Quality of Life Associated Factors in a North African Sample of Lower Limbs Amputees

OBJECTIVE: To study factors associated to the quality of life in a North African sample of lower limbs amputees. METHODS: We conducted a prospective study in the Department Physical Medicine and Rehabilitation, University Hospital of Monastit, Tunisia. A consecutive sample of patients with amputations of the lower limbs was included. The evaluated parameters were quality of life using the Short-Form quality-of-life questionnaire (SF-36), pain using a visual analog scale, function using, the perimeter of walking (PW), the Special Interest Group of the Amputee Medicine (SIGAM) and the Locomotion Capacities Index of the Prosthetic Profile of the Amputee (LCI), and psychological status thanks to the Hospital Anxiety and Depression scale. In the study, the patients were evaluated at the first consultation (T0) and again at 12 months (T1). RESULTS: We included 85 patients (age, 59.3±16.7 years) with a sex ratio of 3. The patient quality of life was positively correlated to distal type of amputation, traumatic origin, better LCI (p≤0.001, r=0.349), SIGAM (p=0.046) and PW. A negative correlation was noted with age (p=0.012, r=−0.483) and higher psychological scores (p=0.002, r=−0.321). CONCLUSION: In our sample of North African lower limbs amputees the age and the functional status were the most important predictors of the quality of life.

[Quality of life in ankylosing spondylitis]

Ankylosing Spondylarthritis [AS] involves by its frequency and its repercussion on the functional capacity an important handicap and deterioration of the patients quality of life. To evaluate the handicap and the quality of life during the AS and to seek the predictive factors of the deterioration of this quality of life. A prospective study relating to 50 patients recruited in the Department of Rheumatology of F. B. Hospital of Monastir during 6 months period [Mars to September 2008]. The studied parameters were the quality of life evaluated by a specific sore [ASQOL] and a generic score [SF-12]. Also the physical, social and economic felt handicap was evaluated using a qualitative scale. Predictive factors [clinical, biological and radiological] of the quality of life were carried out. Our patients are divided in 42 men and 8 women with an average age of 38.9 +/- 10.7 years. The average duration of AS is of 11.9 +/- 7.6 years. The average of ASQOL is of 11.9 +/- 4 [extremes: 0-17]. The average of physical SF12 is of 29.8 +/- 6 [21.7-53.2] and of mental SF-12 of 35.3 +/- 6.6 [22.5-55.8]. The physical, social and economic felt handicap was considered to be average or important in respectively 88%, 72% and 86% of the cases. The predictive factors of a high ASQOL [faded quality of life] are absence of occupation, high BASMI, a high number of painful articulations and high BASFI, BASDAI, BASG, BASRI and EVA total pain. The factors associated to the alteration of the quality of life according to SF-12'S are male sex, professional statute, high number of painful articulations and high BASDAI, BASFI and BASRI. Our study shows the important deterioration of the quality of life in AS patients. The existence of the predictive factors of quality of life primarily related to the functional capacity of the patients and to the disease activity implicates an early and adequate disease management in order to decrease this repercussion

[ contribution of the new scale for assessing disability]

The assessment of disability and its management is complex and problematic. With a view to ensuring equality of opportunity between disabled people and others, a new law adopted in August 2005 proposed a new method for assessing disability is applicable on a wider scale by GPs. Assessing the contribution of the new scale for assessing disability in patients suffering from debilitating diseases, to verify compliance in Tunisia. Cross- sectional study on 60 hemiplegic, paraplegic and post traumatic head injuries. The patients underwent clinical evaluation and a functional assessment. The assessment tools used were: the classification of the American Spinal Injury Association, the Barthel index, Glasgow Outcome Scale, Functional independence Measure, the Health Assessment Questionnaire and the Social Function-36. Patients were also evaluated with the new scale of disability. Concerning paraplegic patients, limitations of activity concerned mobility, maintenance staff, domestic life, social relationships, community life and major areas of life. On the hemiplegic, areas related to communication, mobility, maintenance staff, domestic life, social relationships, community life and major areas of life have been affected. We have noted a correlation between the new scale and the Barthel Index. Regarding traumatic brain injury, the areas most affected were those related to mobility, maintenance staff, domestic life and the major areas of life. A correlation was found between the new scale and the Functional Independence Measure in three populations, as well as the quality of life that has been correlated with disability. Disability was observed in 90% of paraplegics, 80% and 50% of hemiplegic patients with severe brain injury. The handicap was the heaviest seen in traumatic brain injury patients with a frequency of 20%. The new scale for assessing disability has reproduced disability and special needs of paraplegic patients, stroke patients and traumatic brain injury

[Functional impairment in patients with rheumatoid pelvispondilyte]

To assess functional impairment in patients with rheumatoid pelvispondylite. cross-sectional study conducted on patients with rheumatoid pelvispondylite. Data are collected in a form specifying the epidemiological and demographic data, disease activity by Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]. metrological static and dynamic examination. Evaluation of functional impairment by Bath Ankylosing Spondylitis Functional Index [BASFI], and likert scale assessing social, economic arid physical disability. 30 patients [22 men], the mean age is 37.2 years old; twenty one patients are without work. The mean duration of disease is 13.36 years, 50%are annoyed by morning stiffness than one hour, spinal pain and fatigue. The average value of BASDAI is 43.72/100: the average value of EVA fatigue is 56.16/100. The average value of BASFI is 56.36/100. An important or very important social economic and physical disability was felt among 67%of the patients, which is correlated with duration of the disease, the BASDAI index, work, and the BASFI index. The functional impairment caused is statistically correlated with the intensity of the pain, the fatigue, the morning stiffness and BASDAI index. This impact on the quality of life is increased by the low level of education and poor professional integration

[Neurogenic bladder in diabetes mellitus]

Diabetic bladder dysfunction is among the most common complications of diabetes mellitus. It is principally caused by autonomic neuropathy defining diabetic cystopathy. Characterize the bladder dysfunction in patients with diabetes mellitus. The clinical and urodynamic records of patients with diabetes mellitus were reviewed. 40 patients with diabetes mellitus were included in the study mean aged 55 years. 32 patients had voiding dysfunction. Urinary frequency and difficulty emptying were the predominant symptoms that led to patient referral. 15 patients [31.25%] had decreased flow rates. 12 patients [37.5%] had diminished bladder sensation and/or impaired detrusor contractility. 10 patients [25%] had detrusor hyperreflexia. And 6 patients had impaired detrusor contractility with increased bladder sensation. Vescico-uretral dyssynergia was found in 2 patients [5%]. This study suggests that classical diabetic cystopathy is not the most common urodynamic findings in patients with diabetes mellitus and demonstrates the importance of urodynamic studies in diagnosing bladder dysfunction in diabetics before initiation of therapy

Facteurs predictifs d'evolution de l'algodystrophie en rheumatologie. A propos de 60 cas

We analysed 60 cases of algodystrophy admitted in the rheumatology department of the university hospital of Monastir. We used a univariate analysis to search the factors associated with the disease evolution. Our patients were 40 males and 20 females. The mean age was 51.6 years [16-81]. The traumatisation was the dominant cause [46.7% of the cases]. Calcitonines were used in 70% of the cases. Functional results at one year were satisfying and not satisfying in 62.5% and 37.5% of the cases, respectively. The primitive algodystrophy was associated with a satisfying result. Sequella were observed in 10.5% of the cases. The primitive algodystrophy was associated with a satisfying result. Algodystrophy remain a benign disease and the best treatment remains the preventive one mainly in traumatic and orthopaedic circumstances