Y. Macé

Relation of inflammatory modic changes to intradiscal steroid injection outcome in chronic low back pain

The purpose of this study was to analyze the association between the severity of inflammatory endplate changes (Modic) on MRI and the clinical response to intradiscal injection of corticosteroids (IDIC) in chronic low back pain (LBP). A total of 74 patients with LBP and inflammatory Modic changes who showed no response to 3-month conservative treatment received lumbar IDIC. Two spine specialists and a radiologist assessed independently the endplate marrow changes of the injected discs. We classified patients with a pure edema endplate changes on MRI as Modic type I (nxa0=xa037); those with a mixture of Modic type I and type II changes but predominantly edema changes as Modic I-2 (nxa0=xa025) and those with predominantly fatty changes as Modic II-1 (nxa0=xa012). The primary outcome was the change in LBP intensity between baseline and 1xa0month after IDIC, as measured on a visual analog scale (range 0–100xa0mm). At 1xa0month, reduction in pain score was significantly higher in the Modic I and Modic I-2 groups than in the Modic II-1 group (30.2xa0±xa026.6 and 29.4xa0±xa021.5 vs 5.3xa0±xa025.5; Pxa0=xa00.009 and Pxa0=xa00.017, respectively). At 3 and 6xa0months, IDIC tended to be more effective in the Modic I and Modic I-2 groups but not significantly. No complications such as infection or hematoma were reported. IDIC could be a short-term efficient treatment for patients with chronic LBP and predominantly inflammatory endplate changes when conservative treatments have failed.

Les échelles d'incapacité fonctionnelle de l'épaule : revue systématique

OBJECTIVESnTo identify all available shoulder disability questionnaires designed to measure physical functioning and to examine those with satisfactory clinimetric quality.nnnMETHODSnWe used the Medline database and the Guide des outils de mesure de lévaluation en médecine physique et de réadaptation textbook to search for questionnaires. Analysis took into account the development methodology, clinimetric quality of the instruments and frequency of their utilization. We classified the instruments according to the International Classification of Functioning, Disability and Health.nnnRESULTSnThirty-eight instruments have been developed to measure disease-, shoulder- or upper extremity-specific outcome. Four scales assess upper-extremity disability and 3 others shoulder disability. We found 6 scales evaluating disability and shoulder pain, 7 scales measuring the quality of life in patients with various conditions of the shoulder, 14 scales combining objective and subjective measures, 2 pain scales and 2 unclassified scales. Older instruments developed before the advent of modern measurement development methodology usually combine objective and subjective measures. Recent instruments were designed with appropriate methodology. Most are self-administered questionnaires.nnnCONCLUSIONnNumerous shoulder outcome measure instruments are available. There is no gold standard for assessing shoulder function outcome in the general population.

Analyse de la littératureLes échelles d'incapacité fonctionnelle de l'épaule : revue systématiqueShoulder disability questionnaires: a systematic review

OBJECTIVESnTo identify all available shoulder disability questionnaires designed to measure physical functioning and to examine those with satisfactory clinimetric quality.nnnMETHODSnWe used the Medline database and the Guide des outils de mesure de lévaluation en médecine physique et de réadaptation textbook to search for questionnaires. Analysis took into account the development methodology, clinimetric quality of the instruments and frequency of their utilization. We classified the instruments according to the International Classification of Functioning, Disability and Health.nnnRESULTSnThirty-eight instruments have been developed to measure disease-, shoulder- or upper extremity-specific outcome. Four scales assess upper-extremity disability and 3 others shoulder disability. We found 6 scales evaluating disability and shoulder pain, 7 scales measuring the quality of life in patients with various conditions of the shoulder, 14 scales combining objective and subjective measures, 2 pain scales and 2 unclassified scales. Older instruments developed before the advent of modern measurement development methodology usually combine objective and subjective measures. Recent instruments were designed with appropriate methodology. Most are self-administered questionnaires.nnnCONCLUSIONnNumerous shoulder outcome measure instruments are available. There is no gold standard for assessing shoulder function outcome in the general population.