Massokinésithérapie dans les lombalgies communes

Évaluation à quatre ans d'un programme de reconditionnement à l'effort pour lombalgie chronique

OBJECTIVE

To assess at four years follow-up the efficiency of exercise therapy for chronic low back pain in terms of pain, physical ability, quality of life and return to work.

MATERIALS AND METHODS

Patients who graduated from a functional restoration program between April 1997 and June 1999, answered a questionnaire at one year follow-up. The patients who had answered this questionnaire were evaluated 48 months later: they first answered another questionnaire and then most underwent a clinical examination assessing pain on a visual analogue scale, flexibility by use of the Schöber index and the finger-ground distance test, endurance of abdominal and spinal muscles, and quality of life as assessed by the Dallas pain questionnaire.

RESULTS

Thirty-four patients graduated from the program; 26 were studied at four-year follow-up. Pain intensity was significantly reduced. Improvement in flexibility after the program remained at four-year follow-up, whereas improvement in endurance did not. Scores on the Dallas pain questionnaire remained as improved as those at one-year follow-up. Initially, 23 of the 26 patients had a job; 19 were on sick leave for an average of 35 weeks. At four-year follow-up, 16 patients were still working, and 56% had changed jobs. Six patients pursued a regular activity before entering the program; at four-year follow-up, 17 were regularly active. No significant relationship was found between the pursuit of physical activity and return to work. Nevertheless, a significant relationship was found between having a regular physical activity and improvement of the finger-ground distance and endurance of spinal muscles. This observation was not true for the Dallas pain questionnaire scores.

CONCLUSION

Despite the lack of a control group, this study seems to favour a benefit in the functional restoration program.

Gestion des risques infectieux liés aux piscines et bains collectifs à usage médical

There is no specific legislation concerning pools and others medical hydrotherapy equipments relating hygiene and security rules. For this reason, the hydrotherapy pools use the public swimming pools legislation.

METHOD

This article is based on literature review (database Medline and Embase--manual research).

RESULTS

This article offers a review of pool associated infections along with the description of the measures designed to minimise the possible transmission of infection during hydrotherapy activities such as: Technical measures: pool and premises conception, water treatments, feed tanks, air quality. Hygiene rules for patients and hospital staff and pathologies which are contra-indications to hydrotherapy activities. Microbiological and physico-chemical monitoring.

DISCUSSION

The infectious risk remains low with therapeutic pools. However, the development of specific legislation and surveillance should be enhanced.

CONCLUSION

All these measures are part of the quality assurance program that must be implemented to control the safety of these installations.

Intérêt des critères de Cochin pour poser l’indication d’infiltrations articulaires postérieures chez le lombalgique chronique : étude comparative prospective

The seven Criteria of Cochin (CC), clinical descriptive criteria of low back pain (LBP), have been shown to be able to select patients whose LBP would respond well to facet joint anesthesia.

AIM

To determine if these seven criteria set are able to select patients with significant relief of LBP after corticosteroid facet joint injections (CFJI).

METHODS

Ninety-one patients with chronic LBP were included in a positive group (PG) or a negative group (NG) according to the number of the positive CC. Patients placed in the PG had five or more of the positive CC and those in the NG had less than five of the positive CC. All of them received CFJI on day 0 (D0). The severity of LBP and leg pain, disability and CFJI effect were evaluated on a self-questionnaire on D0, D2, D8 and D30.

RESULTS

Two hundred and seventeen CFJI were performed (mean 2.1 per patient). Compared to the initial values we observed a significant reduction of the LBP at D2, D8 and D30 in both the groups (P < 0.05), a significant augmentation of the leg pain at D30 in the GN (P < 0.05) and a significant improvement of the Quebec back pain disability scale (QBDS) at D8 and D30 in the PG (P <0.05). Compared to the NG values, the PG had a significant higher global estimation of the efficacy of the treatment (P < 0.05) and a significant lesser intensive LBP (P <0.05) on D2, D8 and D30, a significant lesser intensive leg pain (P < 0.05) on D30, and a tendency to a more important reduction of the QBDS on D8 and D30 (P > 0.05).

CONCLUSION

CC seems to be an effective test to select patients whose LBP would respond well to CFJI.

[Effectiveness and compliance to a center-based short rehabilitation program with a home-based program for chronic low back pain]

OBJECTIVES

To assess the effectiveness and compliance to a short center-based intensive rehabilitation program followed by a home-based program for chronic low back pain.

METHODS

Open prospective study in patients with chronic low back pain. The program included five weekly meetings of 12 day. Followed by a home-based program consigned on a booklet. Evaluation of deficiencies (lumbar and radicular pains on an analog visual scale, Schöber Mac Rae test, distance finger-ground, Shirado test, Sorensen test), disabilities (Quebec functional index), and handicap (analog visual scale) were assessed at J0, five weeks, three months and one year. Compliance was assessed quantitatively (a number of exercises, duration of the meetings, numbers meetings per week) and qualitatively (semi-quantitative ordinal scale). Patient's global opinion on the effectiveness of the program was collected on a semi-quantitative ordinal scale.

RESULTS

60 patients (20 women), aged of 45 +/- 10,4 years, were included. Duration of the symptoms was 110 +/- 123 months. At five weeks, a significant improvement of all parameters was observed. This improvement was maintained at three months. At 12 months, there was no more significant improvement. Compliance to the program was 64,4%. 40.7% of the patient did not realize their exercises correctly. The majority gave up back muscle isometric reinforcement exercises. Score of Shirado test, Quebec index and EVA handicap were significantly different in the group realizing the home-base program. At one year, 79% of the patients regarded this program as useful.

CONCLUSION

Although quantitative compliance with the home-based program can be considered as satisfactory, the effectiveness of this intensive rehabilitation program of lumbar decrease after three months. This can be explained by a fast deterioration of qualitative compliance. The effectiveness of a short supervised program between 3 and 6 months associated a more powerful message of motivation must be evaluated.