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Background There is an urgent need for objective assessment of the result of osteopathic treatment. The non-invasive equipment Diers 4-D formetric ® , using the Moiré principle to estimate spine and pelvis configuration from the external aspect of the back, allows for the quantification of angles, surfaces, torsion and balance. Objective To assess the reproducibility and coefficient of variation of formetric 4D measurements in repeat assessments of healthy, asymptomatic persons. Materials and methods Repeat measurements were performed in an initial group of 38 volunteers by assessors with basic training, and in an advanced group of 113 persons by fully trained assessors, who have gone through a learning curve. Variables related to kyphosis, lordosis and trunk as well as pelvis torsion were measured, and results of the repeat measurements were analysed using appropriate statistics. Aside from estimating correlations between repeat measurements, Bland and Altman plots and receiver operating characteristic curve analysis were applied in order to quantify the inter-assay variability and the coefficient of variation. Results The kyphotic and lordotic angulations were higher in women than in men. In the initial group the correlation between the repeat measurements was satisfactory ( r = 0.49–0.55), and there was no trend towards over- or underestimation between repeat measurements. However, the dispersion of the difference between the repeat measurements was relatively broad, resulting in a coefficient of variation of approximately 13–14% for the kyphotic and lordotic angulations. The reproducibility in the advanced group was clearly better with coefficients of variation of approximately 7% for angulations of kyphosis and lordosis, as well as for pelvic inclination. In contrast, the reproducibility of estimates of torsion was poor. Conclusion The examinations using the Diers 4-D formetric system must be performed with great care for exact positioning of the person, and require adequate training. The interpretation of the effect of treatment should take into account the variability between repeat measurements. Provided the technique is applied correctly, the reproducibility of results is excellent, making this non-invasive system appropriate for clinical trials. [ABSTRACT FROM AUTHOR]

Background Context: Nonspecific low back pain (LBP) is a common disorder with a high economic, social and psychological burden. Many systems have been developed for evaluating the severity of LBP, though these are mainly based on scoring questionnaires for the functional status of the patients. Objective quantifiable methods relating LBP with anthropometric factors are scarce.Purpose: To find the correlates of nonspecific LBP with spine shape variables and demographic characteristics. To investigate the possible relationship between the latter and the result of a questionnaire subjectively quantifying the severity of LBP.Study Design/setting: This is a pragmatic observational prospective cohort study.Patient Sample: 218 subjects participated in this study. A first group of participants were 160 patients consulting at an osteopathic outpatient clinic for back pain complaints. The second group consisted of 58 healthy pain-free volunteers.Outcome Measures: The Oswestry Disability Index (ODI) was used to quantify the degree of functional impairment due to low back pain. The surface topography of the back was registered statically with the Diers-4D formetric® system.Methods: Multivariate analyses of the DIERS 4D formetric system recordings in the subjects with or without nonspecific, acute or chronic LBP.Results: Different patterns between female and male subjects were found. Age, coronal and sagittal imbalance correlated with LBP in female subjects, whereas pelvic inclination, the trunk torsion and apical deviation correlated with LBP in male. Multivariate analyses allowed creating an algorithm to predict the functional disability (predicted LBP-score, PLBP), based on the above variables for females and males. Logistic stepwise regression analysis indicated the probability of a patient having a LBP-score above or below ODI 20 (P= <0.0001), which is considered the clinically relevant threshold value for justifying absence from work.Conclusions: In this study LBP was correlated with spine shape variables leading to an algorithm predicting the functional disability of a patient due to LBP. Discrepancies between the model and the ODI result may suggest elements that are clinically relevant. [ABSTRACT FROM AUTHOR]

Objective: Although many women with recurrent vulvovaginal candidiasis initially benefit from prophylactic intermittent treatment with antimycotics, most of them experience relapse after cessation of therapy, and often they return to the pretreatment recurrence rate. The purpose of this study was to demonstrate the efficacy and safety of an individualized, degressive, prophylactic regimen in 136 women with recurrent vulvovaginal candidiasis. Study Design: After an induction dose of 600 mg fluconazole during the first week, 117 women started maintenance therapy: 200 mg fluconazole weekly for 2 months, followed by 200 mg biweekly for 4 months, and 200 mg monthly for 6 months, according to their individual response to therapy. All women were tested for recurrences monthly with wet mount microscopy and vaginal culture during the first 6 months and bimonthly during the next 6 months. Patients were allowed to move on to the next level of maintenance therapy only if they were symptom free and microscopy and culture negative. Results: Of the women who were cured successfully after the induction phase, 101 women (90%) were disease-free after 6 months of maintenance therapy with this degressive regimen, and 80 women (77%) were disease-free after 1 year. The weekly incidence of the first clinical relapse was 0.5% during any period of the maintenance phase, and the rate of all new relapses, which included evidence of mycologic or microscopic colonization, was 1% per week. Women who experienced several relapses (poor responders) had experienced more relapses before entering the study compared with the optimal responders (odds ratio, 4.9; 95% CI,1.8-13.7; P = .002), experienced the disease for a longer period of time (6.5 vs 3.7 years; P = .06), and harbored significantly more Candida non-albicans during maintenance therapy (P = .001). No serious side-effects were noted. Conclusion: Individualized, degressive, prophylactic maintenance therapy with oral fluconazole is an efficient treatment regimen to prevent clinical relapses in women with recurrent vulvovaginal candidiasis. [Copyright &y& Elsevier]