[Diabolically intense axillary-scapular pain in a colleague]. / Kollegan pirullisen ankara kainalo-lapakipu.

We describe a middle-aged patient, in whom a rare subluxation of the costotransversal joint caused a severe axillary pain. Diagnosis was not achieved by imaging studies or electroneuromyography, but instead simply by palpation. A good treatment outcome was obtained by manipulation.

Development of the Finnish neurological function testing battery for dogs and its intra- and inter-rater reliability.

BACKGROUND: The Finnish neurological function testing battery for dogs (FINFUN) was developed to meet the increasing demand for objective outcome measures in veterinary physiotherapy. The testing battery should provide consistent, reproducible results and have established face and content validity. Internal consistency and intra- and inter-rater reliability of the FINFUN were also investigated. RESULTS: The FINFUN comprised 11 tasks: lying, standing up from lying, sitting, standing up from sitting, standing, proprioceptive positioning, starting to walk, walking, trotting, walking turns and walking stairs. A score from 0 to 4, (0: unable to perform task, 4: performing task with normal motor function) was given for each task, the maximum score being 44. Twenty-six dogs were filmed when performing the FINFUN. Seven observers scored the performances from the video recordings. The FINFUN was considered to have appropriate face and content validity based on a pilot study, clinical experience and critical reflection of the development process. Its internal consistency was excellent, with no Cronbach's alpha values below 0.922. The intra-rater reliability for total score of experienced observers was almost perfect: 0.999 (observer 1) and 0.994 (observer 2). The inter-rater reliability for both experienced and novice observers' total scores was also almost perfect (0.919-0.993). Analysis of each individual task showed substantial intra-rater and inter-rater agreement for the tasks "lying" and "sitting". CONCLUSIONS: The FINFUN is an objective, valid and reliable tool with standardized scoring criteria for evaluation of motor function in dogs recovering from spinal cord injury.

Finnish version of the Tampa Scale of Kinesiophobia: Reference values in the Finnish general population and associations with leisure-time physical activity.

OBJECTIVES: To create reference values for the general Finnish population using the Tampa Scale of Kinesiophobia (TSK-FIN), to study gender differences in the TSK-FIN, to assess the internal consistency of the TSK-FIN, to estimate the prevalence of high levels of kinesiophobia in Finnish men and women, and to examine the association between kinesiophobia and leisure-time physical activity and the impact of co-morbidities on kinesiophobia. METHODS: The study population comprised 455 men and 579 women. Participants completed a self-administered questionnaire about their socio-demographic factors, leisure-time physical activity, co-morbidities and kinesiophobia. RESULTS: The mean TSK-FIN score was significantly higher for men (mean 34.2, standard deviation (SD) 6.9) compared with women (mean 32.9, SD 6.5), with an age-adjusted p = 0.004 for the difference between men and women. Cronbach's alpha was 0.72, indicating substantial internal consistency. Men over 55 years of age and women over 65 years of age had a higher (p < 0.001) TSK score compared with younger people. There was a significant (p < 0.001) inverse association between kinesiophobia and leisure-time physical activity among both sexes. The presence of cardiovascular disease, musculoskeletal disease or a mental disorder was associated with a higher TSK-FIN score compared with the absence of the aforementioned disorders. CONCLUSION: We present here the reference values for the TSK-FIN. The reference values and prevalence among the general population may help clinicians to define the level of kinesiophobia among patients. Disorders other than musculoskeletal diseases were associated with kinesiophobia, which should be noted in daily practice.

Anxiety and depression are independent predictors of quality of life of patients with chronic musculoskeletal pain.

We examined the relative impact of baseline anxiety, depression and fear of movement on health related quality of life at 12-month follow-up after a multidisciplinary pain management programme. One hundred and eleven patients who had chronic musculoskeletal pain (mean age 45 years, 65% women) attended during 2003-2005 a multidisciplinary three-phase pain management programme with a total time frame of six to seven months, totalling 19 days. The Beck Anxiety Inventory was used to rate anxiety, the Beck Depression Inventory depression, the Tampa Scale of Kinesiophobia fear of movement. The generic 15D questionnaire was used to assess health related quality of life. Baseline data were collected at admission, follow-up data at 12 months. Mean health related quality of life increased significantly from baseline to 12-month follow-up. Anxiety at baseline predicted significant negative change in the health related quality of life, depression predicted significant positive change in the health related quality of life. Fear of movement did not predict any significant change in the health related quality of life. We concluded that patients with chronic musculoskeletal pain and mild to moderate depression benefit from a multidisciplinary pain management programme in contrast to anxious patients. The findings imply further research with bigger sample sizes, other than HRQoL outcome measures as well as with other groups of patients.

Association of fear of movement and leisure-time physical activity among patients with chronic pain.

OBJECTIVE: The aim of this study was to clarify the association of fear of movement and physical activity among patients with chronic musculoskeletal pain. METHODS: The sample comprised 93 patients participating in a multidisciplinary pain management programme. The purpose of the programme was to regain overall functioning by means of physical and functional exercises, education and personal pain management training. Tampa Scale of Kinesio-phobia and Leisure Time Physical Activity questionnaires were completed at baseline, and at 6-month and 12-month follow-ups. RESULTS: At baseline, low and medium kinesiophobia groups showed more leisure-time physical activity than did the high kinesiophobia group (p = 0.024). At a 6-month follow-up the high kinesiophobia group had increased their physical activity index to the level of the low and medium kinesiophobia groups and maintained that change to 12-month follow-up. The effect sizes of the change in the physical activity index and pain intensity at the 12-month follow-up were both moderate (0.56) in the high kinesiophobia group. CONCLUSION: The change in physical activity and kinesiophobia was associated with the level of baseline kinesiophobia. Multidisciplinary rehabilitation seems to produce favourable effects in terms of physical activity and pain among the high kinesiophobia patients.