[Contribution of physical rehabilitation to cancer follow-up]. / Apport de la rééducation dans le suivi d'un cancer.

The number of people with cancer is constantly increasing. Thanks to new screening techniques and treatment protocols, the number of survivors is also increasing. However, treatments cause some undesirable side effects that usually persist over time. The level of physical activity of these patients tends to decrease with the diagnosis of cancer and does not usually increase before the end of the treatments or even beyond. However, physical activity is beneficial not only in terms of preventing the progression or recurrence of the disease but also in the fight against side effects related to the disease and its treatments. There are various physical activity recommendations for cancer survivors that will be developed in this article. The project «Sport après cancer. Citoyen sportif, j'agis pour ma santé¼, developed by the University and the University Hospital of Liège, aims to promote adapted physical activity after cancer, creating a link between outpatient rehabilitation in a hospital setting and the practice of physical activity in a sporting and associative context.

Le nombre de personnes atteintes d'un cancer est en augmentation constante. Grâce aux nouvelles techniques de dépistage et protocoles de traitement, le nombre de survivants est, lui aussi, en progression. Cependant, les traitements contre le cancer entraînent certains effets secondaires indésirables qui persistent généralement dans le temps. Le niveau d'activité physique de ces patients a tendance à diminuer dès l'annonce du diagnostic du cancer et n'augmente généralement pas avant la fin des traitements, voire bien au-delà. Pourtant, l'activité physique est bénéfique, non seulement en termes de prévention face à la progression ou à la récidive, mais également pour lutter contre les effets secondaires liés à la maladie et à ses traitements. Il existe diverses recommandations en matière de pratique d'activité physique pour les sujets ayant survécu au cancer qui seront développées dans cet article. Le projet «Sport après cancer. Citoyen sportif, j'agis pour ma santé¼, développé par le CHU et l'Université de Liège, a pour but de promouvoir l'activité physique adaptée après un cancer, en créant un lien entre la réadaptation ambulatoire en milieu hospitalier et la pratique d'activité physique dans un contexte sportif et associatif.

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.

Added value of a triaxial accelerometer assessing gait parameters to predict falls and mortality among nursing home residents: A two-year prospective study.

BACKGROUND: Gait impairment seems to be a risk factor for falls and mortality. Because gait change cannot be determined easily with classical clinical tests, some authors have suggested that it might be useful to use a gait-analysis system among elderly community-dwelling people. OBJECTIVE: The main objective of the present study was to determine the predictive value of a quantitative evaluation of the gait characteristics in nursing home residents for the occurrence of falls and death performed using a tri-axial accelerometer (Locométrix®). MATERIAL AND METHODS: One hundred elderly nursing home residents (80 women and 20 men, mean age 86.4 ± 6.04 years) were included in this study with the aim to follow them for 2 years. Deaths and falls were systematically recorded. A quantitative evaluation of a 10-second walk was performed with a tri-axial accelerometer (Locometrix®). Demographic data (i.e age, sex, body mass index) and clinical data (i.e. fall risk evaluated by the Tinetti test) were also recorded. RESULTS: During the two years of follow-up, 27 patients died. After adjustment on all potential confounding variables, only body mass index was significantly associated with the risk of mortality with an odds ratio of 0.86 (95% CI: 0.77-0.96, p=0.04). At the end of the study period, 440 falls had occurred (mean: 4.44 ± 6.79 falls per patient) but no single factors were independently associated with fall incidence. CONCLUSION: Our results show that a quantitative gait analysis performed using a tri-axial accelerometer is not predictive of long-term falls and mortality among nursing home residents.

Evaluation of the impact of 6-month training by whole body vibration on the risk of falls among nursing home residents, observed over a 12-month period: a single blind, randomized controlled trial.

BACKGROUND: We have previously shown that short sessions of whole body vibration (WBV) were not able to significantly improve fall risk among nursing home residents but some trends towards an improvement of motor capacity were observed. OBJECTIVE: The objective of the present study was to evaluate the impact of 6-month training by WBV on functional and motor abilities among nursing home residents observed over a 12-month period. METHODS: Patients were randomized into two groups: the WBV group which received three training sessions every week composed of five series of 15 s of vibration at 30 Hz intensity for a period of 6 months and a control group with normal daily life. The impact of this training on the risk of falls was assessed blindly after 6 and 12 months by the Tinetti Test, the "Timed Up and Go" test and a quantitative evaluation of a 10-s walk performed with a tri-axial accelerometer. The occurrence of falls was also observed. RESULTS: 62 elderly healthy volunteers, (47 women and 15 men, mean age 83.2 ± 7.9 years) were included in this study. There was no significant difference between the two groups regarding the Tinetti test (p = 0.75), the "Timed Up and Go" test (p = 0.19) and the Locométrix(®) test, except for the step length, measured by dual task (p < 0.01). No significant inter-group difference in the frequency of falls was observed during the 12 months of research. A total of 42 falls were recorded during the first 6 months of experimentation: 24 falls in the treated group and 18 in the control group (p = 0.60). During the next 6 months, 19 falls occurred: 8 falls in the treated group and 11 in the control group (p = 0.52). CONCLUSION: This study failed to establish the effectiveness of low doses of WBV, under the conditions used in our study, on functional and motor abilities of institutionalized elderly patients. However, given the positive results of other studies, further investigations, with modified therapeutic protocols, seem necessary to clarify the effects of WBV in the elderly.

Effect of the lengthening of the protocol on the reliability of muscle fatigue indicators.

The aim of this study was to examine absolute and relative reliability of fatigue measures calculated from peak torque or total work during 20, 30, 40 and 50 reciprocal maximal concentric contractions performed on an isokinetic dynamometer at 180 degrees x s(-1). Eighteen moderately active men performed 50 reciprocal maximal concentric contractions on three occasions with one 7-10 days recovery between each session. Peak torque and total work were computed for each contraction and subsequently summed to compute cumulated performance after respectively 20, 30, 40 and 50 repetitions. Muscle fatigue was determined after 20, 30, 40 and 50 repetitions by the fatigue index, the percent decrease in performance and the slope. Reliability of average peak torque or average total work was similar and was not affected by the lengthening of the protocol, although a learning effect was evident for knee flexors. Reliability of fatigue measures calculated from peak torque or total work was similar, improved with the lengthening of the protocol and was better for knee extensors. Measuring average peak torque or average total work and the slope during a protocol involving 30 maximal reciprocal concentric contractions appear to represent a better compromise between reliability and physiological interpretability of the data.

Gait analysis in elderly adult patients with mild cognitive impairment and patients with mild Alzheimer's disease: simple versus dual task: a preliminary report.

UNLABELLED: SUMMARY BACKGROUND/AIMS: The aim of this study was to assess gait characteristics during simple and dual task in patients with mild cognitive impairment (MCI) and compare them with those of healthy elderly subjects and mild Alzheimer's disease (AD) patients. METHODS: We proposed a gait analysis to appreciate walking (simple task and dual task) in 14 MCI, 14 controls and six AD subjects who walked at their preferred speed. A 20-second period of stabilized walking was used to calculated stride frequency, stride length, symmetry and regularity. Speed walking was measured by electrical photocells. RESULTS: Variables measured during simple and dual tasks showed an alteration of motor function as well in mild AD patients as in MCI patients. CONCLUSION: At the end of this preliminary study, we defined a specific gait pattern for each cognitive profile. Further researches appear necessary to enlarge the study cohort.

The value of instrumental gait analysis in elderly healthy, MCI or Alzheimer's disease subjects and a comparison with other clinical tests used in single and dual-task conditions.

In the elderly, gait disorders and cognitive frailty may influence each other and increase the risk of falling. The aim of the present study was to determine gait parameters in elderly people with different cognitive profiles (controls, individuals with mild cognitive impairment [MCI] and Alzheimer's disease [AD] patients) with the Locometrix three-axis accelerometer and establish whether or not this tool is more useful than conventional clinical tests (the timed "get up and go" test, the pull test and the single-leg balance test). Study subjects were all over 65, living at home and free of known gait impairments. A neuropsychological battery was applied to 14 control subjects, 14 MCI subjects and six AD patients. A motor evaluation (in single- and dual-task paradigms) was performed with three conventional clinical tests and the Locometrix (standardized gait). Our results showed that in a single-task paradigm, the Locometrix was more accurate than validated, conventional tests and generated a characteristic gait profile for each of the three cognitive profiles. In a dual-task paradigm, the gait of MCI subjects more closely resembled that of AD patients than that of control subjects. We conclude that the Locometrix is a high-performance tool for defining gait profiles, which correspond to given cognitive profiles. The use of a dual-task paradigm is a good way to screen for gait abnormalities in MCI.

The ability of isoinertial assessment to monitor specific training effects.

AIM: The aim of this study was to investigate the ability of isoinertial assessment to monitor training effects. Both parametric and curve analysis of the results were used to underline the specificity of maximal strength and maximal velocity resistance training methods. METHODS: Twenty-four untrained subjects were randomly assigned into three groups: a maximal strength-training group (heavy loads: 80% to 98% of the one repetition maximum [1-RM]), a maximal velocity-training group (light loads: 25% to 50% of 1-RM) and a control group. All the subjects were tested in bench press exercises before and after the 6-week training period. An isoinertial dynamometer was used to assess velocity and power at four increasing loads: 35%, 50%, 70% and 95% of the 1-RM load. Post-test protocol also included a trial at 105% of the 1-RM load. RESULTS: Isoinertial assessment demonstrated for both training groups significant gains at each load. Some specific adaptations appeared: strength training presented a greater increase for average power (+49%, P<0.001) and average velocity (+48%, P<0.001) at 95% of 1-RM, while velocity training emerged as a more effective way to improve performance at 35% and 50% of 1-RM (+11 to 22%) in comparison with strength training (+7 to 12%). The analysis of power and velocity curves specified that strength training enhanced performance earlier in the movement, while velocity training extended the propulsive action at the end of movement. CONCLUSION: The original combination of parametric and curve isoinertial assessment appears to be a relevant method for monitoring specific training effects. The complementarity of both strength and velocity training programmes underlined in this study could lead to practical applications in profiling training programmes.

Benefits of physical training in fibromyalgia and related syndromes.

OBJECTIVE: To review the published information on physical training for fibromyalgia (FM) and related syndromes. METHODS: A search of Medline literature (via Ovid and PubMed) with the following keywords: FM, chronic fatigue syndrome, therapy, rehabilitation, aerobic, exercise, and cognitive behavioral therapy. The reference lists of articles were examined for additional related articles. RESULTS: Several studies investigated the benefits of graded exercise therapy for patients with FM or related syndromes. Although some systematic reviews have not established an unequivocal benefit of physical training, most authors report a benefit for patients with chronic pain or fatigue. Ideally, such a therapy should be a part of multidisciplinary program. Muscular rehabilitation is reserved for preventing the deconditioning syndrome often reported in patients and the vicious cycle of pain, avoidance and inactivity behaviors, or even kinesiophobia, deconditioning, incapacity and psychological distress. CONCLUSION: This review emphasizes the relevance of graded physical training for treating FM and related syndromes. The development of rehabilitation centers, with experts able to propose a relevant therapy to patients with chronic pain or fatigue, should help alleviate this public health problem.

Chronic fatigue syndrome: a systematic review.

OBJECTIVE: A systematic review of the literature about chronic fatigue syndrome (CFS). METHODS: A search of the Medline database (via Ovid and PubMed) with the key words chronic fatigue syndrome, diagnosis, classification, epidemiology, etiology, physiopathology, metabolism, microbiology, immunology, virology, psychology, drug therapy, rehabilitation, and therapy. The reference lists of each article were examined for additional related articles. RESULTS: CFS was defined in 1988 by the US Centes for Disease Control and Prevention. The prevalence of chronic fatigue syndrome has ranged from 0.2% to 0.7% in the general population. In 1994, the definition of CFS was revised by Fukuda et al. Despite various research in several topics (e.g. infection, immune systems, neuroendocrinology, autonomic activity, neuromuscular involvement), the pathophysiology remains unknown. CONCLUSION: CFS, with its various major clinical and functional impacts, should be associated with a "biopsychosocial model". Progressive muscular rehabilitation, combined with behavioral and cognitive treatment, is an essential part of therapy.

[Value of aerobic rehabilitation in the management of fibromyalgia]. / Intérêt de la revalidation aérobie dans la prise en charge de la fibromyalgie.

This study assesses the influence of a muscular aerobic revalidation program on the management of the fibromyalgia syndrome. After 3 months, benefits consisting of increased muscle performances associated with a reduction of pain and an improvement of quality of life were documented. This study confirms the value of aerobic muscle exercise in fibromyalgia patients.

[What happens to the fibromyalgia syndrome?]. / Le point sur la fibromyalgie.

OBJECTIVE: To realize a clarification about fibromyalgia, attempting to consider diagnostic criteria, prevalence, pathophysiology and therapeutic approach. METHOD: A systematic literature search was conducted to select articles about fibromyalgia and connected diseases. The database are Premedline, Medline and Medlineplus. RESULTS: Fifty-eight articles about fibromyalgia and twelve articles about connected diseases were selected to realize this review of literature. DISCUSSION: Fibromyalgia constitutes a syndrome characterized by widespread musculo-skeletal pain, present above the waist and below the waist and in the axial skeleton. Widespread pain must have been present for at least three months. "Spasmophilie", chronic fatigue syndrome and myofascial syndrome represent diseases connected with fibromyalgia: differential diagnosis must be established. Researches related to fibromyalgia suggest a reduction of muscular performances associated with histological and biochemical anomalies. Patients are characterized by shorter and nonrestorative sleep. Psychological, neuroendocrine and central alterations appear often associated with fibromyalgia. The reduction of pressure tolerance and pain thresholds may be linked to the alterations of neuroendocrine substances. Literature recommend a multidisciplinary therapeutic approach in management of fibromyalgia. CONCLUSION: The pathophysiologic mechanisms in fibromyalgia appear multiple and interdependent. With the aim to optimizing treatment, investigations are necessary to determine biochemical repercussions of various therapeutic approaches.

[Fibromyalgia in the year 2000]. / La fibromyalgie en l'an 2000.

Musculoskeletal pain is common in the population. Several pathologies like fibromyalgia (FM), chronic fatigue syndrome (CFS) or spasmophilia are associated with functional myalgia. The etiology of FM remains elusive, but the diagnosis is well established. The criteria for the classification are widespread pain combined with tenderness at 11 or more of the 18 specific tender points sites. The prevalence is 2% in the general population. This article reviews recent data on the pathophysiology and treatment of FM.