Philippe Corbeil

Purpose: Limited data are available on the cardiorespiratory and muscle fitness of children with acute lymphoblastic leukemia (ALL) during chemotherapy. This pilot study evaluated the safety of testing the cardiorespiratory and muscle fitness of two children with ALL at different risk levels in early chem treatment. Methods: Two girls with low- and high-risk B-cell ALL (DFCI-16-001) took part in two test sessions: T1 (induction, consolidation 1A/C) and T2 (consolidation 2). Each testing session included a maximal oxygen uptake ( V ˙ O ₂ max) exercise test, muscular strength tests, physical activity and quality of life questionnaires, and a semi-structured interview. The parents agreed to these assessments at the start of chemotherapy treatment. Results: The participants experienced no significant adverse effects from undertaking the cardiorespiratory and muscular tests, and there was no impact on their chemotherapy treatment schedule. At their post-test interview, both participants reported that thigh pain and fatigue were the most difficult part of the V ˙ O ₂ max exercise test. Regarding physical performance outcomes, both participants exhibited low scores compared to their gender, weight- and age-predicted V ˙ O ₂ max and on most strength test values. Conclusion: The physical tests were safely and successfully conducted with these two participants during early chemotherapy.

Background/Objectives: Transferring non-mobile patients from the ground to a stretcher represents one of the riskiest tasks for musculoskeletal disorders among emergency medical technicians–paramedics (EMT-Ps), but there is little information available on how they perform in real-life work situations. Methods: This study aimed to describe EMT-Ps’ patterns of behavior observed from field data and highlight safe work operations. A secondary analysis was conducted on 27 videos collected during EMT-Ps’ responses to live calls. Contextual variables (workspace and external assistance), operations during the preparation subtask (move patient or interfering objects and adjust stretcher’s height and position), and movements and postures related to the transfer subtask were extracted from the videos. Results: The results demonstrate that despite stratification based on similar contextual factors (equipment and limited workspace), EMT-Ps’ behavior varied between interventions during the preparation and transfer subtasks. Several operations to adjust the patient–stretcher configuration before the lifting phase were carried out to facilitate patient transfer, but these were not always optimal from a safety perspective. Strategies such as fast loading (1 out of 4) and the use of external assistance (6 out of 15) were beneficial in certain circumstances. Conclusions: EMT-Ps demonstrated their ability to analyze the situation, organize accordingly, and adapt their behavior by applying these safety skills.

Introduction: Multiple biomechanical models have been suggested to quantify lower limb joint contact stress distributions, with varying results. Among others, the choice of cartilage morphology and gait loading patterns can significantly affect simulation results. Moreover, there is currently no consensus on simulating the input and output data needed to obtain reliable results and enable a comprehensive analysis. Objectives: The aim of this study was to compare the reliability and clinical relevance of joint contact metrics by calculating pre‐ and postoperative hip joint contact stress distributions of a dysplastic cohort under various simulation scenarios. Methods: A cohort of 22 dysplastic patients has been treated using periacetabular osteotomy (6‐month follow‐up). Five radiographic measurements of the acetabular cup were taken from imagery pre‐ and postoperatively. Eight osteoarthritis‐predictive joint stress metrics were computed using discrete element analysis in 6 unique simulation scenarios (2 cartilage models; 3 hip gait loading profiles) pre‐ and postoperatively. Results: A multivariate analysis of variance confirmed the significant effects of treatment, cartilage model, and loading profile on the computed stress metrics ( p < 0.01). Also, average‐ and threshold‐based metrics, such as average contact area, average stress, and Maxian overdose, were shown as more reliable indicators of successful surgical treatment than the maximum‐based metrics. Finally, correlations between radiographic measurements and stress metrics revealed greater influence of the acetabular index and anterior center‐edge angle than the lateral center‐edge angle. Conclusions: Average and threshold‐based metrics, as well as the acetabular index and anterior center‐edge angle, should be of greater interest in future studies regarding hip dysplasia. Clinical Significance: Level 2 (Prospective Study: Therapeutic).

Purpose: Immediate biomechanical and functional benefits of knee braces and lateral wedge foot orthoses (FO) are often reported on patients with medial knee osteoarthritis. However, the effectiveness of their combined use in a longer‐term orthotic treatment remains unclear. The aim was to evaluate pain, function, comfort and knee adduction moment (KAM) during the stance phase of gait with three modalities of orthotic treatment. Methods: Twenty‐two patients with knee osteoarthritis were analysed in a randomised crossover trial including a knee brace with valgus and external rotation functions (VER), FO and their combined use (VER + FO). Western Ontario and McMaster Universities scale (WOMAC) and Knee injury and Osteoarthritis Outcome Scores and KAM during gait were obtained before and after each orthotic treatment of 3 months. Repeated measures analyses of variance contrasted the factors orthosis (VER, FO, VER + FO), treatment (pre and post) and wear (without and with) on pain, function, comfort and KAM. Results: An interaction between orthosis and treatment on the WOMAC pain (effect size [ES] = 0.17) and a main effect on the pain visual analogue score (ES = 0.24) indicated that VER and VER + FO were more alleviating than FO. The three modalities of orthotic treatment significantly improved functional scores (ES > 0.2) and reduced discomfort (ES = 0.25). A significant multivariate interaction between orthosis and wear (ES = 0.73) showed that the KAM reduction while wearing the orthoses was more pronounced with the VER and VER + FO than the FO. Conclusion: The VER‐brace obtained more effectiveness than FO on pain and KAM after 3 months for medial knee osteoarthritis and the combined treatment did not substantially improve biomechanical and functional outcomes. Level of Evidence: Therapeutic study level I randomised crossover trial.

Inertial motion capture (IMC) has gained popularity in conducting ergonomic studies in the workplace. Because of the need to measure contact forces, most of these in situ studies are limited to a kinematic analysis, such as posture or working technique analysis. This paper aims to develop and evaluate an IMC-based approach to estimate back loading during manual material handling (MMH) tasks. During various representative workplace MMH tasks performed by nine participants, this approach was evaluated by comparing the results with the ones computed from optical motion capture and a large force platform. Root mean square errors of 21 Nm and 15 Nm were obtained for flexion and asymmetric L5/S1 moments, respectively. Excellent correlations were found between both computations on indicators based on L5/S1 peak and cumulative flexion moments, while lower correlations were found on indicators based on asymmetric moments. Since no force measurement or load kinematics measurement is needed, this study shows the potential of using only the handler’s kinematics measured by IMC to estimate kinetics variables. The assessment of workplace physical exposure, including L5/S1 moments, will allow more complete ergonomics evaluation and will improve the ecological validity compared to laboratory studies, where the situations are often simplified and standardized.

Le concept de marge de manœuvre se définit comme la liberté dont dispose un travailleur pour élaborer différentes façons de travailler afin de répondre aux exigences de production, et ce, sans effet défavorable sur sa santé (Coutarel, Caroly, Vézina et Daniellou, 2015; St-Vincent et al., 2011). Une forte charge de travail jumelée à une faible latitude décisionnelle restreint l’élaboration des gestes et pourrait pénaliser ainsi la santé des opérateurs. Les connaissances actuelles des façons de faire des manutentionnaires, qu’ils soient experts ou non, ne nous permettent pas d’apprécier dans sa totalité l’ampleur de cette liberté lorsqu’un individu doit répéter un même geste et comment la maîtrise de cette gestuelle diffère entre manutentionnaires. Sur la base de trois études précédentes (Corbeil, Plamondon, Teasdale, Handrigan, Ten Have et Manzerolle, 2013; Plamondon, Denis, Bellefeuille, et al., 2010; Plamondon, Denis, et al., 2012) regroupant 65 manutentionnaires (experts ou novices hommes, femmes, manutentionnaires en surplus de poids ou de poids santé), trois objectifs spécifiques ont été répondus : 1. Documenter les variations intra-individuelles de la signature gestuelle propre à chaque manutentionnaire (signature gestuelle) et les variations interindividuelles; 2. Comprendre la relation entre les différents modes opératoires et les chargements au dos en fonction de différents contextes; 3. Identifier, s’il y a lieu, des sous-groupes homogènes de participants définis selon le niveau de sollicitation des structures musculosquelettiques au dos et ses variations et caractériser leurs modes opératoires prévalents et les variations connexes. La tâche de manutention consistait à empiler quatre caisses, une caisse par-dessus l’autre, en s’assurant que l’empilement des caisses (15 kg ou 23 kg) soit en équilibre, et ensuite déposer l’une après l’autre ces caisses sur un convoyeur. Ce rapport de recherche a permis de : - Proposer une méthode pour définir la signature gestuelle permettant de caractériser la diversité motrice (choix des façons de faire) et la variabilité motrice (mouvement) adaptée à la manutention de charge; - Mesurer l’ampleur de la variabilité motrice d’une tâche séquentielle en manutention et préciser les effets des facteurs externes sur la variabilité motrice : Effet Hauteur : La manutention de charge près du sol engendre, de manière générale, une réduction de la diversité des façons de faire et de la variabilité des mouvements. Les variations des chargements à L5/S1 ont augmenté au fur et à mesure que les charges manipulées se rapprochaient du sol. Effet Masse : L’augmentation de la masse a entraîné une diminution de la variabilité motrice et de la diversité motrice, peu importe la hauteur de manipulation de la charge. L’effet Masse a de plus engendré une augmentation nette de la sollicitation relative des structures musculosquelettiques du bas du dos et de ses variations. De manière globale, les experts hommes, ceux en surplus de poids et les manutentionnaires femmes se sont distingués de leurs comparses en adoptant des mouvements moins variables. Seuls les experts ont démontré une sélection de façons de faire plus constante lorsque comparés aux participants hommes novices. Effet Expertise : Les chargements en asymétrie au dos des experts étaient 33% inférieurs à ceux des manutentionnaires novices lorsque les caisses étaient déposées au sol et les sollicitations musculo-squelettiques au dos étaient plus constantes chez les experts comparativement aux novices. De grandes différences interindividuelles ont été observées au sein même des groupes de manutentionnaires. Les différences interindividuelles, dues à l’hétérogénéité marquée des participants constituant chacun des groupes de manutentionnaires, masquent potentiellement des effets marquants au niveau des préférences opératoires et la minimisation de certains coûts musculosquelettiques au dos. - Identifier les coûts des différents modes opératoires et faire ressortir les dimensions du compromis : Trois variables clés de la signature gestuelle sont fortement associées aux chargements au dos : Position des pieds, Posture du corps et Asymétrie. Il n’y a pas de solution unique qui satisfait tous les critères de performance désirés : une phase de transition rapide, de faibles moments de force à L5/S1 en sagittal et en asymétrie, de faibles moments de forces aux genoux, et un faible cumul des chargements lombaires. Les deux tendances (technique sécuritaire, mode de transition directe) illustrent bien la notion du compromis : quand un risque est diminué, un autre est augmenté. Il existe toutefois des façons de faire plus performantes que d’autres. - Décortiquer la relation entre la variabilité motrice et les sollicitations musculosquelettiques au dos (coût lié à la préservation de la santé) : Proposition d’un modèle de classification selon les coûts initiaux au dos et ses variations qui sépare les participants qui présentent des hypo- des hypersollicitations au dos, et ceux qui varient peu leurs façons de faire (Repeaters) de ceux qui varient plus leur façon de faire d’une répétition à une autre (Replacers). On...