Association between isokinetic abdominal muscle strength, pelvic floor muscle strength and stress urinary incontinence severity.

OBJECTIVES: Studies have shown that there is co-activation between abdominal and pelvic floor muscles (PFM) in physiological conditions. This study aimed to assess pelvic floor and isokinetic trunk flexors function in non-active incontinent women, and to investigate the association between the strength of these muscle groups and the severity of stress urinary incontinence (SUI). METHODS: A cross-sectional study was carried out. Twenty-five incontinent women were enrolled after one-hour pad test results and compared to twenty asymptomatic women. The severity of SUI was determined by the Pad test and Urinary Distress Inventory, Short Form (UDI-6). PFM function was assessed using the modified Oxford Scale, intra-vaginal PFM electromyography, and PFM endurance according to the PERFECT scheme. Trunk flexors strength was assessed using a Cybex Norm II dynamometer. RESULTS: Incontinent women had a weaker PFM and isokinetic abdominal muscle strength compared to continent women (P<0,05). SUI severity was negatively correlated with PFM strength (r=-0,620, P=0,001), isokinetic trunk flexors strength (r=-0,605, P=0,001), and PFM endurance (r=-0,561, P=0,003) in incontinent women. A positive correlation between PFM function and isokinetic trunk flexors strength was found in incontinent women (r=0,488, P=0,013). CONCLUSION: Non-active incontinent women had weaker pelvic floor muscles and isokinetic trunk flexors strength compared to continent ones. The positive correlation found between these two muscle groups may be explained by their synergic activity. These findings suggest that the severity of SUI could be related not only to PFM strength but also to abdominal muscle weakness. Further research is needed to recommend abdominal wall training as an alternative method to treat SUI. LEVEL OF PROOF: 3.

Neurogenic bowel dysfunction (NBD) translation and linguistic validation to classical Arabic.

OBJECTIVE: To translate and linguistically validate in classical Arabic; the French version of the neurogenic bowel dysfunction (NBD). PATIENTS AND METHODS: Arabic translation of the NBD score was obtained by the "forward translation/backword translation" method. Patients with multiple sclerosis (MS) and spinal cord injury were included. Evaluation of intestinal and anorectal disorders was conducted by the self-administered questionnaire NBD, which was filled twice two weeks apart. An item-by-item analysis was made. The feasibility, acceptability, internal consistency using Cronbach's alpha, and test-retest repeatability by non-parametric Spearman correlation were studied. RESULTS: Twenty-three patients with colorectal disorders secondary to neurological disease were included, the average age was 40.79±9.16years and the sex-ratio was 1.85. The questionnaire was feasible and acceptable, no items were excluded. The spearman correlation was of 0.842. Internal consistency was judged good through the Cronbach's alpha was of 0.896. CONCLUSION: The Arabic version of NBD was reproducible and construct validity was satisfactory. The study of its responsiveness to change with a larger number of patients will be the subject of further work. LEVEL OF EVIDENCE: 4.

Effects of a low-intensity dynamic-resistance training protocol using an isokinetic dynamometer on muscular strength and aerobic capacity after coronary artery bypass grafting.

OBJECTIVE: Study the effect of muscle strength training on muscle strength, maximal oxygen uptake (VO2max), hemodynamic and anthropometric parameters as well as quality of life after coronary artery bypass grafting (CABG). METHODS: After CABG surgery, 32 patients were randomized into two groups. The first group was to perform aerobic-type training with a cycle ergometer (AT=16). The second group was to perform low-intensity muscle strength training of the quadriceps and hamstrings using an isokinetic dynamometer (i.e. 20 to 30% of peak torque) (ST=16). Before and after the strength training program we conducted a stress test, evaluation of isokinetic force production, 6-minute walking test, body impedance analysis (BIA) and SF-36 quality of life test. RESULTS: Compared to the AT group, the ST group showed better results with improved quadriceps strength (48.2% vs. 8.2%), VO2max (P<.001) and diastolic blood pressure at rest (P=0.01). Quality of life improved in both groups. CONCLUSION: The dynamic-resistance muscle strength training protocol using isokinetic dynamometer can safely (i.e. without clinical symptoms or changes to the ECG and arterial blood pressure) improve muscle strength and VO2max without any major risks in patients post-CABG. These findings should encourage additional studies to validate the relevance of these strength training modalities in rehabilitation centers.

Translation in Arabic, adaptation and validation of the SF-36 Health Survey for use in Tunisia.

OBJECTIVE: To translate into Arabic and validate the SF-36 quality of life index in a Tunisian Arabic population. BACKGROUND: No validated Arabic quality of life index is published. DESIGN: Arabic translation of the SF-36 scale was obtained by the "forward/backward translation" method. Adaptations were made after a pilot study involving 22 subjects from general population. Inter-rater reliability was assessed by use of intraclass correlation coefficient (ICC) and Bland and Altman method. Construct validity was assessed by Spearman rank correlation coefficient (convergent and divergent validity), and factor analysis with Varimax rotation. Internal consistency was assessed by Cronbach alpha coefficient. RESULTS: We note that 130 Tunisian subjects were included in the validation study. No items were excluded. Inter-rater reliability was excellent (ICC=0.98). Cronbach alpha coefficient was 0.94 conferring to translated index a good internal consistency. Expected divergent and convergent validity results suggested good construct validity. Two main factors were extracted by factor analysis and explained 62.3% of the cumulative variance: the first factor represented mental component, the second physical component. The Cronbach alpha coefficient was 0.88 and 0.91 respectively for factor 1 and factor 2. CONCLUSION: We translated into Arabic language and adapted the SF-36 scale for use in Tunisian population. The Arabic version is reliable and valid. Although the scale was validated in a Tunisian population, we expect that it is suitable for other Arab populations, especially North Africans. Further studies are needed to confirm such a hypothesis.

Relationship between muscular strength, gait and postural parameters in multiple sclerosis.

OBJECTIVE: To evaluate muscle strength, balance control and gait capacity in patients with multiple sclerosis (MS) and to study the correlations between these parameters. PATIENTS AND METHODS: Twenty MS patients were evaluated in terms of knee muscle strength, gait and balance parameters. These evaluations were performed using an isokinetic dynamometer (the Cybex II(®)), a Bessou gait analyzer and a Satel(®) force platform, respectively. The patients' results were compared with those of a healthy control group. RESULTS: Hamstring and quadriceps peak torque values were lower in the MS group than in the control group. The sway area was greater in the MS group under eyes-open and eyes-closed conditions. The MS patients displayed lower gait speed, cadence and stride length. Hamstring and quadriceps strength values were significantly correlated with posture and gait parameters. CONCLUSION: The present study revealed the value of an overall evaluation of knee muscle strength, gait and posture in MS patients.

Translation into Arabic and validation of the ASES index in assessment of shoulder disabilities.

OBJECTIVE: To translate into Arabic and validate the "American Shoulder and Elbow Surgeons Evaluation Form" (ASES) for use in a Tunisian population presenting with periarticular pathologies of the shoulder. BACKGROUND: No functional index assessing the functional capacities of the shoulder is presently available in Arabic. PATIENTS AND METHODS: The translation was achieved by means of forward/backward translation. Adaptations were carried out subsequent to a preliminary test involving 15 persons. Patients with periarticular shoulder disabilities were included. Clinical measurements evaluated pain and functional disability by means of the visual analogue scale (VAS). Interrater concordance (repeatability) was assessed using the intraclass correlation coefficient (ICC) and the Bland and Altman method. Construct validity (convergent and discriminant validity) was investigated using the Spearman rank correlation coefficient and a factorial analysis followed by orthogonal rotation. The internal consistency of each factor was graded in terms of the Cronbach alpha coefficient. RESULTS: Eighty (80) patients were included in the study. Interrater concordance was excellent (ICC=0.96). The Bland and Altman method showed a low-variability mean difference. Correlations of the index score with the pain VAS (r=-0.49) and functional disability (r=-0.58) suggested satisfactory convergent validity, and our index likewise showed good discriminant validity. Factorial analysis led to the extraction of two factors with a cumulative variance rate of 92.6% that could not be explained. CONCLUSION: Translated into Arabic, the ASES index was found to possess high metrological qualities. While the index has been satisfactorily validated with regard to a Tunisian population, additional studies are needed to verify its applicability to other Arab populations.

A study of isokinetic trunk and knee muscle strength in patients with chronic sciatica.

OBJECTIVE: To evaluate trunk and knee muscle strength in patients with chronic sciatica. PATIENTS AND METHOD: Twenty-eight patients with right-side chronic sciatica (group 1, G1) and 40 healthy controls (group 2, G2) were evaluated using an isokinetic dynamometer (Cybex Norm II). Quadriceps and hamstring muscle strength were evaluated at concentric velocities of 60 and 120 degrees /s and the trunk muscles were evaluated at concentric velocities of 60 and 90 degrees /s. RESULTS: G1 comprised 15 women and 13 men (mean +/- SD age: 34.787+/-6.06; weight: 65.85+/-5.33kg; height: 165+/-6.92cm). G2 comprised 20 women and 20 men (mean +/- SD age: 35.92+/-6.66; weight: 67.07+/-6.12kg; height: 165.82+/-7.65cm. There were no significant inter-group differences concerning these parameters. In G1, the peak torque values for the trunk extensors were 123.71+/-32.45 and 108.85+/-32.07 Newton metres (Nm) at angular velocities of 60 and 90 degrees /s, respectively. In G2, the values were 192.73+/-64.24 and 168.65+/-53.96Nm, respectively. In G1, the peak torque values for the trunk flexors were 134.32+/-30.77 and 124.39+/-32.59Nm at angular velocities of 60 and 90 degrees /s, respectively. In G2, they were 177.44+/-44.1 and 157.81+/-39.01 Nm, respectively. The difference between G1 and G2 was statistically significant. The peak torque for the right quadriceps in G1 was 100.03+/-24.45 and 78.71+/-22.92Nm at angular velocities of 60 and 120 degrees /s, respectively. In G2, these values were 160.5+/-36.34 and 131.05+/-33.42Nm. The peak torque for the hamstrings in G1 was 56.42+/-13.02 and 50+/-13.55Nm at angular velocities of 60 and 120 degrees /s, respectively. In G2, these values were 97.77+/-33.32 and 84.72+/-31.41Nm. Again the difference between G1 and G2 was statistically significant. We also noted a statistically significant difference between G1 and G2 in terms of the peak quadriceps and hamstring torque values on the left side. In G1, the quadriceps and hamstrings were significantly weaker on the sciatica side than on the unaffected side. CONCLUSION: The present study demonstrated trunk and knee muscle weakness in patients with chronic sciatica, when compared with healthy subjects. This weakness was predominant on the sciatica side. Consequently, the management of these patients should include a knee muscle reinforcement programme.

Chronic neck pain and vertigo: Is a true balance disorder present?

OBJECTIVE: We sought to establish whether chronic neck pain patients suffering from vertigo and instability have true balance disorders. PATIENTS AND METHODS: Ninety-two patients having suffered from chronic neck pain for at least 3 months were enrolled in the present study. Patients with a history of neck trauma or ear, nose and throat, ophthalmological or neurological abnormalities were excluded. The patients were evaluated in a clinical examination (neck mobility) and a test of dynamic and static balance on the Satel((R)) platform in which mediolateral (Long X) and anterior-posterior deviations (Long Y) were monitored. Our patients were divided into three groups: a group of 32 patients with neck pain and vertigo (G1), a group of 30 patients with chronic neck pain but no vertigo (G2) and a group of 30 healthy controls. RESULTS: All groups were comparable in terms of age, gender, weight and shoe size. Osteoarthritis was found in 75% and 70% of the subjects in G1 and G2, respectively. Neck-related headache was more frequent in G1 than in G2 (65.5% versus 40%, respectively; p=0.043). Restricted neck movement was more frequent in G1 and concerned flexion (p<0.001), extension (p<0.001), rotation (p<0.001), right inclination (p<0.001) and left inclination (p<0.001). Balance abnormalities were found more frequently in G1 than in G2 or G3. Static and dynamic posturographic assessments (under "eyes open" and "eyes shut" conditions) revealed abnormalities in statokinetic parameters (Long X and Long Y) in G1. CONCLUSION: Our study evidenced abnormal static and dynamic balance parameters in chronic neck pain patients with vertigo. These disorders can be explained by impaired cervical proprioception and neck movement limitations. Headache was more frequent in these patients.

Physical training combined with dietary measures in the treatment of adult obesity. A comparison of two protocols.

OBJECTIVE: Our objective was to study the effects of physical training combined with dietary measures in obese adults. In a second step, we sought to compare two training protocols and establish the additional contribution of strength training. METHODS: We performed a randomized, prospective survey from July 2004 to November 2007. Included patients were randomized into three groups: a control group (G1), a group (G2) performing dietary measures and a programme of treadmill training at 60% of each individual's maximum heart rate (HRmax) and a group (G3) who followed the G2 programme supplemented with strength training. All patients underwent an initial and final assessment of anthropometric & cardiovascular parameters, muscle strength, dyspnoea during activities of daily living, metabolic disorders, psychological status and quality of life. RESULTS: The greatest weight loss (7.24%) was observed in G3. Reduction in waistline measurement (WL) of 4.3% and 10.26% were noted in G2 and G3, respectively (p < 0.001). The percentage fat body mass fell by 10.4% in G3 (p < 0.001) and 8.6% in G2 (p = 0.03).We particularly noted an improvement in physical condition in groups 2 and 3, with lower HR and blood pressure values at rest and at maximum effort. The overall improvement in both arm and leg muscle strength was greater for G3 than for G2. Likewise, we noted an improvement in the metabolic parameters and depression & anxiety scores for the trained groups (G2, G3), relative to the control group (G1). We also noted improvements in the total impact of weight on quality of life (IWQOL) lite score of 15.2% in G2 and 18% in G3. CONCLUSION: Our survey demonstrated the beneficial effect of combining dietary measures and physical training in obese patients. In addition to weight loss, the programme enabled a reduction in the patients' body fat mass and abdominal obesity, a correction of metabolic disorders and an improvement in aerobic capacity. The improvement in all these parameters also enhanced the patients' psychological status and quality of life. The addition of strength training produced notable improvements in weight loss, arm muscle strength and abdominal obesity.

Results of surgical treatment of congenital convex pes valgus (ten nonidiopathic feet).

PURPOSE OF THE STUDY: Congenital pes valgus is a rare and complex deformity of the foot raising serious diagnostic and therapeutic challenges. The purpose of our work was to present the surgical procedures used in our series and to analyze outcome. MATERIAL AND METHODS: Ten feet presenting congenital convex pes valgus treated surgically over a six-year period using the same operative technique were reviewed at minimum five years follow-up. Idiopathic deformities were excluded from this series. Deformities were secondary to arthrogryposis in five feet, multiple malformative syndrome in four, and diastematomyelia in one. The surgical technique used two approaches: a posteromedial incision to release the dorsal flexors, disinsert the tibialis posterior, open the talonavicular joint, release the Achilles tendon and release the posterior tibiotalar capsule; a lateral incision to lengthen the fibular tendons and perform an osteotomy of the anterior process of the calcaneum. A talonavicular pin and a calcaneocuboid pin maintained the correction. The tibialis posterior tendon was reinserted on the anterior aspect of the talonavicular capsule after incision of the dislocation chamber. RESULTS: Outcome was considered good in five cases and fair in five. Outcome was fair in the arthrogryposis feet. Under correction was observed in two feet and valgus flatfoot in three. Talar necrosis occurred in one foot and navicular necrosis in two. DISCUSSION: Simultaneous correction of the different anomalies observed in the congenital convex foot was achieved in this series. The anatomic and functional results were satisfactory. We recommend avoiding overly extensive release in order to decrease the risk of talar and navicular necrosis. It is also important to check the reduction radiographically during the operation. Patients should use an orthesis for several months postoperatively to avoid recurrence.

[The contribution of capsular distension to the treatment of primary adhesive capsulitis of the shoulder: a comparative study versus rehabilitation]. / Apport de l'arthrodistension dans la prise en charge de la capsulite rétractile primitive de l'épaule : étude comparative versus rééducation.

OBJECTIVES: To describe the epidemiological and clinical features of patients with primitive adhesive capsulitis of the shoulder treated by capsular distension and then rehabilitation; to evaluate the short-, mid- and long-term efficiency of this therapeutic protocol and compare it with rehabilitation alone. MATERIALS AND METHODS: This was a two-year prospective study. Sixty patients were included and divided into populations P1 (capsular distension and rehabilitation) and P2 (rehabilitation only). Assessment of the treatments' efficacy was based on the following parameters: pain on a visual analogue scale (VAS), joint motion in several axes, a simplified Constant score (functional ability) and the SF-36 quality of life score. RESULTS: Thirty patients (mean age: 56) underwent capsular distension. The Constant score was judged to be poor in over half of the patients. All the quality of life parameters were modified. When compared with P2, the P1 group showed a statistically significant improvement in terms of the pain score (p=0.005), anterior elevation (p=0.001), lateral elevation (p=0.005), external rotation (p=0.006) and the Constant score (p<0.001) one week after capsular distension. One year after capsular distension, this gain persisted in a statistically significant manner for all functional parameters and all SF-36 dimensions (p<0.001 for PF, RP, BP, SF and RE; p=0.01 for GH and VT and p=0.002 for MH). CONCLUSION: Our results show that capsular distension and subsequent intensive rehabilitation have a beneficial effect. This combination enables rapid, significant improvement from the first week onwards. The improvement phase lasts for one month and may hold steady for up to 12 months.

[Contribution of exercise and diet in the management of knee osteoarthritis in the obese]. / Apport de l'exercice physique et du régime dans la prise en charge de la gonarthrose chez l'obèse.

OBJECTIVE: Our objective was to determine whether exercise and weight loss are more effective either separately or in combination, in improving pain and physical function in obese adults with moderate knee osteoarthritis (OA). PATIENTS AND METHODS: Forty-five obese adults, with a body mass index greater than 35 kg/m2 or 30

[Functional and quality of life outcome of non-operated rotator cuff tears]. / Le devenir fonctionnel et la qualité de vie des ruptures de la coiffe des rotateurs non opérées.

UNLABELLED: Our objective was to determine the long-term functional and quality-of-life outcomes for patients with rotator cuff tears receiving conservative treatment. We also studied correlations between the Constant and SF-36 scores. MATERIAL AND METHODS: This was a prospective survey carried out on patients having consulted in our Rehabilitation Department between January 1995 and December 2004 for radiologically-confirmed rotator cuff tears and having received medical treatment combined with a rehabilitation programme. The outcome measures used in our study were as follows: degree of motion, muscle strength, degree of pain on a visual analogical scale (VAS) and scores on the Constant and SF-36 scales. RESULTS: The study population consisted of 38 women and 21 men (mean age: 61 years; range 46-75). The mean final outcome measurements were taken after an average of seven years of follow-up (range: 4-12). The VAS score for pain at rest dropped from 68.3+/-31 to 28.3+/-12 (p<10(-3)) over the follow-up period. The score for pain during effort fell from 82.5+/-36 to 40.3+/-15. In all cases, active joint mobility was better at the final assessment (p<0.001). The Constant score rose from 28.8+/-14.2 to 51.6+/-21.8. The SF36 score showed a 16% improvement. Sixty-two percent of patients were satisfied or very satisfied with this treatment. The change over time was rated as good to very good by 42 patients (71.8%). The observed improvement in quality of life was correlated with reduced pain at rest (r=0.62) and during effort (r=0.59) and with the increased Constant score. CONCLUSION: Our results underline the benefits (in terms of short- and long-term pain reduction, functional improvements and better quality of life) of an individualized rehabilitation programme (combined with medical treatment) in cases of rotator cuff tears.

Knee osteoarthritis in 50 former top-level soccer players: a comparative study.

OBJECTIVES: To study the prevalence of knee osteoarthritis in a group of former top-level football players and to assess the condition's impact on joint function and structure, compared with a control group. MATERIALS AND METHODS: A cross-sectional, descriptive study was performed on a group of male former top-level football players (group G1), aged over 45 and with no history of knee trauma, arthritis, arthropathy or surgery. A second group of otherwise matched nonsporting subjects (group G2) was compared with the first group. For each subject, we specified age, weight, height, body mass index (BMI), dominant foot, the presence of knee axis deviation, the presence of pain and functional impairment. The pain level was assessed using a visual analogue scale (VAS). The functional assessment was performed using the Arabic version of the Lequesne index. Moreover, for each former player, we specified a number of sporting parameters, including those related to their playing career. The diagnosis of knee osteoarthritis was made using standard radiological and clinical criteria. The radiological severity of knee osteoarthritis was assessed using the Kellgren and Lawrence classification. We compared the two groups in terms of the frequency of knee osteoarthritis, the severity of pain and disability and the severity of structural impairment. RESULTS: Our study included two groups of patients: a group of 50 former football players (G1) with a mean age of 49.2. Overweight was noted in 40 subjects. The mean number of training hours a week was 14+/-3.5 during their professional career and 2.5 during their retirement. Half of the sportsmen had taken part in more than 200 matches. Knee axis deviation was observed in 29 former players (i.e. 58% of the cases) and 27 displayed genuvarum. A group of 50 nonsporting volunteers (G2) was matched to the G1 group in terms of age, BMI and frequency of axis deviation. Knee osteoarthritis was more common in the football players than in the nonsporting subjects (80% versus 68%), although the difference was not statistically significant. Whereas pain was noted in only six footballers (with an average VAS score of 25.4+/-6.3mm) and was observed in 50% of controls (with a mean VAS score of 39.2mm+/-7.3) (P=0.001). Disability was recorded in six sportsmen, with a mean Lequesne score of 0.38+/-1.27. Disability was more frequent (23 subjects) and more intense (with a mean Lequesne score of 1.71+/-3.2) in the nonsportsmen (P=0.001). The Kellgreen and Lawrence radiological classification revealed that 57.5% of the sportsmen had scores of III or IV, compared with just 29.4% in the control group. CONCLUSION: Knee osteoarthritis is common in male football players. However, our study shows that the condition is less painful and less likely to cause functional disability (but paradoxically more destructive) than in nonsportsmen.

[Results of surgical treatment of congenital convex pes valgus (10 non-idiopathic feet)]. / Résultats du traitement chirurgical du pied convexe congénital.

PURPOSE OF THE STUDY: Congenital pes valgus is a rare and complex deformity of the foot raising serious diagnostic and therapeutic challenges. The purpose of our work was to present the surgical procedures used in our series and to analyze outcome. MATERIAL AND METHODS: Ten feet presenting congenital convex valgus treated surgically over a six-year period using the same operative technique were reviewed at minimum five years follow-up. Idiopathic deformities were excluded from this series. Deformities were secondary to arthrogryposis in five feet, a multiple malformative syndrome in four and diastematomyelia in one. The surgical technique used two approaches: a posteromedial incision to release the dorsal flexors, disinsert the tibialis posterior, open the talonavicular joint, release the Achilles tendon and release the posterior tibiotalar capsule; a lateral incision to lengthen the fibular tendons and perform an osteotomy of the anterior process of the calcaneum. A talonavicular pin and a calcaneocuboid pin maintained the correction. The tibialis posterior tendon was reinserted on the anterior aspect of the talonavicular capsule after incision of the dislocation chamber. RESULTS: Outcome was considered good in five cases and fair in five. Outcome was fair in the arthrogyrposis feet. Undercorrection was observed in two feet and valgus flatfoot in three. Talar necrosis occurred in one foot and navicular necrosis in two. DISCUSSION: Simultaneous correction of the different anomalies observed in the congenital convex foot was achieved in this series. The anatomic and functional results were satisfactory. We recommend avoiding overly extensive release in order to decrease the risk of talar and navicular necrosis. It is also important to check the reduction radiographically during the operation. Patients should use an orthesis several months postoperatively to avoid recurrence.

[Effect of conservative treatment in the management of low-degree urogenital prolapse]. / Apport du traitement conservateur dans la prise en charge du prolapsus urogénital de bas grade. Le devenir après deux ans.

OBJECTIVE: The objective of our study was to determine the respective effects of conservative treatment (pelvic muscle exercises plus advice on healthy living) and the absence of treatment in the management of urogenital prolapse. MATERIALS AND METHODS: Forty-seven women (mean+/-S.D. age: 53.42+/-11.01 years) consulting for genital prolapse (grade I or II cystocele) were randomized into two groups: a conservative treatment group (CTG) and a nontreated group (NTG). The patients' outcomes were rated according to several parameters; a clinical examination, the "Measurement of Urinary Handicap" (MUH) scale, urodynamic tests, the Ditrovie quality of life scale and patient satisfaction on a visual analogue scale (VAS). RESULTS: The immediate post-treatment results showed that pelvic heaviness persisted in only five patients (18.51%) in the CTG compared with fourteen (70%) in the NTG (p<0.001). Furthermore, a significant improvement in the MUH scale score was noted in the CTG compared with the NTG. The Ditrovie score also improved. The maximum urethral closure pressure (MUCP) ranged from 54.4+/-13.23 to 57.81+/-12.8 cm H(2)O in the CTG versus 54.05+/-12.18 to 52.95+/-12.18 cm H(2)O in the NTG. Uroflowmetry revealed a significant improvement in the maximum flow rate. These benefits were maintained two years after cessation of the conservative treatment in 20 of the CTG patients. CONCLUSION: Conservative treatment can be effective in the treatment of low-degree urogenital prolapse and enables the improvement of clinical symptoms and urodynamic parameters. The benefits were maintained two years after treatment cessation.

[Fibromyalgia prevalence in Tunisia]. / Prévalence de la fibromyalgie en Tunisie.

OBJECTIVE: to estimate fibromyalgia (FM) prevalence in Tunisia. METHODS: Data on a cross-section of 1000 individuals aged 15 years or older living in Sfax were collected by interviewers using the London Fibromyalgia Epidemiology Study Screening Questionnaire (LFES- SQ). The sampling was realized by empirical poll and respecting quota according to delegation, rural or urban environment, sex and age according to the demographic national data. The positive screened subjects were invited to be examined to confirm or exclude the FM by applying the 1999 ACR criteria. The questionnaire was administered to a second group of 252 volunteers, all were afterward examined. This allowed to study specificity and sensibility of the questionnaire and allowed to calculate the FM prevalence. RESULTS: 159 subjects were screened positive, only 141 were examined. The specialized exam allowed confirming the diagnosis of FM in 67 subjects. FM prevalence is different according to sex, age, study level and socio-economic level. Two hundred and fifty two volunteers answered the questionnaire then all examined. The questionnaire specificity was 90.8% and the sensibility 79.4%. FM prevalence in Tunisia, calculated by Bayes theorem, is estimated between 8.27% and 12.3%. CONCLUSION: FM prevalence in Tunisia is estimated at least at 8.27%.

[Abdominal obesity and knee ostheoarthritis]. / Obésité abdominale et gonarthrose.

UNLABELLED: The objective of our study was to determine whether waist circumference (WC) is a more reliable indicator than body mass index (BMI) of the presence of knee osteoarthritis in obese subjects. PATIENTS AND METHODS: We performed an observational study of obese patients with no other risk factors for knee osteoarthritis. For each patient, we evaluated BMI, WC, duration of obesity and knee pain. Two groups were identified: "asymptomatic patients" (AG), without knee pain, and "symptomatic patients" (SG). For the SG, we measured pain intensity (visual analog scale [VAS], 0-100 mm) and functional repercussions (using the Lequesne and WOMAC indexes). Patients with knee pain underwent standard radiographic procedures to search for signs of osteoarthritis, and the SG was divided into two subgroups: with radiological signs of osteoarthritis (SG-1) and without radiological signs of osteoarthritis (SG-2). The AG and SG groups and SG-1 and SG-2 groups were compared for age, sex, and duration of obesity. Comparisons of BMI, WC, and function involved the Student's t-test. RESULTS: We recruited 56 patients for the study (82.5% females; mean obesity duration (13+/-6.5 years; mean age 43.21+/-9.58 years). The mean BMI was 39.6+/-7.23 kg/m(2) and mean WC was 113+/-14.3 cm. We found 33 patients (59%) with knee pain. Independent of age, sex, duration of obesity and BMI, the SG showed more significant WC (117.27+/-14.71 cm vs. 107+/-11.75 cm for the AG, P 0.01). In the same group and independent of the already mentioned factors, the patients with radiological signs of osteoarthritis showed significant WC [122+/-15.57 cm (SG-1) vs. 108+/-6.88 cm (SG-2) (P 0.01)]. Moreover, the VAS score of pain at rest and during effort and the WOMAC and Lequesne scores were 16+/-25.7 mm, 75+/-18.3 mm, 12.3+/-8.92 and 11.5+/-5.44 (SG-1) and 7+/-18.4 mm, 70+/-19.2 mm, 5.7+/-3.05, and 6.9+/-3.79 (SG-2), respectively. The difference between SG-1 and SG-2 was significant only for the WOMAC (P=0.015) and Lequesne (P=0.026) scores. CONCLUSION: Independent of BMI, WC appears to be a factor associated with the presence of knee pain and osteoarthritis in obese patients. Furthermore, a high WC is associated with significant functional repercussion.

The isokinetic assessment of peripheral muscle function in patients with coronary artery disease: correlations with cardiorespiratory capacity.

OBJECTIVE: We aimed to determine whether diminished cardiorespiratory capacity in patients with coronary artery disease (CAD) is accompanied by impaired skeletal muscle function as measured by isokinetic dynamometry. We also evaluated the correlation between isokinetic strength and aerobic capacity in these patients. MATERIALS AND METHODS: Fifteen CAD patients and 15 age-matched healthy subjects (mean age 60+/-6 vs. 57+/-3.5 years) underwent maximal laboratory exercise testing, a 6-min walking test and an assessment of peripheral skeletal muscle function by use of an isokinetic apparatus. Quadricep and hamstring function was tested at two angular velocities, 150 and 180 degrees s(-1) with simultaneous electrocardiography monitoring. The cardiorespiratory and mechanical parameters (VO(2), ventilatory threshold [VT], heart rate [HR], and power) were measured at VT and at maximal effort. RESULTS: Quadricep and hamstring peak torque was impaired in CAD patients, with quadriceps peak torque at 180 degrees being 71.13 +/- 14 vs. 91.13 +/- 23 Nm (P<0.01) and hamstring peak torque 46.50+/-10 vs. 59.86+/-12 Nm (P<0.01). CAD subjects presented a deficient aerobic capacity as compared with the healthy subjects at maximal effort. At VT, the VO(2), ventilation, and HR were significantly lower in CAD patients, at 13.77+/-2.33 vs. 17.08+/-3.59 ml min(-1) kg(-1) (P<0.05), 29.64 +/- 664 vs. 37.76 +/- 7.2 ml min(-1) (P<0.05), and 86+/-14 vs. 111+/-15 beats min(-1) (P=0.001), respectively. The 6-min walking distance was significantly shorter for CAD patients than healthy subjects (425.93+/-52.77 vs. 551.46 +/- 57.94 m; P<0.01). In CAD patients quadriceps and hamstring strength was not correlated with VO(2) at maximal effort and at VT. Total distance walked during the 6-min walk and VO(2)max were correlated (r=0.869; P<0.001) but not at VT. CONCLUSION: CAD patients showed impaired cardiorespiratory capacity accompanied by increased muscle fatigability as compared with healthy subjects. An isokinetic muscle assessment in these patients must be achieved systematically and seems to have value in cardiovascular rehabilitation.