Biomedical musculoskeletal applications of infrared thermal imaging on arm and forearm: A systematic review

Pressure pain sensitivity, thermographic changes, function, life and sleep quality in patients with unilateral rotator cuff injury: A case-control study

INTRODUCTION-AIM

This study aimed to assess pressure pain sensitivity, thermographic changes, functional status, quality of life, and sleep in individuals with unilateral shoulder pain due to rotator cuff tear and compare these parameters with the unaffected side and asymptomatic individuals.

MATERIAL-METHOD

Thirty-two patients with unilateral rotator cuff injury and 32 volunteers without shoulder problems were included. Pain was evaluated using a visual analogue scale, pressure pain sensitivity with a digital algometer, thermographic changes with a thermal camera, upper extremity function through the Disabilities of the Arm, Shoulder, and Hand Disability Questionnaire, sleep quality using the Pittsburgh Sleep Quality Index, and quality of life using SF-36.

RESULTS

Pressure pain sensitivity of the deltoideus, supraspinatus, and subscapularis muscles in the affected limb was lower than in the unaffected limb (p = 0.027, p = 0.005, p < 0.001). Conversely, pressure sensitivity of the deltoideus, biceps brachii, and subscapularis muscles was higher in the patient group (p = 0.008, p = 0.042, p < 0.001). Furthermore, a decrease in temperature was observed in all patients, except for the trapezius muscles of the affected side (p < 0.05).

CONCLUSION

This study sheds light on altered pressure pain sensitivity and thermographic changes in individuals with unilateral shoulder pain due to rotator cuff tear. Additionally, the study highlights impairments in functional status, quality of life, and sleep in these individuals, emphasizing the broader impact of such injuries. Targeted interventions based on these findings have the potential to enhance overall well-being and functional outcomes for affected individuals.

LEVEL OF EVIDENCE

Level III, Case-control study, prognosis study.

Infrared Thermography-A Novel Tool for Monitoring Fracture Healing: A Critically Appraised Topic With Evidence-Based Recommendations for Clinical Practice

CLINICAL SCENARIO

Stress fractures are one of the most common injuries in athletes. Unfortunately, they are hard to diagnose, require multiple radiology exams and follow-up which leads to more exposure to radiation and an increase in cost. Stress fractures that are mismanaged can lead to serious complications and poorer outcomes for the athlete. During the rehabilitation process, it would be beneficial to be able to monitor the healing of fractures to know when it is safe to gradually allow a patient to a return to sport because the return to activity is not usually objective and based on pain level.

CLINICAL QUESTION

Can infrared thermography (IRT) be a useful tool to measure the pathophysiological state of the fracture healing? The aim of this critically appraised topic is to analyze the current evidence of IRT for measuring the temperature change in fractures to provide recommendations for medical practitioners.

SUMMARY OF KEY FINDINGS

For this critically appraised topic, we examined 3 articles that compared medical imaging and IRT over multiple time points during the follow-up. The 3 articles concluded that a 1 °C asymmetry in temperature followed by a return to normal (less than 0.3 °C) temperature during the healing process of fractures can be monitored using IRT.

CLINICAL BOTTOM LINE

Once the patient has been diagnosed with a fracture, IRT can safely be used to monitor the evolution of a fracture. When the thermogram progresses from a hot thermogram to a cold thermogram, the healing is considered good enough to return to sport.

STRENGTH OF RECOMMENDATION

Grade 2 evidence exists to support IRT being used by clinicians to monitor fracture healing. Due to the limited research and novelty of the technology, the current recommendations are for following the treatment of the fracture once the initial diagnosis is made.

Acute physiological responses to a pyramidal exercise protocol and the associations with skin temperature variation in different body areas

This study aimed to examine the skin temperature (Tsk) variations in five regions of interest (ROI) to assess whether possible disparities between the ROI's Tsk could be associated with specific acute physiological responses during cycling. Seventeen participants performed a pyramidal load protocol on a cycling ergometer. We synchronously measured Tsk in five ROI with three infrared cameras. We assessed internal load, sweat rate, and core temperature. Reported perceived exertion and calves' Tsk showed the highest correlation (r = -0.588; p < 0.01). Mixed regression models revealed that the heart rate and reported perceived exertion were inversely related to calves' Tsk. The exercise duration was directly associated with the nose tip and calf Tsk but inversely related to the forehead and forearm Tsk. The sweat rate was directly related to forehead and forearm Tsk. The association of Tsk with thermoregulatory or exercise load parameters depends on the ROI. The parallel observation of the face and calf Tsk could indicate simultaneously the observation of acute thermoregulatory needs and individual internal load. The separate Tsk analyses of individual ROI appear more suitable to examine specific physiological response than a mean Tsk of several ROI during cycling.

A review of non-invasive sensors and artificial intelligence models for diabetic foot monitoring

Diabetic foot complications have multiple adverse effects in a person's quality of life. Yet, efficient monitoring schemes can mitigate or postpone any disorders, mainly by early detecting regions of interest. Nowadays, optical sensors and artificial intelligence (AI) tools can contribute efficiently to such monitoring processes. In this work, we provide information on the adopted imaging schemes and related optical sensors on this topic. The analysis considers both the physiology of the patients and the characteristics of the sensors. Currently, there are multiple approaches considering both visible and infrared bands (multiple ranges), most of them coupled with various AI tools. The source of the data (sensor type) can support different monitoring strategies and imposes restrictions on the AI tools that should be used with. This review provides a comprehensive literature review of AI-assisted DFU monitoring methods. The paper presents the outcomes of a large number of recently published scholarly articles. Furthermore, the paper discusses the highlights of these methods and the challenges for transferring these methods into a practical and trustworthy framework for sufficient remote management of the patients.

Application of an infrared thermography-based model to detect pressure injuries: a prospective cohort study

BACKGROUND

It is challenging to detect pressure injuries at an early stage of their development.

OBJECTIVES

To assess the ability of an infrared thermography (IRT)-based model, constructed using a convolution neural network, to reliably detect pressure injuries.

METHODS

A prospective cohort study compared validity in patients with pressure injury (n = 58) and without pressure injury (n = 205) using different methods. Each patient was followed up for 10 days.

RESULTS

The optimal cut-off values of the IRT-based model were 0·53 for identifying tissue damage 1 day before visual detection of pressure injury and 0·88 for pressure injury detection on the day visual detection is possible. Kaplan-Meier curves and Cox proportional hazard regression model analysis showed that the risk of pressure injury increased 13-fold 1 day before visual detection with a cut-off value higher than 0·53 [hazard ratio (HR) 13·04, 95% confidence interval (CI) 6·32-26·91; P < 0·001]. The ability of the IRT-based model to detect pressure injuries [area under the receiver operating characteristic curve (AUC)_{lag 0 days} , 0·98, 95% CI 0·95-1·00] was better than that of other methods.

CONCLUSIONS

The IRT-based model is a useful and reliable method for clinical dermatologists and nurses to detect pressure injuries. It can objectively and accurately detect pressure injuries 1 day before visual detection and is therefore able to guide prevention earlier than would otherwise be possible. What is already known about this topic? Detection of pressure injuries at an early stage is challenging. Infrared thermography can be used for the physiological and anatomical evaluation of subcutaneous tissue abnormalities. A convolutional neural network is increasingly used in medical imaging analysis. What does this study add? The optimal cut-off values of the IRT-based model were 0·53 for identifying tissue damage 1 day before visual detection of pressure injury and 0·88 for pressure injury detection on the day visual detection is possible. Infrared thermography-based models can be used by clinical dermatologists and nurses to detect pressure injuries at an early stage objectively and accurately.

Application of infrared thermography in the early warning of pressure injury: A prospective observational study

AIMS AND OBJECTIVES

To verify the ability of infrared thermography in objectively identifying pressure injury and its application value in the early warning of pressure injury.

BACKGROUND

There is subjectivity in assessing the risk of pressure injury as well as diagnosis in clinical settings, which makes early detection and prevention difficult.

DESIGN

Prospective, cohort study.

METHOD

Four hundred and fifteen patients admitted to the adult intensive care units were enrolled by a convenience sampling method, and they received a follow-up monitoring for 10 days. The risk of pressure injury was assessed via Braden scale, and thermal images of sacral area were obtained by infrared thermal imager once a day. The predictive effects of infrared thermography and Braden scale on pressure injury were compared by the receiver operating characteristic curve from which the optimal cut-off value of skin temperature for predicting pressure injury was determined. The effect of skin temperature on pressure injury was described and compared, using Kaplan-Meier curve and Cox proportional hazard regression model, respectively. We followed STROBE checklist for reporting the study.

RESULTS

The relative temperature of sacral area was negatively correlated with the risk of pressure injury. The efficiency of infrared thermography for diagnosing pressure injury was better than that of Braden scale. Based on the relative temperature optimal cut-off value (-0.1°C), Kaplan-Meier curve and Cox proportional hazard regression model analysis showed the incidence of pressure injury with relative temperature below -0.1°C was higher than the group with relative temperature above -0.1°C.

CONCLUSIONS

Infrared thermography can objectively and accurately identify local hypothermia warnings of pressure injury before visual recognition. The application of infrared thermography into routine pressure injury risk assessment provides a timely and reliable method for nursing practitioners.

RELEVANCE TO CLINICAL PRACTICE

Infrared thermography has great value of clinical application in daily pressure injury assessment. It is of great significance to make a faster and more objective clinical judgement for patients at risk of pressure injury.

Musculoskeletal applications of infrared thermography on back and neck syndromes: a systematic review

INTRODUCTION

Thermography is a noninvasive method to detect temperature changes on or near the surface of the body. Despite its utility has not yet been fully verified, it may be used as a complementary method to screening and/or monitoring treatment effectiveness. This systematic review evaluates the role of infrared thermography as a helpful outcome measure tool in subjects with back and neck syndromes.

EVIDENCE ACQUISITION

A literature search was conducted across the National Library of Medicine (MEDLINE), Web of Science and Scopus databases for studies that evaluated the role of infrared thermography as a helpful outcome measure tool in subjects with back and neck syndromes. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA).

EVIDENCE SYNTHESIS

The search strategy and selection criteria yielded 812 articles. From these, 268 duplicates were removed, and only 16 were in line with the aim of this review. Ultimately, only seven precisely fulfilled the inclusion and exclusion criteria and were included in the review. According to the articles reviewed, thermography seems to give an objective notion of change in inflammatory activity, which can corroborate the usefulness of treatment or the improvement/worsening of the patient's symptoms. The overall quality of research was uneven in the study design, endpoint measures, and sample characteristics.

CONCLUSIONS

The number of high-quality studies of the role of infrared thermography in patients with back and neck syndromes remains limited. More than a diagnostic tool, thermography can be an objective tool for monitoring the effectiveness of treatment by identifying deviations from a healthy state.

Occupational Risk Evaluation Through Infrared Thermography: Development and Proposal of a Rapid Screening Tool for Risk Assessment Arising from Repetitive Actions of the Upper Limbs

Risk analysis is one of the main tools for preventing the occurrence of Work-Related Musculoskeletal Disorders. New methods of risk analysis should seek to be more agile and simplified, encouraging them to be widely applied in work environments. This paper aimed to develop a rapid tool for assessing the risk of developing Work-Related Musculoskeletal Disorders (WMSDs) arising from repetitive actions of the upper limbs, while using a thermographic camera to measure skin temperature variation. A workstation was developed in an environmentally controlled laboratory, representing the five levels of risk presented by the Occupational Repetitive Actions Index (OCRA) Index, which were performed by 32 participants for 20 min. each level. There was a significant change in forearm skin temperature at all risk levels (p < 0.001), with a positive linear correlation (r = 0.658 and p < 0.001), which led the authors to perform linear regression analysis for the forearm region. The Predicted OCRA Index calculation equation was successfully developed (R = 0.767 and R² = 0.588), while using as independent variables: air temperature and temperature variation of the forearm skin. The Predicted OCRA Index can be applied as a screening tool for large numbers of workers in the same company or sector, due to its speed of application and the determination of risk level, but it does not replace the original OCRA Index.