[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.

[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.

Efficacy and cost-effectiveness: A study of different treatment approaches in a tertiary pain centre.

BACKGROUND: Chronic pain is considered to be a complex phenomenon, involving an interrelation of biological, psychosocial and sociocultural factors. Currently, no single treatment or therapy can address all aspects of this pathology. In our expert tertiary pain centre, we decide to assess the effectiveness of four treatments for chronic pain classically proposed in our daily clinical work: physiotherapy; psycho-education; physiotherapy combined with psycho-education; and self-hypnosis/self-care learning. METHODS: This study included 527 chronic pain patients, with a mean duration of pain of 10 years. Patients were allocated either to one of the four pre-cited treatment groups or to the control group. Pain intensity, quality of life, pain interference, anxiety and depression were assessed before and after treatment. RESULTS: This study revealed a significant positive effect on pain interference and anxiety in patients included in the physiotherapy combined with psycho-education group, after 20 sessions spread over 9 months of treatment. The most prominent results were obtained for patients allocated to the self-hypnosis/self-care group, although they received only six sessions over a 9-month period. These patients showed significant benefits in the areas of pain intensity, pain interference, anxiety, depression and quality of life. CONCLUSIONS: This clinical report demonstrates the relevance of biopsychosocial approaches in the improvement of pain and psychological factors in chronic pain patients. The study further reveals the larger impact of self-hypnosis/self-care learning treatment, in addition to a cost-effectiveness benefit of this treatment comparative to other interventions.

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.