[Critical appraisal of the battery of questionnaires used in the French-speaking Belgian spine rehabilitation centers for low back pain]. / Analyse critique de la batterie de questionnaires utilisée par les centres francophones belges de revalidation du rachis pour la lombalgie.

OBJECTIVES: to investigate the questionnaires used in French-speaking Belgian spine multidisciplinary rehabilitation centers for patients with low back pain and to propose a minimal core set of questionnaires based on the results of our survey and on the (inter)national guidelines. METHODS: the spine centers offering the 36 two-hour sessions defined by the Belgian national Institute for Health and disability insurance were invited to provide their battery of questionnaires. RESULTS: among the 37 identified and contacted centers, 21 participated in our survey. Results pointed out the use of questionnaires assessing pain intensity, disability, anxiety/depression and kinesiophobia in most centers as well as a huge heterogeneity regarding the questionnaires (and even the version of the questionnaire) reported and the non-systematic use of questionnaires recommended by the guidelines. CONCLUSION: taking into account the results of this survey, the present article proposes a minimal core set of questionnaires meeting the guidelines, which would make it possible to harmonize the assessments in the different centers and would facilitate the realization of multicenter studies.

Objectifs : examiner les questionnaires utilisés dans les centres francophones belges de revalidation multidisciplinaire du rachis pour la prise en charge des patients lombalgiques et proposer une batterie de questionnaires minimale basée sur les résultats de cette étude et sur les recommandations (inter)nationales. Matériel et méthodes : les centres proposant le programme de 36 séances de 2 heures défini dans la nomenclature de l'INAMI (Institut National d'Assurance Maladie Invalidité), ont été invités à nous fournir leur batterie de questionnaires. Résultats : parmi les 37 centres identifiés et contactés, 21 ont participé à l'enquête. Si celle-ci met en évidence l'utilisation de questionnaires évaluant l'intensité de la douleur, l'incapacité fonctionnelle, l'anxiété/dépression et la kinésiophobie dans les différents centres, elle révèle également une grande hétérogénéité en termes de questionnaires (et même de version du questionnaire) utilisés et la non-utilisation systématique des questionnaires recommandés par les guides de pratique clinique. Conclusion : compte tenu des résultats de l'enquête, cet article propose une batterie minimale de questionnaires répondant aux guidelines, qui permettrait d'harmoniser les évaluations dans les différents centres et faciliterait la réalisation d'études multicentriques.

[Comparative analysis between orthopaedic manual therapy and osteopathy : focus on the Belgian situation]. / Analyse comparative entre la thérapie manuelle orthopédique et l'ostéopathie une mise au point sur la situation en Belgique.

Orthopaedic manual therapy (OMT) and osteopathy have been coexisting since a long time in Belgium to manage musculoskeletal disorders (MSDs). There are millions of consultations per year in these both disciplines. Both of them offer good clinical outcomes as well as patient satisfaction with care, good cost-effectiveness, as well as minor side effects. Nevertheless, a major misunderstanding remains in Belgium concerning these both professions. A narrative review by Belgian experts in osteopathy and/or in OMT has been undertake. In Belgium, both professions present several major differences concerning the primary first care access, the recognition as health care profession, tailored reimbursement systems, types and organization of education, the use of rehabilitation and motor control, the integration of evidence based practice concept, the reasons/indications of consultation, the degree of confidence within the therapeutic touch concept. In the meantime, several similarities also exist including the integration of the bio-psycho-social model, the evaluation of the neuromusculoskeletal system and the treatment of MSDs using sometimes identical manual techniques, as well as the use of therapeutic education of the patient and specific clinical reasoning. This analysis may help health professionals, students and patients to better understand the convergences and divergences between these both disciplines of musculoskeletal care in Belgium.

La thérapie manuelle orthopédique (TMO) et l'ostéopathie coexistent depuis longtemps en Belgique pour prendre en charge les troubles musculosquelettiques (TMS). On comptabilise des millions de consultations par an pour ces deux disciplines. Chacune offre, à la fois, une bonne satisfaction des patients et une bonne efficacité clinique, un bon rapport coût-efficacité, ainsi que des effets secondaires mineurs. Néanmoins, une méconnaissance majeure demeure en Belgique au sujet de ces approches thérapeutiques. Une revue narrative rédigée par des experts Belges en ostéopathie et/ou en thérapie manuelle a été réalisée. La TMO et l'ostéopathie présentent plusieurs différences majeures en Belgique. Elles concernent l'accès direct, la reconnaissance comme profession de santé, les systèmes de remboursement, les types et l'organisation de l'enseignement, l'utilisation de la rééducation et du contrôle moteur, l'intégration du concept d' «evidence-based-practice¼, les motifs/indications de consultation, le degré de confiance dans le toucher à des fins diagnostiques et thérapeutiques. Cependant, plusieurs similitudes existent également, dont l'intégration du modèle bio-psycho-social, l'évaluation du système neuro-musculo-squelettique, l'utilisation de techniques manuelles parfois identiques pour le traitement des TMS, une éducation thérapeutique du patient ainsi que l'utilisation d'un raisonnement clinique, propre, cependant, à chacune des disciplines. Cette analyse devrait aider les professionnels de la santé, les étudiants, ainsi que les patients à mieux comprendre les convergences et les divergences entre ces deux disciplines en Belgique.

[Low back and radicular pain : which management in 2018 ?] / Comment je traite Les lombalgies et douleurs radiculaires : quelle prise en charge en 2018 ?

Both frequent reason for consultation and cause of absence at work, low back pain is a notorious public health concern. The Belgian Health Care Knowledge Centre (KCE) has been surrounded by 31 clinicians from different disciplines to develop a guideline covering the entire management of low back and radicular pain. A recently published guideline of the British National Institute for Health and Care Excellence (NICE) was largely used as a starting point and adapted to the Belgian context.

A la fois motif de consultation et cause d'absence au travail très fréquents, les lombalgies sont un enjeu de santé publique notoire. Le Centre fédéral d'Expertise des Soins de Santé (KCE) s'est entouré de 31 cliniciens de différentes disciplines pour élaborer un guide de pratique clinique couvrant l'entièreté de la prise en charge des douleurs lombaires et radiculaires. Ce guide se base sur le tout récent «guideline¼ britannique du National Institute for Health and Care Excellence (NICE) dont chaque recommandation a été adaptée au contexte belge.

Influence of a dynamic seating habit on lumbar motor control in schoolchildren.

BACKGROUND: Adequate motor control is considered important for spinal stability and the prevention of low back pain in adulthood and in childhood. OBJECTIVE: Given that the sitting position can affect proprioception, this study aimed to evaluate the influence of using at school a triangular and dynamic cushion on schoolchildren's trunk motor control. METHODS: Thirty 8-year-old schoolchildren were randomized into a control group (n= 15) and a "cushion group" (n= 15), in which the children used the cushion for one year and a half. At the end of this period, a 3D-analysis was used to assess lumbar spine proprioception by means of a trunk repositioning task performed blindfolded in a seated position in two conditions (on a stable and on an unstable surface). RESULTS: The schoolchildren in the cushion group performed better at the trunk repositioning task (p= 0.02) and hold their lumbar lordosis (p= 0.03) better than the control children, in both conditions (stable and unstable). CONCLUSIONS: This preliminary study suggests that daily use of a triangular dynamic cushion has a beneficial impact on children's lumbar proprioception. Further studies are needed to confirm these results and investigate the effectiveness of its use to prevent low back pain in adulthood.

[Platelet-rich plasma (PRP) and disc lesions: A review of the literature]. / Plasma riche en plaquettes (PRP) et lésions discales : revue de la littérature.

The spine has been the subject of extensive clinical research since it is the source of many painful complaints. However, there is little scientific evidence concerning the therapeutic proposals. During the course of life, the intervertebral disc degenerates, which over time diminishes its damping capacity and facilitates the expulsion of the nucleus pulposus through the annulus fibrosus. The degeneration of the intervertebral disc (DDI) is the origin of some back pain and various specific treatments have been developed. These include the infiltration at the center of the intervertebral disc of plasma rich platelet (PRP), composed of multiple growth factors which act on the disc degeneration. This treatment is recent and less invasive than surgery. Preliminary results seem promising. However, many gray areas and several parameters remained to be clarified. In an attempt to do this, a literature review was conducted based on bibliographic databases Pubmed, Medline and Scopus® using the following Mesh terms : PRP, platelet-rich plasma, intradiscal disc degeneration, disc, intradiscal, discogenic. This analysis reveals that at the present time, no reported study has a sufficient perspective to judge the effectiveness of the infiltration of PRP. Early harvest results will be used to set the limits of this treatment. Accordingly, it is therefore currently recommended to introduce PRP injection as a complementary solution to comprehensive care of the spine. Future research will need to generate randomized controlled studies including comparing the results with conservative treatment and measure the cost-benefit relationship.

Relevance of adding a triangular dynamic cushion on a traditional chair: A 3D-analysis of seated schoolchildren.

BACKGROUND: Low back pain is highly prevalent in the general population and is even reported as early as at primary school. A poor sitting position has been suggested as an etiologic factor. This study analysed, in primary schoolchildren, the influence of a triangular dynamic cushion that aims to help children maintain their physiological lumbar lordosis and to induce movement to reduce the static effect of the sitting position. METHODS: Thirty 8-year-old children took part in this study. A 3D analysis combined with electromyography was used to evaluate the biomechanics and the related muscle activation in two sitting positions (with and without a triangular cushion on a horizontal stool) during a 15-minute working task. In addition, the force of the feet on the ground was assessed with a force plate. FINDINGS: The cushion improved the trunk-thighs angle, lumbar lordosis, anterior pelvis tilt, and feet support on the ground (p<0.0001). In addition, sitting on the cushion appeared to be more dynamic (p<0.05) and induced a decrease of the lumbar paravertebral muscle activity (p<0.01). INTERPRETATION: Sitting on a dynamic triangular cushion tends to favour the "ideal" siting position usually described in the literature and to decrease the level of paravertebral muscle recruitment. Seeing that sitting position is a risk factor to develop low back pain, the cushion could be a solution to prevent it.

[Orthopaedic manual therapy : definition, characteristics and update on the situation in Belgium]. / La thérapie manuelle orthopédique : définition, caractéristiques et mise au point sur la situation en Belgique.

Although orthopaedic manual therapy (OMT) has existed for decades, and although a recent Belgian Royal Decree, published in 2014, recognized it as a particular professional qualification in physiotherapy for the treatment of neuromusculoskeletal dysfunctions, OMT remains little known by patients, but also by healthcare professionals. Yet, this professional qualification, based on clinical reasoning, using highly specific treatments, guided by the best available scientific and clinical evidence and the specific biopsychosocial characteristics of each patient, is the subject of a growing number of scientific studies pointing out its effectiveness. This article summarizes the knowledge related to OMT (definition, history, characteristics, techniques, indications, access and reimbursement) and describes its situation in Belgium.

Bien que la thérapie manuelle orthopédique (TMO) existe depuis des décennies et qu'un récent arrêté royal belge reconnaissant cette discipline comme une qualification professionnelle particulière en kinésithérapie pour la prise en charge des troubles neuro-musculo-squelettiques ait été publié en 2014, la TMO demeure méconnue des patients, mais également du monde médical. Pourtant, cette discipline, basée sur un raisonnement clinique, utilisant des approches thérapeutiques hautement spécifiques guidées par les meilleures évidences scientifiques et cliniques disponibles ainsi que par la spécificité biopsychosociale propre à chaque patient, fait l'objet d'un nombre croissant d'études scientifiques mettant en évidence son intérêt. Cet article vise à synthétiser les connaissances relatives à la TMO (sa définition, son historique, ses caractéristiques, ses techniques, ses indications, son accès et son remboursement, ainsi que son enseignement) en décrivant la situation en Belgique.

[THE MALADAPTIVE BELIEFS OF PATIENTS WITH LOW BACK PAIN. A NARRATIVE REVIEW]. / LES CROYANCES DÉLÉTÈRES DES PATIENTS LOMBALGIQUES. Revue narrative de la literature.

OBJECTIVE: to summarize the knowledge regarding the maladaptive beliefs of patients with non-specific low back pain. METHODS: a narrative literature review on these beliefs was conducted by an international and multidisciplinary team of experts in the field. RESULTS: these beliefs, which can result in negative consequences on functioning and on patient prognosis, have various origins: family and friends, media, previous experience and/or health care professionals' messages. The latter, who have a considerable and enduring influence, have the potential to change and correct the patients' misbeliefs; however, they can also reinforce them in case of inappropriate messages and attitudes. Informing and educating the patient (by means of reassurance, explanations of the non-systematic association pain-injury, encouragement to get and stay physically active) are the basis of treatment. Taking into account the consequences of some words which may be misinterpreted, the results of imaging should be wisely discussed with the patient. Pain neurophysiology education and cognitive behavioral therapy (i.a., in vivo graded exposure techniques) are effective additional treatments. CONCLUSIONS: Misbeliefs are frequent in patient with low back pain. They do need to be looked for and corrected.

How much does the Dallas Pain Questionnaire score have to improve to indicate that patients with chronic low back pain feel better or well?

PURPOSE: The Dallas Pain Questionnaire (DPQ) assesses the impact of low back pain (LBP) on four components (0-100) of daily life. We estimated the minimal clinically important improvement (MCII) and the patient acceptable symptom state (PASS) values of DPQ in LBP patients. METHODS: 142 patients with LBP lasting for at least 4 weeks completed a battery of questionnaires at baseline and 6 months later. Questions for MCII addressed patient-reported response to treatment at 6 months on a five-point Likert scale, while a yes/no question concerning satisfaction with present state was used to determine PASS. MCII was computed as the difference in mean DPQ scores between patients reporting treatment as effective vs. patients reporting treatment as not effective, and PASS was computed as the third quartile of the DPQ score among patients who reported being satisfied with their present state. RESULTS: MCII values were 22, 23, 2 and 10 for daily activities, work and leisure, social interest, and anxiety/depression, respectively. PASS values were 29, 23, 20 and 21 for the four components, respectively. The PASS total score threshold of 24 correctly classified 84.1 % of the patients who reported being unsatisfied with their present state, and 74.7 % of patients reported being satisfied. CONCLUSIONS: These values give information of paramount importance for clinicians in interpreting change in DPQ values over time. Authors should be encouraged to report the percentage of patients who reach MCII and PASS values in randomized clinical trials and cohort studies to help clinicians to interpret clinical results.

Core Outcome Measure Index for low back patients: do we miss anxiety and depression?

PURPOSE: The Core Outcome Measure Index (COMI) is a multidimensional questionnaire that investigates five dimensions in low back pain (LBP) patients, but does not address the psychological dimension. As the biopsychosocial perspective is recognized as important to capture the entire clinical picture of these patients, this multicenter prospective cohort study was designed to investigate the psychometric properties of a modified version of the COMI (COMIAD) which included 2 additional items, exploring anxiety and depression, respectively. METHODS: 168 subacute or chronic LBP patients recruited in spine clinics completed a set of questionnaires before and after treatment (follow-up at 6 months). Construct validity was explored by comparing each item of the COMIAD to validated full-length questionnaires. Thus two additional questionnaires were included to assess the construct validity of the anxiety and depression measures. The psychometric properties of the COMI and COMIAD were then compared. RESULTS: The two new items showed good internal consistency, high correlations with the corresponding full-length questionnaires, no floor or ceiling effect and good reproducibility (test-retest agreement kappa 0.68 for anxiety, 0.62 for depression). The addition of the 2 items did not alter internal validity (Cronbach's alpha = 0.88 and 0.87, respectively). The smallest detectable difference, the Minimal Clinically Important Improvement and the Patient Acceptable Symptom State were only minimally affected by the changes. CONCLUSION: The questions exploring anxiety and depression have good intrinsic and psychometric capacities (i.e., no floor or ceiling effects and high correlations with full-length scales) and did not significantly modify the psychometrics of the original COMI questionnaire. The COMIAD offers the possibility to include the psychological dimension in the multidimensional evaluation without significantly affecting questionnaire length.

Trunk muscle profile in elite tennis players with and without low back pain.

AIM: The aim of this study was to compare tennis players with and without low back pain (LBP) and healthy sedentary participants regarding the trunk muscle strength and flexibility. METHODS: Thirty-eight male elite tennis players and 22 healthy sedentary male students (24.8±4.0 years) participated in this investigation. Tennis players were divided into two groups: 11 players (27.8±5.5 years) with current LBP and 27 players (24.3±5.9 years) without LBP. Maximal isometric strength of trunk extensor, rotator, flexor and lateralflexor muscles was assessed by means of specific trunk dynamometers. Pelvic and lumbar flexion mobility were measured by means of inclinometer technique. RESULTS: Comparison of tennis players with and without LBP revealed no significant difference regarding trunk muscle strength and ratio or lumbar spine flexibility (all P>0.05). In comparison with sedentary participants, the tennis players showed a sport-specific profile determined by a non-dominant trunk lateralflexors (P=0.02, F=4.05) and rotators (P=0.03, F=3.62) strength significantly higher than the dominant side. CONCLUSION: In the current study, comparison of tennis players with and without LBP showed no significant difference regarding trunk strength and spine flexibility. Trunk profile of tennis players showed selective unilateral strength increase of the non-dominant trunk lateralflexors and rotators. This finding could result from the forehand and the service action which involves simultaneously left trunk rotators and lateralflexors, in right-handed players, to generate power. In order to confirm that trunk muscle imbalance has no influence on LBP, further studies should study the effectiveness of a programme aiming to normalize strength ratios in tennis players with LBP.

Effectiveness of preventive back educational interventions for low back pain: a critical review of randomized controlled clinical trials.

PURPOSE: A systematic search was conducted to study the efficiency of preventive educational interventions mainly focused on a biomechanical/biomedical model. METHODS: The PubMed electronic database and the Cochrane Library were searched based on a combination of keywords related to low back pain (LBP) and posture education. Only randomized controlled trial (RCT) studying the efficiency on outcomes directly related to LBP of a preventive intervention programme mainly based on education of proper care of the back for subjects not seeking treatment were included. References of the articles meeting these inclusion criteria were also checked to identify other potential citations. Besides, a methodological study assessment of the included RCTs was performed. RESULTS: Nine studies, all conducted at the workplace were included in this review. Their mean quality level was low (5.1/12) and among the four studies with a huge sample size (n > 400 subjects), only one had an acceptable methodological quality score (6/12). The education interventions differed widely from one study to another. No significant differences between the control and education groups were found at the follow-up in eight out of the nine studies on the incidence of back pain, disability and sick leave. CONCLUSIONS: The results of the RCTs included in this review suggest that educational interventions mainly focused on a biomechanical/biomedical model are not effective in preventing LBP. However, taking into account the methodological quality level of the RCTs as well as the very short and heterogeneous interventions often proposed, additional high-quality studies with a longer education period are needed to conclude that such interventions are inefficient.

Comparison of gaseous cryotherapy with more traditional forms of cryotherapy following total knee arthroplasty.

OBJECTIVE: The aim of this study was to assess the efficacy of gaseous cryotherapy following total knee arthroplasty (TKA) and to compare it to routinely used strategies for applying cold therapy. PATIENTS AND METHODS: Sixty-six patients undergoing primary unilateral TKA were randomized into three groups and received "gaseous cryotherapy (GC)", "cold pack" and "cryocuff" applications, respectively throughout the hospital stay. Primary outcomes (knee pain intensity, mobility and girth measurements) were recorded on preoperative day 1 as well as on postoperative day (POD) 7. Cutaneous temperature of the knee sides were also measured on POD7 just before and immediately after cold application. RESULTS: Although skin temperature dropped to 14°C following GC versus 22 to 24°C for the other two applications (P<0,05), the three groups did not differ at POD7 regarding the three primary outcomes. No adverse effects were observed with any of the ways of application. CONCLUSIONS: Gaseous cryotherapy was not more beneficial than routinely used strategies for applying cold therapy. Further studies with larger sample size and with a more frequent and closer gaseous cryotherapy applications are needed to confirm our results.

Current management of lobular in situ neoplasia.

Although the term of lobular neoplasia was first proposed in 1978 and the term Lobular In situ Neoplasia (LIN) has been incorporated in the current World Health Organisation (WHO) classification to cover both atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS), the clinical significance and the natural history of lobular neoplasia is far from being fully understood. Furthermore problems and confusion still remain surrounding (1) the most appropriate terminology and classification for these lesions, (2) the best course of long-term management after diagnosis.This article summarizes the opinions on LCIS management of a group of Belgian experts.

The ability of isoinertial assessment to monitor specific training effects.

AIM: The aim of this study was to investigate the ability of isoinertial assessment to monitor training effects. Both parametric and curve analysis of the results were used to underline the specificity of maximal strength and maximal velocity resistance training methods. METHODS: Twenty-four untrained subjects were randomly assigned into three groups: a maximal strength-training group (heavy loads: 80% to 98% of the one repetition maximum [1-RM]), a maximal velocity-training group (light loads: 25% to 50% of 1-RM) and a control group. All the subjects were tested in bench press exercises before and after the 6-week training period. An isoinertial dynamometer was used to assess velocity and power at four increasing loads: 35%, 50%, 70% and 95% of the 1-RM load. Post-test protocol also included a trial at 105% of the 1-RM load. RESULTS: Isoinertial assessment demonstrated for both training groups significant gains at each load. Some specific adaptations appeared: strength training presented a greater increase for average power (+49%, P<0.001) and average velocity (+48%, P<0.001) at 95% of 1-RM, while velocity training emerged as a more effective way to improve performance at 35% and 50% of 1-RM (+11 to 22%) in comparison with strength training (+7 to 12%). The analysis of power and velocity curves specified that strength training enhanced performance earlier in the movement, while velocity training extended the propulsive action at the end of movement. CONCLUSION: The original combination of parametric and curve isoinertial assessment appears to be a relevant method for monitoring specific training effects. The complementarity of both strength and velocity training programmes underlined in this study could lead to practical applications in profiling training programmes.

Lumbar functional instability: a critical appraisal of the literature.

The goals of this paper were to define the concept of instability, to describe the way it can be assessed, to report on impairments of the spine stabilization system in patients with low back pain (LBP), to cite the recommended exercises and, lastly, to examine the results of programs based on lumbar stabilization. Patients suffering from lumbar instability appear to belong to a particular subgroup of subjects with LBP. In the literature, several definitions of lumbar instability have been proposed. Radiological instability, for instance, differs from functional instability. Diagnosis remains difficult: the relevance of static and dynamic radiographs appears limited whereas several signs and clinical instability tests have been described in the literature but remain controversial. The functional stability system of the spine consists of three interdependent components: the passive, the active and the neuromuscular subsystems. The benefits of lumbar stabilization programs for LBP patients have been underlined. Lumbar stabilization exercises are aimed at sensorimotor reprogrammation of spine stabilizer muscles intended to improve their motor control skill and delay of response and consequently to compensate for weakness of the passive stabilization system.

Benefits of physical training in fibromyalgia and related syndromes.

OBJECTIVE: To review the published information on physical training for fibromyalgia (FM) and related syndromes. METHODS: A search of Medline literature (via Ovid and PubMed) with the following keywords: FM, chronic fatigue syndrome, therapy, rehabilitation, aerobic, exercise, and cognitive behavioral therapy. The reference lists of articles were examined for additional related articles. RESULTS: Several studies investigated the benefits of graded exercise therapy for patients with FM or related syndromes. Although some systematic reviews have not established an unequivocal benefit of physical training, most authors report a benefit for patients with chronic pain or fatigue. Ideally, such a therapy should be a part of multidisciplinary program. Muscular rehabilitation is reserved for preventing the deconditioning syndrome often reported in patients and the vicious cycle of pain, avoidance and inactivity behaviors, or even kinesiophobia, deconditioning, incapacity and psychological distress. CONCLUSION: This review emphasizes the relevance of graded physical training for treating FM and related syndromes. The development of rehabilitation centers, with experts able to propose a relevant therapy to patients with chronic pain or fatigue, should help alleviate this public health problem.

Chronic fatigue syndrome: a systematic review.

OBJECTIVE: A systematic review of the literature about chronic fatigue syndrome (CFS). METHODS: A search of the Medline database (via Ovid and PubMed) with the key words chronic fatigue syndrome, diagnosis, classification, epidemiology, etiology, physiopathology, metabolism, microbiology, immunology, virology, psychology, drug therapy, rehabilitation, and therapy. The reference lists of each article were examined for additional related articles. RESULTS: CFS was defined in 1988 by the US Centes for Disease Control and Prevention. The prevalence of chronic fatigue syndrome has ranged from 0.2% to 0.7% in the general population. In 1994, the definition of CFS was revised by Fukuda et al. Despite various research in several topics (e.g. infection, immune systems, neuroendocrinology, autonomic activity, neuromuscular involvement), the pathophysiology remains unknown. CONCLUSION: CFS, with its various major clinical and functional impacts, should be associated with a "biopsychosocial model". Progressive muscular rehabilitation, combined with behavioral and cognitive treatment, is an essential part of therapy.

[Value of aerobic rehabilitation in the management of fibromyalgia]. / Intérêt de la revalidation aérobie dans la prise en charge de la fibromyalgie.

This study assesses the influence of a muscular aerobic revalidation program on the management of the fibromyalgia syndrome. After 3 months, benefits consisting of increased muscle performances associated with a reduction of pain and an improvement of quality of life were documented. This study confirms the value of aerobic muscle exercise in fibromyalgia patients.

[Recommendations for a basic functional assessment of low back pain]. / Recommandations pour l'elaboration d'un bilan fonctionnel de base du patient lombalgique.

This article aims to recommend easy, reproducible and valid physical tests and questionnaires to allow a functional and physical assessment of sub-acute and chronic low back pain patients. We recommend the pain visual analogue scale, the French translation of the Roland-Morris Disability Questionnaire (EIFEL) and the Dallas questionnaire to appreciate pain intensity and its influence on patients' quality of life. Sorensen's test is recommended in order to assess trunk extensor muscles endurance. We suggest to measure pelvic and lumbar flexion mobility by means of the inclinometer technique. The test described by McQuade is recommended to assess abdominal muscles static endurance.