Biomedical subjects

M Revel

Publications and source records attributed to M Revel.

At least 37 records · Page 2Linked to original sources

PubMed2002

[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.

Adult↗

PubMed2002

Algo-functional assessment of knee osteoarthritis: comparison of the test-retest reliability and construct validity of the WOMAC and Lequesne indexes.

OBJECTIVE: To assess and compare the test-retest reliability and the construct validity of the Lequesne and the French-Canadian version of the WOMAC indexes. DESIGN: Patients with symptomatic knee osteoarthritis (OA) fulfilling the revised criteria of the American College of Rheumatology completed both the Lequesne and the French-Canadian version of the WOMAC indexes twice at a 3-h interval. Impairment outcome measures, patients' perceived discomfort in walking and handicap were recorded. For both questionnaires, an analysis was performed item by item. Repeatability was assessed using the intraclass correlation coefficient (ICC) and the Bland and Altman method. Construct validity was investigated using the Spearman rank correlation coefficient and a factor analysis was performed. RESULTS: 88 patients were included. Eight questions of the WOMAC section C and one question of the Lequesne index had insufficient psychometric properties. Although repeatability of questionnaires was fair to excellent (0.82, 0.68, 0.74, 0.95 for the WOMAC sections A, B, C and Lequesne index respectively), construct validity could not be demonstrated. Factor analysis of the WOMAC extracted five factors which differed from the a priori triple stratification. Factor analysis of the WOMAC section C extracted two factors explaining 71% of the variance which could not be clinically characterized. For the Lequesne index, expected convergent correlations were not always achieved. Three factors were extracted by factor analysis explaining 58% of the variance. CONCLUSION: Despite their good test-retest reliability, the two composite indexes evaluated are not valid to assess the concept of functional disability induced by knee OA in a French population.

Adult↗

PubMed2001

Increased post-traumatic survival of neurons in IL-6-knockout mice on a background of EAE susceptibility.

Axonal injury initiates a process of neuronal degeneration, with resulting death of neuronal cell bodies. We show here that in C57BL/6J mice, previously shown to have a limited ability to manifest a post-traumatic protective immunity, the rate of neuronal survival is increased if IL-6 is deficient during the first 24 hours after optic nerve injury. Immunocytochemical staining preformed 7 days after the injury revealed an increased number of activated microglia in the IL-6-deficient mice compared to the wild-type mice. In addition, IL-6-deficient mice showed an increased resistance to glutamate toxicity. These findings suggest that the presence of IL-6 during the early post-traumatic phase, at least in mice that are susceptible to autoimmune disease development, has a negative effect on neuronal survival. This further substantiates the contention that whether immune-derived factors are beneficial or harmful for nerve recovery after injury depends on the phenotype of the immune cells and the timing and nature of their dialog with the damaged neural tissue.

Animals↗

PubMed2001

Stimulation of myelin gene expression in vitro and of sciatic nerve remyelination by interleukin-6 receptor-interleukin-6 chimera.

Induction of myelin gene expression denotes the last stage of differentiation of myelinating glial cells. Following peripheral nerve transection, Schwann cells (SC) lose myelin gene expression and proliferate, resembling premyelinating embryonic SC (eSC). We show that a fusion protein of the soluble interleukin-6 receptor to interleukin-6 (IL6RIL6), a potent activator of the gp130 signaling receptor, is an inducer of MBP and Po gene products in rat E18 embryonic dorsal root ganglia (DRG) 3 day cultures. Cells whose growth is dependent on the IL6RIL6 chimera were isolated from DRG. These cells (designated CH cells) express Krox-20, as do promyelinating and myelinating SC (mSC). IL6RIL6 induces Po and MBP in CH cells and their cocultures with neurons. In addition, IL6RIL6 leads to a disappearance of Pax-3, a marker of eSC and nonmyelinating Schwann cells (nmSC). Glial fibrillary acidic protein, present in nmSC, is not significantly induced by IL6RIL6. The CH cells acquire glial morphology when exposed to IL6RIL6 and cover axons in cocultures. In a sciatic nerve-derived SC line, IL6RIL6 also induces Po and triggers a rapid attachment along axons. In vivo administration of IL6RIL6 intraperitoneally to rats after sciatic nerve transection and resuture increases 4-fold the number of myelinated nerve fibers (MF) measured on day 12, 2.5-5 mm distal to the suture. The stimulation by IL6RIL6 treatment is highest (7.1-fold) at the more distant 5 mm site, and the thickness of myelin sheaths is increased. Compared to known SC growth factors, the gp130 activator IL6RIL6 appears to combine both in vitro mitogenic effects and promotion of myelin gene expression.

Animals↗

PubMed2001

In vitro effects of recombinant TNF-alpha binding protein (rTBP-1) on hematopoiesis of HIV-infected patients.

Tumor necrosis factor-alpha (TNF-alpha) is believed to contribute to the hematopoietic failure often observed in patients with AIDS. Soluble TNF receptors (sTNFR) compete for TNF-alpha with cell surface receptors and thus may block its activity. The effect of the p55 sTNFR (recombinant TNF-binding protein-1 [rTBP-1]) on the clonogenic growth of hematopoietic progenitor cells from 27 HIV-infected patients was evaluated in comparison with 11 normal study subjects. Peripheral blood-derived, myelopoietic (i.e., granulomonocytic colony-forming cells [GM-CFC]) and erythropoietic (i.e, burst-forming unit, erythroid [BFU-E]) colonies were grown in 10-day semisolid cultures with increasing concentrations of rTBP-1. Significantly, dose-dependent increases occurred in GM-CFC from 17 of 21 AIDS patients and 12 of 21 in BFU-E at rTBP-1 concentrations of 1microg/ml to 25 microg/ml. In contrast, rTBP-1 failed to induce any appreciably increased colony formation in normal cell cultures. In 6 patients treated with highly active antiretroviral treatment (HAART), TBP-1 alone did not demonstrate the in vitro hematopoiesis-enhancing effect. This study may provide an initial step in development of therapeutic use of TBP as a TNF-alpha antagonist in HIV-infected patients who do not benefit sufficiently from antiretroviral treatment, and in other conditions in which increased levels of TNF-alpha may contribute to hematopoietic deficiencies.

Acquired Immunodeficiency Syndrome↗

PubMed2001

[French translation and validation of a functional disability scale for neck pain].

OBJECTIVES: To translate and to assess the reliability and the construct validity of the French translation of the Neck Pain and Disability Scale (NPDS), an American functional disability scale for neck pain. PATIENTS AND METHODS: Non randomised prospective study, where patients with neck disorders were included. Impairment outcomes measures (VAS Pain, range of motion of neck, score of neck sensitivity, radiologic score of Kellgren) and patientsperceived handicap (VAS) were recorded at the baseline visit. Disability was assessed with the NPDS, that was recorded twice, at baseline visit and 24 hours later. Reliability was assessed using the intraclass correlation coefficient (ICC) and the Bland and Altman method. Construct (convergent and divergent) validity was investigated using the Spearman rank correlation coefficient and a factor analysis was performed. RESULTS: One hundred and one patients were included. French versions were obtained using the "translation/backward translation" method. Expected convergent (r = 0.51 with VAS Pain, 0.63 with VAS Functional Disability, 0.67 with VAS Handicap) and divergent (r = 0.39 and 0.49 respectively for the anxiety and depression scores of HAD, palpation sensitivity r = 0.31, neck mobility r = - 0.45 and 0.28, and Kellgrens radiologic score r = 0.04) validity were observed, suggested good construct validity. Test-retest was excellent for NPDS with ICC = 0.91. The Bland and Altman method showed distribution of differences homogenous and no systematic trend. Three mains factors were extracted by factors analysis of the NPDS, and explained 78% of the cumulative variance. CONCLUSION: The French version of NPDS has good metrologic qualities. This scale can be used in clinical practice to assess disability in neck pain and to normalise disability assessment.

Disability Evaluation↗

PubMed2001

[Validity and reliability of spinal clinical measures in ankylosing spondylitis].

OBJECTIVES: To evaluate the validity and the reliability of the main clinical measures of mobility and sagittal spinal curves in ankylosing spondylitis (AS). METHODS: Criterion validity of the measure of the distance between C7 spinous process to plumbline (dorsal kyphosis), L3-plumb line (lumbar lordosis), lumbar, dorsolumbar and dorsal mobility. The gold standard was the value obtained from lateral radiological views of the dorsal and lumbar spine in standing position and maximum flexion. The correlation between radiological and clinical measures was assessed by a Spearman correlation coefficient (SCC). The reliability was assessed for all the clinical parameters and for chin-sternum distance (flexion, extension), chin-acromion distance (rotations) and chest expansion using the intraclass correlation coefficient (ICC) and the Bland and Altman method. Were included patients with AS and needing dorsal and lumbar Xrays. RESULTS: Twenty-two patients (21 men), 32 +/- 11 year old, 51 +/- 10 kg weight, with a mean duration of the disease of 120 +/- 60 months. The ICC values were good or excellent for all parameters except for the measures of dorsal mobility. The validity was evaluated in 18 patients. The value of the SCC between clinical and radiological measures was good except the measures of dorsal kyphosis and dorsal mobility. CONCLUSION: The clinical measures of mobility and sagittal curves have metrological properties good enough to be used in the monitoring of AS mainly for the follow-up and the evaluation of the rehabilitation. The measurement of dorsal mobility should be restricted to the lower part only. Although apparently not valid the distance C7-plumbline can be used in management of AS because of its excellent reliability.

Adult↗

PubMed2001

[Critical analysis of a systematic review of the literature and a meta-analysis on exercise therapy and chronic low back pain].

OBJECTIVES: To determine wether the type of quality assessment scale used for evaluating the role of the physical training in chronic low back pain affects the conclusions of meta-analytic studies. DESIGN AND SETTING: Analysis of 20 trials assessing exercise therapy in chronic low back pain using 16 different scales to identify high-quality trials. Correlations between the scale scores were assessed using the Spearmans rank correlation coefficient. Inter-reader reliability was assessed with the intraclass correlation coefficient (ICC) and with the Bland and Altman technique. For the quality assessment scales allowing the classification in high quality or low quality trials, the degree of agreement between the two readers was calculated using the kappa coefficient. RESULTS: The range of the Spearman rank correlation coefficients between the different quality scales was wide (from 0.94 to 0.49). The quality scales inter-reader reliability were heterogeneous, ICC ranging from 0.86 to 0.39. The Bland and Altman analysis showed that with two scales the differences were not centered and that with 3 scales there was a systematic effect (r=0.32, 0.41, and 0.50). Finally, inter-reader agreement was low most of the time, the K coefficient being less than or equal to 0.60 for 8 of the 12 quality scales tested. CONCLUSIONS: Our data suggest that the use of summary scores to identify trials of high quality is problematic. Relevant methodological aspects should be assessed more specifically based on treatment strategies than on the own disease. A large reflexion on the elaboration and validation of specific quality scales is needed.

Humans↗

PubMed2001

[Cartilage: from biomechanics to physical therapy].

OBJECTIVES: To review the current knowledge about the relationship between physical activities, cartilage biology, osteoarthritis and rehabilitation. METHOD: PubMed, Ovid, Cochrane Data base were interrogated for the period 1966-2000. Key words were: chondrocyte, cartilage, osteoarthritis, mechanical stimulation, exercises, physical therapy, rehabilitation. Were reviewed: the mechanical biology of the chondrocytes and the cartilage, the mechanisms of transduction, the metabolic response of the chondrocytes to mechanical stresses; the effects of physical activity and immobilization on the cartilage in animal models, the main studies on the epidemiology of limbs osteoarthritis and clinical trials on rehabilitation. RESULTS: In vitro studies have demonstrated that some molecules are involved in the transduction of mechanical stress into intracellular biological event. Chondrocytes and cartilage are sensitive to mechanical stress and cartilage extracellular matrix synthesis and degradation can be modulated by mechanical events. Applications of cyclic loads usually lead to an enhanced matrix synthesis while static loads usually decrease matrix production. In animal models, intensive physical activity or immobilization lead to cartilage alteration mimicking osteoarthritis. In human, intensive and prolonged physical activities are probably associated with hip and knee osteoarthritis. However, there is evidence that exercise therapy and continuous passive motion have beneficial effects on patients with knee or hip osteoarthritis. Fundamental and clinical studies are still needed to determine if exercise programs could have an effect on chondromodulation. Continuous passive motion could help, in the future, to better understand the relationship between mechanical stimulation and cartilage homeostasis. CONCLUSION: Rehabilitation could be beneficial in the therapeutic management of limbs osteoarthritis. The protocols of rehabilitation should however be more evaluated in controlled trials.

Activities of Daily Living↗

PubMed2001

Cyclic GMP-dependent protein kinase potentiates serotonin-induced Egr-1 binding activity in PC12 cells.

The NO/cyclic GMP (cGMP) signal transduction pathway, which involves the cGMP-dependent protein kinase (PKG), regulates transcription of several genes, including immediate early genes. Using transfection experiments with the PKG-Ialpha cDNA cloned from human aorta, we show here that addition of membrane-permeable cGMP analogues to PC12 cells slightly upregulated ERK MAP (mitogen-activated protein) kinase. Likewise, PKG-Ialpha was found to activate weakly DNA binding activity of the Egr-1 transcription factor. On the other hand, PKG-Ialpha overexpression was shown to tremendously amplify the Egr-1 binding activity induced by the neurotransmitter serotonin, which activates egr-1 gene expression also via the stimulation of the ERK MAP kinase pathway. Since this potentiation occurred neither at the level of ERK nor at the egr-1 transcriptional level, the mechanism of amplification probably results from the convergence of ERK and PKG pathways at the level of the transcription factor Egr-1.

Animals↗

PubMed2001

Disk degeneration and disk herniation: the contribution of mechanical stress.

Experimental studies on the role for mechanical stresses in the genesis of disk degeneration and herniation are reviewed. Simple mechanical stimulations of functional vertebral segments cannot cause a disk herniation: a complex mechanical stimulation combining forward and lateral bending of the spine followed by violent compression is needed to produce posterior herniation of the disk. Intervertebral disk degeneration seems to influence the development of posterior disk herniation or foraminal disk protrusion. Furthermore, direct mechanical stimulation of the disk tissue or cells generates complex metabolic and cellular responses that lead to qualitative and quantitative modulation of disk matrix proteins. Thus, it is becoming increasingly likely that physical and metabolic factors act in concert to produce disk herniation.

Animals↗

PubMed2001

Pelvic mobility when bending forward in standing position: validity and reliability of 2 motion analysis devices.

OBJECTIVE: To evaluate the validity and reliability of 2 measurement devices that assess pelvic mobility in persons bending forward while in a standing position. DESIGN: Validity and reliability studies. PATIENTS: The validity study included 10 patients (4 men, 6 women) aged 42 (range, 33--51yr). The reliability study included 50 subjects (25 men, 25 women) aged 30 (range, 18--49yr). INTERVENTIONS: A 3-dimensional ultrasound motion analyzer (CMS 50) and a spine motion analyzer using potentiometers (Rachimètre). METHODS: Two lateral radiographs of the patients' lumbosacral junction were taken, the first in neutral position, the second in full trunk flexion. Correlations between mobilities assessed by radiographs and both devices were evaluated by Spearman's rank correlation coefficient. Reliability was studied in healthy volunteers using the intraclass coefficient correlation (ICC) and the Bland and Altman plot. RESULTS: Spearman's coefficient between radiographic measures and the Rachimètre and the CMS 50 evaluations were.89 and.81, respectively. For the Rachimètre, ICC was.65 and increased with a better standardization of the measurement procedures. For the CMS 50, ICC was.85, and the Bland and Altman plot revealed no systematic trend. CONCLUSIONS: The Rachimètre and the CMS 50 have acceptable metric properties. Because few simple clinical measurements are available to evaluate pelvic mobility during trunk flexion in standing position, these 2 devices could be useful in the clinical evaluation of low back pain.

Adult↗

PubMed2001

Validity, reliability, and responsiveness of the fingertip-to-floor test.

OBJECTIVE: To evaluate the validity, reliability, and responsiveness of the fingertip-to-floor test to assess total mobility when bending forward in standing position. DESIGN: Experimental, prospective, correlational. SETTING: Rehabilitation and radiology departments in a university hospital in France. PARTICIPANTS: Ten patients (6 women, 4 men; mean age, 42yr) with chronic low back pain (LBP) in the validity study; 32 LBP patients (16 women, 16 men; mean age, 52yr) in the reliability study; and 72 LBP patients (22 women, 50 men; mean age, 30yr) in the responsiveness study. INTERVENTIONS: Dynamic radiographs and fingertip-to-floor test. MAIN OUTCOME MEASURES: For the validity study, 2 lateral radiographs of the upper dorsal spine, 1 in neutral position, and then 1 in full trunk flexion, were made. Validity was assessed by means of Spearman's correlation coefficient. Reliability was studied by using intraclass correlation coefficient (ICC) and the Bland and Altman method. Responsiveness was assessed by the effect size and the standardized response mean (SRM). RESULTS: The Spearman's correlation coefficient for trunk flexion assessed by the test and the radiologic measure was excellent (r(s) = -.96). The intra- and interobserver reliability were excellent (ICC = .99). The Bland and Altman method showed no systematic trend. The values observed for the test were .97 for SRM and .87 for effect size. CONCLUSIONS: Because the fingertip-to-floor test has excellent validity, reliability, and responsiveness, it can be used in clinical practice and therapeutic trials.

Adult↗

PubMed2001

Reliability, validity, and sensitivity to change of the Cochin hand functional disability scale in hand osteoarthritis.

OBJECTIVE: To assess the reliability, validity and sensitivity to change of the Cochin hand functional scale in hand osteoarthritis (OA). BACKGROUND: The Cochin hand functional disability scale has been validated in rheumatoid arthritis. DESIGN: Patients with hand OA according to Altman's criteria were included. Impairment outcome measures (VAS of pain, hand score of tenderness, clinical hand score of impairment, Kallman's radiographic scale), functional disability measures [Cochin scale, Revel's functional index (RFI), Dreiser's functional index (DFI)] and patients' perceived handicap (VAS) were recorded twice, at baseline and at a 6-month follow-up visit. Interobserver reliability was assessed using the intraclass correlation coefficient (ICC) and the Bland and Altman method. Construct (convergent and divergent) validity was investigated using the Spearman rank correlation coefficient and a factor analysis was performed. Sensitivity to change was assessed using the effect size (ES) and the standardized response mean (SRM), and the non-parametric Spearman rank correlation coefficient (r) was used to assess the correlation between quantitative variable changes and patient's overall opinion. RESULTS: 89 patients (8 males, mean age 63 years) were included. Interobserver reliability was excellent (ICC=0.96). The Bland and Altman method showed no systematic trend. Correlations of the Cochin scale score with RFI (r=0.86), DFI (r=0.87), VAS of handicap (r=0.67), VAS of pain (r=0.54), tenderness (r=0.51), clinical impairment (r=0.32), and Kallman's radiographic scale (r=0.13) indicated a good construct validity. Factor analysis extracted four main factors, accounting for 65% of the total variance. 51 patients were evaluated at the 6-month visit. The Cochin scale score had worsened with SRM and ES values of -0.26 and -0.17 respectively. Changes in the score had one of the highest correlation (r=0.47) with the patient's overall opinion. CONCLUSION: The Cochin hand functional disability scale which was first developed to assess the rheumatoid hand can be used to evaluate functional disability in hand OA.

Adult↗

PubMed2001

Value of the bell test and the hyperextension test for diagnosis in sciatica associated with disc herniation: comparison with Lasègue's sign and the crossed Lasègue's sign.

OBJECTIVES: To evaluate the reliability, sensitivity, specificity and positive (PPV) and negative (NPV) predictive values for the diagnosis of sciatica associated with disc herniation of the bell test (BT) and the hyperextension test (HT). METHODS: According to magnetic resonance imaging, computed tomography scanning or myelography findings, patients were classified as having sciatica associated with disc herniation (group A) or sciatica without disc herniation or sciatica of other mechanical origin (group B). Four clinical manoeuvres [bell test (BT), hyperextension test (HT), Lasègue's sign (LS) and the crossed Lasègue's sign (CL)] were tested by three investigators. Intra- and interobserver reliabilities were calculated using the kappa correlation coefficient or the intraclass correlation coefficient (ICC). The sensitivity, specificity, PPV and NPV of the four manoeuvres were calculated. Stepwise logistic regression analysis was performed to determine the best set of variables predicting sciatica caused by disc herniation. RESULTS: Seventy-eight patients (43 in group A, 35 in group B; 33 males) with a mean age of 50+/-16 yr were included. Interobserver reliabilities ranged from 0.58 to 0.64 for the BT, 0.35 to 0.50 for the HT, 0.27 to 0.47 for LS and 0.43 to 0.72 for CL. LS had the best sensitivity (0.77-0.83) and CL the best specificity (0.74-0.89), while PPV and NPV were equivalent for the four manoeuvres (0.55-0.75 for PPV and 0.45-0.59 for NPV). The best PPV was observed for the association of HT with CL (0.67-0.85). Stepwise logistic regression analysis did not allow us to propose a set of variables predicting sciatica caused by disc herniation. CONCLUSION: This study suggests that clinical values of the BT and HT are of interest, and are similar to those of LS and CL.

Adolescent↗

PubMed2001

Responsiveness of the Cochin rheumatoid hand disability scale after surgery.

OBJECTIVE: To assess the responsiveness of the Cochin functional disability scale for the rheumatoid hand after surgery. METHOD: In a prospective study, patients with rheumatoid arthritis (RA) scheduled for surgery of the wrist and/or fingers were evaluated within 48 h before surgery and at least 6 months after surgery. Clinical outcome measures included duration of morning stiffness, total score for tenderness, total score for swelling, visual analogue scale score for pain in the hands and wrists, a score for overall mobility of the wrist and the fingers, grip and pinch strength, the Hand Functional Index (HFI), the Kapandji index and the Cochin scale. Responsiveness was assessed with the paired t-test, the effect size (ES), the standardized response mean (SRM) and the non-parametric Spearman rank correlation coefficient (r(S)). RESULTS: Fifty patients (42 women) were evaluated twice at an interval of 7.16 +/- 2.10 months (mean +/- s.d.) (range 6-15 months). Thirty-six patients (72%) were very satisfied or satisfied with the results of surgery, seven (14%) were not satisfied or dissatisfied and seven (14%) were dissatisfied or very dissatisfied. The Cochin scale score improved at the second visit (P < 0.0001), with SRM and ES values of 0.66 and 0.58 respectively. The correlation of the change in Cochin score with patient overall satisfaction was r(S) = 0.40. Among the impairment measures, grip strength showed the best responsiveness (SRM = - 0.43, ES = - 0.36, correlation with patient overall satisfaction r(S) = 0.46). The change in Kapandji index had the best correlation (r(S) = 0.51) with patient overall satisfaction but its SRM and ES values were low (- 0.19 and - 0.10 respectively). CONCLUSION: The Cochin scale is responsive and appropriate for the assessment of the effects of surgical treatments on disability in RA hands.

Adult↗

PubMed2001

Long-term disability assessment after surgical treatment of low grade spondylolisthesis.

The aim of this study was to determine whether assessment of back surgery with disability scores is relevant. We also attempted to answer the question of whether this evaluation should be conducted by a surgeon or a medical doctor. This retrospective study analyzes the long-term outcome (average follow-up 7 years, range: 3-12) of 40 patients (mean age: 46.2 years) treated by posterior surgical decompression, posterolateral arthrodesis, with or without instrumentation, for symptomatic low-grade spondylolisthesis. All patients were interviewed postoperatively and examined the same day by an orthopedic surgeon, who was not involved in the patients' treatment, as well as by a medical doctor rehabilitation specialist. Impairment was assessed by a standardized clinical examination and by visual analog scales (VAS) of pain. Disability was assessed using two scales: the Quebec disability scale and the Beaujon scale. Anxiety and depression were assessed with a validated specific questionnaire (HAD). Patient's perceived handicap was assessed on a 100-mm VAS. Our results show that the scores of the two disability scales were highly correlated with the patient's overall satisfaction ( r = 0.73 and 0.77 for the Quebec scale and the Beaujon scale, respectively). The intraclass correlation coefficient showed very good or excellent correlation between the data collected by the surgeon and the rehabilitation specialist, ranging from 0.8 to 0.97. This finding clearly demonstrates that interview by a surgeon who is not involved in the patient's treatment does not influence the patient's assessment in terms of impairment, disability, or handicap. Moreover, our results suggest that disability scales are the most relevant outcome measures in the assessment of spine surgery.

Adult↗

PubMed2000

[Which rehabilitation for which low back pain?].

Many rehabilitation technics for low back pain are available. Their aims are short time pain decrease, muscular strengthening in flexion or extension, increased hip and lumbar spine mobility, improved lumbar and pelvic proprioceptive sensibility, improved general fitness. During the past ten years, studies meeting widely accepted validity and applicability for therapeutic trials have addressed the clinical efficacy of rehabilitation in low back pain patients. Most studies assessing the back school approach have found no benefit. Spinal extension and flexion programs have yielded short-time improvements, without difference between the two methods. There is now strong evidence that functional restoration programs provide long-term benefits including better social and occupational outcomes.

Humans↗