SAS-PRP Study: A Real-Life Satisfaction Assessment in Patients with Cartilage Lesions of the Knee Treated by Platelet-Rich Plasma.

Platelet-rich plasma (PRP) is a rising therapy treating locomotor system lesions such as knee osteoarthritis. The objective of this study was to evaluate patients' satisfaction 6 to 12 months after a PRP injection for cartilage lesions of their knee under real-life conditions. Patients' satisfaction was assessed by a specific questionnaire named SATMED-Q©, which explores six different dimensions of a given treatment. In addition, pain and function were assessed thanks to VAS pain, WOMAC, and IKDC scores. Responders were identified through the OMERACT-OARSI criteria. We observed excellent satisfaction after a PRP injection with a SATMED-Q© score of 80.81% 6 to 12 months after the procedure. Even when there was no significant improvement in pain and function scores, 52% of the evaluated population fulfilled the OMERACT-OARSI criteria and were considered responders. According to the sub-group analysis, patients with less osteoarthritis damage (i.e., Kellgren-Lawrence grades 1-2) and older study subjects (i.e., >40 years old) with focal chondropathy had benefited most from their PRP injection. Thus, platelet-rich plasma seems to be a well-tolerated and efficient therapy for cartilage lesions of the knee.

Chronic Low Back Pain: A Narrative Review of Recent International Guidelines for Diagnosis and Conservative Treatment.

Chronic low back pain (cLBP) is a public and occupational health problem that is a major professional, economic and social burden. We aimed to provide a critical overview of current international recommendations regarding the management of non-specific cLBP. We conducted a narrative review of international guidelines for the diagnosis and conservative treatment of people with non-specific cLBP. Our literature search yielded five reviews of guidelines published between 2018 and 2021. In these five reviews, we identified eight international guidelines that fulfilled our selection criteria. We added the 2021 French guidelines into our analysis. Regarding diagnosis, most international guidelines recommend searching for so-called yellow, blue and black flags, in order to stratify the risk of chronicity and/or persistent disability. The relevance of clinical examination and imaging are under debate. Regarding management, most international guidelines recommend non-pharmacological treatments, including exercise therapy, physical activity, physiotherapy and education; however, multidisciplinary rehabilitation, in selected cases, is the core treatment recommended for people with non-specific cLBP. Oral, topical or injected pharmacological treatments are under debate, and may be offered to selected and well-phenotyped patients. The diagnosis of people with cLBP may lack precision. All guidelines recommend multimodal management. In clinical practice, the management of individuals with non-specific cLBP should combine non-pharmacological and pharmacological treatments. Future research should focus on improving tailorization.

Traum'cast: an online, open-access educational video podcast series for teaching military trauma care to all healthcare providers.

The aim of this paper was to describe the development of 'Traum'cast', an ambitious project to create a high-quality, open-access, 12-week video podcast programme providing evidence-based continuing medical education for civilian and military healthcare practitioners dedicated to the management of trauma caused by weapons of war. The management of such patients became a particular public health issue in France following the 2015 terrorist attacks in Paris, which highlighted the need for all healthcare professionals to have appropriate knowledge and training in such situations. In 2016, the French Health General Direction asked the French Military Medical Service (FMMS) to create a task force and to use its unique and considerable experience to produce high-quality educational material on key themes including war injuries, combat casualty care, triage, damage control surgery, transfusion strategies, psychological injury and rehabilitation. The material was produced by FMMS and first broadcast in French and for free, on the official FMMS YouTube channel in September 2020. Traum'cast provides evidence-based continuing medical education for civilian and military healthcare practitioners. Traum'cast is an educational innovation that meets a public health requirement.

Core qualities of an educational program to reduce fears and beliefs of GPs about low back pain: Results of a GPs, experts and literature survey.

BACKGROUND: Despite the fact that non-specific low back pain (LBP) is a frequent symptom, its management remains suboptimal in primary care. A plausible reason is the persistence of erroneous fears and beliefs among general practitioners (GPs). OBJECTIVE: We aimed to determine the core qualities an educational program should have to reduce erroneous fears and beliefs about LBP among GPs. METHODS: We used a two step-approach. In the first step, meaningful qualities were collected using comprehensive data source triangulation from GPs, experts and literature. In the second step, qualities were extracted by three independent investigators in a standardized manner using the Template for Intervention Description and Replication checklist. RESULTS: Qualities were collected from 8 GPs, 24 experts and 15 articles. Extraction revealed a wide range of qualities depending on participants' background and literature. After consensus between investigators, the most meaningful qualities included evidence-based messages and web-based interventions (videos and classes) delivered by a multidisciplinary panel of experts. We found no systematic trend for when and how much, and how to tailor the intervention. CONCLUSIONS: Data source triangulation revealed that the core qualities of an educational program targeting fears and beliefs about LBP among GPs should include evidence-based information, web-based interventions and a multidisciplinary panel of experts. Our findings will help us to design a provisional targeted educational intervention. This will be further assessed in a mixed-method feasibility study and then in a randomized controlled trial.

Spinopelvic sagittal alignment of patients with transfemoral amputation.

PURPOSE: This study aims to describe the spinopelvic sagittal alignment in transfemoral amputees (TFAs) from a radiologic study of the spine with a postural approach to better understand the high prevalence of low back pain (LBP) in this population. METHODS: TFAs underwent X-rays with 3-D reconstructions of the full spine and pelvis. Sagittal parameters were analyzed and compared to the literature. Differences between TFAs with and without LBP were also observed. RESULTS: Twelve subjects have been prospectively included (TFA-LBP group (n = 5) and TFA-NoP group (n = 7)). Four of the five subjects of the TFA-LBP group and two of the seven in TFAs-NoP group had an imbalanced sagittal posture, especially regarding the T9-tilt, significantly higher in the TFA-LBP group than in the TFA-NoP (p = 0.046). Eight subjects (6 TFA-NoP and 2 TFA-LBP) had abnormal low value of thoracic kyphosis (TK). Moreover, the mean angle of TK in the TFA-NoP group was lower than in the TFA-LBP group (p = 0.0511). CONCLUSION: In the considered sample, TFAs often present a sagittal imbalance. A low TK angle seems to be associated with the absence of LBP. It can be hypothesized that this compensatory mechanism of the sagittal imbalance is the most accessible in this population. This study emphasizes the importance of considering the sagittal balance of the pelvis and the spine in patients with a TFA to better understand the high prevalence of LBP in this population. It should be completed by the analysis of the spinopelvic balance and the lower limbs in 3D. These slides can be retrieved under Electronic Supplementary Material.

[Rehabilitation after a war injury]. / Des blessés jeunes et sportifs polytraumatisés « de la tête aux pieds ¼.

Rehabilitation after a war injury. Combat wounds can be the cause of serious physical and mental trauma. Injuries caused by the explosion of improvised devices are responsible for multiple penetrating injuries, limb amputations, brain or spinal-cord injuries, and sometimes severe burns. The performance of protective equipment and the effectiveness of the initial medical care allow those injured to survive, often at the cost of severely compromised functional prognoses. Following critical and surgical care, the multidisciplinary teams of Physical Medicine and Rehabilitation (PM et R) intervene with the wounded to initiate rehabilitation and assist with social and occupational reintegration. This support takes place in two steps: the primary phase of "acute rehabilitation" is aimed at preventing and treating complications and starting to relearn activities of daily living; the second phase of "rehabilitation-reintegration" encompasses both the medical and social fields. The implementation of individualized rehabilitation requires the collaboration of PM et R and psychiatric teams, along with various officials within the military institution. New processes specific to the military environment and adapted to the war wounded have been developed: the creation of the War Wounded Rehabilitation and Reintegration Unit (C2RBO: Cellule de Réadaptation et Réinsertion des Blessés en Opération); the use of new technologies and funding of bionic prostheses for amputees; the development of sports rehabilitation programs; the creation of tools to promote social and family reintegration; and the improved recognition of and compensation for injuries. In parallel, the care connection has been reorganized to create a "Defense Rehabilitation Pole" underpinned by a territorial network ensuring the implementation of a care course for every injured soldier, from the initial care in the Parisian military hospital complex to the military medical centers closer to the forces.

Rééducation et réadaptation après une blessure de guerre. Le blessé de guerre est un traumatisé grave à la fois physique et psychique. Les blessures sont souvent provoquées par l'explosion d'engins improvisés responsables de lésions multiples et pénétrantes, d'amputations de membre, de traumatismes crâniens ou vertébro-médullaires et parfois de brûlures graves. La performance des équipements de protection et l'efficacité de la prise en charge médicale initiale permettent à ces blessés de survivre, souvent au prix d'un pronostic fonctionnel sévèrement engagé. Après la prise en charge critique réanimatoire et chirurgicale, les équipes pluridisciplinaires de médecine physique et de réadaptation (MPR) interviennent auprès des blessés pour initier la rééducation et les accompagner jusqu'à la réinsertion socio-professionnelle. Cette prise en charge se déroule en deux temps : les phases primaires de « rééducation initiale ¼ visent à prévenir et traiter les complications médico-chirurgicales et à débuter les actions d'autonomisation du blessé dans les activités quotidiennes ; les phases secondaires dites de réadaptation-réinsertion entrent dans le champ du médico-social. La mise en oeuvre des projets de réadaptation personnalisés nécessite la collaboration des équipes de MPR et de psychiatrie avec les différents acteurs sociaux de l'institution militaire. De nouveaux processus spécifiques au milieu militaire et adaptés au blessé de guerre ont été développés : la création de la Cellule de réadaptation et réinsertion des blessés en opération dite C2RBO, le recours aux nouvelles technologies et le financement des prothèses bioniques chez l'amputé, le développement de la réinsertion par le sport, la création d'outils favorisant la réinsertion socio-familiale et l'amélioration des processus de reconnaissance et de réparation du préjudice. En parallèle, le réseau de soins est réorganisé pour créer à terme un véritable « Pôle de réhabilitation de la défense ¼ sous-tendu par un maillage territorial garantissant la mise en oeuvre d'un parcours de soins adapté à chaque blessé, depuis sa prise en charge initiale sur l'ensemble hospitalier militaire parisien, jusqu'au plus près des forces, dans les centres médicaux des armées.