Digital Rehabilitation Interventions in Sub-Saharan Africa: Protocol for a Scoping Review.

BACKGROUND: Estimations show that at least one in every 3 people in the world needs rehabilitation at some point in the course of their illness or injury. Access to rehabilitation services is an essential part of the continuum of care and is integral to achieving universal health coverage. However, most of the world's population living in low- and middle-income countries, especially in the sub-Saharan African region, does not have access to adequate rehabilitation services. Wider adoption of digital solutions offers opportunities to support and enhance access to rehabilitation services in sub-Saharan Africa. A region where there is a greater burden and need for these services. There is also little published research about digital rehabilitation in sub-Saharan Africa, as it is an underexamined topic in the region. OBJECTIVE: This scoping review aims to provide a comprehensive picture of the current evidence of digital interventions in rehabilitation implemented in any health, social, educational, or community setting in the sub-Saharan Africa region. METHODS: We will conduct a scoping review using Arksey and O'Malley's methodological framework and follow the Joanna Briggs Institute methodology for scoping reviews. We will develop search strategies for a selected number of web-based databases, search for peer-reviewed scientific publications until September 2023, and screen the reference lists of relevant articles. We will include research articles if they describe or report the use of digital interventions in the rehabilitation of patients with any health problem or disability in sub-Saharan Africa. For selected articles, we will extract data using a customized data extraction form and use thematic analysis to compare the findings across studies. RESULTS: The preliminary database search in MEDLINE (EBSCO) was completed in May 2023. The research team will conduct a search of relevant articles in the autumn. The results will be synthesized and reported under the key conceptual categories of this review, and we expect the final scoping review to be ready for submission in early 2024. CONCLUSIONS: We expect to find gaps in the research and a lack of detailed information about digital rehabilitation interventions in sub-Saharan Africa, as well as potential areas for further study. We will identify opportunities to inform the development of digital rehabilitation interventions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/48952.

Technologies in Home-Based Digital Rehabilitation: Scoping Review.

BACKGROUND: Due to growing pressure on the health care system, a shift in rehabilitation to home settings is essential. However, efficient support for home-based rehabilitation is lacking. The COVID-19 pandemic has further exacerbated these challenges and has affected individuals and health care professionals during rehabilitation. Digital rehabilitation (DR) could support home-based rehabilitation. To develop and implement DR solutions that meet clients' needs and ease the growing pressure on the health care system, it is necessary to provide an overview of existing, relevant, and future solutions shaping the constantly evolving market of technologies for home-based DR. OBJECTIVE: In this scoping review, we aimed to identify digital technologies for home-based DR, predict new or emerging DR trends, and report on the influences of the COVID-19 pandemic on DR. METHODS: The scoping review followed the framework of Arksey and O'Malley, with improvements made by Levac et al. A literature search was performed in PubMed, Embase, CINAHL, PsycINFO, and the Cochrane Library. The search spanned January 2015 to January 2022. A bibliometric analysis was performed to provide an overview of the included references, and a co-occurrence analysis identified the technologies for home-based DR. A full-text analysis of all included reviews filtered the trends for home-based DR. A gray literature search supplemented the results of the review analysis and revealed the influences of the COVID-19 pandemic on the development of DR. RESULTS: A total of 2437 records were included in the bibliometric analysis and 95 in the full-text analysis, and 40 records were included as a result of the gray literature search. Sensors, robotic devices, gamification, virtual and augmented reality, and digital and mobile apps are already used in home-based DR; however, artificial intelligence and machine learning, exoskeletons, and digital and mobile apps represent new and emerging trends. Advantages and disadvantages were displayed for all technologies. The COVID-19 pandemic has led to an increased use of digital technologies as remote approaches but has not led to the development of new technologies. CONCLUSIONS: Multiple tools are available and implemented for home-based DR; however, some technologies face limitations in the application of home-based rehabilitation. However, artificial intelligence and machine learning could be instrumental in redesigning rehabilitation and addressing future challenges of the health care system, and the rehabilitation sector in particular. The results show the need for feasible and effective approaches to implement DR that meet clients' needs and adhere to framework conditions, regardless of exceptional situations such as the COVID-19 pandemic.

A longitudinal study of restless legs symptoms among patients with depression.

BACKGROUND: The aim of this study was to analyse the relationship between depressive symptoms and clinical depression and restless legs symptoms in a longitudinal primary care setting. METHODS: The prevalence of restless legs symptoms at baseline and after a six-year follow-up was studied in 474 patients with depressive symptoms and 333 population-based control subjects without depressive symptoms. Depressive symptoms at the baseline and after the six-year follow-up were evaluated with the Beck Depression Inventory (BDI) Second Edition. A psychiatric diagnosis was confirmed with a diagnostic interview (M.I.N.I.). Statistical comparisons between groups were made using analysis of variance (ANOVA) for continuous variables and a chi-square test or logistic models for categorical variables. Repeated measures were analysed using generalizing estimating equations (GEE) models. RESULTS: At baseline the prevalence of restless legs symptoms was 24.3% in control subjects, 43.8% in the patients with depressive symptoms without a depression diagnosis, and 49.3% in clinically depressed patients. During the follow-up up the prevalence of restless legs symptoms declined significantly (p = 0.003). In addition to baseline restless legs symptoms, the prognostic factors for restless legs symptoms among patients with clinical depression were age and BDI score. In the control subjects, moderate and high leisure time physical activity was inversely associated with restless legs symptoms at the follow-up. CONCLUSIONS: A higher level of baseline depressive symptoms was a risk factor for restless legs symptoms in patients with clinical depression. In the prevention and treatment of restless legs symptoms among the patients with depression, the priority is the effective treatment of depression.

Does baseline leisure-time physical activity level predict future depressive symptoms or physical activity among depressive patients? Findings from a Finnish five-year cohort study.

OBJECTIVES: The aims of this study were to investigate whether baseline leisure-time physical activity (LTPA) is associated with future recovery from depression among patients with a depression diagnosis and whether baseline LTPA is associated with total physical activity after five years of follow-up. METHODS: A total of 258 patients aged ≥35 years with clinically confirmed depression at baseline participated. The study was conducted between 2008 and 2016 in municipalities within the Central Finland Hospital District. Depressive symptoms (DS) were determined with the Beck Depression Inventory (BDI) with a cutoff score ≥10, and depression diagnoses were confirmed by the Mini-International Neuropsychiatric Interview (MINI). Blood pressure and anthropometric parameters were measured and blood samples for glucose and lipid determinations were drawn at baseline. LTPA, physical activity, and other social and clinical factors were captured by standard self-administered questionnaires at baseline and the five-year follow-up point. RESULTS: Of the 258 patients, 76 (29%) had DS at follow-up. Adjusted odds ratio (OR) for future DS was 1.43 (confidence interval [CI] 0.69-2.95) for participants with moderate LTPA and 0.92 (CI 0.42-2.00) for participants with high LTPA, compared with low LTPA at baseline. Higher baseline LTPA levels were associated with higher total physical activity in the future (ß=0.14 [95% CI: 0.02-0.26] for linearity = 0.024). CONCLUSION: Baseline LTPA did not affect the five-year prognosis of depression among depressed patients in a Finnish adult population. Because the baseline LTPA level predicted the future total physical activity, it could be included as a part of the overall health management and treatment of depression in clinical practices.

The influence of restless legs symptoms on musculoskeletal pain in depression.

Background and aims Restless legs syndrome is a sensorimotor disorder associated with mental health conditions notably depression. Restless legs symptoms and depression are commonly associated with pain. The study investigated the influence of restless legs symptoms on musculoskeletal pain in patients with depression or with increased depressive symptoms. Methods A cross-sectional study of primary care patients in the Central Finland Hospital District. The prevalence of restless legs symptoms was studied in patients with depressive symptoms (n = 695) and controls without a psychiatric diagnosis (n = 410) by using a structured questionnaire. The depressive symptoms were evaluated with the Beck Depression Inventory and the psychiatric diagnosis was confirmed by means of a diagnostic interview (MINI). The prevalence and intensity of musculoskeletal pain was captured with form-based questions. A single-question screen for restless legs symptoms was applied. Results There was a significant difference in the prevalence of continuous widespread musculoskeletal pain between the three study groups: the controls 4.6% (95% CI: 2.8-7.1), the patients with symptoms of depression without a diagnosis 16.0% (11.7-21.1), and the patients with diagnosed depression 22.1% (18.3-23.3) (p = 0.006 after being adjusted for age, sex, smoking, use of alcohol, education years, body mass index, use of antidepressants, and physical activity, after multiple corrections, all groups were significantly different from each other). Compared with those not having restless legs symptoms, subjects with restless legs symptoms had more often continuous widespread musculoskeletal pain in the control subjects (p = 0.001; 2.3% vs. 10.5%) and in the patients with depressive symptoms without a depression diagnosis (p = 0.024; 9.1 vs. 18.7%) but not in those with diagnosed depression (p = 0.98; 19.5 vs. 19.4%). The restless legs symptoms were associated with the intensity of pain in all groups (p < 0.001). Conclusions Restless legs symptoms were related to continuous widespread musculoskeletal pain in subjects without depressive symptoms and in patients with depressive symptoms without a depression diagnosis. Pain intensity was higher in the subjects with restless legs symptoms regardless of depressive symtoms or depression. Implications Clinical management of pain in patients with restless legs symptoms should include an increased focus on the prevention and treatment of either conditions.

Bilateral activations in operculo-insular area show temporal dissociation after peripheral electrical stimulation in healthy adults.

Interhemispheric transfer is necessary for sensory integration and coordination of body sides. We studied how somatosensory input from one body side may reach both body sides. First, we investigated with 17 healthy adults in which uni- and bilateral brain areas were involved in consecutive stages of automatic sensory processing of non-nociceptive peripheral stimulation. Somatosensory evoked fields (SEFs) to electrical stimulation were recorded with 306-channel magnetoencephalography in two conditions. First, SEFs were registered following sensory radial nerve (RN) stimulation to dorsal surface of the right hand and second, following median nerve (MN) stimulation at the right wrist. Cortical activations were located in contralateral postcentral gyrus after MN and RN stimulations and in bilateral operculo-insular area after RN stimulation. First component occurred earlier after MN than RN stimulation. Middle latency components had similar latencies with stronger activation in contralateral postcentral gyrus after MN than RN stimulation. Interestingly, long latency components located in bilateral operculo-insular area after RN stimulation showed latency difference between hemispheres, i.e. activation peaked earlier in contralateral than in ipsilateral side. Additional experiments comparing novel intracutaneous nociceptive, RN and MN electrical stimuli confirmed bilateral long latency activation elicited by each stimulus type and highlighted latency differences between hemispheres. Variations in activation of bilateral operculo-insular areas may corroborate their role in pain network and in multisensory integration. Our findings imply that these areas present a relay station in multisensory stimulus detection.

Leisure time physical activity and its relation to psychiatric comorbidities in depression. Findings from Finnish Depression and Metabolic Syndrome in Adults (FDMSA) study.

PURPOSE: The study aim was to examine association between leisure time physical activity (LTPA) and psychiatric comorbidities among people with depression. METHODS: Total 447 patients aged 35 years and older suffering from depressive symptoms (DS) and who were confirmed depression positive participated this study. The study was conducted between 2008 and 2011 in municipalities within Central Finland Hospital District. DS were determined with Beck Depression Inventory (BDI-21) with cutoff score ≥10 and psychiatric diagnoses were confirmed by Mini-International Neuropsychiatric Interview (M.I.N.I.). LTPA, other diseases as well as use of antidepressant were captured by self-reported questionnaire. Participants also took part in physical examination. The associations between LTPA and psychiatric comorbidities were analyzed using generalized linear models. RESULTS: LTPA level was not related to number of psychiatric comorbidities (after adjustment for age, gender, BMI, BDI and use of antidepressant p = 0.24) among depressed patients. The higher levels of LTPA were linearly associated with lower cardiovascular diseases (p = 0.036) and obesity (p = 0.006) as well as fewer DS (p < 0.001) among depressed patients. LIMITATIONS: Possibility of LTPA level overestimation and study results generalizability to younger persons. CONCLUSIONS: According to this study, LTPA level is not associated with psychiatric comorbidities among depressed patients in Finnish adult population. However, our results showed that the higher the LTPA level was, the less the participants suffered from depressive symptoms. In addition, higher levels of physical activity were associated with fewer heart diseases and obesity outlining the importance of overall health-care and health promotion although other forms of treatment are also needed.

The profiles of health care utilization among a non-depressed population and patients with depressive symptoms with and without clinical depression.

Objective: To examine health service (HS) utilization profiles among a non-depressive population and patients with depressive symptoms (DS) with and without clinical depression. Design, subjects and setting: The study population was based on primary care patients with DS scoring ≥10 in the 21-item Beck Depression Inventory (BDI) and who were at least 35 years old and had been referred to depression nurse case managers (n = 705). Their psychiatric diagnosis was confirmed with the Mini-International Neuropsychiatric Interview (M.I.N.I.). Of these patients, 447 had clinical depression. The number of patients with DS without clinical depression was 258. The control group consisted of a random sample of 414 residents with a BDI score < 10. Use of HS (visits and phone calls to a doctor and a nurse) was based on patient records. Main outcome measures: Number of visits and calls to physicians and nurses. Results: Patients with DS regardless of their depression diagnosis used primary health care (PHC) services three times more than the controls (p < 0.001). In the secondary care, the differences were smaller but significant. Of the controls, 70% had 0-4 HS contacts per year whereas a majority of the patients having DS had more than 5 contacts per year. The number of contacts correlated with the BDI from a score of 0 to 10 but not as clearly in the higher scores. Conclusion: Depressive symptoms, both with or without clinical depression, are associated with increased HS use, especially in PHC. This study suggests that even mild depressive symptoms are associated with an increased use of HS. KEY POINTS We analyzed the health service (HS) use among primary health care patients screened for depression and non-depressive population. Screen positive patients without clinical depression used as much HS as those having clinical depression. Regardless of depression diagnosis, screen positive patients visited a GP and nurse three times more often than the control population. In the screen negative control population, milder depressive symptoms were correlated with the use of HS. Primary health care was responsible for most of the HS use among patients having depressive symptoms.

Psychiatric diagnosis in primary care patients with increased depressive symptoms.

BACKGROUND: Screening of depression has been recommended in primary care and Beck's 21-item Depression Inventory (BDI-21) is a commonly used tool for screening. Depression has been shown to be frequently accompanied by comorbidities. AIMS: This study aimed to analyze the characteristics, psychiatric diagnoses, and psychiatric comorbidity of primary care patients who have been screened for depression and referred to a depression nurse. METHODS: The study subjects were primary care patients aged ≥ 35 years with depressive symptoms (BDI-21 > 9). Their psychiatric diagnosis were based on a diagnostic interview (Mini-International Neuropsychiatric Interview; M.I.N.I.) conducted by a trained study nurse. RESULTS: Of the 705 study subjects, 617 (87.5%) had at least one and 66.1% had at least two psychiatric diagnoses. The most common diagnosis was depression (63.4%). The next most common diagnoses were generalized anxiety disorder (GAD) (48.1%) and panic disorder (22.8%). Only 8.8% of the study subjects had depression without other psychiatric disorders. Ten percent of the subjects had both depression and a generalized anxiety disorder (GAD). Also other psychiatric comorbidities were common. Age was inversely associated with the psychiatric diagnosis in the M.I.N.I. CONCLUSIONS: This study suggests that most of the primary care patients with increased depressive symptoms have a psychiatric disorder. Although depression is the most common diagnosis, there are several other concurrent psychiatric comorbidities. Therefore, diagnostic assessment of primary care patients with a screening score over 9 in the BDI-21 should be reconsidered.

Transcultural adaption and preliminary evaluation of "understanding low back pain" patient education booklet.

BACKGROUND: Low back pain (LBP) is the number one cause of disability globally. LBP is a symptom associated with biological, psychological and social factors, and serious causes for pain are very rare. Unhelpful beliefs about LBP and inappropriate imaging are common. Practitioners report pressure from patients to provide inappropriate imaging. A recently developed patient education and management booklet, 'Understanding low back pain', was designed to target previously identified barriers for reducing inappropriate imaging. The booklet includes evidence-based information on LBP and supports communication between patients and practitioners. Our aim was to 1) describe the translation process into Finnish and 2) study patients' and practitioners' attitudes to the booklet and to evaluate if it improved patients' understanding of LBP and practitioners' ability to follow imaging guidelines. METHODS: We translated the booklet from English to Finnish. Preliminary evaluation of the booklet was obtained from LBP patients (n = 136) and practitioners (n = 32) using web-based questionnaires. Open-ended questions were analysed using thematic analysis. RESULTS: Approximately half of the patients reported that reading the booklet helped them to understand LBP, while a third thought it encouraged them to perform physical activity and decreased LBP-related fear. Eighty percent of practitioners reported that the booklet helped them to follow imaging guidelines. In addition, practitioners reported that they found the booklet helpful and that it decreased the need for imaging. CONCLUSIONS: The booklet seemed to be helpful in LBP management and in decreasing the need for LBP imaging according to patients and practitioners. Further research on the clinical effectiveness of the booklet in controlled study settings is needed. TRIAL REGISTRATION: ISRCTN, ISRCTN14389368, Registered 4 April 2019 - Retrospectively registered; ISRCTN11875357, Registered 22 April 2019 - Retrospectively registered.

Elevation of tumor necrosis factor alpha levels is associated with restless legs symptoms in clinically depressed patients.

BACKGROUND: Restless legs syndrome is a sensorimotor disorder associated with several mental illnesses particularly depression. METHODS: A cross-sectional study of primary care patients. The prevalence of restless legs symptoms was studied in 706 patients with depressive symptoms and 426 controls without a psychiatric diagnosis by using a structured questionnaire. The depressive symptoms were evaluated with the BDI and the psychiatric diagnosis was confirmed by means of a diagnostic interview (M.I.N.I.). The subjects with elevated depressive symptoms were divided into two groups subjects with depressive symptoms with and without clinical depression. RESULTS: The prevalence of restless legs symptoms was 24.8% in the controls, 50.0% in the patients with clinical depression and 42.4% in the patients with depressive symptoms. CRP value was significantly higher (p = .003) in the clinically depressed patients than in the other groups. There was a higher concentration of TNF-α in the subjects with restless legs symptoms (7.4 ng/l ±â€¯3.2) compared with the subjects without symptoms (6.7 ng/l ±â€¯2.3)(p < .001). There was a significant difference in the TNF-α levels between the subjects with and without restless legs symptoms in the depression group (p < .001) and among the patients with depressive symptoms but no a depression diagnosis (p = .022). In these groups, restless legs symptoms were associated with elevated levels of TNF-α. CONCLUSIONS: TNF-α level was associated with restless legs symptoms only among subjects with depressive symptoms whether they had clinical depression or not. We suggest that TNF-α could be an underlying factor between restless legs symptoms and comorbidities.

Prevalence of restless legs symptoms according to depressive symptoms and depression type: a cross-sectional study.

BACKGROUND: Restless legs syndrome is a sensorimotor disorder and it is associated with several other diseases especially mental illnesses. AIMS: To analyze the relationship between the symptoms of restless legs syndrome and the severity of depressive symptoms and the prevalence of restless legs symptoms in depression subtypes. METHODS: A cross-sectional study of primary care patients in the Central Finland Hospital District. The prevalence of restless legs symptoms was studied in 706 patients with increased depressive symptoms and 426 controls without a psychiatric diagnosis by using a structured questionnaire. The depressive symptoms were evaluated with the Beck Depression Inventory (BDI) and the psychiatric diagnosis was confirmed by means of a diagnostic interview (Mini-International Neuropsychiatric Interview). The subjects with increased depressive symptoms were divided into three groups (subjects with depressive symptoms without a depression diagnosis, melancholic depression and non-melancholic depression). RESULTS: In the whole study population, the prevalence of restless legs symptoms increased with the severity of depressive symptoms. The prevalence of restless legs symptoms was highest in the melancholic and non-melancholic depressive patients (52 and 46%, respectively) and then in subjects with depressive symptoms without a depression diagnosis (43.4%), but the prevalence was also substantial (24.6%) in subjects without a psychiatric diagnosis. CONCLUSIONS: Restless legs symptoms are very common in primary care among subjects with depression, regardless of the depression type. The prevalence of restless legs symptoms increased with increasing severity of depressive symptoms, regardless of the diagnosis. These findings should be considered in clinical evaluation and treatment of patients visiting their physician due to restless legs or depressive symptoms.

Musculoskeletal Pain in Melancholic and Atypical Depression.

Objective: Pain and depressive disorders often present together, but little is known about the prevalence of pain in depression subgroups. The objective of this study was to examine the possible differences in the prevalence of musculoskeletal pain between participants in melancholic and atypical depression subgroups. Design: Cross-sectional study. Setting: Depression nurse case managers where depression patients receive treatment in primary health care. Subjects: Participants included 413 depression patients and 401 controls. Methods: Depressive symptoms were determined with the Beck Depression Inventory (BDI-21), and diagnosis of depression was confirmed with the Mini-International Neuropsychiatric Interview (MINI). The participants were dichotomized into subgroups with melancholic depression (n = 269), atypical depression (n = 144), and controls (n = 401). Musculoskeletal pain was identified during last four weeks. Participants were enrolled in the study between 2008 and 2009. Results: The prevalence of pain was 37% in controls, 57% in atypical depression, and 71% in melancholic depression (P < 0.001, after adjusting for sex and age). A logistic regression model showed that the odds ratio of pain after adjusting for confounding factors was 2.35 (1.56 to 3.56) with atypical depression compared with controls (P < 0.001) and 4.38 (3.03 to 6.33) with melancholic depression compared with atypical depression (P = 0.006). BDI scores were higher for those with melancholic depression than for those with atypical depression (P < 0.001). Conclusions: Melancholic depression showed to be associated with a higher prevalence of musculoskeletal pain in comparison with atypical depression. This finding highlights the need for further studies about the mechanisms behind the association, particularly in melancholic depression.

Reduced Neck Muscle Strength and Altered Muscle Mechanical Properties in Cervical Dystonia Following Botulinum Neurotoxin Injections: A Prospective Study.

OBJECTIVE: To evaluate changes in the strength and mechanical properties of neck muscles and disability in patients with cervical dystonia (CD) during a 12-week period following botulinum neurotoxin (BoNT) injections. METHODS: Eight patients with CD volunteered for this prospective clinical cohort study. Patients had received BoNT injections regularly in neck muscles at three-month intervals for several years. Maximal isometric neck strength was measured by a dynamometer, and the mechanical properties of the splenius capitis were evaluated using two myotonometers. Clinical assessment was performed using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) before and at 2, 4, 8, and 12 weeks after the BoNT injections. RESULTS: Mean maximal isometric neck strength at two weeks after the BoNT injections decreased by 28% in extension, 25% in rotation of the affected side and 17% in flexion. At four weeks, muscle stiffness of the affected side decreased by 17% and tension decreased by 6%. At eight weeks, the muscle elasticity on the affected side increased by 12%. At two weeks after the BoNT injections, the TWSTRS-severity and TWSTRS-total scores decreased by 4.3 and 6.4, respectively. The strength, muscle mechanical properties and TWSTRS scores returned to baseline values at 12 weeks. CONCLUSIONS: Although maximal neck strength and muscle tone decreased after BoNT injections, the disability improved. The changes observed after BoNT injections were temporary and returned to pre-injection levels within twelve weeks. Despite having a possible negative effect on function and decreasing neck strength, the BoNT injections improved the patients reported disability.

Construct validity and reliability of Finnish version of Örebro Musculoskeletal Pain Screening Questionnaire.

INTRODUCTION: Chronic pain causes suffering for affected individuals and incurs costs to society through work disability. Interventions based on early screening of psychological risk factors for chronic pain using screening tools such as the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) have been found to reduce work absenteeism and health care visits and increase perceived health. The aim of the current study was to translate the ÖMPSQ into Finnish and test its validity and reliability in a patient sample. METHODS: The ÖMPSQ was forward-backward translated and cross-culturally adapted, and applied to our study population (n=69), the members of which had been referred to the Department of Physical and Rehabilitation Medicine of Oulu University Hospital from primary health care centres in Northern Finland due to chronic low back pain. The patients answered the ÖMPSQ two weeks before the hospital visit, and the follow-up questionnaire either during the hospital visit, or after by mail. The reliability of the ÖMPSQ was evaluated using intraclass correlation coefficients (ICC). Factor analysis was used to group items of the ÖMPSQ, and internal consistency between the items was determined by calculating Cronbach's alphas. RESULTS: The cross-cultural adaptation revealed only minor semantic and cultural differences. Measurements showed reliability as moderate to nearly perfect for all of the ÖMPSQ items (ICC values ranged from 0.59 to 0.96). Items loaded into five different factors: disability, psychological symptoms, pain, fear avoidance, and work. All except one (work) showed acceptable internal consistency. The ÖMPSQ score was positively associated with both intensity of pain and the Oswestry Disability Index. CONCLUSIONS AND IMPLICATIONS: The reliability and construct validity of the Finnish version of the ÖMPSQ were good. The predictive ability of the ÖMPSQ in the Finnish population should be evaluated in further studies.

Translation and validation of the Finnish version of the Fear-Avoidance Beliefs Questionnaire (FABQ).

BACKGROUND AND AIM: Low back pain (LBP) is a debilitating problem worldwide causing disability and reducing quality of life. The Fear Avoidance Beliefs Questionnaire (FABQ) was developed on the basis of the assumption that fear-avoidance beliefs play a major role in LBP-related disability. It comprises 16 items scored by the patient and includes sub-scores for fear-avoidance beliefs regarding work and physical activity. This study aimed to translate and validate the Finnish version of the FABQ and to measure its properties among Finnish patients with LBP. MATERIAL AND METHODS: A forward-backward translation procedure was used based on modified recommended guidelines. The FABQ was applied to 66 Finnish patients with LBP. Patients answered the FABQ at baseline and again approximately two weeks later. The test-re-test reliability between the baseline and follow-up FABQ was evaluated by calculating intraclass correlation coefficients (ICC). Internal consistency between the items within total and sub-scores was evaluated by calculating Cronbach's alpha. The items of the baseline FABQ were grouped using factor analysis and the correlations between the FABQ, pain intensity in visual analogue scale (VAS) and Oswestry Disability Index (ODI) were assessed using linear regression analysis. RESULTS: The Finnish version of the FABQ was successfully adapted. The mean age of patients was 46. Almost all patients (97%) reported LBP, most patients (76%) had chronic pain lasting more than 3 months and the mean intensity of LBP was 58mm on VAS. The follow-up time between the first and second questionnaire ranged from 2 days to 59 days with the median of 16 days. The ICC value for reliability between the baseline and follow-up questionnaires was excellent for the total score (0.91) and work sub-score (0.89), and good for the physical activity sub-score (0.73). The items regarding work showed high or excellent reliability throughout, with ICC values ranging from 0.63 to 0.89. The ICC values for the items related to physical activity ranged from 0.43 to 0.66, displaying moderate to good reliability. Cronbach's alpha for internal consistency was excellent for the total score (0.92) and work (0.89), and good for physical activity (0.71). The best factor analysis solution yielded three factors characterized by the fear that pain aggravates due to (1) work or (2) physical activity, and (3) fear-avoidance beliefs concerning work. Higher total FABQ score was associated significantly with higher VAS (p-value 0.021) and ODI (<0.001). CONCLUSIONS AND IMPLICATIONS: The expert committee successfully created an applicable Finnish version of the FABQ. The Finnish FABQ is a valid and reliable instrument for assessing LBP patients' fear avoidance behaviour and has similar properties to those found in other validation studies of the FABQ. Thus it can be used for assessing the risk of disability due to fear avoidance behaviour in Finnish-speaking patients with LBP for both clinical and scientific purposes.

Transcultural adaption and psychometric properties of the STarT Back Screening Tool among Finnish low back pain patients.

PURPOSE: The STarT Back Screening Tool (SBST) is a 9-item questionnaire designed for screening low back pain (LBP) patients into three prognostic groups for stratified care. The stratified care approach has proven to be clinically more beneficial and cost-effective than the current best physiotherapy practice. The objective of this study was to translate, culturally adapt and study psychometric properties of the SBST among Finnish LBP patients. METHODS: The SBST was translated into Finnish using appropriate translation guidelines. A total of 116 patients were recruited from outpatient clinics. They were asked to fill out two questionnaires within 1-7 days. The first questionnaire set included the SBST, Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) and intensities of back and leg pain (10-cm Visual Analogue Scale). The second questionnaire form included the SBST and a question about persistence of symptoms. RESULTS: Some linguistic and cultural differences emerged during the translation process with item 1 ("spread down my legs"), item 2 ("neck and shoulder pain"), item 6 ("worrying thoughts") and item 9 ("bothersome"). The test-retest reliability of the SBST total score was excellent (intraclass correlation coefficient 0.78) and of the psychosocial subscale good (0.68). Cronbach's alpha for the psychosocial subscale was 0.55. Spearman's correlation coefficient between SBST total score and BDI was 0.38, ODI 0.39, ÖMPSQ 0.45, intensity of leg pain 0.45 and LBP 0.31. Based on analysis of variance, the SBST discriminated low- and medium-risk groups better than medium- and high-risk groups. CONCLUSIONS: The Finnish translation of the SBST is linguistically accurate and has been adapted to the Finnish-speaking population. It showed to be a valid and reliable instrument and comparable with the original English version. Therefore, it may be used in clinical work with Finnish LBP patients.

Relationships between depressive symptoms and self-reported unintentional injuries: the cross-sectional population-based FIN-D2D survey.

BACKGROUND: There is a lack of knowledge on the influence of different levels of physical activity (PA) on unintentional injuries among those with depressive symptoms (DS). The aim of this study was to evaluate the relationship between PA categories and unintentional injuries among participants with and without DS based on a cross-sectional population-based FIN-D2D survey conducted in 2007. METHODS: Out of 4500, 2682 participants (60%) aged 45-74 years attended in this study. The unintentional injuries over the past year were captured in a questionnaire. DS were determined with the Beck Depression Inventory (≥ 10 points) and PA with the International Physical Activity Questionnaire. The statistical significance between DS and unintentional injury categories was evaluated by using t-test, chi-square test, or permutation test, analysis of covariance, or regression models. The factors related to unintentional injuries were estimated by univariate and multivariate logistic regression models. RESULTS: The proportion of subjects with unintentional injuries was higher among those with DS (17%) compared to those without DS (10%) (age- and gender-adjusted p = 0.023). The median (range) number of activity-loss days after injury was 22 (0-365) in participants with DS and 7 (0-120) in participants without DS ( p = 0.009). The percentage of subjects with unintentional injuries was not significantly different between PA categories in participants with DS and without DS. A stepwise multivariate logistic regression analysis showed that DS, functional ability, and musculoskeletal diseases were related to unintentional injuries. CONCLUSIONS: PA level was not related to unintentional injuries, whereas those with DS had a higher prevalence of unintentional injuries and prolonged activity-loss after injury. These results underline the importance of injury prevention, especially among those who have DS and additional risk factors.

Lifetime leisure-time physical activity and the risk of depressive symptoms at the ages of 65-74 years: the FIN-D2D survey.

OBJECTIVES: To investigate the association between lifetime leisure-time physical activity (LTPA) and depressive symptoms (DS) based on the population-based FIN-D2D cross-sectional survey conducted in 2007. METHODS: Nine hundred twenty seven randomly selected Finnish men and women aged 65-74 years were included in this study. DS were determined with the Beck Depression Inventory (≥10 points), and lifetime historical LTPA frequency from age 15 years onwards was recalled retrospectively. RESULTS: The frequency of LTPA was highest at the ages of 15-24 years in both the DS present and not present groups (14.6 times per month). LTPA frequency was significantly lower among those with DS compared with those without DS at the age of 45-54 (10.0 vs. 11.3, p=0.041), 55-64 (9.6 vs. 12.6, p<0.001), and 65-74 (8.6 vs. 11.9, p<0.001). Also the prevalence of somatic diseases was higher for those with DS compared with participants without DS. CONCLUSIONS: This study reveals lifetime LTPA variation and its potential consequences. The relationship found between reduced lifetime LTPA and the occurrence of DS suggest that promoting LTPA throughout one's lifetime would be beneficial in terms of DS and somatic diseases in older age.

Association of depressive symptoms with impaired glucose regulation, screen-detected, and previously known type 2 diabetes: findings from the Finnish D2D Survey.

OBJECTIVE: To study the association between impaired glucose regulation (IGR), screen-detected type 2 diabetes, and previously known diabetes and depressive symptoms. RESEARCH DESIGN AND METHODS: Altogether, 2,712 participants from three hospital districts in Finland attended a health examination. Cutoff scores ≥10 and ≥16 in the 21-item Beck Depression Inventory (BDI-21) were used for depressive symptoms. The participants were defined as having known diabetes if they reported diabetes. An oral glucose tolerance test was used to detect normal glucose regulation (NGR), impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and screen-detected diabetes. The participants were defined as having IGR if they had IFG or IGT. RESULTS: Prevalence of depressive symptoms, defined as a BDI-21 cutoff score ≥10, was 14.4% for those with NGR, 13.7% for those with IGR, 14.8% for those with screen-detected diabetes, and 26.4% for those with previously known diabetes. The corresponding prevalences for a cutoff score ≥16 were 3.4, 3.4, 4.2, and 7.5%, respectively. Compared with NGR and adjusted for demographic, lifestyle, and biological factors, the odds ratios for IGR, screen-detected diabetes, and previously known diabetes were 0.91 (95% CI 0.69-1.20), 0.70 (0.45-1.08), and 1.35 (0.84-2.15), respectively, for a cutoff score ≥10. For a cutoff score ≥16, the corresponding odds ratios were 1.05 (0.62-1.76), 0.87 (0.40-1.90), and 1.56 (0.69-3.50), respectively. CONCLUSIONS: Participants with diagnosed diabetes had a higher prevalence of depressive symptoms than participants with NGR, IGR, and previously unknown diabetes. When potential confounding factors were included in the analysis, previously known diabetes was not significantly associated with depressive symptoms.