Patients' preferences for fracture risk communication: the Risk Communication in Osteoporosis (RICO) study.

The RICO study indicated that most patients would like to receive information regarding their fracture risk but that only a small majority have actually received it. Patients globally preferred a visual presentation of fracture risk and were interested in an online tool showing the risk. PURPOSE: The aim of the Risk Communication in Osteoporosis (RICO) study was to assess patients' preferences regarding fracture risk communication. METHODS: To assess patients' preferences for fracture risk communication, structured interviews with women with osteoporosis or who were at risk for fracture were conducted in 11 sites around the world, namely in Argentina, Belgium, Canada at Hamilton and with participants from the Osteoporosis Canada Canadian Osteoporosis Patient Network (COPN), Japan, Mexico, Spain, the Netherlands, the UK, and the USA in California and Washington state. The interviews used to collect data were designed on the basis of a systematic review and a qualitative pilot study involving 26 participants at risk of fracture. RESULTS: A total of 332 women (mean age 67.5 ± 8.0 years, 48% with a history of fracture) were included in the study. Although the participants considered it important to receive information about their fracture risk (mean importance of 6.2 ± 1.4 on a 7-point Likert scale), only 56% (i.e. 185/332) had already received such information. Globally, participants preferred a visual presentation with a traffic-light type of coloured graph of their FRAX® fracture risk probability, compared to a verbal or written presentation. Almost all participants considered it important to discuss their fracture risk and the consequences of fractures with their healthcare professionals in addition to receiving information in a printed format or access to an online website showing their fracture risk. CONCLUSIONS: There is a significant communication gap between healthcare professionals and patients when discussing osteoporosis fracture risk. The RICO study provides insight into preferred approaches to rectify this communication gap.

Assessment of Temporal Somatosensory Discrimination in Females with Fibromyalgia: Reliability and Discriminative Ability of a New Assessment Tool.

We assessed the test-retest reliability and discriminative ability of a somatosensory temporal discrimination (SSTD) assessment tool for fibromyalgia syndrome (FMS) and determined if pain-related variables were associated with SSTD performance. Twenty-five women with FMS and twenty-five asymptomatic women were assessed during two sessions 7 to 10 days apart. The proportion of correct responses (range 0-100) was calculated. Sociodemographic information was collected for both groups. The participants with FMS also completed the widespread pain index and the Brief Pain Inventory. Test-retest reliability was verified by calculating intraclass correlation coefficients. Discriminative ability was verified by a between-group comparison of scores using a t-test. Associations between SSTD score and pain variables were tested using Pearson or Spearman correlation coefficients. The test-retest reliability of the SSTD score was excellent (ICC > 0.9, CI: 0.79-0.96) for the asymptomatic group and good for the FMS group (ICC: 0.81, 95% CI: 0.62-0.91). The median (Q1-Q3) test session SSTD score differed significantly between the FMS 84.1 (71-88) and the asymptomatic 91.6 (83.4-96.1) groups (p < 0.001). Only pain duration was associated with the SSTD score. In conclusion, the new SSTD test seems reliable for people with FMS and is discriminative. Further studies should examine its sensitivity to change and correlations with other SSTD tests.

Continuous suprascapular nerve blockade to potentiate intensive rehabilitation for refractory adhesive shoulder capsulitis: a cohort study.

PURPOSE: Evaluating the short- and long-term efficacy of a continuous ten day suprascapular nerve block combined with daily multidisciplinary rehabilitation on shoulder range of motion (ROM), pain, and function in patients with refractory adhesive capsulitis (AC). METHODS: In this retrospective cohort study, patients admitted to a specialized pain clinic for refractory AC for more than 6 months underwent continuous suprascapular nerve blockade for ten days and received 2 hours of physiotherapy and occupational therapy daily. Standardized assessments were performed at baseline, at days three, six, ten, 30, 90, and 180, and included active and passive ROM measurements, the visual analog scale (VAS) for pain and the disabilities of the arm, shoulder and hand (DASH) questionnaire to assess pain, disability, and quality of life. Improvements over time were assessed using ANOVAs. RESULTS: Thirty-two patients were followed (age: 52 ± 8 years, 25 females, mean symptoms duration of two years). There was a significant improvement in ROM for all amplitudes at day ten (short-term; range: 20-35°, p < 0.001) and at day 180 (long-term; range: 18-47°, p < 0.001). The pain and disability scores significantly reduced by day 180 (mean VAS reduction: 2.6 units, p < 0.001; mean DASH reduction: 9.5 points, p < 0.001). CONCLUSION: Continuous SSNB combined with intensive multidisciplinary rehabilitation represents an efficient therapeutic option for patients with chronic AC who did not respond to conventional treatments.

[Physical activity, a key-role in preventive medicine]. / L'activité physique, un rôle essentiel dans le cadre d'une médecine préventive.

The importance of physical activity in preventing diseases and maintaining physical and mental health in humans is undeniable. An active lifestyle plays a significant role in the primary, secondary, and tertiary prevention of chronic diseases. Despite abundant evidence in the literature and recommendations from the World Health Organization (WHO) on physical activity, the global population remains insufficiently active. It is therefore essential to promote physical activity and educate individuals in order to create an environment conducive to the sustainable adoption of an active lifestyle and the maintenance of health. In Belgium, initiatives such as «Sport-Health¼ programmes are emerging to overcome barriers to autonomous physical activity by offering tailored programmes for individuals with chronic diseases or those wishing to age healthily. With this perspective, the «Citizen, in motion for my health¼ project offers physical activity sessions while improving the physical literacy of participants to promote their autonomy.

L'importance de l'activité physique dans la prévention des maladies et le maintien de la santé physique et mentale de l'être humain n'est plus à démontrer. Un mode de vie actif joue un rôle considérable dans la prévention primaire, secondaire et tertiaire des maladies chroniques. Malgré les preuves abondantes dans la littérature ainsi que les recommandations de l'Organisation Mondiale de la Santé (OMS) en matière d'activité physique, la population mondiale demeure insuffisamment active. Il est donc essentiel de promouvoir l'activité physique et l'éducation des individus pour créer un environnement favorable à l'adoption durable d'un mode de vie actif en vue de la préservation de la santé. En Belgique, des initiatives telles que les programmes «Sport-Santé¼ émergent pour surmonter les obstacles à la pratique autonome de l'activité physique en proposant des programmes adaptés aux besoins des personnes atteintes de maladies chroniques ou souhaitant vieillir en bonne santé. C'est dans cette optique que le projet «Citoyen, en mouvement pour ma santé¼ offre des séances d'activité physique, tout en développant la littératie physique des participants pour favoriser leur autonomie.

Effect of robot-assisted gait training on quality of life and depression in neurological impairment: A systematic review and meta-analysis.

OBJECTIVE: Robot-assisted gait training (RAGT) is often used as a rehabilitation tool for neurological impairments. The purpose of this study is to investigate the effects of rehabilitation with robotic devices on quality of life and depression. DATA SOURCES: Two electronic databases (MEDLINE and Scopus) were searched for studies from inception up to December 2022. REVIEW METHODS: Randomized controlled trials (RCTs) and non-RCTs were pooled separately for analyses, studying each one's mental and physical health and depression. Random effect meta-analyses were run using standardized mean difference and 95% confidence interval (CI). RESULTS: A total of 853 studies were identified from the literature search. 31 studies (17 RCTs and 14 non-RCTs) including 1151 subjects met the inclusion criteria. 31 studies were selected for the systematic review and 27 studies for the meta-analysis. The outcome measure of mental health significantly improved in favor of the RAGT group in RCTs and non-RCTs (adjusted Hedges'g 0.72, 95% CI: 0.34-1.10, adjusted Hedges g = 0.80, 95% CI 0.21-1.39, respectively). We observed a significant effect of RAGT on physical health in RCTs and non-RCTs (adjusted Hedges'g 0.58, 95% CI 0.28, 0.88, adjusted Hedges g = 0.73, 95% CI 0.12, 1.33). After realizing a sensitivity analysis in RCTs, a positive impact on depression is observed (Hedges' g of -0.66, 95% CI -1.08 to -0.24). CONCLUSION: This study suggests that RAGT could improve the quality of life of patients with neurological impairments. A positive impact on depression is also observed in the short term. Further studies are needed to differentiate grounded and overgrounded exoskeletons as well as RCT comparing overground exoskeletons with a control group.

Exercise therapy including the cervical extensor muscles in individuals with neck pain: A systematic review.

OBJECTIVE: To review the use (dosage parameters and combination with other therapeutic interventions) of cervical extensor muscle exercises and their effect on pain, disability (primary outcomes), range of motion, endurance and strength (secondary outcomes) in people with neck pain. DATA SOURCES: An extensive literature search was conducted through MEDLINE (Ovid), Scopus (Elsevier) and Physiotherapy Evidence Database (PEDro) up to May 2023. The reference lists of all included studies and relevant reviews were screened for additional studies. REVIEW METHODS: Randomised controlled trials reporting the use of cervical extensor muscle exercises (alone or combined) applied to adults with idiopathic or traumatic neck pain were included. Study selection, data extraction and critical appraisal (PEDro assessment scale) were performed by two blinded reviewers. Data extraction included dosage parameters, other modalities combined with these exercises and outcomes. RESULTS: Thirty-five randomised controlled trails (eight of which were complementary analyses) with 2409 participants fulfilled the inclusion criteria. Twenty-six were of moderate to high quality. In most studies, cervical extensor muscle exercises were combined with various other therapeutic modalities and applied at different dosages. Only two studies (one high and one low quality) specifically assessed their effectiveness. The high-quality study showed significant improvements in neck pain and disability, pressure point threshold and neck mobility after both low load and high load training for 6 weeks. CONCLUSION: The results suggest cervical extensor muscle exercises may reduce neck pain and disability; however firm conclusions cannot be drawn because of the few studies that addressed this question and the heterogeneity of the dosage parameters.

Links Between Swallowing and Consciousness: A Narrative Review.

This literature review explores a wide range of themes addressing the links between swallowing and consciousness. Signs of consciousness are historically based on the principle of differentiating reflexive from volitional behaviors. We show that the sequencing of the components of swallowing falls on a continuum of voluntary to reflex behaviors and we describe several types of volitional and non-volitional swallowing tasks. The frequency, speed of initiation of the swallowing reflex, efficacy of the pharyngeal phase of swallowing and coordination between respiration and swallowing are influenced by the level of consciousness during non-pathological modifications of consciousness such as sleep and general anesthesia. In patients with severe brain injury, the level of consciousness is associated with several components related to swallowing, such as the possibility of extubation, risk of pneumonia, type of feeding or components directly related to swallowing such as oral or pharyngeal abnormalities. Based on our theoretical and empirical analysis, the efficacy of the oral phase and the ability to receive exclusive oral feeding seem to be the most robust signs of consciousness related to swallowing in patients with disorders of consciousness. Components of the pharyngeal phase (in terms of abilities of saliva management) and evoked cough may be influenced by consciousness, but further studies are necessary to determine if they constitute signs of consciousness as such or only cortically mediated behaviors. This review also highlights the critical lack of tools and techniques to assess and treat dysphagia in patients with disorders of consciousness.

The awareness of injury prevention programmes is insufficient among French- and German-speaking sports medicine communities in Europe.

PURPOSE: Evaluate the current state of sports injury prevention perception, knowledge and practice among sports medicine professionals located in Western Europe and involved in injury prevention. METHODS: Members of two different sports medicine organizations (GOTS and ReFORM) were invited to complete a web-based questionnaire (in German and in French, respectively) addressing perception, knowledge and implementation of sports injury prevention through 22 questions. RESULTS: 766 participants from a dozen of countries completed the survey. Among them, 43% were surgeons, 23% sport physicians and 18% physiotherapists working mainly in France (38%), Germany (23%) and Belgium (10%). The sample rated the importance of injury prevention as "high" or "very high" in a majority of cases (91%), but only 54% reported to be aware of specific injury prevention programmes. The French-speaking world was characterized by lower levels of reported knowledge, unfamiliarity with existing prevention programmes and less weekly time spent on prevention as compared to their German-speaking counterparts. Injury prevention barriers reported by the respondents included mainly insufficient expertise, absence of staff support from sports organizations and lack of time. CONCLUSION: There is a lack of awareness regarding injury prevention concepts among sports medicine professionals of the European French- and German-speaking world. This gap varied according to the professional occupation and working country. Relevant future paths for improvement include specific efforts to build awareness around sports injury prevention. LEVEL OF EVIDENCE: Level IV.

[Complex regional pain syndrome]. / Syndrome douloureux régional complexe.

Complex regional pain syndrome is a clinical entity that usually occurs following trauma, surgery, or other triggering event. Patients complain of pain described as burning, associated with sensory, vasomotor, sudomotor, motor and/or trophic disorders. The pain appears disproportionate to the initial lesion. The diagnosis is purely clinical and based on the Budapest criteria. It is a diagnosis of exclusion. The pathophysiology is still poorly understood and is thought to be multifactorial. Several mechanisms have been described: an inflammatory state, an overactivation of the sympathetic autonomic nervous system and a poor perception of pain at the central level. The management of signs and symptoms is therefore global. It involves physiotherapy and occupational therapy, often combined with analgesic medications. Psychological treatment may be proposed in certain circumstances. The natural evolution is rather favourable.

Le syndrome douloureux régional complexe constitue une entité clinique survenant habituellement suite à un traumatisme, une chirurgie ou un autre événement déclencheur. Les patients se plaignent d'une douleur décrite comme une brûlure, associée à des troubles sensoriels, vasomoteurs, sudomoteurs, moteurs et/ou trophiques. La douleur apparaît disproportionnée par rapport à la lésion initiale. Le diagnostic est purement clinique et repose sur les critères de Budapest. Il s'agit d'un diagnostic d'exclusion. La physiopathologie est encore peu connue, et serait multifactorielle. Plusieurs mécanismes sont décrits : un état inflammatoire, une suractivation du système nerveux autonome sympathique et une mauvaise perception de la douleur au niveau central. La prise en charge des signes et symptômes est donc globale. Elle fait intervenir une rééducation en kinésithérapie et ergothérapie, souvent associée à un traitement antalgique médicamenteux. Une prise en charge en psychologie peut être proposée dans certaines circonstances. L'évolution naturelle est plutôt favorable.

[Hamstring muscle injury in football players - Part I : epidemiology, risk factors, injury mechanisms and treatment]. / La lésion musculaire des ischio-jambiers chez le footballeur. Partie 1 : épidémiologie, facteurs de risque, mécanismes lésionnels et traitement.

Due to its high frequency and recurrence rate, hamstring injury represents an important issue in football currently. The mechanisms of injury and the main modifiable and non-modifiable risk factors are now well documented and should allow the implementation of effective preventive strategies. In the treatment of the injured player, the physician will have to rely on a close collaboration with a quality sports physiotherapist and implement a series of key elements allowing an optimal return to the soccer field, which means at the same level of performance compared to the pre-injury period and with a minimal risk of recurrence. This article discusses these different elements in the form of a narrative review of the literature.

La lésion musculaire des ischio-jambiers, de par sa fréquence et son taux de récidive élevés, représente une problématique actuelle importante dans le football. Les mécanismes lésionnels et les principaux facteurs de risque modifiables et non modifiables sont désormais bien documentés et devraient permettre la mise en place de stratégies préventives efficaces. Dans le suivi du joueur blessé, le médecin devra compter sur une collaboration étroite avec un kinésithérapeute du sport de qualité et mettre en place toute une série d'éléments clés permettant un retour optimal sur les terrains de football, c'est-à-dire au même niveau de performance comparativement à la période d'avant blessure et avec un risque minimal de récidive. Cet article aborde ces différents éléments sous l'aspect d'une revue narrative de la littérature.

[Hamstring muscle injury in football players. Part 2 : preventive strategies]. / La lésion musculaire des ischio-jambiers chez le footballeur. Partie 2 : stratégies de prévention lésionnelle.

Prevention of hamstring injuries represents an important issue for football players and clubs. Preventive strategies can be effective if they include multiple dimensions and are well-structured. Five points appear essential in order to obtain a high-quality preventive strategy: progressive muscle strengthening, optimal workload management, lumbopelvic stability exercises, development of physical condition and optimization of sprint technique. While recognizing the limitations of preventive screening and the difficulty of predicting future injury, screening tests appear relevant for the identification of an individual risk profile for each footballer and in defining each player's work priorities. Finally, secondary prevention starts with the implementation of rigorous and high-level rehabilitation, as well as a special attention to players with a history of hamstring injury.

La prévention des lésions musculaires des ischio-jambiers représente une thématique de première importance pour les joueurs et clubs de football. Les stratégies préventives peuvent se révéler efficaces, à condition d'inclure de multiples dimensions à celles-ci et de structurer ces démarches. Cinq points apparaissent incontournables dans l'optique d'obtenir une stratégie préventive de qualité : le renforcement musculaire progressif et raisonné, la gestion équilibrée de la charge de travail, le travail de la stabilité lombo-pelvienne, le développement de la condition physique et l'optimalisation de la gestuelle de course. Tout en reconnaissant les limites du screening préventif et la difficulté de prédire une future blessure, un état des lieux précis peut s'avérer pertinent pour identifier le profil de risque individuel de chaque footballeur et pour définir les priorités de travail de chacun. Enfin, la prévention secondaire démarre par la mise en place d'une rééducation rigoureuse et structurée, ainsi que par une attention particulière aux joueurs avec antécédents de lésions aux ischio-jambiers.

[Whole-body training using HUBER® system in physical therapy rehabilitation: a systematic review]. / Rééducation globale à l'aide du système HUBER® en kinésithérapie : une revue systématique de la littérature.

INTRODUCTION: HUBER®, an isometric strengthening device, has been promoted as rehabilitation tool for a wide population of patients presenting heterogenous profiles. METHODS: Medline and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched. Only interventional studies aiming to assess the effectiveness of HUBER® device (any versions, any protocol of intervention used) on physical rehabilitation outcomes of adults were included. Quality of studies was assessed using Cochrane RoB tools. RESULTS: Out of 142 references, six interventional studies were included in this systematic review. The number of participants included per study varied from 12 to 53, length of intervention varied from 4 to 8 weeks and number of sessions per week varied from 2 to 4. Different profiles of participants were included. Globally, training sessions using the HUBER® device showed moderate beneficial effects on the following outcomes: morphological characteristics, strength, balance and muscle power. The overall quality of the included studies was, however, rated as moderate to low. CONCLUSION: Because of its capacity to collect various physiological parameters simultaneously, the HUBER® device seems to be an interesting rehabilitation tool.

INTRODUCTION: HUBER® est un dispositif de renforcement isométrique qui a été développé comme outil de rééducation pour des profils de patients présentant des pathologies variées. Méthodes : Medline et le registre Cochrane des essais contrôlés (CENTRAL) ont été consultés. Seules les études interventionnelles visant à évaluer l'efficacité du dispositif HUBER® (toutes versions, tout protocole d'intervention utilisé) sur les objectifs de la réadaptation physique des adultes ont été incluses. La qualité des études a été évaluée à l'aide des outils Cochrane RoB. Résultats : Sur 142 références identifiées par notre stratégie de recherche, six études interventionnelles répondaient à nos critères d'inclusion et ont été incluses dans cette revue systématique. Le nombre de participants inclus par étude variait de 12 à 53, la durée de la rééducation s'étendait de 4 à 8 semaines et le nombre de séances par semaine variait de 2 à 4. Différents profils de participants ont été inclus. Globalement, les entraînements utilisant le dispositif HUBER® ont montré des effets bénéfiques significatifs modérés sur les mesures suivantes : caractéristiques morphologiques, force, équilibre et puissance musculaire. La qualité globale des études incluses a toutefois été jugée modérée à faible. CONCLUSION: En raison de sa capacité à évaluer simultanément différents paramètres physiologiques, le dispositif HUBER® semble être un outil de rééducation intéressant.

[Acute deltoid compartment syndrome]. / Cas clinique. Syndrome de loge aigu du deltoïde.

In this article, we present a rare type of acute compartment syndrome affecting the deltoid muscle, which occurred after a crush syndrome in a patient discovered at home in a stuporous state. Although compartment syndromes are not rare, certain circumstances cause unusual consequences and localizations, shoulder impotence in the present case. The importance of an early diagnosis is obvious to avoid the risk of irreversible lesions. We describe predisposing circumstances and provide a brief review of the pathophysiology of this syndrome.

Nous présentons un type rare de syndrome de loge aigu touchant le deltoïde apparu après un crush syndrome chez un patient découvert au domicile dans un état stuporeux. Bien que les syndromes de loge ne soient pas rares au sens large du terme, certaines circonstances provoquent des conséquences et localisations inhabituelles, une impotence de l'épaule dans le cas rapporté. L'importance de réaliser un diagnostic précoce est évidente au risque de laisser évoluer des lésions irréversibles. Nous décrivons les circonstances favorisantes et présentons un bref rappel concernant la physiopathologie de ce syndrome.

[Recommendations for functional evaluation and rehabilitation of chronic low back pain]. / Recommandations pour l'évaluation et la rééducation fonctionnelles du patient souffrant d'une lombalgie chronique.

The majority of non-specific low back pain has a favourable evolution within a short period of time but in some cases the pain becomes persistent or recurrent. These chronic forms are responsible for most of the social and economic burden of low back pain. The crucial role of psycho-social factors in the chronicisation of low back pain justifies a thorough bio-psycho-social assessment. An active semi-intensive ambulatory multidisciplinary programme (Spine Unit Center) that complies with international and national recommendations (KCE and INAMI) has demonstrated its effectiveness in chronic low back pain in terms of algo-functional, physical and psycho-social components. In contrast to intensive programmes requiring hospitalisation, this outpatient treatment allows the patient to remain in his/her social and professional network. The active participation and motivation of the patient are essential for the success of the treatment. The multidisciplinary team will help the patient to define his/her functional objectives and to manage, via the psychologist, emotional aspects. The programme includes therapeutic education and physical reconditioning sessions including progressive aerobic training, group exercises, and individualised and progressive strengthening of the trunk muscles. The introduction of physical activity at home will be encouraged in order to sustain the changes in the patient's behaviour.

La majorité des lombalgies non spécifiques présente une évolution favorable dans un délai assez court, mais, dans certains cas, les douleurs deviennent persistantes ou récurrentes. Ces formes chroniques sont responsables de l'essentiel du poids social et économique des lombalgies. Le rôle crucial des facteurs psycho-sociaux dans la chronicisation de la lombalgie justifie une évaluation bio-psycho-sociale approfondie. Un programme pluridisciplinaire ambulatoire actif semi-intensif («Clinique du Dos¼) répondant aux recommandations internationales et nationales (KCE et INAMI) a démontré une efficacité sur les composantes algo-fonctionnelles, physiques et psycho-sociales du patient lombalgique chronique. Contrairement aux programmes intensifs imposant une hospitalisation, cette prise en charge ambulatoire permet au patient de rester dans son réseau social et professionnel. La participation active et la motivation du patient constituent les éléments essentiels pour la réussite du traitement. L'équipe pluridisciplinaire l'aidera à définir ses objectifs fonctionnels et à gérer, via le psychologue, certains aspects émotionnels en lien avec la douleur. Le programme comprend des séances d'éducation thérapeutique et de reconditionnement physique, incluant un entraînement aérobie progressif, une gymnastique collective de tonification et un renforcement individualisé et graduel des muscles du tronc. L'instauration d'une activité physique à domicile sera encouragée de manière à pérenniser les changements de comportement du patient.

Frailty but not sarcopenia nor malnutrition increases the risk of developing COVID-19 in older community-dwelling adults.

BACKGROUND: The identification of coronavirus disease 2019 (COVID-19) risk factors is requested to implement prevention strategies. AIM: To explore the associations between the COVID-19 incidence and malnutrition, sarcopenia, and frailty, identified as potential risk factors in previous cross-sectional studies. METHODS: Malnutrition, sarcopenia, and frailty were assessed at the last available follow-up from the Sarcopenia and Physical Impairments with Advancing Age (SarcoPhAge) cohort (i.e., the fifth year that ended in 2019) according to the Mini-Nutritional Assessment short-form, the European Working Group on Sarcopenia in Older People (EWGSOP2), and the Fried criteria, respectively. Information regarding the COVID-19 was gathered by phone calls interviews in April 2021 to measure its self-declared incidence. Adjusted Cox regressions and Kaplan-Meier curves were performed. RESULTS: The present study included 241 participants [median age 75.6 (73.0-80.6) years, 63.1% women]. Among them, 27 participants (11.2%) developed the non-fatal Covid-19. No significant increased risks of COVID-19 were observed in patients with malnutrition [adjusted HR 1.14 (0.26-5.07)] and sarcopenia [adjusted HR 1.25 (0.35-4.42)]. Nevertheless, the incidence of COVID-19 was significantly higher in frail (44.4%) than in robust participants (8.5%) [Adjusted HR 7.01 (2.69-18.25)], which was confirmed by the Kaplan-Meier curves (p < 0.001). Among the frailty syndrome components, a low physical activity level was the only one significantly associated with an increased risk of COVID-19 [adjusted HR 5.18 (1.37-19.54)]. CONCLUSION: Despite some limitations in the methodology of this study (i.e., limited sample size, COVID-19 incidence self-reported and not assessed systematically using objective measurements) requiring careful  consideration, an increased risk to develop COVID-19 was observed in the presence of the frailty syndrome. Further investigations are needed to elaborate on our findings.

Validity and reliability of the French translation of the Identification of Functional Ankle Instability (IdFAI).

PURPOSE: To translate and validate the Identification of Functional Ankle Instability (IdFAI) into French. METHODS: The IdFAI was translated according to international recommendations. Discriminative power, floor and ceiling effects, construct validity (including confirmatory factorial analysis (CFA)), internal consistency and test-retest reliability were measured. Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC) were also calculated. RESULTS: 160 participants were included. The IdFAI-F showed a very good test-retest reliability (ICC = 0.95). The SEM was 1.37 and the MDC was 3.79. The internal consistency was moderate (Cronbach's alpha coefficient = 0.68). The correlation between the IdFAI and the Cumberland Ankle Instability Tool (CAIT) was high (r = -0.75, p < 0.001). No floor, nor ceiling effects were observed. The CFA analyses did not confirm the factor structure proposed by the authors of the original English version. CONCLUSIONS: The IdFAI-F is a valid and reliable tool to accurately identify and measure chronic ankle instability in research and clinical settings for French-speaking individuals.

Current practice for safe return-to-play after lateral ankle sprain: A survey among French-speaking physicians.

BACKGROUND: Recommendations are available for assessment criteria for safe return-to-play (RTP) after a lateral ankle sprain. However, their current use among physicians is unknown. METHODS: French-speaking physicians in Belgium, France and Switzerland were asked to complete an online survey and report their clinical assessment of selected RTP criteria. RESULTS: The respondent sample (n=109) included physicians with and without Sports Medicine education, varied level of experience and proportion of athletes in their practice population. Pain was the most selected criterion for safe RTP (90% of physicians), followed by ability to engage in functional tasks (82%), functional instability (73%), range of motion (61%), proprioception (47%), mechanical instability (39%), strength (38%) and swelling (31%). A low proportion of physicians use quantitative measures to assess these criteria (between 4% and 53%). CONCLUSIONS: A large proportion of physicians consider the recommended criteria for RTP decisions. However, physicians do not frequently use quantitative measures.

Safety and efficacy of a single intra-articular injection of a novel enhanced protein solution (JTA-004) compared to hylan G-F 20 in symptomatic knee osteoarthritis: a randomized, double-blind, controlled phase II/III study.

BACKGROUND: New minimally invasive treatments are vital to delay joint replacement surgery in patients with knee osteoarthritis. This study was designed to select the most effective among three formulations of an enhanced protein solution containing clonidine, hyaluronic acid, and human plasma (JTA-004), and compare the safety and efficacy of intra-articular administration of the selected formulation with a reference treatment (hyaluronic acid) in symptomatic knee osteoarthritis patients. METHODS: In this two-stage, double-blind, phase II/III study conducted in 12 Belgian centers, 50-79-year-old patients with primary knee osteoarthritis were randomized (1:1:1:1) to receive one dose of one of three JTA-004 formulations (differing in clonidine concentration [50 or 100 µg/ml] and volume [2 or 4 ml]) or the reference treatment (hylan G-F 20). Patients were evaluated using Western Ontario McMaster Universities (WOMAC®) Scores and the Short-Form health survey up to 6 months post-injection (Month 6). Drug consumption and safety were evaluated. RESULTS: Among 164 treated patients, 147 completed the study. The JTA-004 formulation containing 200 µg clonidine and 20 mg hyaluronic acid in 2 ml (JTA-200/2) was selected based on interim results at Month 6. The difference in adjusted mean change in WOMAC Pain Subscale Score from baseline (JTA-200/2 minus reference group) at Month 6 was - 9.49 mm; statistical superiority of JTA-200/2 over the reference was not demonstrated. No statistically significant differences in adjusted mean changes from baseline between JTA-200/2 and reference groups were observed for Pain, Physical Function and Stiffness Subscales WOMAC Scores, Total WOMAC Score, and Well-being Score at any timepoint, although JTA-200/2 induced larger improvements in WOMAC Scores than the reference. Statistically significantly larger improvements in WOMAC Pain Subscale Scores for JTA-004 versus the reference were observed in post-hoc analyses on pooled data from all JTA-004 formulations at Month 6 (p = 0.030) and Month 3 (p = 0.014). All JTA-004 formulations had clinically acceptable safety profiles. CONCLUSIONS: This study provided preliminary evidence of the safety of intra-articular injection of JTA-004 in knee osteoarthritis patients. Phase III randomized controlled trials with larger sample sizes are needed to evaluate the efficacy of JTA-004 in knee osteoarthritis. TRIAL REGISTRATION: Clinicaltrials.gov/identifier NCT02740231; clinicaltrialsregister.eu/identifier 2015-002117-30. Retrospectively registered 13/4/2016.

Patients-centered SurvivorShIp care plan after Cancer treatments based on Big Data and Artificial Intelligence technologies (PERSIST): a multicenter study protocol to evaluate efficacy of digital tools supporting cancer survivors.

BACKGROUND: It is encouraging to see a substantial increase in individuals surviving cancer. Even more so since most of them will have a positive effect on society by returning to work. However, many cancer survivors have unmet needs, especially when it comes to improving their quality of life (QoL). Only few survivors are able to meet all of the recommendations regarding well-being and there is a body of evidence that cancer survivors' needs often remain neglected from health policy and national cancer control plans. This increases the impact of inequalities in cancer care and adds a dangerous component to it. The inequalities affect the individual survivor, their career, along with their relatives and society as a whole. The current study will evaluate the impact of the use of big data analytics and artificial intelligence on the self-efficacy of participants following intervention supported by digital tools. The secondary endpoints include evaluation of the impact of patient trajectories (from retrospective data) and patient gathered health data on prediction and improved intervention against possible secondary disease or negative outcomes (e.g. late toxicities, fatal events). METHODS/DESIGN: The study is designed as a single-case experimental prospective study where each individual serves as its own control group with basal measurements obtained at the recruitment and subsequent measurements performed every 6 months during follow ups. The measurement will involve CASE-cancer, Patient Activation Measure and System Usability Scale. The study will involve 160 survivors (80 survivors of Breast Cancer and 80 survivors of Colorectal Cancer) from four countries, Belgium, Latvia, Slovenia, and Spain. The intervention will be implemented via a digital tool (mHealthApplication), collecting objective biomarkers (vital signs) and subjective biomarkers (PROs) with the support of a (embodied) conversational agent. Additionally, the Clinical Decision Support system (CDSS), including visualization of cohorts and trajectories will enable oncologists to personalize treatment for an efficient care plan and follow-up management. DISCUSSION: We expect that cancer survivors will significantly increase their self-efficacy following the personalized intervention supported by the m-HealthApplication compared to control measurements at recruitment. We expect to observe improvement in healthy habits, disease self-management and self-perceived QoL. Trial registration ISRCTN97617326. https://doi.org/10.1186/ISRCTN97617326 . Original Registration Date: 26/03/2021.

Intra-articular injections of platelet-rich plasma in symptomatic knee osteoarthritis: a consensus statement from French-speaking experts.

PURPOSE: There has been much debate regarding the use of intra-articular injections of platelet-rich plasma (PRP) as symptomatic treatment for knee osteoarthritis. The objective of this consensus was to develop guidelines for PRP injections in knee osteoarthritis according to the French National Authority for Health recommendations. METHODS: Fifteen physicians from different French-speaking countries (10 rheumatologists, 4 specialists in rehabilitation and sports medicine and 1 radiologist) were selected for their expertise in the areas of PRP and osteoarthritis. A comprehensive literature review was conducted on Medline including all published therapeutic trials, open studies, meta-analysis and systematic reviews focusing on the effects of PRP in knee OA, as well as fundamental studies concerning the characteristics of the various types of PRP and their mechanisms, indexed before April 2019. Using the method recommended by the French National Authority for Health inspired by the Delphi consensus process, 25 recommendations were finally retained and evaluated. The recommendations were classified as appropriate or not appropriate, with strong or relative agreement, or uncertain if a consensus was not achieved. RESULTS: Among the 25 recommendations selected, the main ones are the following: (1) Intra-articular injections of PRP are an effective symptomatic treatment for early to moderate knee osteoarthritis. This recommendation was considered appropriate with a relative agreement (Median = 8; rank = 6-9). Level of evidence 1A. (2) A PRP treatment sequence in knee osteoarthritis may include 1-3 injections. This recommendation was considered appropriate with a strong agreement (Median = 9; rank = 7-9). Level of evidence 1A. (3) Leucocytes-poor PRP should be preferred in knee osteoarthritis. This recommendation was considered appropriate with a relative agreement (Median = 8; rank = 5-9). Level of evidence 5. (4) Intra-articular PRP knee injections should be performed under ultrasound or fluoroscopic guidance. This recommendation was considered uncertain with no consensus (Median = 8; rank = 3-9). Level of evidence 5. (5) PRP should not be mixed with an anesthetic or intra-articular corticosteroid. This recommendation was considered appropriate with a relative agreement (Median = 9; rank = 6-9). Level of evidence 5 CONCLUSION: Those 25 recommendations should standardize and facilitate the use of IA PRP injections, which are considered by experts as an effective treatment especially in early or moderate knee OA. Although a strong or relative agreement from the experts was obtained for most of the recommendations, many of them had a very low level of evidence (Level 5) and were principally based on the clinical experience of the experts.