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Background: Chronic athletic pubalgia is a frequent sport condition in which the effectiveness of medical treatment has not been proven. Intra-muscular injection of botulinum toxin A may have positive effects on pain in some chronic tendinitis. We aimed to describe the short-term evolution of pain, activity limitations and quality of life, after an injection of the adductor longus with botulinum toxin A, in individuals with chronic athletic pubalgia, for whom medical and/or surgical treatments have failed.Method: We conducted a retrospective observational single-centered study. We included consecutive individuals with chronic athletic pubalgia for whom medical and/or surgical treatments have failed and who were treated with an intra-muscular injection of botulinum toxin A injection (100 International Unit (IU) of botulinum toxin A in the adductor longus) under ultrasound guidance. Participants were assessed 50 days after injection for pain using a numerical rating scale (NRS) (0, no pain, and 100, maximal pain) and for activity limitations and quality of life using the Copenhagen Hip and Groin Outcome Score (HAGOS) (0, worse outcome, and 100, most favorable outcome). Participants were also asked to self-report adverse events.Results: We included 20 participants. Mean age was 34.3 (11.7) years and mean symptom duration was 48.9 (61.6) months. Mean pain decreased from 55.3 (SD [22.4] before injection to 38.3 [21.7], 50 days after injection (p=0.027). Mean HAGOS total score increased from 47.0 (12.1) to 58.6 (10.7). No adverse events were self-reported in participants included in analyses. Serious adverse events were reported in 3 individuals who were not included in analyses because of missing data.Conclusion: We observed a numerical decrease in pain intensity in individuals with chronic athletic pubalgia 50 days after intra-muscular botulinum toxin A injection in the adductor longus. Trial registration number: Clinical Trial: NCT05430893 (24/06/2022)

BACKGROUND: In people with chronic low back pain (cLBP) and active discopathy, glucocorticoid intradiscal injection (GC IDI) reduces LBP in the short-term. Lumbosacral immobilization may be useful to obtain long-term results. OBJECTIVE: To assess the feasibility of a lumbosacral immobilization using a pantaloon cast following GC IDI in people with cLBP sand active discopathy. METHODS: We conducted a retrospective feasibility study. Participants were allocated to experimental or control groups by preferences. The experimental group received lumbosacral immobilization using a custom-made pantaloon cast worn continuously for one week following a GC IDI of 25 mg of prednisolone acetate. The control group received GC IDI alone. The primary endpoint was the feasibility of lumbosacral immobilization assessed by the rate of refusal and early withdrawal of the cast. RESULTS: Twelve patients were offered lumbosacral immobilization following GC IDI: the rate of refusal was 3/12 (25.0%) and was 3/9 (33.3%) of early withdrawal. Mean (95% CI) acceptability of the procedure was 55.0 (26.9–83.1)/100 in the experimental group (N= 6) and 61.6 (25.1–98.2)/100 in the control group (N= 6). CONCLUSIONS: We found high rates of refusal and early withdrawal of the lumbosacral immobilization using a pantaloon cast following GC IDI in people with nonspecific cLBP and active discopathy.

Objectives To develop an International Classification of Functioning, Disability and Health (ICF) core set for SSc and to conceive a patient-centred ICF-based questionnaire assessing activities and participation in patients with SSc. Methods The construction of the ICF core set followed two steps. In the first step, meaningful concepts related to SSc were collected using data source triangulation from patients (n = 18), experts (n = 10) and literature (n = 174 articles). In the second step, concepts were linked to the best-matching ICF categories by one reviewer according to prespecified linking rules. Finally, patient-reported activities and participation categories of the ICF core set were translated into understandable questions. Results After linking concepts to ICF categories, 150 ICF categories were collected from focus groups, 22 from experts and 82 from literature. After fusion of the sources and removal of duplicates, the ICF core set included 164 categories: one at the first level, 157 at the second level and six at the third level, with 50 categories on body functions, 15 on body structures, 52 on activities and participation, and 47 on environmental factors. Patient-reported ICF categories on activities and participation were translated into a patient-centred ICF-based 65-item questionnaire. Conclusion The present study proposes an ICF core set that offers a conceptual framework for SSc patients’ care and health policy. Using a patient-centred approach, a patient-centred ICF-based questionnaire, the Cochin Scleroderma ICF-65 questionnaire, assessing activities and participation in patients with SSc, was conceived. Trial registration ClinicalTrials.gov, http://clinicaltrials.gov, NCT01848418.

Resume Objectif Decrire et evaluer la place de l’appareillage et de la kinesitherapie dans la prise en charge des scolioses idiopathique et degenerative de l’adulte. Methodes Une revue de la litterature sans restriction de date ou de langue faite dans Medline a permis d’identifier quelques rares etudes de methodologie correcte. Nous en avons rapporte les resultats en plus de notre experience clinique. Resultats Chez l’adulte, l’objectif de ces traitements est avant tout de soulager les douleurs et ameliorer la fonction. En cas de scoliose lombaire ou thoracolombaire evolutive (majoration de 5° entre deux radiographies), le port d’un corset orthopedique pourrait freiner l’evolution de la deformation s’il est porte 6 heures par jour. Si la scoliose n’est pas evolutive mais douloureuse, un corset de maintien lombaire sur mesure en coutil baleine ou un corset rigide (plastique, resine ou plâtre) porte a la demande est suffisant. La kinesitherapie est indispensable si le patient est symptomatique. Elle repose sur un travail d’autocorrection (surtout dans le plan frontal et sagittal), de redressement actif, sur des exercices de renforcement musculaire des extenseurs du tronc, des etirements, sur la realisation de tractions lombaires et s’associe a une reeducation fonctionnelle. Une activite physique aerobie est recommandee en complement. Conclusion L’appareillage et la kinesitherapie ont une place importante dans la prise en charge des scolioses de l’adulte, qu’elles soient idiopathiques ou degeneratives, evolutives ou non. Les modalites sont fixees apres un examen clinique rigoureux et apres evaluation des attentes des patients.

Background: Recent guidelines regarding systemic sclerosis (SSc) emphasized the need of measuring functioning along with organ-specific measures, pointing out the importance of patient-reported outcome measures (1). The International Classification of Functioning, Disability and Health (ICF) endorsed by the WHO in 2001 set a unified language covering all dimensions of human functioning, including body structures, body functions, activities and participation and environmental factors. Objectives: To develop a comprehensive ICF core set for SSc and to conceive a patient-centered ICF-based questionnaire assessing activities and participation in patients with SSc. Methods: The development of the ICF comprehensive core set followed 2 steps (2). In the first step, meaningful concepts related to SSc were collected using data source triangulation from patients (N=18), experts (N=10) and literature (N=174 articles). In the second step, concepts were linked to the best-matching ICF categories by 2 independent reviewers according to prespecified linking rules (3). Finally, patient-reported activities and participation categories of the comprehensive ICF core set were translated into understandable questions Results: After linking concepts to ICF codes, 151 ICF categories were collected from focus groups, 22 from experts and 82 from literature. After fusion of the sources and removal of duplicates, the comprehensive ICF core set included 165 categories: 1 at the first level, 158 at the second level, 6 at the third level, with 50 categories on body functions, 15 on body structures, 53 on activities and participation and 47 on environmental factors. Patient-reported ICF categories on activities Conclusion: We developed a comprehensive ICF core set that offers a conceptual framework for SSc patients’ care and health policy. Using a patient-centered approach, we conceived a patient-centered ICF-based questionnaire, the Cochin Scleroderma ICF-65 questionnaire, assessing activities and participation in patients with SSc. References [1] Merkel PA, Clements PJ, Reveille JD, Suarez-Almazor ME, Valentini G, Furst DE, et al. Current status of outcome measure development for clinical trials in systemic sclerosis. Report from OMERACT 6. J Rheumatol. 2003;30(7):1630-47. [2] Selb M, Escorpizo R, Kostanjsek N, Stucki G, Ustun B, Cieza A. A guide on how to develop an International Classification of Functioning, Disability and Health Core Set. Eur J Phys Rehabil Med. 2015;51(1):105-17. [3] Cieza A, Geyh S, Chatterji S, Kostanjsek N, Ustun B, Stucki G. ICF linking rules: an update based on lessons learned. J Rehabil Med. 2005;37(4):212-8. Disclosure of Interests: None declared

Background Intervertebral disc therapies (IDT) for the management of non-specific chronic low back (NScLBP) pain are raising interest (1). Objectives To review evidence on the benefits and harms of IDT in people with NScLBP. Methods We searched 4 databases and conference abstracts, from inception to July 2018, for randomized trials of IDT versus placebo interventions, active comparators or usual care. Two independent investigators extracted data and assessed the risk of bias. The primary outcome was LBP intensity at short, intermediate and long terms (2). Secondary outcomes were LBP-specific activity limitation and safety (3). Our review was registered with the International Prospective Register of Systematic Reviews (CRD42019106336). Results Of 17 eligible trials, 5 trials (436 patients) assessed glucocorticoid (GC) IDT and were included in a quantitative synthesis. Twelve trials assessed IDT of other products including ozone (n=2, 140 patients), methylene blue (n=1, 72 patients), stems cells (n=1, 24 patients), glycerol (n=1, 11 patients), etanercept (n=2, 96 patients), tocilizumab (n=1, 60 patients), platelet-rich plasma (n=1, 47 patients), chymopapaine (n=1, 39 patients) and rhGDF-5 (n=2, 55 patients) and were included in a narrative synthesis. Standardized mean differences (SMD) of GC IDT for LBP intensity and activity limitations were -1.33 (-2.34;-0.32) and -0.76 (-1.85;0.34) at short-term, -2.22 (-5.34;0.90) and -1.60 (-3.51;0.32) at intermediate-term and -1.11 (-2.91;0.70) and -0.63 (-1.68;0.42) at long-term, respectively. OR of GC IDT for serious and minor adverse events were 1.13 (0.20; 4.59) and 0.97 (0.49;1.91). Conclusion GC IDT are associated with a reduction in LBP intensity at short-term in people with NScLBP. Positive effects are not sustained. There is no effect on activity limitations. References [1] Knezevic NN, Mandalia S, Raasch J, Knezevic I, Candido KD. Treatment of chronic low back pain - new approaches on the horizon. J Pain Res. 2017;10:1111-23. [2] Chiarotto A, Boers M, Deyo RA, Buchbinder R, Corbin TP, Costa LOP, et al. Core outcome measurement instruments for clinical trials in nonspecific low back pain. Pain. 2018;159(3):481-95. [3] Team QAaSM. Safety of medicines : a guide to detecting and reporting adverse drug reactions : why health professionals need to take action. In: Organization WH, ed. Geneva; 2002. Disclosure of Interests None declared

Objectives: We aim to evaluate the benefits and harms of intervertebral disc therapies (IDTs) in people with non-specific chronic low back pain (NScLBP). Methods: We conducted a systematic review and meta-analysis of randomized trials of IDTs versus placebo interventions, active comparators or usual care. EMBASE, MEDLINE, CENTRAL and CINHAL databases and conference abstracts were searched from inception to June 2020. Two independent investigators extracted data. The primary outcome was LBP intensity at short term (1 week–3 months), intermediate term (3–6 months) and long term (after 6 months). Results: Of 18 eligible trials (among 1396 citations), five assessed glucocorticoids (GCs) IDTs and were included in a quantitative synthesis; 13 assessed other products including etanercept ( n = 2), tocilizumab ( n = 1), methylene blue ( n = 2), ozone ( n = 2), chymopapaine ( n = 1), glycerol ( n = 1), stem cells ( n = 1), platelet-rich plasma ( n = 1) and recombinant human growth and differentiation factor-5 ( n = 2), and were included in a narrative synthesis. Standardized mean differences (95% CI) for GC IDTs for LBP intensity and activity limitations were −1.33 (−2.34; −0.32) and −0.76 (−1.85; 0.34) at short term, −2.22 (−5.34; 0.90) and −1.60 (−3.51; 0.32) at intermediate term and −1.11 (−2.91; 0.70) and −0.63 (−1.68; 0.42) at long term, respectively. Odds ratios (95% CI) for serious and minor adverse events with GC IDTs were 1.09 (0.25; 4.65) and 0.97 (0.49; 1.91). Conclusion: GC IDTs are associated with a reduction in LBP intensity at short term in people with NScLBP. Positive effects are not sustained. IDTs have no effect on activity limitations. Our conclusions are limited by high heterogeneity and a limited methodological quality across studies. Registration PROSPERO: CRD42019106336.

Introduction/Background Active disc disease is characterized by inflammatory-like low back pain (LBP) and the presence of Modic 1 changes on MRI. Its prevalence ranges from 19% to 50% in patients with nonspecific chronic LBP. Pelvic parameters are important determinants of shear and compressive forces applied to the lumbar intervertebral disc. The association between an active disc disease and abnormal pelvic parameters has not been addressed yet. We aimed to compare pelvic parameters between chronic LBP patients with an active disc disease (Modic 1) and those without (Modic 0). Material and method We used a convenient sample from patients prospectively and consecutively recruited in a previous single center case-control pilot study. Cases were defined as chronic LBP male patients with an active disc disease on MRI and controls as patients without. Pelvic parameters, namely sacral slope, pelvic tilt and pelvic incidence, were assessed in an independent and standardized manner by two trained investigators using EOS system imaging performed at inclusion. Results Overall, 35 cLBP patients (13 cases and 22 controls) fulfilled inclusion criteria and had an EOS imaging available. Median age was 42 (35–51.5) years and median LBP duration 50 (33.5–104) months. Pelvic parameters did not differ between the 2 groups: absolute mean (95% IC) difference between Modic 0 and Modic 1 was −7.2° (−15.5; 1.0) for pelvic incidence, −3.7° (−8.7; 1.3) for pelvic tilt and −3.3 (−8.9; 2.3) for sacral slope. Conclusion Pelvic parameters in patients with chronic LBP and an active disc disease do not differ from those in patients without.

Objective The chronic lateral epicondylitis is a common pathology with an economic impact. Actually, many costly therapies are prescribed without evidence of their effectiveness. Physical therapies seem to be neglected. However, they can correct actions at risk and involve the patient in his rehabilitation. Material/patients and methods This study evaluated the effectiveness of a standardized 2 month rehabilitation program composed of: an outpatient group education session, 18 liberal physical therapy sessions with correction of the posture of the trunk and shoulder, eccentric strengthening of the supinator muscles and the wrist extensor muscles, stretching, and some self daily exercises (transverse friction massage and stretching) according to Pernot-Comtet protocol. Patients were evaluated at 3 and 6 months follow-up. Twenty-three patients aged from 18 to 65 years old, who had failed an initial treatment, without physiotherapy recently, were enrolled. Results In total, 71% of patients reported being restored by this protocol. At 3 months, the mean VAS decreased 6.2 ± 1.84 to 4.26 ± 2.68 and was maintained at 6 months (4 ± 2.84), P = 0.0005. The Pain Free Grip Test evaluated on Jamar dynamometer had increased significantly at 3 months: 26.12 kg ± 12.3 versus 21.29 kg ± 8.94 initially (P = 0.027). This effect was maintained at 6 months (24.3 kg ± 10.14, P = 0.17). The significant improvement of the score “Patient Rated Tennis Elbow Evaluation Functional Capacity” reflects a functional gain at 3 months (26.7 ± 10.5 initially versus 19.32 ± 14.46, P = 0.0035), maintained at 6 months (20.21 ± 14.25, P = 0.017). Half of the patients initially on sick leave restarted working at 6 months. The rate of active population has about tripled from 25% to 70%. An initial Pain Free Grip Test superior to 21 kg predicted to succeed in this protocol (sensibility 73%, sensitivity 83%). Discussion–conclusion These results argue for efficiency of an appropriate physical therapy, which had no side effect. However, this pilot study should be confirmed by methodology with a higher level of evidence.