Jean-Christophe Daviet

Clinical factors in the prognosis of complex regional pain syndrome type I after stroke: a prospective study.

Daviet JC, Preux PM, Salle JY, Lebreton F, Munoz M, Dudognon P, Pelissier J, Perrigot M: Clinical factors in the prognosis of complex regional pain syndrome type I after stroke: A prospective study. Am J Phys Med Rehabil 2002;81:34–39. ObjectiveTo evaluate clinical prognostic factors of complex regional pain syndrome type I (CRPS I) in patients with stroke in an attempt to improve the Perrigot score, which does not include shoulder subluxation, unilateral neglect, or depression. DesignThis was a prospective study. The initial clinical data (first month) included motor index, Ashworth scale, de Bats score for shoulder subluxation, Montgomery-Asberg Depression Rating Scale, and sensory disorders evaluation. The prognosis of CRPS I was evaluated from the Perrigot score. A score of CRPS I severity was measured on entry and 3 mo later. ResultsOf the 71 patients with hemiplegia who were included, 34.8% had a CRPS I. The five main clinical factors in the prognosis of CRPS I were motor deficit, spasticity, sensory deficits, and initial coma. The prognostic score of Perrigot was strongly correlated with the CRPS I severity and was predictive of subsequent progression. ConclusionShoulder subluxation, unilateral neglect, and depression did not seem to be determinant predictive factors of CRPS I severity.

Physical Factors Associated With Fatigue After Stroke: An Exploratory Study

Abstract Objective: To look for a relationship between physical fatigue and physical parameters in patients at least 3 months post stroke. Methods: We conducted a prospective cross-sectional study of 32 poststroke patients (average duration of stroke 40 months) who were recruited among in- and outpatients followed by the Department of Physical and Rehabilitation Medicine of a university hospital. Fatigue was defined as a Fatigue Severity Scale (FSS) score of 4 or more. The parameters studied were age, sex, time since stroke, Demeurisse Motor Index, Barthel Index score, new Functional Ambulation Category, Berg Balance Scale, 10-meter walk test, 6-minute walk test, Dijon Physical Activity Score, Montgomery and Asberg Depression Rating Scale, Epworth Sleepiness Scale, presence of pain, and length and area of the center of pressure displacement obtained posturographically. Results: Two-thirds of patients (65.6%) were fatigued. The mean FSS score was 4.3 ± 1.8. Fatigue was not associated with the physical parameters studied; notably, there was no correlation with motor impairment, autonomy and walking capacity, or balance and physical activity. However, after multivariate analysis, we found an association between physical fatigue and time since the occurrence of stroke (P = .05). Conclusions: Our study revealed a relationship between pain and physical fatigue, as reported by 2 other studies. Poststroke fatigue management should include appropriate pain management. Further studies are necessary to determine the causes of physical fatigue after stroke.

Evaluation of a multidisciplinary consultation of diabetic foot

OBJECTIVES To evaluate the effectiveness of a multidisciplinary consultation of diabetic foot in terms of ulcer healing rate and podiatric complications prevention. METHODS A longitudinal observational study was conducted on 78 patients consulting multidisciplinary clinic of diabetic foot between the 1st January 2005 and the 31th December 2006. There were two evaluations: the first one in June 2008, the second one in January 2010, at a medium follow-up of 48 months. RESULTS 30.8% of diabetic patients were addressed in primary prevention, 53.8% for treatment of foot ulcer, and 15.4% in secondary prevention. The global healing rate was 76.19% after a medium follow-up of 29 months, and the recurrence rate at a medium follow-up of 48 months was 9.52%. Healing was achieved in 63.6% of patients with off-loading shoes versus 81.8% of whom with fiberglass cast boot. CONCLUSION Care and follow-up of diabetic patients with foot at risk in multidisciplinary consultation seem to be effective not only in curative treatment, but also in primary and secondary prevention. The economic benefits need to be evaluated.

Evaluation of surgical treatment for ruptured Achilles tendon in 31 athletes

INTRODUCTION In the past few decades, the incidence of Achilles tendon rupture has increased in parallel with increased sports participation. Although the optimal treatment remains controversial, there is a trend towards surgical treatment in athletes. HYPOTHESIS Surgical repair of ruptured Achilles tendon in athlete results in good functional and objective recovery, irrespective of the type of surgery performed. Subsidiarily, are the results different between percutaneous surgery (PS) and standard open surgery (OS)? MATERIALS AND METHODS This was a cross-sectional study of 31 patients who presented with a ruptured Achilles tendon that occurred during sports participation. Percutaneous surgery was performed in 16 patients and open surgery in 15 patients between 2005 and 2009. The objective recovery status was evaluated by open chain goniometry, measurement of leg muscle atrophy and assessment of isokinetic strength. The functional analysis was based on the delay, level of sports upon return, AOFAS and VAS for pain. RESULTS Our series of Achilles tendon rupture patients consisted of 88% men and 12% women, with an average age of 38 years. In 71% of cases, the rupture occurred during eccentric loading. After a follow-up of 15 months, the muscle atrophy was 13 mm after PS and 24 mm after OS (P=0.01). A strength deficit of 19% in the plantar flexors was found in the two groups. No patient experienced a rerupture. The return to sports occurred at 130 days after PS and 178 days after OS (P=0.005). The average AOFAS score was 94 and the VAS was 0.5. There were no differences in ankle range of motion between the two groups. The majority (77%) of patients had returned to their preinjury level of sports activity. DISCUSSION The return to activities of daily living was slower in our study than in studies based in Anglo-Saxon countries; this can be explained by the different sick leave coverage systems. Percutaneous surgery resulted in a faster return to sports (about 130 days) and less muscle atrophy than open surgery. Our results for return to sports and return to preinjury levels were similar to published results for athletes and were independent of the type of surgery performed. The AOFAS score was comparable to published studies. We found no difference in muscle strength between the two surgery groups 15 months after the procedure. Apart from venous thrombosis typically described after lower-limb immobilization, secondary postoperative complications mostly consisted of sural paresthesia, which had resolved at the 15-month postoperative follow-up evaluation. CONCLUSION The results of surgical treatment for ruptured Achilles tendon are good overall. By combining the simplicity of conservative treatment and the reliability of standard surgical treatment, percutaneous surgery is the treatment of choice to achieve excellent results. The return to sports occurred earlier, the muscle atrophy was less and the functional score was better in our patients treated by percutaneous surgery. LEVEL OF EVIDENCE Level IV.

Acute stroke phase voluntary cough and correlation with maximum phonation time.

Objective This study aimed to assess cough effectiveness after a stroke and to propose a bedside screening test. Design Patients who had had ischemic hemispheric stroke were recruited and followed up for 2 mos. Maximum phonation time (MPT) was assessed during the first 10 days. Aspiration was evaluated on days 2 and 10 after stroke. Lung function testing was performed on day 10. Peak cough flow less than 160 liters/min was defined as the criterion for cough ineffectiveness. Correlation between peak cough flow and MPT was determined, and the optimal cutoff value relating MPT to effective cough was determined using receiver operating characteristic analysis when referring to peak cough flow. Results Of the 70 patients, 6 developed pneumonia (mean time, 1.7 ± 2.4 days). Lung function assessment in 32 cases revealed general reduced cough effectiveness. MPT was correlated with peak cough flow (r = 0.413, P = 0.025), and an MPT cutoff of 10 secs was identified. Forty-seven patients were able to perform MPT on day 2; 49 were able to perform on day 10. Patients with MPT of 10 secs or longer had less frequent aspiration on both day 2 (5.9% vs. 36.7%, P = 0.034) and day 10 (2.9% vs. 26.6%, P = 0.026). Conclusions Cough effectiveness was reduced at the time of greatest risk for pneumonia. MPT provides a reliable bedside screening test of cough effectiveness.

Physical Activity Level Among Stroke Patients Hospitalized in a Rehabilitation Unit

The current literature contains little information about the level of physical activity of hospitalized patients who have had a stroke. Improving knowledge in the area could help optimize rehabilitation.

Long-term transanal irrigation's continuation at home. Preliminary study

OBJECTIVE To determine the long-term outcome of Peristeens home use. METHOD Retrospective study on the 16 first patients treated by Peristeen in the department of physical and readaptation medicine of Limoges universitary hospital, by the mean of phone interviews. RESULTS Successful outcome was achieved in 62.5% patients after a mean follow-up of 2.6 years. All patients had neurogenic bowel disorders, including 75% of constipation. Most of cases of Peristeen discontinuation occurred at the treatment beginning, one month after introduction in two thirds of cases. In patients who were still using transanal irrigation (TAI), mean grade of satisfaction with the Peristeen system was 9.12/10, despite the high rate of technical problems (77.8% of cases). CONCLUSION This study highlights the limits of Peristeens long-term using and suggests the interest of a specific therapeutic education to Peristeen and of a systematic control consultation within the 3 first months of treatment.

Can energy expenditure be accurately assessed using accelerometry-based wearable motion detectors for physical activity monitoring in post-stroke patients in the subacute phase?

Background In the subacute stroke phase, the monitoring of ambulatory activity and activities of daily life with wearable sensors may have relevant clinical applications. Do current commercially available wearable activity trackers allow us to objectively assess the energy expenditure of these activities? The objective of the present study was to compare the energy expenditure evaluated by indirect calorimetry during the course of a scenario consisting of everyday activities while estimating the energy expenditure using several commercialised wearable sensors in post-stroke patients (less than six months since stroke). Method Twenty-four patients (age 68.2 ± 13.9; post-stroke delay 34 ± 25 days) voluntarily participated in this study. Each patient underwent a scenario of various everyday tasks (transfer, walking, etc.). During the implementation, patients wore 14 wearable sensors (Armband, Actigraph GT3X, Actical, pedometer) to obtain an estimate of the energy expenditure. The actual energy expenditure was concurrently determined by indirect calorimetry. Results Except for the Armband worn on the non-plegic side, the results of our study show a significant difference between the energy expenditure values estimated by the various sensors and the actual energy expenditure when the scenario is considered as a whole. Conclusion The present results suggest that, for a series of everyday tasks, the wearable sensors underestimate the actual energy expenditure values in post-stroke patients in the subacute phase and are therefore not accurate. Several factors are likely to confound the results: types of activity, prediction equations, the position of the sensor and the hemiplegia side.

Outcome 4 years after non-operative and operative treatment of posterior cruciate ligament (PCL) injuries

taux optimum de vitamine et seulement 14 % une hypovitaminose. L’année suivante en février 2012 et juin 2012, nous avons retrouvé des chiffres similaires. Après supplémentation en novembre 2012, 94 % des sujets présentaient un taux supérieur à 30 ng/mL en février 2013. Discussion.– Comme Galan [1] l’avait déjà démontré en 2012, un taux sériqu de 25(OH)D3 d’environ 48,5 ng/mL est nécessaire à la mi-octobre pour assurer suffisance en vitamine D 30 ng/mL au début de février. La pratique intensive d’un sport d’extérieur n’exclut pas le risque d’hypovitaminose D, d’autant plus que les patients sont d’origine africaine. Il serait intéressant de corréler ces résultats aux apports quotidiens en vitamine D et calcium du sportif. Conclusion.– Les footballeurs professionnels ont un risque élevé d’hypovatimanose D, majoré chez les footballeurs de d’origine africaine, bien qu’ils pratiquent un sport intensif en extérieur. Cette réflexion attire des questions sur le statut vitaminique du sportif. Cela mériterait de poursuivre notre étude sur une éventuelle relation avec les blessures et la contre-performance. Référence [1] Galan F. Serum25-hydroxyvitamin D in early autumn to ensure vitamin D sufficiency in mid-winter in professional football players. Clin Nutr 2012;132–6.

Devenir à quatre ans après rupture du ligament croisé postérieur (LCP) opéré et non opéré

CO21-001-f Devenir à quatre ans après rupture du ligament croisé postérieur (LCP) opéré et non opéré J. Bordes *, C. Coste , R. Jallageas , J.Y. Salle , C. Mabit , J.C. Daviet d a CHU de Bordeaux, service de médecine physique et réadaptation, hôpital Tastet-Girard, CHU Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France b Clinique Chénieux, 18, rue du Général-Catroux 87000 Limoges, France c CHU de Rennes, Pontchaillou, service de médecine physique et réadaptation, 2, rue Henri Le-Guilloux, 35000 Rennes, France d CHU Dupuytren, service de médecine physique et réadaptation, hôpital Jean-Rebeyrol, avenue du Buisson, 87000 Limoges, France e CHU Dupuytren, service de chirurgie orthopédique et traumatologique, 2, rue du Docteur-Marcland, 87000 Limoges, France *Auteur correspondant. Adresse e-mail : Jeremie.bordes@chu-bordeaux.fr