To investigate whether unilateral cervical facet nerve blockade (FNB) is associated with changes in head repositioning accuracy (HRA), shoulder joint relocation accuracy (JRA), and standing balance in patients with chronic neck pain. This retrospective single-center interventional study included 99 patients treated at the Department of Physical Medicine and Rehabilitation. Cervical proprioception (HRA), shoulder proprioception (JRA), and standing balance (computerized posturography) were assessed before the intervention, immediately after FNB, and at 1-month follow-up. Because normal distribution could not be assumed, non-parametric tests were applied (Mann–Whitney U for independent comparisons and Wilcoxon signed-rank test for paired comparisons). Cervical proprioception during sagittal movements improved significantly after FNB, with effects maintained at 1-month follow-up. The most consistent improvement was observed for HRA during flexion (p < 0.001). Shoulder JRA during abduction also improved significantly after FNB (p = 0.002–0.02), and the improvement persisted at follow-up on the right side. Differences in JRA were observed between patients with upper versus lower cervical dysfunction, with lower cervical dysfunction showing a greater impact on shoulder relocation accuracy. Postural performance improved after FNB, particularly for trace length in the Romberg test (p = 0.02–0.002), and improvements were sustained at follow-up. Patients with higher baseline postural sway demonstrated greater balance improvements than those with low baseline sway. Significant correlations were observed between postural performance and HRA/JRA measures. Secondary outcomes showed significant improvement at 1-month follow-up in neck pain (p < 0.001), health-related quality of life (EQ-5D) (p = 0.005), and disability (Oswestry Disability Index) (< 0.001). Unilateral cervical FNB was associated with improvements in cervical repositioning accuracy, shoulder abduction relocation accuracy, and postural performance, with effects persisting at 1-month follow-up. Improvements were also observed in pain, health-related quality of life, and disability. Given the retrospective single-arm design and single-center setting, these findings should be interpreted as preliminary and require confirmation in prospective controlled studies.

CONTEXT:While medications have their place in the treatment of pain, incorporating the century-old practice of osteopathic manipulative treatment (OMT) into pain treatment protocols may be beneficial. OMT has been administered with positive results in the reduction of pain, but it has been difficult to quantify palpable somatic changes, post-OMT. However, with technological advancement, adding objective documentation could potentially support the many published subjective studies demonstrating OMT effectiveness, reproducibility of OMT techniques, and the effect of OMT in pain reduction. OBJECTIVES:This study documented objective changes in cervical hysteresis, consistent reproducible palpatory diagnosis, and treatment pressures with associated pain levels. METHODS:A total of 213 subjects were enrolled and randomized into two treatment groups. Subjects reported their cervical pain via pre- and posttreatment questionnaires. One physician measured somatic tissue hysteresis pre- and posttreatment in all cervical segments utilizing the ULTRAlign SA201®. A second physician independently diagnosed for significant somatic dysfunction and treated with cervical OMT (while wearing the IsoTouch® palpation monitoring system). RESULTS:Statistically significant or suggestive overall cervical changes were observed in all four ULTRAlign SA201® hysteresis measurement components. Consistent diagnostic and treatment IsoTouch® pressure measures were documented in the cervical region. Neck pain subjects reported pain reduction posttreatment, with no subjects remaining in the severe pain subgroup. CONCLUSIONS:Statistically significant or suggestive objective cervical hysteresis changes were noted after direct method OMT, along with a reduction in pain scores in this subject population. Consistent palpatory pressures for cervical diagnosis and treatment were measured, supporting the reproducibility of these techniques.

Objective: This study investigates the impact of different rehabilitation approaches on functional recovery and health-related quality of life (HRQoL) in stroke patients. Design: A longitudinal retrospective observational study. Subjects: The study included all 538 consecutive stroke patients treated in Satakunta County, Finland, between January 2021 and January 2022. Methods: Functional recovery was assessed using the modified Rankin Scale (mRS), WHODAS 2.0, and HRQoL using the EQ-5D. Outcomes were evaluated at 1, 3, 6, and 12 months. Patients were categorized into 3 groups: no rehabilitation, primary care (PC) rehabilitation, and multidisciplinary (MD) rehabilitation. Longitudinal changes in mRS, WHODAS, and EQ-5D were further assessed at a 3-year follow-up. Results: MD rehabilitation resulted in significantly greater improvements in HRQoL and functional recovery compared with PC rehabilitation and no rehabilitation. Female patients reported lower HRQoL and poorer functioning than males; however, rates of improvement were similar between the sexes. Dependency (mRS > 2) was associated with lower HRQoL, although changes over the 1-year follow-up were comparable between dependent and independent patients. Depression emerged as the strongest predictor of HRQoL improvements. Substantial correlations were observed among mRS, EQ-5D, and WHODAS 2.0 scores, with the strength of these correlations increasing over time. At the 3-year follow-up, stroke survivors continued to exhibit decreasing HRQoL and functional status. Conclusions: Multidisciplinary rehabilitation substantially enhances functional recovery and HRQoL during the first year after stroke compared with primary care or no rehabilitation. Although women and patients with greater dependency report lower HRQoL, their rates of improvement are similar to those of other groups. Depression is a key determinant of HRQoL gains, underscoring the importance of integrating mental health support into rehabilitation pathways. The persistently low HRQoL observed 3 years post-stroke highlights the long-term burden of stroke and the need for sustained, comprehensive follow-up and rehabilitation strategies to address ongoing functional limitations.

OBJECTIVE:Assessing functional abilities in stroke rehabilitation is essential, combining subjective self-reports with objective clinical evaluations. METHODS:This study aimed to compare self-reported impairments from stroke patients with rehabilitation team evaluations using the ICF stroke core set at 3 time points: 1 month post-discharge, after 6 months, and 12 months post-diagnosis. Additionally, the study sought to identify ICF subdomains most impacting health-related quality of life (HRQOL) as measured by EQ-5D. This longitudinal, retrospective observational study included consecutive 118 stroke patients at the Satahospital Rehabilitation Unit (2021-2022). RESULTS:Results showed that, 1 month after discharge, patients rated their functioning higher than team assessments, particularly in cognitive domains. By 12 months, patients' self-reports indicated lower functioning than team evaluations, with discrepancies diminishing over time. Objective assessments revealed significant improvements in mobility, self-care, and cognitive functions, while patients reported progress in life activities and social interactions but little change in physical or cognitive domains. Depression levels and self-care ability (washing) were the strongest predictors of improved HRQOL. CONCLUSION:These findings reveal that patients initially overestimate their abilities, influenced by a lack of awareness and emotional factors, while rehabilitation teams provide more objective evaluations and individualized rehabilitation. Integrated assessment frameworks combining subjective and objective perspectives are crucial to optimizing rehabilitation outcomes.

Objective: This study aimed to determine whether robot-assisted therapy, low-frequency rTMS, or intensive therapist-guided upper-limb training provides additional recovery beyond self-directed training in individuals 4-9 months post-stroke. Design: A five-phase single-case experimental study was conducted with two baseline phases and three randomized 3-week intervention phases. Subjects/Patients: Sixteen adults with moderate-to-severe upper-limb motor impairment in the late subacute phase after stroke (4-9 months post-stroke) were included. Methods: Participants completed intensive task-oriented training, low-frequency rTMS, and robot-assisted therapy in a randomized order. Primary outcomes were Fugl-Meyer Assessment for the Upper Extremity (FMA-UE), active range of motion, and muscle strength. Secondary outcomes included EQ-5D and WHODAS 2.0. Results: FMA-UE motor scores improved significantly over the study period (8-10 points). However, comparable gains occurred during baseline phases. rTMS and intensive training produced within-phase improvements, whereas robotic therapy did not. Participants with higher initial FMA-UE scores improved, while those with severe paresis showed minimal benefit and occasional decline during rTMS. Disability and quality-of-life measures remained stable. Gains were maintained at 1-year follow-up. Conclusions: In the late subacute phase after stroke, modest upper-limb motor improvements occurred, but effects were not clearly attributable to specific interventions beyond ongoing recovery. Treatment response depended strongly on baseline motor severity, with limited benefit in severe paresis.

Background Assessment, diagnosis, and treatment of motor control impairments are among the most widely implemented management strategies for chronic low back pain (CLBP). Low back movement control tests described by Luomajoki et al. are reliable and valid for assessing the presence and severity of motor control impairment. However, very little is known about the importance of demographic and well-established CLBP contributing factors in explaining the presence and severity of any type of motor control impairment. Objective The study objectives were to evaluate the associations of the presence and the severity of movement control impairment with age, gender, BMI, CLBP and its intensity and duration, postural stability, self-reported central sensitization, kinesiophobia, and CLBP-related disability with logistic and ordinal regressions and Wald chi-squared tests. Methods This cross-sectional study included 161 subjects with CLBP and 42 pain-free controls. The study was carried out in single private chiropractic clinic. Results Higher age and BMI were distinctly greater associated with a higher presence and severity of movement control impairment compared to the pain-related factors, namely the CLBP or its intensity or duration, central sensitization, kinesiophobia, and CLBP-related disability. Conclusions Results highlight the importance of considering demographic factors, such as age and BMI, when interpreting motor control impairment findings. Accordingly, the findings challenge the validity of testing motor control impairment in the management of CLBP.

BACKGROUND:Well-being is closely related to health, recovery, and longevity. Chronic musculoskeletal pain (CMP) is a major health challenge in the general population, which can have a negative effect on subjective well-being. The ability to identify patients' well-being protective factors, including psychological, social, and lifestyle components, can help guide the therapeutic process in the management of CMP. Recognizing the absence of a dedicated well-being questionnaire, tailored specifically for CMP populations, an 11-item well-being in pain questionnaire (WPQ) was developed. OBJECTIVES:The objectives were to develop a valid and reliable patient-reported measure of personal pain-specific well-being protective factors and to evaluate its psychometric properties, including (i) internal consistency; (ii) known-group validity between subjects with chronic low back pain (CLBP) and healthy pain-free controls; (iii) convergent validity between the WPQ and measures of health-related quality of life, catastrophizing, sleep quality, symptoms of central sensitization, and anxiety; and (iv) structural validity with exploratory factor analysis. DESIGN:This is a cross-sectional validation study. METHODS:After reviewing previous CMP and well-being literature, the novel WPQ items were constructed by expert consensus and target population feedback. The psychometric properties of the WPQ were evaluated in a sample of 145 participants, including 92 subjects with CLBP and 53 pain-free controls. RESULTS:Feedback from a preliminary group of CMP patients about the relevance, content, and usability of the test items was positive. Internal consistency showed acceptable results (α = 0.89). The assessment of convergent validity showed moderate correlations (≤0.4 or ≥-0.4.) with well-established subject-reported outcome measures. The assessment of structural validity yielded a one-factor solution, supporting the unidimensionality of the WPQ. CONCLUSIONS:The psychometric results provided evidence of acceptable reliability and validity of the WPQ. Further research is needed to determine the usability of the WPQ as an assessment and outcome tool in the comprehensive management of subjects with CMP.

Background. Treatment of persistent spinal pain syndrome (PSPS) is challenging. Chronic pain associated with PSPS can lead to an impaired ability to work. Objective. To obtain information on whether receiving a disability pension (DP) affects pain and pain treatments in retiring working-age PSPS patients. Neuropathic pain medication and antidepressant use were considered as an indicator of neuropathic pain. Methods. The study group comprised 129 consecutive PSPS patients with spinal cord stimulation (SCS) devices implanted at Kuopio University Hospital Neurosurgery between January 1, 1996, and December 31, 2014. Purchase data of gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors from January 1995 to March 2016, as well as the data on working ability, were retrieved from national registries. Results. The data showed that 28 of 129 (21.7%) SCS permanent patients had a DP, and 27 had a sufficient follow-up time (two years before and one year after DP). Most patients (61%) used neuropathic pain medications during the follow-up, while 44% used antidepressants. Most patients (70%, n = 19) retired because of dorsopathies. The dose of gabapentinoids started to increase before the DP; after the DP, the doses started to increase again after the decrease but remained at a lower level. Conclusions. Neuropathic pain medication and antidepressant use suggest that pain continues after the DP—that is, pensioners continue to experience inconvenient chronic pain. Resources for patient care are therefore needed after the DP. However, the DP reduces the dose increase of gabapentinoids; the dose is higher immediately before retirement than at the end of the follow-up.

BACKGROUND: Exercise is a first-line treatment for chronic non-specific low back pain (CNSLBP). Exercise combined with specific breathing techniques have the potential to improve multifactorial outcomes. No previous studies, however, have compared outcomes between identical exercises with or without a specific breathing protocol in a uniform clinical study setting. OBJECTIVES: 1) To investigate the feasibility of combining synchronized breathing with movement control exercises and evaluate eligibility criteria, randomization procedures, and dropout rates. 2) To study the preliminary efficacy of the interventions on multifactorial outcome measures. METHODS: Thirty subjects with CNSLBP were randomized into two groups. Both groups had four contact clinic visits where they received personalized home movement control exercises to practice over two months. The experimental group included a movement control exercise intervention combined with synchronized breathing techniques. Trial registration number: NCT05268822. RESULTS: Feasibility was demonstrated by meeting the recruitment goal of 30 subjects within the pre-specified timeframe with enrolment rate of 24.8% (30/121). Synchronized breathing techniques were successfully adhered by participants. Home exercise adherence was nearly identical between the groups without any adverse events. Preliminary efficacy findings on pain intensity, disability, and self-efficacy in the experimental group exceeded the minimal clinically important difference. No such findings were observed in any outcome measures within the control group. Overall, multifactorial differences were consistent because nine out of eleven outcome measures showed greater improvements for the experimental group. CONCLUSION: The synchronized breathing with movement control exercises protocol was feasible and may be more beneficial for improving multifactorial outcomes compared to identical exercises alone. Results suggested progression to a full-scale trial.

Background: In Finland, elite level ice hockey injury studies have not been conducted since 1990s. Epidemiological data is needed for developing injury prevention. The aim of this study was to calculate the injury incidences and to describe details of the injuries in the men's elite-level ice hockey league in Finland (Liiga). Methods: During the three seasons of 2017–2020, injuries from eight Liiga teams were documented by team physicians to a digitalized injury-reporting system. All acute injuries requiring medical attention or causing a player's time loss were reported. Injury incidences were calculated, and injury details were described. Results: Overall, 326 injuries occurred in 1147 matches, comprising an injury rate (IR) of 12.9 per 1000 player-games. The head, including face, was the most commonly injured body part (IR 4.7 per 1000 player-games; 36.2% of the injuries), followed by the upper extremity (IR 3.5; 27.3%) and lower extremity (IR 3.3; 25.8%). Concussions were more frequent (IR 1.9) than knee (IR 1.6) or shoulder (IR 1.2) injuries. Body checking (31.5%) was the most common mechanism of injury, and contusion (29.3%) was the most typical diagnosis. The player's time loss was over three weeks in 17.7% of all injuries, of which mostly were knee (23.1%), hand (21.2%) and shoulder (13.5%) injuries. Conclusions: The injury rate was slightly lower than in other elite-level ice hockey studies and 28.2% lower than in previous studies conducted in Finland in the 1990s. Head injuries were the most common. Concussions persisted as frequent injuries in elite ice hockey.

Objectives The 13-item pain catastrophizing scale (PCS) is the most commonly used measure of pain catastrophizing. A validated Finnish version of the PCS has previously been unavailable. The objectives were to translate the original English version of the PCS into Finnish (PCS-FI), then to evaluate (i) structural validity of the PCS-FI with a confirmatory factor analysis (CFA), (ii) internal reliability with Cronbach's alpha, Omega, and Omega hierarchical, (iii) convergent validity with measures of well-being, quality of life, sleep quality, symptoms of central sensitization, and anxiety, and (iv) known-groups validity between participants with chronic low back pain (CLBP) and pain-free controls.Methods The translation process was performed with established guidelines. The PCS-FI was psychometrically validated using 92 participants with CLBP and 53 pain-free controls.Results Structural validity with CFA supported a bifactor solution. However, low reliability was found for the three specific factors (omega h ranging from 0.14 to 0.18) compared to the general factor (omega h = 0.88) suggesting that only the total score should be used. Convergent validity analysis showed satisfactory correlations and medium effect sizes with the other patient-reported outcome measures. Participants with CLBP had significantly higher total PCS-FI scores than pain-free controls.Conclusions The PCS-FI appears to be a valid and reliable instrument for assessing pain-related catastrophizing in Finnish-speaking populations. Ethical approval for this study was obtained from the Research Ethics Committee of the Northern Savo Hospital District, identification number 2131/2022, on the 31st of January 2022.

OBJECTIVES:Chronic musculoskeletal pain is associated with decreased parasympathetic and increased sympathetic activity in the autonomic nervous system. The objective of this study was to determine the associations between objective measures of heart rate variability (a measure of autonomic nervous system function), actigraphy (a measure of activity and sleep quality), respiration rates, and subjective patient-reported outcome measures (PROMs) of central sensitization, kinesiophobia, disability, the effect of pain on sleep, and life quality. METHODS:Thirty-eight study subjects were divided into two subgroups, including low symptoms of central sensitization (n = 18) and high symptoms of central sensitization (n = 20), based on patient-reported scores on the Central Sensitization Inventory (CSI). Heart rate variability (HRV) and actigraphy measurements were carried out simultaneously in 24 h measurement during wakefulness and sleep. RESULTS:A decrease in HRV during the first 2 h of sleep was stronger in the low CSI subgroup compared to the high CSI subgroup. Otherwise, all other HRV and actigraphy parameters and subjective measures of central sensitization, disability, kinesiophobia, the effect of pain on sleep, and quality of life showed only little associations. DISCUSSION:The high CSI subgroup reported significantly more severe symptoms of disability, kinesiophobia, sleep, and quality of life compared to the low CSI subgroup. However, there were only small and nonsignificant trend in increased sympathetic nervous system activity and poorer sleep quality on the high central sensitization subgroup. Moreover, very little differences in respiratory rates were found between the groups.

Background Chronic low back pain (CLBP) is a leading cause of disability globally. Exercise therapies are one of the commonly prescribed treatment options for CLBP. The specific exercise therapies for CLBP most commonly target movement dysfunction, but seldom brain-based pain modulation. Exercise therapies with specific breathing techniques (SBTs) have been shown to influence and enhance brain-based structural and functional pain modulation. Aims and objectives To assess the feasibility of the SBTs protocol, eligibility criteria, randomization, and dropout rates. To quantify the changes in patient outcome measures and choose the most relevant measure for larger-scale study. To quantify self-adherence levels to home exercise and monitor and record possible pain medication and other treatment modality usage, and adverse events during exercise. Design A parallel randomised analyst-blinded feasibility trial with two-month follow-up. Outcome measures Feasibility related to aims and objectives. Multiple pain- and health-related patient-reported outcome measures of pain intensity, disability, central sensitization, anxiety, kinesiophobia, catastrophising, self-efficacy, sleep quality, quality of life, and health and well-being status. Exercise adherence, pain medication and other treatment modality usage, and possible adverse events related to exercises will be monitored and recorded. Methods Thirty participants will be randomized to movement control exercise with SBTs (15 subjects in experimental group) or movement control exercise without SBTs (15 subjects in control group) in private chiropractic practice setting with two-month follow-up. Trial registration number; NCT05268822. Discussion The clinical difference in effectiveness between practically identical exercise programs in uniform study settings with or without SBTs has not been studied before. This study aims to inform feasibility and help determine whether progression to a full-scale trial is worthwhile.

Abstract Context When choosing to incorporate osteopathic manipulative treatment (OMT) into a patient’s care, the risk-to-benefit ratio, the choice of treatment technique, as well as the frequency of treatments are always taken into consideration. This has been even more important during the COVID-19 pandemic, in which social distancing has been the best preventative measure to decrease exposure. By increasing treatment intervals, one could not only limit possible exposure/spread of viruses but also decrease the overall cost to the system as well as to the individual. This is an expansion of a previous study in which quantifiable changes in cervical hysteresis characteristics post-OMT were documented utilizing a durometer (Ultralign SA201®; Sigma Instruments; Cranberry, PA USA). This study compared two treatment modalities, muscle energy (ME) and high-velocity low-amplitude (HVLA) postcervical treatment. Subjects in this study were allowed to re-enroll, provided that they could be treated utilizing the alternate treatment modality. By allowing repeat subjects, analysis of the data for lasting effects of OMT could be observed. Objectives To determine whether a significant change in cervical hysteresis would be observed after each treatment regardless of a short treatment interval. Methods A total of 34 subjects were retrospectively noted to be repeat subjects from a larger, 213-subject study. These 34 subjects were repeat participants who were treated with two different direct-treatment modalities 7–10 days apart. Each subject was randomly assigned to receive a single-segmental ME or HVLA treatment technique directed toward a cervical (C) segment (C3–C5 only). Subjects were objectively measured pretreatment in all cervical segments utilizing the Ultralign SA201®, then treated with cervical OMT to a single segment, and finally reassessed at all cervical levels with the Ultralign SA201® posttreatment to assess for change in cervical hysteresis. Results Statistically significant or suggestive changes (p-values 0.01–0.08) with good clinical effect size (0.30 or greater) were noted in all four components of the Ultralign SA201® at multiple cervical levels after the first treatment, but only one component (frequency) had a statistically significant change after the second treatment (AA cervical level, p-value 0.01) with good clinical effect size (0.45). However, when comparing the post–first-treatment values to the pre–second-treatment values, no statistically significant differences (p-value 0.10 or higher) were observed between them. Conclusions Statistically significant changes were noted after the first treatment; however, when comparing cervical hysteresis changes after the first treatment to the cervical hysteresis values prior to the second treatment delivered 7–10 days later, there were no statistically significant or suggestive changes. This data suggest that several post-OMT changes noted after the first treatment were still in effect and may indicate that follow-up visits for direct manipulation may be deferred for a least two weeks.

BACKGROUND CONTEXT:Physical activity in its various forms are the most recommended prevention and treatment strategy for chronic low back pain (CLBP). Standing postural stability is a prerequisite for many types of physical activities. Systematic reviews have investigated the evidence for an association between CLBP and postural stability but results remain inconclusive. PURPOSE:Our primary objective was to compare postural stability between pain-free controls and subjects with CLBP with or without leg pain and single and multisite chronic musculoskeletal pain subjects. The secondary objectives were to evaluate the association between postural stability with CLBP intensity and duration, demographics, physical characteristics and validated health and pain-related patient-reported outcome measures (PROMs). STUDY DESIGN/SETTING:Cross-sectional study in a private chiropractic clinic setting PATIENT SAMPLE: Subjects included 42 pain-free controls and 187 patients with chronic musculoskeletal pain divided into CLBP with or without leg pain and single and multisite pain groups. OUTCOME MEASURES:Pain intensity was measured using the numerical pain rating scale, PROMs Central Sensitization Inventory, Tampa Scale of Kinesiophobia, The Depression Scale, EuroQol-5D, Roland-Morris Disability Questionnaire, and Pain and Sleep Questionnaire Three-Item Index disability. Group differences were measured using area and velocity of sway on the force plate. METHODS:Postural stability was assessed using a force plate on four 60-second bipedal quiet stance tests: eyes open on a stable surface, eyes closed on a stable surface, eyes open on an unstable foam surface, eyes closed on an unstable foam surface. Following the clinic visit, subjects completed an online web-based data entry detailing pain history, demographic data, physical characteristics, pain intensity via the numerical pain rating scale, and PROMS. RESULTS:Postural sway parameters did not differ between pain-free controls and subjects with CLBP with or without leg pain and single and multisite chronic musculoskeletal pain subjects. Furthermore, severity and duration of CLBP pain in addition to central sensitization, kinesiophobia, depression, quality of life, disability, and effect of pain on sleep only had very weak associations with postural stability. CONCLUSIONS:Chronic musculoskeletal pain appears not to influence bipedal postural stability.

Objective Deep brain stimulation (DBS) is an effective treatment for motor symptoms of advanced Parkinson’s disease (PD). Currently, DBS programming outcome is based on a clinical assessment. In an optimal situation, an objectively measurable feature would assist the operator to select the appropriate settings for DBS. Surface electromyographic (EMG) measurements have been used to characterise the motor symptoms of PD with good results; with proper methodology, these measurements could be used as an aid to program DBS. Methods Muscle activation measurements were performed for 13 patients who had advanced PD and were treated with DBS. The DBS pulse voltage, frequency, and width were changed during the measurements. The measured EMG signals were analysed with parameters that characterise the EMG signal morphology, and the results were compared to the clinical outcome of the adjustment. Results The EMG signal correlation dimension, recurrence rate, and kurtosis changed significantly when the DBS settings were changed. DBS adjustment affected the signal recurrence rate the most. Relative to the optimal settings, increased recurrence rates (median ± IQR) 1.1 ± 0.5 (−0.3 V), 1.3 ± 1.1 (+0.3 V), 1.7 ± 0.4 (−30 Hz), 1.7 ± 0.8 (+30 Hz), 2.0 ± 1.7 (+30 μs), and 1.5 ± 1.1 (DBS off) were observed. With optimal stimulation settings, the patients’ Unified Parkinson’s Disease Rating Scale motor part (UPDRS-III) score decreased by 35% on average compared to turning the device off. However, the changes in UPRDS-III arm tremor and rigidity scores did not differ significantly in any settings compared to the optimal stimulation settings. Conclusion Adjustment of DBS treatment alters the muscle activation patterns in PD patients. The changes in the muscle activation patterns can be observed with EMG, and the parameters calculated from the signals differ between optimal and non-optimal settings of DBS. This provides a possibility for using the EMG-based measurement to aid the clinicians to adjust the DBS.

BACKGROUND Spinal cord stimulation (SCS) is an effective treatment for failed back surgery syndrome (FBSS). In patients with FBSS, opioids have often been initiated, even before SCS is trialed. OBJECTIVE We studied the effect of retirement on opioid use in patients with chronic pain after failed back surgery. STUDY DESIGN A retrospective study design. SETTING The study was conducted at Kuopio University Hospital. METHODS The study group consisted of all 230 patients with SCS trialed or implanted for FBSS at Kuopio University Hospital Neurosurgery from January 1, 1996 through December 31, 2014. All purchases of prescribed opioids and their daily defined doses, as well as data on working ability, were obtained from the Social Insurance Institution. Patients were divided into 3 groups: SCS trial only, SCS implanted permanently, and SCS implanted but later explanted. We analyzed the differences in opioid use among these groups 2 years before and 2 years after the start of their disability pension (DP). RESULTS During the follow-up period, a total of 60 patients received a DP. One year before DP, the majority of patients used opioids (n = 43, 72%), and throughout the one-year follow-up after retirement, the number of users increased slightly (n = 46, 77%). In the permanently implanted SCS group, the number of strong opioid users decreased after retirement. Most patients used a moderate dose (0.1-10.5 morphine milligram equivalent/d). Retirement appeared to interrupt dose escalation in all groups, but doses increased further as the follow-up continued. LIMITATIONS No structured questionnaires were used in this study. Also, many underlying factors contributing to chronic pain were missing. CONCLUSIONS DP did not reduce the use of opioids in patients with FBSS. Opioid doses were lower and dose escalation less steep with continuous SCS therapy.

AIMS:Perform a pilot study of a static nerve root foramen opening protocol for lumbar radiculopathy from disc hernia in an emergency hospital setting to establish if patients could execute the protocol, consistency would occur across outcomes, superior outcomes would occur in the experimental group, and if the protocol would be safe. METHODS:Patients with sciatica arrived of their own volition at the local emergency hospital department, were admitted for care and were randomized into two groups: 1) control (n = 10): forward bending, walking, and medication; and 2) experimental (n = 10) as control subjects, plus a static lumbar foramen opening protocol using flexion and contralateral lateral flexion (side-lying). Outcomes were back and leg pain (i.e. visual analog scale), disability (i.e. EuroQol5D5L and Oswestry) and straight leg raise. RESULTS:At admission, the baseline outcome variables between groups were not significantly different. All patients had moderate or large disc hernias on MRI and 75% had neurological deficits in electrophysiology. At discharge, patients in the experimental group were significantly better (p ≤ .05) than controls in all outcomes. Statistical analysis of the outcomes produced greater significance, effect sizes and minimal clinically important differences in the experimental group. Patients in the experimental group consumed less medication than control patients (21% versus 79%), including less than half the opioids (tramadol). No adverse responses occurred. CONCLUSIONS:Patients could perform the protocol and superior outcomes occurred, with no adverse effects. The data support more detailed study of therapeutic efficacy, days in hospital, costs, conversion to surgery, and medication consumption, including opioids.

Reciprocal relationships between chronic musculoskeletal pain and various sleep disturbances are well established. The Pain and Sleep Questionnaire three-item index (PSQ-3) is a concise, valid, and reliable patient-reported outcome measure (PROM) that directly evaluates how sleep is affected by chronic low back pain (CLBP). Translation and cross-cultural validation of The Pain and Sleep Questionnaire three-item index Finnish version (PSQ-3-FI) were conducted according to established guidelines. The validation sample was 229 subjects, including 42 pain-free controls and 187 subjects with chronic musculoskeletal pain. Our aims were to evaluate internal consistency, test–retest reliability, measurement error, structural validity, convergent validity, and discriminative validity and, furthermore, to study the relationships between dizziness, postural control on a force plate, and objective sleep quality metrics and total PSQ-3-FI score. The PSQ-3-FI demonstrated good internal consistency, excellent test–retest reliability, and small measurement error. Confirmatory factor analysis confirmed acceptable fit indices to a one-factor model. Convergent validity indicated fair to good correlation with pain history and well-established pain-related PROMs. The PSQ-3-FI total score successfully distinguished between the groups with no pain, single-site pain, and multisite pain. A higher prevalence of dizziness, more impaired postural control, and a general trend towards poorer sleep quality were observed among subjects with higher PSQ-3-FI scores. Postural control instability was more evident in eyes-open tests. The Finnish PSQ-3 translation was successfully cross-culturally adapted and validated. The PSQ-3-FI appears to be a valid and reliable PROM for the Finnish-speaking CLBP population. More widespread implementation of PSQ-3 would lead to better understanding of the direct effects of pain on sleep.

Recent studies suggest that professional athletes seem to experience significant sleeping problems. However, little is still known about the occurrence of sleeping challenges at different stages of an athletic career. This descriptive study aimed to compare the sleep of professional athletes with younger elite amateur athletes. A total of 401 sportsmen, 173 youth elite amateur athletes and 228 professional athletes fulfilled a validated questionnaire. The self-estimated quality of sleep (on a linear scale 0–10) was significantly better in youth, being 7.9 compared to 7.4 (p < 0.001). The professional athletes had a significantly higher risk for sleeping problems, especially during the competitive season (OR = 7.3, 95% confidence interval 4.1–12.9) and they also used significantly more sleep medications (OR = 8.3, 95% confidence interval 1.7–4.1). Interestingly, majority of youth athletes (85.4%) had received adequate sleep counselling compared with professional athletes (58.1%), (p < 0.001). Furthermore, 75.8% of professional athletes considered that additional sleep counselling would improve their performance compared with only 45.6% of youth athletes (p < 0.001). Our study demonstrates that compared with the younger counterparts, professional athletes experience impaired sleep quality and significantly more sleeping problems. There may be various underlying factors to induce the problems. The early intervention with sleep counselling may play an important role in preventing these problems and, therefore, it is recommended to be integrated in athletes’ overall training process.