Kinesiophobia negatively influences recovery of joint function following total knee arthroplasty.

BACKGROUND: The influence of kinesiophobia on disability in patients with knee osteoarthritis is known, but its influence on functional recovery after total knee arthroplasty remains unexplored. AIMS: To assess the influence of kinesiophobia on functional recovery following total knee arthroplasty (TKA) in patients with knee osteoarthritis and to investigate if kinesiophobia was more common in obese patients than in non-obese patients. DESIGN: Cohort study. SETTING: Inpatients of the Physical Medicine and Rehabilitation unit of the Château-Renault hospital (France). POPULATION: The study included 89 consecutive patients (mean age = 72.6 years) hospitalized for postoperative rehabilitation after TKA. All patients completed the study. METHODS: We evaluated functional outcome by testing maximum passive flexion, pain intensity, the duration of hospitalization, and performance in a six minute walk test. Kinesiophobia was assessed by the Tampa Scale for Kinesiophobia (TSK) score. Obesity was assessed by calculation of body mass index (BMI). A Stepwise multiple linear regression was used to determine significant independent predictors of the distance at the six minute walk test. RESULTS: During the six minute walk test, patients without kinesiophobia walked significantly farther than patients with kinesiophobia (309.5 [83.6] m vs. 264.8 [96.5] m, P=0.048). There were no significant differences in the duration of hospitalization, the maximum passive flexion, or pain intensity between the two groups. The best multivariate model of factors associated with the performance in the 6 minute walk test included the Lequesne's score before surgery, the degree of active extension of the knee at the beginning of hospitalization, the TSK scores (total score, classification with the TSK score, "avoidance" subscale score). The overall TSK score did not differ between the obese and non-obese groups. CONCLUSION: Our study is consistent with previous reports that cognitive and behavioral maladaptative strategies can impair functional recovery after TKA. Moreover, unlike previous work, the principal endpoint of our study is an objective measurement of walking capacity, and not a questionnaire. CLINICAL REHABILITATION IMPACT: WE suggest that programs aimed at the management of such cognitive and behavioral factors which contribute to activity avoidance during rehabilitation are likely to improve functional recovery after TKA.

VO2max in patients with chronic pain: the effect of a 4-week rehabilitation program.

BACKGROUND: In patients with chronic pain, aerobic deconditioning can explain part of observed disability and disadvantage. The objective of the present study was to assess the change in VO2max after a four-week exercise rehabilitation programme in this population. METHODS: In a prospective study, 121 patients underwent a cycle ergometer exercise tolerance test with VO2max measurement before and after a four-week exercise rehabilitation programme (which included aerobic training, muscle strengthening, occupational therapy and stretching). RESULTS: We observed a statistically significant increase in VO2max (P=0.03) and an improvement in the patients' distribution according to the Shvartz fitness classification after rehabilitation. DISCUSSION: The four-week exercise rehabilitation program was associated with an improvement in aerobic capacities in patients with chronic pain. However, in all but one of the 121 patients, the VO2max value at the end of the program was below average for gender and age. Maintenance of aerobic training after the end of a rehabilitation programme is essential.

Validation of a French version of Roland-Morris questionnaire in chronic low back pain patients.

OBJECTIVE: To validate a French version of the Roland-Morris Disability Questionnaire (RMDQ) in patients with chronic low back pain (LBP). MATERIAL AND METHODS: Fifty-eight patients due to participate in a functional rehabilitation programme for chronic low back pain were included prospectively. The RMDQ, the Quebec Back Pain Disability Scale (QBPDS) and the "daily activities" subscale of the Dallas Pain Questionnaire (DPQ) were administered. The RMDQ was assessed for internal consistency, reliability, criterion validity and sensitivity to change. RESULTS: Cronbach's alpha for the RMDQ was 0.84. The intraclass correlation coefficient [95% confidence interval] was 0.89 [0.83-0.93]. The RMDQ score was correlated with the QBPDS score (r=0.713) and the DPQ's "daily activities" subscore (r=0.514). The results of assessments before and after functional rehabilitation showed that the French version of the RMDQ had very high sensitivity to change (effect size: 1.49) and was more sensitive than the QBPDS and the DPQ's "daily activities" subscore. CONCLUSIONS: Our study validated the French version of the RMDQ in patients suffering from chronic low back pain. Furthermore, we highlighted the questionnaire's very high sensitivity to change.

Care related pain and functional restoration for chronic low back pain: a prospective study.

OBJECTIVE: To assess care related pain during a program of functional restoration for chronic low back pain. PATIENTS AND METHODS: Chronic low back pain patients were prospectively included in a program of functional restoration. Low back pain was recorded before and after each morning and afternoon sessions, all over the program of functional restoration, for equivalence study. Equivalence was admitted if 95% confidence interval of the difference in pain falled wholly in the interval ± 10/100mm. Medication was recorded during the program. Progression of the patients during the program and 3-month effectiveness were also recorded for internal validity. RESULTS: Thirty-seven patients were included. They underwent a progression in load and spent energy during the program. Follow-up also indicated improvement of functional ability and quality of life. There was no variation in pain during the program however medication intake increased. CONCLUSION: There was no significant care related pain during our program of functional restoration for chronic low back pain. This may be due to adaptation of the medication and suggests the importance of close medical management of patients during functional restoration.

VO(2)max in patients with chronic pain: comparative analysis with objective and subjective tests of disability.

OBJECTIVES: To establish the level of maximal aerobic capacity in patients with chronic pain of different etiologies and to compare these results with different parameters of disability. PATIENTS AND METHODS: A cycloergometer exercise test with VO(2)max measurement, fatigue assessment and objective and subjective disability parameter testing was performed on 155 patients (mean age 42.1 ± 9.9 years) classified into three groups: patients with chronic lower back pain, patients with an upper limb musculoskeletal disorder, and patients with multifocal chronic pain. RESULTS: The mean VO(2)max value was 22.18 mL/min/kg. There was no statistically significant difference in VO(2)max between the three groups. The patients with poorest aerobic condition were older (P<0.007), were on sick leave longer (P<0.03), had weaker Sorensen test (P<0.01) and P.I.L.E. (P<0.004) results, had more perceived fatigue (P<0.04), a higher mean BMI (P<0.0001) and gained more weight during sick leave (P<0.02). DISCUSSION: Numerous studies have examined loss of aerobic capacity due to chronic low back pain with contradictory results. This is probably due to variability of in the methods used to measure or calculate VO(2)max as well as to the variability in the studied populations. CONCLUSION: It seems appropriate to offer patients with chronic pain multidisciplinary exercise rehabilitation programs.

[Adhesive capsulitis: evaluation of a treatment coupling capsular distension and intensive rehabilitation]. / Capsulite de l'épaule: évaluation d'une prise en charge combinée par arthrodistension et rééducation intensive (à propos d'une série de 39 épaules).

INTRODUCTION: Adhesive capsulitis is a clinical entity characterized by a loss of motion and a decrease of the joint volume capacity. Results of clinical trials have shown that distensions can help to decrease pain and increase the range of motion. OBJECTIVE: The purpose of the study was to measure the effect of repeated distension arthrography combined with an intensive program of rehabilitation on pain, range of motion, and occupational outcome in patients with adhesive capsulitis. DESIGN: 39 cases of idiopathic capsulitis (7 cases) or secondary capsulitis (19 post-traumatic, 13 post-surgery of the rotator cuff) were included in the study. Intervention consisted of an intensive program of passive and active physiotherapy during one? Week and then distension arthrography, performed 3 times at 1- week intervals, with steroid injections in the glenohumeral joint and 1 in the subacromial space. RESULTS: Lateral elevation improved substantially after the first week of physiotherapy and medial rotation after the first distension. Pain intensity decreased after the first distension. After the third distension, very small changes were noted. Results did not differ by etiology of capsulitis. At the end of the program, 9 of 17 patients could return to their previous job. CONCLUSIONS: Two repeated arthrographic distensions with steroid injection and an intensive program of physiotherapy improves the range of motion and the painful condition associated with capsulitis and allows for a rapid return to employment. A third distension does not seem to provide a further benefit, as has been found by other studies.

Gene expression profiles predict complete pathologic response to neoadjuvant paclitaxel and fluorouracil, doxorubicin, and cyclophosphamide chemotherapy in breast cancer.

PURPOSE: The goal of this study was to examine the feasibility of developing a multigene predictor of pathologic complete response (pCR) to sequential weekly paclitaxel and fluorouracil + doxorubicin + cyclophosphamide (T/FAC) neoadjuvant chemotherapy regimen for breast cancer. PATIENTS AND METHODS: All patients underwent one-time pretreatment fine-needle aspiration to obtain RNA from the cancer for transcriptional profiling using cDNA arrays containing 30721 human sequence clones. Analysis was performed after profiling, and 42 patients' clinical results were available, 24 of which were used for predictive marker discovery; 18 patients' results were used as an independent validation set. RESULTS: Thirty-one percent of patients had pCR (six discovery and seven validation), defined as disappearance of all invasive cancer in the breast after completion of chemotherapy. We could identify no single marker that was sufficiently associated with pCR to be used as an individual predictor. A multigene model with 74 markers (P

Single nucleotide polymorphisms in multiple novel thrombospondin genes may be associated with familial premature myocardial infarction.

BACKGROUND: Recent advances in high-throughput genomics technology have expanded our ability to catalogue allelic variants in large sets of candidate genes related to premature coronary artery disease. METHODS AND RESULTS: A total of 398 families were identified in 15 participating medical centers; they fulfilled the criteria of myocardial infarction, revascularization, or a significant coronary artery lesion diagnosed before 45 years in men or 50 years in women. A total of 62 vascular biology genes and 72 single-nucleotide polymorphisms were assessed. Previously undescribed variants in 3 related members of the thrombospondin protein family were prominent among a small set of single-nucleotide polymorphisms that showed a statistical association with premature coronary artery disease. A missense variant of thrombospondin 4 (A387P) showed the strongest association, with an adjusted odds ratio for myocardial infarction of 1.89 (P=0.002 adjusted for covariates) for individuals carrying the P allele. A variant in the 3' untranslated region of thrombospondin-2 (change of thymidine to guanine) seemed to have a protective effect against myocardial in individuals homozygous for the variant (adjusted odds ratio of 0.31; P=0.0018). A missense variant in thrombospondin-1 (N700S) was associated with an adjusted odds ratio for coronary artery disease of 11.90 (P=0.041) in homozygous individuals, who also had the lowest level of thrombospondin-1 by plasma assay (P=0.0019). CONCLUSIONS: This large-scale genetic study has identified the potential of multiple novel variants in the thrombospondin gene family to be associated with familial premature myocardial infarction. Notwithstanding multiple caveats, thrombospondins specifically and high-throughput genomic technology in general deserve further study in familial ischemic heart disease.