D. Colin

Torque–velocity and power–velocity relationships during isokinetic trunk flexion and extension

BACKGROUND No study has reported the possibility of establishing torque-velocity and power-velocity relationships for both flexor and extensor trunk muscles. The present study therefore sought to assess these relationships during isokinetic exercise. METHODS Nine healthy male subjects performed series of isokinetic trunk flexions and extensions at six different velocities ranging from 45 degrees s(-1) to 120 degrees s(-1). Trunk flexor and extensor muscles were, respectively, assessed on two separate days. All experiments used a Biodex dynamometer. FINDINGS Torque-velocity relationships were significantly well described by a linear relationship for both trunk flexor (P<0.01; r=0.92-0.99) and extensor muscles (P<0.05; r=0.82-0.97) in all subjects. Power-velocity relationships exhibited a parabolic shape for all subjects (P<0.05; r=0.96-0.99) for both muscle groups. INTERPRETATION Results showed that trunk muscle torque- and power-velocity relationships can be assessed during isokinetic exercise. The findings were in agreement with previous studies of lower and upper limbs. This kind of measurement can therefore be applied in assessing low-back pain patients during rehabilitation.

As of 2012, what are the key predictive risk factors for pressure ulcers? Developing French guidelines for clinical practice

INTRODUCTION An evaluation of predictive risk factors for pressure ulcers is essential in development of a preventive strategy on admission to hospitals and/or nursing homes. OBJECTIVES Identification of the predictive factors for pressure ulcers as of 2012. METHOD Systematic review of the literature querying the databases PASCAL Biomed, Cochrane Library and PubMed from 2000 through 2010. RESULTS Immobility should be considered as a predictive risk factor for pressure ulcers (grade B). Undernutrition/malnutrition may also be a predictive risk factor for pressure ulcers (grade C). DISCUSSION Even if the level of evidence is low, once these risk factors have been detected, management is essential. Sensitizing and mobilizing health care teams requires training in ways of tracking and screening. According to the experts, risk scales should be used. As decision aids, they should always be balanced and complemented by the clinical judgment of the treatment team. CONCLUSION According to experts, it is important to know and predictively evaluate risk of pressure ulcers at the time of hospital admission. The predictive risk factors found in this study are identical to those highlighted at the 2001 consensus conference of which was PERSE was the promoter.

Return to work of 87 severely impaired low back pain patients two years after a program of intensive functional restoration

UNLABELLED Return to work is the main long-term objective of rehabilitation programs for patients with chronic low back pain (LBP). OBJECTIVES Evaluation of work status and number of sick leaves in 87 severely impaired LBP patients 2 years after a functional restoration program. PATIENTS AND METHODS Open prospective study. POPULATION 87 chronic LBP patients. INTERVENTION multidisciplinary functional restoration program. Ergonomic advice on the workplace was performed for 53 patients. OUTCOME work status and number of sick leaves due to LBP. RESULTS The characteristics of the 26 patients lost to follow-up did not differ significantly from the rest of the population before the program. In the 61 remaining patients, 48 (78%) were at work at 2 years, 43 full-time and 22 at the same job. Nineteen worked in a different environment. Sick leaves were reduced by 60% compared to the 2 years prior to the program: 128 days (+/-200 days) versus 329 days (+/-179 days); p<0.005. CONCLUSION Sick leaves remained significantly reduced and the number of workers who were at work significantly increased at 2 years after an intensive program.

What is the best support surface in prevention and treatment, as of 2012, for a patient at risk and/or suffering from pressure ulcer sore? Developing French guidelines for clinical practice.

INTRODUCTION The use of support surfaces in the prevention and treatment of pressure ulcers prevention is an important part of care for a patient at risk and/or suffering from sore(s). OBJECTIVES Define which support surfaces to use in prevention and treatment of at-risk and/or pressure sore patients. METHODOLOGY A systematic review of the literature querying the several Pascal Biomed, PubMed and Cochrane Library databases from 2000 through 2010. RESULTS (GRADE A): In prevention, a structured foam mattress is more efficient than a standard hospital mattress. An alternating pressure mattress is more effective than a visco-elastic mattress limiting the occurrence heel pressure ulcers, but those that do occur are more serious. A low-air-loss bed is more efficient than a mixed pulsating air mattress in prevention of heel pressure ulcers. Some types of sheepskin can reduce sacral pressure ulcer incidence in orthopedic patients. Use of an overlay on an operating table limits the occurrence of peroperative and postoperative pressure ulcers. An air-fluidized bed improves pressure ulcer healing. DISCUSSION The data in the literature are not always relevant and do not suffice to dictate a clinicians choices. We are compelled to recognize the methodological limitations of many studies, the lack of corporate interest in conducting such studies and the relatively small number of available trials. However, the effectiveness of some support surfaces reaches a sufficient level of evidence, especially when they are associated with postural, hydration and nutritional measures. CONCLUSION Support surfaces are recommended in prevention and treatment of patients at risk and/or already suffering from pressure ulcer, and their use should constitute part of an overall preventive or curative strategy.

Which medical device and/or which local treatment are to be used, as of 2012, in patients with infected pressure sore? Developing French guidelines for clinical practice.

INTRODUCTION Taking care of a patient with an infected pressure sore necessitates a diagnosis allowing for a suitable treatment strategy. AIMS To choose the dressings and topical antimicrobial agents that can be used as of 2012 in treatment of an infected pressure sore. METHODS A systematic review of the literature with queries to the databases Pascal Biomed, PubMed and Cochrane Library from 2000 through 2010. RESULTS Diagnosis of local infection is essentially clinical. It is subsequently difficult to destroy and/or permeabilize biofilm by means of mechanical wound debridement. Application of an antimicrobial product and a disinfectant solution are of utmost importance in this respect. DISCUSSION The studies do not demonstrate that one topical product is better than another in wound cleaning. The papers recommending antimicrobial topics lead to the conclusion that they may be interesting, but show little clinical evidence of their beneficial effects. Dressings including silver, iodine, polyhexamethylene biguanide (PHMB) and negative pressure wound therapy could likewise be of interest, but once again, existing studies present only a low level of evidence (Grade C). CONCLUSION Local antimicrobial treatment can be used when there are signs of local infection (Grade C). Systemic antibiotic treatment is to be used when there are general medical signs of infection (Grade B).

Which medical device and/or which local treatment for prevention in patients with risk factors of pressure sores in 2012. Towards development of French guideline for clinical practice

INTRODUCTION Implementation of a prevention strategy after the identification of risk factors is essential at the entrance in a care unit or in a medical-social unit. OBJECTIVES Determine which medical devices and which treatments may be used in order to prevent pressure sore in 2012. METHOD Systematic review of the literature using databases: Pascal, Biomed, PubMed, and Cochrane library between 2000 and 2010. RESULTS Nursing care including use of soft product, non-irritating for the cleaning, hydration of the skin with emollients, protection of fragile skin in case of incontinence by applying a skin protector and application of dressings in front of bony prominences to reduce shear forces, remain valid (level C). DISCUSSION Nursing cares and use of dressing in patients with high risks of pressure sores are the responsibility of the nurses. The engagement of health care teams involves screening of risk factors and the knowledge of treatments and local devices. CONCLUSION Local preventive treatment in a patient with risk factors of pressure sore is of great interest at entrance in a care unit or in a medical-social unit.

Evaluating self-reported pressure ulcer prevention measures in persons with spinal cord injury using the revised Skin Management Needs Assessment Checklist: reliability study.

Study design:Cross-cultural adaptation and reliability study.Objective:To translate, evaluate the reliability and cross-culturally adapt the Skin Management Needs Assessment Checklist (SMnac), a questionnaire evaluating the knowledge on pressure ulcer (PU) prevention measures in persons with spinal cord injury (SCI).Subjects:138 persons with SCI, mean age 45.9 years, mean time since injury 94 months.Material and method:The study was carried out in two stages. First, the questionnaire went through a forward–backward translation process and was cross-culturally adapted, according to a validated methodology for self-reported measures. Then, the test–retest reliability was evaluated on a population of persons with SCIResults:The standardized back-translation and cross-cultural adaptation led to the revised Smack grid, with the addition of seven items representing an update of PU prevention measures. The reliability was excellent (intraclass correlation coefficient: 0.899).Conclusion:The revised SMnac is an adaptation of the SMnac, including therapeutic education frameworks and the latest PU prevention practices. It appears to be a reliable tool for assessing the knowledge and benefits of PU prevention in persons with SCI. Further studies are needed to explore its validity and responsiveness to change.

Which medical technology and/or local treatment is most conducive, as of 2012, to pressure sore debridement ? Developing French guidelines for clinical practice

INTRODUCTION Implementation of a curative strategy at the debridement stage associates systemic therapy with local therapy. OBJECTIVES To determine which medical devices and technology other than support surfaces and what kinds of drugs to use in order to cleanse a pressure ulcer in 2012. METHOD A systematic review of the literature querying the databases PASCAL Biomed, Cochrane Library and PubMed from 2000 to 2010 along with a compendium of prevailing professional practices. RESULTS Pressure sore debridement is based on local care and on the use of alginates, hydrogels and hydrocolloids. DISCUSSION The analyzed articles do not take into account any specific stage of pressure ulcer debridement. Data that might favor some kinds of dressings show a low level of evidence. Were it possible to decide on the dressing to be used for a given indication, professionals would be better able to orient and narrow down their choices. CONCLUSION Use of alginates and hydrogels in pressure ulcer debridement is of real interest. According to expert opinion, other dressings (irrigo-absorbents, for instance) seem promising, but have yet to receive adequate scientific validation.

Torque– and power–velocity relationships of trunk muscle during isokinetic conditions in chronic low back pain patients

Chronic low-back pain (LB) constitutes a major healthcare problem in industrialised countries and has been found to be associated with certain anthropometric, postural, muscular and mobility characteristics (Bayramoglu et al. 2001). Among these parameters, poor abdominal muscle strength, imbalance between flexor and extensor trunk muscle strength seems to be linked (Pope et al. 1985). These muscular disabilities are commonly evaluated from isokinetic apparatus (Thorstensson and Arvidon 1982), but to our knowledge, no study focused on the force–velocity relationships during isokinetic trunk flexor and extensor muscle measurements in low back pain patients. The purpose of the study was two-fold: (1) compare the torque–velocity relationships of trunk muscles for healthy and chronic low back pain patients; (2) determine the flexor/extensor ratio for each population to find predictive parameters of low back pain.

Prevalence, characteristics and risk factors of pressure ulcers in public and private hospitals care units and nursing homes in France

ABSTRACT Objective: The aim of this study conducted in 2014 was to describe the prevalence of pressure ulcers in different types of French hospital unit at the national level to compare them with data from the 1994 and 2004 study. Methods: This cross-sectional study was conducted over a single day. All care units were invited to participate by drawing lots stratified by region in successive waves until 1,200 agreements were obtained. Lots were drawn for towns with more than 10,000 inhabitants. All public- and private-sector hospital facilities in each town drawn by lot were invited to participate in the survey. Results: 776 hospital services throughout France took part and accommodated 21,538 patients: 12,752 women (59.2%) and 8,786 men (40.8%). Of these patients, 1,753 (8.1%; IC95% = 7.7; 8.5) had pressure ulcers. The pressure-ulcer rate was 7.8% (IC95% = [7.3; 8.3] (n = 997)) for hospitalized women and 8.6% (IC95% = [8.0; 9.2] (n = 756)) for men (p = 0.0381). The 8.1% level reported in 2014 therefore points to a reduction in pressure-ulcer prevalence; 8.6% in 1994 and 8.9% in 2004. Conclusions: The actions performed daily by healthcare professionals to prevent pressure ulcers, supported by research and training programs, including those by PERSE, are having a real impact over time.