Biomedical subjects

F Béthoux

Publications and source records attributed to F Béthoux.

10 recordsLinked to original sources

PubMed2006

Fatigue and multiple sclerosis.

Even if the definition and pathophysiology of fatigue in multiple sclerosis (MS) are still debated, and despite the scarcity of objective markers correlated with the subjective sensation of fatigue, a review of the literature shows the importance of its detection and management, and allows one to propose therapeutic strategies. Fatigue is not only the most frequently reported symptom in MS, but also a frequent source of activity and participation limitations, psychological distress, and impairment of quality of life. Its management, which must be initiated early, is based on a comprehensive evaluation of its characteristics and consequences (sometimes with the use of scales such as the Fatigue Severity Scale and the Modified Fatigue Impact Scale), and on the identification of many potential contributing factors (psychological disorders, sleep disturbances, pain, infections and other comorbidities, medications, and deconditioning). Rehabilitative interventions are essential to the treatment of fatigue. Beyond the traditional energy conservation strategies and cooling techniques, several randomized controlled studies have demonstrated the positive impact of aerobic exercise. Medications are partially beneficial, and with the exception of amantadine, their efficacy has not been confirmed by randomized double-blind trials.

Fatigue↗

PubMed2005

[Is very old age a prognostic factor for outcome after a first stroke?].

AIM: To determine whether very old age, older than 80 years, after a stroke is a significant predictor of mortality, orientation to a specific care pathway after the acute phase and functional status at 6 months after the stroke. PATIENTS: A sample of 112 consecutive patients admitted to the emergency department because of a first stroke, with hemiplegia and/or aphasia over 6 months, who satisfied strict inclusion/exclusion criteria. Forty-seven patients were older than 80. METHOD: After initial diagnosis and enrolment in the study, follow-up assessments were conducted at 48 hours, 15 days and 6 months. Demographic, medical, and radiographic data were collected, and patients were evaluated on the NIHSS, MMSE, Barthel Index, FIM(TM) and FAM scales. Descriptive statistics were generated, as were uni- and multivariate between group comparisons. RESULTS: Our study shows that after a first stroke, old age is significantly associated with a high rate of death, a low rate of orientation to a physical medicine and rehabilitation unit and return to home but not poorer functional outcome. CONCLUSION: Old age is therefore a determinant of post stroke management. Further studies are needed to evaluate whether in patient rehabilitation would result in significant functional benefit, considering the high cost of care, high risk of recurrent stroke, and high rate of death.

Age Factors↗

PubMed2005

[Low back pain disability assessment tools].

OBJECTIVES: To identify and compare low back pain functional assessment tools and to determine their characteristics and the selection criteria for their use. MATERIALS AND METHOD: We systematically searched Medline with the key words: low back pain, scale validity, questionnaire, assessment, outcome, and functional evaluation and with some data from the "Guide des Outils de Mesure et d'Evaluation en Médecine Physique et de Réadaptation", which allowed us to complete the search on specific tools including the Roland Disability Questionnaire, Dallas Pain Questionnaire, Quebec Back Pain Questionnaire, and Oswestry Back Pain Questionnaire. We restricted our analysis to studies about the psychometric properties of functional tools. RESULTS: We identified 19 scales or questionnaires, 9 specifically for low back pain and with a concept of functional incapacity. Four tools are recognised as having good psychometric properties and are widely used with linguistic adaptations in different countries. We also identified 10 generic tools proposed to assess outcome in low back pain, which are more conceptually linked to perceived health status, quality of life, and pain assessment. CONCLUSION: A "gold standard" to evaluate disability in low back pain does not exist, but only 4 tools (the Dallas Pain Questionnaire, Roland Disability Questionnaire, Quebec Back Pain Disability Scale and Oswestry Low Back Pain Disability Questionnaire) demonstrated strong qualities (content and construct validity, feasibility, linguistic adaptation and international use).

Disability Evaluation↗

PubMed2005

[Evaluation and multiple sclerosis].

We conducted a review of existing assessment tools that can be useful to physical medicine and rehabilitation professionals involved in the management of patients with multiple sclerosis (MS). Most generic tools traditionally used in neurorehabilitation, such as gait tests, the functional independence measure, or the SF-36, can be applied to MS, but few have been tested on large patient samples. Disease-specific scales often seem more pertinent and sensitive to change, and their qualities and limitations are better known through clinical trials of disease-modifying therapies.

Disability Evaluation↗

PubMed2003

[Evaluation of the handicap and the quality of life in spinal cord injuries: study in a population of 58 patients living at home].

GOAL: The main purpose of this study was to identify objective factors (social and economic status, impairments, functional limitations) contributing to the subjective quality of life of subjects presenting with residual neurological deficits from a traumatic spinal cord injury (SCI) and living at home. SUBJECTS AND METHOD: This is a cross-sectional descriptive study of a sample of SCI patients followed at a Physical Medicine and Rehabilitation facility. After informed consent was obtained, a clinical and functional examination was conducted and questionnaires were filled out by the subjects. The following parameters were assessed: impairments (sensory and motor ASIA scores), disability (Barthel Index and Functional Independence Measure), and quality of life (Reintegration to Normal Living Index and Nottingham Health Profile). RESULTS: Fifty-eight subjects completed the study (mean age 41.38 +/-13.55 years and mean delay from onset 6.24 +/- 6.06 years). There was a strong significant correlation between the level of quality of life and the current age, the age at the time of the accident and the disability level, particularly for the dimensions of physical independence, social integration and mobility. CONCLUSION: Our results are consistent with published data, which identify age as a determining factor of quality of life after SCI. Our review of the literature indicated that time from onset influences quality of life. Longitudinal studies, taking into account the levels of social participation, are needed to better understand the impact of time on quality of life after SCI.

Activities of Daily Living↗

PubMed2001

[Functional assessment scales and lower limb amputation].

INTRODUCTION: This paper is a review of the literature on assessment tools in lower limb amputees. MATERIAL AND METHODS: The authors have research on Medline(R) data base the different tools with keys words "lower limb amputee or amputation, functional evaluation or outcome assessment tools, activity of daily living", and have completed the research with the references of papers. RESULTS: A comprehensive approach of the consequences of an amputation and of the outcome of prosthetic care should include an evaluation of gait, use of the prosthesis in activities of daily life, acceptability and satisfaction with the device. DISCUSSION: Functional assessment tools that are validated are recent, and most of them were developed in English. They take into account the use and the acceptance of the device, but there is no study using them for an important sample population. CONCLUSION: It is now necessary to translate the recent tools into French, and to confirm their validity and sensitivity to change.

Activities of Daily Living↗

PubMed2000

A meta-analysis of methylprednisolone in recovery from multiple sclerosis exacerbations.

Despite recent advances in multiple sclerosis treatment, patients experience relapses for which standard treatment remains glucocorticosteroids (GCS). However, there is limited information comparing doses or routes of administration for different GCS types or the benefit of GCS compared to natural recovery. Currently, high dose (HD) methylprednisolone (MP) is the preferred therapy. We conducted meta-analyses of published studies assessing MP at different doses and in comparison to other steroid products or no treatment. Relevant studies were identified through predetermined processes and five articles met the inclusion criteria. Three studies compared HD MP to placebo; two studies compared the effect of HD MP and low dose (LD) MP; only one accepted report compared HD MP to another GCS. This report could not be included in a meta-analysis. The meta-analysis of HD MP vsplacebo studies indicated a mean treatment difference of 0.76 in Expanded Disability Status Score (EDSS) changes from baseline. The meta-analysis of HD and LD MP demonstrated no difference in EDSS change. Despite these rather obvious findings, these meta-analyses have been valuable in identifying further research questions. We recommend studies to determine optimum benefit related to dosage, timing for starting therapy and the most appropriate GCS type. Given the advances in MS therapeutics, these studies will have to include patients on additional disease modifying therapy. Multiple Sclerosis (2000) 6 267 - 273

Disability Evaluation↗

PubMed1996

Quality of life of the spouses of stroke patients: a preliminary study.

To study the global quality of life (QOL) of spouses of chronic stroke patients, and to determine its most pertinent factors, we assessed nine stroke patients and their spouses, using the Barthel index, the Functional Independence Measure (FIM), the Montgomery and Asberg Depression Rating Scale (MADRS), the Reintegration to Normal Living Index (RNLI), and a 10-cm visual analogue scale (VAS) to evaluate spouses' QOL. Correlation analysis was performed with the Spearman rank correlation analysis. Mean age of spouses was 53.6 +/- 11.3 years (male:female ratio, 8:1). The mean interval from stroke was 17.6 +/- 10.6 months. The spouses' median QOL score was 4.9, with a significant correlation between spouses' QOL scores and patients Barthel index scores, FIM global scores, and FIM locomotion scores. Spouses complained of the physical burden, but psychological, social, economic and marital consequences of the stroke were also reported. This study confirms the constant impact of stroke on the QOL of the spouses, and demonstrates the role of patients' physical disability. However, the VAS allows only a global approach. A self-administered composite index, exploring the consequences of the stroke on the spouses' daily life, would be a useful complement.

Activities of Daily Living↗

PubMed1995

Heterotopic ossification and rhabdomyolysis.

Heterotopic ossification and rhabdomyolysis are well described entities but, as far as we know, their association has never been described in the literature. We recently treated a patient who presented with this association. After a suicide attempt, this patient developed rhabdomyolysis of the left upper and lower limbs with peripheral neurological impairment. Two months later radiographs showed ectopic ossification around the left hip. Rhabdomyolysis is underdiagnosed, and is due to local disturbance of the calcium-phosphorus metabolism resulting in soft tissue calcifications. Underlying rhabdomyolysis may be a possible aetiology of heterotopic ossification. Recognition of this may help us to understand the pathophysiology and to improve the management of heterotopic ossification.

Adult↗

PubMedDate not supplied

Changes in the quality of life of hemiplegic stroke patients with time: a preliminary report.

To evaluate the influence of time on the quality of life of hemiplegic stroke patients living at home, we analyzed a sample of 45 outpatients. The sample was divided into two groups, according to the delay between the discharge time from hospital and the assessment (Group 1, fewer than 6 mo; Group 2, more than 6 mo after discharge). We hypothesized that patients in Group 2 would have a lower level of quality of life than patients in Group 1. Disability was assessed with the Functional Independence Measure, and the quality of life was assessed with the Reintegration to Normal Living Index. Both groups were comparable with regard to demographic and stroke characteristics. There was no statistically significant difference in Functional Independence Measure scores (global and subscales). Reintegration to Normal Living Index-perception of self subscale scores were significantly lower in Group 2. At the item level, quality of life scores were also significantly lower in Group 2 for indoor mobility (Mann-Whitney U test; P = 0.001), self-care needs (P = 0.005), personal relationships (P = 0.02), and the handling of life events (P = 0.05). These results confirm our hypothesis and suggest that quality of life may deteriorate in some domains over time, even when the disability level is unchanged, but these results need to be replicated in prospective studies with larger samples of stroke survivors.

Activities of Daily Living↗