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International audience; Background: Individuals with chronic low back pain (cLBP) may benefit from multimodal functional restoration programs (FRPs).Objective: The aim of this study was to analyze characteristics of individuals with cLBP who were referred or not to an FRP. Because cLBP is a bio-psycho-social disorder, medical and social parameters were analysed.Methods: This was an observational cross-sectional study performed in 2017 in 6 tertiary centres in France. Consecutive individuals with cLBP visiting a rheumatologist or physical medicine and rehabilitation physician were included. Individuals referred or not to an FRP were compared by demographic characteristics, duration of sick leave over the past year, self-reported physical activity>1h/week, pain (numeric rating scale 0-10), anxiety/depression (Hospital Anxiety and Depression Scale), disability (Oswestry Disability Index) and kinesiophobia (Tampa Kinesiophobia Scale). Univariate and multivariate logistic regression analyses were performed, estimating odds ratios (ORs) and 95% confidence intervals (CIs).Results: We included 147 individuals with cLBP. The mean (SD) age was 49 (12) years and 88 (60%) were women; 58 (38%) were referred to an FRP. On multivariate analysis, referral to an FRP was associated with reduced pain level (OR: 0.95, 95% CI: 0.91-0.99, for each 1-point increase in pain score), self-reported lack of physical activity (OR: 0.84, 95% CI: 0.72-0.98) and longer sick leave (OR: 1.03, 95% CI: 1.01-1.05, for 30 more days of sick leave).Conclusion: In this multicentric observational study, referral to an FRP was linked to pain, self-reported physical activity and sick leave but not medical characteristics assessed. These findings confirm the bio-psycho-social approach of FRPs for cLBP.

Background Flap surgery for deep pelvic pressure ulcers (PPUs) has been found effective, but the recurrence rate remains high and few risk factors have been identified. Objective We evaluated risk factors for PU recurrence after primary flap surgery in people with spinal cord injury (SCI). Patients and methods This observational retrospective study based on medical charts included all individuals with SCI who underwent primary flap surgery for a PPU in the Herault department in France between 2006 and 2014. Overall, 100 biomedical, psychological, socioeconomic and care management factors were studied. The primary outcome was PPU recurrence (surgical site and/or other pelvic site). The secondary outcome was recurrence at the surgical site. Cox proportional hazards regression was used to determine associated factors, estimating hazard ratios (HRs) and 95% confidence intervals (CIs). Results We included 85 patients. Half had a PPU recurrence, and in one-third, the recurrence was at the surgical site. On multivariate analysis, global PPU recurrence was associated with colostomy (HR = 2.79) and living with a partner (HR = 2.29). Non-traumatic SCI and sacral wound were associated with PPU recurrence (HR = 3.39, HR = 0.48) and recurrence at the surgical site (HR = 3.3, HR = 0.3). Conclusion Risk factors of PPU recurrence are based on both biomedical and social models. After primary flap surgery, the risk of recurrence justifies regular follow-up and strict monitoring.

International audience; Since 1988, France has been committed to drafting laws regulating clinical research. These laws must both reflect general legal standards relating to personal data protection and patient information and comply with EU regulations, which are supra-national norms. The 2012 legislation known as "Jardé law" came into force in 2016 and distinguishes between 3 different types of research involving human subjects: category 1:interventional research implying an intervention on the patient which is not justified by their usual treatment. Category 2: interventional research, which does not focus on medicinal products and only entails minimal risks and constraints. Category 3: non-interventional research implying one or multiple acts or proceedings devoid of listed risks. These studies require preliminary favourable opinions from the French Ethical Research Committees (CPP), who are appointed by the State, and must ensure the protection of personal data. For the other types of studies (retrospective data, practice surveys), French legislation only requires that the protection of personal data is ensured. However, it is highly recommended to submit these studies to an Institutional Review Board (IRB) in order to confirm that human subjects are not involved and to obtain an ethical opinion in the event of a scientific journal submission. These laws are constantly evolving in order to comply with the various international recommendations and European regulations, which are binding in France.

Letter; International audience; Dear Editor. We read with interest the letter ‘‘Pelvic parameters and sagittal alignment in people with chronic low back pain and active discopathy (Modic 1 changes): a case–control study’’ by Blandin et al. [1] and would like to propose some comments.

Background Indications and techniques of rehabilitation differ widely across types of lumbar surgery, including timing (before or after surgery) and prescriptions (surgeons but also medical or paramedical professionals). Objectives This project aimed to build consensual recommendations for practice in this context. Methods The SOFMER methodology was used to establish recommendations for physical medicine and rehabilitation: a steering committee defined the types of lumbar surgery involved and developed the main questions to be addressed; a scientific committee performed a literature review for grading evidence and proposed the first version of recommendations, which were discussed during a dedicated session at the national Physical and Rehabilitation Medicine congress; then an e-Delphi method with cross-professional experts was used to finalise recommendations and reach a multidisciplinary consensus. Results The main questions developed were the value of rehabilitation before and after surgery, timing and type of rehabilitation, benefit of supervision and instrumental rehabilitation, value of patient education, and complementary interventions concerning rehabilitation for discectomy, fusion, and disc prosthesis (excluding decompression for spinal stenosis). The literature review identified 60 articles, but for several of the questions, no article in the literature addressed the issue. The multidisciplinary scientific committee analysed the literature and addressed the questions to propose the first version of a set of 23 recommendations. The congress session failed to answer all questions or to reach consensus for all items. After a three-step e-Delphi, 20 recommendations were retained, for which consensus among experts was reached. The recommendations are applicable only to patients without a neurological lesion. Conclusions These recommendations provide important and consensual knowledge to assist clinicians in decision-making for rehabilitation in lumbar surgery. Despite many of the recommendations relying exclusively on expert opinion rather than published evidence, this approach is an important advance to improve concordance among healthcare professionals.

The benefit of an intradiscal injection of corticosteroids for low back pain with active discopathy is not totally resolved.The objective of this study was to estimate the clinical efficacy of an intradiscal injection of glucocorticoids versus lidocaine in patients with low back pain and active discopathy (Modic 1 changes).A prospective, single-blind, randomized controlled study was conducted in 2 tertiary care centers with spine units. We enrolled 50 patients (mean age 50 years; 46% women) with lumbar active discopathy on MRI and failure of medical treatment for more than 6 weeks. Participants were randomly assigned to receive an intradiscal injection of glucocorticoids [50mg prednisolone acetate (GC group), n=24] or lidocaine [40mg (L group), n=26] by senior radiologists. Outcome measures were low back pain in the previous 8 days (10-point visual analog scale), Dallas Pain Questionnaire, Oswestry Disability Index, analgesic treatment and work status at 1, 3 and 6 months as well as pain at 1, 2 and 3 weeks. The primary outcome was change in pain between baseline and 1 month.Data for 39 patients (78%; 17 in the GC group, 22 in the L group) were analyzed for the primary outcome. Pain intensity was significantly reduced at 1 month in the GC versus L group [mean (SD) -2.7 (2.3) and +0.1 (2.0), P0.001] but not at 3 and 6 months. At 1 and 3 months, the groups significantly differed in daily activities of the Dallas Pain Questionnaire in favour of the GC group. The groups did not differ in consumption of analgesics or professional condition at any time. No serious intervention-related adverse events occurred. Study limitations included patients lost to the study because of injection-related technical issues in the L5/S1 disc and short time of follow-up.As compared with intradiscal injection of lidocaine, intradiscal injection of prednisolone acetate for low back pain with active discopathy may reduce pain intensity at 1 month but not at 3 and 6 months.

Letter; International audience; Dear editor, Lumbar spinal stenosis (LSS) is the narrowing of the lumbar canal caused by degenerative processes [1]. LSS results in back and lower-limb pain when standing and walking, and symptoms regress in sitting position [1]. These symptoms are named neurogenic claudication and result from mechanical irritation and from exercise-induced ischemia of the cauda equina [2]. The inability to stand or walk alters functioning and health-related quality of life (HRQoL)

International audience; OBJECTIVE:This study compared the effects of high-force versus low-force lumbar traction in the treatment of acute lumbar sciatica secondary to disc herniation.METHODS:A randomized double blind trial was performed, and 17 subjects with acute lumbar sciatica secondary to disc herniation were assigned to high-force traction at 50% body weight (BW; LT50, n = 8) or low force traction at 10% BW (LT10, n = 9) for 10 sessions in 2 weeks. Radicular pain (visual analogue scale [VAS]), lumbo-pelvic-hip complex motion (finger-to-toe test), lumbar-spine mobility (Schöber-Macrae test), nerve root compression (straight-leg-raising test), disability (EIFEL score), drug consumption, and overall evaluation of each patient were measured at days 0, 7, 1, 4, and 28.RESULTS:Significant (P < .05) improvements were observed in the LT50 and LT10 groups, respectively, between day 0 and day 14 (end of treatment) for VAS (-44% and -36%), EIFEL score (-43% and -28%) and overall patient evaluation (+3.1 and +2.0 points). At that time, LT50 specifically improved in the finger-to-toe test (-42%), the straight-leg-raising test (+58), and drug consumption (-50%). No significant interaction effect (group-by-time) was revealed, and the effect of traction treatment was independent of the level of medication. During the 2-week follow-up at day 28, only the LT10 group improved (P < .05) in VAS (-52%) and EIFEL scores (-46%). During this period, no interaction effect (group-by-time) was identified, and the observed responses were independent of the level of medication.CONCLUSIONS:For this preliminary study, patients with acute lumbar sciatica secondary to disc herniation who received 2 weeks of lumbar traction reported reduced radicular pain and functional impairment and improved well-being regardless of the traction force group to which they were assigned. The effects of the traction treatment were independent of the initial level of medication and appeared to be maintained at the 2-week follow-up.

Many practitioners, pediatricians, and general practitioners prescribe physical therapy when tracking scoliosis. However, has physical therapy alone proved its efficacy in the care of the scoliosis to slow down progression? Our purpose is to report the results of a literature review on the effectiveness of rehabilitation in idiopathic scoliosis. No current study presents sufficient scientific proof to validate the efficacy of isolated exercise therapy in scoliosis. Learned societies recognize, however, the efficacy of combining conservative therapy (brace+physiotherapy) in idiopathic scoliosis. Should we then still prescribe rehabilitation without brace treatment? Although physical therapy alone does not seem effective in treating scoliosis, it can limit potential painful phenomena and be beneficial for respiratory function. The physical therapist can also teach the teenager the classic principles of hygiene of the back. It may therefore be appropriate to prescribe physical therapy, but the principles and objectives must be explained to the patient and family in light of current evidence-based medicine.

L’education therapeutique des patients (ETP) souffrant de lombalgie chronique n’a jamais fait l’objet d’une evaluation specifique. Il n’existe d’ailleurs aucune recommandation a ce sujet dans la litterature. Cependant, le National Institute of Health and Clinical Excellence britannique (NICE) suggere de tenir compte des attentes et des preferences des patients. Cette ETP doit donc partir de l’evaluation des patients lors d’un diagnostic educatif approfondi qui identifie notamment les connaissances, les croyances, les peurs, les strategies de gestion et les attentes. Grâce a cette etape initiale indispensable, il est possible de proposer aux patients des techniques de gestion de la douleur et de ses consequences. Les outils utilises au cours de l’ETP de la lombalgie chronique sont l’information, la reformulation des croyances sur la maladie, l’apprentissage des moyens de gestion de la douleur et la reassurance afin de renforcer l’efficacite personnelle. L’entretien d’une activite physique, la connaissance des differentes classes therapeutiques et de leurs objectifs, l’execution de gestes appropries, l’utilisation adaptee des aides techniques, l’apprentissage des techniques de relaxation, de gestion du stress, du sommeil, de la fatigue, sont autant d’outils complementaires permettant de faire face a la lombalgie chronique. Les objectifs educatifs sont de rendre le patient actif vis-a-vis de son traitement et de transformer les « comportements douloureux » en comportements bien portants. Ce nouvel apprentissage permet d’eviter les complications des poussees aigues douloureuses responsables de consultations iteratives, d’evitement, de repli et d’abus medicamenteux, grâce a l’acquisition de competences d’adaptation. Differentes modalites d’education therapeutique sont possibles : consultations individuelles medicales, infirmieres, de kinesitherapie, travail en groupes de patients par ateliers cibles sur un objectif (neurostimulation electrique transcutanee [TENS], relaxation, reentrainement a l’effort, gestion des medicaments).

Resume Objectifs Evaluer l’impact a moyen terme d’ateliers d’education sur la lombalgie (L) dans le contexte d’une cure thermale sur : les croyances de peur et d’evitement, l’incapacite, la douleur et la satisfaction. Methodes Une etude randomisee prospective, avec periodes d’inclusion alternees d’un mois (alternate month design) incluant 360 individus suivant une cure thermale pour lombalgie : 188 dans le groupe interventionnel (trois ateliers d’education standardises durant chacun 1 h 30 associes a une therapie classique par thermalisme de trois semaines), 172 dans le groupe temoin (thermalisme classique et information verbale non standardisee). Le critere d’analyse principal concernait la difference dans le score de croyance de peur et d’evitement (score FABQ physique) entre le moment de l’entree dans l’etude et six mois apres le traitement ; les criteres secondaires etaient : evolution de l’incapacite (echelle Quebec) et intensite douloureuse (echelle visuelle analogique [EVA]), et satisfaction par rapport aux informations recues. Resultats Une diminution significative du score FABQ physique a six mois a ete observee (p Conclusion Les ateliers d’education standardises exercent un impact benefique sur la lombalgie et contribuent a une amelioration des soins medicaux dispenses au cours d’une cure thermale en reduisant la croyance de peur et d’evitement ainsi qu’en soulageant la douleur. En developpant l’utilisation de tels ateliers, nous pourrions contribuer a augmenter l’impact positif des soins thermaux dans la prise en charge des maladies invalidantes chroniques.

Introduction/Background The profit of an intradiscal injection of corticoids in low back pain with Modic 1 changes is not totally resolved. The objectives of this work is to estimate the clinical profit at 1, 3 and 6 months after an intradiscal injection of prednisolone acetate versus a lidocain one in low back pain with Modic. Material and method Fifty patients with low back pain in failure of the medical treatment for more than 6 weeks where included in this prospective, double blind, randomized study. Results Pain intensity was significantly improved a 1 month in the prednisolone acetate group compared to the lidocain group. A significant diffrence is also observed at 1 and 3 months in the activities of the everiday life of DALLAS questionnaire in favour of the glucocorticoid group. There was no significant difference, throughout the follow up on Oswestry evolution, comsuption of analgesic or in professional condition. Conclusion Intradiscal injection of prednisolone acetate in low back pain with modic 1 changes reduces pain intensity at 1 month but not at 3 and 6 months versus lidocain.

Gelis A, Fattal C, Dupeyron A, Perez-Martin A, Colin D, Pelissier J. Reproducibility of transcutaneous oxygen pressure measurements in persons with spinal cord injury. Objectives To assess the reproducibility and the effects of the subjects' characteristics on the reproducibility of transcutaneous oxygen pressure (TcPO 2 ) measurements in the sacral area in persons with spinal cord injury during loading in the supine position. Design Test-retest study. Setting Physical medicine and rehabilitation center. Participants Thirty spinal cord–injured American Spinal Injury Association grade A subjects. Main Outcome Measures Two TcPO 2 monitoring sessions in the sacral area during loading in the supine position were performed at 24-hour intervals, including the measurement of absolute resting sacral and chest TcPO 2 values and the calculation of regional perfusion index (RPI) and delta from rest oxygen pressure, taking into account systemic TcPO 2 changes. Results The intraclass coefficient of the sacral TcPO 2 absolute resting value, RPI, and delta from rest oxygen pressure was .787 and .798, .704 and .635, .760 and .465, respectively, at 20 and 40 minutes. The only characteristic with an influence on RPI reproducibility was the subject's smoking status, whereas age, weight, time since injury, lesion level, and presence of pressure ulcer showed no influence. Conclusions TcPO 2 measurement is a reproducible method for assessing cutaneous microcirculation during loading over 20-minute monitoring sessions, with RPI exhibiting better reproducibility than delta from rest oxygen pressure at 40 minutes.

International audience; OBJECTIVE: To establish a normative database for isometric strength measured by quantitative muscle testing (QMT) for a French adult population.DESIGN: Measurement of maximal voluntary isometric contraction.SETTING: Four clinical centers involved in neuromuscular disorders.PARTICIPANTS: A total of 315 healthy adults (147 men, 168 women) ages 20 to 80 years.INTERVENTIONS: Not applicable.MAIN OUTCOME MEASURE: Isometric torque values of 14 muscle functions (13 bilaterally and neck).RESULTS: This study led to the development of a French isometric strength normative database for adults measured by QMT. For each muscle function, predictive regression models using age, sex, and weight are proposed. Some methodologic issues concerning strength measurement are discussed.CONCLUSIONS: This database can be used to compute relative deficits in muscle strength for 27 muscle functions and also to estimate composite scores for follow-up of patients either during the natural history of their disease or during a therapeutic trial.

Resume Introduction La grande variabilite du pronostic de la sclerose en plaques de forme remittente (SEP-RR) et l’existence de traitements modifiant le cours de la maladie rendent necessaire la connaissance de marqueurs pronostiques. L’influence des poussees au-dela des premieres annees de la maladie sur la progression du handicap reste controversee. Methodes Il s’agit d’une etude longitudinale observationnelle de patients atteints de SEP-RR suivis dans le service de neurologie du CHU de Nimes. L’observation debutait apres la deuxieme poussee de la maladie et prenait fin lors du passage a une forme secondairement progressive (SP) ou a un score EDSS≥4,0. Les criteres de jugement analyses (courbe de survie, Kaplan-Meier) etaient le risque et le delai de survenue d’une forme SP ou d’un score EDSS≥4,0, en fonction du taux de poussees annuel median (TAP). Resultats 99 patients ont ete inclus. La mediane de la duree du suivi depuis les premiers symptomes etait de 9,8 ans (4 a 44 ans) et le TAP median de 0,4. 20,2 p. 100 des patients ont atteint le critere de jugement principal. L’analyse multivariee a montre que le groupe de patients ayant un TAP≥0,4 (n = 47) avait un risque 8 fois plus eleve de developper une forme SP ou un score EDSS de 4,0 (IC-95 p. 100 : 2,74-23,46 ; p = 0,0001), dans un delai plus court (25e percentile a 17,8 versus 6,9 ans, logrank ; p Conclusions Cette etude suggere qu’une frequence elevee de poussees au cours de la SEP-RR au-dela de la deuxieme poussee de la maladie est un facteur predictif independant de progression du handicap irreversible a long terme jusqu’a une forme SP ou un niveau de handicap relativement severe.

Camptocormia is characterised as an extreme bent-forward posture of the trunk that disappears in the recumbent position. On X-ray, trunk flexion appears without vertebral rotation as in scoliosis. The condition is a well-known complication of Parkinson's disease (PD) at the late stage. The authors present the case of a 77-year-old woman affected by severe camptocormia, which appeared and worsened in less than 6 months and hindered gait. Despite no signs of PD, neuro-imaging (DAT-Scan) showed an L-Dopa transducer decrease in putamens. A few weeks later, bradykinesia appeared and the clinical diagnosis of PD became more obvious. L-Dopa improved bradykinesia but did not change the bent-spine posture. A 1-year follow-up showed no other signs of PD other than bradykinesia, but the camptocormia was unchanged.

Resume Objectifs Determiner la prevalence de l'osteoporose, de ses facteurs de risque et des traitements a visee antifracturaire dans une population admise en service de reeducation apres fracture de hanche. Contexte Les fractures de hanches sont responsables d'une surmortalite pouvant atteindre 20 % la premiere annee et reste un important facteur de handicap chez les survivants. Malgre les outils de depistage et les campagnes d'information, l'osteoporose reste sous-diagnostiquee et de fait sous-traitee. Patients et methode Quarante et un patients operes d'une fracture de hanche et admis en service de reeducation sont explores par le recueil des antecedents, de donnees cliniques, la realisation d'une densitometrie osseuse et d'un bilan biologique. Resultats Seuls trois patients ont une osteoporose connue avant la fracture, plus de 50 % ont au moins un facteur de risque de fragilite osseuse issu de l'interrogatoire, tous presentent au moins une osteopenie densitometrique, 68 % une osteoporose densitometrique, une patiente est traitee efficacement. Discussion Conformement aux grandes enquetes internationales, l'osteoporose est encore sous-diagnostiquee. Il existe des outils simples permettant un depistage et une prise en charge adaptee dans le but de reduire le risque de refracture. Une strategie de prevention secondaire des fractures osteoporotiques peut parfaitement s'inscrire dans la mission du medecin de medecine physique.

We report four cases of sciatica in patients with same-level disk herniation confirmed by computed tomography and a final diagnosis of acute radiculitis caused by Borrelia burgdorferi, with a favorable response to ceftriaxone therapy. The neurological manifestations of Lyme disease are protean, and a potential contribution of concomitant disk disease to sciatica can lead to diagnostic wanderings. Disk lesions and infectious conditions that can cause sciatica are discussed. Whether a favorable response to antibiotic therapy should be taken as proof of B. burgdorferi radiculitis deserves discussion. In practice, in a patient with clinical manifestations suggesting disk-related nerve root pain and residing or having traveled to an endemic area, B. burgdorferi infection should be looked for, as both etiologies can coexist. © 2003 Elsevier SAS. Tous droits reserves.

Resume Objectifs. – Faire le point des connaissances sur le syndrome de loge d'effort ou chronique. Methodes. – Recherche bibliographique sur la banque de donnees Medline et textes en francais. Les mots cles etaient compartment syndrome, exertional, chronic, pressure, fasciotomy. Resultats. – Le syndrome de loge d'effort se caracterise par des douleurs apparaissant a l'effort et regressant au repos et par l'elevation excessive de la pression intramusculaire dans la loge. La mesure de la pression intramusculaire est l'examen de reference qui n'est cependant pas standardise et valide. La pression pendant les cinq minutes suivant l'arret de l'effort est le plus souvent utilisee dans les etudes actuelles. Les premiers travaux sur les investigations non invasives, imagerie par resonance magnetique, scintigraphie au thallium et spectroscopie proche de l'infrarouge ne mettent pas en evidence de valeur diagnostique suffisante. La physiopathologie reste mal connue : augmentation du contenu musculaire de la loge, epaississement et rigidite de la paroi aponevrotique de la loge, stimulation des recepteurs sensitifs aponevrotiques, perturbations du retour veineux, microlesions musculaires traumatiques, forme mineure de myopathies. Le traitement comprend la reduction de l'activite sportive en cause ou l'aponevrotomie avec eventuellement aponevrectomie partielle. Plusieurs auteurs operent par voie endoscopique. Les bons resultats therapeutiques constates dans la plupart des etudes retrospectives sont a moduler par des etudes de suivi a plus long terme qui objectivent la persistance frequente de douleurs moderees d'effort et des recidives. Conclusion. – D'autres etudes sont necessaires pour comprendre la physiopathologie, standardiser la mesure de pression et valider les valeurs seuils, evaluer des explorations non invasives et preciser l'evolution a long terme de l'aponevrotomie.

Objective Among pelvitrochanteric muscles, the internal obturator muscle is implicated in some pain projected at the buttock or perineum. Even though the pathophysiology is not completely understood, its responsibility is often held in clinical practice and in the literature due to effectiveness of botulinum toxin injections, constituting a therapeutic test. The objective is to enhance the couple ultrasound/EMG in difficult injections. Material/Patients and methods Eighteen patients were treated in the physical medicine department (Besancon) from September 2015 to February 2016 for gluteal or perineal pain suspected to be related to abnormal spasm of the internal obturator muscle. All patients had a normal MRI of the pelvis. They received an injection of botulinum toxin associated with an anesthetic in the internal obturator muscle under ultrasound and electromyographic guidance. Results There were 11 women and 7 men (mean age 57 years). The effectiveness of botulinum toxin injections cannot be evaluated because some of the patients were included as part of a national study (PHRC) whose results are not yet known. Regarding the gesture as such, the tolerance is good with, visual analog scale (VAS) is given to 3.1 [1.5–7] in the immediate aftermath of the injection, and 2.8 [1–6.5] to the memory of the injection gesture during a new evaluation 6 to 8 weeks later. It has not been described complication (no hematoma, any orthopedic, visceral or neurological disorders have been reported). Discussion/Conclusion Botulinum toxin injections into the internal obturator muscle can be performed under CT control, the patient is placed in the prone position. The aim is to achieve the muscular endopelvic part. This position does not allow under ultrasound guidance to follow the end of the needle, which is why we developed the transforaminal approach of injection in gynecological position. The clinical tolerance of this gesture is good and the images are of very good quality to optimize and secure this type of injection. The couple ultrasound/EMG is available to the clinician and should be enhanced to guide some injections especially for deep sites.

Objective Martial arts are physical and meditative discipline available as complementary strategies able to improve functional capacity, physical performances, postural control of patients suffering from chronical diseases. They can probably slow their clinical evolution. The objective of this communication is a review of the literature about the effects of martial arts training into a said chronical disease. Material/patients and methods A literature research in PubMed and Pedro databases was performed with the following keywords: martial arts, rehabilitation, chronic disease, neurologic disorders, heart disease, chronic obstructive pulmonary disease, musculo-squelettal disorders, low back pain. Abstracts had to include an intervention being a martial arts program for a determined period with clearly defined measured criteria. Two independent reviewers did the literature research and the article analysis. Results Eighty-one abstracts were found, 1 meta-analysis and 3 randomized controlled studies were analyzed. Patients underwent a martial arts program controlled versus medical treatment only. Primary outcome were respectively: UPDRS, postural control and balance for Parkinson's disease; VO 2 peak for post-myocardial infarction rehabilitation; forced expiratory volume in one second for chronic obstructive pulmonary disease respiratory rehabilitation; pain and functional capacity in low back pain. It seems the only martial art studied is Tai Chi Chuan. In Parkinson's diseases, there is a significant difference compared to the control group: UPDRS –4.34, Functional Reach Test 3.89, Berg Balance scale 4.25. In post-myocardial infarction, VO 2 peak was significantly improved by 5.2 mL/kg/min. For COPD, average FEV1 after Tai Chi training was improved at 1.43 L versus 1.21 (47.6% of predicted FEV1 vs. 41.2) within the Tai Chi group and versus 1.18 L (42%) for the controlled group after Tai Chi training. Concerning lower back pain, patients reported improvements in pain and functional capacity (pain VAS 1.3 and Rolland Morris scale 2.6). Discussion–conclusion All these results seem to show that Tai Chi Chuan is an effective complementary strategy associated with medical and rehabilitation care of chronic diseases and larger scale studies could confirm them. Further more, it would be interesting to study the effects of other martial arts with different intervention modalities.

Resume Introduction. – Des etudes recentes ont precise l'incidence et la sous-estimation habituelle, dans la litterature, des accidents lies aux manipulations vertebrales (MV). L'objectif de ce travail est de preciser l'incidence de ces accidents vasculaires, medullaires, radiculaires ou osteo-articulaires presumes lies aux MV dans le nord-est de la France. Materiel et methode. – Nous avons interroge 240 medecins neurologues, neurochirurgiens, rhumatologues, reeducateurs et medecins generalistes diplomes de medecine manuelle sur les accidents lies aux MV rencontres durant les deux dernieres annees. Resultats. – Nous avons obtenu 133 reponses et rapportons 93 accidents. La majorite de ces accidents sont radiculaires (69 %). Pres de 50 % de ces accidents surviennent a l'etage cervical, en moins de 24 h, avec ou sans sequelles « legeres » dans 68 % des cas. Nous recensons 30 fois plus d'accidents vertebrobasilaires que dans les estimations habituelles. Conclusion. – Il parait important que les manipulations vertebrales, therapeutiques tres efficaces, restent tres strictement encadrees dans le domaine medical et que le medecin puisse choisir l'acte manipulatif et le realiser lui-meme afin de diminuer le risque de complications, en particulier au niveau cervical.

Objective Eighty percent of poststroke patients are temporarily unable to walk without help, often with a dropfoot during the midswing phase. Functional electrical stimulation (FES) induces compensation of dropfoot by preprogrammed fixed stimulation, however they are not more effective than mechanical ankle foot orthesis. FES has the advantage of being able to provoke a physiological muscular contraction and respect the articular amplitude. Our objective is to evaluate the metrological quality of the inertial sensors for movement reconstruction in comparison to the gold standard motion analysis. The aim is to improve the SEF using adaptive triggers for dorsiflexion, in hemiplegic poststroke patients. Material/patients and methods Adults with supratentorial ischaemic or hemorrhagic stroke, presenting a foot-drop, able to walk 10 metres without human help, with or without a walking stick were included from May 2016 to June 2017. Patients with ankle dorsiflexion Results Eleven patients included so far, 7 right sided hemiplegia, 8 male, mean age 56 years. To compare the IMU with the gold standard VICON, the measurement errors were estimated by Blant Altman analysis. Dorsiflexion angle measurements demonstrated a bias of 0.43° between the two techniques, with the limits of agreement [−13.46°; + 14.32°] during stance phases and a bias of 0.72° with agreement values [−16.19°; + 17.64°] during swing phases. Discussion, conclusion The data treatment algorithms from IMU seem to be effective in measuring ankle dorsiflexion with small biases between techniques. The limits of agreement are too wide from a clinical perspective, probably due to a small sample size, but are narrow enough to warrant further technological research. Analysis of the full sample size will provide further information on the limits of agreement.

Objective Fears and beliefs play a key role in the development of low back pain according to the biopsychosocial model without specific tool in French. The Back and Beliefs Questionnaire (BBQ) is a validated self-administered questionnaire, allowing to detect the presence of false beliefs related to lumbar disease and that can guide therapeutic management. The objectives of this study were to (i) translate, (ii) validate the BBQ in French, (iii) and compare results with published validations. Material/patients and methods A prospective bicentric study was conducted in chronic low back pain (CLBP) adults included in a specific multidisciplinary rehabilitation program. The translation was made according to the method of translation/back-translation by three independent translators. The validation included a content validity (acceptability, value of each item), construct (correlation tests), internal consistency (Cronbach's alpha), reliability (test-retest), sensitivity to change. The tests used as comparators were the FABQ and TAMPA (avoidance), the Quebec (function), the Dallas (participation), the HAD (mood) and the VAS (pain). The questionnaire was given two times before the rehabilitation intervention and one time after. Results In total, 131 patients were enrolled. Acceptability was excellent (0.43% non response) without ceiling or floor effect for the overall score. No correlation was detected with pain (−0.15, P = 0.19), an anticorrelation was intermediate with the Tampa (−0.66, P P P Discussion–Conclusion The French version of BBQ demonstrated excellent psychometric properties consistent with the original release. The agreement, however, is lower in this work compared to original validation probably related to the concomitant realization of educational assessment modifying beliefs at the first visit (like changing FABQ). The link with the work has not been tested. The results of this work allow to use the BBQ in clinical practice (patient education) and research in chronic low back pain population.

Objective Pisa syndrome (PS) is a common abnormal posture of the trunk in Parkinson disease which is defined as a lateral flexion of the spine in the coronal plane and/or scoliosis. Few studies described focal treatment of dystonia of paraspinal muscles, with unpredictable results, while the participation of quadratus lumborum and external oblique homolateral seem to be interesting. The aim of this study is to estimate the effects of treatment by botulinum toxin of trunk muscles dystonia in PS. Materials/patients and methods The patients were seen in multidisciplinary program to do morphological imagery of spine and electromyographic examination of quadratus lumborum, external oblique, internal oblique and paraspinal. Only the patients with dystonia in muscle that are in homolateral side were treated by toxin A. The evaluation of the effects of treatment was realized in posteriori on the data of clinical file. Results Txenty-six patients were seen from March 2014 to January 2016. Fourteen patients did not present a dystonia of the trunk. Two of them were treated in analgesic purpose among whom, one had beneficial effects. Twelve patients were treated, among whom, 7 in quadratus lumborum, 3 in quadratus lumborum and external oblique and 2 in external oblique. The treatment was effective for 8 of them on the pain and for 6 of them on the slope of spine. Discussion/Conclusion Focal dystonia treatment in quadratus lumborum and external oblique seem to be interesting in PS. A treatment with analgesic aim could be processed, at the risk of seeing deteriorating posture because of the weakening of the muscles that retain the fall. Other studies are necessary to specify the algorithm of care of this syndrome, including global rehabilitation program.

Objective Heel bedsore is frequent in population motionless more than 50 years old. The score of risk of bedsore do not take into account the biomechanical factor, as the flessum of knee. The main objective of this study is to evaluate the relationship between the angle of knee flexion in a supine position with joint relaxation and the maximum interface pressure at the heel area. Material/patients and methods This study is a cohort with one investigator center, which is in MPR department, CHU de Nimes. The inclusion criteria are ummper age or 50 year-old equal, possibility to stay in decubitus, no bedsore. The study consists of a photographic picture, after cutaneous marking, to assess angle of knee flessum, by two different operators and a measure of the pressure in heel area two consecutive days to assess reproducibility inter- et intra-operator. The concordance of knee angle measure and interface pressure of knee area is studying with coefficient of correlation of Pearson. Results Sixty-five patients are included. The reproductibility of the mesure of knee flessum by operators is good (general coefficient of correlation and intra class in 0.89). There is a linear correlation between maximum interface pressure at the heel area and angle of knee flexion if the flessum is between 8° and 20° (0.76). Except theses values, there is no statistical correlation. Discussion–conclusion In this population, the knee flessum could be considered as a risk factor of heel bed sore, in particular during medical situations in which there are other known risk factor. It would seem interesting to implement scales with these type of specific risk factor in this type of population, including when people is in air mattress which don’t have any prevention in the heel area.

Objective To compare prevalence of refractometry disorders in post-stroke patients compared to case control in hospital, using the refractometer PlusoptiX ® . Material/patients and methods The measurement was made using a refractometer PlusoptiX®: binocular measurement a meter away in the dark with usual patient pre-existing correction. The same examiner performed 3 measurements at 2 different times to study reproducibility. Twenty-eight patients (mean age: 59.6 years) who experienced an ischemic or haemorrhagic stroke than 3 months were included, and 28 controls without neurological history, matched on age and sex. Results Twenty-four patients had an ischemic stroke (82.7%) and 4 patients haemorrhagic stroke. Wearing optical correction did not differ significantly. The refractometer intrajuge reproducibility was good, 0.84 average correlation coefficient for measures 2 different days. The ideal refractometry with correction is zero, and reduced in absolute value was on the right average 1.46 (DS: 1.28) for patients versus 0.95 (DS: 0.63) for case control ( P = 0.79) and on the left 1.28 DS (0.95) versus 0.86 DS (0.77) ( P = 0.48). In contrast, in the 18 patients with refractometry > 1.5 to baseline, only 18% of neurological patients complained of visual impairment against 50% of controls. Discussion There are few available data on refractometry disorders prevalence after stroke, some authors report around 20 to 25% [1] . Despite non-significant results, and because of the important refractometer disorders in stroke patients, expressing few visual impairment, this study suggests the interest of a refractometer PlusoptiX ® testing to improve their rehabilitation and quality of life [2] .

Contexte.– La litterature recente semble suggerer un effet positif des strategies educatives dans la lombalgie sub-aigue. L’effet sur la douleur d’un simple livret (Back Book) a ete demontre dans la lombalgie aigue. Objectif .– Evaluer l’effet du Back Book sur la douleur, l’incapacite et le travail chez des patients lombagiques sub-aigus (6 a 12 semaines). Methode.– Etude prospective randomisee comparant une population recevant a la sixieme semaine le back book a une population controle sans information specifique. Les variables dependantes mesurees a J45, J90 et J180 etaient le ressenti douloureux, l’apprehension (FABQ), les repercussions (Oswestry), la duree d’arret de travail et la consommation de soin. Resultats.–Un echantillon de 372 patients a ete inclus dans les departements de l’Herault et du Gard. Le back book faisait apparaitre a J45 une diminution de l’apprehension des activites physiques (FABQ Phys, p = 0,018), de l’apprehension et des repercussions professionnelles (FABQ pro, p 0,032 ; Dallas pro, p = 0,023), sans incidence sur les repercussions dans les activites de vie journaliere ou la douleur. Ces effets disparaissent a 3 et 6 mois. Le retour au travail a six mois est plus important dans le groupe intervention seulement dans le departement de l’Herault (p = 0,042) sans facteur explicatif evident. Aucune difference sur la consommation de soins n’a ete mise en evidence. Conclusion.– Ce travail confirme l’interet d’une information precoce et standardisee chez les patients lombalgiques. Les informations fondees sur le modele biopsycho social permettent de rassurer les patients. Comme l’apprehension liee a la douleur conditionne l’evolution et la duree d’arret de travail, l’utilisation plus large de ce livret peut etre recommandee des la phase sub-aigue.

blood analysis, cognitive performances, maximal exercise tolerance with gas exchange analysis, non-invasive cardiac output measurement and Near-Infrared Spectroscopy (NIRS) cerebral signals were measured before and after training. Results.–We found significant improvements in maximal power and VO2max, a decrease in maximal heart rate without other hemodynamic changes. Weight, BMI, fat mass, and waist circumference significantly decreased (P < 0.01), whereas no effects on biological parameters, nor on muscle mass were observed. Some cognitive tests for executive functions (Digit Symbol Substitution Test, P < 0.01; Digit span, P < 0.05) and memory (Rey Auditory Verbal Learning Test, P = 0.03) significantly improved. Regarding the kinetics of the NIRS signals during exercise, both deoxyhemoglobin (HHb) and hemoglobin difference between oxyand deoxyhemoglobin (HbDiff) had higher amplitudes after training (P < 0.05). Conclusion.– In addition to improvements in exercise tolerance, a program combining HIIT and resistance training could improve executive functions in overweight adults. These results were associated with changes in cerebral oxygenation measured using NIRS.

Significant correlations between isokinetics total work at 120◦/s in flexion (r = 0.461) and in extension (r = 0.475) were observed with the body mass index. A high correlation was also found between the total work at 120◦/s in extension (r = 0.668) and the number of hours per week of sport activities. The mean power in extension at 120◦/s was correlated positively (r = 0.453) to the lumbar radiological lordosis. The endurance of agonist (flexors) and antagonist (extensors) ratio were high in both populations compared to expected values in general population (0.91 vs 0.89). Conclusion.– This study reveals no significant difference in the isokinetic trunk strength of both flexors and extensors in the two groups. Based on the results, the usefulness of studying the effect of isokinetic rehabilitation is to remove the inhibition at high speed. So, isokinetic strength parameters, as measured in this study, do not seem to explain the occurrence of low back pain among children. ReferencesExercise reduces the intensity and prevalence of low back pain in 12–13-year-old children: a randomised trial. Gina L Fanucchi, Aimee Stewart et al. Australian Journal of Physiotherapy 2009;55:97–104.The Association between isoinertial trunk muscle performance and low back pain in male adolescents. Federico Balague, Evelyne Bibbo et al. Eur Spine Journal 2010;19;624–32.