Annales de readaptation et de medecine physique : revue scientifique de la Societe francaise de reeducation fonctionnelle de readaptation et de medecine physique最新文献

Our objective was to determine the long-term functional and quality-of-life outcomes for patients with rotator cuff tears receiving conservative treatment. We also studied correlations between the Constant and SF-36 scores.

Material and methods

This was a prospective survey carried out on patients having consulted in our Rehabilitation Department between January 1995 and December 2004 for radiologically-confirmed rotator cuff tears and having received medical treatment combined with a rehabilitation programme. The outcome measures used in our study were as follows: degree of motion, muscle strength, degree of pain on a visual analogical scale (VAS) and scores on the Constant and SF-36 scales.

Results

The study population consisted of 38 women and 21 men (mean age: 61 years; range 46–75). The mean final outcome measurements were taken after an average of seven years of follow-up (range: 4–12). The VAS score for pain at rest dropped from 68.3 ± 31 to 28.3 ± 12 (p < 10⁻³) over the follow-up period. The score for pain during effort fell from 82.5 ± 36 to 40.3 ± 15. In all cases, active joint mobility was better at the final assessment (p < 0.001). The Constant score rose from 28.8 ± 14.2 to 51.6 ± 21.8. The SF36 score showed a 16% improvement. Sixty-two percent of patients were satisfied or very satisfied with this treatment. The change over time was rated as good to very good by 42 patients (71.8%). The observed improvement in quality of life was correlated with reduced pain at rest (r = 0.62) and during effort (r = 0.59) and with the increased Constant score.

Conclusion

Our results underline the benefits (in terms of short- and long-term pain reduction, functional improvements and better quality of life) of an individualized rehabilitation programme (combined with medical treatment) in cases of rotator cuff tears.

Introduction

Clean intermittent self-catheterization is the recommended mode of bladder voiding in patients with urinary retention. Hence, this procedure should be well known and understood by the general practitioners (GP) who are responsible for monitoring such patients.

Objective

To assess GP’ state of knowledge regarding clean intermittent self-catheterization and to make recommendations for dealing with problems that occur during patient follow-up.

Method

A questionnaire focusing on the practice of clean intermittent catheterization was sent to 910 family GP in the Franche-Comté region of eastern France.

Results

Two hundred and fourty-six replies were analyzed. Sixty-four percent of GP believed that the appropriate number of bladder catheterizations per day was between two and four. Ninety percent of the GP prescribed perineal cleaning before catheterization and 29% prescribed the use of sterile gloves. Eighty-seven percent of general practitioners considered urinary tract infection to be the main complication of intermittent catheterization. Thirty percent always requested a urine culture in patients performing self-catheterization and 29% prescribed antibiotic therapy in cases of bladder colonization.

Discussion

General practitioners need to receive additional information on the role of clean intermittent catheterization in the prevention of urinary tract infection. In accordance with the French Urology Association guidelines, we produced a practical summary guide on preventing asymptomatic bacteriuria and urinary tract infections and/or preparing for urological investigations.

Objectives

To describe the epidemiological and clinical features of patients with primitive adhesive capsulitis of the shoulder treated by capsular distension and then rehabilitation; to evaluate the short-, mid- and long-term efficiency of this therapeutic protocol and compare it with rehabilitation alone.

Materials and methods

This was a two-year prospective study. Sixty patients were included and divided into populations P1 (capsular distension and rehabilitation) and P2 (rehabilitation only). Assessment of the treatments’ efficacy was based on the following parameters: pain on a visual analogue scale (VAS), joint motion in several axes, a simplified Constant score (functional ability) and the SF-36 quality of life score.

Results

Thirty patients (mean age: 56) underwent capsular distension. The Constant score was judged to be poor in over half of the patients. All the quality of life parameters were modified. When compared with P2, the P1 group showed a statistically significant improvement in terms of the pain score (p = 0.005), anterior elevation (p = 0.001), lateral elevation (p = 0.005), external rotation (p = 0.006) and the Constant score (p < 0.001) one week after capsular distension. One year after capsular distension, this gain persisted in a statistically significant manner for all functional parameters and all SF-36 dimensions (p < 0.001 for PF, RP, BP, SF and RE; p = 0.01 for GH and VT and p = 0.002 for MH).

Conclusion

Our results show that capsular distension and subsequent intensive rehabilitation have a beneficial effect. This combination enables rapid, significant improvement from the first week onwards. The improvement phase lasts for one month and may hold steady for up to 12 months.

Objective

Comment on spinal damage in Charcot's disease.

Observation

We report on a paraplegic patient with T9 spinal cord injury who developed destructive arthropathy of the lumbosacral joint.

Discussion

Charcot's disease occurs sporadically during the progression of certain chronic neurological diseases. It affects the limbs and the spine, where it causes major disc and vertebral damage. In cases of spinal cord injury, Charcot's disease must be considered when faced with the appearance of spinal deformity or the aggravation of neurological symptoms. Treatment of Charcot's disease requires spinal osteosynthesis for the relief of neurological compression and the re-establishment of spinal stability.