François-André Allaert

Quality of sleep in patients with chronic low back pain: a case-control study

Animal experiments and studies in humans clearly show that the relation between pain (acute and chronic) and sleep quality is two-way: sleep disorders can increase pain, which in turn may cause sleep disorders. Sleep disorders and chronic low back pain are frequent health problems and it is unsurprising that the two can co-exist. This study was conducted to evaluate if sleep disorders and chronic pain associated are more frequently than one would expect. The objective of the study was to compare sleep quality in a population of patients with chronic low back pain and a control population. Sleep quality was assessed in 101 patients with chronic low back pain (CLBP) and in 97 sex- and age-matched healthy control subjects using the Pittsburgh Sleep Quality Index [PSQI; score from 0 (no disorder) to 21]. The French version of the Dallas Pain Questionnaire (DPQ) was used to assess the impact of low back pain on patients’ quality of life. This impact was taken as nil in the healthy controls. The patients with CLBP and the controls were comparable in age, sex, and height, but mean bodyweight was higher in the CLBP group (70.3xa0±xa014.5 vs. 61.8xa0±xa011.4xa0kg; Pxa0<xa00.05). The patients with CLBP were also more frequently on sick leave than the controls (32.3%; nxa0=xa031 vs. 0.0% nxa0=xa00; Pxa0<xa00.001). Coffee, tea, and cola intakes were comparable in the two groups. Patients with CLBP had statistically higher scores in all items of the PSQI than the healthy controls. The mean PSQI was 4.7xa0±xa03.2 for the healthy controls and 10.9xa0±xa07.9 for the patients with CLBP (Pxa0<xa00.0001). Sleep disorders were greater when the impact of CLBP on daily life (the four aspects of the DPQ) was greater [Pxa0<xa00.0001]). The sleep of the patients with CLBP was significantly altered compared with that of the healthy controls, in proportion to the impact of low back pain on daily life. Our findings do not indicate whether sleep disorders are a cause or a consequence of CLBP.

Primary osteoarthritis of hip, knee, and hand in relation to occupational exposure

Aim: To identify occupations with excess prevalence of osteoarthritis of the knee, hip, and hand in a nationwide survey and to compare occupations with and without excess prevalence with regard to biomechanical stresses and severity of osteoarthritis. Methods: Patients presenting with osteoarthritis of the knee, hip, or hand were recruited throughout France by their treating physician who collected information on history, including age at onset, occupation, and occupational stresses to joints. Severity was assessed using joint specific functional status questionnaires: Lequesne for the hip and knee and Dreiser for the hand. The distribution of osteoarthritis patients by occupation was compared with the distribution of occupations in all workers in France to obtain prevalence rate ratios. Results: Occupations with the greatest prevalence rate ratio were female cleaners (6.2; 95% CI 4.6 to 8.0), women in the clothing industry (5.0; 95% CI 3.9 to 6.3), male masons and other construction workers (2.9; 95% CI 2.6 to 3.3), and agriculture male and female workers (2.8; 95% CI 2.5 to 3.2). A twofold greater prevalence rate was observed within certain occupations between self-employed and salaried workers. Early onset of osteoarthritis was seen in the more heavy labour jobs with almost 40% of patients reporting their first symptoms before the age of 50. Conclusion: The early onset and severity of osteoarthritis in certain occupations warrants an urgent need for occupation specific studies for the development and evaluation of preventive strategies in this leading cause of disability in Western countries.

Primary osteoarthritis and occupations: a national cross sectional survey of 10 412 symptomatic patients.

Aims: To describe the age standardised prevalence of symptomatic osteoarthritis (OA) in a nationwide cross sectional survey of 10 412 patients in France, and their functional and work limitations. Methods: Cases in the survey were compared with their expected counterpart by age, gender, and occupational groupings using data from the 1998 French National Survey on Health Impairment and Disability. Results: Women represented 66.2% of the sample; mean age was 66.2 years. One third of patients had OA of the knee, 16% of the hip, and 12% of the hand; a third had multiple joint OA. Peak prevalence of symptomatic OA was in the 60–69 year category in women and in the 70–79 year category in men. Agricultural workers showed a significant excess prevalence of OA, with an observed to expected (O/E) ratio of 1.7 in women and 2.3 in men. Linear trends in prevalences between white collar, “mixed” collar, and blue collar workers were also significant, with odds ratios respectively of 1.0, 2.9, and 2.6 in women and 1.0, 1.2, and 1.7 in men. Specific excess prevalence was found in women among housekeepers (O/E 4.4), and in men among unskilled labour workers (O/E 10.3) and truck drivers (O/E 6.7). Total work disability was highest among blue collar workers and partial disability among agricultural workers. Conclusion: Results contribute to the mounting evidence that OA is potentially aetiologically linked to occupation in a sizeable segment of the population and that OA can no longer be considered an inevitable disease of ageing.

Compliance among general practitioners in France with recommendations not to prescribe bed rest for acute low back pain.

UNLABELLEDnAcute low back pain is a very common reason for general practitioner visits.nnnOBJECTIVEnTo evaluate practices among French general practitioners regarding the prescription of bed rest in patients with low back pain.nnnMETHODSn2000 general practitioners were to include the first three patients presenting within the first 3 d of onset of acute low back pain without nerve root pain. The characteristics of the pain, social and demographic characteristics of the patients, and treatments prescribed by the physicians were recorded.nnnRESULTSn5355 patients were included, of whom more than half had a history of one or more episodes of low back pain. The mean pain severity score on a 100-mm visual analog scale was 57.2 +/- 22.7 mm. Bed rest was recommended to 27.6% of the patients, for a mean duration of 4.4 d. Patients to whom bed rest was recommended were significantly more likely than the other patients to have chronic low back pain (32.1% vs. 26.5%) and received a greater number of medications. Bed rest was associated with significantly poorer outcomes in the multivariable analysis adjusting for confounding factors.nnnCONCLUSIONnRecommendations to avoid bed rest in patients with acute low back pain are widely followed in France. Furthermore, our results confirm that bed rest is associated with poorer outcomes.

Attitude thérapeutique et place du maintien d’activité dans la lombalgie aiguë en pratique de médecine générale

Resume La lombalgie aigue constitue un motif tres frequent de consultation en medecine generale. Objectif. – Lobjectif de cette enquete francaise etait de recueillir les donnees concernant la prescription de repos au lit en pratique de ville. Cette enquete a ete realisee aupres de 2000 medecins generalistes devant inclure a la date de lenquete les 3 premiers patients lombalgiques. Les patients devaient souffrir de lombalgie aigue sans irradiation, de moins de 3 j et consulter pour la premiere fois pour cet episode. Les caracteristiques de la lombalgie, les caracteristiques sociodemographiques des patients et les prescriptions du medecin etaient recueillies. Resultats. – Cinq mille trois cent cinquante-cinq patients ont ete inclus. Plus de la moitie des patients avait deja eu un ou plusieurs episodes lombalgiques. L’intensite de la douleur lombaire moyenne sur EVA etait de 57,2 ± 22,7 mm. La prescription dun repos au lit a ete recommandee a 27,6 % des patients. La duree moyenne de cette prescription etait de 4,4 j. Le groupe des patients ayant eu une prescription de repos au lit comportait un pourcentage significativement plus eleve de patients lombalgiques chroniques compare au groupe sans repos au lit (32,1 vs 26,5 %). Les prescriptions medicamenteuses etaient plus importantes dans le groupe avec repos au lit. Conclusion. – Levolution de la lombalgie etait significativement plus favorable dans le groupe sans repos au lit. Les resultats de cette enquete confirment que les recommandations deviter le repos au lit dans la lombalgie aigue sont appliquees en France a la majorite des patients lombalgiques, ainsi que l’effet deletere du repos au lit dans l’evolution de la lombalgie aigue.