Detection of progressive idiopathic scoliosis during growth using back surface topography: a prospective study of 100 patients.

UNLABELLED: The progression of adolescent idiopathic scoliosis is typically monitored via regular radiographic follow-up. The Cobb angle (as measured on whole-spine radiographs) is considered as the gold standard in scoliosis monitoring. OBJECTIVE: To determine the sensitivity and specificity of back surface topography parameters, with a view to detecting changes in the Cobb angle. PATIENT AND METHOD: One hundred patients (mean age: 13.3) with Cobb angles greater than 10 degrees were included. Topographic parameters were measured in a standard position and in a position with hunched shoulders. Gibbosities and spinal curvatures were evaluated. RESULTS: An increase of more than 2 degrees in any one gibbosity or in the sum of the gibbosities (in either of the two examination positions) enabled the detection of a five-degree increase in the Cobb angle with a sensitivity of 86% and a specificity of 50%. CONCLUSION: If the present results are confirmed by other studies, analysis with back surface topography parameters may reduce the number of X-ray examinations required to detect increases in the Cobb angle.

Inter-observer reproducibility of back surface topography parameters allowing assessment of scoliotic thoracic gibbosity and comparison with two standard postures.

The objective of this work was to analyze the inter-observer reproducibility of an upright posture designed to bring out the thoracic humps by folding the upper limbs. The effect of this posture on back surface parameters was also compared with two standard radiological postures. A back surface topography was performed on 46 patients (40 girls and 6 boys) with a minimum of 15° Cobb angle on coronal spinal radiographs. Inter-observer reliability was evaluated using the typical error measurement (TEM) and Intraclass Correlation Coefficient (ICC). Variations between postures were assessed using a Student's t test. The inter-observer reproducibility is good enough for the three postures. The proposed posture leads to significant changes in the sagittal plane as well as in the identification of thoracic humps. This study shows the reproducibility of the proposed posture in order to explore the thoracic humps and highlights its relevance to explore scoliosis with back surface topography systems.

Physical and rehabilitation medicine (PRM) care pathways: "patients after total knee arthroplasty".

This document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (SOFMER) and the French Federation of PRM (FEDMER). These documents describe the needs for or a specific type of patients; PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes. "Care pathways in PRM" is a short document designed to enable the reader (physicians, decision-maker, administrator, lawyer or finance manager) to quickly apprehend the needs of these patients and the available therapeutic care structures for proper organization and pricing of these activities. Patients after total knee arthroplasty are classified into three care sequences and two clinical categories, each one being treated with the same six parameters according to the International Classification of Functioning, Disability and Health (WHO), while taking into account personal and environmental factors that could influence the needs of these patients.

Physical and rehabilitation medicine (PRM) care pathways: "patients after total hip arthroplasty".

This document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (SOFMER) and the French Federation of PRM (FEDMER). These documents describe the needs for or a specific type of patients; PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes. "Care pathways in PRM" is a short document designed to enable the reader (physicians, decision-maker, administrator, lawyer or finance manager) to quickly apprehend the needs of these patients and the available therapeutic care structures for proper organization and pricing of these activities. Patients after total hip arthroplasty are classified into three care sequences and two clinical categories, each one being treated with the same six parameters according to the International Classification of Functioning, Disability and Health (WHO), while taking into account personal and environmental factors that could influence the needs of these patients.

The field of competence of the specialist in physical and rehabilitation medicine (PRM).

The Field of Competence (FOC) of specialists in Physical and Rehabilitation Medicine (PRM) in Europe follows uniform basic principles described in the White Book of PRM in Europe. An agreed basis of the field of competence is the European Board curriculum for the PRM-specialist certification. However, due to national traditions, different health systems and other factors, PRM practice varies between regions and countries in Europe. Even within a country the professional practice of the individual doctor may vary because of the specific setting he or she is working in. For that reason this paper aims at a comprehensive description of the FOC in PRM. PRM specialists deal with/intervene in a wide range of diseases and functional deficits. Their interventions include, prevention of diseases and their complications, diagnosis of diseases, functional assessment, information and education of patients, families and professionals, treatments (physical modalities, drugs and other interventions). PRM interventions are often organized within PRM programmes of care. PRM interventions benefit from the involvement of PRM specialists in research. PRM specialists have knowledge of the rehabilitation process, team working, medical and physical treatments, rehabilitation technology, prevention and management of complications and methodology of research in the field. PRM specialists are involved in reducing functional consequences of many health conditions and manage functioning and disability in the respective patients. Diagnostic skills include all dimensions of body functions and structures, activities and participation issues relevant for the rehabilitation process. Additionally relevant contextual factors are assessed. PRM interventions range from medication, physical treatments, psychosocial interventions and rehabilitation technology. As PRM is based on the principles of evidence-based medicine PRM specialist are involved in research too. Quality management programs for PRM interventions are established at national and European levels. PRM specialists are practising in various settings along a continuum of care, including acute settings, post acute and long term rehabilitation programs. The latter include community based activities and intermittent in- or out-patient programs. Within all PRM practice, Continuous Medical Education (CME) and Continuous Professional Development (CPD) are part of the comprehensive educational system.

An assessment of patient satisfaction for a short-stay program in a physical and rehabilitation medicine day hospital.

INTRODUCTION: The aim of the Physical and Rehabilitation Medicine (PRM) day hospital's short-stay program is to propose a one- or two-day medical and psychosocial assessment to patients with disabilities. The day hospital is run by an interprofessional team, using interdisciplinary cooperation and a hospital/community network. OBJECTIVES: To describe a tool for assessing patient satisfaction and to present the results of our survey. PATIENTS AND METHODS: A self-administered questionnaire about patient satisfaction was created and given to patients coming to the PRM day hospital. The questionnaire included 27 multiple-choice questions, two visual analogic scales, and one free-response question. The survey was conducted over two months. For the 603 annual day hospital sessions, 143 questionnaires on 143 sessions were filled out. RESULTS: Patients found the questionnaire easy to use, but a few needed help to fill it out. It permitted us to highlight the places where the short-stay program performed unsatisfactorily. CONCLUSIONS: The self-administered questionnaire seems to be appropriate for assessing patient satisfaction. The highest scores helped to emphasize where the program was functioning correctly, and the lowest scores allowed us to identify the points that needed to be improved.

Physical and rehabilitation medicine section and board of the European Union of Medical Specialists. Community context; history of European medical organizations; actions under way.

The European Community is based on a series of treaties and legal decisions, which result from preliminary documents prepared long before by different organizations and lobbies. The European union of medical specialists (Union européenne des médecins specialists [UEMS]) came into being in order to address the questions raised by European directives (e.g., free circulation of people and services, reciprocal recognition of diplomas, medical training, quality improvements). The specialty sections of the UEMS contribute actively to this work. The physical and rehabilitation medicine (PRM) section is composed of three committees: the PRM board is devoted to initial and continuing education and has published a harmonized teaching programme and organized a certification procedure, which can be considered as a European seal of quality; the Clinical Affairs Committee is concerned with the quality of PRM care, and it has set up a European accreditation system for PRM programs of care, which will help to describe PRM clinical activity more concretely; and the Professional Practice Committee works on the fields of competence in our specialty. This third committee has already published a White Book, and further documents are being prepared, based on both the International classification of functioning, disability and health (ICF) and reference texts developed by the French Federation of PRM.

[Rehabilitation after anterior cruciate ligament reconstruction: inpatient or outpatient rehabilitation? A series of 103 patients]. / Rééducation après reconstruction du ligament croisé antérieur: kinésithérapie de proximité ou centre de rééducation? A propos d'une série de 103 patients.

PURPOSE OF THE STUDY: The goal of this work was to evaluate outpatient rehabilitation after anterior curciate ligament reconstruction using the bone-tendon technique. MATERIAL AND METHODS: This was a prospective non-randomized study of 103 consecutive patients participating in the same rehabilitation program, excepting for the first month. During the first postoperative month, 55 patients (group A) attended a physical therapy outpatient clinic near their home and 48 patients (group B) followed the same rehabilitation protocol at an inpatient facility of their choice. We recorded preoperative data for age, sex, weight, height and function (sports, occupational activities). Surgery data concerned delay between severe sprain and surgery, and the exact surgical procedure used (meniscal tear, associated procedure). Clinical assessment (mobility, effusion, clinical and radiological laxity) and functional scores (Tegner, Lysholm, Arpege, IKDC) as well as delay to recovery of gait and to renewed physical activity were recorded at 3 and 6 weeks and 4, 6 and 12 months postoperatively. Two isokinetic tests were done 4 and 6 months postoperatively. RESULTS: There was no statistical difference for the pre and peroperative data between the two groups, with the exception of meniscal tears that were more frequent in group A (p<0.05). Postoperative outcome and complications were not significantly different between the 2 groups except for greater flexion at 3 weeks in group B (related to difference in measurement date). Fifteen complications were observed in each group: 4 reflex dystrophies and 2 cyclope syndromes in each group, 5 patellar syndromes in group A and 1 in group B; 3 painful surgical wound sites in group A and 8 in group B (including one requiring revision). In group A there was one early failure due to a surgical error requiring revision. At 1 year, there were 2 cases of persistent femoropatellar syndromes, one of which occurred after reflex dystrophy. A high percentage of the patients were lost to follow-up (45% in group A and 50% in group B) and lack of randomization should also be considered when interpreting the results. DISCUSSION: This is the first report comparing inpatient and outpatient rehabilitation protocols after anterior cruciate ligament reconstruction. The only reports in the literature have compared different ambulatory rehabilitation programs that appear to be internationally accepted as the routine procedure. The current trend towards short hospital stays for surgery is compatible with outpatient rehabilitation programs if dependent patients receive proper support from an ambulatory medical unit, a physical therapist or a home assistant. Our study demonstrated that the bone-tendon technique for anterior cruciate ligament reconstruction is compatible with an outpatient rehabilitation program if quality medical and surgical follow-up is ensured. This type of rehabilitation program gives results comparable with those obtained after inpatient programs conducted in a rehabilitation facility during the first postoperative month.