[Non-pharmacological treatments for osteoarthritis: unavoidable and essential]. / Traitements non pharmacologiques de l'arthrose : incontournables et indispensables.

The optimal treatment of osteoarthritis requires the combination of pharmacological and non-pharmacological treatments. The non-pharmacological treatments recommended by the medical and scientific associations are information, education, weight management (especially in case of overweight) and physical activity. Antalgic and anti-inflammatory pharmacological treatments should be used to facilitate the recovery and regular physical activity that is central in the management of osteoarthritis patients. It should include aerobic cardio-respiratory, resistance, flexibility and neuromuscular reprogramming and be associated with cognitive-behavioral therapies. Health professionals have to promote the activity and to inform their patients about the benefits, not only about the symptoms of osteoarthritis, but also about their overall health.

La gonarthrose est une des pathologies musculo-squelettiques les plus fréquentes. Elle est à l'origine de douleurs parfois très intenses et d'une limitation fonctionnelle qui peut être invalidante. À ce jour, il n'existe aucun traitement capable de limiter la progression structurale. Seule la part symptomatique est accessible au traitement. La prise en charge doit être globale, intégrant des traitements non pharmacologiques -perte pondérale, kinésithérapie, exercices physiques, orthèses, attelles- et pharmacologiques, regroupant des traitements généraux et locaux. Nous discuterons ici des bénéfices et des risques des principaux traitements par voie orale -paracétamol, anti-inflammatoires non stéroïdiens, opioïdes faibles et forts- et par voie locale regroupant les topiques -anti-inflammatoires locaux, capsaïcine faiblement dosée- et les injections intra-articulaires de corticoïdes, d'acide hyaluronique et du plasma riche en plaquettes, ainsi que de l'intérêt éventuel des lavages articulaires. Enfin, nous proposons une stratégie thérapeutique englobant ces différents traitements.

Development and validation of a questionnaire assessing volitional competencies to enhance the performance of physical activities in chronic low back pain patients.

BACKGROUND: Motivation has long been emphasized as the most important determinant of action. However, there is a substantial gap between people's goals and their attainment. Patients may be motivated and yet unable to take action if their volitional competencies are insufficient. One of the important tasks of volition is goal-maintenance. Research has stressed the importance of a volitional tool, the implementation intentions. Implementation intentions indicate where, when, and how the action leading to the goal will be performed. Forming implementation intentions favours the execution of goal-directed efforts, and reinforces the relationship between intentions and behaviours. Results from various studies clearly suggest that volitional competencies and implementation intentions could play a role in low back pain (LBP) patients. However, there is at present no questionnaire allowing assessing the capacity of implementation intentions of physical activities in LBP patients. METHODS/DESIGN: This study will develop such a questionnaire, using a 3-step approach. A first qualitative step to build categories and generate items; 30 patients suffering chronic LBP will be invited to participate in semi-structured interviews; verbatim and derived items will then be submitted to a panel of experts, using a Delphi method; a second quantitative step to examine the properties of items, and determine the factorial structure of the questionnaire; 100 patients suffering chronic LBP will be recruited to respond to this phase; and third, preliminary psychometric analyses (item-scale correlations, construct validity, reliability); 180 chronic LBP patients will be recruited for this phase of the study. The relationships between implementation intentions and variables affecting physical activity on chronic LBP patients, i.e. pain, physical capacities, fear-avoidance beliefs, kinesiophobia, work status, and level of physical activity will be considered. DISCUSSION: Developing a questionnaire to assess implementation intentions would allow investigating the role of these intentions in the transition from acute to chronic LBP. The results of this study should contribute to the understanding of the psychological processes at stake in the development of chronic LBP, and in particular to the identification of factors eventually favouring patients' participation in and adherence to active physical treatments.