BackgroundFibromyalgia (FM) is a syndrome expressed by chronic widespread pain which leads to reduced physical function and frequent use of healthcare services (1). The beneficial effects of a relaxation training and aerobic exercise in the management of fibromyalgia (FM) patients were recognized (2).ObjectivesIn our study - a single blind randomized controlled trial – was assessed the effects of a standardized 6 week home training (relaxation training – autotraining Scultz and submaximal aerobic exercise daily) on pain, functional ability, and quality of life in females with FM.Methods36 females diagnosed with FM by ACR criteria were randomized into two groups: group 1 – 18 females (G1) was treated by complex therapy (pharmacotherapy, 6 week home training), and group 2 – 18 females control (G2), receiving only pharmacotherapy. We measured pain (quantified with algometer and visual analogue scale), quality of life (Spitzer scale) and value of Fibromyalgia Impact Questionnaire (FIQ). Instruction in home training techniques was given by physiotherapists.ResultsThe improvements were found FIQ (45.5% in G1 and 28.5% in G 2, respectively) (p<0.05) and improvement in G1 was significantly higher than G2 (p<0.01). VAS scores for pain reduced in all females; this reduction was significantly higher in G1. The algometer values measured in tender points decreased significantly, especially in lower limbs. The quality of life (Spitzer Scale) was significant improved in G1 group (51%).ConclusionsHome training program, based on relaxation training and aerobic exercises, can lead to long-term success for quality of life and clinical status in females with FM. All patients proved compliance to the daily training protocol (autotraining Schultz and submaximal aerobic program) was daily applied in the management of females with FM, especially. Early implementation of self management training in association with controlled medication may be a successful key for improvement of quality of life in females with FM.ReferencesBusch A.J., Schachter C.L., Overend T.J. et.al., J Rheumatol. 2008; 35(6):1130-44.Persson A.L., Veenhuizen H., Zachrison L., Gard G., Physical Therapy Reviews 2008; Volume 13, Issue 5, pp. 355-365.Disclosure of InterestNone declared

BackgroundHaving an important negative impact not only on bone health, but also on general health, with serious consequences as the fragility fractures, osteoporosis had became a major public health problem, with high socio-economic cost.ObjectivesThe aim of this study was to assess the efficacy of a 6 months ambulatory exercise program on functional status and quality of life in women with postmenopausal osteoporosis.MethodsThe randomized, controlled, observational study included 81 patients with postmenopausal osteoporosis, mean age 68.7±7.3 years, randomly assigned to a control group (40 patients) and an exercise group (42 patients). All patients were diagnosed with osteoporosis based on DEXA assessment and had a stable cardiovascular status. All patients continued to take their prescribed medication for osteoporosis. They followed exercise programs based on increasing spinal mobility, muscular strength and endurance, improving balance, coordination, respiratory exercises. The patients in the control group continued their daily living activities. The evaluation was made at the beginning of the study and after 6 months based on spinal mobility, muscular strength, pain assessment on a Visual Analogue Scale (VAS) and quality of life evaluation using SF-36 Questionnaire.ResultsThe benefits of the kinetic programs were shown by a significant improvement on spinal mobility and muscular strength for spinal extensor and abdominal flexor muscles. For muscular strength, the values we obtained followed an ascendant curve for all the tested muscular groups and the results had high statistic significance. Pain, evaluated on a Visual Analogue Scale, had a mean decrease of 3.558 points and the results were also high statistic significant (p=0.000054). For SF-36 Questionnaire, the best results were obtained for vitality (37.2% amelioration), mental health (20.8% amelioration) and body pain (53.5% amelioration) domains and were also statistic significant (p<0.05). The results for the control group remained basically unchanged. The compliance of the study participants was very good: only three patients did not completed the 6 months training program.ConclusionsThe physical exercise program improves both functional status and quality of life in patients with postmenopausal osteoporosis by increasing spinal mobility and muscular strength and by reducing pain. Kinetic programs that combine aerobic exercise with exercises for increasing muscular strength and endurance, balance and coordination should be introduced in the rehabilitation programs of patients with osteoporosis without medical contraindications for moderate level exercise.Disclosure of InterestNone declared

BackgroundKnee osteoarthritis is a long- term disease and its medical management is not always effective in reducing pain or improving mobility. The studies concerning the quality of life in patients with knee osteoarthritis proved the impact of functional impairment on their daily living activities and on their social and professional life.ObjectivesThe main purpose of this observational study was to evaluate the efficacy of complex rehabilitation treatment and its influence on the functional status and on the quality of life in patients with knee osteoarthritis and to identify possible correlations between various clinical and functional parameters.MethodsThe study included 138 patients with knee osteoarthritis (diagnosed according to the American College of Rheumatology criteria), mean age 64.52±11.63 years. All patients performed a complex rehabilitation program for 12 days and were evaluated clinical and functional at baseline, at 2 weeks and at 8 weeks. We used VAS scale for pain measure, WOMAC index for functional status and the Short Form 36 Helth Survey (SF-36) for assessing quality of life. The physical performance measures included the Six- Minute Walk Test (SMW) and the Timed “Up & Go” Test (TUG).ResultsThe efficacy of physical-kinetic treatment is reflected by statistically significant improvements (p<0.05) of mean scores for functional status and for quality of life questionnaires, for pain evaluated on a visual analogue scale (VAS). WOMAC influence on SF-36 improvement is well above 50%; there is a correlation between indicators estimated as moderately high (0.8). Multivariate analysis showed that physical performance measures (SMW and TUG) correlated statistically with pain measure (VAS score) and WOMAC index.ConclusionsImprovement of the clinical and functional parameters has a significant impact on increasing the quality of life in patients with knee osteoarthritis.Disclosure of InterestNone declared

BackgroundSingle congenital fusions are common anomalies, found most often at the C2–3 and C5–6 levels had moderate or severe degenerative changes in their cervical spines, or displayed signs of cervical instability. There is no motion at the level of congenital block vertebrae, as noted in flexion and extension radiographic analysis, resulting in excessive mobility and early degenerative changes at the adjacent unfused motion segments.ObjectivesThe aim of our single blind, randomized controlled study was to assess the efficacy of comprehensive home exercise program on neck pain and physical performance in patients with block vertebrae in lower cervical segments (C5-C6 and C6-C7).Methods36 patients with chronic neck pain and cervical block vertebrae were randomly assigned into exercise home group (G1, 19 patients) and second group (G2, 17 patients - noncompliant to exercise program). All patients were complete assessed (clinical, imagistic, functional). Kinetic program (first light positive exercise, next gradually strengthening exercises for the all cervical muscle exercise, one set of 10 repetitions each direction, twice a day and neck school exercises) was initiated in rehabilitation clinic. Duration of follow-up was 16 weeks after start of the intervention. At 4 and 16 weeks an independent physiotherapist unaware of the treatment allocation performed outcome assessments - pain (VAS) and Neck Disability Index (NDI) for functional status.ResultsComparing week 16 with baseline, pain improved significantly (p<0.05). Significant improvement in NDI scores for pain and functional status were found at week 4 and week 16 in the G1 compared to baseline. At 16 weeks, 16 (84.2%) patients mentioned their functional status as improved and only 3 (15.8%) as similar at baseline.ConclusionsThe exercise program performed daily led to improvements in pain and physical measures. Optimal neck care in congenital cervical vertebra block includes pain-relieving exercises that also help restore neck posture, limitation of the neck movement and the muscular weakness. These techniques can help recover and provide good control against future symptoms (atrophy and neurological sensory loss, myelopathy).Disclosure of InterestNone declared

Background It is known that patients with rheumatoid arthritis have frequently associated osteoporosis, both within the context of the disease and due to the treatment with corticosteroids. Objectives We are to evaluate the progression of osteoporosis at patients with rheumatoid arthritis and osteoporosis - in therapy with bisphosphonates, D3 vitamin and 500mg calcium daily-at two groups of patients; one group in remissive treatment with leflunomid versus the other group in treatment with biological agents. For this evaluation we have developed a retrospective study within a 5-year period of time, 2007-2012. Methods We have analyzed a number of 48 patients split in two homogeneous groups – each with 24 patients; all the patients have been diagnosed with osteoporosis, T score in between -2,5 and -4,2 standard deviation. The A Group has received a treatment with 20 mg of leflunomid daily and non steroidal anti-inflammatory drugs. The B Group has received a treatment with biological agents: infliximab 3mg/kg in infusion at 2 months, etanercept 50mg weekly and adalimumab 40 mg once at two weeks. Both groups have received bisphosphonates in therapeutic doses being evaluated for osteoporosis. The median patients` age was of 52.1 of which only 38 patients were at the beginning of the postmenopausal study. There was evaluated the level of the disease activity by the 28 DAS score. We also mention that at 12 patients treated with leflunomid there was necessary corticosteroids therapy in doses of 16 mg per day with a diminishing level of 8 mg on a period of 2 up to 6 months; meanwhile there was necessary the pulse therapy with metilprednisolon 1 mg/kg at 6 patients for a period of 3 days. Patients in biological therapy did not need corticosteroids therapy. We evaluated a witness group of 14 patients with rheumatoid arthritis and osteopeny who received only the supplement with D3 and 500mg of Calcium per day. Results The A group of study presented the maintenance of median of T score at -3,1 standard deviation, and DAS 28 median was lowered from 4.2 to 3.6. The B Group of study presented the diminishing of the level of osteoporosis from a T score from -3.9 to 3.2; the median of 28 DAS was reduced from 4.2 to 3.1. These levels showed osteopeny a T score from -1.8 to -2.4 with a passing to osteoporosis at 6 patients who needed to receive bisphosphonates, and the DAS 28 score presented a raise from 2.9 la 3.4 Conclusions The diminishing level of osteoporosis with 0.2 standard deviations per year at the group of patients in therapy with biologic agents as compared to the group treated with leflunomid proves the fact that despite the beginning of the first group with lower values it obtained better results in both reducing the level of disease activity and the pathogenic immune inflammatory context. The witness group of patients with osteopeny proves both the role played by the patients’ age in the beginning of menopause at 4 patients as well as the presence of the immune inflammatory factor in generating osteoporosis to pati...