[What knows a frail swiss population about chronic obstructive pulmonary disease?] / Que sait une population suisse fragilisée de la bronchopneumopathie chronique obstructive ?

COPD affects nearly 400 000 people in Switzerland. It remains under-diagnosed and patients know little about it. This survey study aimed to measure this knowledge in a population receiving home care in the canton of Neuchâtel. Knowledge of the terms « COPD ¼ and « emphysema ¼ was not related to gender, the fact that patients had already had spirometry or the COPD risk group to which they belonged. Patients treated with inhaled drugs, smokers and ex-smokers were more familiar with the term « COPD ¼. The treatment of people with COPD requires careful monitoring of those diagnosed with the disease, but also increased attention to the disease itself and its symptoms among patients, caregivers and physicians.

La bronchopneumopathie chronique obstructive (BPCO) atteint près de 400 000 personnes en Suisse. Elle reste sous-diagnostiquée et les patients la connaissent peu. Cette étude sous forme d'enquête visait à mesurer ces connaissances dans une population qui reçoit des soins à domicile dans le canton de Neuchâtel. La connaissance des termes « BPCO ¼ et « emphysème ¼ n'avait pas de relation avec le sexe, le fait que les patients aient déjà eu une spirométrie ou le groupe de risque de BPCO auquel ils appartenaient. Les patients traités par médicaments inhalés, les fumeurs et les ex-fumeurs étaient plus familiers avec le terme « BPCO ¼. Le traitement des personnes atteintes de BPCO passe par un suivi attentif de celles chez qui on a diagnostiqué la maladie, mais aussi par une attention accrue à la maladie elle-même et à ses symptômes chez les patients, les soignants et les médecins.

Intra-rater reliability of hip abductor isometric strength testing in a standing position in older fallers and non-fallers.

BACKGROUND: Reduced hip muscle strength has been shown to be a major factor related to falls in older persons. However, comprehensive assessment of hip abduction strength in the clinical setting is challenging. The aim of this study was to investigate the feasibility and intra-rater reliability of a quick and simple hip abductor strength test in a functional standing position. METHODS: Individuals over 65 years of age were recruited from the geriatric department of a university hospital and an outpatient clinic. Thirty-two older subjects, including 16 fallers (≥1 fall during the last 12 months) and 16 non-fallers were included. Maximum voluntary isometric strength (MVIS) and rate of force generation (RFG) of the hip abductors of the right leg were evaluated in a standing position using a hand-held dynamometer. Two test-sessions were carried out. All hip strength values were normalized to participants' weight. Reliability was determined using the intra-class correlation coefficient agreement (ICCagreement), the standard error of measurement (SEM) and a Bland and Altman analysis (BA). RESULTS: All participants completed the strength tests, which took a mean 2.47 ± 0.49 min (one limb). Intra-rater reliability was higher for MVIS (0.98[0.95-0.99]) than RFG (ICC = 0.93[0.87-0.97]) for the entire sample. In the non-fallers, ICC was 0.98[0.95-1.00] (SEM = 0.08 N.kg- 1) for MVIS and 0.88[0.75-0.96] for RFG (SEM = 1.34 N.kg-1.s-1). In the fallers, ICC was 0.94[0.89-0.98] (SEM = 0.11 N.kg- 1) for MVIS and 0.93[0.84-0.98] (SEM = 1.12 N.kg- 1.s- 1) for RFG. The BA plot showed that the MVIS and RFG values did not differ across test-sessions, showing that no learning effect occurred (no systematic effect). The mean differences between test-sessions were larger and the LOA smaller in the fallers than in the non-fallers. CONCLUSION: Assessment of hip strength in a standing position is feasible, rapid and reliable. We therefore recommend this position for clinical practice. Future studies should investigate the diagnostic value of hip abductor strength in standing to discriminate between fallers and non-fallers, and to determine if change in strength following a falls prevention program reduces the risk of falls.

Modifying beliefs about back pain: A pilot study among healthcare professionals.

OBJECTIVES: This study aimed to explore whether a preventive intervention based on the non-injury model and the biopsychosocial model of back pain succeeded in shifting beliefs toward less negative representations and in decreasing fear-avoidance beliefs related to back pain. METHODS: One hundred and one healthcare professionals took part in a 10-h educational program held over 2 consecutive days, based on the key messages of the "Back Book." Baseline values were measured 6 weeks before the intervention and when it started. Follow-up was performed at the end of the intervention and six months later. RESULTS: No significant changes were observed between baseline values and values measured at the beginning of the intervention, but participants' beliefs about LBP changed significantly after the program. The benefit remained at 6 months follow-up. CONCLUSION: A prevention program based on the non-injury and bio-psychosocial models of LBP, introducing empowerment and problem-solving strategies, significantly reduced fear-avoidance and negative beliefs about LBP. The change was clinically relevant and thus could decrease direct and indirect healthcare costs.

Cost-Effectiveness of Physical Therapy Only and of Usual Care for Various Health Conditions: Systematic Review.

BACKGROUND: Given continually rising health care costs, interventions of health care providers should be cost-effective. PURPOSE: This review aimed to summarize current cost-effectiveness of physical therapy. Specific aims were: (1) to analyze cost-effectiveness of physical therapy only compared with usual care only, (2) to analyze cost-effectiveness of physical therapy added to usual care compared with usual care only, and (3) to specify in which health conditions physical therapy only or physical therapy added to usual care was cost-effective. DATA SOURCES: Topic-related systematic reviews were searched in MEDLINE, CINAHL, PEDro, and Cochrane Library and manually. STUDY SELECTION: Studies published between 1998 and 2014 that investigated the cost-effectiveness of interventions carried out by physical therapists were reviewed. The methodological quality was assessed with the Cochrane risk of bias assessment for intervention studies and with the Quality of Health Economic Analyses Scale. DATA EXTRACTION: Effectiveness and cost data for calculating incremental cost-effectiveness ratios (ICERs) and the original authors' conclusions were extracted. DATA SYNTHESIS: The 18 included studies presented low risk of bias and contained 8 comparisons of physical therapy only with usual care only and 11 comparisons of physical therapy added to usual care with usual care only. Based on ICERs, physical therapy only or added to usual care was cost-effective in 9 out of the 19 comparisons and in 10 comparisons according to the original authors' conclusions. CONCLUSION: Physical therapy only or added to usual care implies improved health in almost all studies. The cost-effectiveness of such interventions was demonstrated in half of the studies. This result might have been influenced by the fact that different definitions of the notion of "cost-effectiveness" exist.

Ziconotide adverse events in patients with cancer pain: a multicenter observational study of a slow titration, multidrug protocol.

BACKGROUND: Ziconotide is a new analgesic agent administered intrathecally. It is challenging to use and can induce several and sometimes serious adverse events. A low initial dosage followed by slow titration may reduce serious adverse events. OBJECTIVE: To determine whether a low starting dosage of ziconotide, followed by slow titration, decreases the incidence of major adverse events associated with ziconotide when used for intractable cancer pain. STUDY DESIGN: Observational cohort study. SETTING: Three French cancer centers. METHODS: Patients with incurable cancer causing chronic pain rated above 6/10 on a numerical scale while receiving high-dose opioid therapy (more than 200 mg/d of oral morphine equivalent) and/or exhibiting severe opioid-related adverse events received intrathecal infusions of ziconotide combined with morphine, ropivacaine, and clonidine. RESULTS: Seventy-seven patients were included. Adverse events were recorded in 57% of them; moderate adverse events occurred in 51%. Adverse events required treatment discontinuation in 7 (9%) including 5 (6%) for whom a causal role for ziconotide was highly likely; among them 4 (5%) were serious. All patients experienced a significant and lasting decrease in pain intensity (by 48%) in response to intrathecal analgesic therapy that included ziconotide. LIMITATIONS: Limitations include the nonrandomized, observational nature of the study. Determining the relative contributions of each drug to adverse events was difficult, and some of the adverse events manifested as clinical symptoms of a subjective nature. CONCLUSIONS: The rates of minor and moderate adverse events were consistent with previous reports. However, the rate of serious adverse events was substantially lower. Our study confirms the efficacy of intrathecal analgesia with ziconotide for relieving refractory cancer pain. These results indicate that multimodal intrathecal analgesia in patients with cancer pain should include ziconotide from the outset in order to provide time for subsequent slow titration.

Job strain, work characteristics and back pain: a study in a university hospital.

OBJECTIVES: The demand-control-support "job strain" model is frequently used in occupational health research. We sought to explore the relationship between job strain and back pain. METHOD: One thousand two hundred and ninety-eight collaborators of a Swiss teaching hospital responded to a cross-sectional questionnaire survey that measured job strain, the occurrence of back pain as well as the characteristics and consequences of this pain. RESULTS: Job strain computed with both psychological and physical demands was strongly and significantly associated with various measures of back pain. These associations displayed a dose-response pattern, and remained strong even after adjustment for job characteristics and professional categories. In contrast, separate dimensions of job strain (except physical demands) and job strain computed with only psychological demands did not remain significantly associated with back pain after adjustment for other variables. CONCLUSION: Our results support the findings linking back pain to job strain. Moreover, the relationship between back pain and job strain is much stronger if job strain includes both psychological and physical demands. Results of this study suggest that workplace interventions that aim to reduce job strain may help prevent back pain and may alleviate the personal, social, and economic burden attributable to back pain.

Work related characteristics of back and neck pain among employees of a Swiss University Hospital.

OBJECTIVES: 1) To explore the staff- and work-related risk factors for spinal pain among hospital employees, 2) to investigate the effect of staff- and work-related variables on the consequences of spinal pain, such as doctor visits and sick leave. METHODS: A mailed survey was carried out in a random sample of 2700 employees stratified for occupational categories (administration staff, nurses, nurse assistants, physicians, support staff and allied health professionals). The questionnaire measured self-reported spinal pain, consequences of pain, and work characteristics. RESULTS: The response rate was 48.1% (1298/2700). The one-year prevalence of spinal pain was 67.3%, highest among nurses (75.6%) and lowest among support staff (54.9%). Reported work characteristics associated with spinal pain included frequent work at a poorly adapted work station (odds ratio (OR) 1.90 [1.24-2.93]) and having to maintain a position for a long time (OR 1.71 [1.25-2.34]). No significant correlations were observed with lifting, patient handling, material handling, or working on nightshift. Sickness leave due to spinal pain was significantly associated with duration of pain episode (OR 4.08 for>3 months compared to less than 10 days), and with work categories (OR 2.58 for nurse assistants compared to nurses). CONCLUSION: In this population of hospital employees, being a nurse, working at a poorly adapted work place, and having to maintain positions for a long time were related independently to spinal pain. Nurse assistants had a higher risk of work absenteeism.

Effect of different walking aids on walking capacity of patients with poststroke hemiparesis.

OBJECTIVE: To examine the effects of 3 different walking aids on walking capacity, temporo-spatial gait parameters, and patient satisfaction. DESIGN: Observational study. SETTING: University Hospital of Geneva. PARTICIPANTS: Hemiparetic inpatients (N=25) with impaired gait, at an early stage of rehabilitation, unfamiliar with any of the walking aids tested. INTERVENTIONS: On 3 consecutive days subjects used, in random order, 1 of 3 walking aids: 4-point cane, simple cane with ergonomic handgrip, and Nordic stick. MAIN OUTCOME MEASURES: Maximal walking distance in 6 minutes, temporo-spatial gait parameters determined with a commercial electronic gait analysis system, and patients' preference on a subjective ranking scale. RESULTS: Walking distance was greatest with the simple cane with an ergonomic handgrip, followed by the 4-point cane and the Nordic walking stick. Walking velocity was highest with the simple cane, which was also indicated as the preferred walking aid by the patients. There was no significant difference in step length symmetry. CONCLUSIONS: The simple cane with the ergonomic handgrip was not only preferred by patients, but was also the most efficient among 3 commonly used walking aids. It appears justified to take patients' subjective preference into account when prescribing a walking aid.

Enhancing regular physical activity and relapse prevention through a 1-day therapeutic patient education workshop: A pilot study.

OBJECTIVE: Physical activity (PA) is important for managing chronic diseases, such as diabetes and obesity. Yet over half of patients who adopt PA programs do not maintain them at 6 months. To encourage regular PA among our patients, we developed a 1-day outpatient motivational workshop based on well-known theoretical frameworks. The purpose of this pilot study was to evaluate the effectiveness of the motivational workshop in terms of total and activity-specific energy expenditures (EE) and body mass index (BMI). METHODS: This workshop is an integrative model of multiple theoretical frameworks for therapeutic education and behavior change, alternating individual sessions and group sessions in a multidisciplinary setting. Patients completed a validated, self-administered, quantitative PA frequency questionnaire at baseline and at 1 year. Stages of change and relapse risk were identified at baseline. RESULTS: Twenty-five subjects, mean age 48 years and BMI 34.1kg/m(2), completed pre-/post-evaluations. At baseline, 73% of subjects reported regular activities of daily living and 52% reported regular formal exercise. Using total and activity-specificEE, we identified 69.2% as sedentary. A relapse risk was recognized in 76%. Paired t-tests showed significant (P=0.048) reductions in weight and BMI and a significant (P=0.015) increase in high-intensity exerciseEE. Total EE showed no difference. Among baseline sedentary subjects, 39% became active. CONCLUSION: This workshop may be effective in modifying PA patterns, thereby decreasing sedentarism and fostering PA maintenance. PRACTICE IMPLICATIONS: The theory-based workshop for increasing motivation to maintain optimal PA behavior provides an example of translational intervention from theoretical models to clinical practice.

[Postmastectomy pain syndrome evidence based guidelines and decision trees]. / Prise en charge du syndrome douloureux post-mastectomie: revue de la littérature pour des recommandations de bonnes pratiques evidence based et proposition d'arbres de décision.

A multidisciplinary expert group had reviewed all scientific data available of post mastectomy pain syndrome. Seventy six publications were retained and thirty evidence based diagnosis, treatment and follow-up recommendations are listed. Few of theses recommendations are classed level A. Datas analysis make possible to propose a strategy based on systematic association of drugs, kinesitherapy and psychological support. Evaluation and closer follow-up are necessary. Several decisional trees are proposed.

[Parkinson disease: description of an interdisciplinary program of functional group rehabilitation]. / Maladie de Parkinson: description d'un programme interdisciplinaire de rééducation fonctionnelle en groupe.

Neurorehabilitation for Parkinson's disease, in the form of physical and occupational therapy, has long been advocated but also seriously questioned with respect to its specific content, its mechanisms, its efficacy and its costs. Many factors may be put forward to explain the lack of consensus surrounding these interventions, including the multiplicity of different programs proposed, the scarcity of controlled studies available and the inadequacy of some assessment methods used. In this article, we describe a new neurorehabilitation program for Parkinson's disease which is characterized by some original features. In particular, the specific functional patients' needs were taken into account instead of the symptoms related to the condition, therapeutic interventions favoured a multidisciplinary approach, patients trained in groups rather than individually, the program combined different methods and was continuously evolving over time, and finally we used simple but goal-oriented measurement methods to assess efficacy. The study included 22 patients. Statistically significant positive results were obtained by the end of the program, suggesting that the program in its current form was indeed capable to generate a functional benefit of sufficient magnitude to be objectively detected by the assessment methods used. In our opinion, our data emphasizes the usefulness of specific neurorehabilitation programs in the global management of Parkinson's disease.

Scale to measure patient satisfaction with physical therapy.

BACKGROUND AND PURPOSE: Patient satisfaction can be one indicator of quality of care. In this study, a patient satisfaction questionnaire for physical therapy was developed. SUBJECTS: The subjects were a consecutive sample of 1,024 patients who received physical therapy between January and March 1999 at a teaching hospital in Geneva, Switzerland. METHODS: A cross-sectional mail survey was conducted in which a structured questionnaire measuring patient satisfaction with various aspects of physical therapy followed by open-ended questions was sent to the subjects. RESULTS: Overall, 528 of 1,024 patients (52%) responded (patient demographics for 501 respondents who provided demographic data: mean years of age=58.6, SD=18.9, range=15-95; 258 men, 243 women). Factor analysis was used to identify main domains of satisfaction, and a scale was constructed to measure satisfaction with each dimension: treatment subscale (5 items), admission subscale (3 items), logistics subscale (4 items), and a global assessment subscale (2 items). All subscales had good acceptability and small floor and ceiling effects. Internal consistency coefficients varied between.77 and.90, indicating good reliability for all subscales. Scale validity was supported by a logical grouping of items into subscales, according to their content, and by correlations of satisfaction scores with the patient's intention to recommend the facility and with the number of positive and negative comments to open-ended questions. Younger patients were less satisfied than older patients for 2 of the subscales (admission and logistics). DISCUSSION AND CONCLUSION: The 14-item instrument is a promising tool for the evaluation of patient satisfaction with physical therapy in both inpatients and outpatients.