Determinants of Return to Work After a Stroke: A Systematic Review and Meta-analysis.

OBJECTIVE: To identify prognostic factors for return to work (RTW) after stroke. DATA SOURCES: PubMed, MEDLINE, Cochrane, and Embase were systematically searched. STUDY SELECTION: Studies had to include people of working age (<65 years old) at the time of stroke (ischemic, hemorrhagic, or subarachnoid hemorrhage). The evaluation of RTW and rate of RTW had to be mentioned. Study selection was done by 2 independent authors. In total, 1241 articles were screened, 39 met all inclusion criteria. DATA EXTRACTION: Characteristics of included studies were recorded independently by 2 authors. Differences were resolved through discussion or with a third author. Quality was assessed using the Scottish Intercollegiate Guidelines Network quality assessment tool. DATA SYNTHESIS: Among the 39 studies, prognostic factors for RTW were hemorrhagic stroke (odds ratio 0.53 [95% confidence interval 0.45-0.60], n=18 studies), sex (men) (1.26 [1.14-1.40], n=31), aphasia (0.37 [0.20-0.69], n=7), occupation (white collar worker) (1.84 [1.64-2.06], n=17), independence in activities of daily living (3.99 [1.73-9.23], n=7), and stroke severity (NIHSS) (1.23 [1.08-1.39], n=6). CONCLUSIONS: This meta-analysis highlighted positive and negative prognostic factors associated with RTW after stroke. Two categories were distinguished: modifiable and non-modifiable prognostic factors. This study provides information to help understand the issues, set appropriate objectives and implement appropriate strategies to guide people to RTW after stroke. Randomized controlled studies are needed to better evaluate work-place intervention programs as well as the effects of intravenous thrombolysis, and cognitive and neuropsychological rehabilitation on return-to-work rates after stroke.

Combined Endurance and Strength or Only Endurance Training? Effects of Training Mode on Neuromuscular Characteristics and Functional Abilities in Obese Adolescent Girls Enrolled in a Weight-Reduction Program.

The aim of the present study was to examine whether combining strength and endurance training would promote better improvements in neuromuscular characteristics and functional abilities than endurance training alone in obese adolescent girls enrolled in a weight-reduction program. Twenty-four obese adolescent girls (12-15 years) volunteered to participate in a 9-month training program. Participants were allocated into two groups following either (i) combined training (endurance + strength; E+ST) or (ii) endurance training (ET) program. Absolute and specific maximal torque, muscle size, and maximal voluntary activation level (VA) of the knee extensor (KE) and plantar flexor (PF) muscles were assessed. Moreover, functional abilities such as balance and fatigability during a maximal isometric intermittent contraction test of the KE muscles were measured before and after the intervention. The force of the adductor pollicis (AP) muscles was used as a control to account for any effect of growth or mechanical unloading on neuromuscular properties and muscle size. While absolute and specific torque of the KE (+14.7 ± 12.1% and +14.4 ± 15.5%; p < 0.05) and PF (+19.2 ± 16.7% and +18.3 ± 17.5%; p < 0.001) muscles increased in the E+ST group, PF torque decreased, and KE torque did not change in the ET group (-22.6 ± 10.5% and -15.0 ± 17.2%; p < 0.001). Moreover, the VA of the KE muscles increased for the E+ST (+6.1 ± 5.6%; p < 0.01) group and decreased for the ET group (-5.4 ± 5.4%; p < 0.05). In contrast, VA remained similar in the PF muscles for both groups. The number of repetitions during the fatigability test increased in the ET group (38.4 ± 22.3 vs. 84.1 ± 33.3; p = 0.032) and was unchanged in the E+ST group (50.8 ± 14.1 vs. 54.2 ± 37.8), but it was associated with a higher force level. Moreover, balance improved in the E+ST group, but not in the ET group. To conclude, physical training combining strength and endurance training promoted larger improvement in neuromuscular characteristics and functional abilities than endurance training alone in obese adolescent girls. Greater neuromuscular adaptations resulting from the E+ST training may be beneficial for preserving or even increasing functional abilities and possibly induce greater engagement in the active lifestyle of obese adolescents. However, the endurance component seems necessary in training programs to reduce fatigability during daily living activities.

Sex-Related Neuromuscular Adaptations to Youth Obesity: Force, Muscle Mass, and Neural Issues.

Young obese are generally stronger than their typically developing counterparts. Strength differences could be partly ascribed to nervous adaptations, due to the loading effect of carrying overweight. We hypothesized that central adaptations of the muscles highly involved in weight bearing, i.e., plantar flexors (PF) and knee extensors (KE) could be greater in girls than boys due to their reduced potential for muscle hypertrophy. Furthermore, it is possible that neuromuscular adaptations in weight-bearing muscles will be greater compared to the unloaded muscles such as the adductor pollicis (AP).Twenty-four non-obese and 21 obese (body mass index: 33 ± 4 kg·m-2) adolescent girls and boys (12-15 years) performed maximal voluntary isometric contractions (MVC) of the PF and KE muscles. Voluntary activation (VA), assessed with the twitch interpolation technique, the antagonist co-activation (Co-Act) level, and the normalized root-mean-square value (RMS) of the agonist muscles were measured to account for central adaptations.The results revealed a weight status effect (p < 0.001) on the absolute MVC torque and VA of both KE and PF muscles. Moreover, these differences were also related to the sex of the participants (p < 0.05) for the PF muscles. While the VA, absolute, and specific MVC torque were greater in obese compared with non-obese girls, no difference was found between boys. A similar Co-Act level was observed between groups, whatever the sex and muscle group considered. Finally, no significant differences were found for the AP regarding peripheral and neural factors.This study highlighted a favorable effect of obesity on the central mechanisms (i.e., VA) responsible for force production within the lower limb muscles. However, obesity-related central adaptation was only observed in girls for the PF muscles. Thus, the excess of body mass supported by the muscles involved in weight-bearing could act as a chronic training stimulus responsible for these adaptations in obese adolescents but mostly in girls.

Creatine supplementation and VO2max: a systematic review and meta-analysis.

Although creatine supplementation is well-known to increase exercise performance in acute high-intensity exercises, its role in aerobic performance based on VO2max is more controversial. Thus, we performed a systematic review and meta-analysis on the effects of creatine supplementation on VO2max. PubMed, Cochrane, Embase, and ScienceDirect were searched for randomized controlled trials (RCTs) reporting VO2max in creatine supplementation and placebo groups before and after supplementation. We computed a random-effects meta-analysis on VO2max at baseline, within groups following supplementation, on changes on VO2max between groups, and after supplementation between groups. Sensitivity analyses and meta-regression were conducted. We included 19 RCTs for a total of 424 individuals (mean age 30 years old, 82% men). VO2max did not differ at baseline between groups (creatine and placebo). Participants in both groups were engaged in exercise interventions in most studies (80%). Using changes in VO2max, VO2max increased in both groups but increased less after creatine supplementation than placebo (effect size [ES] = -0.32, 95%CI = -0.51 to -0.12, p = 0.002). Comparisons after creatine supplementation confirmed a lower VO2max in the creatine group compared to the placebo group (ES= -0.20, 95%CI = -0.39 to -0.001, p = 0.049). Meta-analysis after exclusion from meta-funnel resulted in similar outcomes in a subgroup of young and healthy participants. Meta-regressions on characteristics of supplementation, physical training, or sociodemographic were not statistically significant. Creatine supplementation has a negative effect on VO2max, regardless of the characteristics of training, supplementation, or population characteristics.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2021.2008864 .

Health management of patients with COVID-19: is there a room for hydrotherapeutic approaches?

With highly variable types of coronavirus disease 2019 (COVID-19) symptoms in both severity and duration, there is today an important need for early, individualized, and multidisciplinary strategies of rehabilitation. Some patients present persistent affections of the respiratory function, digestive system, cardiovascular function, locomotor system, mental health, sleep, nervous system, immune system, taste, smell, metabolism, inflammation, and skin. In this context, we highlight here that hydrothermal centers should be considered today as medically and economically relevant alternatives to face the urgent need for interventions among COVID-19 patients. We raise the potential benefits of hydrotherapy programs already existing which combine alternative medicine with respiratory care, physical activity, nutritional advice, psychological support, and physiotherapy, in relaxing environments and under medical supervision. Beyond the virtues of thermal waters, many studies reported medical benefits of natural mineral waters through compressing, buoyancy, resistance, temperature changes, hydrostatic pressure, inhalations, or drinking. Thermal institutions might offer individualized follow-up helping to unclog hospitals while ensuring the continuity of health care for the different clinical manifestations of COVID-19 in both post-acute and chronic COVID-19 patients. Our present review underlines the need to further explore the medical effectiveness, clinical and territorial feasibility, and medico-economic impacts of the implementation of post-COVID-19 patient management in hydrotherapeutic establishments.

Foot Function Index: A Promising Questionnaire for Individuals With Charcot-Marie-Tooth Disease Type 1A.

OBJECTIVE: To evaluate in a preliminary methodologic study, the Foot Function Index (FFI), a 3-subscale (pain, disability, and activity restriction) foot disability assessment questionnaire, in patients with Charcot-Marie-Tooth disease type 1A (CMT1A). DESIGN: Monocentric exploratory cross-sectional study with 2 identical evaluations by the same physical medicine and rehabilitation physician at 14-day intervals (test-retest) according to international guidelines for validating health-related patient-reported outcomes, the Consensus-based Standards for the Selection of Health Measurement Instruments Criteria. SETTING: Physical medicine and rehabilitation and neurology departments in a French academic hospital. PARTICIPANTS: Patients with CMT1A confirmed by molecular biology (N=26). INTERVENTION: The FFI and a health-related quality-of-life questionnaire (Medical Outcomes Study Short Form 36 [SF-36] with mental and physical composite scores) combined with quantitative walk analysis by instrumental gait analysis and evaluation of isokinetic quadriceps and hamstrings peak torque by isokinetic dynamometer. MAIN OUTCOME MEASURES: FFI score and its dimensions. RESULTS: Acceptability was satisfactory, with less than 5% missing data and good distribution of results. Internal consistency was very satisfactory, with Cronbach α of 0.95. Reproducibility was very satisfactory, with Lin concordance coefficient 0.82. External consistency was satisfactory, with expected correlation coefficients: the FFI was significantly correlated with the SF-36 physical composite score and gait parameters (cadence) (r=-0.58 and r=-0.52; P<.005) but not with peak torque or SF-36 mental composite score. CONCLUSIONS: This study confirms the very good metrologic properties of the FFI in patients with CMT1A. The FFI could be a promising questionnaire to assess foot-related disability in a neurologic disease. Complementary studies are still needed to confirm these promising preliminary results.

Eccentric cycling is more efficient in reducing fat mass than concentric cycling in adolescents with obesity.

The benefits of eccentric (ECC) training on fat mass (FM) remain underexplored. We hypothesized that in obese adolescents, ECC cycling training is more efficient for decreasing whole-body FM percentage compared to concentric (CON) performed at the same oxygen consumption (VO2 ). Twenty-four adolescents aged 13.4 ± 1.3 years (BMI > 90th percentile) were randomized to ECC or CON. They performed three cyclo-ergometer sessions per week (30 min per session) for 12 weeks: two habituation, 5 at 50% VO2peak , and 5 at 70% VO2peak . Anthropometric measurements, body composition, maximal incremental CON tests, strength tests, and blood samples were assessed pre- and post-training. Whole-body FM percentage decreased significantly after compared to pretraining in both groups, though to a larger extent in the ECC group (ECC: -10% vs CON: -4.2%, P < 0.05). Whole-body lean mass (LM) percentage increased significantly in both groups after compared to pretraining, with a greater increase in the ECC group (ECC: 3.8% vs CON: 1.5%, P <0.05). The improvements in leg FM and LM percentages were greater in the ECC group (-6.5% and 3.0%, P = 0.01 and P < 0.01). Quadriceps isometric and isokinetic ECC strength increased significantly more in the ECC group (28.3% and 21.3%, P < 0.05). Both groups showed similar significant VO2peak improvement (ECC: 15.4% vs CON: 10.3%). The decrease in homeostasis model assessment of insulin resistance index was significant in the ECC group (-19.9%). In conclusion, although both ECC and CON cycling trainings are efficient to decrease FM, ECC induces greater FM reduction, strength gains, and insulin resistance improvements and represents an optimal modality to recommend for obese adolescents.

French validation of the Arthritis Self-Efficacy Scale and further psychometric properties exploration among 168 people with osteoarthritis.

OBJECTIVE:: To validate the Arthritis Self-Efficacy Scale-French version (ASES-F) of the ASES questionnaire designed to evaluate self-efficacy in arthritis population and to confirm its psychometric properties. DESIGN:: The translation/back-translation procedure was done in line with cross-cultural adaptation international guidelines. Prospective multicenter validation was performed on 168 patients with osteoarthritis who filled out the ASES-F. Function subscale of the Western Ontario and McMaster Universities Arthritis Index, Hospital Anxiety and Depression (HAD), Knee Osteoarthritis Fears and Beliefs Questionnaire, and pain on visual analog scale were collected. Acceptability, internal consistency, reproducibility, internal and external structure validity, and sensitivity following a self-management program focused on physical activity were analyzed. The retest was performed 15 days later. RESULTS:: A culturally adapted version was obtained following the validation procedure. The final translated questionnaire is available within the full article. Cronbach's alpha coefficient was at 0.95 for the overall ASES-F. Regarding the test-retest reproducibility, Lin's concordance coefficient was at 0.84. The internal and external validity was also explored with correlations at -0.50 between ASES-F and (WOMAC), and significant correlations between ASES-F and HAD. Sensitivity shown significant improvement at three months for the subscale function only (+2.65, P < 0.01). CONCLUSION:: The ASES-F, French version of the ASES, available in supplemental data, was validated in knee osteoarthritis patients and could be used in clinical practice and research for French-speaking patients. Sensitivity needs to be more explored.

Maturation-related changes in the development and etiology of neuromuscular fatigue.

PURPOSE: The aim of the present study was to investigate the role of maturation on the etiology of neuromuscular fatigue induced by repeated maximal voluntary isometric contractions (MVIC). METHODS: Nine prepubertal boys (9.9 ± 1.3 years), eight male adolescents (13.6 ± 1.3 years) and eleven men (23.4 ± 3.0 years) performed a series of repeated isometric MVICs of the knee extensors until the MVIC torque reached 60% of its initial value. Magnetic stimulations were delivered to the femoral nerve every five MVICs to follow the course of voluntary activation level (VA) and the potentiated twitch torque (Qtwpot). RESULTS: Task failure was reached after 52.9 ± 12.7, 42.6 ± 12.5, and 26.6 ± 6.3 repetitions in boys, adolescents and men, respectively. VA remained unchanged in men whereas it decreased significantly and similarly in boys and adolescents (p < 0.001). In contrast, Qtwpot remained unchanged in boys and decreased significantly less in adolescents than adults (p < 0.05). CONCLUSIONS: Children and adolescents experience less peripheral and more central fatigue than adults. However, adolescents experience more peripheral fatigue than children for a comparable amount of central fatigue. This finding supports the idea that the tolerance of the central nervous system to peripheral fatigue could increase during maturation.

Efficacy of self-management exercise program with spa therapy for behavioral management of knee osteoarthritis: research protocol for a quasi-randomized controlled trial (GEET one).

BACKGROUND: Osteoarthritis (OA) is not limited to joint pain and stiffness, which can lead to disability; it is also linked to comorbidities such as overweight, obesity and fears and beliefs related to the pathology. The knee OA population appears more affected by these risk factors and has a lower physical activity (PA) level than the general population. The key challenge for OA treatment is increasing the PA level to decrease the risk factors. METHODS: We aim to perform a prospective, multicentric, quasi-randomized controlled trial with an alternate-month design (1-month periods). People aged 50-75 years old with symptomatic knee OA (stage I-IV Kellgren and Lawrence scale) with low and moderate PA level will be included in 3 spa therapy resorts. The experimental arm will receive 5 self-management exercise sessions (1.5 h each; education, aerobics, strength training, range of motion) + an information booklet + 18 sessions (1 h each) of spa therapy treatment (STT). The active comparator arm will receive an information booklet + 18 sessions of STT. The primary outcome will be a change at 3 months in PA level (International Physical Activity Questionnaire short form score). Secondary outcomes will be function (WOMAC) pain (numerical scale), anxiety/depression (HAD), fears and beliefs about OA (KOFBeQ) and arthritis self-efficacy (ASES). The barriers to and facilitators of regular PA practice will be assessed by using specific items specifically designed for the study because of lack of any reference scale. DISCUSSION: The study could demonstrate the impact of a self-management exercise program associated with spa therapy in the medium term by increasing PA level in people with OA. A benefit for ameliorating fears and beliefs and anxiety/depression and improving self-efficacy will also be analysed. The findings could offer new prospects while establishing best clinical practice guidelines for this population. TRIAL REGISTRATION: ClinicalTrials.gov NCT02598804 (November 5, 2015).

[Using connected objects to favour patients' adherence to physical activity]. / Activité physique et objets connectés : comment favoriser l'adhésion des patients ?

A study explored the factors which can have an impact on the use of connected objects to improve patients' adherence to physical activity, when they suffer from chronic low back pain. The results can be used to adjust the development of an application aimed at patients with chronic low back pain.

[A driving simulator for the benefit of patients]. / Un simulateur de conduite au service des patients.

Particularly innovative in the management of patients with non-progressive brain injuries, the unit for the assessment of fitness to drive at Clermont-Ferrand university hospital is equipped with a driving simulator. It allows assessments and specific driver rehabilitation to be carried out in optimal safety.

Effect of muscle length on voluntary activation of the plantar flexors in boys and men.

PURPOSE: The aim of the present study was to compare the effect of muscle length on the maximal voluntary activation level (VA) of the plantar-flexors between children and adults. METHODS: Fourteen boys (10.0 ± 1.0 years) and fifteen men (24.6 ± 4.2 years) performed 5-s maximal isometric voluntary contractions (MVC) of the plantar-flexor muscles at seven ankle angles [from 10° in dorsi-flexion (DF) to 20° in plantar-flexion (PF); 0° = reference position; the angle between the plantar surface and leg is a right angle]. Single magnetic stimulations were delivered to the posterior tibial nerve during MVCs to determine VA. RESULTS: Results showed a higher absolute torque of the plantar-flexor muscles at long (10° DF) than at short muscle length (20° PF) in men (89.4 ± 19.4 vs. 46.8 ± 17.0 N m, P < 0.001) and boys (44.9 ± 18.5 vs. 26.6 ± 12.8 N m, P < 0.001). On average, VA was significantly higher in men than in boys (92.4 ± 1.7 vs. 87.6 ± 1.6 %, P < 0.05). However, no significant main effect of the ankle angle was observed on VA. CONCLUSIONS: The VA partly accounts for the plantar-flexors MVC torque difference between children and adults but is not affected by the muscle length changes in both groups. Therefore, VA cannot account for the shape of the torque-angle relationship on the plantar-flexor muscles.

Evaluation of the efficacy of a short-course, personalized self-management and intensive spa therapy intervention as active prevention of musculoskeletal disorders of the upper extremities (Muska): a research protocol for a randomized controlled trial.

BACKGROUND: Musculoskeletal disorders (MSDs) constitute a major occupational health problem in the working population, substantially impacting the quality of life of employees. They also cause considerable economic cost to the healthcare system, with, notably, the reimbursement of treatments and compensation for lost income. MSDs manifest as localized pain or functional difficulty in one or more anatomical areas, such as the cervical spine, shoulder, elbow, hand, and wrist. Although prevalence varies depending on the region considered and the method of assessment, a prevalence of 30% is found in different epidemiological studies. The disease needs to be prevented, not only for medical and economic reasons, but also for legal reasons, owing to the requirement of assessing occupational risks. The strategy envisaged may thus revolve around active, multimodal prevention that has employees fully involved at the heart of their care. Although physical exercise is widely recommended, few studies with a good level of evidence have enabled us to base a complete, well-constructed intervention on exercise that can be offered as secondary prevention in these disorders. METHODS: A prospective, multicenter, comparative (intervention arm vs. control arm), randomized (immediate vs. later treatment) study using Zelen's design. This study falls under active prevention of MSDs of the upper extremities (UE-MSDs). Participants are workers aged between 18 and 65 years with latent or symptomatic MSDS, with any type of job or workstation, with or without an history of sick leave. The primary aim is to show the superiority at 3 months of a combination of spa therapy, exercise, and self-management workshops for 6 days over usual care in the management of MSDs in terms of employee functional capacity in personal and professional daily life. Secondary aims are to assess the benefit of the intervention in terms of pain, quality of life, and accumulated duration of sick leave. DISCUSSION: This randomized controlled trial is the first that will aim to evaluate multidisciplinary management of UE-MSDs using nonpharmacological treatment combining exercise, self-management, and spa therapy. The originality of this intervention lies, in its short, intensive format, which is compatible with remaining in work; and in its multidisciplinary approach. This trial has the potential to demonstrate, with a good level of evidence, the benefits of a short course of spa therapy combined with a personalized self-management program on the functional capacity, pain, and quality of life of employees in their daily life. TRIAL REGISTRATION: Clinical trial.gov NCT02702466 retrospectively registered. PROTOCOL: Version 4 of 9/10/2015.

[Osteoarthritis and patient therapeutic education, learning to move more]. / Arthrose et éducation thérapeutique, apprendre à mieux bouger.

As part of the prevention strategies offered to people with osteoarthritis, therapeutic education plays a key role. It seeks to help the patient become a player in their own care and focuses in particular on the factors influencing regular participation in suitable physical activity.

Obesity-related differences in neuromuscular fatigue in adolescent girls.

PURPOSE: The aim of this study was to investigate the effect of obesity on neuromuscular fatigue in adolescent girls. METHODS: Twelve lean (13.6 ± 0.8 years) and 12 obese (13.9 ± 0.9 years) girls repeated 5-s maximal voluntary contractions (MVC) of the knee extensors until the generated torque reached 55 % of its initial value. Magnetic stimulations were delivered to the femoral nerve every five MVCs to follow the course of voluntary activation (VA) and potentiated twitch torque (Qtwpot). RESULTS: Torque reached 55 % of its initial value after 52.6 ± 20.4 and 74.9 ± 22.8 repetitions in obese and lean girls, respectively (p < 0.01). Furthermore, the decline of VA was smaller in obese girls (p < 0.001). In contrast, Qtwpot decreased to a greater extent in obese girls (p < 0.05). CONCLUSIONS: Obese girls fatigue faster than their lean counterparts. The peripheral factors mainly account for fatigue in obese girls, whereas central factors are mainly involved in lean girls.

Do Teaching General Practitioners' Fear-Avoidance Beliefs Influence Their Management of Patients with Low Back Pain?

OBJECTIVES: To describe fear-avoidance beliefs about low back pain (LBP) in a sample of teaching general practitioners (TGPs) and to investigate the impact on following the guidelines for LBP. METHODS: A sample of 112 French TGPs were contacted to complete a self-administered questionnaire including socio-demographic and professional data, personal history of LBP, CME about LBP and usual practices, and their low back pain beliefs using the Fear-Avoidance Beliefs Questionnaire (FABQ) and the Back Belief Questionnaire (BBQ). RESULTS: Forty-seven responded, 48% treated more than 10 LBP patients per month, and 45% participated in an educational session on LBP during the previous 3 years. Seventy percent reported a previous episode of acute LBP, while 30% suffered from chronic LBP. The median scores for the FABQ-phys and work were 8 (4 to 10) and 17 (11 to 21), and 35 (31 to 38) for the BBQ. There were no correlations between age or years of practice and FABQ scores. TGPs suffering more than 1 acute LBP episode per month had a lower BBQ score (P < 0.05). Those prescribing more imaging exams in acute LBP had higher FABQ and lower BBQ scores, while those who recommended rest in both acute and chronic LBP had a higher FABQ-phys score. DISCUSSION: Teaching general practitioners' fear-avoidance beliefs about LBP are lower than previously reported by their GP colleagues but still negatively influence the way they follow guidelines for LBP patients. This may influence the way they teach the management of LBP.

Barriers and facilitators for medication adherence in stroke patients: a qualitative study conducted in French neurological rehabilitation units.

OBJECTIVE: To describe the perceptions of French patients, caregivers and healthcare professionals on stroke and secondary preventive medications. METHOD: A qualitative study was conducted, based on four predetermined topics: stroke, secondary prevention medications, patient's experience, relationship between patient/caregiver and healthcare team. RESULTS: Twenty-six interviews were conducted. Difficulties in taking medications, lack of knowledge on stroke and medication benefits, fear of over medication were identified as barriers for adherence in patients. Doubts about generic drugs were expressed by caregivers. Healthcare professionals reported lack of knowledge and absence of clinical symptoms as barriers. On the other hand, support from caregivers and healthcare professional support is essential for compliance in all participants. Patients and caregivers expressed that fear of recurrence was a facilitator for treatment compliance. CONCLUSION: This study highlights the barriers and facilitators for stroke treatment adherence and underlines the similarities and differences between the perceptions of patients, caregivers and healthcare professionals. These results must be integrated into the future French educational programs to improve medication adherence.

Eccentric Muscle Strengthening Using Maximal Contractions Is Deleterious in Knee Osteoarthritis: A Randomized Clinical Trial.

Objectives: To show the superiority of eccentric versus concentric strengthening in terms of improving quadriceps strength in knee osteoarthritis (OA), a randomized controlled study was conducted to perform 12 sessions of either eccentric or concentric isokinetic muscle strengthening over 6 weeks. Methods: We recruited males and females, aged between 40 and 70 years, with predominantly unilateral femorotibial OA. Exclusion criteria were having a prosthesis, inflammatory arthritis or flare-up of OA, symptomatic patellofemoral OA, cardiovascular or pulmonary disease that could be a contraindication to the study treatment, and any pathology that could cause muscle weakness. The primary endpoint was the between-group difference in change in maximum concentric isokinetic knee extension peak torque (PT) at 60°/s on the OA side at 6 weeks. Secondary endpoints were between-group difference in change in concentric hamstring PT at 60°/s; eccentric quadriceps and hamstring PT at 30°/s; 10 m and 200 m walking speeds; pain and functional status (WOMAC score) at 6 weeks and 6 months. Results: The sample consisted of 11 females and 27 males, with a mean age of 57.7 ± 7.52 years and a body mass index (BMI) of 25.95 ± 3.93 kg/m2. Quadriceps strength increased more at 6 weeks in the concentric than the eccentric group with no statistical difference. There was a rate of 25% major adverse events in the eccentric group. Conclusions: Eccentric training resulted in a smaller improvement in quadriceps strength than concentric training and was associated with a high risk of muscle injury, particularly to the hamstring muscles.

Nitrous oxide provided during intensive physiotherapy for shoulder adhesive capsulitis does not improve function: A randomised controlled trial.

BACKGROUND: There is no consensus on treatment for adhesive capsulitis of the shoulder. Physiotherapy is often used to increase range of motion but individuals may experience pain during mobilisation. OBJECTIVES: The objective of this study was to determine whether rehabilitation under N2O for shoulder AC improved pain and function more than rehabilitation alone (with placebo gas). METHOD: A randomised, 1:1 parallel arm, double-blind study in 4 university hospital outpatient centres. Adults with adhesive capsulitis for at least 3 months with intact cartilage were included. Participants were randomised in blocks of 4 and stratified by centre to receive 20 sessions of intensive physiotherapy over 10 days; the 10 morning sessions were performed with either nitrous oxide (intervention) or sham gas (placebo). PRIMARY OUTCOME: improvement in shoulder function at day 14 (D14) (Constant-Murley score). RESULTS: Seventy-five participants were included, and data from 69 were analysed: 37 in the placebo group and 32 in the intervention group. Improvements occurred in both groups after the intervention. No significant difference in the Constant-Murley score was found between groups at D14 (median score increase of 12.0, IQR 5.6; 19.5 points in placebo group vs. 13.7, 5.2; 18.2 in the N20 group, p = 0.78). Pain score during sessions reduced in the intervention group from the first to final session (-11.6, p = 0.053) but not for the placebo group (-4.2, p = 0.414). Seven serious adverse events were recorded, 4 in the intervention group and 3 in the placebo group, with 11 minor adverse events only in the intervention group (mostly shortness of breath). CONCLUSION: Nitrous oxide gas associated with intensive physiotherapy for shoulder adhesive capsulitis did not improve function, pain or quality of life more than physiotherapy alone. zHowever, pain experienced during physiotherapy sessions appeared lower. TRIAL REGISTRATION: Clinical Trial registration number NCT01087229.