Multimodal evoked potentials for functional quantification and prognosis in multiple sclerosis.

BACKGROUND: Functional biomarkers able to identify multiple sclerosis (MS) patients at high risk of fast disability progression are lacking. The aim of this study was to evaluate the ability of multimodal (upper and lower limbs motor, visual, lower limbs somatosensory) evoked potentials (EP) to monitor disease course and identify patients exposed to unfavourable evolution. METHODS: One hundred MS patients were assessed with visual, somatosensory and motor EP and rated on the Expanded Disability Status Scale (EDSS) at baseline (T0) and about 6 years later (T1). The Spearman correlation (rS) was used to evaluate the relationship between conventional EP scores and clinical findings. Multiple (logistic) regression analysis estimated the predictive value of baseline electrophysiological data for three clinical outcomes: EDSS, annual EDSS progression, and the risk of EDSS worsening. RESULTS: In contrast to longitudinal correlations, cross-sectional correlations between the different EP scores and EDSS were all significant (0.33 ≤ rS < 0.67, p < 0.001). Baseline global EP score and EDSS were highly significant predictors (p < 0.0001) of EDSS progression 6 years later. The baseline global EP score was found to be an independent predictor of the EDSS annual progression rate (p < 0.001), and of the risk of disability progression over time (p < 0.005). Based on a ROC curve determination, we defined a Global EP Score cut off point (17/30) to identify patients at high risk of disability progression illustrated by a positive predictive value of 70%. CONCLUSION: This study provides a proof of the concept that electrophysiology could be added to MRI and used as another complementary prognostic tool in MS patients.

Lumbopelvic motor control and low back pain in elite soccer players: a cross-sectional study.

This study aimed to investigate the relationship between the history of low back pain and quality of lumbopelvic motor control in soccer players. Forty-three male elite soccer players (mean age, 18.2 ± 1.4 years) filled in questionnaires related to low back pain and attended a session to assess lumbopelvic motor control by means of five tests (the bent knee fall out test, the knee lift abdominal test, the sitting knee extension test, the waiter's bow and the transversus abdominis test). A physiotherapist, blinded to the medical history of the participants, scored (0 = failed, 1 = correct) the performance of the players for each of the tests resulting in a lumbopelvic motor control score ranging from 0 to 5. Forty-seven per cent of the soccer players reported a disabling low back pain episode lasting at least two consecutive days in the previous year. These players scored worse lumbopelvic motor control than players without a history of low back pain (lumbopelvic motor control score of 1.8 vs. 3.3, P < 0.01). The between-groups difference was particularly marked for the bent knee fall out test, the knee lift abdominal test and the transversus abdominis test (P < 0.01). In conclusion, most soccer players with a history of low back pain had an altered lumbopelvic motor control. Further research should examine whether lumbopelvic motor control is etiologically involved in low back pain episodes in soccer players.

One-year follow-up of platelet-rich plasma infiltration to treat chronic proximal patellar tendinopathies.

Infiltration of Platelet-Rich Plasma (PRP) may be considered as a recent therapeutic option for chronic tendinopathies. The aim of this study is to evaluate the clinical status and the return to sports activities in patients with chronic proximal patellar tendinopathies. Twenty subjects with chronic proximal patellar tendinopathy benefited from 1 infiltration of PRP coupled with a standardized eccentric rehabilitation. The follow-up (up to 1 year) was assessed by means of a Visual Anologue Scale (VAS), the International Knee Documentation Committee (IKDC) form and the Victorian Institute of Sport Assessment (VISA-P) score. Moreover, subjects had to answer an information questionnaire concerning their life and sports activities. Seventy percents of the patients reported a favourable evolution with decrease of pain, and returned to sports activities. With time, VAS dropped significantly and both IKDC and VISA-P scores improved also significantly. This study confirms that a local injection of PRP coupled with a program of eccentric rehabilitation for treating a chronic jumper's knee, improves pain symptoms and the functionalities of the subjects' knee up to 1 year after injection.

Exuberant inflammatory reaction as a side effect of platelet-rich plasma injection in treating one case of tendinopathy.

Platelet-rich plasma (PRP) contains a large number of growth factors, which may enhance tendon healing processes. Local injection of PRP represents a relatively new treatment for tendinopathies. To date, no side effects have been reported after injection of PRP to treat tendinopathy. We report a case of exuberant inflammatory reaction after 1 injection of PRP to treat jumper's knee in a 35-year-old male type 1 diabetic patient. Injections of PRP should be proposed only after careful consideration in cases of patients with morbidity risks linked to insulin-dependent diabetes.

Effects of 3 months of short sessions of controlled whole body vibrations on the risk of falls among nursing home residents.

BACKGROUND: Fatigue, lack of motivation and low compliance can be observed in nursing home residents during the practice of physical activity. Because exercises should not be too vigorous, whole body vibration could potentially be an effective alternative. The objective of this randomized controlled trial was to assess the impact of 3-month training by whole body vibration on the risk of falls among nursing home residents. METHODS: Patients were randomized into two groups: the whole body vibration group which received 3 training sessions every week composed of 5 series of only 15 seconds of vibrations at 30 Hz frequency and a control group with normal daily life for the whole study period. The impact of this training on the risk of falls was assessed blindly by three tests: the Tinetti Test, the Timed Up and Go test and a quantitative evaluation of a 10-second walk performed with a tri-axial accelerometer. RESULTS: 62 subjects (47 women and 15 men; mean age 83.2 ± 7.99 years) were recruited for the study. No significant change in the studied parameters was observed between the treated (n=31) and the control group (n=31) after 3 months of training by controlled whole-body-vibrations. Actually, the Tinetti test increased of + 0.93 ± 3.14 points in the treated group against + 0.88 ± 2.33 points in the control group (p = 0.89 when adjusted). The Timed Up and Go test showed a median evolution of - 1.14 (- 4.75-3.73) seconds in the treated group against + 0.41 (- 3.57- 2.41) seconds in the control group (p = 0.06). For the quantitative evaluation of the walk, no significant change was observed between the treated and the control group in single task as well as in dual task conditions. CONCLUSIONS: The whole body vibration training performed with the exposition settings such as those used in this research was feasible but seems to have no impact on the risk of falls among nursing home residents. Further investigations, in which, for example, the exposure parameters would be changed, seem necessary. TRIAL REGISTRATION NUMBER: NCT01759680.

Platelet-rich plasma application in the management of chronic tendinopathies.

Platelet-rich plasma (PRP) may represent a new therapeutic option for chronic tendinopathies. Platelets release various cytokines and growth factors which promote angiogenesis, tissue remodeling, and wound healing. We made an extended literature review of the use of PRP in chronic tendinopathies: epicondylitis, rotator cuff, patellar and calcaneal tendinopathies, and plantar fasciitis. Medline, Embase and Google Scholar were used (until July 31, 2012). Clinical studies on PRP and tendinopathies published in English and French language peer-reviewed journals were included. Articles with a high level of evidence were given special consideration. Despite the proven efficacy of PRP on tissue regeneration in experimental studies, there is currently scanty tangible clinical evidence with respect to its efficacy in chronic tendon disorders. The few studies that have been performed appear unlikely to be comparable. Randomized controlled studies with appropriate placebo groups are needed to determine the real effectiveness of PRP for treating chronic musculoskeletal injuries.

Effects of platelet-rich plasma (PRP) on the healing of Achilles tendons of rats.

Platelet-rich plasma (PRP) contains growth factors involved in the tissular healing process. The aim of the study was to determine if an injection of PRP could improve the healing of sectioned Achilles tendons of rats. After surgery, rats received an injection of PRP (n = 60) or a physiological solution (n = 60) in situ. After 5, 15, and 30 days, 20 rats of both groups were euthanized and 15 collected tendons were submitted to a biomechanical test using cryo-jaws before performing transcriptomic analyses. Histological and biochemical analyses were performed on the five remaining tendons in each group. Tendons in the PRP group were more resistant to rupture at 15 and 30 days. The mechanical stress was significantly increased in tendons of the PRP group at day 30. Histological analysis showed a precocious deposition of fibrillar collagen at day 5 confirmed by a biochemical measurement. The expression of tenomodulin was significantly higher at day 5. The messenger RNA levels of type III collagen, matrix metalloproteinases 2, 3, and 9, were similar in the two groups at all time points, whereas type I collagen was significantly increased at day 30 in the PRP group. In conclusion, an injection of PRP in sectioned rat Achilles tendon influences the early phase of tendon healing and results in an ultimately stronger mechanical resistance.

Alteration of muscle function after electrical stimulation bout of knee extensors and flexors.

The purpose was to study the effects on muscle function of an electrical stimulation bout applied unilaterally on thigh muscles in healthy male volunteers. One group (ES group, n = 10) received consecutively 100 isometric contractions of quadriceps and 100 isometric contractions of hamstrings (on-off ratio 6-6 s) induced by neuromuscular electrical stimulations (NMES). Changes in muscle torque, muscle soreness (0-10 VAS), muscle stiffness and serum creatine kinase (CK) activity were assessed before the NMES exercise (pre-ex) as well as 24h (d+1), 48h (d+2) and 120h (d+5) after the bout. A second group (control group, n = 10) were submitted to the same test battery than the ES group and with the same time-frame. The between-group comparison indicated a significant increase in VAS scores and in serum levels of CK only in the ES group. In the ES group, changes were more pronounced in hamstrings than in quadriceps and peaked at d+2 (quadriceps VAS scores = 2.20 ± 1.55 a.u. (0 at pre-ex); hamstrings VAS scores = 3.15 ± 2.14 a.u. (0 at pre-ex); hip flexion angle = 62 ± 5° (75 ± 6° at pre-ex); CK activity = 3021 ± 2693 IU·l(-1) (136 ± 50 IU·l(-1) at pre-ex)). The results of the present study suggested the occurrence of muscle damage that could have been induced by the peculiar muscle recruitment in NMES and the resulting overrated mechanical stress. The sensitivity to the damaging effects of NMES appeared higher in the hamstrings than in quadriceps muscles.

Using the load-velocity relationship for 1RM prediction.

The purpose of this study was to investigate the ability of the load-velocity relationship to accurately predict a bench press 1 repetition maximum (1RM). Data from 3 different bench press studies (n = 112) that incorporated both 1RM assessment and submaximal load-velocity profiling were analyzed. Individual regression analysis was performed to determine the theoretical load at zero velocity (LD0). Data from each of the 3 studies were analyzed separately and also presented as overall group mean. Thereafter, correlation analysis provided quantification of the relationships between 1RM and LD0. Practically perfect correlations (r = ∼0.95) were observed in our samples, confirming the ability of the load-velocity profile to accurately predict bench press 1RM.

Current opinions on tendinopathy.

Tendinopathy is characterized by pain in the tendon and impaired performance sometimes associated with swelling of the tendon. Its diagnosis is usually clinical but ultrasonography and magnetic resonance imaging can refine the diagnosis. Tendinopathy is highly prevalent and is one of the most frequently self reported musculoskeletal diseases in physical workers and sports people. Nevertheless, it is very difficult to carry out general epidemiologic studies on tendinopathy because of the varying sports cultures and sports habits in different countries. The aetiology of tendinopathy seems to be multi-factorial, involving intrinsic and extrinsic factors. The role of inflammation is still debated but the absence of inflammatory cells does not mean that inflammatory mediators are not implicated. Different theories have been advanced to explain pain and chronicity mechanisms, but these mechanisms remain largely unknown. "Conventional "treatments are generally employed empirically to fight pain and inflammation but they do not modify the histological structure of the tendon. However, these treatments are not completely satisfactory and the recurrence of symptoms is common. Currently, eccentric training remains the treatment of choice for tendinopathy, even though some studies are contradictory. Moreover, many interesting new treatments are now being developed to treat tendinopathy, but there is little evidence to support their use in clinical practice. Key pointsThe word "tendinopathy "is the correct term for the clinical diagnosis of pain accompanied by impaired performance, and sometimes swelling in the tendon.The aetiology of tendinopathy seems to be a multi-factorial process, involving promoting factors that are intrinsic or extrinsic, working either alone or in combination.US (with color Doppler) and MRI are usually prescribed when tendinopathy is unresponsive to treatment and entails lingering symptoms.Eccentric training is currently considered to be the most efficient treatment for tendinopathy; nevertheless, in order to be effective, this treatment needs specific modalities: slow speed, low intensity and gradual intensification, with minimum 20 to 30 sessions of exercises often being needed.Many interesting new treatments are now being developed to treat tendinopathy, but currently there is little evidence to support their use in clinical practice.

Scapular positioning in athlete's shoulder : particularities, clinical measurements and implications.

Despite the essential role played by the scapula in shoulder function, current concepts in shoulder training and treatment regularly neglect its contribution. The 'scapular dyskinesis' is an alteration of the normal scapular kinematics as part of scapulohumeral rhythm, which has been shown to be a nonspecific response to a host of proximal and distal shoulder injuries. The dyskinesis can react in many ways with shoulder motion and function to increase the dysfunction. Thoracic kyphosis, acromio-clavicular joint disorders, subacromial or internal impingement, instability or labral pathology can alter scapular kinematics. Indeed, alteration of scapular stabilizing muscle activation, inflexibility of the muscles and capsule-ligamentous complex around the shoulder may affect the resting position and motion of the scapula. Given the interest in the scapular positioning and patterns of motion, this article aims to give a detailed overview of the literature focusing on the role of the scapula within the shoulder complex through the sports context. Such an examination of the role of the scapula requires the description of the normal pattern of scapula motion during shoulder movement; this also implies the study of possible scapular adaptations with sports practice and scapular dyskinesis concomitant to fatigue, impingement and instability. Different methods of scapular positioning evaluation are gathered from the literature in order to offer to the therapist the possibility of detecting scapular asymmetries through clinical examinations. Furthermore, current concepts of rehabilitation dealing with relieving symptoms associated with inflexibility, weakness or activation imbalance of the muscles are described. Repeating clinical assessments throughout the rehabilitation process highlights improvements and allows the therapist to actualize rationally his or her intervention. The return to the field must be accompanied by a transitory phase, which is conducive to integrating new instructions during sports gestures. On the basis of the possible scapular disturbance entailed in sports practice, a preventive approach that could be incorporated into training management is encouraged.

Preseason Strength Assessment of the Rotator Muscles and Shoulder Injury in Handball Players.

CONTEXT: Few researchers have identified intrinsic risk factors for shoulder injury in team handball players by analyzing measurements of maximal isokinetic rotator muscle strength. OBJECTIVE: To identify possible intrinsic risk factors for shoulder injury by analyzing measurements of maximal isokinetic rotator muscle strength. DESIGN: Cross-sectional study. SETTING: Male team handball senior divisions (the highest level) in France and Belgium. PATIENTS OR OTHER PARTICIPANTS: A total of 108 male high-level handball players (age = 24 ± 4 years, height = 189 ± 6 cm, mass = 87 ± 11 kg) were enrolled. MAIN OUTCOME MEASURE(S): All players completed a preseason questionnaire and performed a bilateral isokinetic assessment of the shoulder rotator muscles. On a monthly questionnaire, players reported any shoulder injury that they sustained during the season. RESULTS: On the preseason questionnaire, 51 of 108 (47%) participants reported a history of dominant-shoulder injury. A total of 106 participants completed the in-season questionnaire, with 22% (n = 23) reporting a shoulder injury on their dominant side during the subsequent season. Fourteen percent (n = 15) sustained microtraumatic injuries, and 8% (n = 8) described a traumatic injury. Backcourt players had a 3.5-times increased risk of injury during the new season compared with players in other positions. Among the isokinetic results, no risk factor for further injury was identified in handball players with microtraumatic injuries. For traumatic injuries, the concentric maximal strength developed by the internal rotators at high speed (240°/s) in the dominant shoulder was a protective factor against the risk of further injury. CONCLUSIONS: These results can potentially identify intrinsic risk factors for shoulder injury and may be used to determine potential interventions for reducing this risk in handball players.

Exercise and Education Program After Breast Cancer: Benefits on Quality of Life and Symptoms at 3, 6, 12, and 24 Months' Follow-up.

BACKGROUND: Various clinical trials have demonstrated the benefits of physical training offered during and/or after breast cancer treatments. However, given the variety of adverse events that may be encountered, physical training could be combined with psychologic, relational, and social guidance. This kind of multidisciplinary program, as well as its long-term effects, have been little studied so far. Therefore, the objective of our study was to determine the benefits at 3, 6, 12, and 24 months of a 3-month exercise and education program among women after breast cancer treatment. PATIENTS AND METHODS: Two hundred nine outpatients treated for primary breast carcinoma were divided into a control group (n = 106) and an experimental group (n = 103) which underwent a 3-month rehabilitation program including physical training and psychoeducational sessions. The assessments, performed before the program and at 3, 6, 12, and 24 months after inclusion, included validated questionnaires on quality of life and symptoms. RESULTS: The analyses revealed an improvement in quality of life and symptoms after the exercise and education program within the experimental group and a maintenance of these improvements during the 2 years of follow-up. These improvements were significantly better than those in the control group, clearly demonstrating that the program has benefits. CONCLUSION: This trial identified the benefits of a well-detailed 3-month exercise and education program over 24 months' follow-up among women after breast cancer treatment.

An isokinetic eccentric programme for the management of chronic lateral epicondylar tendinopathy.

BACKGROUND: Lateral epicondylitis represents a frequent overuse injury. In spite of many conservative treatment procedures, prolonged symptoms and relapse are frequently observed. OBJECTIVE: To compare the outcome of patients performing an isokinetic eccentric training with that of age-, gender-, activity-matched patients receiving a non-strengthening classical rehabilitation. METHODS: Ninety-two patients with unilateral chronic lateral epicondylar tendinopathy (mean duration of symptoms 8+/-3 months) were assigned either to a control group (n = 46) or to an eccentrically trained group (n = 46). The control group underwent a passive standardised rehabilitation programme that excluded strengthening exercises. In addition to this programme, the trained group also performed eccentric exercises based on the repetitive lengthening of the active musculo-tendinous unit. The latter exercises started with submaximal contraction intensity and slow speed movement. Modalities were progressively intensified (increase in intensity contraction and speed movement) over a long period of treatment. Programme effectiveness was assessed through pain score evaluation, a disability questionnaire, muscle strength measurement and ultrasonographic examination. RESULTS: Compared to the non-strengthening control group, the following observations were made in the eccentrically trained group: (1) a significantly more marked reduction of pain intensity, mainly after one month of treatment; (2) an absence of strength deficit on the involved side through bilateral comparison for the forearm supinator and wrist extensor muscles; (3) an improvement of the tendon image as demonstrated by decreasing thickness and a recovered homogenous tendon structure; and (4) a more marked improvement in disability status during occupational, spare time and sports activities. CONCLUSION: These results highlight the relevance of implementing isokinetic adapted eccentric training in the management of chronic lateral epicondylar tendinopathy.

Do evoked potentials contribute to the functional follow-up and clinical prognosis of multiple sclerosis?

The clinical variability and complexity of multiple sclerosis (MS) challenges the individual clinical course prognostication. This study aimed to find out whether multimodal evoked potentials (EP) correlate with the motor components of multiple sclerosis functional composite (MSFCm) and predict clinically relevant motor functional deterioration. One hundred MS patients were assessed at baseline (T 0) and about 7.5 years later (T 1), with visual, somatosensory and motor EP and rated on the Expanded Disability Status Scale (EDSS) and the MSFCm, including the 9 Hole Peg Test and the Timed 25 Foot Walk (T25FW). The Spearman correlation coefficient (r S) was used to evaluate the cross-sectional and longitudinal relationship between EP Z scores and clinical findings. The predictive value of baseline electrophysiological data for clinical worsening (EDSS, 9-HPT, T25FW, MSFCm) during follow-up was assessed by logistic regression analysis. Unlike longitudinal correlations, cross-sectional correlations between EP Z scores and clinical outcomes were all significant and ranged between 0.22 and 0.67 (p < 0.05). The global EP Z score was systematically predictive of EDSS and MSFCm worsening over time (all p < 0.05). EP latency was a better predictor than amplitude, although weaker than latency and amplitude aggregation in the global EP Z score. The study demonstrates that EP numerical scores can be used for motor function monitoring and outcome prediction in patients with MS.

Cross-cultural translation, validity, and reliability of the French version of the Neurophysiology of Pain Questionnaire.

Pain physiology education is an important component in the management of patients with chronic musculoskeletal pain. The Neurophysiology of Pain Questionnaire (NPQ) was developed in English to assess pain physiology knowledge in patients. This study aimed to translate the NPQ into French (NPQ-Fr) and to investigate the main psychometric properties of the NPQ-Fr. The translation was performed using the best practice translation guidelines. One hundred and one French-speaking patients with chronic non-specific spinal pain completed the NPQ-Fr to assess its acceptability and presence of floor/ceiling effects and test its dimensionality. The construct validity was tested by comparing the patients' NPQ-Fr scores to those of 17 physiotherapists and investigating its correlation with subscales of the Short Form-36 questionnaire. The reliability (i.e., internal consistency and test-retest reliability) was also investigated. To test the test-retest reliability, 70 patients were asked to complete the NPQ-Fr twice with one week in between. Regarding the NPQ-Fr psychometric properties: 1) acceptability was good; 2) internal consistency reached a Cronbach α-coefficient of 0.44; 3) no floor and ceiling effects were observed in patients; 4) a principal factor analysis generated three major factors; 5) construct validity was good; and 6) reliability was acceptable (intraclass correlation coefficient = 0.644; standard error of measurement = 1.5). The NPQ-Fr has satisfactory basic psychometric properties in patients with chronic spinal pain.

Eccentric Training for Tendon Healing After Acute Lesion: A Rat Model.

BACKGROUND: The tendon is a dynamic entity that remodels permanently. Platelet-rich plasma (PRP) injection has been shown to have a beneficial effect on tendon healing after lesion in rats. Furthermore, eccentric exercise seems to improve the mechanical quality of the tendon. HYPOTHESIS: A combination of PRP injection and eccentric training might be more effective than either treatment alone. STUDY DESIGN: Controlled laboratory study. METHODS: Adult male rats were anesthetized, an incision was performed in the middle of their left patellar tendon and an injection of physiological fluid (PF) or homologous PRP was randomly made at the lesion level. The rats were then divided into 2 groups: the eccentric group, undergoing eccentric training 3 times a week, and the untrained group, without any training. Thus, 4 groups were compared. After 5 weeks, the tendons were removed and their ultimate tensile strength and energy were measured. Tendons were frozen for proteomic analyses when all biomechanical tests were completed. Statistical analysis was performed with linear mixed effect models. RESULTS: No significant difference was found between the treatments using PF injection or PRP injection alone. However, the value of the ultimate tensile force at rupture was increased by 4.5 N (108% of control, P = .006) when eccentric training was performed. An intragroup analysis revealed that eccentric training significantly improved the ultimate force values for the PRP group. Proteomic analysis revealed that eccentric training led to an increase in abundance of several cytoskeletal proteins in the PF group, while a decrease in abundance of enzymes of the glycolytic pathway occurred in the PRP-treated groups, indicating that this treatment might redirect the exercise-driven metabolic plasticity of the tendon. CONCLUSION: Eccentric training altered the metabolic plasticity of tendon and led to an improvement of injured tendon resistance regardless of the treatment injected (PF or PRP). CLINICAL RELEVANCE: This study demonstrates the necessity of eccentric rehabilitation and training in cases of tendon lesion regardless of the treatment carried out.

Multidisciplinary rehabilitation program after breast cancer: benefits on physical function, anthropometry and quality of life.

BACKGROUND: Different clinical trials show beneficial effects of physical training offered during and/or after breast cancer treatment. However, given the variety of side effects that may be encountered, physical training could be combined with psychological, relational and social guidance. This kind of multidisciplinary program has been little studied so far. AIM: The aim of this study was to determine the benefits of a three-month multidisciplinary rehabilitation program among women after breast cancer treatment. DESIGN: Controlled no-randomized trial. SETTING: University for outcomes, University Hospital Center for interventions. POPULATION: Two hundred and nine outpatients who have been treated for a primary breast carcinoma. METHODS: Patients were divided into a control group (N.=106) and an experimental group (N.=103) which has benefited from a rehabilitation program of three months including physical training and psycho-educational sessions. The assessments, performed before and after the program, included functional assessments ("Sit and Reach Test", maximal incremental exercise test and "Six-Minute Walk Test"), body composition measurements (Body Mass Index [BMI] and body fat percentage) and a questionnaire (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30). RESULTS: After three months, flexibility, walking distance and all parameters measured during the maximal incremental exercise, except maximal heart rate, were significantly improved in the experimental group. The body fat percentage was significantly decreased and a significant improvement was observed for perceived health status (quality of life), functional role, emotional state, physical, cognitive and social functions and for most symptoms. In the control group, most of these improvements didn't appear and a significant increase in BMI and body fat percentage was observed. CONCLUSIONS: This trial identifies the benefits of a well detailed multidisciplinary rehabilitation program, including physical re-conditioning and psycho-educational sessions, with important improvements in functional capacity, body composition and the majority of functions and symptoms among women after breast cancer treatment. CLINICAL REHABILITATION IMPACT: Through its results, this study could contribute to the development of hospital quality standards for oncologic rehabilitation. Physiotherapists can efficiently propose this kind of multidisciplinary rehabilitation program.

Spinal muscle evaluation using the Sorensen test: a critical appraisal of the literature.

The first test for evaluating the isometric endurance of trunk extensor muscles was described by Hansen in 1964. In 1984, following a study by Biering-Sorensen, this test became known as the "Sorensen test" and gained considerable popularity as a tool reported to predict low back pain within the next year in males. The test consists in measuring the amount of time a person can hold the unsupported upper body in a horizontal prone position with the lower body fixed to the examining table. This test has been used in many studies, either in its original version or as variants. Although its discriminative validity, reproducibility, and safety seem good, debate continues to surround its ability to predict low back pain; in addition, the gender-related difference in position-holding time remains unexplained and the influence of body weight unclear. A contribution of the hip extensor muscles to position holding has been established, but its magnitude remains unknown. The influence of personal factors such as motivation complicates the interpretation of the results. Despite these drawbacks, the Sorensen test has become the tool of reference for evaluating muscle performance in patients with low back pain, most notably before and after rehabilitation programs.

Multidisciplinary management of breast cancer.

Breast cancer, with an increasing incidence, is the most frequently diagnosed cancer in women worldwide. The treatments proposed, generally a combination of surgery, radiotherapy, chemotherapy, endocrine therapy and/or targeted therapy, are constantly improving, allowing a reduction in the mortality rate, but they are still causing many side effects, not only early but also late, which leads us to consider the post-cancer period as a chronic condition. Side effects, reviewed in this commentary, may affect physical functions, psychological status, social situation, body composition, well-being and quality of life of the patient. In view of the extent of these areas in which side effects of breast cancer and of its treatments can be found, the supportive care offered at the end of treatment need to be multidisciplinary. Different supportive care interventions may be proposed to the patients such as psychological and behavioral interventions, complementary therapies, diet interventions, physical activity/rehabilitation or also physiotherapy interventions for example, all having shown some beneficial effects in the literature. The benefits of these supportive care interventions are thereby already established and they are described in this article, but others studies will be needed to clearly define indications and most optimal modalities of application to reduce side effects and improve quality of life of patients.