The Effectiveness of Compression Garments for Reducing Pain in Non-Vascular Ehlers-Danlos Syndromes: A Prospective Observational Cohort Study.

Patients with Ehlers-Danlos Syndrome (EDS) frequently suffer from severe chronic pain. We carried out an observational cohort study to assess the effectiveness of compression garments (CGs) for reducing this pain. Patients with non-vascular EDS were given custom-made Cerecare® CGs during a visit to a specialist clinic (visit V0). They were followed up over 2 years with visits every 6 months (V1-V4). At each visit, pain was assessed for the joints treated with CGs using a visual analogue scale (VAS; 0-100 mm). Additional measures were obtained to assess neuropathic pain (painDETECT questionnaire), proprioception/balance (Berg Balance Scale), and functional independence, amongst others. Data were analyzed for 67 patients with EDS (hypermobile: 91%; classical: 6%; kyphoscoliotic: 3%). For the most painful joint, the mean VAS rating was 71.5 ± 22.8 mm at V0; this decreased to 53.5 ± 25.5 mm at V1 and 45.7 ± 29 mm at V4 (t-tests: p < 0.0001). From V0 to V4, improvements were also seen for pain at the other joints, neuropathic pain, functional independence, proprioception/balance, and the incidence of sprains and dislocations/subluxations, although not all comparisons were statistically significant (p < 0.05 level). These results indicate that CGs may effectively reduce the pain and joint instability in non-vascular EDS patients.

Responsiveness of the Motor Capacities Scale to upper limb reconstructive surgery in persons with tetraplegia due to cervical spinal cord injury.

STUDY DESIGN: Psychometric Study. OBJECTIVES: To assess responsiveness of the Motor Capacities Scale (MCS) in people with tetraplegia who have undergone upper limb reconstructive surgery. SETTINGS: Rehabilitation clinics in France. METHODS: The MCS is an arm/hand function test with 31 basic tasks, subdivided into four sub-categories (MCS A, MCS B, MCS C, and MCS D). Data were recorded preoperatively and following full completion of the surgical program. The Functional Independence Measure (FIM) and a ten-point numeric scale related to patients' satisfaction with the overall surgical result were included. Data were analyzed using responsiveness measures-the effect size (ES), the standardized response mean (SRM), and the minimal clinically important difference (MCID). RESULTS: Twenty-seven participants were included. Fourteen patients underwent unilateral surgery and 13 bilateral surgery. ES and SRM were moderate or good (ES/SRM of MCS B = 0.76/0.81, ES/SRM MCS C = 0.68/0.77, and ES/SRM MCS D = 0.77/0.88). For MCS A and FIM, both SRM and ES showed a small degree of responsiveness. For the MCS total score, the ES value indicated a moderate degree of responsiveness while SRM was excellent. Total MCS score, MCS C subscore and MCS D subscore showed significantly higher ES values in the "bilateral surgery" group than in the "unilateral group". The estimation of MCIDs showed low threshold values of MCS scores changes (total score and subscores) beyond which the satisfaction rate is >6. CONCLUSIONS: This study provides evidence of acceptable responsiveness of the MCS to changes using the SRM following upper limb reconstruction in patients with tetraplegia.

Validity and internal consistency of the French version of the revised Skin Management Needs Assessment Checklist in people with spinal cord injury.

STUDY DESIGN: Cross-sectional psychometrics study. OBJECTIVES: To determine the construct validity and internal consistency of the revised Skin Management Needs Assessment Checklist (revised SMnac). SETTING: Six spinal cord rehabilitation centers. METHODS: One-hundred and thirty-two community-dwelling individuals with spinal cord injury (SCI) were included. Construct validity was assessed by a Spearman's rank correlation coefficient between the revised SMnac and several questionnaires: Rosenberg Self-Esteem Scale, Ways of Coping Questionnaire, Hospital Anxiety and Depression Scale (HADS), Braden scale; or clinical variables: educational level, presence of a pressure ulcer (PU), history of multiple PUs, time since injury, and pain. RESULTS: The study evidenced construct validity with a fair to moderate correlation coefficient between the revised SMnac and Rosenberg scale (rs = 0.25; p = 0.03), active coping (rs = 0.29; p = 0.001), HADS (rs = -0.43; p < 0.0001), and time since injury (rs = 0.49; p < 0.0001). The presence of PU and history of multiple PUs were strongly correlated with the revised SMnac score (respectively, p = 0.01 and 0.001). Internal consistency was excellent (α = 0.907). CONCLUSION: These results show that the revised SMnac is a valid tool to assess PU self-management in individuals with SCI. Further studies are needed to assess the revised SMnac's responsiveness to change.

Return to drive after non-evolutive brain damage: French recommendations.

Return to drive after brain damage is a crucial question either for patients than health professionals. The Société française de medicine physique et de réadaptation (SOFMER) and Comète France association developed recommandations for patient's identification, evaluation and accompaniment as part of their project to resume to drive. The place of rehabilitation process and patient's focus has been also discussed. AIMS: Using a literature review, the aim was to define clinical pathways to determine people who need a fitness to drive evaluation after a non-evolutive brain damage as well as the assessment process. METHOD: Following the method for Clinical practice guidelines, 1388 abstracts were identified, among which 379 were analysed and confronted with the working group's experience. The draft propositions were submitted to a review group before being validated by the High French Health Autority. RESULT: No article enabled the development of recommendations above the "expert opinion". The detection of sensory (visual), sensitive, motor and/or cognitive sequelaes is needed before return to drive. It is not recommended to return to drive in case of unilateral spatial neglect. Different assessment strategies, function of sequeale's gravity, are proposed after stroke or brain injury. In case of sequeale, the assessment process (clinical, cognitive, on road evaluation) has to be pluriprofessional. The results are the subject of a pluriprofessional synthesis, shared with the patient and, if possible, in the presence of a close. An accompaniment to maintain the best mobility of the person is needed, whatever the assessment result.