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In this study, we examined how mental health inequities by gender and sexual identity changed from before the COVID-19 pandemic to during the early phase of the pandemic. Sexual and gender minority (SGM) adults and non-SGM adults were recruited through social media to complete online questionnaires. Results indicate a worsening change in depression from before the pandemic to during the early phase of the pandemic that was significantly greater for gender minorities compared to cisgender women. Anxiety and loneliness scores did not change differentially for gender minorities (vs cis women) or sexual minorities (vs heterosexuals). Overall, COVID-19 had a greater negative impact on depression for gender minorities compared with cisgender women.

Adolescence is a crucial period for bone growth, and many factors during this period can influence bone quality and the intensity of peak bone mass, e.g., nutritional intakes and physical activity ...

Fragility fractures that occur after a fall from a standing height or less are almost always due to osteoporosis, which remains underdiagnosed and untreated. Patient-specific finite element (FE) models have been introduced to predict bone strength and strain. This approach, based on structure mechanics, is derived from Quantitative Computed Tomography (QCT), and element mechanical properties are computed from bone mineral densities. In this study, we developed a credible finite element model of the radius to discriminate low-trauma-fractured radii from non-fractured radii obtained experimentally. Thirty cadaveric radii were impacted with the same loading condition at 2 m/s, and experimental surface strain was retrieved by stereo-correlation in addition to failure loads in fracture cases. Finite element models of the distal radius were created from clinical computed tomography. Different density-elasticity relationships and failure criteria were tested. The strongest agreement (simulations-experiments) for average strain showed a Spearman's rank correlation (ρ) between 0.75 and 0.82, p 0.0001, with a root mean square error between 0.14 and 0.19%. The experimental mean strain was 0.55%. Predicted failure load error (23%) was minimized for derived Pistoia's failure criterion. Numerical failure demonstrated area under the receiver operating characteristic (ROC) curves of 0.76 when classifying radius fractures with an accuracy of 82%. These results suggest that a credible FE modelling method in a large region of interest (distal radius) is a suitable technique to predict radius fractures after a forward fall.

45e Congrès de la Société de Biomécanique, Metz, France, 26-/10/2020 - 28/10/2020; Distal radius fractures are the most common upper extremity fractures in adults (65 years and older) occurring after a fall from standing height or lower (Vogt et al. 2002). These fractures are associated with age related decline in bone quality and because they occur earlier in life than other osteoporotic fractures, they can be interpreted as a warning signal for later and more deleterious fractures (Melton et al. 2010). Subject-specific finite elements models have been proposed to evaluate both bone strain and fracture risk. The accuracy of these models is heavily dependent on material properties, boundary conditions and the chosen failure criterion that defines fracture threshold (Edwards and Troy 2012). The main aim of the current study was to assess the surface strains prediction of radius specimen-specific finite element models.

44è congrès de la Société de Biomécanique, POITIERS, FRANCE, 28-/10/2019 - 30/10/2019; Fragility fractures of bones are a worldwide health problem. Actual gold standard methods to assess bone fragility have shown to be insufficient (Siris et al. 2004; Chapurlat 2013). Finite elements models (FEM) have been proposed to evaluate bone strength. Most of the previous studies used a static axial loading to assess bone strength. However, among fractures due to a fall from the standing height, only 15% are related to an axial loading (Melton et al. 2010) and the velocity can reach 2 m/s (Tan et al. 2006). Thus, we assume that this dynamic loading should be considered. The main aim of our study is to develop and validate a finite elements model to predict radius bone strain under loading conditions simulating a fall. To reach this goal a first step consisted in developing an ex-vivo protocol to reproduce a forward fall leading to fractured and non-fractured bones (already published) and now comparing experimental surface strains of the distal radius with a specimen-specific finite element model.

OBJECTIVE: Black gay, bisexual, and other men who have sex with men (BMSM) are at elevated risk for HIV infection in the United States. BMSM who inject drugs may be face even higher HIV risk. METHODS: Random time-location sampling was used to survey BMSM attending Black Pride events in 6 U.S. cities about HIV risk and protective behaviors, including injection drug use, prior HIV testing, and pre-exposure prophylaxis (PrEP). 3,429 individuals who reported a HIV negative/unknown serostatus at enrollment were included in the analysis. HIV status was determined by in-field rapid HIV testing. RESULTS: 3.6% of BMSM had injected drugs in their lifetime and 58.5% of BMSM who had injected drugs reported sharing syringes in the past six months. BMSM who had injected drugs more commonly reported current PrEP use than BMSM who had never injected (32.5% vs. 8.2%, p

Objective To develop clinical practice guidelines for the identification, evaluation and treatment of chronic neuropathic pain in spinal cord injury patients. Methods and results the methodology was developed by the SOFMER (the French Society for Physical Medicine and Rehabilitation) and incorporates both guidelines for clinical practice and an expert consensus meeting. Following the creation of a Steering Committee and a Scientific Committee, twelve relevant questions were developed. Two experts from different medical specialties were assigned to each question. The scientific literature was assessed according to the grading scale used by the French Agency for Accreditation and Evaluation in Healthcare (ANAES). The conclusions from the experts’ literature analysis were presented at the 2007 SOFMER congress. Lastly, a multidisciplinary expert panel validated the guidelines. Conclusion Each question generated a number of good practice guidelines, based on the available scientific level of proof and expert opinion.

Resume Objectifs Rechercher les facteurs predictifs de diminution des lombalgies sous le niveau de douleur cliniquement acceptable (NDCA) a la fin d’un programme de reentrainement a l’effort (RAE) chez les lombalgiques chroniques, puis comparer l’efficacite du RAE en terme de reprise du travail que le seuil d’acceptabilite de la douleur ait ete atteint ou non en fin de programme. Methode Etude prospective ouverte chez 303 patients lombalgiques chroniques inclus dans un programme de RAE. Une evaluation des deficiences (distance doigts-sol (DDS, cm), indice de Schober (cm), V O 2 max (1/min), tests de Shirado et de Sorensen (secondes), EVA (0–100) lombalgie et radiculalgie), de l’incapacite fonctionnelle (echelles de Wadell (0–9) et de Quebec (0–100)), et de l’etat psychologique (echelles de Beck et Hamilton (0–30 et 0–35), echelle HAD (0–21), FABQ travail (0–42) et physique (0–24)) a ete realisee au debut et en fin de programme. Les donnees concernant le travail ont egalement ete recueillies (penibilite physique du travail, accident de travail ou non, arret de travail ou non et sa duree, reprise du travail a l’issu du programme). Les variables associees a un NDCA en fin de programme de RAE et une association entre le niveau de douleur et la reprise du travail ont ete recherchees. Resultats Les parametres significativement ameliores sont : DDS (−17,5 ± 16,2), Schober (−0,5 ± 5,4), EVA lombalgie (−6,3 ± 23,6), V O 2 max (0,14 ± 0,4), scores de Wadell (−1,3 ± 2,4), Quebec (−10,5 ± 17), Beck D (−3,1 ± 4,5), Beck A (−2,5 ± 4,3), HAD D (−2,4 ± 4,7), HAD A (−1,3 ± 3,8) et FABQ1 (−5,7 ± 11,6), FABQ2 (−3,9 ± 9,6), endurance des flechisseurs (35 ± 63,83) et extenseurs (44,8 ± 112) du rachis. Les patients atteignant le NDCA reprennent significativement plus le travail (73 % versus 52 %). Cinq parametres predictifs d’une diminution de la lombalgie sous le NDCA ont ete identifies : EVA lombalgie et endurance des flechisseurs du rachis a j0, variations de DDS, d’EVA radiculalgie et du score de Beck pour l’anxiete. Conclusion Le NDCA chez les lombalgiques chroniques lourdement handicapes semble etre une notion pertinente, associee a la reprise d’activite professionnelle apres un programme de RAE.

Objectives To develop clinical practice guidelines concerning the interest of post-operative rehabilitation in physical medicine and functional rehabilitation (PMR) ward after total knee arthroplasty (TKA). Method The SOFMER (French Physical Medicine and Rehabilitation Society) methodology, associating a systematic literature review, collection of everyday clinical practice, and external review by a multidisciplinary expert panel, was used. Main outcomes were impairment, disability, medico-economic implications and postoperative complications. Results Post-operative rehabilitation in a PMR ward after TKA is recommended for patients because of preoperative joint stiffness, and/or associated co-morbidities. The other parameters used by French physician for post-operative rehabilitation in a PMR ward after TKA are: the self-governing of the patient at home, the wishes of the patient and the opinion of the surgeon on the post-operative functional evolution of the patients. For patients in whom sustained rehabilitation is not necessary but who cannot return home, a stay in a non-specific (non-PMR) post-operative centre could be recommended. Post-operative rehabilitation in a PMR ward after TKA could reduce the length of stay in a surgical ward and increase the functional status of patients with co-morbidities. Studies with good methodological quality are needed to evaluate the cost/benefit ratio in the French health care system. Conclusion This study suggests a value of rehabilitation in a PMR ward after TKA, but good methodological quality studies are needed to evaluate the cost/benefit ratio of rehabilitation in a PMR ward after TKA in the French health care system.

Objective To develop clinical practice guidelines concerning predictive criteria for transfer of patients to a rehabilitation ward after hip and knee total arthroplasty. Method The SOFMER (French Physical Medicine and Rehabilitation Society) methodology, associating a systematic literature review, collection of everyday clinical practice, and external review by a multidisciplinary expert panel, was used. Results From systematic literature review and collection of French professional practice, we cannot distinguish the patients undergoing THA and TKA who can transfer to a rehabilitation ward. For both types of patients, the main criteria determining transfer are demographic criteria such as older age or female sex; psychosocial and environmental criteria such as living alone, feeling unable to return home directly (pre-operative education could modify this criterion); and surgeon advice based on the pre and post-operative clinical and functional status. Conclusion Studies with good methodological quality are urgently needed to evaluate the use of predictive tools such as the RAPT, separating THA and TKA, and using as parameters of assessment functional status and handicap reduction.

Resume Objectifs Elaborer des recommandations concernant l'orientation vers un service de reeducation apres la pose d'une prothese totale de hanche ou de genou. Methode La methodologie utilisee, proposee par la Societe francaise de medecine physique et readaptation (Sofmer), associe une revue systematique de la litterature, un recueil des pratiques professionnelles et une validation par un panel pluridisciplinaire d'experts. Resultats Les conclusions issues de la revue de la litterature et des pratiques professionnelles actuelles en France ne permettent pas de distinguer les contextes de la prothese totale de hanche et de genou pour orienter le malade apres l'operation vers un service de reeducation. Dans les deux situations, les principaux criteres d'orientation vers un service de reeducation sont : 1) demographique : âge eleve et sexe feminin ; 2) psychosociaux et environnementaux : absence d'entourage a domicile, sentiment du patient de ne pas pouvoir reintegrer dans l'immediat son domicile (une education preoperatoire pourrait permettre d'orienter ce parametre « preference du patient ») ; 3) predictifs du chirurgien a partir de l'evaluation clinique et fonctionnelle du patient : mauvais etat fonctionnel pre- et postoperatoire. Conclusion Il est necessaire de mettre en place rapidement des etudes de bonne qualite methodologique permettant d'evaluer des outils predictifs d'orientation comme l'indice RAPT en distinguant le contexte des protheses totales de hanche et de genou et en retenant comme criteres principaux d'evaluation le statut algofonctionnel final ainsi que la reduction des situations de handicap.

Objective To develop clinical practice guidelines concerning the use of continuous passive motion (CPM) compared with intermittent mobilization after total knee arthroplasty (TKA). Method We used the SOFMER (French Physical Medicine and Rehabilitation Society) methodology, combining systematic literature review and collection of everyday clinical practice concerning postoperative rehabilitation techniques and external review by a multidisciplinary expert panel, to develop the guidelines. Results The literature contains no evidence of the advantages of CPM over other techniques of mobilization, although CPM could be adjuvant therapy used to accelerate short-term recovery. However, in France, CPM remains widely used after TKA, both in orthopedic surgery units and in physical medicine and rehabilitation services. Conclusion Good methodological quality studies are needed to assess different CPM modalities and compare them to alternative intermittent mobilization techniques, particularly those with therapy starting from a flexed position.

Objective To develop clinical practice guidelines concerning the use of continuous passive motion (CPM) compared with intermittent mobilization after total knee arthroplasty (TKA).

Objective To develop clinical practice guidelines concerning preoperative rehabilitation for hip and knee total arthroplasty. Method We used the SOFMER (French Physical Medicine and Rehabilitation Society) methodology, combining systematic literature review, collection of everyday clinical practice, and external review by a multidisciplinary expert panel, to develop the guidelines. Main outcomes considered in the recommendations were impairment, disability, medico-economic implications and postoperative complications. Results A preoperative rehabilitation program, comprising at least physical therapy and education, is recommended before total hip and knee arthroplasty. Occupational therapy could be combined with patient home visits. Isolated physical therapy before total knee arthroplasty (TKA) is not recommended. Multidisciplinary rehabilitation comprising at least occupational therapy and education is desirable for the most fragile patients because of major disability, co-morbidity or social problems. Complementary studies are required to confirm the impact of pre-operative rehabilitation before total hip and knee arthroplasty, to define components of rehabilitation and the patients most likely to benefit. Conclusion Rehabilitation before total hip and knee arthroplasty contributes to reduced hospital length of and modifying discharge conditions. This rehabilitation necessitates the collaboration of qualified health care professionals in the educational topic and return-home preparation. Preoperative patient assessment is important.

Resume Objectifs Elaborer des recommandations concernant la prise en charge en reeducation precedant une arthroplastie totale de hanche ou de genou. Methode La methodologie utilisee, proposee par la Societe francaise de medecine physique et readaptation (Sofmer), associe une revue systematique de la litterature, un recueil des pratiques professionnelles, une validation par un panel pluridisciplinaire d'experts. Les criteres d'analyse concernent les deficiences et l'incapacite fonctionnelle, les donnees medicoeconomiques et les complications postoperatoires. Resultats Une reeducation preoperatoire qui doit comporter au minimum de la kinesitherapie associee a de l'education est recommandee avant arthroplastie totale de hanche et de genou. De l'ergotherapie pouvant comporter une visite a domicile peut etre egalement etre proposee. La kinesitherapie isolee avant arthroplastie totale de genou n'est pas recommandee. Pour les patients les plus fragiles du fait de capacites fonctionnelles alterees, de comorbidites, et/ou de problemes sociaux une reeducation pluridisciplinaire comportant au minimum de l'ergotherapie et une education est souhaitable. Il est souhaitable d'entreprendre des etudes complementaires afin de confirmer l'interet de la reeducation precedant une arthroplastie totale de la hanche (PTH) ou du genou (PTG), d'en preciser les modalites et de mieux definir les patients les plus susceptibles d'en beneficier. Conclusion La realisation d'une reeducation avant arthroplastie totale de la hanche ou du genou contribue a reduire la duree de sejour et a modifier les modalites de retour a domicile. Cette prise en charge doit faire appel a des professionnels de sante competents dans l'education des patients et la preparation du retour a domicile. L'evaluation preoperatoire des besoins des patients est egalement capitale.

Objective The development of a rigorous methodology based on published results of clinical trials, evaluation of daily practice in France and multidisciplinary expert opinion to elaborate recommendations for rehabilitation interventions. Methods and results The following describes the methodology of SOFMER (Societe Francaise de Medecine Physique et de Readaptation [French Society of Physical Medicine and Rehabilitation]) for developing recommendations for rehabilitation interventions. The test case was developing recommendations for rehabilitation in hip or knee osteoarthritis (OA) and hip or knee arthroplasty. Physicians in rehabilitation, orthopedic surgery and rheumatology identified, synthesized, and analyzed data from the literature by use of the usual French system of grading trials (the French Agency for Accreditation and Evaluation in Healthcare [ANAES] scale). The data were published results of comparative controlled studies such as randomized controlled trials, controlled clinical trials, cohort studies, case control studies, reviews of clinical trials, and case series, as well as uncontrolled cohort studies. The resulting recommendations were presented to the three annual French national congresses of rehabilitation, rheumatology, and orthopedic surgery for comment and for adapting to French professional practice. Finally, a panel of multidisciplinary experts (physicians in physical medicine and rehabilitation, rheumatologists, orthopedic surgeons, general practitioners, physical therapists, social workers, podologists, occupational therapists, nurses, and patients) validated the recommendations. Conclusion The SOFMER methodology could be an interesting tool for use in developing recommendations elaborated by all the concerned medical and surgical specialists in the wide domain of rehabilitation.

Resume Objectif Developper une methode rigoureuse s'appuyant sur les resultats d'etudes publiees, l'evaluation des pratiques professionnelles francaise et l'opinion d'experts pluridisciplinaire pour elaborer des recommandations dans le domaine de la prescription de reeducation. Methodes et resultats La methode de la SOFMER (Societe francaise de medecine physique et de readaptation) a ete elaboree pour le developpement de recommandations en reeducation. Elle a ete utilisee initialement pour etablir des recommandations pour la pratique clinique dans la reeducation de l'arthrose de la hanche et du genou operee et non operee. Des praticiens specialises en medecine physique et readaptation (MPR), chirurgie orthopedique et rhumatologie ont identifie, analyse et resume la litterature a l'aide de la grille de cotation de l'Anaes (Agence nationale pour l'accreditation et l'evaluation en sante). Les donnees utilisees etaient issues d'etudes comparatives controlees randomisees ou non, d'etudes de suivi de cohorte, d'etudes cas temoins, de revues d'etudes controlees et d'etudes de cas. Les conclusions ont ete presentees lors des trois congres nationaux des societes savantes francaises de MPR, rhumatologie et chirurgie orthopedique afin qu'elles soient discutees et adaptees aux pratiques professionnelles francaises. Enfin, un panel d'experts pluridisciplinaire (medecins specialistes de MPR, rhumatologie et chirurgie orthopedique ; medecins generalistes ; kinesitherapeutes ; assistantes sociales ; pedicure–podologues ; ergotherapeutes ; infirmieres et patients) ont valide les recommandations elaborees a partir du travail d'expertise et des reponses obtenues lors des congres sur les pratiques. Conclusion La methode SOFMER peut etre un outil util pour le developpement de recommandations par tous les medecins concernes par le vaste champ de la reeducation.

Resume Objectif Faire une mise au point sur la fatigue dans la spondylarthrite ankylosante (SPA), evaluer les outils de mesure, la relation avec les autres symptomes, et sa prise en charge therapeutique. Methodes La recherche a ete effectuee a partir des bases de donnees Medline, Embase, Pascal et Cochrane avec les mots cles : fatigue , spondyloarthropathy , ankylosing spondylitis , evaluation, assessment , outcome , exercise , rehabilitation , et completee par les donnees bibliograhiques des articles consultes. Resultats La fatigue est un symptome frequent dans la SPA. Elle est mesuree sur une echelle visuelle analogique dans un item de l'indice d'activite de la SPA (BASDAI). Elle est fortement liee aux autres symptomes de la maladie (raideur et douleur), et elle est influencee par les troubles du sommeil. La fatigue reduit la qualite de vie de ces patients. Les anti-TNF semblent mieux reduire la fatigue que les anti-inflammatoires non steroidiens. L'activite physique est recommandee pour ameliorer ce symptome. Discussion Il n'existe pas d'outil valide et pertinent composite, tenant compte de son caractere multidimensionnel et multifactoriel pour evaluer la fatigue dans la SPA. L'existence d'un traitement efficace sur la fatigue comme semblent l'etre les anti-TNF est un element important pour faciliter les mesures de reeducation. La pratique reguliere d'exercices physiques a un effet favorable sur la fatigue et sur la qualite de vie.

Objective To translate into Arabic and validate the Oswestry index for low back pain in an Arab population. Background No functional disability index to assess low back pain written in the Arabic language and validated in an Arab population is available. Design Arabic translation of the Oswestry index was obtained by the "forward translation/backward translation" method. Adaptations were made after a pilot study involving ten patients aged 18 to 65 years old. Impairment outcome measures (pain as measured on a visual analog scale [VAS], Schober-McRae, index, duration of morning stiffness and number of night awakenings), disability (Quebec index, Waddell index), handicap (as measured on a VAS) and Beck depression scale scores were recorded. Inter-rater reliability was assessed by use of the intra-class correlation coefficient (ICC) and the Bland and Altman method. Construct validity was investigated with use of the Spearman rank correlation coefficient (convergent and divergent validity), and factor analysis was performed. Internal consistency was assessed by use of the Cronbach alpha coefficient. Results Eighty Tunisian patients with low back pain were included in the validation study. Two items were excluded. Inter-rater reliability was excellent (ICC = 0.98). Expected divergent and convergent validity results suggested good construct validity. Two main factors were extracted by factor analysis and explained 58.19% of the cumulative variance: the first factor represented discomfort in dynamic activities, the second discomfort in static activities. The Cronbach alpha coefficient was 0.76 for factor 1 and 0.70 for factor 2. Conclusion We translated into and adapted the Oswestry index for the Arabic language in a population of Tunisian women? with low back pain. The 8-item version is reliable and valid. Although the scale was validated in a Tunisian population, we expect that it is suitable for other Arab populations, especially North Africans. Further study is needed to confirm such a hypothesis.

Resumen La columna lumbar es una estructura compleja con capacidad para soportar fuerzas mecanicas externas y moverse en varias direcciones. Ambas funciones dependen del disco intervertebral y de las articulaciones interapofisarias posteriores, pero tambien de los musculos y de los ligamentos. El disco intervertebral esta poco inervado y es avascular; la degeneracion del mismo desempena un papel fundamental en los trastornos lumbares comunes. La inflamacion local y el estres mecanico son las causas principales de la degeneracion discal. En esta revision se describen la anatomia, el laboratorio, la fisiologia y la biomecanica de la columna lumbar.

Resume Le rachis lombaire est une structure complexe ayant a la fois la capacite de resister aux contraintes mecaniques externes mais egalement de permettre une mobilite multidirectionnelle. Ces deux fonctions sont assurees par le disque intervertebral, les articulations interapophysaires posterieures, la colonne lombaire mais egalement des muscles et des ligaments. Le disque intervertebral est peu innerve et non vascularise et sa degenerescence joue un role primordial dans la pathologie lombaire commune. Les phenomenes inflammatoires locaux et le stress mecanique sont les deux principales causes de la degenerescence discale. Dans cette revue, il est presente l'anatomie, la biologie, la physiologie et la biomecanique du rachis lombaire.

Objectives To identify all available shoulder disability questionnaires and to examine those that could be used for athlete. Methods We systematically reviewed the literature in Medline using the keywords shoulder, function, scale, index, score, questionnaire, disability, quality of life, assessment, and evaluation. We searched for scales used for athletes with the keywords scale name AND (sport OR athlete). Data were completed by using the "Guide des Outils de Mesure et d'Evaluation en Medecine Physique et de Readaptation" textbook. Analysis took into account the clinimetric quality of the instruments and the number of items specifically related to sports. Results A total of 37 instruments have been developed to measure disease-, shoulder-specific or upper extremity specific outcome. Older instruments were developed before the advent of modern measurement methods. They usually combined objective and subjective measures. Recent instruments were designed with use of more advanced methods. Most are self-administered questionnaires. Fourteen scales included items assessing sport activity. Four of these scales have been used to assess shoulder disability in athlete. Six scales have been used to assess such disability but do not have specific items related to sports. Conclusion There is no gold standard for assessing shoulder outcome in the general population and no validated outcome instruments specifically for athletes. We suggest the use of ASES, WOSI and WORC scales for evaluating shoulder function in the recreational athletes. The DASH scale should be evaluated in this population. The principal criterion in evaluating shoulder function in the high level athlete is a return to the same level of sport performance. Further studies are required to identify measurement tools for shoulder disability that have a high predictive value for return to sport.

Resume La lombalgie commune, bien que benigne, entraine des retentissements personnels et sociaux majeurs. De nombreux instruments ont ete elabores et valides pour evaluer ces retentissements. Les incidences socioeconomiques de la lombalgie commune sont considerables, equivalant au cout induit par la depression, les pathologies coronariennes, le diabete et la migraine. L'absence de suivi des recommandations concernant la prise en charge des lombalgies aigues et chroniques entraine un surcout de ces pathologies.

Resume Objectifs. – Traduction en arabe et validation de l'indice algofonctionnel de Lequesne sur une population tunisienne de gonarthrosiques. Aucun indice fonctionnel n'est actuellement disponible en langue arabe pour evaluer le retentissement de la gonarthrose sur les capacites fonctionnelles du sujet. Patients et methodes. – La traduction a ete obtenue par la methode de « translation/back-translation ». Des adaptations ont ete apportees apres un pre-test effectue sur 13 patients. Ont ete inclus dans cette etude les patients ayant une gonarthrose symptomatique selon les criteres radiologiques et cliniques de « L'American College of Rheumatology » (ACR). Les mesures cliniques comprenaient l'evaluation de la deficience (par l'EVA douleur, la mobilite en flexion–extension et le score radiologique de Kellgren), de l'incapacite (par le perimetre de marche et le score du WOMAC), et de l'etat psychologique du patient par l'indice de depression de Beck. La repetabilite a ete evaluee en utilisant le coefficient de correlation intraclasse et la methode de Bland et Altman, la validite de construit a ete evaluee a l'aide du coefficient de correlation non parametrique de Spearman (pour l'etude des validites de convergence et de divergence), et d'une analyse factorielle suivie de rotation orthogonale. La coherence interne de chacun des facteurs a ete jugee par l'etude du coefficient alpha de Crohnbach. Resultats. – Cent trois patients ont participe a cette etude. La repetabilite est excellente (ICC = 0,91). La methode de Bland et Altman montre une moyenne des differences centree et l'absence d'effet systematique. Les correlations du score de l'indice avec le perimetre de marche (r = –0,77), l'EVA douleur (r = 0,543), le score de la section A du WOMAC (r = 0,58), le score de la section B du WOMAC (r = 0,48), le score de la section C du WOMAC (r = 0,66), le score de depression de Beck (r = 0,28), le tour de cuisse (r = 0,13), et le score de Kellgren (r = 0,32) suggerent une validite de construit satisfaisante (validites convergente et divergente). L'analyse factorielle a permis d'extraire deux facteurs expliquant 55,3 % de la variance totale. Le premier facteur represente la fonction, le deuxieme represente la douleur et la raideur. Le coefficient alpha de Crohnbach a ete de 0,68 pour le premier facteur et de 0,54 pour le deuxieme facteur. Conclusion. – L'indice de Lequesne traduit en arabe a des qualites metrologiques satisfaisantes. L'indice est valide sur une population tunisienne, d'autres etudes sont necessaires pour verifier son applicabilite sur d'autres populations arabes.

Resume La pathologie radiculaire est bien definie cliniquement par des criteres precis : trajet radiculaire des douleurs, apparaissant a l’effort, avec un syndrome rachidien net et souvent une histoire lombaire ancienne. Cette symptomatologie est connue des medecins, mais ne prejuge en rien de l’etiologie de ce conflit radiculaire. Seuls un interrogatoire precis, une etude de l’evolution de la symptomatologie, le caractere parfois particulier de ces douleurs peuvent orienter les recherches. Ces recherches doivent etre systematiques, comprenant des imageries precises (imagerie par resonance magnetique), avant de conclure a une radiculalgie dite « commune ». Leur meconnaissance peut avoir de graves consequences dans le cadre d’une pathologie tumorale.

Resume Les sciatiques par hernie discale resultent d'une action a la fois mecanique et chimique sur les racines nerveuses a l'interieur du canal lombaire. Les principaux facteurs de l'inflammation semblent etre l'interleukine 1 et le tumor necrosis factor α. Pour exercer un effet reel de compression, la hernie doit etre volumineuse. Le diagnostic de sciatique par hernie discale est avant tout clinique. L'association d'un signe de Lasegue controlateral et d'une aggravation de la douleur du membre inferieur en extension lombaire semble avoir une bonne specificite pour predire une hernie discale. L'evolution naturelle de la sciatique discale n'est pas seulement favorable sur la symptomatologie mais aussi sur la hernie elle-meme, qui diminue ou disparait dans plus de la moitie des cas. En dehors des syndromes de la queue de cheval et des deficits moteurs qui s'aggravent, la discectomie peut etre retardee sans compromettre le pronostic.