Perceived Usefulness of Telerehabilitation of Musculoskeletal Disorders: A Belgium-France Pilot Study during Second Wave of COVID-19 Pandemic

International audienceBackground: COVID-19 has affected the practice of physiotherapy, and telerehabilitation (TR) may be seen as an alternative model of care if it is accepted by patients and physiotherapists. This study investigates the perceived usefulness of TR and the intention to use it among physiotherapists and patients from Belgium and France concerned with musculoskeletal disorders (MSDs) during the pandemic period. Methods: An online questionnaire based on the technology-acceptance model was designed. Sociodemographic data were collected and Likert scales were proposed to assess perceived ease-of-use, perceived usefulness and intention to use TR. Data were collected between 17 January and 17 March 2021; 68 patients and 107 physiotherapists answered. Results: In total, 88% of patients and 76% physiotherapists had not used TR at the time they answered. Only 12% of patients and 1% of physiotherapists are willing to use TR, and 50% of physiotherapists think they will never use TR compared to 25% of patients. A total of 98% of participants agreed that they had a good mastery of the technological tools requested. Conclusions: Physiotherapists are more reluctant to use TR than patients, regardless of convincing EBM results. This is related to their own representation of proper MSD management, which must include the use of hands-on techniques

Thermoregulation in wakefulness and sleep in humans

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Involvement of autonomic nervous activity changes in gastroesophageal reflux in neonates during sleep and wakefulness.

BACKGROUND: It has been suggested that disturbed activity of the autonomic nervous system is one of the factors involved in gastroesophageal reflux (GER) in adults. We sought to establish whether transient ANS dysfunction (as assessed by heart rate variability) is associated with the occurrence of GER events in neonates during sleep and wakefulness. METHODS: Nineteen neonates with suspected GER underwent simultaneous, synchronized 12-hour polysomnography and esophageal multichannel impedance-pH monitoring. We compared changes in HRV parameters during three types of periods (control and prior to and during reflux) with respect to the vigilance state. RESULTS: The vigilance state influenced the distribution of GER events (P<0.001), with 53.4% observed during wakefulness, 37.6% observed during active sleep and only 9% observed during quiet sleep. A significant increase in the sympathovagal ratio (+32%, P=0.013) was observed in the period immediately prior to reflux (due to a 15% reduction in parasympathetic activity (P=0.017)), relative to the control period. This phenomenon was observed during both wakefulness and active sleep. CONCLUSION: Our results showed that GER events were preceded by a vigilance-state-independent decrease in parasympathetic tone. This suggests that a pre-reflux change in ANS activity is one of the factors contributing to the mechanism of reflux in neonates

Effects of Smoking Exposure in Infants on Gastroesophageal Reflux as a Function of the Sleep-Wakefulness State

International audienceObjective To determine whether perinatal smoking exposure is associated with gastroesophageal reflux (GER)-related changes in sleep-wakefulness states in neonates. Study design Thirty-one neonates. referred for the investigation of suspected GER, were recruited and underwent multichannel impedance-pH monitoring and synchronized 8- to 12-hour polysomnography. The infants' exposure to tobacco smoke was estimated by means of a urine cotinine assay. The total number. frequency (h(-1)), and mean duration (minutes) of GER-pH (reflux events detected by the pH electrode only) and GER-imp (reflux events with bolus movement detected by impedance) events were determined. Intergroup differences (smokingexposed group vs nonexposed group) were probed with nonparametric. unpaired Mann-Whitney U tests. A chi(2) test was used to assess a possible intergroup difference in bolus retrograde migration during GER-imp events. Results According to the urine cotinine assay, 21 of the 31 neonates had been exposed to cigarette smoke during the perinatal period. The number (and frequency) of GER-imp was significantly greater (P= .016) in the exposed group (29 [0-90]) than in the nonexposed group (12 [2-35]). Migration of the esophageal bolus from the distal segment to the most proximal segment was significantly more frequent (P= .016) in the exposed group (83% of GER) than in the nonexposed group (41%). The GER pattern associated with smoking exposure was particularly obvious during Rapid eye movement sleep. Conclusions The more frequent occurrence and greater proximal migration of GER-imp in the smoking-exposed group (especially during rapid eye movement sleep) may have clinical relevance. Smoking exposure is a preventable risk factor for limiting the occurrence of GER in neonates

Effect of the period on the sympathovagal balance (LF/HF) (mean ± SEM).

<p>*<i>P</i><0.05. (pairwise multiple comparison procedures were used to test the differences between the <i>control</i>, <i>prior</i> and <i>during</i> periods. Data were adjusted for multiple testing with the Tukey-Kramer test).</p

Effect of the period on normalized values (mean ± SEM) of the power spectra in the low- (LF_nu) and high-frequency (HF_nu) bands.

<p>*<i>P</i><0.05, **<i>P</i><0.01. (pairwise multiple comparison procedures were used to test the differences between the control, prior and during periods. Data were adjusted for multiple testing with the Tukey-Kramer test).</p