Leisure-time physical activity and metabolic syndrome plus depressive symptoms in the FIN-D2D survey.

OBJECTIVE: To examine the association between leisure-time physical activity (LTPA) and simultaneous presence of metabolic syndrome (MetS) and depressive symptoms (DS) based on a population-based FIN-D2D cross-sectional survey conducted in 2007. METHODS: 4500 randomly selected Finnish men and women aged 45-74 years were initially enrolled; 2868 (64%) attended a health examination. Participants with complete information (n=2778) were grouped into three LTPA categories: low, moderate and high. MetS was based on the National Cholesterol Education Program criteria and DS on the Beck Depression Inventory (≥10 points). RESULTS: The prevalence of MetS and DS were 53% and 15%, respectively; the prevalence of simultaneous MetS and DS was 10%. The proportion of subjects with MetS, DS and simultaneous presence of MetS and DS increased with decreasing LTPA (p<0.001). On multivariate ordered analysis, LTPA was related to education years, household income, smoking, and the presence of MetS only, DS only and simultaneous MetS and DS. CONCLUSION: The prevalence of simultaneous MetS and DS was higher in participants with low LTPA compared with participants with high LTPA. Furthermore, LTPA level was associated with socioeconomic status and other health related outcomes, outlining the importance of LTPA as part of the general health promotion.

Intra- and Interrater Reliability of Sagittal Spinopelvic Parameters on Full-Spine Radiographs in Adults With Symptomatic Spinal Disorders.

OBJECTIVE: To evaluate the intra- and interrater reliability (I-IR) of sagittal spinopelvic parameters from digital full-spine plain radiographs with basic software tools in an unselected adult population with degenerative spinal complaints who were evaluated for surgery. METHODS: Forty-nine adult full-spine digital radiographs were measured twice by 3 independent observers, including an experienced spine surgeon, an experienced radiologist, and a resident orthopedic surgeon. Clinical picture archiving and communication system workstations and software tools were used and landmarks were set manually. The I-IR of the sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), and thoracic kyphosis in T4-T12 (TK) were assessed. RESULTS: The intrarater intraclass correlation coefficient (ICC) scores varied from 0.82 to 0.99. The interrater ICC scores ranged from 0.78 to 0.99. The intrarater standard error of measurement (SEM) values for SS, PT, PI, and TK varied from 0.8° to 5.0°, and the interrater SEM values ranged from 2.5° to 6.2°, depending on the parameter and the reading round. The I-IR SEM values for SVA varied from 2.2 to 5.7 mm and from 4.6 to 5.0 mm, respectively. Kappa values were >0.88 for all readers. The intrarater variability was the smallest for the most experienced rater. CONCLUSION: The I-IR of measuring sagittal spinopelvic parameters on digital full-spine images with basic software tools was high. Parameters consisting of several anatomic landmarks were more liable to error. Rater experience had a positive influence on reliability and repeatability. Reader experience should be assessed before accepting measurements for surgical planning and the interpretation of surgical correction during postoperative follow-up.

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.

Trunk muscle strength in flexion, extension, and axial rotation in patients managed with lumbar disc herniation surgery and in healthy control subjects.

STUDY DESIGN: A cross-sectional study was conducted. OBJECTIVE: To compare maximal flexion, extension, and rotation strength as well as force-time characteristics of trunk muscles in patients who undergo lumbar disc herniation with those in healthy control subjects 2 months after surgery. SUMMARY OF BACKGROUND DATA: Insufficient attention has been paid to muscle strength characteristics after lumbar disc herniation surgery. METHODS: For this study, 30 postoperative patients with lumbar disc herniation and 30 healthy control subjects volunteered to participate. Isometric trunk flexion, extension in the standing position, and seated rotation strength were tested bilaterally in a neutral posture and at 30 degrees axial prerotation. The area under the curve was calculated to analyze explosive force capacity. Dynamic endurance strength was measured by calculating the repetition maximum. Pain during the strength measurements was assessed by a visual analog scale. RESULTS: The healthy control subjects showed 44% and 36% higher isometric trunk flexion (P < 0.001) and extension (P < 0.001) forces, respectively, than the patients. The respective values for the area under the curve were 41% and 37% higher for the trunk flexors (P < 0.001) and extensors (P < 0.001) in the healthy control subjects than in the patients. The differences in trunk rotation force between the groups were statistically significant when the lower body was rotated 30 degrees to the right (P = 0.023) or to the left (P = 0.043) and the upper body was rotated in the opposite direction. Furthermore, in the dynamic endurance strength test, the healthy control subjects performed 70% more repetitions both for trunk flexors and extensors than did the patients. Some of the patients reported mild pain during the strength measurements, but the level of pain did not correlate with the strength values. CONCLUSIONS: The recovery of maximal endurance and explosive type strength characteristics is incomplete in patients with lumbar disc herniation 2 months after surgery. Active strength training is recommended to restore muscle function in these patients.