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Évaluation des effets de thérapie manuelle des tissus mous chez des femmes, présentant des douleurs lombaires suite à une anesthésie péridurale obstétricale : étude contrôlée randomisée

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Abstract

La lombalgie est fréquente chez les femmes qui ont subi une anesthésie péridurale durant leur accouchement. Elle est instantanée, restreint la fonction du rachis lombaire et réduit ses amplitudes. Le traitement est médicamenteux, physiothérapique ou manuel.MéthodesVingt femmes primipares et lombalgiques, qui ont un âge moyen de 31,5 ± 3,35 ans, qui avaient accouché par voie basse et qui avaient reçu une anesthésie péridurale ont participé à notre étude sur une durée de quatre semaines. Un groupe (n = 10) a bénéficié d’une séance par semaine (1 s/s) de fasciathérapie et l’autre groupe (n = 10) de deux séances par semaine (2 s/s) de physiothérapie (massage, infrarouge, ultra-son, électrothérapie).RésultatsLes deux groupes ont eu une amélioration comparable de leurs variables (sauf pour le Slump test). Un avantage en faveur du traitement manuel a été relevé avec l’obtention des mêmes effets en quatre semaines par un traitement de quatre sessions au lieu de huit.Conclusion Nous avons constaté une différence liée à l’utilisation des deux traitements. Les résultats observés nous incitent à continuer à mieux comprendre les phénomènes neurophysiologiques associés.Niveau de preuveIII.

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The Oswestry Disability Index (ODI) has become one of the principal condition-specific outcome measures used in the management of spinal disorders. This review is based on publications using the ODI identified from the authors' personal databases, the Science Citation Index, and hand searches of Spine and current textbooks of spinal disorders. To review the versions of this instrument, document methods by which it has been validated, collate data from scores found in normal and back pain populations, provide curves for power calculations in studies using the ODI, and maintain the ODI as a gold standard outcome measure. It has now been 20 years since its original publication. More than 200 citations exist in the Science Citation Index. The authors have a large correspondence file relating to the ODI, that is cited in most of the large textbooks related to spinal disorders. All the published versions of the questionnaire were identified. A systematic review of this literature was made. The various reports of validation were collated and related to a version. Four versions of the ODI are available in English and nine in other languages. Some published versions contain misprints, and many omit the scoring system. At least 114 studies contain usable data. These data provide both validation and standards for other users and indicate the power of the instrument for detecting change in sample populations. The ODI remains a valid and vigorous measure and has been a worthwhile outcome measure. The process of using the ODI is reviewed and should be the subject of further research. The receiver operating characteristics should be explored in a population with higher self-report disabilities. The behavior of the instrument is incompletely understood, particularly in sensitivity to real change.
Article
To investigate possible short and long term side effects of epidural analgesia, compared with non-epidural analgesia for pain relief in labour. Randomised controlled study, with long term follow up by questionnaire. Analysis by intention-to-treat. Busy maternity unit within a district general hospital in England. Three hundred and sixty nine primigravid women in labour were included (randomised allocation: epidural n = 184, non-epidural n = 185). Backache at three and twelve months after delivery, instrumental delivery rates and maternal opinion of pain relief in labour. No significant differences were found in the reported incidence of backache between the groups at three months: middle backache [22% vs 20%, chi2 = 0.057, P = 0.81; odds ratio (95% CI) 1.4(0.9-2.3)]; low backache [35% vs 34%, chi2 = 0.009, P = 0.92; odds ratio (95% CI) 1.0(0.6-1.6)]. Nor were there significant differences at 12 months: [middle backache 16% vs 16%, chi2 = 0.013, P = 0.91; odds ratio (95% CI) 1.0(0.5-1.8)]; or low backache [35% vs 27%, chi2 = 1.91, P = 0.17; odds ratio (95% CI) 1.4(0.9-2.3)]. The incidence of instrumental delivery was somewhat higher in the epidural group [30% vs 19%, odds ratio (95% CI) 1.77(1.09-2.86)]. Maternal satisfaction was not significantly different between the groups. This study provided no evidence to support the suggestion of a direct association between the use of epidural anaesthesia in labour and the incidence of long term backache. Despite a significant proportion of women in each group not receiving their allocated analgesia, a significant difference in terms of instrumental delivery rates remained. Satisfaction in both groups of women was high.
Article
A randomized between-groups design evaluated massage therapy versus relaxation for chronic low back pain. Treatment effects were evaluated for reducing pain, depression, anxiety and stress hormones, and sleeplessness and for improving trunk range of motion associated with chronic low back pain. SUMMARY of Twenty-four adults (M age=39.6 years) with low back pain of nociceptive origin with a duration of at least 6 months participated in the study. The groups did not differ on age, socioeconomic status, ethnicity or gender. Twenty-four adults (12 women) with lower back pain were randomly assigned to a massage therapy or a progressive muscle relaxation group. Sessions were 30 minutes long twice a week for five weeks. On the first and last day of the 5-week study participants completed questionnaires, provided a urine sample and were assessed for range of motion. By the end of the study, the massage therapy group, as compared to the relaxation group, reported experiencing less pain, depression, anxiety and improved sleep. They also showed improved trunk and pain flexion performance, and their serotonin and dopamine levels were higher. Massage therapy is effective in reducing pain, stress hormones and symptoms associated with chronic low back pain. Adults (M age=39.6 years) with low back pain with a duration of at least 6 months received two 30-min massage or relaxation therapy sessions per week for 5 weeks. Participants receiving massage therapy reported experiencing less pain, depression, anxiety and their sleep had improved. They also showed improved trunk and pain flexion performance, and their serotonin and dopamine levels were higher.
Article
Unlabelled: Parturients who receive labor epidural analgesia may experience breakthrough pain that requires supplemental medications. We investigated the factors associated with breakthrough pain. This prospective observational study included 1963 parturients who received epidural analgesia. Subjects were categorized into two groups on the basis of the number of episodes of breakthrough pain: the Recurrent Breakthrough Pain (RBP) group experienced three or more episodes. Univariate and multivariate regression analyses were used to evaluate factors associated with the RBP group. By multivariate analysis, nulliparity, heavier fetal weight, and epidural catheter placement at an earlier cervical dilation were found to be independently associated with the RBP group. These factors may predict which parturients' analgesia may be complicated by breakthrough pain. Parturients who received a combined spinal/epidural technique were less likely to be associated with the RBP group. The combined spinal/epidural technique may be superior to conventional epidural anesthesia, because breakthrough pain occurred less often. It is interesting to note that the characteristics that are associated with the RBP group are similar to those that have been associated with increased severity of maternal pain. Implications: Nulliparity, heavier fetal weight, and epidural catheter placement at an early cervical dilation are predictors of breakthrough pain during epidural labor analgesia. The combined spinal/epidural technique may be associated with a decreased incidence of breakthrough pain.
Article
To determine whether epidural analgesia during labour is associated with long term backache. Follow up after randomised controlled trial. Analysis by intention to treat. Department of obstetrics and gynaecology at one NHS trust. 369 women: 184 randomised to epidural group (treatment as allocated received by 123) and 185 randomised to non-epidural group (treatment as allocated received by 133). In the follow up study 151 women were from the epidural group and 155 from the non-epidural group. Self reported low back pain, disability, and limitation of movement assessed through one to one interviews with physiotherapist, questionnaire on back pain and disability, physical measurements of spinal mobility. There were no significant differences between groups in demographic details or other key characteristics. The mean time interval from delivery to interview was 26 months. There were no significant differences in the onset or duration of low back pain, with nearly a third of women in each group reporting pain in the week before interview. There were no differences in self reported measures of disability in activities of daily living and no significant differences in measurements of spinal mobility. After childbirth there are no differences in the incidence of long term low back pain, disability, or movement restriction between women who receive epidural pain relief and women who receive other forms of pain relief.
Article
On the language of pain. By Ronald Melzack, Warren S. Torgerson. Anesthesiology 1971; 34:50-9. Reprinted with permission. The purpose of this study was to develop new approaches to the problem of describing and measuring pain in human subjects. Words used to describe pain were brought together and categorized, and an attempt was made to scale them on a common intensity dimension. The data show that: 1) there are many words in the English language to describe the varieties of pain experience; 2) there is a high level of agreement that the words fall into classes and subclasses that represent particular dimensions or properties of pain experience; 3) substantial portions of the words have approximately the same relative positions on a common intensity scale for people who have widely divergent backgrounds. The word lists provide a basis for a questionnaire to study the effects of anesthetic and analgesic agents on the experience of pain.
Article
Systematic review. To determine the effectiveness of transcutaneous electrical nerve stimulation (TENS) in the management of chronic LBP. Chronic low back pain (LBP) affects a significant proportion of the population. TENS was introduced more than 30 years ago as an adjunct to pharmacologic pain management. However, despite its widespread use, the usefulness of TENS in chronic LBP is still controversial. We searched MEDLINE, EMBASE, PEDro, and the Cochrane Central Register of Controlled Trials (Issue 2, 2005), up to April 1, 2005. Only randomized controlled clinical trials (RCTs) evaluating the effect of TENS on chronic LBP were included. Two reviewers independently selected trials and extracted data using predetermined forms. Heterogeneity was tested with Cochrane's Q test. A fixed effect model was used throughout for calculating continuous variables, except where heterogeneity existed, in which case a random effects model was used. Results are presented as weighted mean differences with 95% confidence intervals (95% CI), where the difference between the treated and control groups was weighted by the inverse of the variance. Standardized mean differences were calculated by dividing the difference between the treated and control by the baseline variance. Standardized mean differences were used when different scales were used to measure the same concept. Dichotomous outcomes were analyzed with odds ratios. Two RCTs (175 patients) were included. They differed with respect to study design, methodologic quality, inclusion and exclusion criteria, characteristics of TENS application, treatment schedule, cointerventions, and measured outcomes. In one RCT, TENS produced significantly greater pain relief than the placebo control. However, in the other RCT, no statistically significant differences between treatment and control groups were shown for multiple outcome measures. Preplanned subgroup analyses, intended to examine the impact of different stimulation parameters, sites of TENS application, treatment durations, and baseline patient characteristics were not possible because of the small number of included trials. Evidence for the efficacy of TENS as an isolated intervention in the management of chronic LBP is limited and inconsistent. Larger, multicenter, RCTs are needed to better resolve its role in this condition. Increased attention should be given to the risks and benefits of long-term use, which more appropriately addresses the realities of managing chronic low back pain.
Article
Heat and cold are commonly utilised in the treatment of low-back pain by both health care professionals and people with low-back pain. To assess the effects of superficial heat and cold therapy for low-back pain in adults. We searched the Cochrane Back Review Group Specialised register, the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2005), MEDLINE (1966 to October 2005), EMBASE (1980 to October 2005) and other relevant databases. We included randomised controlled trials and non-randomised controlled trials that examined superficial heat or cold therapies in people with low-back pain. Two authors independently assessed methodological quality and extracted data, using the criteria recommended by the Cochrane Back Review Group. Nine trials involving 1117 participants were included. In two trials of 258 participants with a mix of acute and sub-acute low-back pain, heat wrap therapy significantly reduced pain after five days (weighted mean difference (WMD) 1.06, 95% confidence interval (CI) 0.68 to 1.45, scale range 0 to 5) compared to oral placebo. One trial of 90 participants with acute low-back pain found that a heated blanket significantly decreased acute low-back pain immediately after application (WMD -32.20, 95%CI -38.69 to -25.71, scale range 0 to 100). One trial of 100 participants with a mix of acute and sub-acute low-back pain examined the additional effects of adding exercise to heat wrap, and found that it reduced pain after seven days. There is insufficient evidence to evaluate the effects of cold for low-back pain, and conflicting evidence for any differences between heat and cold for low-back pain. The evidence base to support the common practice of superficial heat and cold for low back pain is limited and there is a need for future higher-quality randomised controlled trials. There is moderate evidence in a small number of trials that heat wrap therapy provides a small short-term reduction in pain and disability in a population with a mix of acute and sub-acute low-back pain, and that the addition of exercise further reduces pain and improves function. The evidence for the application of cold treatment to low-back pain is even more limited, with only three poor quality studies located. No conclusions can be drawn about the use of cold for low-back pain. There is conflicting evidence to determine the differences between heat and cold for low-back pain.
Article
Question Is transcutaneous nerve stimulation (TENS) effective in the management of chronic low back pain? Data sources Trials were located by searches of Medline, Embase, Cochrane Central Register of Controlled Trials, and PEDro, review of the reference list of relevant articles, and by contact with experts in the field. Study selection and assessment Randomised controlled trials with more than 5 participants per arm were eligible for inclusion. Trials were additionally restricted to those enrolling patients with non-specific LBP with or without sciatica with duration of symptoms greater than 12 weeks in an outpatient setting. All standard modes of TENS were eligible. Acupuncture TENS and neuromuscular stimulation were excluded. Outcomes Eligible outcomes included pain, disability, well being, work loss, and side effects of treatment. Results were expressed as weighted mean differences (WMD) for continuous data. Main results The literature search revealed 39 potentially eligible studies but only two, Cheing 1999 and Deyo 1990, fulfilled all eligibility criteria. Both trials compared active TENS to placebo, however only the Deyo study excluded subjects with previous experience of TENS to assist treatment blinding. The Cheing study reported greater reduction in pain (expressed as % of baseline) one hour following a single one hour treatment with active TENS: WMD = –33.6% (–53.27% to –13.97%); but did not measure beyond this time point or measure other outcomes. The Deyo study reported that a one month course of active TENS was no more effective than placebo at one month follow-up for pain intensity, pain frequency, pain improvement, functional status, and self-rated activity level. For pain intensity (measured on a 0–100 mm VAS) the WMD was –2.3 mm (–9.5 to 5); for pain improvement (1 = entirely gone, 6 = much worse) WMD= 0.0 (–0.4 to 0.4) and for functional status (range 0–100 with higher scores indicating worse function) WMD= –0.5 (–2.3 to 1.3). Conclusions Because of conflicting results the efficacy of TENS in the treatment of chronic low back pain is unclear.
Article
Cochrane systematic review. To assess the effects of superficial heat and cold therapy for low back pain in adults. Heat and cold are commonly used in the treatment of low back pain. We searched electronic databases from inception to October 2005. Two authors independently assessed inclusion, methodologic quality, and extracted data, using the criteria recommended by the Cochrane Back Review Group. Nine trials involving 1,117 participants were included. In two trials of 258 participants with a mix of acute and subacute low back pain, heat wrap therapy significantly reduced pain after 5 days (weighted mean difference [WMD], 1.06; 95% confidence interval [CI], 0.68-1.45, scale range, 0-5) compared with oral placebo. One trial of 90 participants with acute low back pain found that a heated blanket significantly decreased pain immediately after application (WMD, -32.20; 95% CI, -38.69 to -25.71; scale range, 0-100). One trial of 100 participants with a mix of acute and subacute low back pain examined the additional effects of adding exercise to heat wrap and found that it reduced pain after 7 days. The evidence base to support the common practice of superficial heat and cold for low back pain is limited, and there is a need for future higher-quality randomized controlled trials. There is moderate evidence in a small number of trials that heat wrap therapy provides a small short-term reduction in pain and disability in a population with a mix of acute and subacute low back pain, and that the addition of exercise further reduces pain and improves function. There is insufficient evidence to evaluate the effects of cold for low back pain and conflicting evidence for any differences between heat and cold for low back pain.
Article
In this study, we aimed to determine the effects of combined spinal-epidural block on low back pain incidence after vaginal delivery. 198 patients included into the study. Patients were separated into two groups regarding labor analgesia request. Combined spinal-epidural analgesia was performed in sitting position for the first group (CSE Group, n=104). The second group consisted of women who had chosen not the have CSE (non-epidural group, n=94). The patients were asked for low-back pain and other symptoms related to it on the first day, third day, one month and sixth months after the delivery. Totally, we determined 60 new onset low back pain cases after the delivery (32 in CSE and 28 in non-epidural group). We didn't establish any significant differences during long-time follow-ups between the groups. We concluded that, combined spinal-epidural analgesia could be performed safely without increasing the backache incidence after delivery.
Article
Numerous guidelines recommend physical therapy for the management of musculoskeletal conditions. However, specific recommendations are lacking concerning which exercises and adjunct modalities to use. Physical therapists use various techniques to reduce pain and improve mobility and flexibility. There is some evidence that specific exercises performed with the instruction of physical therapists improve outcomes in patients with low back pain. For most modalities, evidence of effectiveness is variable and controlled trials are lacking. Multiple modalities may be used to treat one clinical condition; decisions for the treatment of an individual patient depend on the expertise of the therapist, the equipment available, and the desire of the attending physician. A physical therapy prescription should include the diagnosis; type, frequency, and duration of the prescribed therapy; goals of therapy; and safety precautions.
Article
The management of chronic low back pain (CLBP) has proven to be very challenging in North America, as evidenced by its mounting socioeconomic burden. Choosing among available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers. Although all parties share a common goal and wish to use limited health-care resources to support interventions most likely to result in clinically meaningful improvements, there is often uncertainty about the most appropriate intervention for a particular patient. To help understand and evaluate the various commonly used nonsurgical approaches to CLBP, the North American Spine Society has sponsored this special focus issue of The Spine Journal, titled Evidence-Informed Management of Chronic Low Back Pain Without Surgery. Articles in this special focus issue were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidence for a particular intervention and encouraged to make this information accessible to nonexperts. Each of the articles contains five sections (description, theory, evidence of efficacy, harms, and summary) with common subheadings to facilitate comparison across the 24 different interventions profiled in this special focus issue, blending narrative and systematic review methodology as deemed appropriate by the authors. It is hoped that articles in this special focus issue will be informative and aid in decision making for the many stakeholders evaluating nonsurgical interventions for CLBP.
Abdelnour Lattouf Savoirs
  • R Abi
  • N Daou
R. Abi Zeid Daou, N. Abdelnour Lattouf Savoirs / Mise au point
The slump test: clinical applications and interpretations
  • Miller
Miller J. The slump test: clinical applications and interpretations. Chiropr Tech 1999;11(4):157–63.
Electrophysio-thérapie, 2 e édition
  • De G Bisschop
  • De E Bisschop
  • Commandré
De Bisschop G, De Bisschop E, Commandré F. Electrophysio-thérapie, 2 e édition, Paris: Masson; 1999.
Long term backache after childbirth: prospective search for causative factors
  • Russell