Pain alleviation by vibratory stimulation.

In the present study 366 patients suffering acute or chronic musculoskeletal pain of different origin were given vibratory stimulation for the pain. Many of the patients had previously had treatments of various kinds without satisfactory relief. The effect of vibratory stimulation was assessed during and after stimulation using a graphic rating scale. Sixty-nine per cent of the patients reported a reduction of pain during vibratory stimulation. The best pain reducing site was found to be either the area of pain, the affected muscle or tendon, the antagonistic muscle or a trigger point outside the painful area. In most patients the best pain reducing effect was obtained when the vibratory stimulation was applied with moderate pressure. To obtain a maximal duration of pain relief the stimulation had to be applied for about 25-45 min.

The Disability Rating Index: an instrument for the assessment of disability in clinical settings.

The purpose of this study was to evaluate an instrument for assessment of physical disability, mainly intended for clinical settings, the Disability Rating Index (DRI). Healthy persons (n = 1092), both white and blue collar workers, and patients (n = 366) with different levels of physical capacity, were assessed. Most of the patients (n = 303) underwent rehabilitation programmes for neck/shoulder/low-back pain but some (n = 47) were arthritis patients waiting for hip or knee replacement surgery, or wheelchair patients with multiple sclerosis (n = 16). The reliability was investigated by test-retest studies, intra- and inter-rater and internal consistency studies. Five construct validity tests were carried out: a discrimination study; a converging validity test; a test for sensitivity to small alterations in health status; and two correlational validity tests. Correlation of the self-reported DRI to the actual performance in similar activities was carried out. Responsiveness was tested by correlation of the DRI before/after replacement surgery for arthritis. The test-retest correlations were 0.83-0.95 in the studies, including correlation of different versions. The intra- and inter-rater reproducibility was 0.98 and 0.99 respectively. The Kruskal-Wallis test in the discrimination study yielded p < 0.0001. More than 90% of the respondents completed the questionnaire correctly. Correlation of the DRI to the Functional Status Questionnaire was 0.46. The responsiveness was excellent, p = 0.0001. The DRI proved to be a robust, practical clinical and research instrument with good responsiveness and acceptability for assessment of disability caused by impairment of common motor functions.

Activity-induced pain in rheumatoid arthritis functional class II and its relations with demographic, medical, functional, psychosocial, and work variables. Result of a survey in Bollnäs Medical District, Sweden, II.

One aim of this study was to describe inflammatory activity, joint destruction, work status, and demographic factors in a group of 69 American Rheumatism Association functional class-II rheumatoid arthritis patients: 56 women and 13 men, mean age 54 years (SD 11), mean symptom duration 14 years (SD 11). Another aim was to determine correlations between activity-induced pain and other variables. Patients were assessed with Ritchie's articular index, Larsen's radiologic index, and laboratory tests. Deformity in hands and knee joints, and grip strength, were determined. Results from earlier investigations of functional impairment and psychosocial capacity were also used. Of the patients, 4% had high inflammatory activity. Joint erosions were found in between 4% (knee joints) and 55% (wrists) of the joints examined. Of the patients aged less than 65, 43% were working. Activity-induced pain was related with work status (p = 0.0002). It also correlated significantly (p less than or equal to 0.01) with inflammatory activity (r(s) = 0.34), but not with joint destruction (r(s) = 0.21).

Pain thresholds during standardized psychological stress in relation to perceived psychosocial work situation. Stockholm Music I Study Group.

The hypothesis that perceived psychosocial work situation is associated with pain threshold was tested on a sample of 103 men and women aged 19-65 yr in Stockholm. Half of the studied sample was a random sample of men (N = 26) and women (N = 31), while the remaining subjects were medical secretaries (women, N = 28) and furniture movers (N = 31). Pain thresholds were measured by means of an algometer before, during and after a standardized colour word test. The measurements were made on six different points in the neck and shoulder region. Before psychological stress in the laboratory, perceived psychological demands were significantly associated with pain threshold--the higher the demands the higher the pain threshold. During stress those who reported low decision latitude and high degree of sleep disturbance were shown to have a low pain threshold. The findings are consistent with the hypothesis that subjects with high demand levels have an elevated pain threshold when they are not under excessive psychological stress. During psychological stress, on the other hand, those with low decision latitude are more pain sensitive than others, and this is aggravated in those who also report a high degree of sleep disturbance.

Associations between self-rated psychosocial work conditions and musculoskeletal symptoms and signs. Stockholm MUSIC I Study Group.

OBJECTIVES: The aim was to study the associations between self-rated psychosocial work conditions and the characteristics and location of musculoskeletal symptoms, signs, and syndromes. METHODS: Perceived psychosocial work conditions were recorded in a cross-sectional study with 358 men and women in various occupations. Symptoms were recorded from the musculoskeletal system with a questionnaire, and signs were detected in a medical examination of all body regions. The analyses of statistical associations between the psychosocial factors and musculoskeletal disorders were performed with control for age, gender, and physical load. RESULTS: The most consistent and pronounced associations were mainly seen between poor psychosocial work conditions and coexisting symptoms and signs of the neck and back regions. Poor psychosocial work conditions were more consistently and strongly associated with signs of muscular (soft tissue) tenderness than with signs of tenderness in the joints, tendons, or muscular insertions or signs in nerve compression tests. Mainly low social support at work, but also high psychological demands and high job strain, were associated with such symptoms and signs, whereas decision latitude at work showed few associations with musculoskeletal disorders. CONCLUSIONS: Perceived poor psychosocial work conditions are statistically associated mainly with symptoms and signs of muscular tenderness in the central body regions. Studies on associations between psychosocial work conditions and musculoskeletal disorders should separate effect measures of different clinical signs and different body regions in order to avoid attenuation of the risk estimates.

An activity analysis of hand grips used in housework by female rheumatoid arthritics.

In this nonexperimental study, videofilmed, self-selected housework activities of rheumatic women were analyzed. The women gripped and manipulated objects in their homes. The activities were analyzed under the headings Activity, Actions, Objects, and Grip. The films were viewed frame by frame, and the data was computerized for statistical analysis. The women performed five self-selected housework activities and eight groups of actions (n = 340). During the actions the women handled 12 groups of objects using the eight grip classes of Sollerman's grip classification. The diagonal volar grip was the most common grip (20%), and the tripoid pinch was the least common (0.29%); 34% of the actions were right-handed, 19% left-handed, and 47% bimanual. No clear grip pattern was revealed by the activity analysis.

Physical training in rheumatoid arthritis: A controlled long-term study. II. Functional capacity and general attitudes.

Twenty-three patients with rheumatoid arthritis have been given physical training for 4-8 years. They are compared with a control group of patients with the same disease. In order to evaluate disease outcome, patients were given a self-administered questionnaire to report ADL capacity and some attitudes and feelings concerning their situation. Results are in agreement with earlier reports and show a significantly higher ADL capacity in the trained group compared with the control group. There is a positive correlation between ADL capacity and reported amount of physical training and a negative correlation between ADL capacity and X-ray findings and findings at clinical examination. The feeling of weakness is more pronounced in the control group and patients in this group get more discomfort from joints after physical strain than patients in the trained group. A majority of patients in the two groups wish to participate in organized group-training.

Ultrastructural and histochemical studies of muscle in rheumatoid arthritis.

Muscle biopsy material from 12 patients with rheumatoid arthritis was investigated by electron microscopy. Degenerative changes and atrophy of the muscle fibres were observed. The periphery of the fibre was indistinct and showed an increased content of lipofuscin granules and remnants of myofilaments. Mitochondria were frequent in the subsarcolemmal regions, but between the myofibrils these were rarer than in healthy subjects. The triads were often swollen and displaced. Capillaries were more frequent than in normal material; the endothelial cells and especially the basement membrane showed pathological changes. Satellite cells were frequent and are regarded as an indication of regeneration.

A comparison of pressure pain thresholds in different tissues and body regions. Long-term reliability of pressure algometry in healthy volunteers.

Pressure pain thresholds (PPTs) were measured in 12 healthy female volunteers with a hand-held electronic pressure algometer (Somedic). The PPTs over 30 points, mainly located on the trunk, were measured in a randomized order. The measurements were repeated after one week and again 10-13 weeks later. Three spots over nerve tissue had lower PPTs than nearby muscle. There were no consistent differences between muscle and periosteum within the same region. Overall there was a tendency for points in the nape region to have the lowest PPT, and those in the lumbosacral region to have the highest. The shoulder points had intermediate values. The interindividual differences were great. There was no difference between the mean PPTs from the first session and those from the second session. However, at the third session, 10 weeks later, the average PPT value was substantially higher than in the previous sessions.

Changes in muscle fibre size and physical performance in patients with rheumatoid arthritis after short-term physical training.

Ten patients with rheumatoid arthritis of moderate severity were given 6 weeks' intense physical training. During the investigation period the patients improved their physical performance capacity as well as their rate of perceived exertion. There was an increase in the muscle fibre size, of type I and type II, most pronounced in the latter fibre group. No 'flare-up' of the arthritis could be seen during the training period. Comments are made as to which patients might benefit by a short-term physical training.

Gastrointestinal protection by low-dose oral prostaglandin E2 in rheumatic diseases.

In a previous study oral prostaglandin E2 (PGE2) was shown to protect against indomethacin-induced gastrointestinal bleeding in patients with rheumatic diseases. This study examined whether a lower oral dose of PGE2, without acid antisecretory effect, is protective. Its methylated analogue 15(R)15 Me PGE2, which has effect on the acid secretion given orally, was also tested. Indomethacin, 50 mg three times daily, induced an increase in gastrointestinal bleeding measured by the 51Cr technique. PGE2, 033 mg three times daily, taken concomitantly significantly reduced fecal blood loss. 15(R)15 Me PGE2, 40 microgram three times daily, was also effective. The prostaglandins did not increase joint symptoms and had no significant side effects. It is suggested that the combination of nonsteroidal anti-inflammatory drugs with a low oral dose of E2 prostaglandins could be used clinically, especially in patients with rheumatic diseases.

Assessment of patients with chronic back pain using the "Functional Status Questionnaire".

Forty-eight patients with chronic back pain undergoing a rehabilitation program were assessed with the Functional Status Questionnaire (FSQ) during the first week of rehabilitation and after 6 weeks, 6 months and one year. In their first test, all the patients showed diminished functional capacity in at least one of five summary scales, indicating serious health problems and a need for rehabilitation. The test-retest correlation was k = 0.96, indicating high reliability of the questionnaire. After 6 weeks of rehabilitation the patients estimated significant improvements regarding "Satisfaction with health", "Mental health" and "Number of close friends". Some of these improvements were maintained after 6 months and one year. The "Basic ADL" and "Intermediate ADL" scales, however, showed no changes, indicating either low sensitivity or that no real changes had occurred during the rehabilitation period. The FSQ is recommended for use among patients with chronic back pain, but the tests need to be supplemented with other measurements concerning ADL capacity.

Clinical reliability of shoulder function assessment in patients with rheumatoid arthritis.

A model for functional assessment and a dynamic test of the shoulder joint were designed and tested for normal variation and clinical inter- and intra-rater reliability. The functional assessments, which covered four common shoulder functions, were compared with assessments of pain, recordings of active motion range and the results of a Health Assessment Questionnaire, in eight patients with rheumatoid arthritis according to the ARA criteria. Intra-rater reliability was satisfactory for all four functions and inter-rater reliability was satisfactory for the hand-raising and hand-to-opposite-shoulder functions but less so for hand-behind-back and hand-to-neck. A second test-retest study in 15 patients, with a slight modification of one of the functional tests, confirmed the results and improved the reliability of the modified test. The reliability of the dynamic test and of the active motion range measurement was less satisfactory or not satisfactory. No significant correlation was found between shoulder functional assessment and the Fries index, but there were positive significant correlations between active motion range and shoulder functions. It is concluded that the method presented for evaluating shoulder functions has satisfactory reliability and in the first test-retest study was more reliable than conventional motion range measurement of the shoulder joint.

Relationships between measurements of impairment, disability, pain, and disease activity in rheumatoid arthritis patients with shoulder problems.

Relationships between the results from shoulder movement impairment assessments, a shoulder-arm disability questionnaire, the disability indices Health Assessment Questionnaire (HAQ), Sickness Impact Profile (SIP) and Functional Status Questionnaire (FSQ), shoulder pain, and disease activity (ESR and the number of swollen joints) were analysed in a study evaluation outcome measurements to rheumatoid arthritis patients with shoulder problems. Sixty-seven women aged 24-82 years (mean 59.3) average disease duration 13 years were involved. The associations between shoulder movement impairment and HAQ, SIP physical and overall, FSQ and shoulder-arm disability questionnaire factor 1 were statistically significant, but of moderate magnitude (0.45 < or = r < or = 0.55, p or = 0.001). Shoulder pain correlated significantly but moderately to shoulder impairment and to FSQ (0.44 < or = r < or = 0.49, p < or = 0.001). Disease activity did not correlate to shoulder impairment, disability or shoulder pain. Despite some overlapping, impairment, disability, pain, and disease activity represent different areas and must be measured separately.