Institut Régional de Formation aux
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An alternative treatment for contractures of the elderly institutionalized persons: Microinvasive percutaneous needle tenotomy of the finger flexors / Alexis Schnitzler in Annals of physical and rehabilitation medicine, Vol. 59 n° 2 (April 2016)
[article] An alternative treatment for contractures of the elderly institutionalized persons: Microinvasive percutaneous needle tenotomy of the finger flexors [texte imprimé] / Alexis Schnitzler, Auteur ; Aurélie Diebold, Auteur ; Bernard Parratte, Auteur . - 2016 . - p. 83-86.
Langues : Anglais (eng) Français (fre)
in Annals of physical and rehabilitation medicine > Vol. 59 n° 2 (April 2016) . - p. 83-86
Catégories : ANATOMIE
Main
DÉMOGRAPHIE
Personne âgée
ÉTABLISSEMENT SOCIAL
Maison accueil personne âgée
Thesaurus Santé Publique
MuscleTags : Contractures Tenotomy Needle Finger flexors Résumé : Background: Almost 10% of older adults in nursing homes have a fixed flexion deformity of the fingers (claw hand). Such contractures have important functional consequences, often leading to hygiene difficulties. Medical treatment (such as botulinum toxin injections, physiotherapy or positioning) is not always effective and surgery is often not possible in such fragile patients. Microinvasive tenotomy with a large needle could be a useful alternative because it can be carried out in an ambulatory setting under local anaesthesia.
Methods: A single center, retrospective study involving the 2012–2014 database from the day-hospital unit of a neuro-orthopaedic department in France. All patients who underwent percutaneous needle tenotomy of the finger or thumb flexors were included. Outcomes included Goal Attainment Scaling (GAS) and the distance in centimeters between the palm and the pulp of the most flexed digit (PPD).
Results: Eighteen patients underwent tenotomy (13 women; mean age: 76±14 years); all patients lived in a nursing home. The limb to be treated was nonfunctional in all patients. The principal goal was determined by consensus with the patients and their health-care teams and was most often to facilitate hand hygiene. Eight patients had at least one secondary goal. In total, 10 patients underwent microinvasive tenotomy for 4 fingers, 5 patients 1 to 4 fingers and 3 patients only the thumb. At 3 months after treatment, goals were achieved for 11 patients, 5 patients progressed toward the goal without attaining it, and for 2 patients, scores were worse. The T-scores of the GAS and the PPD were significantly increased at 3 months (P =0.0326 and P =0.0002, respectively). No serious adverse events occurred.
Conclusion: Large-needle tenotomy seems safe and effective for treating claw hand in fragile older patients.En ligne : http://www.em-consulte.com/produit/rehab Permalink : https://ifm3r.centredoc.fr/index.php?lvl=notice_display&id=13532 [article]Botulinum toxin A for treating spasticity in adults: Costly for French hospitals? / Alexis Schnitzler in Annals of physical and rehabilitation medicine, Vol. 58 n° 5 (October 2015)
[article] Botulinum toxin A for treating spasticity in adults: Costly for French hospitals? [texte imprimé] / Alexis Schnitzler, Auteur ; Alexis Ruet, Auteur ; Sophie Baron, Auteur . - 2015 . - p. 265-268.
Langues : Anglais (eng) Français (fre)
in Annals of physical and rehabilitation medicine > Vol. 58 n° 5 (October 2015) . - p. 265-268
Catégories : PATHOLOGIE
Botulisme
DÉMOGRAPHIE
AdulteDe 19 à 59 ans.
ÉTABLISSEMENT SANITAIRE
Hôpital
GÉOGRAPHIE POLITIQUE
FranceTags : Botulinum toxin Spasticity Cost Résumé : Introduction : Intramuscular injection of botulinum toxin (BoNTA) is one of the primary treatments for focal spasticity. This treatment is considered costly and the level of reimbursement by health insurance has been decreasing in many countries for several years. The aim of this study was to determine the real cost of treating spasticity with BoNTA and to compare this with the level of reimbursement by the national health insurance in France in 2008 and with a new fee, specific to the injection of BoNTA in ambulatory services.
Method : A single-center, retrospective study using the 2008 database from a French secondary-care day-hospital unit (treating spasticity in adults with sequelae of stroke, multiple sclerosis or traumatic brain injuries). The level of reimbursement by the French ministry of health for BoNTA treatment for adults with spasticity constituted the “calculated cost” and corresponded to the hospital's “budget”. The “real cost” (incurred by the hospital) included the sum of staffing and material costs as well as the number of toxin vials used. The calculated costs for 2009 and 2013 were based on the levels of reimbursement during those years. The difference between real and calculated cost for 2009 and 2013 was estimated considering that the real cost of 2008 was stable.
Results : In 2008, 364 patients received BoNTA, resulting in 870 day-hospital admissions. The calculated cost was 459,056€/year and the real cost was 567,438€/year (equivalent to 4.27€/day/patient). The total budget deficit (hospital income minus hospital costs) was 108,383€. The deficit was estimated at 222,892€ in 2009 and 241,188€ in 2013.
Conclusion : The daily cost of BoNTA treatment for spasticity is reasonable; however, because of the level of reimbursement by the national health insurance in France, the treatment is costly for French hospitals.En ligne : http://www.em-consulte.com/produit/rehab Permalink : https://ifm3r.centredoc.fr/index.php?lvl=notice_display&id=12897 [article]Parcours de soins en médecine physique et de réadaptation (MPR) : « Le patient après AVC » / Alain Yelnik in Annals of physical and rehabilitation medicine, Vol. 54 n° 8 (novembre 2011)
[article] Parcours de soins en médecine physique et de réadaptation (MPR) : « Le patient après AVC » [texte imprimé] / Alain Yelnik, Auteur ; Alexis Schnitzler, Auteur ; Pascale Pradat-Diehl, Auteur . - 2011 . - p. 506-518.
Langues : Anglais (eng) Français (fre)
in Annals of physical and rehabilitation medicine > Vol. 54 n° 8 (novembre 2011) . - p. 506-518
Catégories : PATHOLOGIE
Accident cérébrovasculaire
SOINS
SoinsTags : Parcours de soins Accident vasculaire cérébral Médecine physique et de réadaptation Résumé : Le présent document fait partie d’une série de documents élaborés par la Société française (Sofmer) et la Fédération française de médecine physique et de réadaptation (Fedmer). Ces documents décrivent, pour une typologie de patients, les besoins, les objectifs d’une prise en charge en MPR, les moyens humains et matériels à mettre en œuvre, leur chronologie, ainsi que les principaux résultats attendus. Le « parcours de soins en MPR » est un document court, qui doit permettre au lecteur (médecin, décideur, administratif, homme de loi ou de finance) de comprendre rapidement les besoins des patients et l’offre de soins afin de le guider pour l’organisation et la tarification de ces activités. Les patients après AVC sont ainsi divisés en quatre catégories selon la sévérité des déficiences, chacun étant traité selon les six mêmes paramètres tenant compte, selon la classification internationale du fonctionnement, des facteurs personnels et environnementaux pouvant influencer les besoins. En ligne : http://www.em-consulte.com/produit/rehab Permalink : https://ifm3r.centredoc.fr/index.php?lvl=notice_display&id=5964 [article]Participation in work and leisure activities after stroke: A national study / Alexis Schnitzler in Annals of physical and rehabilitation medicine, Vol. 62 n° 5 (September 2019)
[article] Participation in work and leisure activities after stroke: A national study [texte imprimé] / Alexis Schnitzler, Auteur ; Claire Jourdan, Auteur ; Loïc Josseran, Auteur . - 2019 . - p. 351-355.
Langues : Anglais (eng) Français (fre)
in Annals of physical and rehabilitation medicine > Vol. 62 n° 5 (September 2019) . - p. 351-355
Catégories : PATHOLOGIE
Accident cérébrovasculaire
SOCIOLOGIE
Activités vie quotidienne , Loisir
INFORMATION & COMMUNICATION
ÉtudeRésumé : Background: Stroke is a common and debilitating neurological disorder having a negative impact on quality of life.
Objectives: We aimed to compare differences in participation in work and leisure activities between patients with and without a self-reported stroke at the national level in France.
Methods: This study used cross-sectional data from the Disability Health Survey that was administered in people's homes (DHH) in 2008 and in institutions (DHI) in 2009. Stroke history and levels of participation in work and leisure activities were collected by interviews. The levels of participation in these activities were compared between participants with and without a history of stroke.
Results: Among the 33,785 interviewed participants, 1725 reported a history of stroke. After weighting, this represented a mean (SD) of 766,641 (36,650) people among 49 million adults living in France. After adjustment, as compared with people without stroke, those with stroke were less likely to work (odds ratio 0.19 [95% confidence interval 0.13–0.27]), use the telephone (0.21 [0.17–0.25]) and drive (0.25 [0.21–0.32]). In the age group 19–59 years, as compared with people without stroke, those with stroke less frequently worked (35.9% vs. 72.2%), drove (54.3% vs. 81.3%) and participated in sports (26.6% vs. 55.8%).
Conclusions: Overall, our study indicates that people with a history of stroke report more difficulties in participating in work and leisure activities than those without a history of stroke.En ligne : http://www.em-consulte.com/produit/rehab Permalink : https://ifm3r.centredoc.fr/index.php?lvl=notice_display&id=17350 [article]Recurrence of heterotopic ossification after removal in patients with traumatic brain injury: A systematic review / Waleed Almangour in Annals of physical and rehabilitation medicine, Vol. 59 n° 4 (September 2016)
[article] Recurrence of heterotopic ossification after removal in patients with traumatic brain injury: A systematic review [texte imprimé] / Waleed Almangour, Auteur ; Alexis Schnitzler, Auteur ; Marjorie Salga, Auteur . - 2016 . - p. 263-269.
Langues : Anglais (eng) Français (fre)
in Annals of physical and rehabilitation medicine > Vol. 59 n° 4 (September 2016) . - p. 263-269
Catégories : SANTÉ PHYSIQUE
Traumatisme crânien
INFORMATION & COMMUNICATION
Revue de littératureTags : Traumatic brain injury Head injury Heterotopic ossification Recurrence Résumé : Objective: A systematic review of the literature to determine whether in patients with neurological heterotopic ossification (NHO) after traumatic brain injury, the extent of the neurological sequelae, the timing of surgery and the extent of the initial NHO affect the risk of NHO recurrence.
Data sources: We searched MEDLINE via PubMed and Cochrane library for articles published up to June 2015. Results were compared with epidemiological studies using data from the BANKHO database of 357 patients with central nervous system (CNS) lesions who underwent 539 interventions for troublesome HO.
Results: A large number of studies were published in the 1980s and 1990s, most showing poor quality despite being performed by experienced surgical teams. Accordingly, results were contradictory and practices heterogeneous. Results with the BANKHO data showed troublesome NHO recurrence not associated with aetiology, sex, age at time of CNS lesion, multisite HO, or “early” surgery (before 6months). Equally, recurrence was not associated with neurological sequelae or disease extent around the joint.
Conclusions: The recurrence of NHO is not affected by delayed surgery, neurological sequelae or disease extent around the joint. Surgical excision of NHO should be performed as soon as comorbid factors are under control and the NHO is sufficiently constituted for excision.En ligne : http://www.em-consulte.com/produit/rehab Permalink : https://ifm3r.centredoc.fr/index.php?lvl=notice_display&id=13870 [article]PermalinkPermalink