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The development of European Union of Medical Specialists (UEMS) physical and rehabilitation medicine programmes of care (PRMPC) and physical and rehabilitation medicine care pathways (PRMCP) in France is a good example of the positive interaction between European and national organizations. PRMPC were defined at the European level to offer a robust template for the description and assessment of physical and rehabilitation medicine (PRM) clinical activity in various fields and contexts. An accreditation procedure was organized as a peer review. It has started to provide very informative documents. In France, discussions on this topic began in 2000. At the end of the same decade, the European approach fostered the interest of French PRM organizations in a period of negotiating with public authorities about two crucial issues: specifications required for reimbursement of functional instrumental assessments in PRM practice and funding of PRM care in postacute facilities. The French Society of PRM (SOFMER) decided to describe the PRM scope in a systematic way, emphasizing the best balance between patient needs, rehabilitation goals, relevant means and justified funding. Nine "PRMCP" have been published since 2010 and others are in progress. PRMPC and PRMCP share the same concern about the best response offered by PRM to patients' needs. The first approach is the description of a local organization with respect to both scientific evidence and local conditions. The latter is an outline of PRM intervention related to a multidimensional pattern of patients' situations. Both enhance the role of PRM doctors, whose expertise is necessary for making a synthesis of medical diagnosis and functional assessment, for setting up a patient-centred care strategy and for supervising the rehabilitation team's intervention.

This study was undertaken to determine whether the resisted-sprint in overstrength (OSt) or the assisted-sprint in overspeed (OSp) could be efficient training methods to increase 100-m front crawl performance. Thirty-seven (16 men, 21 women) competition-level swimmers (mean [+ or -] SD: age 17.5 [+ or -] 3.5 years, height 173 [+ or -] 14 cm, weight 63 [+ or -] 14 kg) were randomly divided into 3 groups: OSt, OSp, and control (C). All swimmers trained 6 days per week for 3 weeks, including 3 resisted or assisted training sessions per week for the groups OSt and OSp respectively. Elastic tubes were used to generate swimming overstrength and overspeed. Three 100-m events were performed before, during, and after the training period. Before each 100-m event, strength of the elbow flexors and extensors was measured with an isokinetic dynamometer. Stroke rate and stroke length were evaluated using the video-recorded 100-m events. In the OSt group, elbow extensor strength, swimming velocity, and stroke rate significantly increased (p < 0.05), while stroke length remained unchanged after the 3-week training period. In the OSp group, stroke rate significantly increased (p < 0.05) and stroke length significantly decreased (p < 0.05) without changes in swimming velocity. No significant variations in the C group were observed. Both OSt and OSp proved to be more efficient than the traditional training program. However, the OSt training program had a larger impact on muscle strength, swimming performance, and stroke technique than the OSp program. Key Words. exercise, muscular strength, overspeed, overstrength, performance

Context: Isokinetic assessment of shoulder internal- (IR) and external-rotator (ER) strength is commonly used with many different postures (sitting, standing, or supine) and shoulder positions (frontal or scapular plane with 45° or 90° of abduction). Objective: To conduct a systematic review to determine the influence of position on the intersession reliability of the assessment of IR and ER isokinetic strength, to identify the most reliable position, and to determine which isokinetic variable appears to be most stable in intersession reliability. Evidence Acquisition: A systematic literature search through MEDLINE and Pascal Biomed databases was performed in October 2009. Criteria for inclusion were that studies be written in English or French, describe the isokinetic evaluation methods, and describe statistical analysis. Evidence Synthesis: Sixteen studies meeting the inclusion criteria were included. Variable reliability of ER and IR peak torque (PT) were generally reported for all assessment positions; intraclass correlation coefficients were .44-.98 in the seated position with 45° of shoulder abduction, .09-.77 in the seated position with 90° of shoulder abduction, .86-.99 (coefficient of variation: 7.5-29.8%) in the supine position with 90° of shoulder abduction, .82-.84 in the supine position with 45° of shoulder abduction, and .75-.94 in standing. The ER:IR ratio reliability was low for all positions. Conclusions: The seated position with 45° of shoulder abduction in the scapular plane seemed the most reliable for IR and ER strength assessment. The standing position or a shoulder posture with 90° of shoulder abduction or in the frontal plane must be used with caution given the low reliability for peak torque. Good reliability of ER and IR PT was generally reported, but ER:IR ratio reliability was low. [ABSTRACT FROM AUTHOR]