Association between isokinetic abdominal muscle strength, pelvic floor muscle strength and stress urinary incontinence severity.

OBJECTIVES: Studies have shown that there is co-activation between abdominal and pelvic floor muscles (PFM) in physiological conditions. This study aimed to assess pelvic floor and isokinetic trunk flexors function in non-active incontinent women, and to investigate the association between the strength of these muscle groups and the severity of stress urinary incontinence (SUI). METHODS: A cross-sectional study was carried out. Twenty-five incontinent women were enrolled after one-hour pad test results and compared to twenty asymptomatic women. The severity of SUI was determined by the Pad test and Urinary Distress Inventory, Short Form (UDI-6). PFM function was assessed using the modified Oxford Scale, intra-vaginal PFM electromyography, and PFM endurance according to the PERFECT scheme. Trunk flexors strength was assessed using a Cybex Norm II dynamometer. RESULTS: Incontinent women had a weaker PFM and isokinetic abdominal muscle strength compared to continent women (P<0,05). SUI severity was negatively correlated with PFM strength (r=-0,620, P=0,001), isokinetic trunk flexors strength (r=-0,605, P=0,001), and PFM endurance (r=-0,561, P=0,003) in incontinent women. A positive correlation between PFM function and isokinetic trunk flexors strength was found in incontinent women (r=0,488, P=0,013). CONCLUSION: Non-active incontinent women had weaker pelvic floor muscles and isokinetic trunk flexors strength compared to continent ones. The positive correlation found between these two muscle groups may be explained by their synergic activity. These findings suggest that the severity of SUI could be related not only to PFM strength but also to abdominal muscle weakness. Further research is needed to recommend abdominal wall training as an alternative method to treat SUI. LEVEL OF PROOF: 3.

Neurogenic bowel dysfunction (NBD) translation and linguistic validation to classical Arabic.

OBJECTIVE: To translate and linguistically validate in classical Arabic; the French version of the neurogenic bowel dysfunction (NBD). PATIENTS AND METHODS: Arabic translation of the NBD score was obtained by the "forward translation/backword translation" method. Patients with multiple sclerosis (MS) and spinal cord injury were included. Evaluation of intestinal and anorectal disorders was conducted by the self-administered questionnaire NBD, which was filled twice two weeks apart. An item-by-item analysis was made. The feasibility, acceptability, internal consistency using Cronbach's alpha, and test-retest repeatability by non-parametric Spearman correlation were studied. RESULTS: Twenty-three patients with colorectal disorders secondary to neurological disease were included, the average age was 40.79±9.16years and the sex-ratio was 1.85. The questionnaire was feasible and acceptable, no items were excluded. The spearman correlation was of 0.842. Internal consistency was judged good through the Cronbach's alpha was of 0.896. CONCLUSION: The Arabic version of NBD was reproducible and construct validity was satisfactory. The study of its responsiveness to change with a larger number of patients will be the subject of further work. LEVEL OF EVIDENCE: 4.

Knee osteoarthritis in 50 former top-level soccer players: a comparative study.

OBJECTIVES: To study the prevalence of knee osteoarthritis in a group of former top-level football players and to assess the condition's impact on joint function and structure, compared with a control group. MATERIALS AND METHODS: A cross-sectional, descriptive study was performed on a group of male former top-level football players (group G1), aged over 45 and with no history of knee trauma, arthritis, arthropathy or surgery. A second group of otherwise matched nonsporting subjects (group G2) was compared with the first group. For each subject, we specified age, weight, height, body mass index (BMI), dominant foot, the presence of knee axis deviation, the presence of pain and functional impairment. The pain level was assessed using a visual analogue scale (VAS). The functional assessment was performed using the Arabic version of the Lequesne index. Moreover, for each former player, we specified a number of sporting parameters, including those related to their playing career. The diagnosis of knee osteoarthritis was made using standard radiological and clinical criteria. The radiological severity of knee osteoarthritis was assessed using the Kellgren and Lawrence classification. We compared the two groups in terms of the frequency of knee osteoarthritis, the severity of pain and disability and the severity of structural impairment. RESULTS: Our study included two groups of patients: a group of 50 former football players (G1) with a mean age of 49.2. Overweight was noted in 40 subjects. The mean number of training hours a week was 14+/-3.5 during their professional career and 2.5 during their retirement. Half of the sportsmen had taken part in more than 200 matches. Knee axis deviation was observed in 29 former players (i.e. 58% of the cases) and 27 displayed genuvarum. A group of 50 nonsporting volunteers (G2) was matched to the G1 group in terms of age, BMI and frequency of axis deviation. Knee osteoarthritis was more common in the football players than in the nonsporting subjects (80% versus 68%), although the difference was not statistically significant. Whereas pain was noted in only six footballers (with an average VAS score of 25.4+/-6.3mm) and was observed in 50% of controls (with a mean VAS score of 39.2mm+/-7.3) (P=0.001). Disability was recorded in six sportsmen, with a mean Lequesne score of 0.38+/-1.27. Disability was more frequent (23 subjects) and more intense (with a mean Lequesne score of 1.71+/-3.2) in the nonsportsmen (P=0.001). The Kellgreen and Lawrence radiological classification revealed that 57.5% of the sportsmen had scores of III or IV, compared with just 29.4% in the control group. CONCLUSION: Knee osteoarthritis is common in male football players. However, our study shows that the condition is less painful and less likely to cause functional disability (but paradoxically more destructive) than in nonsportsmen.

[Effect of conservative treatment in the management of low-degree urogenital prolapse]. / Apport du traitement conservateur dans la prise en charge du prolapsus urogénital de bas grade. Le devenir après deux ans.

OBJECTIVE: The objective of our study was to determine the respective effects of conservative treatment (pelvic muscle exercises plus advice on healthy living) and the absence of treatment in the management of urogenital prolapse. MATERIALS AND METHODS: Forty-seven women (mean+/-S.D. age: 53.42+/-11.01 years) consulting for genital prolapse (grade I or II cystocele) were randomized into two groups: a conservative treatment group (CTG) and a nontreated group (NTG). The patients' outcomes were rated according to several parameters; a clinical examination, the "Measurement of Urinary Handicap" (MUH) scale, urodynamic tests, the Ditrovie quality of life scale and patient satisfaction on a visual analogue scale (VAS). RESULTS: The immediate post-treatment results showed that pelvic heaviness persisted in only five patients (18.51%) in the CTG compared with fourteen (70%) in the NTG (p<0.001). Furthermore, a significant improvement in the MUH scale score was noted in the CTG compared with the NTG. The Ditrovie score also improved. The maximum urethral closure pressure (MUCP) ranged from 54.4+/-13.23 to 57.81+/-12.8 cm H(2)O in the CTG versus 54.05+/-12.18 to 52.95+/-12.18 cm H(2)O in the NTG. Uroflowmetry revealed a significant improvement in the maximum flow rate. These benefits were maintained two years after cessation of the conservative treatment in 20 of the CTG patients. CONCLUSION: Conservative treatment can be effective in the treatment of low-degree urogenital prolapse and enables the improvement of clinical symptoms and urodynamic parameters. The benefits were maintained two years after treatment cessation.

[Results of surgical treatment of congenital convex pes valgus (10 non-idiopathic feet)]. / Résultats du traitement chirurgical du pied convexe congénital.

PURPOSE OF THE STUDY: Congenital pes valgus is a rare and complex deformity of the foot raising serious diagnostic and therapeutic challenges. The purpose of our work was to present the surgical procedures used in our series and to analyze outcome. MATERIAL AND METHODS: Ten feet presenting congenital convex valgus treated surgically over a six-year period using the same operative technique were reviewed at minimum five years follow-up. Idiopathic deformities were excluded from this series. Deformities were secondary to arthrogryposis in five feet, a multiple malformative syndrome in four and diastematomyelia in one. The surgical technique used two approaches: a posteromedial incision to release the dorsal flexors, disinsert the tibialis posterior, open the talonavicular joint, release the Achilles tendon and release the posterior tibiotalar capsule; a lateral incision to lengthen the fibular tendons and perform an osteotomy of the anterior process of the calcaneum. A talonavicular pin and a calcaneocuboid pin maintained the correction. The tibialis posterior tendon was reinserted on the anterior aspect of the talonavicular capsule after incision of the dislocation chamber. RESULTS: Outcome was considered good in five cases and fair in five. Outcome was fair in the arthrogyrposis feet. Undercorrection was observed in two feet and valgus flatfoot in three. Talar necrosis occurred in one foot and navicular necrosis in two. DISCUSSION: Simultaneous correction of the different anomalies observed in the congenital convex foot was achieved in this series. The anatomic and functional results were satisfactory. We recommend avoiding overly extensive release in order to decrease the risk of talar and navicular necrosis. It is also important to check the reduction radiographically during the operation. Patients should use an orthesis several months postoperatively to avoid recurrence.

[Fibromyalgia prevalence in Tunisia]. / Prévalence de la fibromyalgie en Tunisie.

OBJECTIVE: to estimate fibromyalgia (FM) prevalence in Tunisia. METHODS: Data on a cross-section of 1000 individuals aged 15 years or older living in Sfax were collected by interviewers using the London Fibromyalgia Epidemiology Study Screening Questionnaire (LFES- SQ). The sampling was realized by empirical poll and respecting quota according to delegation, rural or urban environment, sex and age according to the demographic national data. The positive screened subjects were invited to be examined to confirm or exclude the FM by applying the 1999 ACR criteria. The questionnaire was administered to a second group of 252 volunteers, all were afterward examined. This allowed to study specificity and sensibility of the questionnaire and allowed to calculate the FM prevalence. RESULTS: 159 subjects were screened positive, only 141 were examined. The specialized exam allowed confirming the diagnosis of FM in 67 subjects. FM prevalence is different according to sex, age, study level and socio-economic level. Two hundred and fifty two volunteers answered the questionnaire then all examined. The questionnaire specificity was 90.8% and the sensibility 79.4%. FM prevalence in Tunisia, calculated by Bayes theorem, is estimated between 8.27% and 12.3%. CONCLUSION: FM prevalence in Tunisia is estimated at least at 8.27%.

[Chronic low back pain and vertebral manipulation]. / Les lombalgiques chroniques et manipulations vertébrales. Etude prospective à propos de 64 cas.

OBJECTIVE: This study examined the short-term effectiveness of vertebral manipulation for treating chronic low back pain and disability. METHODS: Sixty-four patients were randomly assigned into two groups. One group received 4 true vertebral manipulations (VMG), and the other group received sham manipulations (sham-VMG) under the same conditions as for the first technique. Patients formulated assessments after the manipulations and 1 month later. RESULTS: Sixty-four patients participated in the study. Patients receiving the true manipulations showed significant improvement in pain (visual analogic scale score decrease from 71.8+/-18.11 to 49.37+/-16.78; P<0.001) and function (Oswestry scale score decrease from 15.59+/-6.03 to 12.25+/-5.69; P<0.001). Pain improvement persisted at the second month (P=0.01). The improvement was more evident in the VMG than the sham-VMG. No change in perceived disability was observed in the sham-VMG. CONCLUSION: Our study confirms the efficiency of short-term vertebral manipulation for treating chronic low back pain. The assessment of vertebral manipulation effectiveness is difficult. This manual therapy must be preceeded by a specific clinical exam performed by a trained physician.

[Abdominal obesity and knee ostheoarthritis]. / Obésité abdominale et gonarthrose.

UNLABELLED: The objective of our study was to determine whether waist circumference (WC) is a more reliable indicator than body mass index (BMI) of the presence of knee osteoarthritis in obese subjects. PATIENTS AND METHODS: We performed an observational study of obese patients with no other risk factors for knee osteoarthritis. For each patient, we evaluated BMI, WC, duration of obesity and knee pain. Two groups were identified: "asymptomatic patients" (AG), without knee pain, and "symptomatic patients" (SG). For the SG, we measured pain intensity (visual analog scale [VAS], 0-100 mm) and functional repercussions (using the Lequesne and WOMAC indexes). Patients with knee pain underwent standard radiographic procedures to search for signs of osteoarthritis, and the SG was divided into two subgroups: with radiological signs of osteoarthritis (SG-1) and without radiological signs of osteoarthritis (SG-2). The AG and SG groups and SG-1 and SG-2 groups were compared for age, sex, and duration of obesity. Comparisons of BMI, WC, and function involved the Student's t-test. RESULTS: We recruited 56 patients for the study (82.5% females; mean obesity duration (13+/-6.5 years; mean age 43.21+/-9.58 years). The mean BMI was 39.6+/-7.23 kg/m(2) and mean WC was 113+/-14.3 cm. We found 33 patients (59%) with knee pain. Independent of age, sex, duration of obesity and BMI, the SG showed more significant WC (117.27+/-14.71 cm vs. 107+/-11.75 cm for the AG, P 0.01). In the same group and independent of the already mentioned factors, the patients with radiological signs of osteoarthritis showed significant WC [122+/-15.57 cm (SG-1) vs. 108+/-6.88 cm (SG-2) (P 0.01)]. Moreover, the VAS score of pain at rest and during effort and the WOMAC and Lequesne scores were 16+/-25.7 mm, 75+/-18.3 mm, 12.3+/-8.92 and 11.5+/-5.44 (SG-1) and 7+/-18.4 mm, 70+/-19.2 mm, 5.7+/-3.05, and 6.9+/-3.79 (SG-2), respectively. The difference between SG-1 and SG-2 was significant only for the WOMAC (P=0.015) and Lequesne (P=0.026) scores. CONCLUSION: Independent of BMI, WC appears to be a factor associated with the presence of knee pain and osteoarthritis in obese patients. Furthermore, a high WC is associated with significant functional repercussion.

The isokinetic assessment of peripheral muscle function in patients with coronary artery disease: correlations with cardiorespiratory capacity.

OBJECTIVE: We aimed to determine whether diminished cardiorespiratory capacity in patients with coronary artery disease (CAD) is accompanied by impaired skeletal muscle function as measured by isokinetic dynamometry. We also evaluated the correlation between isokinetic strength and aerobic capacity in these patients. MATERIALS AND METHODS: Fifteen CAD patients and 15 age-matched healthy subjects (mean age 60+/-6 vs. 57+/-3.5 years) underwent maximal laboratory exercise testing, a 6-min walking test and an assessment of peripheral skeletal muscle function by use of an isokinetic apparatus. Quadricep and hamstring function was tested at two angular velocities, 150 and 180 degrees s(-1) with simultaneous electrocardiography monitoring. The cardiorespiratory and mechanical parameters (VO(2), ventilatory threshold [VT], heart rate [HR], and power) were measured at VT and at maximal effort. RESULTS: Quadricep and hamstring peak torque was impaired in CAD patients, with quadriceps peak torque at 180 degrees being 71.13 +/- 14 vs. 91.13 +/- 23 Nm (P<0.01) and hamstring peak torque 46.50+/-10 vs. 59.86+/-12 Nm (P<0.01). CAD subjects presented a deficient aerobic capacity as compared with the healthy subjects at maximal effort. At VT, the VO(2), ventilation, and HR were significantly lower in CAD patients, at 13.77+/-2.33 vs. 17.08+/-3.59 ml min(-1) kg(-1) (P<0.05), 29.64 +/- 664 vs. 37.76 +/- 7.2 ml min(-1) (P<0.05), and 86+/-14 vs. 111+/-15 beats min(-1) (P=0.001), respectively. The 6-min walking distance was significantly shorter for CAD patients than healthy subjects (425.93+/-52.77 vs. 551.46 +/- 57.94 m; P<0.01). In CAD patients quadriceps and hamstring strength was not correlated with VO(2) at maximal effort and at VT. Total distance walked during the 6-min walk and VO(2)max were correlated (r=0.869; P<0.001) but not at VT. CONCLUSION: CAD patients showed impaired cardiorespiratory capacity accompanied by increased muscle fatigability as compared with healthy subjects. An isokinetic muscle assessment in these patients must be achieved systematically and seems to have value in cardiovascular rehabilitation.

[Algodystrophy of the lower limbs during pregnancy]. / Algodystrophie des membres inférieurs au cours de la grossesse.

Algodystrophy (AD) of the lower limbs during pregnancy is rare and probably underdiagnosed. The physiopathologic mechanisms remain under discussion and seem multiple and complex. This report describes a retrospective survey of 6 patients seen between 1993 and 2004 who had algodystrophy of the lower limbs during pregnancy. Comparing the clinical, radiological and evolutionary results to the literature allows for identifying the main features of AD during pregnancy: disease progression during the second or third trimester, preferential localization of the left hip associated or not with other lower limb joint involvement and decalcification as seen on radiography. Magnetic resonance imaging (MRI), which is accurate, specific and non-invasive, is currently the exam of choice in early and differential diagnosis. The evolution is favourable in a few months, with general recovery without disability.

[Validity and reliability of Spinal Mouse to assess lumbar flexion]. / Validité et reproductibilité du Spinal Mouse pour l'étude de la mobilité en flexion du rachis lombaire.

OBJECTIVES: To evaluate the validity and reliability of the Spinal Mouse model to assess lumbar spine flexion. MATERIAL AND METHODS: For the validity study, patients with low-back pain underwent radiography to produce 2 lateral radiographs, first from the neutral position, and then with full trunk flexion. The correlation between mobility as assessed by radiography and the Spinal Mouse were evaluated by use of Spearman's correlation coefficient (SCC) for segmental mobility (L1-L2, L2-L3, L3-L4, L4-L5 and L5-S1) and global mobility (L1-L5 and L1-S1). Reliability was studied in healthy volunteers by the intraclass correlation coefficient (ICC). RESULTS: A total of 20 patients (8 women) aged 41.6+/-8.6 (range 24-63), were included in the validity study. The SCC between radiography and Spinal Mouse measures were 0.55; 0.64; 0.69; 0.54; 0.19; 0.7; and 0.86 for flexion mobility of the L1-L2, L2-L3, L3-L4, L4-L5, L5-S1, L1-L5 and L1-S1, respectively. A total of 45 subjects aged 24.2+/-3.7 (range 20-29) were included for the reliability study. For intrarater reliability, the ICC was 0.84; 0.89; 0.96; 0.97; 0.63; 0.95 and 0.83 for the L1-L2, L2-L3, L3-L4, L4-L5, L5-S1, L5-S1, L1-L5 and L1-S1, respectively. For interrater reliability, the ICC was 0.75; 0.81; 0.79; 0.60; 0.83; 0.85, respectively. CONCLUSION: The Spinal Mouse has acceptable metrological properties to assess segmental and global lumbar mobility during trunk flexion. Its metrological properties are not acceptable to assess mobility of L5-S1.

[The Oswestry index for low back pain translated into Arabic and validated in a Arab population]. / Traduction en arabe et validation de l'indice d'Oswestry dans une population de lombalgiques Nord-Africains.

OBJECTIVE: To translate into Arabic and validate the Oswestry index for low back pain in an Arab population. BACKGROUND: No functional disability index to assess low back pain written in the Arabic language and validated in an Arab population is available. DESIGN: Arabic translation of the Oswestry index was obtained by the "forward translation/backward translation" method. Adaptations were made after a pilot study involving ten patients aged 18 to 65 years old. Impairment outcome measures (pain as measured on a visual analog scale [VAS], Schober-McRae, index, duration of morning stiffness and number of night awakenings), disability (Quebec index, Waddell index), handicap (as measured on a VAS) and Beck depression scale scores were recorded. Inter-rater reliability was assessed by use of the intra-class correlation coefficient (ICC) and the Bland and Altman method. Construct validity was investigated with use of the Spearman rank correlation coefficient (convergent and divergent validity), and factor analysis was performed. Internal consistency was assessed by use of the Cronbach alpha coefficient. RESULTS: Eighty Tunisian patients with low back pain were included in the validation study. Two items were excluded. Inter-rater reliability was excellent (ICC = 0.98). Expected divergent and convergent validity results suggested good construct validity. Two main factors were extracted by factor analysis and explained 58.19% of the cumulative variance: the first factor represented discomfort in dynamic activities, the second discomfort in static activities. The Cronbach alpha coefficient was 0.76 for factor 1 and 0.70 for factor 2. CONCLUSION: We translated into and adapted the Oswestry index for the Arabic language in a population of Tunisian women? with low back pain. The 8-item version is reliable and valid. Although the scale was validated in a Tunisian population, we expect that it is suitable for other Arab populations, especially North Africans. Further study is needed to confirm such a hypothesis.

Chondromyxoid fibroma of the scapula : A case report.

Chondromyxoid fibroma of the scapula occurring in a 23 year old woman is of interest because of its unusual site and the extensive invasion of the soft tissues.

[Os acromial and rotator cuff syndrome. Apropos of 12 cases and review of the literature]. / Os acromial et syndrome de la coiffe des rotateurs. A propos de 12 cas et revue de la littérature.

In relation to 12 patients whose complained of pain in the shoulder associated with os acromial, the authors confirmed the rarity of this anomaly of the scapula which predisposes to subacromial impingement and rotator cuff rupture. The diagnosis is radiological. It requires axillary view of the shoulder which precisely shows the os acromial.

[A long-term follow up of the shoulder in obstetrical brachial palsy]. / Suivi à long terme des épaules paralytiques obstétricales (à propos de 129 cas).

OBJECTIVES: To study shoulder impairment and disability caused by obstetrical brachial plexus palsy, their evolution under physical and surgical treatments, and the place of complementary explorations in persistent sequels. METHODS: From 1991 to 2000, 129 patients (66 M, 63 F) were included in a retrospective study. Impairment was assessed by muscle recovery (deltoid, biceps, external rotators) and shoulder passive motion. Disability was assessed by Mallet functional test. RESULTS: Full spontaneous recovery was noted in 20% of patients before the age of 3 months. Repair of the nerve lesion was undertaken in four children between the 18th and 24th months. Full recovery of deltoid and biceps was noted in three-fourth of whole cases before the 12th month, and of the external rotation in only 45% at this same age. Seventy-seven percent of patients showed stage >or= III of Mallet test (VI: 20%, IV: 32%; III: 25%) at a middle age of 3.5 years. A long-term follow-up showed an external rotation limited less than 20 degrees in 15 children. Investigation by RMN or Arthroscanner was realized for five patients, this reveals a deformation with subluxation of the humeral head in two cases. Ten children were operated (liberation of sub-scapula in nine cases associated to a tendinous transfer six times; humeral osteotomie in one case). This surgery has allowed the improvement of the functional state in all cases. CONCLUSION: After-effects in shoulder are frequent especially the limitation of external rotation, which can lead to a deformation, and subluxation of the humeral head. The authors insist on the importance to push investigations in case of limitation of the passive external rotation to improve the therapeutic choice.

[The functional and professional future of lower limb amputees with prosthesis]. / Facteurs liés à l'avenir fonctionnel et professionnel des amputés des membres inférieurs appareillés.

OBJECTIVE: The objective of our study is to evaluate the functional and professional becoming of lower limb amputated population with prosthesis. MATERIAL AND METHODS: Our study is retro-prospective. It interested lower limbs amputated patients who have beneficed during the period between 1982-1998 with prosthesis and have consulted in 1999. Data of our study were gathered by an hetero questionnaire. In order to evaluate the functional results of our patients, we have adopted the score established by the National association of doctors specialized in apparatus in France (ANMA). However, this score was little modified (in fact, we have eliminated the item "use of personalized vehicle for handicapped [VHP]", because no one of our patients possess it). The results were judged favourable: score 6-7; unfavourable: mean score between 3-5 and bad between 0-2. RESULTS: During the year of our survey, we have questioned 85 lower limb amputated patients with prosthesis: 67 were male and 18 were female. The mean age of our patients is 48 years (6 to 86 years). Our population was divided into: 31 traumatic amputated, 28 arteritics and 26 amputated of other etiologies (tumoral, infectious, congenital...). In 76 cases, the amputation is unilateral. It's located upper the knee in 51 cases. The evaluation of functional autonomy of our patients according to score adopted showed those results: 54.11% were favourable and 45.88% were unfavourable. In professional side, only 35 among our 60 active patients before amputation, have been able to resume, 12 have needed a professional rehabilitation. Among the 25 who hadn't taken up again their work, 15 have early retirement and ten are in unemployment. CONCLUSION: The amputation of lower limb constitute a major handicap which involves a functional and professional incapacity. We can reduce the risk of this incapacity by a good and appropriate rehabilitation.

[Translation and construct validity of the Lequesne index for Arab speaking North African patients with osteoarthritis of the knee]. / Traduction en arabe et étude des qualités métrologiques de l'indice de Lequesne sur une population de gonarthrosiques nord-africains.

OBJECTIVE: To translate in Arabic and validate the Lequesne index for use in Tunisian. BACKGROUND: No instrument wording in Arabic language and validated in an Arab population to measure lower limb functional disability caused by OA. DESIGN: Arab translation was obtained using the "forward translation/backward translation" method. Adaptations were made after a pilot study. Patients with symptomatic knee osteoarthritis fulfilling the revised criteria of the American College of Rheumatology were included. Impairment outcome measures (VAS pain; knee mobility; Kellgren's radiological score); disability (the maximum distance walked; WOMAC index) and Beck depression scale were recorded. Inter rater reliability was assessed using the intra-class correlation coefficient (ICC) and the Bland and Altman method. Construct validity was investigated using the Spearman rank correlation coefficient (convergent and divergent validities) and a factor analysis was performed. Internal consistency of each factor was assessed by Crohnbach alpha coefficient. RESULTS: One hundred and three patients were included. All questions were acceptable and retained. Inter rater reliability was excellent with ICC = 0.91. The Bland and Altman method showed distribution of differences homogenous and no systematic trend. Expected divergent validity and convergent validity were observed, suggested good construct validity. Two main factors were extracted by factor analysis of the Lequesne, and explained more than 55% of the cumulative variance, the first factor represents disability and the second represents pain and stiffness. Crohnbach alpha coefficient was, respectively, 0.68 for factor 1 and 0.54 for factor 2. In conclusion, we translated and adapted the Lequesne index into Arabic to suit Tunisian people. Translated questionnaire is reliable and valid. Although the scale was validated in a Tunisian population, we expect that it can suit other Arab populations especially North Africans. Further studies are needed to confirm such hypothesis.

Effects of a low-intensity dynamic-resistance training protocol using an isokinetic dynamometer on muscular strength and aerobic capacity after coronary artery bypass grafting.

OBJECTIVE: Study the effect of muscle strength training on muscle strength, maximal oxygen uptake (VO2max), hemodynamic and anthropometric parameters as well as quality of life after coronary artery bypass grafting (CABG). METHODS: After CABG surgery, 32 patients were randomized into two groups. The first group was to perform aerobic-type training with a cycle ergometer (AT=16). The second group was to perform low-intensity muscle strength training of the quadriceps and hamstrings using an isokinetic dynamometer (i.e. 20 to 30% of peak torque) (ST=16). Before and after the strength training program we conducted a stress test, evaluation of isokinetic force production, 6-minute walking test, body impedance analysis (BIA) and SF-36 quality of life test. RESULTS: Compared to the AT group, the ST group showed better results with improved quadriceps strength (48.2% vs. 8.2%), VO2max (P<.001) and diastolic blood pressure at rest (P=0.01). Quality of life improved in both groups. CONCLUSION: The dynamic-resistance muscle strength training protocol using isokinetic dynamometer can safely (i.e. without clinical symptoms or changes to the ECG and arterial blood pressure) improve muscle strength and VO2max without any major risks in patients post-CABG. These findings should encourage additional studies to validate the relevance of these strength training modalities in rehabilitation centers.

Translation in Arabic, adaptation and validation of the SF-36 Health Survey for use in Tunisia.

OBJECTIVE: To translate into Arabic and validate the SF-36 quality of life index in a Tunisian Arabic population. BACKGROUND: No validated Arabic quality of life index is published. DESIGN: Arabic translation of the SF-36 scale was obtained by the "forward/backward translation" method. Adaptations were made after a pilot study involving 22 subjects from general population. Inter-rater reliability was assessed by use of intraclass correlation coefficient (ICC) and Bland and Altman method. Construct validity was assessed by Spearman rank correlation coefficient (convergent and divergent validity), and factor analysis with Varimax rotation. Internal consistency was assessed by Cronbach alpha coefficient. RESULTS: We note that 130 Tunisian subjects were included in the validation study. No items were excluded. Inter-rater reliability was excellent (ICC=0.98). Cronbach alpha coefficient was 0.94 conferring to translated index a good internal consistency. Expected divergent and convergent validity results suggested good construct validity. Two main factors were extracted by factor analysis and explained 62.3% of the cumulative variance: the first factor represented mental component, the second physical component. The Cronbach alpha coefficient was 0.88 and 0.91 respectively for factor 1 and factor 2. CONCLUSION: We translated into Arabic language and adapted the SF-36 scale for use in Tunisian population. The Arabic version is reliable and valid. Although the scale was validated in a Tunisian population, we expect that it is suitable for other Arab populations, especially North Africans. Further studies are needed to confirm such a hypothesis.