Functional multidisciplinary rehabilitation versus outpatient physiotherapy for non specific low back pain: randomized controlled trial.

INTRODUCTION: In recent decades the treatment of non-specific low back pain has turned to active modalities, some of which were based on cognitive-behavioural principles. Non-randomised studies clearly favour functional multidisciplinary rehabilitation over outpatient physiotherapy. However, systematic reviews and meta-analysis provide contradictory evidence regarding the effects on return to work and functional status. The aim of the present randomised study was to compare long-term functional and work status after 3-week functional multidisciplinary rehabilitation or 18 supervised outpatient physiotherapy sessions. METHODS: 109 patients with non-specific low back pain were randomised to either a 3-week functional multidisciplinary rehabilitation programme, including physical and ergonomic training, psychological pain management, back school and information, or 18 sessions of active outpatient physiotherapy over 9 weeks. Primary outcomes were functional disability (Oswestry) and work status. Secondary outcomes were lifting capacity (Spinal Function Sort and PILE test), lumbar range-of-motion (modified-modified Schöber and fingertip-to-floor tests), trunk muscle endurance (Shirado and Biering-Sörensen tests) and aerobic capacity (modified Bruce test). RESULTS: Oswestry disability index was improved to a significantly greater extent after functional multidisciplinary rehabilitation compared to outpatient physiotherapy at follow-up of 9 weeks (P = 0.012), 9 months (P = 0.023) and 12 months (P = 0.011). Work status was significantly improved after functional multidisciplinary rehabilitation only (P = 0.012), resulting in a significant difference compared to outpatient physiotherapy at 12 months' follow-up (P = 0.012). Secondary outcome results were more contrasted. CONCLUSIONS: Functional multidisciplinary rehabilitation was better than outpatient physiotherapy in improving functional and work status. From an economic point of view, these results should be backed up by a cost-effectiveness study.

Chest pain in daily practice: occurrence, causes and management

QUESTIONS UNDER STUDY: We assessed the occurrence and aetiology of chest pain in primary care practice. These features differ between primary and emergency care settings, where most previous studies have been performed. METHODS: 59 GPs in western Switzerland recorded all consecutive cases presenting with chest pain. Clinical characteristics, laboratory tests and other investigations as well as the diagnoses remaining after 12 months of follow-up were systematically registered. RESULTS: Among 24,620 patients examined during a total duration of 300 weeks of observation, 672 (2.7%) presented with chest pain (52% female, mean age 55 +/- 19(SD)). Most cases, 442 (1.8%), presented new symptoms and in 356 (1.4%) it was the reason for consulting. Over 40 ailments were diagnosed: musculoskeletal chest pain (including chest wall syndrome) (49%), cardiovascular (16%), psychogenic (11%), respiratory (10%), digestive (8%), miscellaneous (2%) and without diagnosis (3%). The three most prevalent diseases were: chest wall syndrome (43%), coronary artery disease (12%) and anxiety (7%). Unstable angina (6), myocardial infarction (4) and pulmonary embolism (2) were uncommon (1.8%). Potentially serious conditions including cardiac, respiratory and neoplasic diseases accounted for 20% of cases. A large number of laboratory tests (42%), referral to a specialist (16%) or hospitalisation (5%) were performed. Twentyfive patients died during follow-up, of which twelve were for a reason directly associated with thoracic pain [cancer (7) and cardiac causes (5)]. CONCLUSIONS: Thoracic pain was present in 2.7% of primary care consultations. Chest wall syndrome pain was the main aetiology. Cardio - vascular emergencies were uncommon. However chest pain deserves full consideration because of the occurrence of potentially serious conditions.

Le « Pain cotidien en la reffection de l'ame » (liv. I).

Commençant par : «... siecle des siecles. Les tiens benefices et biens faicts ordinaires, desquels nous exillez... » et finissant par : «... conduiz nous au pays et region qui donne eternelle joye. Amen. Fin du premier livre du Pain cotidien en la reffection de l'ame. Et contient ce premier livre depuys le premier dismanche de l'advent Nostre Seigneur jusques au jour de l'Epiphaine, qui est la feste des Roys » . Incomplet au commencement.

Le pain et la viande / J. de Brévans,... ; préf. de M. E. Risler,...

Collection : Bibliothèque des connaissances utiles

Arrêt de parlement qui condamne le nommé Muzier, libraire, à être admonestés, et à aumôner 3 livres au pain des prisonniers de la conciergerie, pour avoir vendu et distribué des écrits clandestins

[Acte. 1757-08-27. Paris]

Tableau des distributions de pain, fourrage et bois a bruler qui seront faites pendant trente jours dans le courant des mois d'aoust et septembre 1754 aux troupes du camp de Gray

Ancien possesseur : Argenson, Antoine-René de Voyer (1722-1787 ; marquis de Paulmy d')

Arrêt du Grand Conseil rendu en faveur du officiers commensaux concernant les préséances aux processions et autres cérémonies de l'Eglise et en toutes assemblées publiques et particulières, ensemble touchant le pain béni

[Acte. 1719-07-06. Paris]

Arrêt du grand conseil en faveur du Sr de Vouges, trésorier de France, contre les marguilliers de l'église de Boissy-Saint-Léger, par lequel il est ordonné que lesdits marguilliers seront tenus porter le pain-bénit à lui, sa femme et sa famille et de le faire jouir des honneurs de ladite église immédiatement après le seigneur

[Acte. 1731-01-09. Paris]

Arrêt du grand conseil qui maintient les secrétaires du roi et les présidents trésoriers de France dans le droit d'avoir le pain-bénit par morceau de distinction et toutes préséances auparavant tous les officiers des justices seigneuriales. (En faveur de Yves-Joseph Pommier, paroisse de Wissous.)

[Acte. 1738-01-23. Paris]

Essai sur la pomme de terre... ; suivi de La réfutation de la brochure intituléé : Le pain à un sou la livre ; par M. Saulnier d'Anchald,...

Mécénat texte imprimé : Cet ouvrage a été numérisé grâce à Stéphane Dauvel