Influence de l’anesthésie locorégionale sur la récupération musculaire après ligamentoplastie du genou

Anesthetic agents used for motor blocks have local toxic effects, demonstrated in vitro and in animal models. Little work has been done on the clinical impact of this toxicity. In a context of physical medicine and sports medicine, we examined several patients who had undergone knee ligamentoplasty for tears of the anterior cruciate ligament (ACL). For these patients, functional recovery was correlated with recovery of quadriceps strength. The purpose of this study was to analyze the impact of peripheral nerve blocks on quadriceps recovery at 5.5 months after knee ligamentoplasty.

Patients and methods

We conducted a retrospective analysis of 69 patients divided into three groups: 33 who had had no locoregional anesthesia (NB), 24 had femoral nerve block (FNB) and 12 had an iliofascial block (IFB). Our main outcome criterion was relative loss of quadriceps muscle force compared with the healthy side using isokinetic measures five to six months after ligamentoplasty. Isokinetic parameters were concentric Moment of Force Maximum (MFM) measured at 60°/s and 240°/s.

Results

Loss of concentric force at 60°/s was, on average: 24.7 ± 14.8% in group NB, 17.2 ± 13.9% in group FNB, and 19.7 ± 10.7% in group IFB. The difference between the three groups was not significant (P = 0.208). At rapid speed (240°/s) the deficit was on average: 23.111% in the group NB, 14.4 ± 10.5 in the group FNB and 13.4 ± 11% in the group FNB. The difference was significant only between NB and the two other groups, FNB and IFB. The quadriceps deficit was significantly greater in the patients who did not have a nerve block.

Discussion

Surprisingly, this study demonstrated result contradicting the initial hypothesis. Our finding showed that the local toxicity of anesthetic blocks did not have a negative clinical impact on muscle force, but that there was a positive effect on the quality of quadriceps recovery during the time studied. The conclusions of this retrospective preliminary study, with the resulting methodological limitations, must be re-evaluated with other work.     

Lombalgie chronique et réentraînement à l’effort : application de la notion de niveau de douleur cliniquement acceptable

Objectives

To search for predictors of reduced low back pain under the patient acceptable symptom state (PASS) at the end of a functional restoration program (FRP) in chronic low back pain, and then to compare the effectiveness of FRP depending on the rate of people returning to work, the acceptability threshold of pain has been reached or not at the end of the program.

Method

Open prospective study on 303 patients with chronic low back pain included in a FRP. An assessment of the deficiencies (finger-tip-to-floor (cm) and Schöber tests (cm), VO2 max (l/min), Shirado and Sorensen tests (seconds), lumbar and radicular VAS (0-100), the functional disability (Wadell and Quebec scales (0-9 and 0-100), and the psychological status (Beck and Hamilton scale (0-35 and 0-30), HAD scale (0-21), FABQ (0-42 and 0-24)) was conducted at the beginning and end of the program. Data on the work were also collected (arduous physical labor, work-related accident or not, sick leaves or not and length, return to work at the end of the program). The variables associated with a PASS at the end of the FRP and a correlation between the level of pain and the return to work were sought.

Results

The parameters were significantly improved : finger-tip-to-floor test (−17,5 ± 16,2), Schöber test (−0,5 ± 5,4), lumbar VAS(−6,3 ± 23,6), VO2 max (0,14 ± 0,4), Wadell (−1,3 ± 2,4), Quebec (−10,5 ± 17), Beck D (−3,1 ± 4,5), Beck A (−2,5 ± 4,3), HAD D (−2,4 ± 4,7), HAD A (−1,3 ± 3,8) et FABQ1 (−5,7 ± 11,6), FABQ2 (−3,9 ± 9,6) scores, endurance of the flexor (35 ± 63,83) and extensor (44,8 ± 112) spine. Patients reaching the PASS for pain level return significantly more to work (73% versus 52%). Five parameters indicative of a reduction of back pain under the PASS were identified : lumbar VAS and endurance of the flexor spine at the beginning, changes in finger-tip-to-floor test, radicular VAS and Beck score for anxiety.

Conclusion

The PASS appears to be a relevant concept associated with a successful return to work for patients with chronic low back pain and severe disability after a program of FRP.     

L’acide hyaluronique avant l’arthrose : à propos de 339 sportifs

Introduction

Physical activities, through traumas and intensity of practice expose the athletes to cartilage pain caused earlier compared to a population of sedentary people. Lesions at the origin of the pain may be traumatic or microtrauma however without meeting the radio-clinical osteoarthritis criteria defined by the American College of Rheumatology. Hyaluronic acid (HA) is commonly used in the treatment of knee osteoarthritis. It became legitimate to think that the mechanism of action of the product can lead to a pain relief of patients when used in other joints and pre-arthritic stage. As such, we use it in these indications for over 10 years. The objective of this study is to evaluate its effectiveness in the knee, hip and ankle and to identify prognostic factors.

Method

Retrospective study analysing the effectiveness of the viscosupplementation through a questionnaire assessing pain, athletic/professional level, pain relief on a daily basis and satisfaction. All of the lesions have been classified Kellgren 0 and staging of the ICRS for the knee. Definition of the criteria for response on the sedation of pain, and the maintenance of the sport/professional level. We also searched factors prognostications for the knee, only joint with sufficient sample size expected (biometric data: sex, age, body mass index, sports and professional profile, used presentation and prior injected corticosteroid solution).

Results

Three hundred and thirty-nine protocols have been realized to 332 cartilaginous traumatic or microtraumatic degenerative lesions (279 knees with single cartilaginous injury, 61 patients with associated treated meniscal tear, 29 hips, 31 ankles) and seven painful after-effects of osteochondritis. The average age of patients was 39.30 (± 14.38), 76% male; 83.2% had a sports profile with strong joint solicitation. Overall effectiveness was 49.85% (single chondral injury: 46.26%, chondral injury plus meniscal tear both treated: 60.66%, 44.82% for hip and 57.14% for the ankle). Four patients on seven treated for painful sequela of osteochondritis have been relieved. The rate of adverse events was 4.13%, represented by puncture pain or swelling reaction. In the knee, the stage lesion did not impact on efficiency (P = 0.17), neither the presence of an associated meniscal tear non-treated (P = 0.15); the pursuit of a support activity is correlated with a loss of efficiency (P = 0.039).

Discussion

This study is interesting as far as no study in vivo exists regarding the use of HA in support of isolated microtraumatic or traumatic chondral lesions except in the course of surgery of the meniscus with visualization of an arthroscopic cartilage injury. Efficiency appears interesting, almost equal to that found in the available studies on arthritis in these joints, although, because of the heterogeneity of the protocols and the results obtained, the estimation of a reliable response rate seems delicate.

Conclusion

The use of HA for the treatment of the pain of single traumatic or microtraumatic cartilage injury appears safe, with an interesting efficiency to be confirmed by studies of high level of evidence.     

Évaluation d’un protocole de kinésithérapie ambulatoire pour la prise en charge des coxarthroses et conflits antérieurs fémoro-acétabulaires des sportifs

Introduction

Hip osteoarthritis and femoroacetabular impingement frequently affect sportsmen and are origins of permanent incapacity. The therapic behaviour before surgery step is not yet established. Physiotherapy is often suggested but it is still difficult to prescribe it correctly. The main goal of our study is to show superiority, both in terms of decrease of pain and increase of sportive activity, of the process “PROTOCOX” including both physiotherapy and manual therapy in comparison with a physiotherapy process “CONTROLE”.

Method

Twenty-six sportive patients of the “Institut régional de médecine du sport de Haute Normandie (IRMSHN)” have been included in the study in an 18-month period. Our secondary aims are to show improvement of life quality and range of motion. Several data including HOOS and Lequesne index have been harvested before and after the six sessions and after 3 months.

Results

For patients (n = 11) of the “PROTOCOX” group (P = 0.034), a significant improvement of the HOOS index, mainly on pain (P = 0.04) and allowing an increase of sportive activity (P = 0.007). After 3 months, there was still a transitory improvement allowing an increase of sportive activity for 75% of the patients (n = 8) of the “PROTOCOX” group in comparison of 18.2% for the “CONTROLE” patients.

Conclusion

The “PROTOCOX” process is simple and practicable in liberal sector, and gives benefits in terms of decrease of pain and sportive activity increase with a reduce number of sessions and its transitory efficiency stays at mid term.     

Correlation of plasma and synovial fluid osteopontin with disease severity in knee osteoarthritis

Objectives

The purposes of this study were to examine osteopontin levels in both plasma and synovial fluid of patients with primary knee osteoarthritis (OA) and to investigate their relationship with severity of the disease.

Design and methods

Thirty-two patients aged 53-83 years with knee OA and 15 healthy controls were enrolled in this study. Anteroposterior knee radiographs were taken to determine the disease severity of the affected knee. The radiographic grading of OA in the knee was performed by using the Kellgren-Lawrence criteria. Osteopontin levels in the plasma and synovial fluid were measured using enzyme-linked immunosorbent assay.

Results

The mean plasma osteopontin concentration of the knee OA patients was significantly higher compared with that of healthy controls (168.8 ± 15.6 vs 67.2 ± 7.7 ng/mL, P < 0.0001). Osteopontin levels in synovial fluid were significantly higher with respect to paired plasma samples (272.1 ± 15.0 vs 168.8 ± 15.6 ng/mL, P < 0.001). In addition, plasma osteopontin levels showed a positive correlation with synovial fluid osteopontin levels (r = 0.373, P = 0.035). Subsequent analysis showed that plasma osteopontin levels significantly correlated with severity of disease (r = 0.592, P < 0.001). Furthermore, the synovial fluid levels of osteopontin also correlated with disease severity (r = 0.451, P = 0.01).

Conclusion

The data suggest that osteopontin in plasma and synovial fluid is related to progressive joint damage in knee OA. Osteopontin may serve as a biochemical marker for determining disease severity and could be predictive of prognosis with respect to the progression of knee OA.     

Efficacité thérapeutique de l’autologous conditioned plasma (ACP™) : analyse de sa composition cellulaire et revue de la littérature

Purpose

To analyze the platelet counts of autologous conditioned plasma (ACP™) in a group of patients compared to that of whole blood and to determine the value of ACP™ based on a literature review.

Methods

In 2011, a prospective study was performed in a continuous series of patients presenting with chronic tendinopathies. Three 9 μL venous blood samples were obtained from each patient: the first to perform a full blood count and the second and third to prepare two doses of ACP™, one which was injected into the patient and the other which underwent biological testing. A bibliographic search was performed on PubMed with the key words “autologous conditioned plasma”. All studies both clinical and experimental, in English and in French, were included.

Results

The series included 14 male patients mean age 39 ± 14 years. The mean platelet count was 230,538.5 ± 23,663/μL in whole blood and 377,153.8 ± 69,169.9/μL in ACP™, P = 0.00015. The mean “ACP™ platelet count/whole blood platelet count” ratio was 1.64 ± 0.30. The number of red and white blood cells was below the detection thresholds. The systematic review identified eight studies: three in animals and five in human of which two clinical studies.

Conclusion

The preparation technique for ACP™ was rapid and easy to use. ACP™ had a platelet count that was significantly higher than that of whole blood and did not contain any red or white blood cells. The review of the literature did not clearly confirm the therapeutic efficacy of ACP™. Randomized clinical studies comparing ACP™ to placebo are needed.

Level of evidence

IV.     

Étude du profil postural et de la statique rachidienne chez les femmes postménopausées et lombalgiques chroniques

Objectives

To study postural and spinal static modifications associated with chronic low back pain in menopausal women.

Methods

Clinical appreciation of static spinal profile in sagittal plane; postural evaluation on the Balance Master Neurocom^® force platform by the modified clinical test for the sensory interaction on balance (modified CTSIB test); Radiological evaluation of spinal and pelvic parameters as well as the sagittal profile according to the Roussouly classification.

Results

Spinal curves clinical measurement and the sway velocity of the pressure center on the Balance Master Neurocom^® do not show significant difference between the two groups. While the pressure center position in the anteroposterior axis shows significant difference between the two groups (p = 0.02) with a more backwards projection found in chronic low back pain subjects. Radiological evaluation shows sagittal shelter significantly superior, sacral slope significantly lower and the type 1 of lumbar lordosis more frequent in chronic low back pain women compared to healthy women.

Discussion-conclusion

In menopausal women, chronic low back pain seems to be associated with lower sacal slope, the type 1 of lumbar lordosis more frequent and behindly projection of pressure center.     

Apport de l’arthrodistension dans la prise en charge de la capsulite rétractile primitive de l’épaule : étude comparative versus rééducation

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.     

The effect of a group education programme on pain and function through knowledge acquisition and home-based exercise among patients with knee osteoarthritis: A parallel randomised single-blind clinical trial

Objectives

To assess the effect of a group education programme on pain and function through knowledge acquisition and a home-based exercise programme.

Design

A parallel randomised single-blind clinical trial.

Participants

Fifty patients aged 65 years or over with knee osteoarthritis.

Interventions

The study group (n = 25) was given a group education programme once a week for 4 weeks, followed by a self-executed home-based exercise programme. The controls (n = 25) were given a brief course in short-wave diathermy treatment.

Main outcome measures

Patients were assessed before the intervention, after the intervention (4 weeks) and again 8 weeks later (follow-up) using the Western Ontario McMaster Osteoarthritis Index (WOMAC), the repeated sit-to-stand test and the get-up-and-go test.

Results

At 4 weeks, there was a significant improvement in both groups in all outcome variables except the WOMAC stiffness score; for example, the WOMAC total score was reduced by a mean of 9.5 points [95% confidence interval (CI) −12.3 to −6.7]. However, at follow-up, patients in the study group demonstrated continued improvement in the get-up-and-go test and the WOMAC total, pain and disability scores, but no such improvement was noted among the controls. This difference was significant; for example, the difference in mean WOMAC total score between the groups was −9.0 points (95%CI −14.5 to −3.4).

Conclusion

A simple group education programme for patients with knee osteoarthritis is associated with improved functional abilities and pain reduction. Further study is required to determine if this positive effect can be maintained over a longer period.     

The effectiveness of music in relieving pain in cancer patients: A randomized controlled trial

Objectives

To examine effects of sedative music on cancer pain.

Design

A randomized controlled trial.

Settings

Two large medical centers in Kaoshiung City, in southern Taiwan.

Participants

126 hospitalized persons with cancer pain.

Methods

Participants were randomly assigned to an experimental (n = 62) or a control group (n = 64), with computerized minimization, stratifying on gender, pain, and hospital unit. Music choices included folk songs, Buddhist hymns (Taiwanese music), plus harp, and piano (American). The experimental group listened to music for 30 min; the control group rested in bed. Sensation and distress of pain were rated on 100 mm VAS before and after the 30-min test.

Results

Using MANCOVA, there was significantly less posttest pain in the music versus the control group, p < .001. Effect sizes were large, Cohen's d = .64, sensation, d = .70, distress, indicating that music was very helpful for pain. Thirty minutes of music provided 50% relief in 42% of the music group compared to 8% of the controls. The number needed to treat (NNT) to find one with 50% sensation relief was three patients. More patients chose Taiwanese music (71%) than American music (29%), but both were liked and effective.

Conclusions

Offering a choice of familiar, culturally appropriate music was a key element of the intervention. Findings extend the Good and Moore theory (1996) to cancer pain. Soft music was safe, effective, and liked by participants. It provided greater relief of cancer pain than analgesics alone. Thus nurses should offer calming, familiar music to supplement analgesic medication for persons with cancer pain.     

Effects of high frequency exercise in patients before and after elective percutaneous coronary intervention

Background

The aim of this study was to evaluate the effects of high frequency exercise for patients before and after an elective percutaneous coronary intervention (PCI), with special reference to maximal aerobic capacity, muscle function, health related quality of life (HRQoL), waist-hip ratio (WHR) and restenosis.

Methods

A randomised, controlled study was performed in Sweden between 2004 and 2006 in thirty-seven patients (five women) with stable coronary artery disease (CAD), age 63.6 ± 6.9 years, randomised to either high frequency exercise or control group. The patients in the training group performed three endurance resistance exercises and trained on a cycle ergometer 30 min, 5 times a week for 8 months at 70% of VO_2max.

Results

Patients in the training group significantly improved their maximal aerobic capacity (15 (9-46) vs. 8 (0-18)% p ≤ 0.05), shoulder flexion (p ≤ 0.01), shoulder abduction (p ≤ 0.01) and heel-lift (p ≤ 0.05) compared to the control group. There were no significant differences between the groups in HRQoL, WHR and restenosis.

Conclusion

High frequency exercise in patients treated with PCI seems to improve maximal aerobic capacity and muscle function, which may reduce the risks of further progression of atherosclerosis. However, further larger studies are needed to fully investigate the effects of exercise in patients with PCI.     

Serious gaming technology in major incident triage training: A pragmatic controlled trial

Objective

By exploiting video games technology, serious games strive to deliver affordable, accessible and usable interactive virtual worlds, supporting applications in training, education, marketing and design. The aim of the present study was to evaluate the effectiveness of such a serious game in the teaching of major incident triage by comparing it with traditional training methods.

Design

Pragmatic controlled trial.

Method

During Major Incident Medical Management and Support Courses, 91 learners were randomly distributed into one of two training groups: 44 participants practiced triage sieve protocol using a card-sort exercise, whilst the remaining 47 participants used a serious game. Following the training sessions, each participant undertook an evaluation exercise, whereby they were required to triage eight casualties in a simulated live exercise. Performance was assessed in terms of tagging accuracy (assigning the correct triage tag to the casualty), step accuracy (following correct procedure) and time taken to triage all casualties. Additionally, the usability of both the card-sort exercise and video game were measured using a questionnaire.

Results

Tagging accuracy by participants who underwent the serious game training was significantly higher than those who undertook the card-sort exercise [Chi2 = 13.126, p = 0.02]. Step accuracy was also higher in the serious game group but only for the numbers of participants that followed correct procedure when triaging all eight casualties [Chi2 = 5.45, p = 0.0196]. There was no significant difference in time to triage all casualties (card-sort = 435 ± 74 s vs video game = 456 ± 62 s, p = 0.155).

Conclusion

Serious game technologies offer the potential to enhance learning and improve subsequent performance when compared to traditional educational methods.     

Effects of an acute hamstring stretch in people with and without osteoarthritis of the knee

Objective

To compare the effects of an acute stretching intervention on knee extension range of motion, passive resistive torque and stiffness in subjects with osteoarthritis of the knee, and to compare these variables with subjects without osteoarthritis.

Design

Cross-sectional experimental study.

Setting

Human performance laboratory.

Participants

A total of 55 participants were recruited: 28 subjects (males and females) with osteoarthritis of the knee joint and 27 subjects of a similar age without osteoarthritis of the knee joint.

Intervention

Using the Kincom dynamometer, three 60-second stretches with 60 seconds of rest between stretches were applied to the hamstring muscle group.

Main outcome measures

Peak knee extension range of motion, peak passive torque and stiffness in the final 10% of knee extension range of motion.

Results

A significant (P < 0.05) increase in knee extension range of motion, peak passive torque and stiffness was observed in both groups. For knee extension range of motion, the mean difference for the osteoarthritis group and non-osteoarthritis group was 4.9 degrees [95% confidence interval (CI) 0.9 to 8.5] and 4.4 degrees (95% CI 1.8 to 6.8), respectively. For peak passive torque, the mean difference in the osteoarthritis group and the non-osteoarthritis group was 4.4 N m (95% CI 0.8 to 6.9) and 1.0 N m (95% CI −1.4 to 3.5), respectively. For stiffness in the final 10% of knee extension range of motion, the mean difference for the osteoarthritis group and the non-osteoarthritis group was 0.19 N m/degree (95% CI 0.08 to 0.3) and 0.04 N m/degree (95% CI −0.05 to 0.1), respectively. Stiffness in the final 10% of knee extension range of motion was significantly higher in the osteoarthritis group compared with the non-osteoarthritis group after stretching.

Conclusions

Elderly individuals with and without osteoarthritis of the knee are able to demonstrate immediate beneficial adaptations to a stretching intervention. This is important as stretching is often used in preparation for exercise programmes.     

L’ostéome ostéoïde du col fémoral du sportif : intérêt de la résection percutanée scanno-guidée (À propos de 11 cas avec revue de la littérature)

Introduction

Treatment of the osteoid osteoma was based a long time on the surgical resection, but with a considerable frequency of complications. The percutaneous resection tomography-guided belongs to therapeutic progress of these last years, it became the method of choice for the treatment of osteoid osteoma in our institution. The purpose of our study is to evaluate effectiveness of this technic by analyzing the clinical evolution, the duration of convalescence and resumption of sports activities.

Patients and methods

It is a retrospective study concerning 11 observations of osteoid osteoma of the femoral neck, treated and followed to the service of Traumatology-Orthopedy II of the military hospital of the CHU Rabat between January 2004 and October 2009. Our series was composed of three professional athletes, two footballers exercising in national shampionship and six soldiers subjected to a constant and regular drive.

Results

This intervention was done in the day's hospital, all the patients left the hospital the same day with resumption of the total support in the 24 hours following operation. Nine patients (80%) observed a total disappearance of the pain a few hours after the intervention. With a minimal retreat one year, no case of complication was raised. And finally on the subjective level all the patients were satisfied and took again their sports activities on the same former level.

Discussion

The treatment for osteoid osteoma must be simple, precise, effective and the least expensive possible. In the light of our results and those brought back in the literature, the percutaneous resection tomography-guided is proven effective, sure, not very invasive and is associated with a reduction in the health expenditure. It can be recommended like the treatment of choice of osteoid osteoma as well for the femoral neck as for the other localisations. More aggressive and more expensive treatments are difficult to justify, in particular in sportsmen, thus allowing them a fast convalescence and an early recovery their sports activities.     

Reconstruction du LCA chez le sportif de compétition. Évaluation, à court terme,après reprise du sport

Background

Most studies have observed satisfactory outcome after anterior cruciate ligament (ACL) reconstruction. The best series report 80 to 90% success, irrespective of the type of operation. The purpose of this work was to investigate resumption of sports activities after ACL reconstruction. We studied the impact of the conditions of sports activity after the operation, gender, type of sport, presence of an extra-articular reinforcement and time since surgery.

Material and method

In order to search for significant differences between the postoperative and follow-up scores, a questionnaire with a subjective IKDC grid was addressed 12 months after their hospitalization to all athletes who had undergone ACL reconstruction at the CERS from 1^st January, 2003 through 31^st October, 2004.

Results

For the period considered, 2248 athletes were hospitalized at the CERS for ACL reconstruction. The response rate was 43% (969 responses at 12 months). There was no significant difference between the hospitalized population and the responders in terms of type of sports activity or type of graft. There was however a significant female predominance among responders (p = 0.01). Mean follow-up was 13.9 ± 2.9 months. Reconstruction methods were: hamstring graft 54%, free patellar graft 43%, MacIntosh fascia lata 2%, MacIntosh quadriceps 1%. The main activity was a pivot sport for 74% of the athletes. Male gender predominated: 77%. There was no difference regarding postoperative training, but competition level was achieved more readily by males (65% versus 54%, p = 0.0038), since more females stated resumption of competition was not an objective. It was also noted that resumption of training occurred earlier for gliding sports than for pivot–contact sports (7.32 ± 2.09 months versus 8.23 ± 2.66 months, p = 0.021). The presence of a lateral reinforcement did not have a significant impact on resumption of sports activities which was more frequent in the hamstring group than the patellar group (16% versus 7%, p < 0.0001) and more frequent in the pivot–contact sports (p = 0.0039). Regarding the role of the surgical technique, resumption of training and competition was better after hamstring plasty compared with patellar tendon plasty for follow-up less than or equal to 12 months (p = 0.0009 and 0.0001 respectively). The subjective IKDC score was also significantly better in the hamstring group for the period considered (p = 0.0006). The differences observed early in the follow-up resolved over time and no significant difference was observed at 18 and 22 months. Regarding the MacIntosh fascia lata plasty, resumption of competition was significantly earlier (7.67 ± 1.87 months) compared with hamstring plasty (9.69 ± 2.58 months) and patellar tendon plasty (9.65 ± 3 months). Resumption of training (90%) and competition (76%) was also better with the MacIntosh fascia lata plasty compared with the two other techniques but the difference was not significant. These differences, in favor of the MacIntosh fascia lata plasty, might have been due to a recruitment bias since the level of the sports activities was significantly higher in the MacIntosh population than in the populations of the other two methods.

Conclusion

This study is of particular interest because of the size of the homogeneous study population resulting from the highly selective recruitment of athletes at the CERS. This study is generally in agreement with prior data in the literature, particularly concerning the rate of resumed training one year after surgery. This study shows that the patellar tendon plasty reaches maturity more slowly than the hamstring plasty although the two techniques yielded comparable results at 18 months for all criteria studied.     

Pediatric Vasoocclusive Crisis and Weather Conditions

Background

Previous studies have demonstrated associations of frequency of vasoocclusive crisis with weather conditions in adults, although relationships have been inconsistent.

Objectives

Our objective was to determine if there is an association between weather conditions and pediatric emergency department (ED) visits, hospital admissions, and day and severity of pain precipitation for vasoocclusive crisis (VOC).

Methods

A retrospective observational study was performed at a large tertiary care pediatric center. We reviewed health records of all VOC patients under the age of 18 years with a chief complaint of pain and performed correlations between daily and average weekly and monthly weather conditions and frequency of painful crises.

Results

A total of 430 visits for VOC to the ED were documented from January 2005 to December 2006. Significant correlations were noted between the daily and weekly number of painful crises and colder temperatures (ρ = −0.11, p = 0.004 for daily data and r = 0.25, p = 0.01 weekly) and wind speed (ρ = 0.13, p < 0.001 and r = 0.25, p = 0.01). The monthly number of painful crises was moderately correlated with temperatures (r = −0.42, p = 0.04). The average monthly pain score was higher in more humid months (r = 0.44, p = 0.03).

Conclusion

We found significant correlations of VOC with weather conditions where colder temperatures and higher wind speed were associated with a higher incidence of VOC in children. Health care providers as well as parents should be aware of these findings and ensure that preventive measures are instituted in patients at risk.     

Reliability and validity of the Brazilian-Portuguese version of the Burns Specific Pain Anxiety Scale (BSPAS)

Background

Pain and anxiety are a common problem in all recovery phases after a burn. The Burns Specific Pain Anxiety Scale (BSPAS) was proposed to assess anxiety in burn patients related to painful procedures.

Objectives

To assess internal consistency, discriminative construct validity, dimensionality and convergent construct validity of the Brazilian-Portuguese version of the Burns Specific Pain Anxiety Scale.

Design

In this cross-sectional study, the original version of the BSPAS, adapted into Brazilian Portuguese, was tested for internal consistency (Cronbach's Alpha), discriminative validity (related to total body surface area burned and sex), dimensionality (through factor analysis), and convergent construct validity (applying the Visual Analogue Scale for pain and State-Anxiety—STAI) in a group of 91 adult burn patients.

Results

The adapted version of the BSPAS displayed a moderate and positive correlation with pain assessments: immediately before baths and dressings (r = 0.32; p < 0.001), immediately after baths and dressings (r = 0.31; p < 0.001) and during the relaxation period (r = 0.31; p < 0.001) and with anxiety assessments (r = 0.34; p < 0.001). No statistically significant differences were observed when comparing the mean of the adapted version of the BSPAS scores with sex (p = 0.194) and total body surface area burned (p = 0.162) (discriminative validity). The principal components analysis applied to our sample seems to confirm anxiety as one single domain of the Brazilian-Portuguese version of the BSPAS. Cronbach's Alpha showed high internal consistency of the adapted version of the scale (0.90).

Conclusion

The Brazilian-Portuguese version of the BSPAS 9-items has shown statically acceptable levels of reliability and validity for pain-related anxiety evaluation in burn patients. This scale can be used to assess nursing interventions aimed at decreasing pain and anxiety related to the performance of painful procedures.     

Pilot study of an exercise intervention suitable for older heart failure patients with left ventricular systolic dysfunction

Background

Most studies of exercise training for heart failure have been conducted on relatively young patients with little comorbidity. Such programmes are unsuitable for the majority of older frail heart failure patients.

Aims

To test the acceptability and tolerability of an outpatient exercise programme in older heart failure patients with comorbid disease.

Methods

17 patients aged 70 years and over with left ventricular systolic dysfunction attended twice weekly group exercise classes for 12 weeks, focussing on endurance exercise and everyday functional tasks. Outcome measures were proportion of sessions attended; adverse events and reasons for non-attendance; six-minute walk, accelerometry, hospital depression and anxiety score, Guyatt quality of life scale, carer strain and satisfaction scores.

Results

83% of sessions were attended; 80% of subjects attended at least 80% of allocated sessions. One adverse incident occurred in 324 person-sessions. Encouraging improvements were seen in six minute walk test (+ 19 m, p = 0.14) and in Functional Limitation Profile score (− 82 points, p = 0.02). 50% of informal carers attended at least one session. No increase in carer strain was noted.

Conclusions

Twice-weekly group exercise focussing on aerobic endurance and everyday functional tasks was acceptable and well-tolerated in this patient group.