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James-Belin E, Ostertag A, Couzi E, Petrover D, Yelnik A, Orcel P, Beaudreuil J. [Impact économique de l'incapacité professionnelle au cours des lombalgies disco-vertébrales communes chroniques dans la perspective du patient]. Rev Epidemiol Sante Publique 2023; 71:101858. [PMID: 37271081 DOI: 10.1016/j.respe.2023.101858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/16/2023] [Accepted: 04/12/2023] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVES Low back pain (LBP) is one of the main expenditure items for health systems. Data on the economic impact of LBP are uncommon from the patient perspective. The aim of this study was to estimate the economic impact of work disability related to chronic LBP from the patient perspective. METHODS We conducted a cross-sectional analysis from patients aged over 17 years suffering from non-specific LBP for at least 3 months. Systematic medical, social and economic assessments were collected: pain duration and intensity; functional disability with the Quebec Back Pain Disability Scale (0-100); quality of life with the Dallas Pain Questionnaire; job category; employment status; duration of work disability due to LBP, and income. Factors associated with loss of income were identified by multivariable logistic regression analysis. RESULTS We included 244 workers (mean age 43 ± 9 years; 36% women); 199 patients had work disability, including 196 who were on sick leave, 106 due to job injury. Three were unemployed due to layoff for incapacity. The mean loss of income for patients with work disability was 14% [SD 24, range -100 to 70] and was significantly less for patients on sick leave due to job injury than on sick leave not related to job injury (p < 0.0001). On multivariable analysis, the probability of loss of income with LBP was about 50% less for overseers and senior managers than workers or employees (odds ratio 0.48 [95% confidence interval 0.23-0.99]). CONCLUSION Work disability due to LBP resulted in loss of income in our study. The loss of income depended on the type of social protection and job category. It was reduced for patients on sick leave related to work injury and for overseers and senior managers.
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Affiliation(s)
- Etienne James-Belin
- Service de Médecine Physique et de Réadaptation, Hôpital Lariboisère-Fernand Widal, Département Médico-Universitaire Locomotion, Groupe Hospitalo-Universitaire AP-HP.Nord - Université de Paris, Paris, France.
| | - Agnès Ostertag
- Service de Rhumatologie, Hôpital Lariboisère-Fernand Widal, Département Médico-Universitaire Locomotion, Groupe Hospitalo-Universitaire AP-HP.Nord - Université de Paris, Paris, France
| | - Emmanuel Couzi
- Service de Rhumatologie, Hôpital Lariboisère-Fernand Widal, Département Médico-Universitaire Locomotion, Groupe Hospitalo-Universitaire AP-HP.Nord - Université de Paris, Paris, France
| | - David Petrover
- Service de Rhumatologie, Hôpital Lariboisère-Fernand Widal, Département Médico-Universitaire Locomotion, Groupe Hospitalo-Universitaire AP-HP.Nord - Université de Paris, Paris, France
| | - Alain Yelnik
- Service de Médecine Physique et de Réadaptation, Hôpital Lariboisère-Fernand Widal, Département Médico-Universitaire Locomotion, Groupe Hospitalo-Universitaire AP-HP.Nord - Université de Paris, Paris, France
| | - Philippe Orcel
- Service de Rhumatologie, Hôpital Lariboisère-Fernand Widal, Département Médico-Universitaire Locomotion, Groupe Hospitalo-Universitaire AP-HP.Nord - Université de Paris, Paris, France
| | - Johann Beaudreuil
- Service de Médecine Physique et de Réadaptation, Hôpital Lariboisère-Fernand Widal, Département Médico-Universitaire Locomotion, Groupe Hospitalo-Universitaire AP-HP.Nord - Université de Paris, Paris, France
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Dureigne F, Chagnas MO, Roren A, Couzi E, Lefèvre-Colau MM, Moreau S, Nicol V, Rannou F, Daste C, Nguyen C. Barriers and facilitators to bracing in adults with painful degenerative scoliosis: a single-centred mixed-method feasibility study. BMC Musculoskelet Disord 2023; 24:32. [PMID: 36647098 PMCID: PMC9841704 DOI: 10.1186/s12891-022-06111-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 12/21/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Conservative treatments including bracing and exercise therapy are prescribed on the first-line in adults with degenerative scoliosis. However, adherence to conservative treatments is low. We aimed to assess barriers and facilitators to bracing in adults with painful degenerative scoliosis. METHODS We conducted a single-centred mixed-method pilot and feasibility study. All patients scheduled for a multidisciplinary custom-made bracing consultation, from July 2019 to January 2020, in a French tertiary care centre, were screened. Patients were eligible if they had painful adult degenerative scoliosis and a prescription for a rigid custom-made lumbar-sacral orthosis. The primary outcome was barriers and facilitators to bracing assessed by a qualitative approach using semi-structured interviews. Secondary outcomes were back pain, spine-specific activity limitations, symptoms of depression and satisfaction with bracing post-intervention assessed by a quantitative approach. RESULTS Overall, 56 patients were screened and 14 (25%) were included. Mean age was 68.2 (12.3) years. Mean follow-up was 9.8 (2.0) months. Barriers to bracing were increased limitations in some activities, discomfort in hot weather and burden of aesthetic appearance. Facilitators to bracing were reduced pain, improved activities of daily living, suitable weight and improved spinal alignment. Participants self-implemented solutions to enhance adherence. The mean reduction from baseline in pain intensity was 1.7 (2.3) of 10 points, and 6 of 13 patients (46%) had pain intensity < 4 of 10 points. CONCLUSION Bracing is a feasible intervention for people with painful adult degenerative scoliosis. Patients self-implemented their own solutions to enhance adherence.
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Affiliation(s)
- Flora Dureigne
- grid.508487.60000 0004 7885 7602AP-HP.Centre-Université Paris Cité, Rééducation et Réadaptation de l Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France
| | - Marie-Ombeline Chagnas
- grid.508487.60000 0004 7885 7602AP-HP.Centre-Université Paris Cité, Rééducation et Réadaptation de l Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France
| | - Alexandra Roren
- grid.508487.60000 0004 7885 7602AP-HP.Centre-Université Paris Cité, Rééducation et Réadaptation de l Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France ,grid.7429.80000000121866389INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne, ECaMO Team, 75004 Paris, France ,Fédération pour la Recherche sur le Handicap et l Autonomie, 75013 Paris, France
| | - Emmanuel Couzi
- grid.508487.60000 0004 7885 7602AP-HP.Centre-Université Paris Cité, Rééducation et Réadaptation de l Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France
| | - Marie-Martine Lefèvre-Colau
- grid.508487.60000 0004 7885 7602AP-HP.Centre-Université Paris Cité, Rééducation et Réadaptation de l Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France ,grid.7429.80000000121866389INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne, ECaMO Team, 75004 Paris, France ,Fédération pour la Recherche sur le Handicap et l Autonomie, 75013 Paris, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, Faculté de Santé, UFR de Médecine, 75006 Paris, France
| | - Sylvain Moreau
- grid.508487.60000 0004 7885 7602AP-HP.Centre-Université Paris Cité, Rééducation et Réadaptation de l Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France
| | - Vanina Nicol
- grid.508487.60000 0004 7885 7602AP-HP.Centre-Université Paris Cité, Rééducation et Réadaptation de l Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France
| | - François Rannou
- grid.508487.60000 0004 7885 7602AP-HP.Centre-Université Paris Cité, Rééducation et Réadaptation de l Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, Faculté de Santé, UFR de Médecine, 75006 Paris, France ,grid.7429.80000000121866389INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire (T3S), Campus Saint-Germain-des-Prés, 75006 Paris, France
| | - Camille Daste
- grid.508487.60000 0004 7885 7602AP-HP.Centre-Université Paris Cité, Rééducation et Réadaptation de l Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, Faculté de Santé, UFR de Médecine, 75006 Paris, France ,grid.7429.80000000121866389INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne, METHODS Team, 75004 Paris, France
| | - Christelle Nguyen
- grid.508487.60000 0004 7885 7602AP-HP.Centre-Université Paris Cité, Rééducation et Réadaptation de l Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, Faculté de Santé, UFR de Médecine, 75006 Paris, France ,grid.7429.80000000121866389INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire (T3S), Campus Saint-Germain-des-Prés, 75006 Paris, France
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Charrière S, Maigne JY, Couzi E, Lefèvre-Colau MM, Rannou F, Nguyen C. Conservative treatment for chronic coccydynia: a 36-month prospective observational study of 115 patients. Eur Spine J 2021; 30:3009-3018. [PMID: 34216237 DOI: 10.1007/s00586-021-06911-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/01/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To describe long-term outcomes of conservative treatment for chronic coccydynia. METHODS We conducted a 36-month prospective observational study. Adults with chronic coccydynia (> 2 months) were included. The first-line treatment was coccygeal corticosteroid injection. The second-line treatment was either manual therapy or coccygectomy. The primary endpoint was the mean variation from baseline of coccydynia intensity at 6 and 36 months, using a numeric rating scale (0, no pain; 10, maximal pain). Evolution was considered unfavorable when coccydynia intensity was > 3 of 10 points at 36 months or coccygectomy had been performed. We carried out bivariate and multivariate analyses to identify variables associated with an unfavorable evolution. RESULTS We included 115 participants. Mean (SD) age was 43.5 (12.3) years, duration of coccydynia 18.4 (21.6) months and coccydynia intensity 6.5 (2.0) of 10 points. Mean variations for coccydynia intensity were - 1.5 (3.0) at 6 months and - 2.8 (3.2) at 36 months. At 36 months, 59/115 (51%) participants had an unfavorable evolution. In bivariate analysis, posterior coccyx dislocations were numerically more frequent in participants with an unfavorable evolution compared to others (29/59 (48%) versus 17/56 (30%), p = 0.057). In multivariate analysis, longer duration of coccydynia was associated with an unfavorable evolution (OR = 1.04, 95% CI from 1.01 to 1.07, p = 0.023). CONCLUSION In adults with chronic coccydynia receiving conservative treatment, symptoms decrease overtime, but significantly persist at 36 months in more than half of them. For patients with posterior coccyx dislocation, coccygectomy may be considered rapidly.
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Affiliation(s)
- Solène Charrière
- Hôpital Cochin, Service de Rééducation Et de Réadaptation de L'Appareil Locomoteur et des Pathologies du Rachis, AP-HP. Centre-Université de Paris, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Jean-Yves Maigne
- Hôpital Cochin, Service de Rééducation Et de Réadaptation de L'Appareil Locomoteur et des Pathologies du Rachis, AP-HP. Centre-Université de Paris, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Emmanuel Couzi
- Hôpital Cochin, Service de Rééducation Et de Réadaptation de L'Appareil Locomoteur et des Pathologies du Rachis, AP-HP. Centre-Université de Paris, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Marie-Martine Lefèvre-Colau
- Hôpital Cochin, Service de Rééducation Et de Réadaptation de L'Appareil Locomoteur et des Pathologies du Rachis, AP-HP. Centre-Université de Paris, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France.,Faculté de Santé, UFR de Médecine, Université de Paris, 75006, Paris, France.,Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire Et Biomarqueurs (T3S), INSERM UMR-S 1124, Campus Saint-Germain-des-Prés, 75006, Paris, France.,Institut Fédératif de Recherche Sur Le Handicap, 75013, Paris, France
| | - François Rannou
- Hôpital Cochin, Service de Rééducation Et de Réadaptation de L'Appareil Locomoteur et des Pathologies du Rachis, AP-HP. Centre-Université de Paris, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France.,Faculté de Santé, UFR de Médecine, Université de Paris, 75006, Paris, France.,Centre de Recherche Épidémiologie Et Statistique Paris (CRESS), ECaMO Team, INSERM UMR-S 1153, 75004, Paris, France
| | - Christelle Nguyen
- Hôpital Cochin, Service de Rééducation Et de Réadaptation de L'Appareil Locomoteur et des Pathologies du Rachis, AP-HP. Centre-Université de Paris, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France. .,Faculté de Santé, UFR de Médecine, Université de Paris, 75006, Paris, France. .,Centre de Recherche Épidémiologie Et Statistique Paris (CRESS), ECaMO Team, INSERM UMR-S 1153, 75004, Paris, France.
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Couzi E, Boisson M, Segretin F, Lefèvre-Colau MM, Roren A, Moreau S, Goret S, Poiraudeau S, Rannou F, Nguyen C. Lumbosacral immobilization following glucocorticoid intradiscal injection in patients with chronic low back pain and active discopathy: A feasibility study. J Back Musculoskelet Rehabil 2021; 33:931-937. [PMID: 32310158 DOI: 10.3233/bmr-191552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Emmanuel Couzi
- Université Paris Descartes, Faculté de Médecine, Sorbonne Paris Cité, Paris, France.,AP-HP, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Paris, France
| | - Margaux Boisson
- AP-HP, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Paris, France
| | - François Segretin
- AP-HP, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Paris, France
| | - Marie-Martine Lefèvre-Colau
- Université Paris Descartes, Faculté de Médecine, Sorbonne Paris Cité, Paris, France.,AP-HP, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Paris, France.,INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique, Sorbonne Paris Cité, ECaMO Team, Paris, France.,Institut Fédératif de Recherche sur le Handicap, Paris, France
| | - Alexandra Roren
- Université Paris Descartes, Faculté de Médecine, Sorbonne Paris Cité, Paris, France.,AP-HP, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Paris, France.,INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique, Sorbonne Paris Cité, ECaMO Team, Paris, France.,Institut Fédératif de Recherche sur le Handicap, Paris, France
| | - Sylvain Moreau
- AP-HP, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Paris, France
| | - Stéphanie Goret
- AP-HP, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Paris, France
| | - Serge Poiraudeau
- Université Paris Descartes, Faculté de Médecine, Sorbonne Paris Cité, Paris, France.,AP-HP, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Paris, France.,INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique, Sorbonne Paris Cité, ECaMO Team, Paris, France.,Institut Fédératif de Recherche sur le Handicap, Paris, France.,Université Paris Descartes, Faculté de Médecine, Sorbonne Paris Cité, Paris, France
| | - François Rannou
- Université Paris Descartes, Faculté de Médecine, Sorbonne Paris Cité, Paris, France.,Institut Fédératif de Recherche sur le Handicap, Paris, France.,INSERM UMR 1124, Laboratoire de Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire, Faculté des Sciences Fondamentales et Biomédicales, Paris, France
| | - Christelle Nguyen
- Université Paris Descartes, Faculté de Médecine, Sorbonne Paris Cité, Paris, France.,Institut Fédératif de Recherche sur le Handicap, Paris, France.,INSERM UMR 1124, Laboratoire de Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire, Faculté des Sciences Fondamentales et Biomédicales, Paris, France
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