C. Hérisson

The effect of music therapy on mood and anxiety–depression: An observational study in institutionalised patients with traumatic brain injury

INTRODUCTION A previous study (carried out in 2003-2004) had included 34 patients with traumatic brain injury in order to study the feasibility and usefulness of music therapy in patients with this type of injury. OBJECTIVE To evaluate the effect of music therapy on mood, anxiety and depression in institutionalised patients with traumatic brain injury. STUDY METHODOLOGY A prospective, observational study. MATERIALS AND METHODS Thirteen patients with traumatic brain injury were included in the present study and took part in individual, weekly, 1-hour music therapy sessions over a period of 20 weeks. Each session was divided into two 30-minute periods - one devoted to listening to music (receptive music therapy) and the other to playing an instrument (active music therapy). The assessment criteria (measured at weeks 1, 5, 10, 15 and 20) were mood (on the face scale) and anxiety-depression (on the Hospital Anxiety and Depression [HAD] Scale). Mood was assessed immediately before and after the first music therapy session and every fifth session. RESULTS Music therapy enabled a significant improvement in mood, from the first session onwards. This short-term effect was confirmed by the immediate changes in the scores after music therapy sessions (from 4.6+/-3.2 to 2.6+/-2; p<0.01). Music therapy also led to a significant reduction in anxiety-depression (p<0.05) from week 10 onwards and up until the end of the study (week 20). CONCLUSION These results confirm the usefulness of music therapy in the treatment of anxiety-depression and mood in patients with traumatic brain injury. Music therapy could usefully form an integral part of the management programme for these patients.

Pfannenstiel versus Maylard incision for cesarean delivery: A randomized controlled trial

OBJECTIVE To compare the Pfannenstiel incision with transverse muscle‐cutting Maylard incision in women who had cesarean delivery. METHODS Patients were assigned randomly to a Pfannenstiel or Maylard incision. Postoperative ttreatment was similar for each group. Surgical characteristics, complications, postoperative pain (visual analog scale, analgesic use), and related quality of life (1‐ and 3‐month self‐administered questionnaires) were analyzed. Abdominal wall muscle recovery was compared objectively by dynamometer. RESULTS Fifty‐four women had a Pfannenstiel incision and 43 had the Maylard incision. There were no differences in intraoperative characteristics, postoperative morbidity, or pain. Womens responses to the Nottingham Health Profile questionnaire at 1 and 3 months postoperatively and clinical and isokinetic testing for abdominal wall strength were similar between the two groups. CONCLUSION Transecting the rectus muscle was no more deleterious than the Pfannenstiel incision. There was no difference in objectively measured abdominal wall strength.

Reliability of shoulder rotators isokinetic strength imbalance measured using the Biodex dynamometer

BACKGROUND Isokinetic assessment of shoulder internal and external rotators is commonly used by clinicians to assess muscle performance and to guide rehabilitation. The reliability of isokinetic assessment is fundamental to track small but clinically relevant changes. OBJECTIVES We aimed to analyze the absolute and relative reliability of strength imbalance indices such as peak torque ratios (ERconc/IRconc, ERecc/IRecc, ERecc/IRcon, IRecc/ERcon), bilateral concentric and eccentric strength ratios, and to examine the reliability of external rotator and internal rotator peak torque measured using a Biodex(®) dynamometer in the seated position. DESIGN Cross-sectional laboratory study. METHODS Forty-six healthy participants were tested twice with seven days between sessions, at 60°/s and 120°/s concentrically, and 30°/s eccentrically. RESULTS Low to moderate relative reliability (intraclass correlation coefficient: 0.25-0.81) was found for unilateral and bilateral strength imbalance ratios. High intraclass correlation coefficient values (0.87-0.97) were found for peak torque. Concerning absolute reliability, the standard error of measurement ranged from 9.1 to 25.6% for strength imbalance ratios and from 7.7 to 14.5% for peak torque measurements, and minimal detectable change ranged from 25.2 to 71% for strength imbalance ratios and from 21.3 to 40.2% for peak torque measurements. CONCLUSIONS The standard error of measurement and minimal detectable change reported in the present study should be taken into account when evaluating the individual longitudinal changes in clinical practice.

Les traitements physiques dans la rétraction capsulaire de l'épaule : revue de la littérature

OBJECTIVE To determine the efficacy of physical treatments in adhesive capsulitis of the shoulder by a systematic review of literature, attempting to perform a meta-analysis from randomised clinical trials. METHOD A systematic literature search was conducted to retrieve all randomised controlled trials of physical therapy such as physiotherapy and manipulation, but also arthrographic distension, mobilisation under general anaesthesia or nerve block, arthroscopic distension or arthrolysis, and intra-articular corticoid injections. The main outcome for meta-analysis was the restoration of range of movement between the sixth week and the third month. RESULTS Only 16 articles could be selected, and only three about capsular distension were included in a meta-analysis because of the heterogeneity of the criteria assessing the functional results and of the poor methodological value of most of the articles. DISCUSSION Some open studies stressed the value of daily manipulations and physiotherapy, intra-articular corticosteroid injections, but their quality was poor or limited. Nothing was written about antalgic drugs to facilitate joint mobilisation, and the use of a thoraco-brachial abduction device between exercises was only quoted. The most refractory cases might need more aggressive interventions: arthrographic distension with local anaesthesia and steroid injection; mobilisation under general or local anaesthesia, specially interscalene brachial plexus block; arthroscopic release. But there was no randomised controlled study comparing these three techniques and it seemed impossible to come to any conclusion about the superiority of one of them. The meta-analysis showed yet that capsular distension with intra-articular corticoid injections was better than corticoid injections alone. CONCLUSION This demonstrated the need of a consensus about the criteria of assessment, the time of evaluation, before assessing by randomised clinical trials of good quality their therapeutic value.

Evaluation of the benefits of low back pain patients’ education workshops during spa therapy

OBJECTIVES To evaluate the medium-term impact of education workshops on low back pain (LBP) in the setting of a thermal spa on: fear-avoidance beliefs, disability, pain, and satisfaction. METHODS Randomized prospective alternate-month design-type study including 360 individuals having thermal spa therapy for LBP: 188 in the intervention group (three standardized education workshops lasting 1 h 30 each and usual thermal therapy for 3 weeks), 172 in the control group (usual thermal therapy and non-standardized verbal information). The principal analysis criterion was the difference in the fear-avoidance beliefs (physical FABQ) score between baseline and 6 months after the therapy; secondary criteria were: evolution of disability (Quebec Scale) and pain intensity (Visual Analogue Scale), and satisfaction with the information received. RESULTS There was a significant reduction in the physical FABQ score at 6 months (P<0.05), and this reduction was more marked in the intervention group (-5.8±0.7 vs. -2±0.72 points out of 24; P<0.0001). Disability and pain significantly decreased in both groups (P<0.05), with no difference between groups. These workshops also had a significant effect on satisfaction with the information received. CONCLUSION Standardized education workshops have a beneficial impact on LBP and contribute to an improvement in the medical services provided during spa therapy by reducing the effect of fear-avoidance beliefs as well as relieving pain. Extending the use of such workshops could contribute to enhance the positive impact of spa therapy in the management of chronic disabling diseases.

Reproducibility of isokinetic peak torque assessments of the hip flexor and extensor muscles.

OBJECTIVES Isokinetic assessment is currently the reference method for measuring dynamic muscle strength. We have sought to evaluate the reproducibility over time of isokinetic testing of the hip flexor (FI) and extensor (Ext) muscles and to establish whether there is a significant difference in peak torque (PT) between the left and right hips. PATIENTS AND METHODS Ten adults were tested once a week for 3 weeks by the same investigator and according to the same protocol, with two velocities (60 degrees /s and 180 degrees /s) for the hip FI and Ext in concentric tests and one velocity (30 degrees /s) for the Ext only in eccentric tests. The reproducibility of the measured PT was analyzed by using the intraclass correlation coefficient (ICC) and a Bland and Altman plot. The difference in PT between the right and left hips was tested using Students T test. RESULTS The ICC for the observed PT values revealed very good reproducibility (with a value of between 0.75 and 0.96) for the hip FI and Ext measurements (regardless of the body side, test velocity or contraction mode). We did not observe any significant PT differences between the right and left hips. CONCLUSION The isokinetic assessment of the concentric and eccentric PT values generated by the hip FI and Ext is highly reproducible. There is no difference between dominant and nondominant body sides, which enables the use of the contralateral limb as a reference.

Which physical activities and sports can be recommended to chronic low back pain patients after rehabilitation

BACKGROUND Physical exercise is widely prescribed in rehabilitation programmes for low back pain (LBP). The LBP patient often asks whether this physical activity should be maintained and, in some cases, whether he/she should resume or take up a sport. PURPOSE To answer these two questions by performing a review of literature on the efficacy and safety of post-rehabilitation physical activities and sport in LBP. METHOD A systematic search of computerized databases from 1990 to 2011 was performed using grade 1 to 4 studies articles in English or French. RESULTS Of the 2583 initially identified articles, 121 articles were analysed. Globally, physical activities like swimming, walking and cycling, practiced at moderate-intensity help to maintain fitness and control pain. Inconsistent results were found for avoiding recommendations according to the nature of PA. Sport activities, except ballgames, can be easily resume or take up as tennis, horse riding, martial arts, gymnastics, golf and running which can be performed at a lower intensity or lower competitive level. DISCUSSION AND CONCLUSION Moderate but regular physical activity helps to improve fitness and does not increase the risk of acute pain in chronic LBP patients. The resumption of a sport may require a number of adaptations; dialogue between the therapist and the sports trainer is therefore recommended.

Orthèses plantaires et gonarthrose : évaluation des effets biomécaniques et cliniques à partir d'une revue de la littérature

OBJECTIVE To determine the biomechanical and clinical effectiveness of foot insoles in patients with knee osteoarthritis. MATERIALS AND METHODS A systematic review of the literature (Medline, Pascal and Embase) using the MESH words knee, and insole and plantar orthosis for the biomechanical part and osteoarthritis, and insole and plantar orthosis for the clinical part. Clinical studies were classified by 2 independent readers using the Jadad scale. RESULTS Two biomechanical theories were found: the adduction moment theory, which explains the effect of heel wedging, and articular chain theory, which explains the effect of lateral wedged insoles. The clinical effect was explained more by an anti-algesic effect than an anatomic or functional effect: the treated group consumed fewer nonsteroidal anti-inflammatory drugs than the placebo group for up to 2-years of treatment. Evidence is lacking because of methodological weakness and few clinical trials. The information on side effects is limited. DISCUSSION Laterally wedged foot insoles are proposed for the treatment of knee medial compartment osteoarthritis. The clinical effect is probably limited, but the treatment may reduce the digestive and renal side effects of prolonged use of nonsteroidal anti-inflammatory drugs. Foot insoles could be recommended in clinical practice despite the lack of evidence in comparing the effectiveness of other therapeutics in knee osteoarthritis. CONCLUSION Use of foot insoles is a nonpharmacologic treatment of osteoarthritis of the knee medial compartment.

Evaluation of various ways to deliver information concerning non-steroidal anti-inflammatory drugs to osteoarthritis patients.

INTRODUCTION It is essential to provide complete information to patients using non-steroidal anti-inflammatory drugs (NSAIDs) because of the risk of side effects. Today, most healthcare professionals recommend and privilege oral information regarding NSAIDs. OBJECTIVE Evaluate the impact of three standardized NSAIDs information-delivery modalities on knowledge, anxiety and satisfaction of patients hospitalized in a Physical Medicine and Rehabilitation unit for debilitating and degenerative locomotor diseases. METHOD Randomized prospective study with an alternate month design. Two control groups were provided with only one type of information modality: written (information sheet) or oral (presentation). The intervention group received both modalities of information. The information included: the definition of NSAIDs, advantages and side effects, and practical advice regarding proper use. The main evaluation criterion was knowledge progression assessed by a specific questionnaire. Secondary criteria were anxiety evolution (STAI-Y questionnaire) and satisfaction related to the information delivered. RESULTS One hundred and forty patients were included. Knowledge was improved in the three groups, with a greater score improvement in the group that received both modalities (P=0.05). No intergroup difference was noted on anxiety or satisfaction. DISCUSSION AND CONCLUSION Associating both information-delivery modalities (written+oral) contributes to improving knowledge but does not seem to have an impact on the anxiety of patients treated with NSAIDs for their degenerative locomotor disease. Using standardized information sheets with a validated content could help pharmacists in their role as healthcare education provider and effectively complement the information delivered orally.

Revue de la littérature sur l’efficacité du plasma riche en plaquettes (PRP) en médecine du sport

Méthodes.– Les joueurs de l’équipe de ligue 2 Châteauroux effectuait une évaluation isocinétique du genou en début de saison sur dynamomètre Cybex Norm en mode concentrique (60◦/s et 240◦/s) et excentrique (30◦/s). En cas d’asymétrie > 20 %, d’anomalie du ratio mixte < 0,6 et/ou agoniste/antagoniste < 0,45, les joueurs bénéficiaient d’un protocole personnalisé de prévention. L’étude portait sur les saisons 2010–11, 2011–12 avec recueil prospectif des blessures. Résultats.– La saison 2010–11, 9 joueurs sur 21 présentaient un test isocinétique anormal et sept joueurs se sont blessés (total de 164 jours d’arrêt de travail [AT]). La saison 2011–12, 7 tests isocinétiques anormaux sur 21, 7 joueurs se sont blessés (total de 92 jours d’AT). La moyenne des jours d’AT était de 225 jours les saisons précédentes l’étude. La fréquence des blessures était plus importante dans le groupe ayant un test isocinétique normal (41 % vs 25 %). Conclusion.– Ces résultats nous incitent à proposer de façon systématique pour tous les joueurs un protocole de prévention des blessures car les joueurs avec test normaux qui n’ont pas eu de prévention ont eu plus de blessures.