L’objectif de ce travail est d’évaluer le bénéfice d’un programme court de rééducation de 2 semaines sur la présence au travail et le recours aux arrêts de travail à un an chez des patients lombalgiques chroniques. Il s’agit d’une étude rétrospective. Tous les patients ayant bénéficié d’une rééducation de deux semaines en hospitalisation de médecine physique et de réadaptation entre janvier 2018 et mars 2019, pour le motif lombalgie chronique ont été inclus. Sur les 311 patients éligibles, 134 répondaient aux critères d’inclusions. Sur ces derniers, 96 patients ont répondu au questionnaire à un an d’évaluation. Concernant les patients qui ont pu être évaluée à un an, l’âge moyen était de 46 ans, l’IMC 25,5, l’ancienneté de la lombalgie était de 5,5 ans [2 ; 15], 27 % avaient une radiculalgie associée. Cinquante-cinq pour cent des patients avaient une activité professionnelle à l’entrée, 31 % étaient en arrêt de travail, 14 % sans emploi. La médiane de la durée des arrêts cumulés d’arrêts de travail était de 210 j [83–338]. À la sortie les patients étaient améliorés en termes de douleur (EVA à 3 versus 4,6 à l’entrée, p < 0,001). À un an 64 % avaient une activité professionnelle, 24 % étaient en arrêt de travail, 12 % sans emploi. On observe une diminution de 15 % des arrêts de plus de 6 mois, une diminution de 12 % des arrêts de plus de 3 mois, une diminution de 7 % des arrêts de plus de 1 mois par contre une augmentation de 10 % des arrêts de moins d’1 mois. Les deux secteurs les plus représentés dans le groupe non présent au travail à un an étaient le bâtiment (23 %) et l’aide et soin à la personne (20 %). À un an 73 % pratiquait des auto exercices en moyenne 4 fois par semaine. Quarante-six pour cent pratiquaient une activité physique en moyenne deux fois par semaine. Quatre-vingt-cinq pour cent des patients à un an étaient satisfaits ou très satisfaits du programme. Cette étude rétrospective montre qu’un programme de 2 semaines de rééducation augmente le nombre de patients lombalgiques ayant une activité professionnelle à un an (64 % versus 55 % mais sans différence statistiquement significative p à 0,24), diminue la durée des arrêts de travail (p à 0,023).

Musculoskeletal disorders (MSDs) constitute a major occupational health problem in the working population. MSDs manifest as localized pain or functional difficulty in one or more anatomical areas, such as the cervical spine, shoulder, elbow, hand, and wrist. Although physical exercise is widely recommended, few studies with a good level of evidence have enabled us to base a complete, well-constructed intervention on exercise that can be offered as secondary prevention in these disorders. A prospective, multicenter, comparative, randomized study using Zelen's design. This study falls under active prevention of MSDs of the upper extremities. Participants are workers aged between 18 and 65 years, with any type of job or workstation, with or without a history of sick leave. The primary aim is to show the superiority at 3 months of a combination of spa therapy, exercise, and self-management workshops for 6 days over self-management workshops in terms of employee functional capacity in personal and professional daily life (QUICK DASH scale). We included 148 patients, 73 assigned to the intervention group and 75 to the control group. At 3 months, the total score of functional disability assessed by QUICK DASH decreased in both groups. This reduction was higher in the intervention group (−10.04 ± 15.83) versus control group (−5.57 ± 13.45). We noticed a non-significant decrease for QUICK DASH total score (P = 0.10). However, the field specifically assessing disabilities in physical activities; QUICK DASH sport; had significantly decreased in the intervention group (−14.58 ± 21.49) versus control group (−6.72 ± 19.04) (P = 0.02). The originality of this intervention lies, in its short, intensive format, which is compatible with remaining in work; and in its multidisciplinary approach. This trial demonstrates the benefits of a short course of spa therapy combined with a personalized self-management program on the functional capacity in their daily life.

La revue Médecine et chirurgie du pied est l organe officiel de la SFMCP. Sa spécificité est la multidisciplinarité induisant la collaboration entre les différents spécialistes intéressés par la physiologie et la pathologie du pied.

The profit of an intradiscal injection of corticoids in low back pain with Modic 1 changes is not totally resolved. The objectives of this work is to estimate the clinical profit at 1, 3 and 6 months after an intradiscal injection of prednisolone acetate versus a lidocain one in low back pain with Modic. Fifty patients with low back pain in failure of the medical treatment for more than 6 weeks where included in this prospective, double blind, randomized study. Pain intensity was significantly improved a 1 month in the prednisolone acetate group compared to the lidocain group. A significant diffrence is also observed at 1 and 3 months in the activities of the everiday life of DALLAS questionnaire in favour of the glucocorticoid group. There was no significant difference, throughout the follow up on Oswestry evolution, comsuption of analgesic or in professional condition. Intradiscal injection of prednisolone acetate in low back pain with modic 1 changes reduces pain intensity at 1 month but not at 3 and 6 months versus lidocain.

Spa therapy had proven his efficiency with good safety. Very few studies have been conducted among older subjects (over 60 years old) with musculoskeletal disorders. The objective of this study is to measure the effect size on pain of a spa therapy treatment in a chronic low back pain population aged 60 to 80 years. A prospective study was conducted at Neyrac-les-Bains spa therapy resort (France) from August to November 2015. Included subjects benefited 3-weeks conventional cure. Measurements were made at D0, D18, M3 and M6. The primary endpoint was pain on a numerical scale at 3 months. The secondary outcomes were disability on the Oswestry Disability Index (ODI) and use of NSAIDs and analgesics. Seventy-eight patients were included. Mean pain was significantly improved (P < 0.001) at 3 months: 48.8 (± 19.9) vs. 39.1 (± 20.5), effect size for pain was 0.43 [0.21, 0.66]. The mean ODI significantly changed (P < 0.001) to 3 months: 43.5 (± 10.6) vs. 39.4 (± 9.5), with an effect size of 0.40 [0.17; 0.62]. Intake of NSAIDs and paracetamol significantly decreased at 3 months, respectively −12.8% (P < 0.0075) and-17.9% (P < 0.0005). Drugs intake reduction was maintained at 6 months follow up. This study shows that a conventional spa therapy treatment is an effective treatment for pain, function and intake reduction of NSAID and analgesic for the elderly chronic low back pain (60–80 years) patients. It highlights a modest effect size of the spa therapy, and we were not able to define explanatory factors for a good response. The definition of the effect size of this type of intervention can be used as a basis for future randomized controlled trials.

Scaling up and replication of successful innovative integrated care models for chronic diseases is one of the targets of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). MACVIA-LR® (MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon) is a Reference Site of the EIP on AHA. The main objective of MACVIA-LR® is to develop innovative solutions in order to (1) improve the care of patients affected by chronic diseases, (2) reduce avoidable hospitalization and (3) scale up the innovation to regions of Europe. The MACVIA-LR® project also aims to assess all possible aspects of medicine—including non-pharmacologic approaches—in order to maintain health and prevent chronic diseases. These approaches include hydrotherapy and balneotherapy which can be of great importance if health promotion strategies are considered. Balneotherapy at Balaruc-les-Bains focusses on musculoskeletal diseases and chronic venous insufficiency of the lower limbs. Each year, over 46,000 people attend an 18-day course related to a new falls prevention initiative combining balneotherapy and education. On arrival, each person receives a flyer providing information on the risk of fall and, depending on this risk, a course is proposed combining education and physical activity. A pilot study assesses the impact of the course 6 and 12 months later. This health promotion strategy for active and healthy ageing follows the FEMTEC (World Federation of Hydrotherapy and Climatotherapy) concept.

BackgroundMusculoskeletal disorders (MSDs) are common in the workplace and are a public health issue. Persistent pain despite conservative treatment or surgery may lead to poor long-term outcomes.ObjectiveTo compare the effect of a combined 6-day program of exercise, self-management workshops and spa therapy with self-management on functional capacity in personal and professional daily life at 3 months in people with musculoskeletal disorders.MethodsWe conducted a prospective, randomized controlled trial. Participants were employed (any type of work) and aged between 18 and 65 years, with latent or symptomatic upper extremity MSDs, with or without a history of sick leave. They were randomized to participate in 6 days (2 h per day) of spa therapy, exercise, and self-management workshops immediately (intervention) or at 3 months (control). The control group performed self-management until 3 months. The primary outcome was the score on the self-reported Quick Disability of Arm-Shoulder-Hand (QuickDASH) at 3 months. The primary analysis was conducted using analysis of covariance with baseline QuickDASH score as the covariate.ResultsIn total, 150 participants were randomized (85 % women): 78 to the control group and 72 to the intervention group. At 3 months, the QuickDASH total and work scores did not differ between groups (effect-size [ES] = -0.15, 95 %CI, -0.38 to 0.09, p = 0.215, and ES = -0.11, 95 % CI, -0.35 to 0.12, p = 0.343). However, QuickDASH sport/performing arts score was significantly different between randomization groups at 3 months (ES =-0.25, 95 % CI, -0.48 to -0.02, p = 0.035).ConclusionsThis study provided no evidence in favor of a short-course, personalized self-management, intensive spa therapy intervention over self-management alone for the management of upper-extremity MSDs.Trial registration: ClinicalTrials.gov (NCT02702466) retrospectively registered.

The Région Languedoc Roussillon is the umbrella organisation for an interconnected and integrated project on active and healthy ageing (AHA). It covers the 3 pillars of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA): (A) Prevention and health promotion, (B) Care and cure, (C) and (D) Active and independent living of elderly people. All sub-activities (poly-pharmacy, falls prevention initiative, prevention of frailty, chronic respiratory diseases, chronic diseases with multimorbidities, chronic infectious diseases, active and independent living and disability) have been included in MACVIA-LR which has a strong political commitment and involves all stakeholders (public, private, patients, policy makers) including CARSAT-LR and the Eurobiomed cluster. It is a Reference Site of the EIP on AHA. The framework of MACVIA-LR has the vision that the prevention and management of chronic diseases is essential for the promotion of AHA and for the reduction of handicap. The main objectives of MACVIA-LR are: (i) to develop innovative solutions for a network of Living labs in order to reduce avoidable hospitalisations and loss of autonomy while improving quality of life, (ii) to disseminate the innovation. The three years of MACVIA-LR activities are reported in this paper.

Background: Defining individual educational, or learning, targets is part of the initial educational assessment in rehabilitation programs, but no data are available on how to achieve these goals.Objective: We aimed to evaluate whether educational objectives established with the patient as part of a functional spine restoration program integrating self-care sessions were met after the program and associated therapy outcomes.Methods: This retrospective study involved 104 patients with chronic low-back pain who participated in a self-care rehabilitation program between 2008 and 2012. The program included both physical and educational approaches to dealing with the condition. The main evaluation criterion was achieving the educational objectives established with the patient at 6 months. Secondary criteria were a return to work, pain intensity and impact on function, satisfaction with the program and implementation of physical activity and self-rehabilitation at 6 months.Results: At 6 months, 55% of the established educational objectives were fully achieved and satisfaction was close to 90%. Significantly, more patients were involved in a physical activity at 6 and 12 months and self-rehabilitation exercises at 6 months as compared with at inclusion. Overall, 43.4% were working at inclusion, 64.2% at 6 months and 58.2% at 12 months (P < 0.05 compared with inclusion). Pain intensity and scores from the Quebec, Dallas and FABQ questionnaires had significantly decreased at 6 months.Conclusion: For more than half of the patients in this self-care rehabilitation program, educational objectives established with the patient were achieved, with a positive effect on returning to work and both professional and physical activities at 6 and 12 months. (C) 2016 Elsevier Masson SAS. All rights reserved.

The sensori-motor impairment of upper limb (UL) affects more than 50% of patients after stroke. The objective of this work was to study the efficiency of isokinetic muscle strengthening (IMS) in the chronic phase of stroke in this population. The patients underwent 6 weeks of outpatient rehabilitation, 3 days per week, combining physiotherapy (twice/day) and occupational therapy every day. The program was completed by 30 minutes elbow and wrist concentric slow speed IMS of flexor and extensor muscles, in the study group versus 30 minutes passive mobilisation of the joints carried out by the same isokinetic dynamometer in the control group. Age > 18 years, post stroke period > 6 months, muscle strength > 2/5 manual testing, spasticity < 3/5 on the Ashworth scale. Lack of motion range limitations and cognitive disorders. The UL Fugl Meyer (FM) score gain at the end of the program (6 weeks). FM at 3 and 6 months, Box and Block test, Barthel Index and measures of muscle strength at 6 weeks, 3 and 6 months. Twenty patients were included: 16 men, 13 left hemiplegia, 16 ischemic strokes, average age 63. The gain in the FM score at 6 weeks was comparable between the two groups: 3.5 point (±4.4) versus +6 (±4.5) in the control group (P = 0.224). We have not observed shoulder pain or increase spasticity. No significant differences between the two groups has been demonstrated on secondary endpoints. All patients improved their FM score (4.7; P < 0.001) and Box and Block test (3 cubes; P = 0.013) at the end of the program. This benefit was maintained at 3 and 6 months. Combined with an intensive multidisciplinary rehabilitation program, IMS of UL is not more efficient than passive mobilisation of the wrist and elbow late after stroke. Our study also suggests the value of an intensive, out-patient rehabilitation treatment program in chronic phase after stroke, in cases of mild to moderate motor deficit of UL, remains beneficial over 6 months post-program.

Background: The concept of an ideal sitting posture is often used in practice but lacks a basis in evidence.Objective: We designed a cross-sectional, comparative, matched study to determine the effects of chair and posture on lumbar curvature in 10 patients with chronic non-specific low back pain (CLBP; mean pain duration 24 +/- 18 months) and 10 healthy matched controls.Methods: Pelvic incidence, sacral slope and lumbar curvature were measured on computed radiographs by 2 blinded clinicians for subjects in 2 postures (upright vs slumped sitting) and on 2 chairs (usual flat chair vs kneeling chair).Results: The reliability of measures was excellent (intraclass correlation coefficient > 0.9). As hypothesized, the expected sacral slope and lumbar lordosis changed between standing and sitting on a kneeling chair as compared with a usual chair (P < 0.0001) and less in patients than controls (P = 0.046) for lordosis only. In addition, as expected, changes were more pronounced with slumped than upright sitting (P < 0.0001). An interaction between chairs and postures for lumbar lordosis (P= 0.02) indicated more pronounced effects of the chair in slumped sitting. Therefore, lumbar lordosis was reduced less when sitting on a kneeling chair as compared with a usual chair.Conclusions: Although healthy subjects showed more reduction in lordosis between standing and sitting, the chair effect was found in both CLBP patients and healthy subjects. (C) 2015 Elsevier Masson SAS. All rights reserved.

It is known that the removal of manganese from the water-oxidizing complex (WOC) of photosystem 2 (PS2) leads to activation of oxygen photoconsumption (OPC) [Khorobrykh et al., 2002; Yanykin et al., 2010] that is accompanied by the formation of organic hydroperoxides on the electron-donor side of PS2 [Khorobrykh et al., 2011]. In the present work the effect of trehalose on the OPC in Mn-depleted PS2 preparations (apo-WOC-PS2) was investigated. A more than two-fold increase of the OPC is revealed upon the addition of 1 M trehalose. Drastic (30%–70%) inhibition of the OPC upon the addition of either electron acceptor or electron donor indicates that the trehalose-induced activation of the OPC occurs on both donor and acceptor sides of PS2. A two-fold increase in the rate of superoxide-anion radical photoproduction on the electron-acceptor side of PS2 was also shown. Applying the "variable" chlorophyll fluorescence (ΔF) it was shown that the addition of trehalose induces: (i) a significant increase in the ability of exogenous Mn2 + to donate electrons to the reaction center of PS2, (ii) slowing down the photoaccumulation of the primary quinone electron acceptor of PS2 (QA−) under aerobic conditions, (iii) acceleration of the reoxidation of QA− by QB (and by QB−) as well as the replacement of QB2 − by a fully oxidized plastoquinone, and (iv) restoration of the electron transfer between the quinone electron carriers in the so-called "closed reaction centers of PS2" (their content in the apo-WOC-PS2 is 41%). It is suggested that the trehalose-induced increase in efficiency of the O2 interaction with the electron-donor and electron-acceptor sides of apo-WOC-PS2 is due to structural changes leading to both a decrease in the proportion of the "closed PS2 reaction centers" and an increase in the electron transfer rate in PS2.

Fee-for-service payments encourage high-volume services rather than high-quality care. Alternative payment models (APMs) aim to realign financing to support high-value services. The 2 main components of gastroenterologic care, procedures and chronic care management, call for a range of APMs. The first step for gastroenterologists is to identify the most important conditions and opportunities to improve care and reduce waste that do not require financial support. We describe examples of delivery reforms and emerging APMs to accomplish these care improvements. A bundled payment for an episode of care, in which a provider is given a lump sum payment to cover the cost of services provided during the defined episode, can support better care for a discrete procedure such as a colonoscopy. Improved management of chronic conditions can be supported through a per-member, per-month (PMPM) payment to offer extended services and care coordination. For complex chronic conditions such as inflammatory bowel disease, in which the gastroenterologist is the principal care coordinator, the PMPM payment could be given to a gastroenterology medical home. For conditions in which the gastroenterologist acts primarily as a consultant for primary care, such as noncomplex gastroesophageal reflux or hepatitis C, a PMPM payment can support effective care coordination in a medical neighborhood delivery model. Each APM can be supplemented with a shared savings component. Gastroenterologists must engage with and be early leaders of these redesign discussions to be prepared for a time when APMs may be more prevalent and no longer voluntary.

Numerous studies emphasize the application of music therapy and music medicine in the treatment of pain. The MUSIC CARE© app that was designed at the University Hospital of Montpellier applies the U-shape music composing technique taking into account the available evidence of the literature on relaxation paradigms. The main objective of this article is to summarize recent research on the standardization and evaluation of this new app of music medicine in the treatment of pain. Following a comprehensive review of the literature, a series of controlled, randomized, multi-centered studies were conducted including patients seeking care in such diverse setting as rheumatology, functional rehabilitation, oncology, geriatrics, anesthesiology andintensive care, neurology, obstetrics, pediatrics and general pain treatment. The effect of the MUSIC CARE© app has been evaluated on different types of acute and chronic pain of various origins (i.e. mechanical, inflammatory and neurological fibromyalgia). Physiological effects on hemodynamic and respiratory markers as well as psychological outcomes, including the relationship between care-provider and patient have been emphasized within multiple trials. The MUSIC CARE© app reduces pain, anxiety and depression to a significant degree and decreases the need for anxiolytics and antidepressants. Our first randomized controlled trials demonstrate the benefit of using MUSIC CARE© application in the management of pain. Futuredirections for the use of the app in various settings are discussed.