Description

Publisher details

Elsevier

Publications in this journal

• Non-pharmacological strategies in cardiovascular prevention: 2011 highlights.

  Authors: T Guiraud, M Labrunee, M Gayda, M Juneau, V Gremeaux

  Annals of physical and rehabilitation medicine.

  The clinical efficacy of cardiac rehabilitation programs is clearly recognized. Yet, as regards the three main currently employed strategies (exercise, education, and psychobehavioral support), newThe clinical efficacy of cardiac rehabilitation programs is clearly recognized. Yet, as regards the three main currently employed strategies (exercise, education, and psychobehavioral support), new ideas regularly appear, stemming from studies aimed at providing proof of their efficacy and innocuousness, along with optimal modes of prescription and, at times, their cost-benefit ratio. This ongoing work, which was initially developed in view of enriching the "What's new in?" section of the Sofmer website, represents a selection of articles that may be non-exhaustive, yet is maximally diversified and as representative as possible of the main 2011 highlights in the field of cardiovascular prevention. Each of the articles selected puts forward an original idea, confirms the existence of an effect that was suspected or has had some impact on clinical practice in the field of non-pharmacological management of cardiovascular disease. In line with the multidisciplinary approach of Physical Medicine and Rehabilitation (PMR), the Sofmer cardiovascular rehabilitation group has associated itself with a wide range of specialists (PMR, cardiologists, exercise physiologists, experts in the science and technology of physical activities), all of whom are involved in clinical research and the management of more and more patients. Our objective was consequently to compile a selection of commented articles most likely to interest the different operatives (doctors, nurses, physiotherapists, dietitians, adapted physical activity instructors, psychologists) working with these patients in rehabilitation units or in phase III associative structures. Their goals may vary: (1) learners may wish to further their knowledge of cardiac rehabilitation techniques; (2) practitioners may be interested in continued education but not have the time for regular bibliographic updates; (3) researchers may be intent on informing themselves on the latest breakthroughs and/or arousing their imagination… Enjoy your reading!

• Comparison of energy cost in transtibial amputees using "prosthesis" and "crutches without prosthesis" for walking activities.

  Authors: R K Mohanty, P Lenka, A Equebal, R Kumar

  Annals of physical and rehabilitation medicine.

  BACKGROUND: In a survey of 100 transtibial amputees (TTA) in the study place, it was noticed that nearly 30% of total activities performed by crutches. It was recorded nearly 52% of the amputees wereBACKGROUND: In a survey of 100 transtibial amputees (TTA) in the study place, it was noticed that nearly 30% of total activities performed by crutches. It was recorded nearly 52% of the amputees were totally independent, 39% had to use a crutch or cane and only 9% need not used any devices simply because they are unaware of current technology or availability. Out of 39 TTA, nine used crutches only for performing daily activities while 30 used both prosthesis and crutch. Walking is a major activity in lower limb amputees and therefore it is imperative to know the energy cost in both the mobility devices (prosthesis and crutches without prosthesis) for walking activities. OBJECTIVES: The purpose of this study was to quantify and compare the difference in energy cost between the two most commonly used assistive devices (prosthesis and axillary crutches) in adults with Transtibial amputation by indirect calorimetric method at the self-selected speed in plane surface walking. METHODS: Thirty adults who had a unilateral transtibial amputation participated in this study. Oxygen consumption was measured with a Cosmed K4 b(2) oxygen analysis telemetry unit (Rome, Italy) as the participants walked over level ground for 30 meters at a self-selected speed. The variables that were analyzed were VO(2) rate (mL/min), VO(2) cost (mL/kg/m), heart rate (bpm), self-selected walking velocity (m/min) and energy expenditure per minute (Kcal/min). RESULTS: It was observed that VO(2) uptake rate and EE comparisons were highly significant for both prosthesis and crutches without prosthesis walking in adults with transtibial amputation (P<0.025). There was significant difference between prosthesis walking and crutches without prosthesis walking in terms of VO(2) uptake rate (P<0.005) and EE/min (P<0.00001). It was noticed the adults with transtibial amputation using prosthesis walked with 21% more efficient in terms of VO(2) uptake rate and 92% more efficient in terms of EE/min as compared to crutches without prosthesis. CONCLUSIONS: The data on energy cost indicates that all below knee amputee groups walk with less effort by using prosthesis. It may be concluded that crutches without prosthesis may not be used as a permanent rehabilitative measure in transtibial amputations.

• Comparison of gaseous cryotherapy with more traditional forms of cryotherapy following total knee arthroplasty.

  Authors: C Demoulin, M Brouwers, S Darot, P Gillet, J-M Crielaard, M Vanderthommen

  Annals of physical and rehabilitation medicine.

  OBJECTIVE: The aim of this study was to assess the efficacy of gaseous cryotherapy following total knee arthroplasty (TKA) and to compare it to routinely used strategies for applying cold therapy.OBJECTIVE: The aim of this study was to assess the efficacy of gaseous cryotherapy following total knee arthroplasty (TKA) and to compare it to routinely used strategies for applying cold therapy. PATIENTS AND METHODS: Sixty-six patients undergoing primary unilateral TKA were randomized into three groups and received "gaseous cryotherapy (GC)", "cold pack" and "cryocuff" applications, respectively throughout the hospital stay. Primary outcomes (knee pain intensity, mobility and girth measurements) were recorded on preoperative day 1 as well as on postoperative day (POD) 7. Cutaneous temperature of the knee sides were also measured on POD7 just before and immediately after cold application. RESULTS: Although skin temperature dropped to 14°C following GC versus 22 to 24°C for the other two applications (P<0,05), the three groups did not differ at POD7 regarding the three primary outcomes. No adverse effects were observed with any of the ways of application. CONCLUSIONS: Gaseous cryotherapy was not more beneficial than routinely used strategies for applying cold therapy. Further studies with larger sample size and with a more frequent and closer gaseous cryotherapy applications are needed to confirm our results.

• Isokinetic muscle strengthening after acquired cerebral damage: A literature review.

  Authors: N Hammami, F O Coroian, M Julia, M Amri, D Mottet, C Hérisson, I Laffont

  Annals of physical and rehabilitation medicine.

  OBJECTIVE: Isokinetic strengthening is a rehabilitation technique rarely used in stroke patients. However, the potential benefits of force and endurance training in this population are stronglyOBJECTIVE: Isokinetic strengthening is a rehabilitation technique rarely used in stroke patients. However, the potential benefits of force and endurance training in this population are strongly suspected. METHOD: This literature review synthesizes the results of clinical trials on this topic. The research was conducted on PubMed, using "Stroke", "rehabilitation", "isokinetic", "upper limb" and "training" as keywords. RESULTS: Seventeen studies focusing on the use of isokinetics in assessment or rehabilitation (six studies) following stroke were reviewed. For the lower limb, muscle strength and walking ability improved after isokinetic rehabilitation programs. For the upper limb, the only two studies found in the literature suggest improvement in the strength of the trained muscles, of grip force, of the Fugl-Meyer motor score and of global functional capacities. This review does not reveal any consensus on the protocols to be implemented: type of muscle contraction, velocities…. CONCLUSION: While isokinetic strengthening has not proven its efficiency in rehabilitation of the upper limb following stroke, its interest with regard to rehabilitation of the lower limbs has been recognized. Randomized controlled trials in this field are necessary to confirm its efficiency, especially concerning upper arm rehabilitation.

• Effects of a customized biomechanical therapy on patients with medial compartment knee osteoarthritis.

  Authors: M Drexler, A Elbaz, A Mor, R Debi, E M Debbi, A Haim, R Lador, M Salai, G Segal

  Annals of physical and rehabilitation medicine.

  OBJECTIVE: Previous studies have shown that a customized biomechanical therapy can improve symptoms of knee osteoarthritis. These studies were small and did not compare the improvements acrossOBJECTIVE: Previous studies have shown that a customized biomechanical therapy can improve symptoms of knee osteoarthritis. These studies were small and did not compare the improvements across gender, age, BMI or initial severity of knee osteoarthritis. The purpose of this study was to evaluate the effect of new biomechanical therapy on the pain, function and quality of life of patients with medial compartment knee osteoarthritis. METHODS: Six hundred and fifty-four patients with medial compartment knee osteoarthritis were examined before and after 12weeks of a personalized biomechanical therapy (AposTherapy). Patients were evaluated using the Western Ontario and McMaster Osteoarthritis (WOMAC) Index and SF-36 Health Survey. RESULTS: After 12weeks of treatment, the WOMAC-pain and WOMAC-function subscales were significantly lower compared to baseline (both P≤0.001). All eight categories of the SF-36 health survey significantly improved after treatment (all P≤0.001). Females and younger patients showed greater improvements with therapy. CONCLUSIONS: Twelve weeks of a customized biomechanical therapy (AposTherapy) improved symptoms of patients with medial compartment knee osteoarthritis. We recommend that this therapy will be integrated in the management of knee osteoarthritis.

• Predicting chronicity in acute back pain: Validation of a French translation of the Örebro Musculoskeletal Pain Screening Questionnaire.

  Authors: O Nonclercq, A Berquin

  Annals of physical and rehabilitation medicine.

  OBJECTIVE: To establish the predictive validity of a French translation of the Örebro Musculoskeletal Pain Screening Questionnaire (OMPSQ), a screening tool assessing the risk of chronicity inOBJECTIVE: To establish the predictive validity of a French translation of the Örebro Musculoskeletal Pain Screening Questionnaire (OMPSQ), a screening tool assessing the risk of chronicity in patients with back pain. METHODS: Prospective follow-up study. Assessment was performed at inclusion and 6 months later with the OMPSQ and the Oswestry Disability Index (ODI). Four outcome variables (pain index, two functional variables and work absence) were defined. RESULTS: Ninety-one patients were included, of whom 80% completed the study. Depending on the outcome variable considered, 42 to 82% of the patients recovered within 6 months. ROC AUC, a global measure of the performance of the questionnaire integrating sensitivity and specificity data, ranged from 0.73 to 0.83. When considering the functional outcome variable derived from the ODI, a low cut-off score of 71 (corresponding to 80% sensitivity) and a high cut-off score of 106 (corresponding to 80% specificity) can be used to distinguish three groups of patients: low, intermediate and high risk of chronicity. CONCLUSION: The predictive value of the French version of the OMPSQ is reasonably good, in line with the studies in other languages. This questionnaire may be particularly valuable in secondary care settings.

• Reproducibility of the time to peak torque and the joint angle at peak torque on knee of young sportsmen on the isokinetic dynamometer.

  Authors: P-L Bernard, M Amato, F Degache, P Edouard, S Ramdani, H Blain, P Calmels, P Codine

  Annals of physical and rehabilitation medicine.

  BACKGROUND: Although peak torque has shown acceptable reproducibility, this may not be the case with two other often used parameters: time to peak torque (TPT) and the angle of peak torque (APT).BACKGROUND: Although peak torque has shown acceptable reproducibility, this may not be the case with two other often used parameters: time to peak torque (TPT) and the angle of peak torque (APT). Those two parameters should be used for the characterization of muscular adaptations in athletes. METHODS: The isokinetic performance of the knee extensors and flexors in both limbs was measured in 29 male athletes. The experimental protocol consisted of three consecutive identical paradigms separated by 45min breaks. Each test consisted of four maximal concentric efforts performed at 60 and 180°/s. Reproducibility was quantified by the standard error measurement (SEM), the coefficient of variation (CV) and by means of intra-class correlation coefficients (ICCs) with the calculation of 6 forms of ICCs. RESULTS: Using ICC as the indicator of reproducibility, the correlations for TPT of both limbs showed a range of 0.51-0.65 in extension and 0.50-0.63 in flexion. For APT, the values were 0.46-0.60 and 0.51-0.81, respectively. In addition, the calculated standard error of measurement (SEM) and CV scores confirmed the low level of absolute reproducibility. CONCLUSIONS: Due to their low reproducibility, neither TPT nor APT can serve as independent isokinetic parameters of knee flexor and extensor performance. So, given its reproducibility level, TPT and APT should not be used for the characterization of muscular adaptations in athletes.

• Physical and Rehabilitation Medicine (PRM) care pathways: "Patients after total hip arthroplasty"

  Authors: P Ribinik, F Le Moine, G de Korvin, E Coudeyre, M Genty, F Rannou, A Yelnik, P Calmels

  Annals of physical and rehabilitation medicine.

  This document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (SOFMER) and the French Federation of PRM (FEDMER). These documents describe theThis document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (SOFMER) and the French Federation of PRM (FEDMER). These documents describe the needs for or a specific type of patients; PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes. "Care pathways in PRM" is a short document designed to enable the reader (physicians, decision-maker, administrator, lawyer or finance manager) to quickly apprehend the needs of these patients and the available therapeutic care structures for proper organization and pricing of these activities. Patients after total hip arthroplasty are classified into three care sequences and two clinical categories, each one being treated with the same six parameters according to the International Classification of Functioning, Disability and Health (WHO), while taking into account personal and environmental factors that could influence the needs of these patients.

• Back pain during pregnancy and living conditions - a comparison between Beninese and Canadian women.

  Authors: K Charpentier, J Leboucher, M Lawani, H Toumi, G-A Dumas, A Pinti

  Annals of physical and rehabilitation medicine.

  OBJECTIVE: The objective of this exploratory study was to investigate and underline the contrasts between African and Canadian pregnant women, and their living conditions. We also intended toOBJECTIVE: The objective of this exploratory study was to investigate and underline the contrasts between African and Canadian pregnant women, and their living conditions. We also intended to evaluate how they compared on low back pain, a condition that seems common across all pregnant women everywhere in the world. SUBJECTS AND METHOD: Thirty Beninese and 50 Canadian women were surveyed with demographic disability questionnaires O.D.I at approximately 25 weeks of pregnancy. RESULTS: There were large differences between the two groups due to the differences between the life style. Beninese women were more likely to be self-employed or housewives, while Canadian women were more likely to be employed. Beninese women worked for 18hours more per week, and had on average one more child at home. A higher percentage of Beninese women reported back pain, 83% versus 58% for Canadian women, but the disability scores were in the "moderate disability" range for both groups. A higher percentage of Beninese women also reported at least severe disability, 33% versus 14% for Canadian women. CONCLUSION: The results suggest that the higher percentages of Beninese women affected by back pain and by severe back pain is related to the longer hours worked and more strenuous physical work performed.

• Patients with complicated Pott's disease: Management in a rehabilitation department and functional prognosis.

  Authors: A Zaoui, S Kanoun, H Boughamoura, M Ben Maitigue, M A Bouaziz, F Khachnaoui, N Rejeb

  Annals of physical and rehabilitation medicine.

  OBJECTIVE: The objective is to study the rehabilitation management and to assess autonomy in daily life activities as well as walking recovery in patients with complicated Pott's disease. PATIENTSOBJECTIVE: The objective is to study the rehabilitation management and to assess autonomy in daily life activities as well as walking recovery in patients with complicated Pott's disease. PATIENTS AND METHODS: Retrospective study in nine patients over a period of 8 years extending from 2000 to 2008, collated in the Department of Physical Medicine and Functional Rehabilitation, CHU Sahloul, Sousse, Tunisia. RESULTS: The mean age of our patients was 43.8 years; sex ratio was 5/4. The spine involvement of tuberculosis was dorsal in seven cases, dorso-lumbar in one patient, and multiple (cervical, dorsal and lumbar) in one case. All patients were paraplegic with a neurological involvement of the bladder. They had prior antituberculosis chemotherapy for at least 8 months. Decompression surgery was performed in six cases. Two female patients presented disorders of spinal posture during treatment requiring surgical revision with osteosynthesis. All patients received additional rehabilitation care. Following a mean duration of hospitalisation in the Rehabilitation department of 47 days with twice-daily sessions of tailored physiotherapy, three patients remained in complete paraplegia, autonomous in wheel-chair and with vesical and sphincter incontinence. The measure of functional independence (MFI) was at admission/discharge 71/92. CONCLUSION: Rehabilitation takes an important place in the medico-surgical management in Pott's disease, to limite or compensate the disabilities and handicap related to this pathology.

• Pain assessment in Charcot-Marie-Tooth (CMT) disease.

  Authors: C Ribiere, M Bernardin, S Sacconi, E Delmont, M Fournier-Mehouas, H Rauscent, M Benchortane, P Staccini, M Lantéri-Minet, C Desnuelle

  Annals of physical and rehabilitation medicine.

  OBJECTIVE: The objective of our study was to describe and evaluate the prevalence of chronic pain in persons with Charcot-Marie-Tooth (CMT) disease during a multidisciplinary consultation at theOBJECTIVE: The objective of our study was to describe and evaluate the prevalence of chronic pain in persons with Charcot-Marie-Tooth (CMT) disease during a multidisciplinary consultation at the Center of Reference for Neuromuscular Diseases. METHODOLOGY: This prospective study was conducted between 2008 and 2010, it was a partnership between a Center of Reference for Neuromuscular Diseases (Centre de référence des maladies neuromusculaires [CRMD]) and a Department for the Assessment and Treatment of Pain (Département d'évaluation et de traitement de la douleur [DETD]). The evaluation consisted in a complete assessment of each patient during the first multidisciplinary consultation, with a previously established diagnosis validated by genetic testing, by various specialists: neurologist, PM&R physician, pain management specialist and physiotherapist. The evaluation tools used were Visual Analogical Scale (VAS), Hospital Anxiety and Depression Scale (HAD), DN4 scale, Neuropathic Pain Symptom Inventory (NPSI) (if DN4≥4), Pain Questionnaire of Saint Antoine (QDSA) (if DN4<4), body representation to define the painful areas, Overall Neuropathy Limitations Scale (ONLS), Medical Research Council scale (MRC), Short Questionnaire on Pain (QCD), VAS during transfers, self-care, getting dressed and physiotherapy sessions and quantified use of analgesics. RESULTS: A total of 50 patients were included (28 women, 22 men); two patients (one man and one woman) were discarded from the study because of missing pain assessment data. Mean age was 47years (R: 14-85), in average the symptoms had been present for the past 20years (R: 0.3-68), most patients had little impairment, the mean MRC was 53 (R: 36-60), with CMT1A being predominant (CMT1A: 76.9%, CMTX: 13.5%, CMT2: 5.8%, CMT4: 3.8%). It is noted that 65.4% of patients reported some pain with a mean duration of pain at 140months (R: 5-660). The mean VAS was 5.5 (R: 1-10), greater than 4 in 79.4% of cases, requiring the use of analgesics in 38.4% of cases (step 1: 60%, step 2: 40% on the WHO pain relief ladder). The predominant location of the pain was distal, peripheral and symmetric (64.7%); furthermore the feet were affected in 80% of cases. DN4 was positive in 40.6% of painful patients. In 62.5% of the cases, the pain did not have an underlying mechanical origin. The emotional impact remained quite modest (HAD: A=8; D=5). Patients with CMT1A seemed less affected by pain (P=0.03). CONCLUSION: This original study describes the pain in patients with CMT disease during a primary multidisciplinary consultation. We see that in 66% of cases, patients do report some pain, this pain is usually moderate, preferentially located in the extremities and is symmetric. In 62.5% of cases, the pain has a neuromuscular origin with a positive DN4 in 50% of cases in this etiology. In our study, patients with CMT1A report less pain than patients with other CMT types. This disease being quite rare (rare disease), the number of patients did not allow us to bring up statistically significant results. The pain must be thoroughly screened for because of its frequency in persons with CMT.

• Physical and Rehabilitation Medicine (PRM) care pathways: "Patients after total knee arthroplasty"

  Authors: P Ribinik, F Le Moine, G de Korvin, E Coudeyre, M Genty, F Rannou, A Yelnik, P Calmels

  Annals of physical and rehabilitation medicine.

  This document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (SOFMER) and the French Federation of PRM (FEDMER). These documents describe theThis document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (SOFMER) and the French Federation of PRM (FEDMER). These documents describe the needs for or a specific type of patients; PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes. "Care pathways in PRM" is a short document designed to enable the reader (physicians, decision-maker, administrator, lawyer or finance manager) to quickly apprehend the needs of these patients and the available therapeutic care structures for proper organization and pricing of these activities. Patients after total knee arthroplasty are classified into three care sequences and two clinical categories, each one being treated with the same six parameters according to the International Classification of Functioning, Disability and Health (WHO), while taking into account personal and environmental factors that could influence the needs of these patients.

• Therapeutic education and intermittent self-catheterization: Recommendations for an educational program and a literature review.

  Authors: F Le Breton, A Guinet, D Verollet, M Jousse, G Amarenco

  Annals of physical and rehabilitation medicine.

  PURPOSE: To review the literature and to clarify the recommendations for therapeutic education programs for intermittent self-catheterization. MATERIALS AND METHODS: The literature on Medline,PURPOSE: To review the literature and to clarify the recommendations for therapeutic education programs for intermittent self-catheterization. MATERIALS AND METHODS: The literature on Medline, Pubmed, and Cochrane Library, with specific keywords, as well as the recommendations based on expert consensus. RESULTS: Clean intermittent self-catheterization (CICS) is the gold standard for managing chronic urinary retention, which allows the patients to improve their quality of life and to reduce the complications of upper urinary tract infections. Patient education needs to have a structured procedure in order to evaluate the ability to understand, accept and perform CISC. CONCLUSION: Teaching self-catheterization is now well known; nevertheless, the effectiveness of CISC educational therapeutic programs remains to be demonstrated.

• [The spine throughout time].

  Authors: J-C Bernard

  Annals of physical and rehabilitation medicine. 55(2):75.

• Dystonic pattern in a fibromyalgia patient: Relevance of a biopsychosocial rehabilitation approach.

  Authors: V Prist, V-A De Wilde, E Masquelier

  Annals of physical and rehabilitation medicine.

  We present the complex case of a 49-year-old woman who worked as a cook in a school cafeteria and has been suffering from widespread pain since 2002. This patient showed a very particular gaitWe present the complex case of a 49-year-old woman who worked as a cook in a school cafeteria and has been suffering from widespread pain since 2002. This patient showed a very particular gait pattern with hips adduction, flexed hips and knees and bilateral equinus foot deformity. Clinical examinations conducted by various clinicians, such as physical medicine and rehabilitation (PM&R) physicians and neurologists, yielded very different diagnostic hypotheses, each being nevertheless quite "logical": fibromyalgia syndrome with dystonia, CNS injury, Little's disease, intramedullary spinal cord tumor or multiple sclerosis. The only abnormalities observed occurred during the quantitative sensory test presenting as severe widespread allodynia to cold and hot temperatures and during Laser Evoked Potentials shown as a dysfunctional pattern for central processing of nociceptive data. Gait analysis showed that parameters were in the norms. Considering these different tests and the excellent progression of the patient's gait and general posture, we must envision that the fibromyalgia syndrome hypothesis remained the most likely one. The generalized dystonia was probably due to the patient's analgesic protective attitude. The actual therapy is still based on the biopsychosocial approach.

• Returning to work after a stroke: A retrospective study at the Physical and Rehabilitation Medicine Center "La Tour de Gassies".

  Authors: T Doucet, F Muller, C Verdun-Esquer, X Debelleix, P Brochard

  Annals of physical and rehabilitation medicine. 55(2):112-27.

  To study work re-entry by patients having suffered a stroke at least 3years previously. This was a retrospective survey in which a questionnaire was administered to all patients admitted after aTo study work re-entry by patients having suffered a stroke at least 3years previously. This was a retrospective survey in which a questionnaire was administered to all patients admitted after a first stroke to the "La Tour de Gassies" Centre for Physical and Rehabilitation Medicine (CPRM) in France between January 2005 and June 2007 and who were in work at the time of the incident. Fifty-six of the 72 included patients (78%) completed and returned the survey questionnaire. The mean age at the time of the stroke was 48.3±10.1. Eighteen (32.1%) of the 56 patients returned to work after their stroke (mean post-stroke time interval: 19.2±13.4months). Negative prognostic factors for a return to work were living alone, the presence of severe functional impairment and the presence of speech disorders. Positive prognostic factors included specific, professional support and early involvement of the occupational physician. Patients who resumed driving were more likely to return to work and there was a positive correlation between the time to work re-entry and the time to resumption of driving. Close cooperation between occupational health services and CPRM appears to be necessary to speed the return to work by stroke patients.

• Disabling chronic low back pain with Modic type 1 MRI signal: Acute reduction in pain with intradiscal corticotherapy.

  Authors: J Beaudreuil, P Dieude, S Poiraudeau, M Revel

  Annals of physical and rehabilitation medicine.

  OBJECTIVES: The objective of the current study was to compare short- and long-term effect on chronic low back pain of intradiscal injection of methylprednisolone with or without presence of ModicOBJECTIVES: The objective of the current study was to compare short- and long-term effect on chronic low back pain of intradiscal injection of methylprednisolone with or without presence of Modic type 1 MRI changes. PATIENTS AND METHODS: Medical charts of patients receiving intradiscal injection of methylprednisolone from January 1, 1995 to December 31, 1998 were retrospectively reviewed. Clinical parameters were recorded at baseline, 24h after injection and at follow-up (12-14 months). Patients were studied in three groups: Modic I-a, if patients had Modic type 1 changes with no previous surgery or nucleolysis (n=30); Modic I-b, if patients had Modic type 1 changes at the level of previous surgery or nucleolysis (n=37); Control, if patients had no Modic type 1 changes (n=30). RESULTS: Twenty-four hours after methylprednisolone injection, higher proportion of patients with self-assessed improvement was observed in Modic I-a (90%) and Modic I-b (71%) than in Control (30%). Low back pain decreased in both Modic groups. Low back pain did not vary from baseline in controls. No effect was detected in three groups, neither for radiating pain 24h after injection, nor for any outcome parameters at the latest follow-up. CONCLUSIONS: We suggest that patients with disabling chronic low back pain and Modic type 1 MRI changes have specific acute response to intradiscal injection of methylprednisolone. Clinical studies are however necessary to further investigate the effectiveness and safety of such injections.

• Lower back pain and neck pain: Is it possible to identify the painful side by palpation only?

  Authors: J-Y Maigne, P Cornelis, G Chatellier

  Annals of physical and rehabilitation medicine. 55(2):103-11.

  Back pain is often attributed to increased tension in the back muscles, regardless of whether the tension is primary or related to a disc/facet pathology. We hypothesized that when either lower backBack pain is often attributed to increased tension in the back muscles, regardless of whether the tension is primary or related to a disc/facet pathology. We hypothesized that when either lower back pain or neck pain is unilateral, the muscle tension would be more pronounced on the painful side and could be detected by palpation alone (i.e. without the need to apply pain-triggering manoeuvres). Patients with unilateral neck or lower back pain were enrolled in the study. Participants with scoliosis, obesity, a history of spinal surgery or pain radiating below the knee or the elbow were excluded. The patients were examined by comparative muscle palpation only. The examiner was unaware of which body side was painful and the patient was told to remain still and silent. The spinal muscles were examined bilaterally, with superficial and deep palpation. The examiner had to determine on which side the tension was greater. The patients' age, body mass index, time since onset of symptoms and Rolland Morris (lower back pain) and INDIC (neck pain) functional disability questionnaire scores were recorded. Ninety-one patients with unilateral lower back pain (35males, 56females; mean±SD age: 45.2±15 yrs) and 94patients with unilateral neck pain (26males, 68females, 49.1±15 yrs) were enrolled in the study. The lower back pain and neck pain were right-sided in 50 (54.9%) and 53 (56.4%) of cases, respectively. The examiners correctly identified the painful side in 64.8% of the cases of lower back pain (a significantly better percentage than chance alone (i.e. 50%), P=0.02) and 58.5% (P=0.10) of the cases of neck pain. In lower back pain patients, the results were better for right-side pain than for left-side pain (70.0% and 58.5% of correct answers, respectively, ns). In neck pain patients, the results were better for left-side pain than right-side pain (61% and 56.6%, respectively, ns). There were no significant differences between the two examiners' respective performance levels. The patients' clinical parameters did not appear to influence successful detection of the painful side. Our findings suggest that palpation can detect increased muscle tension in a limited proportion of cases.

• Evaluation of medical students' expectations for multimedia teaching materials: Illustration by an original method using the evaluation of a web site on cardiovascular rehabilitation.

  Authors: J-M Casillas, V Gremeaux

  Annals of physical and rehabilitation medicine. 55(1):25-37.

  Different multimedia tools have been developed to help medical students prepare for the National Ranking Examination (NRE), rendering their choice quite difficult. No study has specifically evaluatedDifferent multimedia tools have been developed to help medical students prepare for the National Ranking Examination (NRE), rendering their choice quite difficult. No study has specifically evaluated students' expectations regarding these materials. To learn how medical students in Dijon assessed a website dedicated to cardiovascular rehabilitation, and collecting their suggestions in order to meet their expectations and the goals of second cycle medical studies. Eighteen second-cyle students were evaluated in a semi-directed manner and in ecological situation, a website specifically designed for the national curricula on cardiovascular rehabilitation for obtaining the Diploma of Specialty Studies (DES) for physical medicine and rehabilitation (PM&R) residents. Students also had to fill out a pretest and a posttest (5 MCQs). The overall quality of the site was deemed satisfactory (65.6±7.7 points/100). Medical information was considered better than non-medical data and site's design (respectively 84.8±8.1, 61.1±20 and 64.4±14.9/100). Students found the site useful in terms of understanding the items related to cardiovascular rehabilitation, although they judged it not completely in line with the NRE goals. The average score increased significantly between the pre-and post-test (6.8±0.8 vs. 5±1.5/8, p<0.05). This site appears to be significantly useful for short-term knowledge improvement, but only partially meeting the expectations of second-cycle students. It seems relevant to study further possibilities for customizing and providing summarized learning for the NRE. These elements could serve as building grounds for the future version of this website.

• [Report of the 26th SOFMER congress in Nantes].

  Authors: B Perrouin-Verbe, J-F Mathé, A Yelnik, G Amarenco

  Annals of physical and rehabilitation medicine. 55(1):1-3.

• Pathogenesis of idiopathic scoliosis: A review.

  Authors: M de Sèze, E Cugy

  Annals of physical and rehabilitation medicine. 55(2):128-38.

  Idiopathic scoliosis is a three-dimensional deformation of the spine. As its name suggests, its pathogenesis remains poorly understood. Enhanced comprehension of its pathogenesis would be likely toIdiopathic scoliosis is a three-dimensional deformation of the spine. As its name suggests, its pathogenesis remains poorly understood. Enhanced comprehension of its pathogenesis would be likely to improve current therapeutic results. While the hereditary and genetic origin of scoliosis appears unassailable and several chromosomes are known to be involved in transmission, the role assumed by each individual chromosome remains uncertain, and the mechanisms leading to the expression of scoliosis have yet to be determined. Even though a large number of pathogenetic hypotheses have been put forward and numerous studies carried out, none of these hypotheses have won unanimous approval, and the controversy remains persistent. The objective of this paper is to identify the existing hypotheses and to group them within large-scale etiological categories. We examined the Pubmed and Goggle databases using as keywords "idiopathic scoliosis" and "pathogenesis". The search was limited to articles in English and French. The vicious cycle hypothesis is markedly preponderant. However, no existing pathogenetic model adequately accounts for the formation of scolioses. We are proposing four main pathogenetic mechanisms: asymmetric bone growth dysregulation, susceptibility of bones to deformation, abnormal passive spinal system maintenance and disturbed active spinal system maintenance.

• Quality of life and brace-treated idiopathic scoliosis: A cross-sectional study performed at the Centre des Massues on a population of 120 children and adolescents.

  Authors: J Deceuninck, J-C Bernard

  Annals of physical and rehabilitation medicine.

  OBJECTIVES: To determine the influence of orthopedic treatment on quality of life (QoL) in children and adolescents with idiopathic scoliosis and treated with either the carbon brace (CMCR, corsetOBJECTIVES: To determine the influence of orthopedic treatment on quality of life (QoL) in children and adolescents with idiopathic scoliosis and treated with either the carbon brace (CMCR, corset monocoque carbone respectant la respiration) or the Lyon brace. To compare these braces. PATIENTS AND METHODS: A cross-sectional study on a population of 120 patients with idiopathic scoliosis, visiting for routine evaluation following the onset of an orthopedic treatment at the Centre des Massues in Lyon. Eighty-two patients used the carbon brace and 38 patients used the Lyon brace. The patients completed the SRS-22 questionnaire (where a low score means a bad QoL), an evaluation scale of QoL specific to spinal deformities, and visual analogue scales (VAS) for pain, motivation and QoL ranging from 0 to 100mm. RESULTS: The QoL of Lyon brace-treated patients is significantly worse than that of patients treated with a carbon brace for the overall score (mean±SD, 4.05±0.37 vs 3.77±0.46, P=0.002) as well as for function (P=0.01), pain (P=0.001), and appearance (P=0.004). These results are confirmed by the VAS for QoL (P=0.001). CONCLUSION: The use of the carbon brace and of the Lyon brace induces a reduction in QoL whatever the evaluation tool, either SRS-22 or VAS. However, the use of the Lyon brace impairs QoL more than the use of the carbon brace.

• Follow-up of the sagittal spine by optical technique.

  Authors: J Legaye

  Annals of physical and rehabilitation medicine.

  OBJECTIVES: Report the use of an optical technique for individual monitoring of the sagittal morphology of the spine in an upright position while avoid irradiation. SUBJECTS AND METHODS: The seriesOBJECTIVES: Report the use of an optical technique for individual monitoring of the sagittal morphology of the spine in an upright position while avoid irradiation. SUBJECTS AND METHODS: The series consists of 15 asymptomatic subjects and 326 cases with spinal disorders. Sagittal analysis is expressed by the global trunk tilt (GTT), the intensity of the curves and their level of inflection. RESULTS: The confidence interval is 2 to 3° and 3 to 6mm according to the parameters. A significant correlation was observed for the global axis measured by optical or radiological techniques. Variations in intensity and proportion of thoracic and lumbar sagittal curves were observed according to the disease, as well as their evolution over a period of 5 to 30 months. Various "strategies" of adaptation have been observed during repeated examinations. DISCUSSION: This non-radiating technique allows to be repeated after initial X-rays, for regular monitoring of a disturbance or a therapeutic effect. Its understandable imaging allows the patient to be aware of his situation. CONCLUSION: This optical technique is reliable and safe for monitoring the sagittal balance while helping further therapeutic target.

• Acquired visual field defects rehabilitation: Critical review and perspectives.

  Authors: M-C Pouget, D Lévy-Bencheton, M Prost, C Tilikete, M Husain, S Jacquin-Courtois

  Annals of physical and rehabilitation medicine. 55(1):53-74.

  Visual field deficit (VFD) is one of the most commonly observed symptoms following brain injury. Persistent VFD and defective exploratory oculomotor scanning patterns often cause severe impairment inVisual field deficit (VFD) is one of the most commonly observed symptoms following brain injury. Persistent VFD and defective exploratory oculomotor scanning patterns often cause severe impairment in daily activities, particularly as regards visual exploration and reading. Homonymous hemianopia is consequently a powerful negative predictor of patient outcome. In spite of these quantitative and qualitative factors, there currently exists no consensus on rehabilitative therapy and treatment. Different approaches have nevertheless been developed, all of them having one therapeutic principle in common; repeated practice of a specific visual task, with the hope/expectation that improved performance will extend to a wide range of ecologically useful visual functions. The four main available methods aim at replacing part of the intact visual field with part of the damaged visual field (optical therapy using prisms), at partially restoring the lost visual field region (restorative therapies), at stimulating detection capacities in the blind field (stimulation or blindsight) or at substituting for the lost region by reorganizing the control of visual information processing and eye movements (compensatory therapies). This review explores the key data relative to these different approaches in terms of behavioral or imagery results. It also aims at critically analyzing the advantages and limits of each one. The importance of strict assessment in terms of deficiencies or disabilities is underlined. Finally, upon consideration of these data taken as a whole, it is suggested that efficient treatment would probably have to associate general components and more specific elements, according to what may be done with regard to other aspects of cognitive rehabilitation.

• Using the Risk Assessment and Predictor Tool (RAPT) for patients after total knee replacement surgery.

  Authors: M Dauty, X Schmitt, P Menu, B Rousseau, C Dubois

  Annals of physical and rehabilitation medicine. 55(1):4-15.

  The aim of this study was to use the Risk Assessment and Predictor Tool (RAPT) to evaluate the risk of complications in patients hospitalized after total knee replacement (TKR) surgery. The medicalThe aim of this study was to use the Risk Assessment and Predictor Tool (RAPT) to evaluate the risk of complications in patients hospitalized after total knee replacement (TKR) surgery. The medical charts of 272 patients who had TKR surgery for knee osteoarthritis (OA) were included in the study. The presurgical RAPT score and Lequesne functional pain index score were determined based on a thorough analysis of the medical charts. Complications that had an impact on the vital prognosis or knee prosthesis outcomes were reported. Patients were compared according to the RAPT and a relative risk of complications was established. Only 12.2% of patients hospitalized in a Physical Medicine and Rehabilitation (PM&R) center after their surgery could have been discharged home directly after their initial hospital stay for TKR surgery (score RAPT more than 9). These patients were mostly men and significantly younger. Their Lequesne score was significantly lower by an average of at least two points. Their relative risk of complications was 0.45 vs. 2.16 for patients who had a RAPT score less than 6. Patients with a RAPT score more than 9 have a low risk of complications. They should not systematically be admitted to a PM&R unit after surgery. On the other hand, for patients with a RAPT score less than 6 a hospital stay in a PM&R care center is justified after TKR surgery.

Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.