A Controlled and Retrospective Study of 144 Chronic Low Back Pain Patients to Evaluate the Effectiveness of an Intensive Functional Restoration Program in France.

STUDY DESIGN: A controlled and retrospective study of 144 chronic low back pain patients to evaluate the effectiveness of an intensive functional restoration program in France. OBJECTIVE: Evaluating the efficiency of an intensive, dynamic and multidisciplinary functional restoration program in patients with chronic low back pain (LBP), during 6 and 12 months follow up. SUMMARY OF BACKGROUND DATA: Chronic low back pain disease has a multifactor nature, involving physical, psychological professional and social factors. A functional restoration program (FRP) has been included in a multidisciplinary training program which provides an efficient therapeutic solution. However, the effectiveness of an FRP has not been yet established. METHODS: 144 subjects (71 males, 73 females) with chronic low back pain were included in a functional restoration program. The FRP includes physiotherapy and occupational therapy interventions together with psychological counselling. Patients participated as in- or outpatients 6 h per day, 5 days a week over 5 weeks. Pain intensity, trunk flexibility, trunk strength, lifting ability, quality of life and return to work were recorded before, immediately after, and at 6 months and 12 months after the treatment period. RESULTS: All outcome measures were significantly higher just after the FRP (144 patients) and at 6 and 12 months (from available data in 31 subjects) compared to pre-treatment values. This FRP for chronic low back pain maintained its benefits whatever the patient's activities. CONCLUSIONS: The effects reflected on all outcome measures, both on short and long term follow-up. The multidisciplinary FRP for chronic low back pain patients durably stopped the de-conditioning syndrome and involved new life-style habits for the patient, daily pain management and a return to work.

Functional restoration of the spine: effect of initial pain level on the performance of subjects with chronic low back pain.

BACKGROUND: Chronic low back pain is a persistent lumbar pain of multifactorial origin. The initial pain level remains poorly used to analyze and compare responses in low back pain patients in a reconditioning program. OBJECTIVE: To assess and evaluate the responses of subjects with very painful chronic low back pain in a dynamic and intensive care program. METHODS: A total of 134 patients with chronic low back pain were included in a spine functional restoration program for five weeks. The subjects were classified into two groups by level of pain: a group experiencing severe pain (n=28) and a group experiencing mild to moderate pain (n=106). All subjects received identical support consisting primarily of physiotherapy, occupational therapy, cardiovascular and muscular reconditioning as well as psychological counselling. The physical parameters (flexibility, muscular strength) and psychological (quality of life) were measured before (T0) and after the program (T5sem). RESULTS: All physical and functional performances of the subjects with severe pain were lower and the impact of back pain on quality of life for these subjects was increased. All significant differences at T0 between the two groups were no longer present at T5sem. DISCUSSION: Muscular atrophy is more important in subjects with severe pain at T0. The intense pain would cause kinesiophobia and central inhibition in chronic low back pain. The analgesic effects of the spine functional restoration program allowed subjects to obtain similar physical, functional and psychological performances at the end of the five weeks of support. CONCLUSIONS: Patients with very painful chronic low back pain respond favourably to the dynamic and intensive program. The intensity of low back pain had no effect on responses to the program. The spine functional restoration program enables patients to better manage their pain, whatever its level.

Quantitative assessment of the velocity-dependent increase in resistance to passive stretch in spastic plantarflexors.

BACKGROUND: Although numerous studies revealed that isokinetic dynamometers were valuable tools for assessing spastic hypertonia, no standard methodology using such devices is currently widespread in clinical setting. The aim of this study was to standardize a protocol to assess spastic hypertonia in the triceps surae. METHODS: The passive resistance during dorsiflexions imposed from 10 to 300 degrees /s with an isokinetic dynamometer was measured at the neutral position in 15 patients with spastic hypertonia and 12 healthy subjects. The normalized passive resistance was obtained by expressing raw passive resistance as a percent of the values measured at the lowest velocity (10 degrees /s). EMG signals from plantar and dorsiflexors were also recorded. FINDINGS: While no significant difference between spastic patients and control subjects was observed in raw passive resistance values, the difference was significant for each tested velocity when considering the normalized values. Furthermore, the Ashworth score was significantly correlated with the normalized passive resistance for each velocity whereas no correlation was observed with the raw passive resistance. For the patients, except at the highest velocity, the normalized passive resistance was not affected by the fact that reflex responses in the triceps surae were elicited or not. INTERPRETATION: The normalized passive resistance, expressed with respect to the initial one, i.e., measured at very low velocity, seems a very effective parameter to quantify the velocity-dependent increase in resistance to passive stretch in spastic plantarflexors. However, while the simplicity of the isokinetic tests and the reduced time of data treatment seems to support the clinical use of this methodology, further investigations are required to definitely standardize the protocol.

Differences in kinematic parameters and plantarflexor reflex responses between manual (Ashworth) and isokinetic mobilisations in spasticity assessment.

OBJECTIVE: The purpose of this study was first to compare the kinematic parameters of imposed ankle mobilizations measured during Ashworth or isokinetic tests and, second, to better understand why the stretch reflex was more or less easily elicited by one method or the other. METHODS: Passive dorsiflexions were applied on eight adult patients with plantarflexor spasticity in two conditions: (i) manually, using the Ashworth test where passive dorsiflexions were performed freely by seven rehabilitation clinicians, and (ii) instrumentally, using an isokinetic device (Cybex Norm) and a dorsiflexion velocity at 300 degrees /s. Mean values of initial ankle position, maximal angular velocity (theta;'(max)), maximal angular acceleration (theta;''(max)) and plantarflexor reflex responses obtained with each method were compared. RESULTS: During the Ashworth test, all the patients presented reflex activities in the triceps surae while, during the isokinetic mobilization, only three out of the eight patients tested shown reflex responses. theta;'(max) values were significantly higher (P<0.05) in the manual test (308+/-80 degrees /s vs 216+/-5.5 degrees /s for the isokinetic test). The most marked difference concerned the theta;''(max) values (5046+/-2181 degrees /s(2) for the Ashworth test vs 819+/-18 degrees /s(2) for the isokinetic test, P<0.001). This parameter was significantly correlated with the mean rms-EMG values of the gastrocnemius lateralis (GL) and the soleus (SOL). CONCLUSIONS: This study indicates that passive dorsiflexions imposed during Ashworth and isokinetic tests largely differ in velocity and acceleration, and the higher dynamic parameters evaluated during the Ashworth test could mainly explain that the stretch reflex was more easily elicited during this manual testing. SIGNIFICANCE: If isokinetic devices offer numerous advantages in the assessment of passive resistance to spastic muscle stretch, they cannot be used to simulate the manual test.

Effect of incremental and submaximal constant load tests: protocol on perceived exertion (CR10) values.

The purpose of the present investigation was to determine to what extent the protocol (incremental and constant load exercises) affects the ratings of perceived exertion for a given submaximal intensity on a cycle ergometer. 10 healthy and well-trained male students (M age=23 yr., SD=2.9) performed an incremental exercise to determine maximal oxygen uptake (VO2 max), maximal aerobic power, and the ratings of perceived exertion (CR10) corresponding to 70% and 75% VO2 max (CR10(70i) and CR10(75i)). Two 30-min. constant load exercises set at these intensities were performed to establish the corresponding CR10 values. CR10(70i) (5.6 +/- 1.9) and CR10(75i) (6.2 +/- 1.9) were significantly higher than all CR10 values collected at Minutes 5, 10, 15, 20, 25, and 30 of the constant load exercises. These results indicate that, for a given exercise intensity (70% and 75% VO2 max), subjects are rated higher during an incremental exercise than during a 30-min. submaximal constant load test. Therefore, when coaches and physiotherapists want to use CR10 values reported during an incremental standard exercise to set training loads, they have to be prudent since the same relative exercise intensity does not seem to be perceived identically during a submaximal constant exercise as during an incremental one.

Cardiorespiratory and efficiency responses during arm and leg exercises with spontaneously chosen crank and pedal rates.

The aim of this study was to compare the cardiorespiratory and efficiency responses between upper (T(UBE)) and lower (T(LBE)) body exercises at the same relative power outputs and with spontaneously chosen crank (SCCR) or pedal (SCPR) rates. Twelve participants performed exercise bouts set at 20, 40, 60 and 80% of maximal power (MP) separated by passive recovery periods. Oxygen uptake, ventilation, gross and work efficiencies during T(LBE) were significantly (P < 0.05) higher than during T(UBE). These results suggest that these responses were not directly related to the relative intensities. However, no significant difference was found for delta efficiency and heart rate values. During T(UBE) and T(LBE), gross efficiency increased significantly (P < of MP for T(UBE) and T(LBE) and the same SCCR and SCPR could explain these results. The present results confirm that the cardiorespiratory and efficiency responses between arm and leg exercises are not always similar, although the power output are normalized in relation to MP and add to the understanding of differences between upper and lower body.

Ventilatory thresholds in arm and leg exercises with spontaneously chosen crank and pedal rates.

The present study assessed whether the first and the second ventilatory thresholds (VT1 and VT2) were dependent on the muscle groups solicited when spontaneously chosen crank and pedal rates are used. 20 physical education male students (22 +/- 2.2 yr.) performed two maximal incremental tests randomly assigned using an increment of 15 and 30 W every minute for arm and leg exercises, respectively. These tests were used to measure the maximal oxygen uptake (VO2 max) and to identify VT1 and VT2. The absolute oxygen uptake (VO2) values measured at VT1, VT2, and at maximal workload were significantly (p < .05) lower during arm and leg exercises. However, VT1 and VT2 expressed in percent of VO2 max were not significantly different between arm and leg exercises (54.1 +/- 8.2 vs 57.2 +/- 11.4%; and 82.5 +/- 6.4 vs 84.6 +/- 5.1% at VT1 and VT2, respectively). In addition, at the two thresholds, none of the variables measured during arm and leg exercises were significantly correlated with the exception of spontaneously chosen crank and pedal rates (p < .01; r = .75 and r = .69 for VT1 and VT2, respectively). Probably due to the different training status and skill level, no extrapolation can be made to specify the arm thresholds from the leg. These results underline the need to specify the ventilatory thresholds from specific arm ergometer measures obtained from tests performed with spontaneously chosen crank and pedal rates and, thus, close to sport and recreational activities, when they are used for training and rehabilitation programs.