Power of lower extremities is most important determinant of agility among physically inactive or active adult people.

OBJECTIVE: The purpose of this cross-sectional study was to determine the relationships between agility, running speed, jumping height and length, body mass index, self-report pain in back and in lower extremities, personal factors as self-report health and fitness, and leisure time physical activity in physically inactive or active adult people. METHODS: Altogether, 233 healthy subjects, 149 women (43.0 ± 7.3 years) and 84 men (44.0 ± 7.7 years), participated into study. Outcome measures were described in the International Classification of Functioning, Disability and Health domains. RESULTS: Multiple regression analysis showed that jumping length explained 24.6% and 15.3% of the variance associated with agility in women and men (adjusted R2  = .246, p < .001; adjusted R2  = .153, p = .001, respectively). CONCLUSIONS: Jumping length was the main determinant of agility among physically inactive or active women and men. The findings of this study strengthen opinion that the Agility Test for Adults demands also other physical and cognitive characteristics as measured now and their part explaining agility results may be relatively great. We suggest that perception and decision making explain for a great part in agility. It seems that body mass index does not play important role in agility, but physical inactivity can explain or increase the decline of agility. Also, various biological mechanisms in aging process can be linked to the deterioration of capacity of agility.

A New Agility Test for Adults: Its Test-Retest Reliability and Minimal Detectable Change in Untrained Women and Men Aged 28-55.

Manderoos, SA, Vaara, ME, Mäki, PJ, Mälkiä, EA, Aunola, SK, and Karppi, S-L. A new agility test for adults: its test-retest reliability and minimal detectable change in untrained women and men aged 28-55. J Strength Cond Res 30(8): 2226-2234, 2016-The aims of this study were to present a new Agility Test for Adults (ATA), to investigate its test-retest reliability and to quantify minimal detectable change at the 95% confidence interval (MDC95). Both the relative and absolute reliabilities were evaluated. Altogether 52 healthy untrained volunteers (25 women: age 43.3 ± 6.6 years; 27 men: age 42.8 ± 7.2 years) were recruited into the study. The subjects performed 3 ATA tests repeated after 2 different intervals: the first test session was baseline, session 2 was a week later, and session 3 was half an hour after session 2. The intraclass correlation coefficient and the SEM of the performance time of ATA were 0.91 and 0.27 seconds (same day), 0.94 and 0.20 seconds (1 week) for women, and 0.95, 0.13 seconds, and 0.94, 0.19 seconds for men, respectively. MDC95 was 0.76 seconds (same day) and 0.56 seconds (1 week) for women, and respectively 0.37 and 0.51 seconds for men. The results showed that ATA is stable and reliable when evaluating agility characteristics in untrained adults. The properties of ATA make it appropriate for screening people to find early signs of declined agility and allow possibility to clinicians and physical trainers to monitor true changes in performance time at agility test by applying the knowledge of MDC95 coefficient. Furthermore, ATA can give tips for planning appropriate exercise programes to prevent clumsiness and falls with more serious consequences among aging people.

The effect of structured exercise intervention on intensity and volume of total physical activity.

This study aimed to investigate the effects of a 12-week structured exercise intervention on total physical activity and its subcategories. Twenty-three overweight or obese middle aged men with impaired glucose regulation were randomized into a 12-week Nordic walking group, a power-type resistance training group, and a non-exercise control group. Physical activity was measured with questionnaires before the intervention (1-4 weeks) and during the intervention (1-12 weeks) and was expressed in metabolic equivalents of task. No significant change in the volume of total physical activity between or within the groups was observed (p > 0.050). The volume of total leisure-time physical activity (structured exercises + non-structured leisure-time physical activity) increased significantly in the Nordic walking group (p < 0.050) but not in the resistance training group (p > 0.050) compared to the control group. In both exercise groups increase in the weekly volume of total leisure-time physical activity was inversely associated with the volume of non-leisure-time physical activities. In conclusion, structured exercise intervention did not increase the volume of total physical activity. Albeit, endurance training can increase the volume of high intensity physical activities, however it is associated with compensatory decrease in lower intensity physical activities. To achieve effective personalized exercise program, individuality in compensatory behavior should be recognised. Key PointsStructured NW or RT training does not increase the volume of total physical activity.NW intervention can increase the volume of higher intensity activities.The increased in volume of LTPA induced by the structured NW and RT interventions was associated with the decreased volume of NLTPA.

Motor development of infants with univentricular heart at the ages of 16 and 52 weeks.

PURPOSE: To compare the motor development of patients with hypoplastic left heart syndrome (HLHS) and other types of univentricular heart (UVH) with peers who are healthy at the ages of 16 and 52 weeks. METHODS: Motor development was assessed with the Alberta Infant Motor Scale (AIMS). RESULTS: Both the 23 patients with HLHS and the 13 patients with UVH had lower total AIMS scores in both observations than the controls. At the age of 52 weeks, patients with HLHS had significantly lower scores in all 4 AIMS subscales, whereas patients with UVH had lower scores only in the prone and standing subscales. CONCLUSION: Motor development of patients with HLHS or UVH is delayed during the first year of life, especially in the prone and standing subscales.

Physical dose of therapeutic exercises in institutional neck rehabilitation.

OBJECTIVE: To determine the intensity and volume of therapeutic exercises during a standard 13-day inpatient neck rehabilitation course in relation to overall physical activity in rehabilitation and everyday life. DESIGN: Cross-sectional study. METHODS: Subjects (n = 19; 16 women and 3 men; mean age 48.6 years, standard deviation (SD) 6.6) with chronic non-specific neck pain were recruited from two inpatient neck rehabilitation courses. Intensity and volume of therapeutic exercises and physical activity were measured in metabolic equivalents (METs) with an objective measurement device and all-time recall questionnaire. Maximum oxygen uptake was determined in METs (METc) by direct maximal cycle ergometer. RESULTS: Subjects' mean METc was 7.2 METs (SD 1.4) or 25.3 ml/kg/min (SD 4.8). Intensity of all therapeutic exercises was 1.9 METs or 27 %METc (SD 5.1) and volume 7.7 MET-hours/week. Intensity of specific neck and shoulder exercises was 2.0 METs or 28 %METc (SD 5.4) and volume 2.5 MET-hours/week. In addition, subjects were more active in everyday life than in inpatient rehabilitation. CONCLUSION: The therapeutic exercise dose failed to reach previously reported target values for pain relief. The dose of therapeutic exercises and confounding physical activity should be carefully controlled in pain rehabilitation programmes.

Effects of long-term home-based exercise on health-related quality of life in patients with chronic neck pain: a randomized study with a 1-year follow-up.

PURPOSE: To evaluate whether long-term neck and upper body exercises conducted in economical community-based outpatient clinic and home-based settings could improve health-related quality of life (HRQoL)for individuals affected by chronic neck pain. The effect of baseline HRQoL and neck pain values on training adherence was also studied. METHODS: Subjects (n = 101, 91 women/10 men, mean age 41.0 ± 9.5 years) with chronic non-specific neck pain were randomized to a combined strength-training and stretching-exercise group (CSSG, n = 49) or to a stretching exercise group (SG, n = 52). HRQoL was assessed at baseline and after 12 months using the RAND-36 questionnaire. Comparisons between groups were performed using bootstrap-type analysis of covariance. The impact of HRQoL and neck pain values on training adherence, determined using participants' exercise logs, was studied using generalized estimating equations. RESULTS: CSSG showed significant improvements in five and SG in four of eight of the HRQoL dimensions. There were no significant differences between the groups. Adherence to long-term training was only slightly affected by baseline-assessed HRQoL and neck pain values. CONCLUSIONS: The two training protocols were feasible and equally effective in improving HRQoL. Baseline HRQoL and pain values had only a minor effect on training adherence. IMPLICATIONS FOR REHABILITATION: • Long-term strength training and stretching are effective in improving HRQoL in people with chronic neck pain. • Baseline HRQoL and neck pain values have little effect on training adherence.

Core muscle activation during dynamic upper limb exercises in women.

Although several everyday functions and sporting activities demand controlled use of the abdominal and back muscles while working with the upper limbs, the activity of core muscles during dynamic upper limb exercises in the standing position has not been studied extensively. The purpose of this cross-sectional study was to examine abdominal and back muscle activity during dynamic upper limb exercises while standing and to evaluate whether dynamic exercises are appropriate for strengthening muscles. The activation of the rectus abdominis, obliquus externus abdominis, longissimus, and multifidus muscles during dynamic bilateral or unilateral shoulder exercises with or without fixation of the pelvis was measured in 20 healthy women using surface electromyography. Trunk muscle activation during isometric maximum contraction was used as a comparative reference. With bilateral shoulder extension and unilateral shoulder horizontal adduction, abdominal muscle activity was >60% of activity during reference exercises. With unilateral shoulder horizontal abduction and shoulder extension exercises, back muscle activity was >60% of the activity level reference exercise. Muscle activation levels were 35-64% lower during shoulder horizontal adduction and abduction without fixation compared with exercises with fixation. The results indicate that upper limb exercises performed in the standing position are effective for activating core muscles. Bilateral and unilateral shoulder extension and unilateral shoulder horizontal abduction and adduction with the pelvis fixed elicited the greatest activity of the core muscles.

Patients' experiences of shoulder problems prior to and following intervention.

Health can be viewed from several perspectives. It has been shown that impingement of the shoulder leads to functional inability and decreased life quality. The aim of this study was to investigate the complexity of the effect of shoulder problems and discern and describe what it entails to be a patient suffering from shoulder problems. The study delineated patients' situations prior to and following medical intervention. This study is qualitative, and the data were collected through focus group interviews. Interviews with 26 respondents aged 43-63 (mean age 53) were made in 2005-2007. The sample group consisted of patients with supraspinatus tendinitis receiving either conservative treatment or surgery. Thematic analysis was used. Meaning units or themes were identified and interpreted in context and related to the ICF model and Antonovsky's theory for the factors capable of affecting health. Prior to intervention, pain was the attribute most strongly associated with shoulder problems. Four clear focus categories, all of which contain a dimension of pain, were identified. Postintervention interviews permitted data analysis from two main perspectives: 1) process and 2) result. Patients should feel part of the care process and their experience should include comprehensibility, manageability, and meaningfulness. A supportive environment helps ensure such, allowing for a successful rehabilitation process.

Is generic physical activity or specific exercise associated with motor abilities?

PURPOSE: Evidence of the effect of leisure time physical activity (LTPA) modes on the motor abilities of a mature population is scarce. The purpose of this study was to compare the motor abilities of physically active and inactive men and women and to examine the associations of different exercise modes and former and recent LTPA (R-LTPA) with motor ability and various physical tests. METHODS: The LTPA of the participants (men n = 69, women n = 79; aged 41-47 yr) was ascertained by a modified Physical Activity Readiness Questionnaire, including questions on the frequency, duration, and intensity of R-LTPA and former LTPA and on exercise modes. Motor abilities in terms of balance, agility, and coordination were assessed with a battery of nine tests supplemented with five physical fitness tests. Multiple statistical methods were used in analyses that were conducted separately for men and women. RESULTS: The MET-hours per week of R-LTPA correlated statistically significantly with the tests of agility and static balance (rs = -0.28, P = 0.022; rs = -0.25, P = 0.043, respectively) among men and with the static balance (rs = 0.41), 2-km walking (rs = 0.36), step squat (rs = 0.36) (P < or = 0.001, respectively), and static back endurance (rs = 0.25, P = 0.024) among women. In the stepwise regression among men, the most frequent statistically significant predictor was the playing of several games. For women, a history of LTPA for more than 3 yr was the strongest predictor for good results in almost all tests. CONCLUSIONS: Participants with long-term and regular LTPA had better motor performance, and especially a variety of games improve components of motor ability. Diverse, regular, and long-term exercise including both specific training and general activity develops both motor abilities and physical fitness.

Pain and clinical findings in the low back: a study of industrial employees with 5-, 10-, and 28-year follow-ups.

Little is known about the relationships of clinical findings in the low back with low back pain (LBP) in the normal working population. We studied whether physiotherapist's findings in the low back were associated with local and radiating LBP among a cohort (n=902) of employees in the engineering industry. A systematic non-proportional sample was drawn in strata by age, gender, and occupational class. The non-proportionality aimed at increasing sample size in smaller strata. Physiotherapists performed the straight-leg raising test (SRL), and made assessments of the fingertip-to-floor distance and pain in palpation of the lumbar interspinous spaces. The variables on pain at the interspinous spaces and the SRL tests were entered in cluster analysis. Three clusters emerged: no, minor, and severe clinical findings. In logistic regression analysis at baseline, limited forward flexion and the clinical findings cluster variable were associated with local and, particularly, radiating LBP. Follow-ups of the occurrence of local and radiating LBP at 5, 10, and 28 years from baseline were made. At the 5-year follow-up among subjects with no radiating LBP at baseline, the OR of radiating LBP for the clusters of minor and severe clinical findings compared to no findings were 2.7 (95% CI 1.4-5.1) and 3.8 (2.0-6.9), respectively, adjusted for age, gender, and occupational class. At the 10-year follow-up, the latter cluster predicted new reports of radiating LBP (1.9; 1.0-3.1) and of local LBP (4.1; 1.9-9.0, among subjects with no local LBP at baseline), similarly adjusted. No associations between limited forward flexion and new cases of LBP were observed. Thus, membership in clusters with different levels of findings in simple clinical measurements predicted new reports of radiating LBP, in particular, among employees. The generalizability of the results may be limited due to the characteristics of the sampling.

Changes in pain and physical function during waiting time and 3 months after knee joint arthroplasty.

OBJECTIVE: To determine changes in physical and social function during a prolonged preoperative waiting period and at 3 months after total knee arthroplasty. SUBJECTS: Forty-three patients were evaluated on the day that surgery was decided, the day before surgery, and 3 months afterwards. METHODS: Knee pain and function were assessed using a visual analogue scale and a functional assessment system. Isometric knee flexion extension strength and mobility were measured. RESULTS: Knee pain and muscle strength remained unchanged during the mean waiting time of 10 (standard deviation 8) months. On the affected side, knee extension strength was 19% weaker than on the contralateral side and did not change pre-operatively. Post-operatively, knee pain decreased by 50%. Knee extension strength decreased by 26% and flexion strength by 12% compared with the initial assessments. Knee extension strength of the operated side was 42% lower than on the non-operated side. Knee flexion mobility was decreased by 8%, while the initially detected knee extension deficit of 10 degrees (SD 7) remained unchanged. The functional assessment system did not detect any changes in function. CONCLUSION: Waiting time did not affect knee pain or isometric knee extension/flexion strength. Three months post-operatively, knee pain had decreased significantly, but the strength of the operated knee was significantly lower than the pre-operative level.

Effect of isometric upper-extremity exercises on the activation of core stabilizing muscles.

OBJECTIVE: To evaluate whether isometric exercises for the upper extremities could sufficiently activate core stabilizing muscles to increase muscle strength. DESIGN: Cross-sectional study. SETTING: Department of physical medicine and rehabilitation at a Finnish hospital. PARTICIPANTS: Healthy adult women (N=20). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Peak isometric strength of the back and abdominal muscles was measured and relative loading in 5 test exercises was evaluated by surface electromyography. RESULTS: The rectus abdominis and obliquus externus abdominis were activated to the greatest degree in a bilateral shoulder extension exercise and the average surface electromyographic activity was 114% and 101% compared with the amplitude elicited during the maximal isometric trunk flexion exercise. Horizontal shoulder extension elicited the greatest activation of the longissimus and multifidus muscles. In this exercise, the activity levels of the left side multifidus and longissimus muscles were 84% and 69%, respectively, compared with the level of activity elicited during trunk extension. CONCLUSIONS: Of all the exercises studied, bilaterally performed isometric shoulder extension and unilaterally performed horizontal shoulder extension elicited the greatest levels of activation of the trunk musculature. Thus, it can be assumed that these exercises elicit sufficient levels of contraction of the trunk muscles for the development of their endurance and strength characteristics in rehabilitation.

Measuring deterioration in international classification of functioning domains of people with multiple sclerosis who are ambulatory.

BACKGROUND AND PURPOSE: Measures to detect important effects related to physical therapy interventions must be able to detect an important change. The purpose of this study was to select the most responsive physical functioning measures for multiple sclerosis (MS) using the International Classification of Functioning, Disability and Health (ICF) as a framework. SUBJECTS: The participants were 120 people with MS who were ambulatory from a population-based sample. METHODS: Physical functioning was assessed by quantitative clinical measures of activities (n=5) and body functions (n=7) and by self-reported performance in self-care, mobility, and domestic life domains in the activities and participation component of the ICF at baseline and 2 years later. A participant's perception of change and a change in Expanded Disability Status Scale (EDSS) scores were used as external criteria in the analysis of the receiver operating characteristic curve and the minimally important change score. The minimal detectable change was calculated as distribution-based responsiveness. RESULTS: According to the external criteria, 51% of the participants showed deterioration as measured by their own perceptions compared with the 26% of the participants who showed deterioration as rated by the clinician. Regardless of the external criterion applied, the measures most responsive to deterioration were self-reported scores in self-care, mobility, and domestic life; distance walked and change in heart rate during a 6-minute walk test; 10-m walk test speeds, stride length, and cadence; repetitive squatting; and Box and Block Test scores. DISCUSSION AND CONCLUSION: The results show the relative responsiveness of different measures in the subsample who deteriorated and provide data that can facilitate the interpretation of score changes in people with MS who are ambulatory for future studies and in clinical practice.

Measures of physical functioning predict self-reported performance in self-care, mobility, and domestic life in ambulatory persons with multiple sclerosis.

OBJECTIVE: To determine the associations between clinically measured physical functioning variables and self-reported performance in mobility, self-care, and domestic life in ambulatory persons with multiple sclerosis (MS), using the International Classification of Functioning, Disability and Health (ICF) as a framework. DESIGN: Survey study. SETTING: Community setting in Finland. PARTICIPANTS: A population-based sample of 120 ambulatory persons with MS (30 men, 90 women) with mean age 45.0+/-10.8 years (range, 20-71 y), mean disease duration from symptom onset 12.3+/-8.8 years (range, 1-39 y), and mean Expanded Disability Status Scale 2.8+/-2.0 (range, 0-6.5). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The primary dependent variables were self-reported performance in self-care, mobility, and domestic life from the Functional Status Questionnaire. The physical functioning variables were drawn from the ICF activities (n=9) and body functions (n=14) categories. Age- and sex-adjusted odds ratios from multinomial logistic regression were estimated for the physical functioning variables associated with activities of daily living (ADL) performance. RESULTS: Overall, of this cohort 31% reported difficulties or dependence in self-care, 52% in mobility, and 68% in domestic life. The most significant predictors of perceived difficulties or dependence in ADL performance were: (1) lower scores in the Box and Block Test; (2) lower Berg Balance Scale scores; (3) greater velocity moment when standing with eyes open; (4) slower ten-meter walk test times and shorter stride length at normal speed; and (5) shorter distance in the six-minute walk test. CONCLUSIONS: Perceived difficulties and dependence were most prominent in domestic life. In particular, measures of activities predicted difficulties in ADL performance. Monitoring of physical functioning should be extended to those independent MS persons reporting difficulties in ADL performance.

Effectiveness of a home exercise programme in low back pain: a randomized five-year follow-up study.

BACKGROUND AND PURPOSE: Therapeutic exercise has been shown to be beneficial in decreasing pain and in increasing functioning in patients with chronic low back pain. However, longitudinal follow-up studies are small in number, and often limited in the numbers of subjects due to drop-outs. In addition there is a shortage of real control groups in most cases. The purpose of the present study was to describe long-term changes in intensity of low back pain and in functioning for two study groups five years after undertaking a home exercise programme. METHOD: This was a randomized follow-up study over five years. Fifty-seven subjects were reassessed with questionnaires five years after their initial recruitment for an intervention study. A home exercise group (n = 29), with training once a day, and a control group (n = 28), without exercise, were included in the present study protocol. The primary outcome measurements included a questionnaire on the intensity of low back pain (Borg CR-10 scale) and on functioning (Oswestry Disability Index; ODI). The confounding physical activity was controlled with metabolic unit (MET) values. RESULTS: The CR-10 and ODI scores decreased during the first three months in both study groups. During the follow-ups, the corresponding indicators of the home exercise group remained below baseline values. The CR-10 score was significantly lower in the home exercise group (p = 0.01) during the last five-year follow-up session compared with the control group. Overall physical activity decreased slightly during the five-year follow-up, but there were no differences between the two study groups. CONCLUSIONS: The present randomized study indicates that supervised, controlled home exercises lead to reduced low back pain, and that positive effects were preserved over five years.

Muscle tone in different joint positions and at submaximal isometric torque levels.

The aim was to evaluate the tone and electric activity of the quadriceps muscle at rest and different torque levels. The second aim was to study whether thickness of soft tissues and change in the joint position would affect muscle tone. Eighteen healthy subjects participated. Computerized muscle tonometer (CMT) and surface electromyography (sEMG) measurements were performed: seated, first at rest with leg straight and then with the knee at 60 degrees . Thereafter measurements were obtained at levels of 80, 60, 40 and 20% of the maximum isometric torque at the same knee angle. Thickness of skin, subcutis and muscle was measured by ultrasound. The CMT values taken were the depth the indenter travelled and the work it did while compressing the right rectus femoris and vastus intermedius muscles. Expressed as mean (SD) depth the change in muscle tone changed from 29.2 (3.6) mm in the relaxed position to 16.9 (5.2) mm at 80% of maximal torque, and expressed as work the values were from 1589 (150) mJ to 739 (149) mJ respectively. The correlation between CMT, sEMG and torque measurements varied from r = -0.52 to -0.71 (p < 0.01). CMT was able to detect a change of 20% in torque production and 4% in tone. Tone values, at each torque level, were significantly separate from the values at the other force levels (p < 0.001-0.04). Soft tissue thickness explained most of the tone results at rest (57%). The repeatability of the CMT measures was good (ICCs 0.75-0.99). Both depth and work correlated with electric activity and muscle torque, but the correlation with work was higher. In conclusion, muscle activity, length and thickness have to be taken into account when evaluating muscle tone.

Dose-response relationship of specific training to reduce chronic neck pain and disability.

PURPOSE: To examine the dose-response relationship of specific strength- and endurance-training regimes for the cervical muscles, which have been shown to be effective among women with chronic neck pain and disability. METHODS: A total of 180 female office workers, aged 25 to 53 yr, with chronic neck pain and disability were randomized into a strength-training, an endurance-training, and a control group. The training groups participated in a 12-d rehabilitation period, in which instructions for the exercises were given by an experienced physical therapist. Both training groups continued with exercises at home for 12 months. Physical activity was measured with a training diary and a 1-month all-time recall questionnaire. All activities were registered and converted into metabolic equivalents (METs). RESULTS: Specific neck, shoulder, and upper-extremity training for more than 8.75 MET.h.wk was an effective training dose for decreasing neck pain. One MET-hour of training per week accounted for an 0.8-mm decrease of neck pain on a visual analog scale (VAS) and a 0.5-mm decrease on a disability index. Both strength and endurance training decreased perceived neck pain and disability. Declines in neck pain and disability correlated positively with the amount of specific training. CONCLUSION: This study revealed that the described specific exercise protocols were associated with decreases in chronic neck pain and disability. The effective dose of training was feasible and safe to perform among female office workers.

Physical functioning in multiple sclerosis: a population-based study in central Finland.

OBJECTIVE: To describe multiple sclerosis and its impact on individuals' perceived problems in functioning, particularly in the domains of self-care, mobility and domestic life. DESIGN: A population-based study in a prevalence cohort of multiple sclerosis subjects in Central Finland region carried out in the year 2000. SUBJECTS: A total of 240 subjects with multiple sclerosis. METHODS: A postal questionnaire for assessing physical functioning was developed. RESULTS: Ninety percent of the study population completed the study. Subjects' average age was 48.2 years (range 20-76 years) and time since symptom onset was 15.8 years (range 0-56 years). Of the subjects, 82% were fully independent in self-care activities and 53% in domestic life, 50% were able to walk without any perceived problems and 38% had a permanent need for a walking aid. Fatigue was the most frequent complaint having an impact on subjects' daily life. Ninety-five subjects out of 240 (40%) were engaged in working life. CONCLUSION: These data give a clear indication of favourable functioning in mobility, self-care and domestic life. However, the fact remains that multiple sclerosis is a disabling and costly disease. These results provide information for use by local and national authorities in planning and co-ordinating rehabilitation interventions and social services.

Isometric strength of the cervical flexor, extensor, and rotator muscles in 220 healthy females aged 20 to 59 years.

STUDY DESIGN: Cross-sectional descriptive study. OBJECTIVES: To determine the maximal isometric strength of the flexor, extensor, and rotator muscles of the cervical spine in healthy females of working age to document reference values for diagnostic and rehabilitation purposes. BACKGROUND: Reference values for the isometric strength of the cervical muscles have often been based on small samples. To date, reference values for rotator muscles of the cervical spine have not been published. METHODS AND MEASURES: The group consisted of 220 volunteer healthy females in 4 age groups (20-29 years, n = 57; 30-39 years, n = 51; 40-49 years, n = 51; 50-59 years, n = 61) from Jyadskyla, Finland. Isometric cervical muscle strength in flexion, extension, and rotation was evaluated with a specially designed measurement system. RESULTS: Across all age groups, mean (+/-SD) maximal isometric neck strength was 73.8 +/- 20.0 N in flexion and 190.8 +/- 31.3 N in extension. Mean (+/-SD) rotation strength was 8.1 +/- 2.3 Nm to the right and 7.9 +/- 2.3 Nm to the left. Absolute strength values did not differ among the age groups. A weak but significant correlation between body mass and neck flexion (r = 0.31, P<.01) and extension (r = 0.25, P<.01) strength was found. Intratester reliability varied from 0.87 to 0.96. CONCLUSIONS: Women aged 20 to 59 years appear to have similar absolute isometric neck muscle strength levels. Thus these values can be used as reference for the working-age female population.

Functioning and preferences for improvement of health among patients with juvenile idiopathic arthritis in early adulthood using the WHO ICF model.

OBJECTIVE: To evaluate functioning and preferences for health among young adult patients with juvenile idiopathic arthritis (JIA) and controls. The WHO International Classification of Functioning, Disability and Health (ICF) was used as a framework. METHODS: The patient files of a rheumatology hospital were screened to identify patients with juvenile arthritis born 1976 to 1980. Functioning was measured by the Finnish version of the Multidimensional Health Assessment Questionnaire (MDHAQ) within the framework of the ICF. Preferences in improvement of health were measured by the Finnish version of the Arthritis Impact Measurement Scales 2. Age and sex matched controls from the community were selected from the Finnish population registry. RESULTS: In all, 123 patients with a mean age of 23 (SD 21-26) years participated in the followup study. The mean time from diagnosis to followup was 16.2 years. Among them, 35% (n = 43) were in remission at followup. Lower levels of functioning for 3 ICF components were found in patients with active disease compared to controls. JIA patients with active disease had more pain and lower levels of mobility, self-care, and domestic and social life compared to controls. Patients with active disease differed from those in remission with pain in preferences for improvement of health. CONCLUSION: Patients with active disease need active treatment and rehabilitation to maintain functioning and decrease pain. The ICF offers a promising model to examine the outcomes of adult patients with JIA. Application of the MDHAQ is supported by our evaluation studies in young adults with JIA.