Zohra Ben Salah Frih

Complex Regional Pain Syndrome Type I: Incidence and Risk Factors in Patients With Fracture of the Distal Radius

OBJECTIVE To examine the incidence and predictors of complex regional pain syndrome type I (CRPS I) after fracture of the distal radius. DESIGN Prospective study. SETTING University hospital. PARTICIPANTS A consecutive sample of patients (N=90) with fracture of the distal radius treated by closed reduction and casting. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Occurrence of CRPS I, occurrence of pain, wrist and hand range of motion, radiographic measures, Patient-Rated Wrist Evaluation, Hospital Anxiety and Depression Scale, and Medical Outcomes Study 36-Item Short-Form Health Survey at baseline and 1, 3, 6, and 9 months follow-up. RESULTS CRPS I occurred in 29 patients (32.2%) with a mean delay ± SD of 21.7±23.7 days from cast removal. Univariate analyses found significant differences between patients with CRPS I and patients without CRPS I at baseline for sex (P=.021), socioeconomic level (P=.023), type of trauma (P=.05), pain at rest and activity (P=.006 and P<.001, respectively), wrist dorsiflexion and pronation (P=.002 and P=.001, respectively), finger flexion (P=.047), thumb opposition (P=.002), function of the hand (P<.001), and physical quality of life (QOL) (P=.013). Logistic regression showed that risk for CRPS I was higher in cases of women (odds ratio [OR]=5.774; 95% confidence interval [CI], 1.391-23.966), medium and low energy trauma patients (OR=7.718; 95% CI, 1.136-52.44), patients with a Medical Outcomes Study 36-Item Short-Form Health Survey physical functioning score <40 (OR=4.931; 95% CI, 1.428-17.025), and patients with Patient-Rated Wrist Evaluation pain subscale score >16 (OR=12.192; 95% CI, 4.484-43.478). CONCLUSIONS CRPS I occurs frequently during the third and fourth week after cast removal, especially in women who report severe pain and impairment of physical QOL. Additional prospective studies are required to verify these findings in comminuted and operated fractures of the distal radius.

Interest of visual biofeedback rehabilitation on balance in the lower limb amputee

Objective The aim of our study was to evaluate the role of the visual biofeedback in balance disorders in lower limb amputees. Material/Patients and methods A prospective study performed in lower limb amputees followed at the Physical Medicine and Rehabilitation department of the University Hospital of Monastir. The first group received visual biofeedback on the balance platform combined with conventional rehabilitation of balance disorders. The second group of patients was treated only by conventional rehabilitation. Patients were evaluated clinically before and after each program. The total duration of the protocol was 24 sessions. Results Ten patients participated in our study. Five patients received only conventional rehabilitation and the five others were treated also using visual biofeedback. Both groups were clinically improved. Patients benefiting from visual biofeedback rehabilitation had a statistically greater improvement in the gain on the functional scores (L Test, monopodal support) as well as an improvement in the area and length of the center of pressure in the stabilogram with closed eyes. Discussion/Conclusion Visual biofeedback rehabilitation seems to improve the integration of proprioceptive information with a functional gain.

Functional and socio-professional outcome of lower limb amputees: About 101 cases

Objective The objective of this study was to assess the functional and socio-professional future of lower limb-amputated patients. Patients and methods This is a 3-year-prospective study of lower limb-amputated patients, followed at the Physical Medicine and Rehabilitation department of the University Hospital of Monastir. The data analyzed were epidemiological, clinical, functional [the index of locomotion (ICL), the score “Special interest group of the amputee physician” (SIGAM)] and socio-professionals. Results We collected 101 patients with a mean age of 61.3 years with a male predominance (75.2%). Sixteen patients (15.8%) were initially braced and 58 (57.4%) had their device during the study period with an average delay of 10.08 months compared to surgery. Seventy-two patients had a job and only 8 amputees initially had a driving license. Forty-nine patients (48.5%) were initially able to do their own toilet against by 52 (51.5%) needing a third person to help them. After fitting, the rates have improved from 74.13% to 82.75 as well as the walking ability. For the device-fitted patients, ICL averaged 28.09. The average value of the non-ICL fitted patients initially increased from 25.89 to 31.25 (at least 6 months after being fitted). The SIGAM score assessment for all fitted patients showed that the most represented clinical grade was grade B for 20 patients (27.02%), followed by the degree F for 18 patients (24.32%). Forty-five patients (44.5%) had a professional outplacement and one remained able to drive after fitting. Discussion/Conclusion The device acquisition is a significant change for patients on the functional and professional levels. It allows a significant improvement in various activities of daily life with greater autonomy.