In vivo measurement of compression bandage interface pressures: the first study.

UNLABELLED: Compression therapy has precise technical characteristics but in vivo pressures exerted by bandages are still poorly understood. OBJECTIVE: To perform in vivo pressure measurements of different compression bandages bearing different technical characteristics with different application methods. METHOD: Interface pressure was measured on the lower limb of 20 healthy women at 3 different points (B1, C and F) using 6 compression techniques (stockings, non-elastic bandage, elastic bandages with 2 technical characteristics and 3 application methods), and in 3 positions. RESULTS: All elastic compression bandages respected the principle of graduated pressure along the length of the limb (P<0.0001), but not the non-elastic bandage. The pressures increase significantly (P<0.0001) between the supine position and the sitting or standing position, especially with the non-elastic compression bandage. There is a marked variation in pressures between subjects for some bandages (non-elastic and elastic applied using the figure-of-eight technique). The pressure increases significantly with the number of bandage overlaps (P<0.01). CONCLUSION: Elastic and non-elastic bandages behave differently from one another, and non-elastic bandages not appearing to comply with medical recommendations concerning graduated pressure. There is a high level of variability between subjects for some compression bandages (non-elastic and figure-of-eight methods).

Sensitivity to change of the Quebec Back Pain Disability Scale and the Dallas Pain Questionnaire.

OBJECTIVE: To study and compare the sensitivities to change of the French versions of the Quebec Back Pain Disability Scale (QBPDS) and the Dallas Pain Questionnaire (DPQ). METHOD: A retrospective study of the medical records of 30 chronic low back pain (LBP) outpatients undergoing a 4-week functional training program in a physical medicine and rehabilitation unit. Physical data (a visual analogue pain scale, the Schöber index, Sorensen and Shirado tests and the finger-to-floor distance) and functional status (QBPDS and DPQ scores) were measured at D0 and D25. Sensitivity to change was assessed in terms of the standardized response mean (SRM) and the effect size (ES). RESULTS: With the exception of the DPQ's "social interest" domain, all QBPDS and DPQ scores improved significantly over the course of the rehabilitation programme. Sensitivity to change was high for the QBPDS (SRM=0.80; ES=0.62) but only moderate for the DPQ (SRM=0.59; ES=0.61). DISCUSSION-CONCLUSION: Our results show that the QBPDS was more sensitive to clinical change than the DPQ in a sample of chronic LBP sufferers. It would be interesting to assess this sensitivity in a population of acute LBP patients and to evaluate the long-term effects of a functional rehabilitation program on the DPQ's "social interest" domain.

Effects of training programs for spinal cord injury.

INTRODUCTION: Endurance exercise training programs in patients with spinal cord injury (SCI) were largely studied to determine different types of adaptations. The aim of specific rehabilitation is to obtain maximal gains in quality-of-life (QoL) after SCI. OBJECTIVE: To review the literature on the efficiency of training programs for SCI. METHODS: We searched the MEDline database with the keywords SCI, paraplegia and quadriplegia and synonyms, then combined them with one of the following terms: rehabilitation, training, exercise conditioning, physical fitness, exercise prescription, adaptation, effect, or benefit. We found 65 articles related to the physiological and psychological effects of training programmes on patients with SCI. RESULTS AND DISCUSSION: Training programs after SCI offer reconditioning cardiorespiratory, cardiovascular, cardiac, metabolic, bone, biomechanical, muscle adaptation, and QoL benefits. Reconditioning training increases VO2 max, reverses leg vascular resistance in the paralyzed legs and has possible cardiac and neural adaptations, favorable catecholamine responses and effects on platelet aggregation. Reconditioning can also modify lipid profile, reduce risk for cardiovascular diseases, prevent osteoporosis and increase maximal upper-extremity muscle strength, sprint power output and maximal power output. This effect allows for considerable improvement in mechanical efficiency and wheelchair propulsion technique. CONCLUSIONS: Reconditioning training programs after SCI have a direct impact on function and QoL, permitting participation in physical activities in addition to daily living activities in subjects with SCI.

[Training programs in spinal cord injury]. / Réentraînement a l'effort chez le blesse médullaire.

INTRODUCTION: Individualised exercise training programs in spinal cord injury (SCI) individuals are considered highly effective for improving and maintaining capacity for physical activity, as well as for reducing cardiovascular risk. However, no consensus exists on the type, intensity, and frequency of the training programs for SCI. OBJECTIVE: To review the literature about training program characteristics for SCI and describe their efficacy, limits, and results, with the aim of proposing specific recommendations. METHODS: Query using Medline and Embase databases. Ninety-nine references were found, including the following: Clinical studies examining physical endurance capacity of individuals with SCI, physiological responses to maximal exercise, or cardiovascular differences between sedentary and wheelchair-trained subjects; Articles? investigating the effects of training programmes for SCI. RESULTS: Various combinations of training intensity, duration, frequency, type, and ergometers have been proposed for SCI. Whatever the characteristics of the training program, a review of 25 cardiorespiratory training studies involving SCI subjects revealed an average improvement of 9% to 99% in VO2max, 19% to 118% in power output, and a decrease in submaximal values after 4 to 36 weeks of training. DISCUSSION - CONCLUSION: Wheelchair ergometers seems to be interesting for SCI because it mimics closely the daily motor tasks of wheelchair users and allows for adjustment of the wheelchair. Both continuous and interval training programmes are appropriate, but intermittent exercise intensities may be more beneficial since they mimic the intermittent nature of daily activity patterns. Furthermore, on the basis of the results of these studies, we recommend that training at or above 70% of maximum heart rate, for 30 minutes of rhythmic exercise, three days per week during eight weeks, will provide a sound of basis for design of an endurance exercise programme for people with SCI.

[Use of isokinetic techniques vs standard physiotherapy in patients with chronic low back pain. Preliminary results]. / Etude comparative entre technique isocinétique et kinésithérapie classique chez le lombalgique chronique. Résultats préliminaires.

OBJECTIVE: To determine if the use of an isokinetic device for trunk exercise is more effective than standard physiotherapy in promoting motor disinhibition for patients with chronic low back pain. POPULATION: chronic low back pain outpatients who are treated in a Rheumatology or PM & R unit within an academic hospital. METHODOLOGY: This is a prospective, controlled, randomized study, with two groups of treatment: one treated with isokinetic techniques and the other with standard physiotherapy, six sessions for each treatment during 2 weeks. Outcome measures include pain (VSA), trunk mobility (Schöber index, distance from fingers to floor), muscle extensibility and muscle strength (Biering-Sorensen and Shirado-Ito test), and functional capacity (Quebec scale). RESULTS: Seventeen subjects were enrolled. The results suggest that both isokinetic exercise and physiotherapy result in improved range of motion, extensibility, muscle strength, and pain, without any significant superiority of one technique over the other. However, each technique has specific advantage. DISCUSSION: Despite methodologic limitations, this study shows that isokinetic exercise is not better than physiotherapy in reversing motor inhibition in chronic low back pain. Our results are consistent with those of other studies in the literature, with regard to the absence of established overall superiority of one exercise technique or program over the other in this population, and with regard to partial benefits of specific exercise techniques. CONCLUSION: The non-specific benefit of one technique indicates that further studies are needed to evaluate the benefit of combining exercise techniques in chronic low back pain, in order to address the multiple factors involved in this pathology.