Reliability and construct validity of the modified Finnish version of the 9-item patient health questionnaire and its associations within the biopsychosocial framework among female health-care workers with sub-acute or recurrent low back pain.

BACKGROUND: Health-care workers have an increased risk for chronic low back pain (LBP) leading to reduced workability. Depression, a highly prevalent, costly and disabling condition, is commonly seen in patients with sub-acute LBP. This study investigated the psychometric properties and construct-validity of a modified 9-item Patient Health Questionnaire (PHQ-9-mFIN) in female health-care workers with sub-acute LBP. METHODS: Reliability (internal consistency, test-retest repeatability) was assessed using standard methods. Construct validity of the PHQ-9-mFIN was assessed as level of depressive symptoms (PHQ-9-mFIN: 0-4 none, 5-9 mild, ≥10 at least moderate) against the RAND 36 Health Survey, a valid measure of health-related quality of life (HRQoL). Additionally, the strength of the association between the levels of PHQ-9-mFIN and selected biopsychosocial factors was determined. RESULTS: The internal consistency of the PHQ-9-mFIN was high (Cronbach's α = 0.82) and the test-retest repeatability scores (n = 64) were moderate: Pearson's correlation was 0.73 and Intraclass Correlation Coefficient (ICC) 0.73 (95% CI: 0.58 to 0.82). Construct validity (Spearman correlation) against the Physical and Mental component items and their summary scales of the RAND 36 were much higher for the Mental (range, - 0.40 to - 0.67 and - 0.64) than for the Physical (range, - 0.08 to - 0.43 and - 0.22). There was a clear stepwise association (p < 0.001) between the levels of depressive symptoms and General health (physical component, range, 59.1 to 78.8). The associations with all items of the Mental components were strong and graded (p < 0.001). All participants had low scores for Bodily pain, regardless of the level of depressive symptoms. There was a strong association (p ≤ 0.003) between the levels of PHQ-9-mFIN and multisite pain, lumbar exertion and recovery after workdays, neuromuscular fitness in modified push-ups, workability, and fear of pain related to work. CONCLUSIONS: The PHQ-9-mFIN showed adequate reliability and excellent construct validity among female health-care workers with recurrent LBP and physically strenuous work. TRIAL REGISTRATION: NCT01465698 .

Efficacy of six months neuromuscular exercise on lumbar movement variability - A randomized controlled trial.

INTRODUCTION: Lumbar movement variability during heavy, repetitive work may be a protective mechanism to diminish the progression of lumbar disorders and maintain neuromuscular functional integrity. The effect of neuromuscular exercise (NME) on the variability of lumbar movement is still to be determined. METHODS: A randomised controlled trial was conducted on a population of nursing personnel with subacute LBP. Following randomization, the NME group participants completed an NME program of six months duration. The participants in the control group only attended the assessment sessions. The outcomes were assessed at: baseline; after six months intervention; 12 months. The primary outcome was lumbar movement variability based on angular displacement and velocity. RESULTS: A positive treatment effect on lumbar movement variability was seen after six months of NME intervention. Angular displacement improved, and angular velocity remained constant. At the 12-month follow up, however, the effect faded in the NME group. Lumbar movement variability worsened in the control group over all time periods. CONCLUSION: NME may improve lumbar movement variability in the short term and may indicate improved neuromuscular functional integrity. The design of an optimal NME program to achieve long-term improvement in lumbar movement variability is a subject worthy of further research.

The effect of muscle fatigue and low back pain on lumbar movement variability and complexity.

INTRODUCTION: Changes in movement variability and complexity may reflect an adaptation strategy to fatigue. One unresolved question is whether this adaptation is hampered by the presence of low back pain (LBP). This study investigated if changes in movement variability and complexity after fatigue are influenced by the presence of LBP. It is hypothesised that pain free people and people suffering from LBP differ in their response to fatigue. METHODS: The effect of an isometric endurance test on lumbar movement was tested in 27 pain free participants and 59 participants suffering from LBP. Movement variability and complexity were quantified with %determinism and sample entropy of lumbar angular displacement and velocity. Generalized linear models were fitted for each outcome. Bayesian estimation of the group-fatigue effect with 95% highest posterior density intervals (95%HPDI) was performed. RESULTS: After fatiguing %determinism decreased and sample entropy increased in the pain free group, compared to the LBP group. The corresponding group-fatigue effects were 3.7 (95%HPDI: 2.3-7.1) and -1.4 (95%HPDI: -2.7 to -0.1). These effects manifested in angular velocity, but not in angular displacement. DISCUSSION: The effects indicate that pain free participants showed more complex and less predictable lumbar movement with a lower degree of structure in its variability following fatigue while participants suffering from LBP did not. This may be physiological responses to avoid overload of fatigued tissue, increase endurance, or a consequence of reduced movement control caused by fatigue.

Self-reported health-enhancing physical activity recommendation adherence among 64,380 finnish adults.

The Finnish recommendations for health-enhancing physical activity (PA) for adults (≥18 years) recommend: (i) ≥150 minutes of moderate-to-vigorous-intensity physical activity (MVPA) and (ii) activities that develop muscle strength and balance ≥2 days/week. However, adherence to these recommendations among the Finnish adults is currently unknown. This study reports on the self-reported adherence to the PA recommendations and associations with sociodemographic factors among Finnish adults. Data were used from the Finnish "Regional Health and Well-being Study." In 2013-2014, postal questionnaires were sent to 132,560 persons, with 69,032 responding (response rate =52.1%). The weighted proportions adhering to the: (i) MVPA recommendation, (ii) sufficient muscle-strengthening activity (≥2 days/week), (iii) sufficient balance training (≥2 days/week), and (iv) Finnish health-enhancing PA recommendations (Finnish recommendations) were calculated. Associations with sociodemographic variables (eg, age, education level, self-rated health) were assessed using multiple logistic regression analyses. Of 69,032 respondents, 92.6% (n=64,380, response rate =48.6%, 18-98 years) reported on their physical activity levels. A total of 31.2% (95% CI: 30.8%-31.6%) met the aerobic MVPA recommendation, 17.2% (95% CI: 16.9%-17.6%) reported sufficient muscle-strengthening activity, 6.7% (95% CI: 6.4%-6.9%) reported sufficient balance training, and 10.8% (95% CI: 10.5%-11.1%) met the Finnish recommendations. In the adjusted analysis, those with poorer self-rated health, older age, lower education levels, and those classified overweight or obese were independently associated with lower odds of meeting the Finnish recommendations. The vast majority of Finnish adults do not meet the full PA recommendations. Public health action is needed to increase PA in Finland.

Pain intensity attenuates movement control of the lumbar spine in low back pain.

INTRODUCTION: Pain intensity attenuates muscular activity, proprioception, and tactile acuity, with consequent changes of joint kinematics. People suffering from low back pain (LBP) frequently show movement control impairments of the lumbar spine in sagittal plane. This cross-sectional, observational study investigated if the intensity of LBP attenuates lumbar movement control. The hypothesis was that lumbar movement control becomes more limited with increased pain intensity. METHODS: The effect of LBP intensity, measured with a numeric rating scale (NRS), on lumbar movement control was tested using three movement control tests. The lumbar range of motion (ROM), the ratio of lumbar and hip ROM as indicators of direction specific movement control, and the recurrence and determinism of repetitive lumbar movement patterns were assessed in ninety-four persons suffering from LBP of different intensity and measured with an inertial measurement unit system. Generalized linear models were fitted for each outcome. RESULTS: Lumbar ROM (+ 0.03°, p = 0.24) and ratio of lumbar and hip ROM (0.01, p = 0.84) were unaffected by LBP intensity. Each one point increase on the NRS resulted in a decrease of recurrence and determinism of lumbar movement patterns (-3.11 to -0.06, p ⩽ 0.05). DISCUSSION: Our results indicate changes in movement control in people suffering from LBP. Whether decreased recurrence and determinism of lumbar movement patterns are intensifiers of LBP intensity or a consequence thereof should be addressed in a future prospective study.

Concurrent validity and reliability of a novel wireless inertial measurement system to assess trunk movement.

INTRODUCTION: Assessment of movement dysfunctions commonly comprises trunk range of motion (ROM), movement or control impairment (MCI), repetitive movements (RM), and reposition error (RE). Inertial measurement unit (IMU)-systems could be used to quantify these movement dysfunctions in clinical settings. The aim of this study was to evaluate a novel IMU-system when assessing movement dysfunctions in terms of concurrent validity and reliability. METHODS: The concurrent validity of the IMU-system was tested against an optoelectronic system with 22 participants. The reliability of 14 movement dysfunction tests were analysed using generalizability theory and coefficient of variation, measuring 24 participants in seven trials on two days. RESULTS: The IMU-system provided valid estimates of trunk movement in the primary movement direction when compared to the optoelectronic system. Reliability varied across tests and variables. On average, ROM and RM were more reliable, compared to MCI and RE tests. DISCUSSION: When compared to the optoelectronic system, the IMU-system is valid for estimates of trunk movement in the primary movement direction. Four ROM, two MCI, one RM, and one RE test were identified as reliable and should be studied further for inter-subject comparisons and monitoring changes after an intervention.

Health-related fitness test battery for middle-aged adults: associations with physical activity patterns.

To evaluate the validity of a health-related fitness (HRFI) test battery with respect to physical activity (PA), we studied how PA patterns of adults are related to different components of HRFI with special interest in musculoskeletal and motor fitness. Subjects (n = 498) were middle-aged (37-57 years) men and women, evenly selected from five age cohorts of a representative population sample. PA was assessed with a questionnaire and classified into three PA groups. Fitness assessment included 9 simple field tests. The odds ratio of low fitness (least fit 40 %) of the measured dimension of HRFI for three PA groups with reference to inactive group were analysed. All PA groups were strongly related to Walk Test results in both genders, and to BMI in women. Muscular type exercise was associated with modified push-ups strength and static back extension endurance in both genders, and with one-leg standing balance in women. One-leg squat for leg strength, jump-and-reach for leg power, trunk side-bending flexibility and hamstring muscle extensibility tests were not associated with PA. Five of the nine fitness tests demonstrated plausible associations with PA patterns among adults suggesting activity-related validity. An exercise intervention study is needed to evaluate the sensitivity of the tests to fitness changes.

Health-related fitness test battery for adults: associations with perceived health, mobility, and back function and symptoms.

OBJECTIVE: To evaluate the health-related content validity of nine fitness tests by studying how low, mid, and high levels of fitness are associated with perceived health and musculoskeletal functioning. DESIGN: Cross-sectional methodological study. SETTING: A research institute for health promotion. PARTICIPANTS: Middle-aged (37 to 57 years) men (n = 245) and women (n = 253), evenly selected from five age cohorts of a random population sample. MAIN OUTCOME MEASURES: The odds ratios (ORs) of selected health outcomes for low (least fit 20%), mid (next 40%), and high (most fit 40%) fitness categories in the different tests adjusted for several possible confounders. RESULTS: Cardiorespiratory fitness, as measured by 2-km walk test, was strongly and consistently associated with perceived health and mobility (stair climbing) in both genders (range of ORs, 2.4 to 17.6), and a somewhat weaker relationship was found with leg power and with leg strength (ORs, 2.5 to 7.2). Low fitness in back muscular endurance and upper-body strength were associated with mobility disability (ORs, 2.8 to 8.5) and with back dysfunction and pain (ORs, 2.9 to 6.1). High fitness in back endurance in men and in balance in women were related to positive back health (ORs, 2.5 to 3.7). Body mass index was associated with musculoskeletal disability in women (ORs, 2.4 to 5.3). Balance, leg strength, and leg flexibility in men; and leg power, trunk and leg flexibility in women were not associated with health outcomes. CONCLUSIONS: Among a middle-aged population, the majority of the evaluated fitness tests demonstrated health-related validity by strong associations with perceived health and musculoskeletal functioning, and by weaker associations with back symptoms.

Safety and feasibility of a health-related fitness test battery for adults.

BACKGROUND AND PURPOSE: Health-related fitness (HRFI) assessment may be useful in promoting physical activity. Health-related fitness refers to those components of fitness that are related to health status. The safety and feasibility of a test battery designed for the assessment of HRFI were evaluated. SUBJECTS AND METHODS: Middle-aged men (n = 246) and women (n = 254), evenly selected from five age cohorts of a random sample (N = 826), were tested. The subjects had a mean age of 47.0 years (SD = 7.9, range = 37-57). Screening to identify subjects with health limitations was conducted by fitness testers who had master's degrees in sport or health sciences. Safety was assessed in terms of acute complications, delayed-onset muscle soreness (DOMS), and heart rate after each test. Subject exclusion and time costs were evaluated for feasibility. RESULTS: No acute complications occurred. The leg function test caused severe DOMS among inactive women. The overall exclusion rate increased with age. Up to 27% of subjects aged 52 and 57 years were excluded from muscle endurance tests, mainly due to self-reported heart disease or elevated blood pressures. Over 90% of the subjects, however, qualified for balance, flexibility, muscle force, and walk tests. CONCLUSION AND DISCUSSION: The test battery offers a safe and feasible method for the assessment of HRFI in working-aged adults, with the limitation that the one-leg squat function test may cause DOMS, particularly in inactive women.

Health-related fitness test battery for adults: aspects of reliability.

OBJECTIVE: In two studies, the reliability of 3 balance, 2 flexibility, and 4 muscular strength tests proposed as test items were investigated in a health-related fitness (HRF) test battery for adults. DESIGN: Methodological study. SETTING: A health promotion research institute. SUBJECTS: In study A, volunteers (n=42) from two worksites participated. In study B, a population sample (n=510) of 37-to 57-year-old men and women was selected. MAIN OUTCOME MEASURES: Intraclass correlation coefficient of repeated measures was used to assess inter-rater reliability. The degree of measurement error was expressed as the standard error of measurement. The mean difference with 95% confidence intervals between the testing days or test trials was used to assess test-retest or trial-to-trial reproducibility. The coefficient of variation(CV=[SD/mean] x 100%) from day to day was also calculated. RESULTS: The following tests appeared to provide acceptable reliability as methods for field assessment of HRF: standing on one leg with eyes open for balance, side-bending of the trunk for spinal flexibility, modified push-ups for upper body muscular function, and jump and reach and one leg squat for leg muscular function. CONCLUSIONS: This reliability assessment provided useful information on the characteristics of potential test items in a HRF test battery for adults and on the limitations of its practical use. Testers must be properly trained to ensure reliable assessment of HRF of adults.