clinicaltrials.gov, study ID NCT05328180.

Intra- and inter-observer agreement in distal radius fracture dislocation measurement of casting position.

BACKGROUND AND PURPOSE: Most displaced distal radius fractures (DRF) are treated nonoperatively, with reduction and immobilization in a cast. Studies assessing intra- or inter-observer agreement on radiologic measurements of casting position have not been published, which was the aim of our study. PATIENTS AND METHODS: Our study is based on the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study. All detected DRFs during the OSTPRE follow-up were retrieved and based on sample size calculations 50 fractures were randomly selected for the study. 5 independent reviewers measured dislocation parameters and wrist position in a cast from the radiographs. A linear mixed model was used to estimate the concordance correlation coefficient (CCC) and total deviance index (TDI) that were used to evaluate intra- and inter-observer agreement. We used Kappa values to determine intra- and inter-rater agreement on radiographically acceptable reduction of the DRF. Limits of acceptable position were those defined by Finnish Current Care Guidelines. RESULTS: For radial inclination, radial shortening, and dorsal/volar tilt, intra- and inter-observer correlations were high (CCC > 0.76). In addition, measurements of wrist angle in a splint had high correlations (CCC > 0.78), whereas measurement of intra-articular gap and step had poor correlations (CCC < 0.52). The Kappa value for overall agreement on the radiographically acceptable position of the DRF was modest (0.59). CONCLUSION: Intra- and inter-observer repeatability of casting position of radial inclination, radial shortening, and dorsal/volar tilt were high whereas intra-articular gap and step had poor correlations.

Effectiveness of exercise on fall prevention in community-dwelling older adults: a 2-year randomized controlled study of 914 women.

BACKGROUND: Communal exercise interventions may help prevent falls and injuries. However, pragmatic trials demonstrating the effectiveness of such strategies are sparse. METHODS: We determined whether a cost-free 12-month admission to the city's recreational sports facilities including initial 6 months of supervised weekly gym and Tai Chi sessions decreases the number of falls and related injuries. The mean (SD) follow-up time was 22·6 (4.8) months in 2016-19. A total of 914 women from a population-based sample with a mean age of 76.5 (SD 3.3, range 71.1-84.8) years were randomized into exercise intervention (n = 457) and control (n = 457) groups. Fall information was collected through biweekly short message (SMS) queries and fall diaries. Altogether 1,380 falls were recorded for the intention-to-treat analysis, with 1,281 (92.8%) being verified by telephone. RESULTS: A 14.3% fall rate reduction was detected in the exercise group (Incidence rate ratio (IRR) = 0.86; CI 95% 0.77-0.95) compared with the control group. Approximately half of the falls caused moderate (n = 678, 52.8%) or severe (n = 61, 4.8%) injury. In total, 13.2% (n = 166) of falls (including 73 fractures) required medical consultation with a 38% lower fracture rate in the exercise group (IRR = 0.62; CI 95% 0.39-0.99). Overall, the greatest reduction of 41% (IRR = 0.59; CI 95% 0.36-0.99) was observed in falls with severe injury and pain. CONCLUSIONS: A community-based approach for a 6-month exercise period combined with a 12-month free use of sports premises can reduce falls, fractures and other fall-related injuries in aging women.

Physical capability and patient-reported well-being after spinal surgery: a 20-year cohort from the Kuopio Osteoporosis Risk Factor and Prevention study combined with the Finnish Care Register for Health Care.

BACKGROUND AND PURPOSE: Studies investigating the effect of spinal surgery on both physical capability (PC) and subjective well-being (SW) are scarce. We aimed to investigate self-reported PC and SW up to 20 years after lumbar spine surgery. PATIENTS AND METHODS: 6,612 postmenopausal Finnish women (47-56 years at baseline [BL]), from the Osteoporosis Risk Factor and Prevention (OSTPRE) study, were followed-up (FU) for 20 years. The Finnish Care Register for Healthcare (CRFH) provided data on surgery in the OSTPRE population on lumbar spinal stenosis (LSS) and lumbar disc herniation (LDH). PC and SW of women with lumbar surgery was compared with that of women without lumbar surgery. A chi-square analysis was conducted to analyze the statistical differences in the distribution of PC and SW. A propensity score-matched control analysis was also performed in addition to analysis of the total populationbased control group. RESULTS: In women without lumbar surgery 94% reported good PC at BL, which decreased to 79% at the 20-year FU. For those with LSS/LDH surgery, 84%/(37/50) reported good PC at BL and 80%/(33/50) at 20-year FU, respectively. Good SW was reported by 48% of the control group at BL, 50% at 10-year FU, and 42% at 20-year FU. Women with LSS/LDH surgery before the 10-year FU reported good SW as follows: (6/50)/38% at BL, (12/48)/39% at 10-year FU, and (9/50)/37% at 20-year FU. CONCLUSION: Patients with LSS and LDH report lower PC and SW. Lumbar spinal surgery improves PC and SW in the short term, with early LDH surgery showing the greatest benefits whereas late surgery did not. Overall, PC and SW are lower both initially and during the 20-year FU when compared with the age-matched controls except for early LDH surgery.

Manipulation under anesthesia after total knee arthroplasty: a retrospective study of 145 patients.

BACKGROUND AND PURPOSE: Manipulation under anesthesia (MUA) is considered to be effective in treating stiffness after total knee arthroplasty (TKA). However, not all patients achieve a satisfactory range of motion (ROM) after MUA. This retrospective study determined the outcome of MUA and identified the factors affecting it. PATIENTS AND METHODS: The final sample consisted of 150 MUAs performed on 145 patients. The parameters of interest were ROM and Knee Society Score (KSS) or Oxford Knee Score (OKS). The associations of preoperative, perioperative, and postoperative risk factors with gain in flexion and flexion at post-MUA follow-up (an average of 2 months after MUA) were analyzed using multivariable regression model. RESULTS: The mean of 26° (95% CI 23-29) gain in flexion and the mean of 3° (CI 2-4) gain in extension were noticed at post-MUA follow-up when compared with the ROM preceding MUA. The mean post-MUA-FU flexion was 99° (CI 97-102) and the mean post-MUA-FU extension deficit was 4° (CI 2-5). KSS (121 vs. 129) and OKS (29 vs. 28) were similar before and after MUA. The early timing of MUA was associated with better gain in flexion -0.04 (CI -0.08 to -0.01), while we found no association between the timing of MUA and flexion after MUA -0.004 (CI -0.03 to 0.03). High BMI was associated with better gain in flexion 0.8 (CI 0.2-1.5). INTERPRETATION: We found that ROM improved substantially after MUA. The gain in flexion decreased as the time between TKA and MUA increased.

Incidence and risk factors of spinal cord stimulation for persistent or recurrent pain after lumbar spine surgery: a population-based study.

PURPOSE: This study aims to elucidate the incidence of and independent risk factors for spinal cord stimulator implantations for patients who underwent lumbar spine surgery. METHODS: The PERFormance, Effectiveness, and Cost of Treatment (PERFECT) episodes database, which was established for selected diseases and procedures in Finland, includes all patients who underwent lumbar spine surgery for degenerative spine conditions or spinal cord stimulation (SCS) in Finland from 1986 to 2018. The data on age, sex, hospital diagnoses, surgical procedures, and causes of death were imported from the Finnish national registers into the PERFECT database. RESULTS: Between 1986 and 2018, 157,824 patients had their first lumbar spine procedure and for 1769 (1.1%) of them, a subsequent SCS procedure was observed during the follow-up. The cumulative incidence of SCS for persistent or recurrent pain after lumbar disk herniation, spinal stenosis, degenerative disk disease, and spondylolysis and spondylolisthesis surgery at 15 years was 1.2%, 1.0%, 2.7%, and 2.6% respectively. At 15 years, the cumulative incidence of SCS for persistent or recurrent pain after lumbar spine surgery after five or more lumbar spinal operations was 11.9%. CONCLUSION: Repeated surgery was the most prominent significant risk factor for SCS for persistent or recurrent pain after lumbar spine surgery. The risk of SCS for persistent or recurrent pain after lumbar spine surgery increases significantly along with the number of lumbar spine procedures. When considering repeated lumbar spine surgery, careful evaluation of treatment options should take place to ensure good patient outcomes.

Pain medication purchases before and after total hip and knee arthroplasty: a register study of 329,743 arthroplasties.

BACKGROUND AND PURPOSE: Total hip (THA) and knee (TKA) arthroplasty are effective pain treatment in osteoarthritis; however, there are patients with long-term pain and in need of analgesics. We studied purchases of paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and neuropathic pain medication before and after THA or TKA. PATIENTS AND METHODS: We searched all THA (n = 149,158) and TKA (n = 180,585) cases in Finland between the years 1998 and 2018 and the drug purchases made by patients during 1997-2018 using linked Finnish register data. Drug purchases were studied in 3-month periods. RESULTS: The purchases of all analgesics increased from 3 years before operation to 3 months before operation. Around the time of THA or TKA, the purchases of all analgesics spiked to 7-56%, depending on drug. The purchases of all analgesics decreased rapidly during the first 6 months postoperatively. Purchases of paracetamol, NSAIDs, and opioids at 6 months postoperatively (6-23%) were lower than they were at 3 months preoperatively. At 3 years postoperatively, only paracetamol purchases were lower (15-18%) postoperatively than they were 3 years before arthroplasty. NSAID, opioid, and neuropathic pain medication purchases remained higher (4-14%). INTERPRETATION: THA and TKA stop and reduce the preoperative increases in purchases of paracetamol, NSAIDs, and opioids. The purchases of pain medications by THA and TKA patients 1 year after operation are close to those in the general population.

The impact of teacher's presence on learning basic surgical tasks with virtual reality headset among medical students.

BACKGROUND: The aim of this study was to investigate whether the presence of a teacher affects learning related outcomes in teaching basic surgical tasks with a Virtual Reality (VR) headset. METHODS: 26 fourth-year medical studentsparticipated in a voluntary exercise. Students practiced basic surgical procedure exercises using the VR4HEALTHCARE application in VR with OCULUS Rift S glasses. 12 students performed the exercises under the guidance of a teacher and 14 without the teacher present. After the exercise, the groups filled out a feedback form. Statistical analysis was performed using IBM SPSS Statistics 25.0 software using the Mann-Whitney U test and multivariate analysis of variance. RESULTS: The most important data collected related to whether the student learned something new and whether VR adds value to medical education. Ratings were based on a scale of 0-10 (0 = worst, 10 = best). When the teacher was present, on average, the students felt that they were learning something new and gave an average rating of 7.8 ± 1.8, and when the teacher was not present 5.3 ± 2.6 (p = 0.003). VR added value to teaching with a rating of 7.8 ± 1.7 when the teacher was present and 5.5 ± 3.0 when not present (p = 0.045). This study also analyzed specific use of VR for abscess incision, suturing and insertion of a suprapubic catheter. DISCUSSION: When a teacher was present VR added value to teaching and the usefulness and usability of VR was experienced more positively. The student should also have adequate knowledge of the subject to be taught before VR training. CONCLUSIONS: VR adds value to teaching, but VR exercises may not completely replace high-quality traditional teaching methods. Consequently, it is important to determine the differences between VR and traditional teaching methods and how to combine these methods in the future.

The effect of COVID-19 lockdown on the incidence of emergency department visits due to injuries and the most typical fractures in 4 Finnish hospitals.

BACKGROUND AND PURPOSE: COVID-19 lockdowns have affected personal mobility and behavior worldwide. This study compared the number of emergency department (ED) visits due to injuries and typical low-energy fractures in Finland during the COVID-19 lockdown period in spring 2020 to the reference period in 2019. PATIENTS AND METHODS: The data was collected retrospectively from the electronic patient records of 4 hospitals covering 1/5 of the Finnish population. We included the patients who were admitted to a hospital ED due to any injury during the lockdown period (March 18-May 31, 2020) and the reference period (March 18-May 31, 2019). We compared the differences between the average daily ED admissions in the 2 years using the zero-inflated Poisson regression model. RESULTS: The overall number of ED visits due to injuries decreased by 16% (mean 134/day vs. 113/day, 95% CI -18 to -13). The number of ED visits due to wrist fractures decreased among women aged over 50 years by 40% (CI -59 to -9). Among women, the number of ED visits due to ankle fractures decreased by 32% (CI -52 to -5). The number of ED visits due to fractures of the upper end of the humerus decreased by 52% (CI -71 to -22) among women. The number of ED visits due to hip fractures increased by 2% (CI -16 to 24). INTERPRETATION: Restrictions in personal mobility decreased the number of ED visits due to injuries during the pandemic. The effect can mainly be seen as a decreased number of the most typical low-energy fractures among women. In contrast, lockdown restrictions had no effect on the number of hip fractures.

Association between severe lumbar disc degeneration and self-reported occupational physical loading.

OBJECTIVES: Occupational physical loading has been reported to be associated with intervertebral disc degeneration. However, previous literature reports inconsistent results for different vertebral levels. The aim of our study was to investigate the association between lumbar disc degeneration (LDD) at different vertebral levels and the self-reported physical loading of occupation. METHODS: The study population consisted of 1,022 postmenopausal women and was based on the prospective Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study cohort. The severity of LDD was graded from T2-weighted MRI images using the five-grade Pfirrmann classification. Five intervertebral levels (L1-L2 to L5-S1) were studied (total 5110 discs). The self-rated occupational physical loading contained four groups: sedentary, light, moderate, and heavy. RESULTS: The heavy occupational physical loading group had higher odds for severe LDD at the L5-S1 vertebral level (OR 1.86, 95% CI: 1.19-2.92, p = .006) in comparison with the sedentary work group. A clear trend of increasing disc degeneration with heavier occupational loading was also observed at the L5-S1 level. Age, smoking, and higher body mass index (BMI) were associated with more severe LDD. Leisure-time physical activity at the age of 11-17 years was associated with less severe LDD. Controlling for confounding factors did not alter the results. CONCLUSIONS: There appears to be an association between occupational physical loading and severe disc degeneration at the lower lumbar spine in postmenopausal women. Individuals in occupations with heavy physical loading may have an increased risk for work-related disability due to more severe disc degeneration.

Characteristics of Long-Term Femoral Neck Bone Loss in Postmenopausal Women: A 25-Year Follow-Up.

The aim of this study was to monitor long-term changes in bone mineral density (BMD) after menopause and factors affecting BMD. The study population consisted of a random sample of 3222 women from the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study, of which 62.1% were postmenopausal at the beginning of the study. This group of women underwent dual-energy X-ray absorptiometry (DXA) measurements at the femoral neck every 5 years from baseline (in 1989) up to 25-year follow-up. They also responded to risk-factor questionnaires at 5-year intervals. During the 25-year follow-up, the baseline cohort decreased to 686 women. The women were divided into quartiles based on their baseline BMD. Self-reported hormone replacement therapy (HRT) and corticosteroid use were divided into ever users and never users. Morbidity was assessed as the total number of self-reported diseases and BMD-affecting diseases. The mean 25-year BMD change was found to be -10.1%, p < 0.001. Higher baseline BMD was associated with higher bone loss rate; the reduction in the highest quartile BMD was 11.1% and in the lowest quartile 7.4% (p = 0.0031). Lower baseline body mass index (BMI) and a greater increase in BMI were found to protect against postmenopausal bone loss (p < 0.001). The lowest bone loss quartile included 15.2% more HRT users than the highest bone loss quartile (p = 0.004). The number of diseases/bone-affecting diseases, use of vitamin D/calcium supplementation, use of corticosteroids, smoking or alcohol use had no statistical significance for annual bone loss rate. This study presents hitherto the longest (25-year) BMD follow-up in postmenopausal women. The linear femoral neck bone loss of 10% was less than previously assumed. A 5-year BMD change appeared to predict long-term bone loss in postmenopausal women. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Dietary omega-3 polyunsaturated fatty acid and alpha-linolenic acid are associated with physical capacity measure but not muscle mass in older women 65-72 years.

PURPOSE: The aim was to investigate the cross-sectional association of dietary omega-3 polyunsaturated fatty acids PUFA (alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA)) intake with multiple physical functions, muscle mass and fat mass in older women. METHOD: Study subjects were 554 women from the Osteoporosis Risk Factor and Prevention Fracture Prevention Study, with dietary intake assessed with 3-day food record. Body composition was measured by dual-energy X-ray absorptiometry. Physical function measures included walking speed 10 m, chair rises, one leg stance, knee extension, handgrip strength and squat. Short physical performance battery (SPPB) score was defined based on the European working group on sarcopenia criteria. RESULTS: The multivariable adjusted models showed statistically significant associations for dietary ALA with higher SPPB (ß = 0.118, P = 0.024), knee extension force at baseline (ß = 0.075, P = 0.037) and lower fat mass (ß = - 0.081, P = 0.034), as well as longer one-leg stance (ß = 0.119, P = 0.010), higher walking speed (ß = 0.113, P = 0.047), and ability to squat to the ground (ß = 0.110, P = 0.027) at baseline. Total dietary omega-3 PUFA was associated with better SPPB (ß = 0.108, P = 0.039), one-leg stance (ß = 0.102, P = 0.041) and ability to squat (ß = 0.110, P = 0.028), and with walking speed (ß = 0.110, P = 0.028). However, associations for dietary EPA and DHA with physical function and body composition were not significant. CONCLUSION: Dietary omega-3 and ALA, but not EPA and DHA, were positively associated with muscle strength and function in older women. The intake of omega-3 and its subtypes was not associated with muscle mass. Longitudinal studies are needed to show whether omega-3 intake may be important for muscle function in older women.

Physical capacity, subjective health, and life satisfaction in older women: a 10-year follow-up study.

BACKGROUND: Physical capacity and subjective wellbeing are important for healthy aging. Our aim was to study how objective/subjective physical capacity and subjective health relate to life satisfaction, in a 10-year follow-up of aging women. METHODS: The participants (n = 1485, mean age 67.4 years) consisted of community-dwelling older women living in Kuopio, Finland. Grip strength and one-legged stance test time were used as objective, and self-rated mobility (SRM) as subjective physical capacity measures. Self-rated health (SRH) and SRM were assessed with one-item scales and life satisfaction with a 4-item scale. Correlation and linear regression were used to analyze these relationships and correlation network analysis to visualize them. Age and BMI were included in the analysis as adjusting factors. RESULTS: All the study variables were significantly correlated with baseline and follow-up life satisfaction, except BMI, which was only associated with life satisfaction at follow-up. On both occasions, SRH and SRM were the two strongest correlates of life satisfaction, but their mutual correlation was still higher. In linear regression analyses, SRH was positively associated with both baseline and follow-up life satisfaction, but physical capacity measures became non-significant after including SRH and SRM in the model. In the partial correlation network analyses, SRH and SRM were the most central nodes, connecting every other variable. CONCLUSIONS: Self-reports on health, mobility, and life satisfaction are closely intertwined and provide easily accessible health information among aging women, but the impacts of objective physical capacity measures warrant further longitudinal studies in respect to subjective wellbeing among aging people.

Physical capability after total joint arthroplasty: long-term population-based follow-up study of 6,462 women.

Background and purpose - There is lack of knowledge concerning patient-reported long-time outcome after arthroplasty. Therefore, we investigated patient self-reported physical capabilities (PC) and subjective well-being (SW) up to 20 years after total hip (THA) or knee (TKA) arthroplasty.Subjects and methods - The self-reports from postal questionnaires for study checkpoints (baseline, 10-year follow-up, 20-year follow-up) were provided by the Kuopio OSTPRE study including only women aged 52-62 years (n = 6,462). The Finnish Arthroplasty Register and Care Register for Health Care provided data on arthroplasties in the OSTPRE population. The results of women with THA/TKA were compared with women without arthroplasty (control group).Results - In subjects with THA performed before the 10-year follow-up, the proportion of good PC was initially decreased by 0.6 percentage points (pp) at the 10-year follow-up and later by 19 pp at the 20-year follow-up. After TKA, the proportion of subjects with good PC decreased by 4.1 pp (10-year follow-up) and 27 pp (20-year follow-up), respectively. The proportion of controls reporting good PC decreased by 1.4 pp at the 10-year follow-up and 14 pp at the 20-year follow-up compared with the baseline. After THA, the proportion of subjects with good SW stayed on the same level at 10-year follow-up and decreased by 2.3 pp at 20-year follow-up. After TKA, the proportion of good SW increased by 9.0 pp (10-year follow-up) and decreased by 14 pp (20-year follow-up). The proportion of controls reporting good SW increased by 4.0 pp (10-year follow-up) and decreased by 8.8 pp (20-year follow-up).Interpretation - THA and TKA maintain PC and SW. The overall PC and SW are lower in women with arthroplasty, in comparison with controls without arthroplasty. THA seems to outperform TKA in maintaining PC.

Cardiovascular and musculoskeletal health disorders associate with greater decreases in physical capability in older women.

BACKGROUND: Good physical capability is an important part of healthy biological ageing. Several factors influencing physical capability have previously been reported. Long-term reports on physical capability and the onset of clinical disorders and chronic diseases are lacking. Decrease in physical capacity has been shown to increase mortality. This study focuses on the prevalence of chronic diseases. The primary objective of the study was to reveal the association between physical capability and morbidity. Secondary objectives included the validity of self-reported physical capability and the association between baseline physical capability and mortality. METHODS: The OSTPRE (Kuopio Osteoporosis Risk Factor and Prevention Study) prospective cohort involved all women aged 47-56 years residing in the Kuopio Province, Finland in 1989. Follow-up questionnaires were mailed at five-year intervals. Physical capability questions were first presented in 1994. From these women, we included only completely physically capable subjects at our baseline, in 1994. Physical capability was evaluated with five scale self-reports at baseline and in 2014 as follows: completely physically capable, able to walk but not run, can walk up to 1000 m, can walk up to 100 m and temporarily severely incapable. The prevalences of selected chronic diseases, with a minimum prevalence of 10% in 2014, were compared with the change in self-reported physical capability. Additionally, associations between long-term mortality and baseline physical capability of the whole 1994 study population sample were examined with logistic regression. The correlation of self-reported physical capability with functional tests was studied cross-sectionally at the baseline for a random subsample. RESULTS: Our study population consisted of 6219 Finnish women with a mean baseline age of 57.0 years. Self-reported physical capability showed statistically significant correlation with functional tests. Cardiovascular diseases and musculoskeletal disorders show the greatest correlation with decrease of physical capability. Prevalence of hypertension increased from 48.7% in the full physical capability group to 74.5% in the "able to walk up to 100 metres" group (p < 0.001). Rheumatoid arthritis showed a similar increase from 2.1 to 7.4% between these groups. Higher baseline body mass index (BMI) decreases long-term capability (P < 0.001). Women reporting full physical capability at baseline had a mortality rate of 15.1%, in comparison to 48.5% in women within the "able to walk up to 100 m" group (p = 0.357). Mortality increased steadily with worsening baseline physical capability. CONCLUSIONS: The results of this study show that chronic diseases, particularly cardiovascular and musculoskeletal disorders, correlate with faster degradation of physical capability in the elderly. Similar results are shown for increase in BMI. We also demonstrate that the risk of mortality over a 20-year period is higher in individuals with poor baseline physical capability.