Publications by authors named "Claude Pichonnaz"

15 Publications

  • Page 1 of 1

Unhelpful beliefs and attitudes about low back pain in the general population: A cross-sectional survey.

Musculoskelet Sci Pract 2021 04 4;52:102342. Epub 2021 Feb 4.

Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland; Department of Musculoskeletal Medicine, University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland.

Background: Unhelpful beliefs about non-specific low back pain (LBP) are associated with poorer coping strategies and unhelpful behaviours. Furthermore, targeting unhelpful beliefs about back pain has been advanced as a major priority to decrease the burden of LBP. Therefore, studies exploring these beliefs are needed to adapt the message delivered to the population.

Objectives: To identify attitudes and beliefs about LBP in the general population in French-speaking Switzerland and to analyse their association with individual characteristics and the belief that exercise is an effective treatment for LBP.

Design: Cross-sectional study.

Method: Attitudes and beliefs were measured with the Back-Pain Attitudes Questionnaire (Back-PAQ). Individual characteristics and participants' beliefs about the effectiveness of exercise for LBP were collected to determine their association with Back-PAQ score.

Results: The questionnaire was completed by 1129 participants. Unhelpful beliefs were widespread (mean (SD) Back-PAQ score: 113.2 (10.6)), especially those that the back needs protection, is easy to injure and that the nature of LBP is special. Only 55% of the participants believed exercise to be one of the most effective treatment for LBP. Individual characteristics only explained 4% of the Back-PAQ score variance.

Conclusion: French-speaking Swiss general population has high levels of unhelpful beliefs and moderate confidence in the effectiveness of exercise for LBP, though the message "staying active is good for LBP" was well understood. The messages to decrease the level of unhelpful beliefs about LBP in the population should specifically target the vulnerability, protection and special nature of LBP, and promote exercise therapy.
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April 2021

Trajectoires de personnes souffrant de lombalgie chronique : ruptures et reconstructions après un programme de rééducation.

Sante Publique 2020 Jun;Vol. 32(1):19-28

Purpose of research: The objective of this article is to investigate, from the perspective of patients, the disruptions of the biographical trajectories induced by chronic low back pain and the impact of a multidisciplinary rehabilitation program on their reconstruction.

Methods: Based on an interdisciplinary qualitative research, we investigated the experience of 20 participants with chronic low back pain following a three-week rehabilitation program at the hospital. Semi-directive interviews were conducted before and after inclusion in the program.

Results: Although affecting each person in a singular way, chronic low back pain induces biographical linearity disruptions related to the apparition of pain, and the disruption of daily and professional activities. For the majority of participants, the rehabilitation program provided a repairative space to restore continuity between past, present and future life. Whether or not there is a significant improvement in pain, most participants report benefits that give them the feeling of getting back to normality. Nevertheless, they identify those more for the domestic, family, and social spheres than at the professional level, effects remaining moderate to mitigated in that area.

Conclusions: The rehabilitation program influences the dynamics of biographical trajectories and promotes a return to what is perceived as normality. By providing individuals with theoretical and practical tools and increasing their functional capacities, it promotes autonomous pain and problem management. Immediate effects are seen as restorative for domestic, family and social activities, but remain limited on the professional level.
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June 2020

[Update on the rehabilitation following anatomic and reverse total shoulder arthroplasty].

Rev Med Suisse 2019 07;15(657):1340-1349

Service d'orthopédie et de traumatologie, Département de l'appareil locomoteur, CHUV et Université de Lausanne, 1011 Lausanne.

This article aims to present the principles of rehabilitation following anatomical and reverse total shoulder arthroplasties. The rehabilitation consist of three phases: wound healing and movement initiation (weeks 0-6), movement recovery (7-12), strengthening and return to activity (13-18). At 6 to 12 months follow-up, most patients report a substantial decrease in pain and a return to light to moderate activity level. The rehabilitation of the reverse arthroplasty specifically requires deltoid muscle strengthening and dislocation prevention. The functional outcome is slightly inferior for reverse arthroplasty, which is indicated when musculotendinous lesions are associated to bone lesions, but satisfaction rates are comparable between the two types of implants. The durability of total shoulder arthroplasties is globally satisfying, though shorter in young active patients.
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July 2019

[Chronic low back pain: from the uncertain medical diagnosis to the profane etiologies].

Rev Med Suisse 2018 Apr;14(603):850-853

MSc Physiothérapie/maître d'enseignement HES, HESAV/HES-SO, Filière physiothérapie, Avenue de Beaumont 21, 1011 Lausanne.

This qualitative research article is based on interviews with 20 participants to a low back pain rehabilitation program in a Swiss hospital. It shows that, in the absence of the obvious cause that can explain pain, patients construct their own interpretations and explanations in order to give meaning to their experience. Their explanatory models mainly include the lifestyle and the physical aspects related to the body function, what leaves little room for the psychosocial component. Their interpretation is consequently discordant with the current medical approach, which considers that chronic low back pain results from bio-psycho-social factors. This discrepancy implies negotiation between patients and professionals about the objectives to achieve in order to treat pain.
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April 2018

[Update on the postsurgical shoulder rotator cuff rehabilitation].

Rev Med Suisse 2016 Jul;12(525):1278-1283

Service de médecine physique et de réadaptation, Département de l'appareil locomoteur, CHUV et Université de Lausanne, 1011 Lausanne.

Primary care physicians play a crucial role in rehabilitation following rotator cuff surgery. This synthesis paper aims to address essential issues of postsurgical rehabilitation, based on recent recommendations. The rehabilitation comprises 4 phases, which are determined by the tendon healing process.For each phase, this article presents the stage of tendon healing, the allowed mechanical constraints, the exercise and physiotherapy modalities, the possible activities and the potential complications. Information and counseling to support the patient implication in the rehabilitation are also detailed. This article contributes to an enhanced comprehension of the healing process, which is a prerequisite for appropriate follow-up and efficient complication detection.
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July 2016

Heightened clinical utility of smartphone versus body-worn inertial system for shoulder function B-B score.

PLoS One 2017 20;12(3):e0174365. Epub 2017 Mar 20.

School of Health Sciences, Queen Margaret University, Edinburgh, Scotland.

Background: The B-B Score is a straightforward kinematic shoulder function score including only two movements (hand to the Back + lift hand as to change a Bulb) that demonstrated sound measurement properties for patients for various shoulder pathologies. However, the B-B Score results using a smartphone or a reference system have not yet been compared. Provided that the measurement properties are comparable, the use of a smartphone would offer substantial practical advantages. This study investigated the concurrent validity of a smartphone and a reference inertial system for the measurement of the kinematic shoulder function B-B Score.

Methods: Sixty-five patients with shoulder conditions (with rotator cuff conditions, adhesive capsulitis and proximal humerus fracture) and 20 healthy participants were evaluated using a smartphone and a reference inertial system. Measurements were performed twice, alternating between two evaluators. The B-B Score differences between groups, differences between devices, relationship between devices, intra- and inter-evaluator reproducibility were analysed.

Results: The smartphone mean scores (SD) were 94.1 (11.1) for controls and 54.1 (18.3) for patients (P < 0.01). The difference between devices was non-significant for the control (P = 0.16) and the patient group (P = 0.81). The analysis of the relationship between devices showed 0.97 ICC, -0.6 bias and -13.2 to 12.0 limits of agreement (LOA). The smartphone intra-evaluator ICC was 0.92, the bias 1.5 and the LOA -17.4 to 20.3. The smartphone inter-evaluator ICC was 0.92, the bias 1.5 and the LOA -16.9 to 20.0.

Conclusions: The B-B Score results measured with a smartphone were comparable to those of an inertial system. While single measurements diverged in some cases, the intra- and inter-evaluator reproducibility was excellent and was equivalent between devices. The B-B score measured with a smartphone is straightforward and as efficient as a reference inertial system measurement.
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August 2017

Effect of Manual Lymphatic Drainage After Total Knee Arthroplasty: A Randomized Controlled Trial.

Arch Phys Med Rehabil 2016 05 30;97(5):674-82. Epub 2016 Jan 30.

Orthopedics and Traumatology Department, University Hospital of Lausanne - University of Lausanne, Lausanne, Switzerland.

Objective: To evaluate the effects of manual lymphatic drainage (MLD) on knee swelling and the assumed consequences of swelling after total knee arthroplasty (TKA).

Design: Randomized controlled trial.

Setting: Primary care hospital.

Participants: Two groups of 30 patients were randomized before TKA surgery (N=60; 65% women [39]; mean age, 70.7±8.8y; weight, 77.8±11.3kg; size, 1.64±0.08m; body mass index, 29.9±4.1kg/m(2)).

Interventions: Participants received either 5 MLD treatments or a placebo, added to rehabilitation, in between the second day and the seventh day after surgery.

Main Outcome Measures: Swelling was measured by blinded evaluators before surgery and at second day, seventh day, and 3 months using bioimpedance spectroscopy and volume measurement. Secondary outcomes were active and passive range of motion, pain, knee function, and gait parameters.

Results: At seventh day and 3 months, no outcome was significantly different between groups, except for the knee passive flexion contracture at 3 months, which was lower and less frequent in the MLD group (-2.6°; 95% confidence interval, -5.0° to -0.21°; P=.04; absolute risk reduction, 26.6%; 95% confidence interval, 0.9%-52.3%; number needed to treat, 4). The mean pain level decreased between 5.8 and 8.2mm on the visual analog scale immediately after MLD, which was significant after 4 of 5 MLD treatments.

Conclusions: MLD treatments applied immediately after TKA surgery did not reduce swelling. It reduced pain immediately after the treatment. Further studies should investigate whether the positive effect of MLD on knee extension is replicable.
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May 2016

Measurement properties of the smartphone-based B-B Score in current shoulder pathologies.

Sensors (Basel) 2015 Oct 22;15(10):26801-17. Epub 2015 Oct 22.

Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne (EPFL), ELH 135 (Bâtiment ELH), Station 11, 1015 Lausanne, Switzerland.

This study is aimed at the determination of the measurement properties of the shoulder function B-B Score measured with a smartphone. This score measures the symmetry between sides of a power-related metric for two selected movements, with 100% representing perfect symmetry. Twenty healthy participants, 20 patients with rotator cuff conditions, 23 with fractures, 22 with capsulitis, and 23 with shoulder instabilities were measured twice across a six-month interval using the B-B Score and shoulder function questionnaires. The discriminative power, responsiveness, diagnostic power, concurrent validity, minimal detectable change (MDC), minimal clinically important improvement (MCII), and patient acceptable symptom state (PASS) were evaluated. Significant differences with the control group and significant baseline-six-month differences were found for the rotator cuff condition, fracture, and capsulitis patient groups. The B-B Score was responsive and demonstrated excellent diagnostic power, except for shoulder instability. The correlations with clinical scores were generally moderate to high, but lower for instability. The MDC was 18.1%, the MCII was 25.2%, and the PASS was 77.6. No floor effect was observed. The B-B Score demonstrated excellent measurement properties in populations with rotator cuff conditions, proximal humerus fractures, and capsulitis, and can thus be used as a routine test to evaluate those patients.
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October 2015

Bioimpedance spectroscopy for swelling evaluation following total knee arthroplasty: a validation study.

BMC Musculoskelet Disord 2015 Apr 25;16:100. Epub 2015 Apr 25.

CHUV-UNIL, Orthopedics and Traumatology Department, CHUV-UNIL, Avenue du Bugnon 21, 1011, Lausanne, Switzerland.

Background: The evaluation of swelling is important for the outcome of total knee arthroplasty (TKA) surgery. The circumference or volume measurements are applicable at the bedside of the patient but are altered by muscular atrophy and the post-surgical dressing. Bioimpedance spectroscopy might overcome these limitations; however, it should be validated. This study aimed to explore the validity, the reliability and the responsiveness of bioimpedance spectroscopy for measuring swelling after TKA.

Methods: The degree of swelling in 25 patients undergoing TKA surgery was measured using bioimpedance spectroscopy (BIS R0), knee circumference and limb volume. The measurements were performed on D-1 (day before surgery), D + 2 (2 days after surgery) and D + 8 (8 days after surgery). The BIS R0 measurements were repeated twice, alternating between two evaluators. The percentage of the difference between the limbs was calculated for BIS R0, circumference and volume. The intra- and inter-observer intraclass correlation coefficients (ICCs), limits of agreement (LOA), effect size (Cohen's d), correlations between the methods and diagnostic sensitivity were calculated.

Results: BIS R0, circumference and volume detected swelling < 3.5% at D-1. The swelling at D2 and D8 was greater with BIS R0 [mean (SD) 29.9% (±9.8) and 38.27 (±7.8)] than with volume [14.7 (±9.5) and 14.9 (±8.2)] and circumference [11.1 (±5.7) and 11.7 (±4.1)]. The BIS R0 intra- and inter-evaluator ICCs ranged from 0.89 to 0.99, whereas the LOA were < 5.2%. The BIS R0 correlation was 0.73 with volume and 0.75 with circumference. The BIS R0 Cohen's d was 3.32 for the D-1-D2 evolution. The diagnostic sensitivity was 83% D2 and 96% at D8.

Conclusion: Bioimpedance is a valid method for the evaluation of swelling following TKA. BIS R0 also demonstrated excellent intra- and inter-evaluator reliability. The diagnostic sensitivity and responsiveness is superior to that of concurrent methods. BIS R0 is an efficient method for post-surgical follow up at the bedside of the patient. The measurement of BIS R0 is a straightforward, valid, reliable and responsive method for lower limb swelling following TKA surgery that could be used in clinics and research.

Trial Registration: Identifier: NCT00627770.
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April 2015

Alteration and recovery of arm usage in daily activities after rotator cuff surgery.

J Shoulder Elbow Surg 2015 Sep 29;24(9):1346-52. Epub 2015 Mar 29.

Department of Orthopaedic and Trauma Surgery, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland.

Background: The objective measurement of dominant/nondominant arm use proportion in daily life may provide relevant information on healthy and pathologic arm behavior. This prospective case-control study explored the potential of such measurements as indicators of upper limb functional recovery after rotator cuff surgery.

Methods: Data on dominant/nondominant arm usage were acquired with body-worn sensors for 7 hours. The postsurgical arm usage of 21 patients was collected at 3, 6, and 12 months after rotator cuff surgery in the sitting, walking, and standing postures and compared with a reference established with 41 healthy subjects. The results were calculated for the dominant and nondominant surgical side subgroups at all stages. The correlations with clinical scores were calculated.

Results: Healthy right-handed and left-handed dominant arm usage was 60.2% (±6.3%) and 53.4% (±6.6%), respectively. Differences in use of the dominant side were significant between the right- and left-handed subgroups for sitting (P = .014) and standing (P = .009) but not for walking (P = .328). The patient group showed a significant underuse of 10.7% (±8.9%) at 3 months after surgery (P < .001). The patients recovered normal arm usage within 12 months, regardless of surgical side. The arm underuse measurement was weakly related to function and pain scores.

Conclusion: This study provided new information on arm recovery after rotator cuff surgery using an innovative measurement method. It highlighted that objective arm underuse measurement is a valuable indicator of upper limb postsurgical outcome that captures a complementary feature to clinical scores.
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September 2015

Evaluation of muscular activity duration in shoulders with rotator cuff tears using inertial sensors and electromyography.

Physiol Meas 2014 Dec 12;35(12):2389-400. Epub 2014 Nov 12.

Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne (EPFL), Station 11, 1015 Lausanne, Switzerland.

Shoulder disorders, including rotator cuff tears, affect the shoulder function and result in adapted muscle activation. Although these adaptations have been studied in controlled conditions, free-living activities have not been investigated. Based on the kinematics measured with inertial sensors and portable electromyography, the objectives of this study were to quantify the duration of the muscular activation in the upper trapezius (UT), medial deltoid (MD) and biceps brachii (BB) during motion and to investigate the effect of rotator cuff tear in laboratory settings and daily conditions. The duration of movements and muscular activations were analysed separately and together using the relative time of activation (T(EMG/mov)). Laboratory measurements showed the parameter's reliability through movement repetitions (ICC > 0.74) and differences in painful shoulders compared with healthy ones (p < 0.05): longer activation for UT; longer activation for MD during abduction and tendency to shorter activation in other movements; shorter activation for BB. In daily conditions, T(EMG/mov) for UT was longer, whereas it was shorter for MD and BB (p < 0.05). Moreover, significant correlations were observed between these parameters and clinical scores. This study thus provides new insights into the rotator cuff tear effect on duration of muscular activation in daily activity.
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December 2014

Distribution of arm velocity and frequency of arm usage during daily activity: objective outcome evaluation after shoulder surgery.

Gait Posture 2013 Jun 21;38(2):247-52. Epub 2012 Dec 21.

Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.

In clinical settings, functional evaluation of shoulder movement is primarily based on what the patient thinks he/she is able to do rather than what he/she is actually performing. We proposed a new approach for shoulder assessment based on inertial sensors to monitor arm movement in the daily routine. The detection of movement of the humerus relative to the trunk was first validated in a laboratory setting (sensitivity>95%, specificity>97%). Then, 41 control subjects and 21 patients suffering from a rotator cuff tear were evaluated (before and after surgery) using clinical questionnaires and a one-day measurement of arm movement. The quantity of movement was estimated with the movement frequency and its symmetry index (SIFr). The quality of movement was assessed using the Kolmogorov-Smirnov distance (KS) between the cumulative distribution of the arm velocity for controls and the same distribution for each patient. SIFr presented differences between patients and controls at 3 month follow-up (p<0.05) while KS showed differences also after 6 months (p<0.01). SIFr illustrated a change in dominance due to the disorder whereas KS, which appeared independent of the dominance and occupation, showed a change in movement velocity. Both parameters were correlated to clinical scores (R(2) reaching 0.5). This approach provides clinicians with new objective parameters for evaluating the functional ability of the shoulder in daily conditions, which could be useful for outcome assessment after surgery.
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June 2013

Bioimpedance for oedema evaluation after total knee arthroplasty.

Physiother Res Int 2013 Sep 27;18(3):140-7. Epub 2012 Nov 27.

Department of Physiotherapy, School of Health Sciences, University of Applied Sciences of Western Switzerland, Lausanne, Switzerland.

Background And Purpose: Electrical bioimpedance spectroscopy (BIS) allows the evaluation of limb extracellular fluid (R0) and total fluid (Rinf). BIS could facilitate post-surgical oedema evaluation after total knee arthroplasty (TKA), as it is easily performed and is non-invasive. However, neither its applicability in this context nor the influence of metallic implants on measurement has been evaluated. The aim of this study was to evaluate the influence of TKA implants on the BIS R0 and Rinf variables used for oedema evaluation.

Method: This was a prospective non-randomized comparative clinical trial. One oedema-free group of patients with TKA was compared with a group presenting similar characteristics except for the arthroplasty, to assess the influence of the implant on BIS measurement in the absence of oedema. The TKA group included 15 patients who had undergone surgery more than a year previously, and the control group included 19 patients awaiting TKA surgery. Volume and perimeter measurements served as reference criterions. The lower limb percentage differences for BIS, knee perimeter and volume were calculated. The significance of differences between groups was calculated for all measurement methods, using the Mann-Whitney test. The setting was a Department of Orthopedic Surgery and Traumatology in a university hospital.

Results: The differences between groups were not significant for R0, Rinf, volume and perimeter. R0 showed the smallest mean difference in limb percentage difference between groups [means (SD): TKA 3.98 (8.09), controls 3.97 (5.16)].

Conclusions: The lower-leg percentage difference in the TKA group is comparable with that of healthy subjects. R0 can be used for oedema evaluation following TKA surgery, as there was no sign of alteration from the metallic implant. These findings indicate the potential for early oedema evaluation after TKA. More research is warranted to extensively validate the application of BIS for oedema evaluation after TKA.
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September 2013

Objective evaluation of shoulder function using body-fixed sensors: a new way to detect early treatment failures?

J Shoulder Elbow Surg 2011 Oct;20(7):1074-81

Department of Orthopaedic Surgery and Traumatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.

Background: Variable definitions of outcome (Constant score, Simple Shoulder Test [SST]) have been used to assess outcome after shoulder treatment, although none has been accepted as the universal standard. Physicians lack an objective method to reliably assess the activity of their patients in dynamic conditions. Our purpose was to clinically validate the shoulder kinematic scores given by a portable movement analysis device, using the activities of daily living described in the SST as a reference. The secondary objective was to determine whether this device could be used to document the effectiveness of shoulder treatments (for glenohumeral osteoarthritis and rotator cuff disease) and detect early failures.

Methods: A clinical trial including 34 patients and a control group of 31 subjects over an observation period of 1 year was set up. Evaluations were made at baseline and 3, 6, and 12 months after surgery by 2 independent observers. Miniature sensors (3-dimensional gyroscopes and accelerometers) allowed kinematic scores to be computed. They were compared with the regular outcome scores: SST; Disabilities of the Arm, Shoulder and Hand; American Shoulder and Elbow Surgeons; and Constant.

Results: Good to excellent correlations (0.61-0.80) were found between kinematics and clinical scores. Significant differences were found at each follow-up in comparison with the baseline status for all the kinematic scores (P < .015). The kinematic scores were able to point out abnormal patient outcomes at the first postoperative follow-up.

Conclusion: Kinematic scores add information to the regular outcome tools. They offer an effective way to measure the functional performance of patients with shoulder pathology and have the potential to detect early treatment failures.
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October 2011

Outcome evaluation in shoulder surgery using 3D kinematics sensors.

Gait Posture 2007 Apr 28;25(4):523-32. Epub 2006 Aug 28.

Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne (EPFL), STI-Bat ELG, CH-1015 Lausanne, Switzerland.

A new method of scoring systems for the functional assessment of the shoulder is presented. 3D accelerometers and gyroscopes attached on the humerus were used to differentiate a healthy from a painful shoulder. The method was first tested on 10 healthy volunteer subjects with no shoulder pathology. The system was then tested on 10 patients with unilateral shoulder pathology (rotator cuff disease, osteoarthritis) before and after surgery (3, 6 months). In order to evaluate the system, nine tests based on the Simple Shoulder Test (SST) were performed on each shoulder for each patient. Three scores were defined: the P score was based on the angular velocities and accelerations of the humerus; the RAV score was based only on the angular velocities of the humerus; the M score was based on the sum of all moments of the humerus. Our kinematic scores indicated significant differences between baseline and follow-up (p<0.05) and differentiated between patients with varying severity of the same condition. We demonstrated a reliable technique of evaluating shoulder pathology and the results of surgery.
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April 2007