ABILOCO: a Rasch-built 13-item questionnaire to assess locomotion ability in stroke patients

Caty GD, Arnould C, Stoquart GG, Thonnard J-L, Lejeune TM. ABILOCO: a Rasch-built 13-item questionnaire to assess locomotion ability in stroke patients.

Objective

To develop a questionnaire (ABILOCO), based on the Rasch measurement model, that can assess locomotion ability in adult stroke patients (International Classification of Functioning, Disability and Health activity domain).

Design

Prospective study and questionnaire development.

Setting

A faculty hospital.

Participants

Adult stroke patients (N=100) (age, 64±15y). The time since stroke ranged from 1 to 260 weeks.

Intervention

A preliminary questionnaire included 43 items representing a large sample of locomotion activities. This questionnaire was tested on the 100 stroke patients, and their responses were analyzed using the Rasch model (RUMM 2020 software) to select items that had an ordered rating scale and fitted a unidimensional model.

Main Outcome Measure

The ABILOCO questionnaire.

Results

The retained items resulted in a 13-item questionnaire, which includes a wide range of locomotion abilities well targeted to the sample population, leading to good reliability (R=.93). The item calibration was independent of age, sex, time since stroke, and affected side. The concurrent validity of ABILOCO was also investigated by comparing it with well-known, criterion standard scales (Functional Walking Category, Functional Ambulation Categories, item 12 of the FIM instrument evaluating walking ability) and the walking speed measured with the 10-meter walk test.

Conclusions

The ABILOCO questionnaire presents good psychometric qualities to measure locomotion ability in adult stroke patients. Its range and measurement precision make it attractive for clinical use throughout the rehabilitation process and for clinical research.     

Use of the Triage Stroke Panel in a neurologic emergency service

Background

Acute stroke is associated with serum elevations of numerous markers. We evaluated the additive accuracy of the Triage Stroke Panel (D-dimer, B-natriuretic peptide, matrix metalloproteinase 9, and S-100β) to the triaging nurse for acute stroke diagnosis.

Methods

Consecutive patients with suspected stroke were included in this prospective, controlled, single-center study. A well-trained stroke center triage nurse assigned a probability that the patient had experienced a stroke (certain, very probable, probable, not likely, doubtful, or other); then, the Triage Stroke Panel testing was performed. Patients' diagnosis was based on clinical and imaging data by a neurologist blinded to the test results.

Results

Two hundred four patients were evaluated. Confirmed strokes and transient ischemic attacks (TIAs) were observed in 131 patients. When considering an experienced stroke nurse's assessment of “other,” “doubtful,” or “not likely” to be negative for stroke and categorizing TIA with stroke, the stroke panel's Multimarker Index (MMX) value had identical accuracy (∼70%) and equivalent sensitivity (∼94%) and specificity (∼24%) for stroke diagnosis to that of the nurse. Combining nurse assessment with the MMX result significantly improved the specificity of diagnosing “mimic” vs stroke + TIA from 25.4% (nurse assessment only) to 46.0% (nurse assessment + MMX; P < .001).

Conclusions

The Triage Stroke Panel provides objective information that complements a triage nurse in the assessment of a suspected stroke patient. Its performance compares favorably with that of a well-trained stroke center triage nurse, suggesting potential use in nonexpert centers for improving the accuracy of stroke diagnosis.     

Reproducibility of the ABILOCO Questionnaire and Comparison Between Self-Reported and Observed Locomotion Ability in Adult Patients With Stroke

Caty GD, Theunissen E, Lejeune TM. Reproducibility of the ABILOCO questionnaire and comparison between self-reported and observed locomotion ability in adult patients with stroke.

Objectives

To test the reproducibility of the ABILOCO questionnaire. To validate the patient self-reporting method and the third-party assessment of the stroke patients' locomotion ability by a treating physical therapist.

Design

Prospective study.

Setting

University hospital.

Participants

Adult stroke patients (N=28; 59±13y). The time since stroke ranged from 3 to 253 weeks.

Interventions

Not applicable.

Main Outcome Measure

The ABILOCO questionnaire.

Results

The results of patient self-assessment and the results of the third-party assessments by the physiotherapists at a 2-week interval were highly correlated (intraclass correlation coefficient [ICC]=.77 and ICC=.89, respectively). The results of the patient self-assessment and the third-party assessment by the physical therapist were both well correlated to assessment by an independent medical examiner who observed the patient during the 13 ABILOCO activities (ICC=.69 and ICC=.87, respectively).

Conclusions

The use of ABILOCO as a self-reporting questionnaire is a valid and reproducible method for assessing locomotion ability in patients with stroke in daily clinical practice and research.     

Verification of changes in the time taken to initiate chest compressions according to modified basic life support guidelines

Objective

The 2010 American Heart Association (AHA) for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science has changed the basic life support (BLS) sequence from “A-B-C” to “C-A-B.” The AHA explained that this change may shorten the initiation time for chest compressions. In this study, the 2010 AHA guidelines for BLS (2010-BLS) were studied through a simulation program and practiced on a manikin. The time saved in initiating initial chest compressions was calculated, and the significance of the new guidelines was evaluated.

Methods

Forty health care providers who had undergone both the BLS guidelines of 2005 (2005-BLS) and the 2010-BLS programs were targeted in this study. The following items were measured: time spent on rescue breathing, including setting up of ventilation equipment; time taken to initiate chest compressions; and time taken to initiate chest compressions without performance of rescue breathing because of the lack of ventilation equipment.

Results

The time taken to initiate chest compressions was 36.0 ± 4.1 seconds when 2005-BLS was followed and 15.4 ± 3.0 seconds when 2010-BLS was followed (P < .001). Furthermore, chest compressions were initiated earlier when 2010-BLS was followed (15.4 ± 3.0 seconds) than when 2005-BLS was followed without the performance of rescue breathing (19.8 ± 2.7 seconds; P < .001). The mean time spent on setting up ventilation equipment and performing rescue breathing was 15.9 ± 3.8 seconds, indicating considerable time variations among individuals.

Conclusion

Chest compressions were initiated earlier by health care providers who were re-educated according to the 2010 AHA guidelines.     

Head position angles to open the upper airway differ less with the head positioned on a support

Introduction

The aim of the study was to assess the effects of positioning the head on a support on “head position angles” to optimally open the upper airway during bag-valve mask ventilation.

Methods

We ventilated the lungs of anesthetized adults with a bag-valve mask and the head positioned with (n = 30) or without a support (n = 30). In both groups, head position angles and ventilation parameters were measured with the head positioned in (1) neutral position, (2) in a position deemed optimal for ventilation by the investigator, and (3) in maximal extension.

Results

Between groups (“head with/without a support”) and between head positions within each group, head position angles and ventilation parameters differed (P < .0001, respectively). However, head position angles and ventilation parameters between head positions differed less “with a support” (P < .001), and ventilation parameters improved with a support compared with the head-without-a-support group (P < .001).

Conclusions

In the head-with-a-support group, when compared with the head-without-a-support group, head position angles differed less, indicating a decreased potential for failure during bag-valve mask ventilation with the head on a support. Moreover, in the head-with-a-support group, ventilation parameters differed less between head positions, and ventilation improved. These findings suggest a potential benefit of positioning the head on a support during bag-valve mask ventilation.     

Emergency Department Team Communication with the Patient: The Patient's Perspective

Background

Effective communication is important for the delivery of quality care. The Emergency Department (ED) environment poses significant challenges to effective communication.

Objectives

The objective of this study was to determine patients' perceptions of their ED team's communication skills.

Methods

This was a cross-sectional study in an urban, academic ED. Patients completed the Communication Assessment Tool for Teams (CAT-T) survey upon ED exit. The CAT-T was adapted from the psychometrically validated Communication Assessment Tool (CAT) to measure patient perceptions of communication with a medical team. The 14 core CAT-T items are associated with a 5-point scale (5 = excellent); results are reported as the percent of participants who responded “excellent.” Responses were analyzed for differences based on age, sex, race, and operational metrics (wait time, ED daily census).

Results

There were 346 patients identified; the final sample for analysis was 226 patients (53.5% female, 48.2% Caucasian), representing a response rate of 65.3%. The scores on CAT-T items (reported as % “excellent”) ranged from 50.0% to 76.1%. The highest-scoring items were “let me talk without interruptions” (76.1%), “talked in terms I could understand” (75.2%), and “treated me with respect” (74.3%). The lowest-scoring item was “encouraged me to ask questions” (50.0%). No differences were noted based on patient sex, race, age, wait time, or daily census of the ED.

Conclusions

The patients in this study perceived that the ED teams were respectful and allowed them to talk without interruptions; however, lower ratings were given for items related to actively engaging the patient in decision-making and asking questions.     

The role of work environment in keeping newly licensed RNs in nursing: A questionnaire survey

Background

In prior studies, newly licensed registered nurses (RNs) describe their job as being stressful. Little is known about how their perceptions of the hospital work environment affect their commitment to nursing.

Objectives

To assess the influence of hospital work environment on newly licensed RN's commitment to nursing and intent to leave nursing.

Design

Correlational survey.

Settings

Newly licensed RNs working in hospitals in Florida, United States.

Participants

40% random sample of all RNs newly licensed in 2006.

Methods

The survey was mailed out in 2008. Dependent variables were indicators of professional commitment and intent to leave nursing. Independent variables were individual, organizational, and work environment characteristics and perceptions (job difficulty, job demands and job control). Statistical analysis used ordinary least squares regressions. Level of significance was set at p < 0.05.

Results

Job difficulty and job demand were significantly related to a lower commitment to nursing and a greater intent to leave nursing, and vice versa for job control. The strongest ranked of the job difficulties items were: incorrect instructions, organizational rules, lack of supervisor support, and inadequate help from others. Workload and other items were significant, but ranked lower. The strongest ranked of the job pressure items were: “having no time to get things done” and “having to do more than can be done well.” The strongest ranked of job control items were “ability to act independent of others.” Nurses with positive orientation experiences and those working the day shift and more hours were less likely to intend to leave nursing and more likely to be committed to nursing. Significant demographic characteristics related to professional commitment were race and health.

Conclusions

Negative perceptions of the work environment were strong predictors of intent to leave nursing and a lower commitment to nursing among newly licensed RNs. These results indicate that retention of newly licensed RNs in nursing can be improved through changes in the work environment that remove obstacles to care-giving, increase resources and autonomy, and reduce workload and other job pressure factors.     

Factors Influencing Receipt of Early Rehabilitation After Stroke

Objective

To identify patient-level characteristics associated with rehabilitation during the acute poststroke phase.

Design

Retrospective cohort. Generalized estimating equations modeled the likelihood of rehabilitation during the index hospitalization to account for patient clusters.

Setting

Rehabilitation facilities.

Participants

Sample included veterans (N=9681; average age, 68.7y; 97.4% men) diagnosed with new stroke discharged from Veterans Affairs hospitals between October 1, 2006, and September 30, 2008.

Interventions

Not applicable.

Main Outcome Measure

Receipt of rehabilitation services.

Results

Of the total cohort, 73% received some type of rehabilitation. After adjustment, stroke patients with cerebral arteries occlusion were most likely to receive rehabilitation compared with other stroke types (P<.001). Patients with prestroke conditions of metastatic cancer (odds ratio [OR]=.68, P<.001) and psychosis (OR=.90, P=.045) were less likely to have rehabilitation, whereas those with hypertension (OR=1.26, P<.001) and other neurologic disorders (OR=1.29, P<.001) were more likely. Compared with patients admitted from home, patients transferred from a non-Veterans Affairs hospital (OR=1.4, P<.004) were more likely to receive rehabilitation, whereas patients admitted from extended care (OR=.59, P<.001) were less likely. Married veterans were less likely to receive rehabilitation services (OR=.87, P<.001) than unmarried veterans.

Conclusions

Within the Veterans Health Administration, initiating rehabilitation in the acute phase poststroke appears to be influenced by patient clinical characteristics and living circumstances.     

The effect of electrical muscle stimulation on the prevention of disuse muscle atrophy in patients with consciousness disturbance in the intensive care unit

Purpose

Disuse atrophy of the lower limbs of patients with consciousness disturbance has often been recognized as “an unavoidable consequence,” such that the mechanism was not investigated diligently. In this study, we examined the preventive effects of electrical muscle stimulation (EMS) against disuse atrophy of the lower limbs in patients in coma after stroke or traumatic brain injury in the intensive care unit.

Materials and Methods

We evaluated changes in cross-sectional area of lower limb muscles weekly with computed tomography in 6 control group patients and 9 EMS group patients. Electrical muscle stimulation was performed daily from day 7 after admission. We evaluated the anterior thigh muscle compartment, posterior thigh muscle compartment, anterior leg muscle compartment, and posterior leg muscle compartment.

Results

In the control group, the decrease in cross-sectional area progressed in all compartments every week (P < .0001). Cross-sectional areas of all compartments at day 14 were significantly decreased in the control group compared with those in the EMS group at day 7 (P < .001). We were able to limit the rate of muscle atrophy as measured in the cross-sectional areas to within 4% during the period of EMS (days 7-42) in 5 patients. The difference between the control and the EMS groups was statistically significant (P < .001).

Conclusion

Electrical muscle stimulation is effective in the prevention of disuse muscle atrophy in patients with consciousness disorder.     

No Diversion in Western Massachusetts

Background

Massachusetts (MA) instituted a moratorium on ambulance diversion (“No Diversion”) on January 1, 2009.

Study Objectives

Determine whether No Diversion was associated with changes in Emergency Department (ED) throughput measures.

Design

Comparison of three 3-month periods. Period 1: 1 year prior (January–March 2008); Period 2: 3 months prior (October–December 2008); Period 3: 3 months after (January–March 2009).

Setting

Seven EDs in Western MA; two – including the only Level I Trauma Center – were “high” diversion (≥562 h/year) and 5 were “low” diversion (≤260 h/year). For “all,” “high” diversion and “low” diversion ED groups, we compared mean monthly throughput measures, including: 1) total volume, 2) number of admissions, 3) number of elopements, 4) length of stay for all, admitted and discharged patients. Mean absolute and percent changes were estimated using mixed-effects regression analysis. Linear mixed models were run for “all,” “high” and “low” diversion EDs comparing means of changes between periods. Results are presented as mean change per month in number and percent, and 95% confidence intervals were calculated. We specified that a clinically significant effect of No Diversion had to meet two criteria: 1) there was a consistent difference in the means for both the Period 1 vs. Period 3 comparison and the Period 2 vs. Period 3 comparison, and 2) both comparisons had to achieve statistical significance at p ≤ 0.01.

Results

According to pre-determined criteria, no clinically significant changes were found in any ED group in mean monthly volume, admissions, elopements, or length-of-stay for any patient disposition group.

Conclusion

No Diversion was not associated with significant changes in throughput measures in “all,” “high” diversion and “low” diversion EDs.     

Counselors' reflections on the administration of screening and brief intervention for alcohol problems in the emergency department and 3-month follow-up outcome

Objectives

The purpose of this paper was to explore how events that counselors endorsed occurring during an emergency department–based screening and brief intervention (SBI) for drinking discriminate patients who reported change in Alcohol Use Disorder Identification Test (AUDIT) domains at follow-up from those who did not.

Method

Patients who scored “>5” on the AUDIT were eligible for SBI. At the end of each intervention, counselors completed the questionnaire indicating which parts of the intervention they just used.

Results

Discriminant function analyses indicated that “Referral made” discriminated for alcohol intake change (Wilks' λ = 0.993, P < .05); “Did the patient set goals during intervention?” and “Referral made” discriminated for alcohol dependency change (Wilks' λ = 0.940 and Wilks' λ = 0.919, P < .05, respectively). “Intention to quit” (Wilks' λ = 0.984, P < .05) discriminated for alcohol-related harm change.

Conclusions

Making referrals to addiction treatment during motivational intervention discriminated for alcohol intake and dependency change. Working on intention to quit is an important point in changing alcohol-related harm. When conducting the SBI in ED, counselors may be mindful in making appropriate referrals to address alcohol use and examine intention to quit to maximize the efficacy of the harm-reduction approach.     

Assessing the quality of interdisciplinary rounds in the intensive care unit

Purpose

Interdisciplinary rounds (IDRs) in the intensive care unit (ICU) are increasingly recommended to support quality improvement, but uncertainty exists about assessing the quality of IDRs. We developed, tested, and applied an instrument to assess the quality of IDRs in ICUs.

Materials and Methods

Delphi rounds were done to analyze videotaped patient presentations and elaborated together with previous literature search. The IDR Assessment Scale was developed, statistically tested, and applied to 98 videotaped patient presentations during 22 IDRs in 3 ICUs for adults in 2 hospitals in Groningen, The Netherlands.

Results

The IDR Assessment Scale had 19 quality indicators, subdivided in 2 domains: “patient plan of care” and “process.” Indicators were “essential” or “supportive.” The interrater reliability of 9 videotaped patient presentations among at least 3 raters was satisfactory (κ = 0.85). The overall item score correlations between 3 raters were excellent (r = 0.80-0.94). Internal consistency in 98 videotaped patient presentations was acceptable (α = .78). Application to IDRs demonstrated that indicators could be unambiguously rated.

Conclusions

The quality of IDRs in the ICU can be reliably assessed for patient plan of care and process with the IDR Assessment Scale.     

Impact of first contact on symptom onset–to-door time in patients presenting for primary percutaneous coronary intervention

Objectives

To determine effect of first medical contact type on symptom onset–to-door time (SODT).

Background

Shorter total ischemic time is associated with improved outcomes in ST-elevation myocardial infarction.

Methods

From 2005 to 2009, we reviewed records of all consecutive patients treated with primary percutaneous coronary intervention for ST-elevation myocardial infarction at our tertiary care teaching hospital (median follow-up 3.85 years). We compared SODT in patients whose first medical contact was a private physician (in person or via telephone) vs patients who presented to the emergency department (ED) directly (in person or via Emergency Medical Services).

Results

Of 366 patients, 84 (23%) contacted a physician (group A) while 282 (77.6%) did not (group B). Group A had higher median SODT (239.5 vs 130 minutes, P = .0043) and significantly higher mortality (log rank P = .0392, Cox Proportional Hazard Model risk factors: physician contact first [P < .013], age [P < .0001] and peripheral vascular disease [P < .035]). Two factors associated with prolonged SODT: (1) contacting a physician first P = .002 and (2) personal mode of transportation, P = .002. Patients presenting during “on-hours” (weekdays) were more likely to first contact a physician compared with those presenting during “off-hours” (weeknights and weekends) (66.67% in group A vs 45.04% in group B, P < .001).

Conclusions

Patients whose first medical contact was a physician had greater pre-hospital delays and worse survival compared to those who sought emergent medical care directly. This pattern occurred more often during “on-hours.” Educational efforts aimed at both patient and physician office practices are warranted.     

Self-Perceived Utilization of the Paretic Arm in Chronic Stroke Requires High Upper Limb Functional Ability

Objective

To explore potential predictors of self-reported paretic arm use at baseline and after task-specific training (TST) in survivors of stroke.

Design

Data were obtained from a randomized controlled trial of somatosensory stimulation and upper limb TST in chronic stroke.

Setting

University laboratory.

Participants

Chronic (≥3mo) survivors of stroke (N=33; mean age, 62y; mean stroke duration, 38mo).

Interventions

Participants received 12 sessions of TST preceded by either active (n=16) or sham (n=17) somatosensory stimulation to all 3 peripheral nerves.

Main Outcome Measures

Demographic and clinical characteristics were entered stepwise into multiple linear regression analyses to determine the factors that best predict baseline Motor Activity Log (MAL) amount of use rating and change 3 months after TST.

Results

The Action Research Arm Test (ARAT) score predicted the amount of use at baseline (R²=.47, P<.001); in using this model, an ARAT score of 54 (maximum of 57) is required to score 2.5 on the MAL (use described as between rarely and sometimes). After TST the change in the ARAT score predicted the change in the amount of use (R²=.31, P=.001). The predictive power of the model for change at 3 months increased if the Fugl-Meyer Assessment wrist component score was added (R²=.41, P=.001).

Conclusions

Utilization of the paretic upper limb in activities of daily living requires high functional ability. The increase in self-reported arm use after TST is dependent on the change in functional ability. These results provide further guidance for rehabilitation decisions.     

Anxiety and Depression Associated With Caregiver Burden in Caregivers of Stroke Survivors With Spasticity

Objective

To investigate the relationship between anxiety/depression and caregiver burden in informal caregivers of stroke survivors with spasticity.

Design

Data were collected via online surveys from informal caregivers 18 years or older who cared for stroke survivors.

Setting

Internet-based survey.

Participants

2007 through 2009 U.S. National Health and Wellness Survey database or Lightspeed Research general panel respondents (N=153).

Interventions

Not applicable.

Main Outcome Measures

Anxiety and depression were self-reported by the caregiver as a physician diagnosis. Depression severity was measured by the Patient Health Questionnaire-9 (PHQ-9). Caregiver burden was measured by the Oberst Caregiving Burden Scale (OCBS) and the Bakas Caregiving Outcomes Scale (BCOS). Logistic regression analyses were conducted with anxiety, depression, and the PHQ-9 depression severity categories as a result of each caregiver burden scale.

Results

Data were analyzed for 153 informal caregivers; they were mostly women (70.6%) and white (78.4%), with a mean age of 51.6 years. For every 1-point increase in the OCBS Difficulty Scale, the odds of anxiety or depression were 2.57 times as great (P<.001) and 1.88 times as great (P=.007), respectively. The odds of PHQ-9 severe depression versus all other categories combined were 2.48 times as great (P<.001). For every 1-point decrease in the BCOS, the odds of anxiety or depression were 2.43 times as great (P<.001) and 2.27 times as great (P=.002), respectively. The odds of PHQ-9 severe depression versus all other categories combined were 4.55 times as great (P<.001).

Conclusions

As caregiver burden increases, caregivers are more likely to have anxiety and depression. Depression severity also increases. Providing treatment to stroke survivors with spasticity that lessens the time and more importantly, the difficulty of caregiving may lead to a reduction in caregiver anxiety and depression.     

The lived experience of parents of children admitted to the pediatric intensive care unit in Lebanon

Background

Family caregivers have a significant responsibility in the care of their child in the Pediatric Intensive Care Unit (PICU). Parents staying with their child in the PICU have particular needs that should be acknowledged and responded to by clinicians. Several studies have been conducted in the USA and Europe to try to understand the experience of family caregivers of children admitted to the Pediatric Intensive Care Unit. There are no such studies in Lebanon or the Middle East where the culture and support systems differ from other countries.

Objective

To understand the lived experience of Lebanese parents of children admitted to the PICU in a tertiary hospital in Beirut.

Design

Phenomenological study.

Methods

The study followed purposeful sampling in which 10 parents (mother or father) of children admitted to PICU were interviewed. Data were analyzed following the hermeneutical process as described by Diekelmann and Ironside (1998).

Results

A constitutive pattern “Journey into the unknown” which constitutes an overarching theme and four major themes with subthemes emerged from the data. These were: We are human beings with dignity “; “looking for a healthier environment”; Dependence on God and “The need to be in the loop” reveal the parents’ journey into the unknown.

Conclusion

This qualitative study adds to the knowledge that would help health care workers understand the experience of Lebanese parents with a child in PICU and to highlight the significance of this experience to them. The findings could be used to inform the development of a PICU parental satisfaction instrument for the sample group.     

Vascular endothelial growth factor receptor and coreceptor expression in human acute respiratory distress syndrome

Background

Acute respiratory distress syndrome (ARDS) is characterized by the development of noncardiogenic pulmonary edema, which has been related to the bioactivity of vascular endothelial growth factor (VEGF). Vascular endothelial growth factor receptors and coreceptors regulate this bioactivity. We hypothesized VEGF receptors 1 and 2 (VEGFR1, VEGFR2) and coreceptor neuropilin-1 (NRP-1) would be expressed in human lung tissue with a significant change in expression in ARDS lung.

Methods

Archival “normal” (no lung pathology and non-ARDS), “early” (within 48 hours), and “later” (after day 7) ARDS lung-tissue sections (n = 5) were immunostained for VEGFR1, VEGFR2, and NRP-1 from human subjects (n = 4). Staining was assessed densitometrically using Histometrix software.

Results

VEGFR1, VEGFR2, and NRP-1 were expressed on both sides of the alveolar-capillary membrane in both normal and ARDS human lung tissue. In later ARDS, there was a significant up-regulation of VEGFR1 and VEGFR2 versus normal and early ARDS (P < .0001). Neuropilin-1 was down-regulated in early ARDS versus normal lung (P < .05), with normalization in later ARDS (P < .001).

Conclusion

Differential temporal VEGFR1, VEGFR2, and NRP-1 up-regulation occurs in human ARDS, providing evidence of further functional regulation of VEGF bioactivity via VEGFR2 consistent with a protective role for VEGF in lung injury recovery. The mechanisms behind these observations remain to be clarified.     

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.     

Hospitalisation en court séjour pour reconstruction du ligament croisé antérieur : étude prospective comparative

Introduction

In France, the median duration of hospitalization for a reconstruction of the anterior cruciate ligament (ACL) is 3 days. The purpose of this study was to evaluate the feasibility and acceptability of hospitalization for one day for this surgery.

Patients and methods

A prospective study conducted in 2011 included patients who underwent surgery for an ACL rupture. Exclusion criteria were age > 60 years, scores ASA3-4 and patients unmanageable in short-stay. Two groups of patients were formed: “short-stay” with an output at D1 and “conventional hospitalization” with an output at D3. The postoperative analgesia protocol included analgesics I-II, morphine on demand during hospitalization. “Short-stay” group received a telephone follow-up (D1–D4). The primary outcome was patient satisfaction at D3. The secondary endpoints were postoperative pain assessed on a visual analogue scale at D3 and adverse events. Thirty patients were included in each group, 34 men and 26 women, mean age 29 ± 5 years.

Results

Patients in group “short-stay” were on average more satisfied than the “conventional hospitalization” group, P = 0.01. The pain was significantly less pronounced in the “short-stay” group, P = 0.00001. No complications occurred.

Conclusion

Inpatients short-stay were significantly more satisfied and less painful than those in conventional hospitalization group. Future studies should evaluate the feasibility of ambulatory surgery for ACL reconstruction.