Jean-Michel Crielaard

Patients' expectations impact their satisfaction following total hip or knee arthroplasty

Introduction The objective of this study was to assess the number and magnitude of preoperative expectations and to correlate them with the degree of satisfaction expressed one year after Total Hip Arthroplasty (THA) or Total Knee Arthroplasty (TKA), in patients with severe and painful osteoarthritis (OA). Materials and Methods Preoperative expectations (within 20 days prior to surgery) and postoperative satisfaction (one year after the intervention) were measured using the previously validated French version of the Hospital for Special Surgery Hip or Knee Replacement Expectations Survey. Postoperative satisfaction was measured using a specific scale, following the same methodology as that used for the assessment of expectations. Prediction of the satisfaction of the patients was performed using multivariate linear regression modelling. Results A total of 138 patients (80 THA and 58 TKA) completed the two parts of the study. The expectations score (mean ± SD) (range 0–100) was 72.58 ± 12.63 before THA and 69.10 ± 13.72 before TKA (p = 0.13). The number of expectations expressed was 14.34 ± 1.32 (out of a potential maximum of 18) before THA and 14.70 ± 2.29 (out of a potential maximum of 19) before TKA. After 1 year, THA generated a significantly higher degree of satisfaction compared to TKA (69.70 ± 14.46 v 60.44 ± 17.54, p<0.001) (range 0–100). The pre-operative expectations score was the single best positive predictor of the post-surgery satisfaction assessment both for TKA and THA. Conclusion Patients undergoing total joint arthroplasty for end-stage OA have a high level of expectations, before both THA and TKA. While both types of interventions significantly improve essential and non-essential activities, the rate of satisfaction is significantly greater post THA. Preoperative expectations are a major contributor to the final degree of satisfaction, one year after surgery. These results re-emphasize the need for an optimal preoperative interaction between health care providers and patients, to allow patients a chance to foresee a reasonable outcome after TJA.

Multidisciplinary management of breast cancer

Breast cancer, with an increasing incidence, is the most frequently diagnosed cancer in women worldwide. The treatments proposed, generally a combination of surgery, radiotherapy, chemotherapy, endocrine therapy and/or targeted therapy, are constantly improving, allowing a reduction in the mortality rate, but they are still causing many side effects, not only early but also late, which leads us to consider the post-cancer period as a chronic condition. Side effects, reviewed in this commentary, may affect physical functions, psychological status, social situation, body composition, well-being and quality of life of the patient. In view of the extent of these areas in which side effects of breast cancer and of its treatments can be found, the supportive care offered at the end of treatment need to be multidisciplinary. Different supportive care interventions may be proposed to the patients such as psychological and behavioral interventions, complementary therapies, diet interventions, physical activity/rehabilitation or also physiotherapy interventions for example, all having shown some beneficial effects in the literature. The benefits of these supportive care interventions are thereby already established and they are described in this article, but others studies will be needed to clearly define indications and most optimal modalities of application to reduce side effects and improve quality of life of patients.

Preseason Strength Assessment of the Rotator Muscles and Shoulder Injury in Handball Players

CONTEXT   Few researchers have identified intrinsic risk factors for shoulder injury in team handball players by analyzing measurements of maximal isokinetic rotator muscle strength. OBJECTIVE   To identify possible intrinsic risk factors for shoulder injury by analyzing measurements of maximal isokinetic rotator muscle strength. DESIGN   Cross-sectional study. SETTING   Male team handball senior divisions (the highest level) in France and Belgium. PATIENTS OR OTHER PARTICIPANTS   A total of 108 male high-level handball players (age = 24 ± 4 years, height = 189 ± 6 cm, mass = 87 ± 11 kg) were enrolled. MAIN OUTCOME MEASURE(S)   All players completed a preseason questionnaire and performed a bilateral isokinetic assessment of the shoulder rotator muscles. On a monthly questionnaire, players reported any shoulder injury that they sustained during the season. RESULTS   On the preseason questionnaire, 51 of 108 (47%) participants reported a history of dominant-shoulder injury. A total of 106 participants completed the in-season questionnaire, with 22% (n = 23) reporting a shoulder injury on their dominant side during the subsequent season. Fourteen percent (n = 15) sustained microtraumatic injuries, and 8% (n = 8) described a traumatic injury. Backcourt players had a 3.5-times increased risk of injury during the new season compared with players in other positions. Among the isokinetic results, no risk factor for further injury was identified in handball players with microtraumatic injuries. For traumatic injuries, the concentric maximal strength developed by the internal rotators at high speed (240°/s) in the dominant shoulder was a protective factor against the risk of further injury. CONCLUSIONS   These results can potentially identify intrinsic risk factors for shoulder injury and may be used to determine potential interventions for reducing this risk in handball players.

Cross-cultural translation, validity, and reliability of the French version of the Neurophysiology of Pain Questionnaire

ABSTRACT Pain physiology education is an important component in the management of patients with chronic musculoskeletal pain. The Neurophysiology of Pain Questionnaire (NPQ) was developed in English to assess pain physiology knowledge in patients. This study aimed to translate the NPQ into French (NPQ-Fr) and to investigate the main psychometric properties of the NPQ-Fr. The translation was performed using the best practice translation guidelines. One hundred and one French-speaking patients with chronic non-specific spinal pain completed the NPQ-Fr to assess its acceptability and presence of floor/ceiling effects and test its dimensionality. The construct validity was tested by comparing the patients’ NPQ-Fr scores to those of 17 physiotherapists and investigating its correlation with subscales of the Short Form-36 questionnaire. The reliability (i.e., internal consistency and test-retest reliability) was also investigated. To test the test-retest reliability, 70 patients were asked to complete the NPQ-Fr twice with one week in between. Regarding the NPQ-Fr psychometric properties: 1) acceptability was good; 2) internal consistency reached a Cronbach α-coefficient of 0.44; 3) no floor and ceiling effects were observed in patients; 4) a principal factor analysis generated three major factors; 5) construct validity was good; and 6) reliability was acceptable (intraclass correlation coefficient = 0.644; standard error of measurement = 1.5). The NPQ-Fr has satisfactory basic psychometric properties in patients with chronic spinal pain.

Influence of a multidisciplinary post-breast cancer rehabilitation program on lifestyle and behavior faced with physical activities

B the gaps in cancer care is a daunting task that requires self-awareness, education, and advocacy founded in the Code of Ethics for Nurses and aligned with our Nursing’s Social Policy Statement (ANA, 2010). Though ethical underpinnings of both the code and social contract with individuals, families, and communities remain constant, healthcare is constantly evolving. One of the most important roles of nurses as leaders in healthcare is to give voice to the under-served and ensure fairness and equity to all people regardless of race, creed, gender, or economic status (ANA, 2010). Now, with growing visibility of marginalized US populations, the healthcare industry and its providers are challenged to meet the needs of the LGBTQ populations in an equitable and just way. For several decades, grassroots efforts, championed by the Fenway Institute (Boston, MA) and many of our national medical and nursing organizations (IOM, ANA,), have called for an adjustments to the binary healthcare structure that has yet to address the new norms of an expanding diversity of culture. Inherent in the lack of readiness to support the LGBTQ community are deficits in provider information, ineffective communication, confusion surrounding gender and sexuality differences and conscious and unconscious biases that interfere with the ability to recognize and to deliver appropriate healthcare. Despite this trending need, pre-professional education has dedicated limited amount of time in preparing nurses, nurse practitioners and medical staff in the standards of care for LGBTQ people. For the purpose of this presentation, cancer risk assessment, screenings, healthcare practices, and health promotion for LGBTQ people, from the very young to the elderly, will be explored. Strategies to provide a compassionate, and welcoming environments to gender, non-conforming individuals will be discussed. Recommendations for nursing education and preparedness using evidence-based applications in clinical practice will be offered.Exercise stage b 3.152 Contemplation .281 1.208 0.054 1.325 (0.124-14.143) Preparation .851 1.282 0.441 2.342 (0.190-28.866) Action 1.291 1.298 0.989 3.636 (0.285-46.305) Maintenance 1.944 1.368 2.020 6.990 (0.478-102.125) Table1 the predictive factor analysis of glycemic control Introduction It is important for patients with diabetes mellitus to understand the importance of drug compliance and healthy lifestyle. However, the actual condition of this management is not ideal. The behavior of personality traits is an important factor of compliance. There is a close relationship between personality traits, self-discipline, and selfcare. It is critical to understand the personality traits of subjects for glycemic control. Methods This study was conducted in the Division of Metabolism in a teaching hospital in Taiwan. There were 219 patients with Type 2 diabetes under survey with questionnaires. The effective sample size is 214. Results a) The older the patients have the lower the risk of poor glycemic control. b) Increase of every 10 years of age, the risk of poor glycemic control decreases by 9.2%. c) Increased fasting blood glucose of 10mg/dl increases 59% risk of poor glycemic control. d) Increased every 10 g/dl TG makes the increase of risk for poor glycemic control by 39%. e) Patients with prudent personality or agreeable personality have a lower risk of poor glycemic control but without significant difference. f) Neuroticism personality is an important predictor for poor glycemic control g) Neuroticism personalities have a 7.52 times higher risk of poor glycemic control.

Eccentric training for tendon healing after lesion: a rat model

Background: The tendon is a dynamic entity that remodels permanently. Platelet-rich plasma (PRP) injection has been shown to have a beneficial effect on tendon healing after lesion in rats. Furthermore, eccentric exercise seems to improve the mechanical quality of the tendon. Hypothesis: A combination of PRP injection and eccentric training might be more effective than either treatment alone. Study Design: Controlled laboratory study. Methods: Adult male rats were anesthetized, an incision was performed in the middle of their left patellar tendon and an injection of physiological fluid (PF) or homologous PRP was randomly made at the lesion level. The rats were then divided into 2 groups: the eccentric group, undergoing eccentric training 3 times a week, and the untrained group, without any training. Thus, 4 groups were compared. After 5 weeks, the tendons were removed and their ultimate tensile strength and energy were measured. Tendons were frozen for proteomic analyses when all biomechanical tests were completed. Statistical analysis was performed with linear mixed effect models. Results: No significant difference was found between the treatments using PF injection or PRP injection alone. However, the value of the ultimate tensile force at rupture was increased by 4.5 N (108% of control, P = .006) when eccentric training was performed. An intragroup analysis revealed that eccentric training significantly improved the ultimate force values for the PRP group. Proteomic analysis revealed that eccentric training led to an increase in abundance of several cytoskeletal proteins in the PF group, while a decrease in abundance of enzymes of the glycolytic pathway occurred in the PRP-treated groups, indicating that this treatment might redirect the exercise-driven metabolic plasticity of the tendon. Conclusion: Eccentric training altered the metabolic plasticity of tendon and led to an improvement of injured tendon resistance regardless of the treatment injected (PF or PRP). Clinical Relevance: This study demonstrates the necessity of eccentric rehabilitation and training in cases of tendon lesion regardless of the treatment carried out.

Effects of twelve weeks of aerobic or strength training in addition to standard care in Parkinson’s disease: a controlled study

BACKGROUND Physical exercise in addition to standard care (SC) in patients with Parkinsons disease (PD) is now a common practice in many care units. However, exercises can cover a wide range of interventions, and the specific effects of different interventions still deserve to be further investigated. AIM The aim of this study was to compare the effects of 12 weeks of two different types of physical exercises with SC in patients suffering from PD. DESIGN Pseudo-randomized controlled trial. SETTING University laboratory for outcomes, University Hospital Centre for interventions. POPULATION Fifty-two outpatients suffering from mild to moderate PD at baseline. METHODS Participants were allocated to three groups: the strength training (ST) group performed individualized upper and lower limbs strength training, the aerobic training (AE) group performed tailored gradual aerobic cycling, and the third group received SC. The effects of the interventions on body function were assessed by measuring isokinetic concentric peak torque for knee extension and flexion, peak oxygen consumption (VO2peak) and peak work load (PWL) during an incremental maximal cycling test. Changes in mobility were evaluated from spatial-temporal gait features measured by mean of an accelerometer system and the Six-Minute Walk Distance (6MWD) Test. We used questionnaires to estimate health-related quality of life and habitual physical activity. RESULTS No significant changes in any outcome measures occurred in the SC group. More than 80% of the participants adequately completed the AE and the ST interventions. The ST group significantly improved all peak torque measures (P≤0.01), except knee extension in the least affected side (P=0.13). This group also improved the PWL (P=0.009) and 6mwd (P=0.03). The AE group improved the VO2peak (P=0.02) and PWL (P<0.001). CONCLUSIONS Physical fitness in patients with PD rapidly improved in compliance with training specificities, but better fitness hardly translated into better mobility and health-related quality of life. CLINICAL REHABILITATION IMPACT Physiotherapists can efficiently propose physical conditioning to patients with mild to moderate PD, but these interventions are insufficient to improve gait and participation. Notwithstanding, ST is an efficient intervention for improving walking capacity.