Changes in pain, disability, and muscle activation patterns in chronic whiplash patients after ambulant myofeedback training

Can biofeedback training in combination with ergonomic information reduce pain among young adult computer users with neck and upper extremity symptoms? - A randomized controlled intervention study

The aim of this randomized controlled study was to explore if an intervention with biofeedback training in combination with ergonomic discussions, could improve working technique and work postures, and reduce pain intensity and perceived exertion in young adult computer users with ongoing neck and upper extremity symptoms. 39 participants were divided into an intervention group and a control group. The intervention consisted of 4 sessions during a three-month period. Working technique, working postures, rated perceived exertion, pain intensity, and duration of computer use were measured at baseline and follow ups after 6 and 12 months. The intervention did not significantly improve working technique and working postures, nor reduce pain intensity and perceived exertion in the intervention group compared to the control group. However, there was a statistically significant reduction in reported pain intensity in the neck/shoulder for the whole group. Also, there was a trend that time spent with computer work without breaks was more reduced in the intervention group than in the control group.

Thoracic outlet syndrome: a review

Thoracic outlet syndrome (TOS) is a rare condition (1-3 per 100,000) caused by neurovascular compression at the thoracic outlet and presents with arm pain and swelling, arm fatigue, paresthesias, weakness, and discoloration of the hand. TOS can be classified as neurogenic, arterial, or venous based on the compressed structure(s). Patients develop TOS secondary to congenital abnormalities such as cervical ribs or fibrous bands originating from a cervical rib leading to an objectively verifiable form of TOS. However, the diagnosis of TOS is often made in the presence of symptoms with physical examination findings (disputed TOS). TOS is not a diagnosis of exclusion, and there should be evidence for a physical anomaly that can be corrected. In patients with an identifiable narrowing of the thoracic outlet and/or symptoms with a high probability of thoracic outlet neurovascular compression, diagnosis of TOS can be established through history, a physical examination maneuvers, and imaging. Neck trauma or repeated work stress can cause scalene muscle scaring or dislodging of a congenital cervical rib that can compress the brachial plexus. Nonsurgical treatment includes anti-inflammatory medication, weight loss, physical therapy/strengthening exercises, and botulinum toxin injections. The most common surgical treatments include brachial plexus decompression, neurolysis, and scalenotomy with or without first rib resection. Patients undergoing surgical treatment for TOS should be seen postoperatively to begin passive/assisted mobilization of the shoulder. By 8 weeks postoperatively, patients can begin resistance strength training. Surgical treatment complications include injury to the subclavian vessels potentially leading to exsanguination and death, brachial plexus injury, hemothorax, and pneumothorax. In this review, we outline the diagnostic tests and treatment options for TOS to better guide clinicians in recognizing and treating vascular TOS and objectively verifiable forms of neurogenic TOS.

Exploring the Underlying Mechanisms of Action of Dry Needling: What Is the Immediate Effect on Muscle Electrophysiology? An Experimental Randomized Controlled Trial

OBJECTIVE

Dry needling is a commonly used treatment technique for myofascial pain syndromes, such as trapezius myalgia. Despite the shown positive clinical effects on pain, the underlying mechanisms of action, such as the effect on muscle electrophysiology, remain unclear. The aim of this study was to investigate the effect of dry needling, compared with sham needling, in the upper trapezius muscle on surface electromyography activity and the relation with pain in office workers with trapezius myalgia.

DESIGN

For this experimental randomized controlled trial, 43 office workers with work-related trapezius myalgia were included. Surface electromyography activity was measured before and after a pain-provoking computer task and immediately after, 15, and 30 mins after treatment with dry or sham needling. Pain scores were evaluated at the same time points as well as 1, 2, and 7 days after treatment.

RESULTS

No significant differences in surface electromyography activity between dry needling and sham needling were found. Significant positive low to moderate Spearman correlations were found between surface electromyography activity and pain levels after dry needling treatment.

CONCLUSIONS

This study shows no immediate effects of dry needling on the electrophysiology of the upper trapezius muscle, compared with sham needling.

Is Biofeedback through an Intra-Aural Device an Effective Method to Treat Bruxism? Case Series and Initial Experience

Biofeedback was reported as an effective concept for bruxism treatment, through increasing patient's awareness of the habit. During bruxing both ear canals become tighter, therefore, an in-ear device can provide biofeedback. The in-ear device is fitted to the ear canal in physiological status, during bruxing the ear-canal tightens resulting in stress on the canal walls and unpleasant feeling. Subsequently, patients stop their bruxing habit. The aim of this study is to provide first clinical evidence that in-ear devices have a positive impact on relieving bruxism in patients. Despite the low number of patients, this early study was designed as a controlled prospective study. The trial included seven female patients with a median age of 47.3 years (23-64 years). Only two patients implemented their devices for eight and seven months, respectively. One patient reported a relief in her symptoms, like headaches and pain intensity during the night, by 50% after three month and 80% after six months. Despite the limited number of participants, the study reflects a potential of Intra-aural devices as effective biofeedback devices in treating bruxism.

Evaluation of Biofeedback Usefulness in Masticatory Muscle Activity Management-A Systematic Review

Temporomandibular disorders (TMD) have multifactorial and complex etiology. Regardless of their etiology, all those conditions may result in centrally mediated chronic muscle pain, myalgia, myofascial pain, myofibrotic contracture, myosistis, myospasm, headache and a variety of neck, shoulder, upper back and lower back pain. Biofeedback (BF) is one of methods that has been used for more than 50 years in rehabilitation to facilitate normal movement patterns after injuries. Some studies suggest that biofeedback may be an effective treatment option for patients with different muscle disorders. The aim of this study was to evaluate the efficiency of biofeedback in masticatory muscle activity management in the light of current medical literature. The authors followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines for this systematic review. The authors searched the MEDLINE, Scopus, Web of Science, CINAHL databases to identify relevant publications. Finally 10 papers were included. Most of the selected studies showed a significant correlation between biofeedback usage and reduction of masticatory muscle activity. By analyzing qualified studies, it can be concluded that biofeedback can be an effective tool in masticatory muscle activity management.

A pilot study - the potential value of an activity-based feedback system for treatment of individuals with chronic lower back pain

PURPOSE

The aim of this pilot study was to evaluate the potential value of a new personalized activity-based feedback treatment.

METHOD

A prognostic cohort study was carried out in the daily environment of the patients. Seventeen individuals with chronic lower back pain (CLBP) symptoms for >3 months were included. Patients were from the Netherlands, aged 18-65 years. Patients wore an accelerometer and a Personal Digital Assistant (PDA) for 15 d. Patients received continuous and time-related personalized feedback and were instructed to follow the activity pattern as displayed on the PDA. Technical performance and compliance with the system were rated. Objective and subjective activity scores were compared for exploring awareness. The absolute difference between the activity pattern of the patient and the norm value used was calculated and expressed as mean difference. Pain intensity was measured using the VAS.

RESULTS

The technical performance and compliance with the system were rated moderate. More than half of the patients were aware of their activity level during the feedback days (67%). A positive effect of the feedback was seen in a trend which showed a decrease in the absolute difference between the activity pattern of the patient and the norm value (p = 0.149) and a significant decrease in pain intensity levels (p = 0.005).

CONCLUSIONS

This pilot study suggested that an individual-tailored feedback system that focuses on the activity behavior of the patient has potential as the treatment of individuals with CLBP. Implications for Rehabilitation Activity-based feedback for individuals with chronic low back pain: Many patients are not aware of their activity patterns. The activity patterns of patients differ from those of healthy controls. It is important to make patients aware of their activity patterns in order to change activity behavior. An individual-tailored feedback system seems promising in decreasing pain intensity levels for a subgroup of patients.

EMG Biofeedback and Exercise for Treatment of Cervical and Shoulder Pain in Individuals with a Spinal Cord Injury: A Pilot Study

BACKGROUND

Chronic or recurrent musculoskeletal pain in the cervical and shoulder region is a common secondary problem after spinal cord injury (SCI), reported by 30% to 70% of individuals.

OBJECTIVE

The purpose of this study was to investigate the effect of electromyographic (EMG) biofeedback training, in addition to a standard exercise program, on reducing shoulder pain in manual wheelchair users with SCI.

METHODS

Fifteen individuals with SCI, C6 or lower, who were manual wheelchair users with shoulder pain were randomly assigned to 1 of 2 interventions. The Exercise group (n = 7) received instruction on a standard home-based exercise program. The EMG Biofeedback plus Exercise group (n = 8) received identical exercise instruction plus EMG biofeedback training to improve muscle balance and muscle relaxation during wheelchair propulsion. Shoulder pain was assessed by the Wheelchair Users Shoulder Pain Index (WUSPI) at baseline, at posttest 10 weeks after the start of intervention, and at follow-up 16 weeks after posttest.

RESULTS

The number of participants per group allowed only within-group comparisons; however, the findings indicated a beneficial effect from EMG biofeedback training. Shoulder pain, as measured by WUSPI, decreased 64% from baseline to posttest for the EMG Biofeedback plus Exercise group (P = .02). Shoulder pain for the Exercise group decreased a nonsignificant 27%. At follow-up, both groups showed continued improvement, yet the benefit of EMG biofeedback training was still discernible. The EMG Biofeedback plus Exercise group had an 82% reduction in shoulder pain from baseline to follow-up (P = .004), while the Exercise group showed a 63% reduction (P = .03) over the same time period.

CONCLUSIONS

This study provides preliminary evidence that EMG biofeedback has value when added to an exercise intervention to reduce shoulder pain in manual wheelchair users with SCI. These findings indicate that EMG biofeedback may be valuable in remediating musculoskeletal pain as a secondary condition in SCI. This preliminary conclusion will need to be studied and verified through future work.

Biofeedback in rehabilitation

This paper reviews the literature relating to the biofeedback used in physical rehabilitation. The biofeedback methods used in rehabilitation are based on biomechanical measurements and measurements of the physiological systems of the body. The physiological systems of the body which can be measured to provide biofeedback are the neuromuscular system, the respiratory system and the cardiovascular system. Neuromuscular biofeedback methods include electromyography (EMG) biofeedback and real-time ultrasound imaging (RTUS) biofeedback. EMG biofeedback is the most widely investigated method of biofeedback and appears to be effective in the treatment of many musculoskeletal conditions and in post cardiovascular accident (CVA) rehabilitation. RTUS biofeedback has been demonstrated effective in the treatment of low back pain (LBP) and pelvic floor muscle dysfunction. Cardiovascular biofeedback methods have been shown to be effective in the treatment of a number of health conditions such as hypertension, heart failure, asthma, fibromyalgia and even psychological disorders however a systematic review in this field has yet to be conducted. Similarly, the number of large scale studies examining the use of respiratory biofeedback in rehabilitation is limited. Measurements of movement, postural control and force output can be made using a number of different devices and used to deliver biomechanical biofeedback. Inertial based sensing biofeedback is the most widely researched biomechanical biofeedback method, with a number of studies showing it to be effective in improving measures of balance in a number of populations. Other types of biomechanical biofeedback include force plate systems, electrogoniometry, pressure biofeedback and camera based systems however the evidence for these is limited. Biofeedback is generally delivered using visual displays, acoustic or haptic signals, however more recently virtual reality (VR) or exergaming technology have been used as biofeedback signals. VR and exergaming technology have been primarily investigated in post-CVA rehabilitation, however, more recent work has shown this type of biofeedback to be effective in improving exercise technique in musculoskeletal populations. While a number of studies in this area have been conducted, further large scale studies and reviews investigating different biofeedback applications in different clinical populations are required.

A review of thoracic outlet syndrome and the possible role of botulinum toxin in the treatment of this syndrome

The objective of this paper is to discuss the classification, diagnosis, pathophysiology and management of Thoracic outlet syndrome (TOS). Thoracic outlet syndrome (TOS) is a complex entity that is characterized by different neurovascular signs and symptoms involving the upper limb. TOS is defined as upper extremity symptoms due to compression of the neurovascular bundle in the area of the neck just above the first rib. Compression is thought to occur at one or more of the three anatomical compartments: the interscalene triangle, the costoclavicular space and the retropectoralis minor spaces. The clinical presentation can include both neurogenic and vascular symptoms. TOS can be difficult to diagnose because there is no standardized objective test that can be used and the clinician must rely on history and several positive findings on physical exam. The medial antebrachial cutaneous nerve conduction may be a sensitive way to detect pathology in the lower trunks of the brachial plexus which is promising for future research. Treatment options continue to be conservative and surgical. However, for those who have failed physical therapy there is research to suggest that botulinum toxin may help with symptom relief. However, given that there has been conflicting evidence, further research is required using randomized controlled trials.

Updated perspectives on neurogenic thoracic outlet syndrome

Pain represents a foremost feature of neurogenic thoracic outlet syndrome (NTOS). Similar to other persistent pain conditions, the physical discomfort associated with NTOS can cause severe and often debilitating symptoms. In fact, those suffering from the syndrome report a quality of life impacted as significantly as those with chronic heart failure. This evidence-based literature review focuses on the classification, etiology, clinical presentation, diagnostic measures, and surgical treatment of NTOS, with a focus on nonoperative therapies such as physical modalities, pharmacological therapies, and more contemporary minimally invasive intramuscular treatments with botulinum toxin.

The clinical effectiveness of a myofeedback-based teletreatment service in patients with non-specific neck and shoulder pain: a randomized controlled trial

We investigated the effectiveness and efficiency of a four-week myofeedback-based teletreatment service in subjects with non-specific neck and shoulder pain. Subjects were recruited in Belgium, Germany and the Netherlands and randomly allocated to the intervention or conventional care. Subjects in the intervention group received four weeks of myofeedback training. Pain intensity and disability were evaluated by questionnaires at baseline, immediately after four weeks of treatment and at follow-up 3 months later. To investigate efficiency, the time-investment of both therapists and patients were assessed. Seventy-one subjects were included in the study (36 in the intervention group and 35 in the conventional care group). Myofeedback-based teletreatment was at least as effective clinically as conventional care. Pain intensity and disability decreased after 4 weeks of treatment in both groups and part of the effect remained at 3 months' follow-up. The teletreatment also increased efficiency for therapists by almost 20% and patients experienced the benefits of less travel time and travel costs by remote consultation. Myofeedback-based teletreatment has the potential to ensure more efficient treatment for patients with non-specific neck and shoulder pain.

A research synthesis of therapeutic interventions for whiplash-associated disorder (WAD): part 4 - noninvasive interventions for chronic WAD

Whiplash-associated disorder (WAD) represents a significant public health problem, resulting in substantial social and economic costs throughout the industrialized world. While many treatments have been advocated for patients with WAD, scientific evidence supporting their effectiveness is often lacking. A systematic review was conducted to evaluate the strength of evidence for various WAD therapies. Multiple databases (including Web of Science, EMBASE and PubMed) were searched to identify all studies published from January 1980 through March 2009 that evaluated the effectiveness of any clearly defined treatment for acute (less than two weeks), subacute (two to 12 weeks) or chronic (longer than 12 weeks) WAD. The present article, the fourth in a five-part series, evaluates the evidence for noninvasive interventions initiated during the chronic phase of WAD. Twenty-two studies that met the inclusion criteria were identified, 12 of which were randomized controlled trials with 'good' overall methodological quality (median Physiotherapy Evidence Database score of 6). For the treatment of chronic WAD, there is evidence to suggest that exercise programs are effective in relieving whiplash-related pain, at least over the short term. While the majority of a subset of nine studies supported the effectiveness of interdisciplinary interventions, the two randomized controlled trials provided conflicting results. Finally, there was limited evidence, consisting of one supportive case series each, that both manual joint manipulation and myofeedback training may provide some benefit. Based on the available research, exercise programs were the most effective noninvasive treatment for patients with chronic WAD, although many questions remain regarding the relative effectiveness of various exercise regimens.

Relation between patient satisfaction, compliance and the clinical benefit of a teletreatment application for chronic pain

We investigated the ease of use and usefulness as a measure of patient satisfaction, compliance, clinical benefit and its mutual relationships concerning a teletreatment application for chronic pain. Fifty-two subjects with neck and shoulder pain received and completed a four-week myofeedback-based teletreatment intervention. Prior to the onset of the intervention (at baseline) and immediately after the intervention they were asked to fill in questionnaires to measure discrepancies (gap scores) between expectations and experiences with the ease of use and usefulness of the treatment, as well as pain intensity and pain disability. In addition, the actual use of the system (i.e. the volume of muscle activity data available on the server) was logged. The subjects reported a significantly higher score on ease of use after the intervention compared to baseline, suggesting that the equipment was easier to use than they expected. Compliance was associated with clinical benefit. There was no significant relation between patient satisfaction and compliance. Patient satisfaction is a key indicator of how well the telemedicine treatment met expectations and compliance is important because of its association with clinical outcomes.

Remote care nearby

A telemedicine application has a better chance of being accepted if the users can easily handle it and if the application fulfils the clinical needs of both patients and professionals. This requires a methodology for development in which three key matters need to be dealt with: (1) clinical content; (2) design; and (3) outcome. Concerning the clinical content, telemedicine services for patients with chronic disorders that aim to increase their level of functioning need to monitor aspects of the patient's functioning and provide adequate feedback about this. Promising parameters of functioning are related to general physical activity and muscle activation patterns. Providing adequate feedback requires choices about the content of the information, the modality of the feedback and its timing. Unfortunately, research into effective feedback strategies is still in its infancy. Concerning the design it appears that the different stakeholders involved speak different languages, that there is a lack of knowledge about aspects related to acceptance and a lack of good methods to define user requirements. Scenario-based requirements analysis is a promising technique to overcome these barriers. Concerning the outcome, evaluation of telemedicine services in everyday clinical practice has been mainly directed at measurement of technical performance and user satisfaction. Large scale clinical evaluation studies with multiple end points are needed. This development methodology with its three aspects was used for a myofeedback-based teletreatment service. This showed that telemedicine applications can be developed that have the potential to make health care more effective, efficient and accessible.

Is surface EMG biofeedback an effective training method for persons with neck and shoulder complaints after whiplash-associated disorders concerning activities of daily living and pain -- a randomized controlled trial

OBJECTIVE

To evaluate the effectiveness of surface electromyographic (EMG) biofeedback training as a supplement to an interdisciplinary rehabilitation programme regarding consequences for activities of daily living and pain.

DESIGN

A randomized controlled unblinded trial.

SETTINGS

The study was carried out in a pain unit at a rehabilitation centre.

SUBJECTS

Sixty-five people with chronic whiplash-associated disorders consecutively referred to the pain unit agreed to participate in the study. Participants were randomly assigned to either the treatment or control group.

INTERVENTION

All participants received interdisciplinary rehabilitation and the treatment group also had four weeks of surface EMG biofeedback training.

MAIN MEASURES

The Canadian Occupational Performance Measure was used at admission discharge and at six-month follow-up to register changes in activities of daily living. The Multidimensional Pain Inventory, Swedish version, was used at admission and at six-month follow-up to capture the multidimensional aspects of pain.

RESULTS

Sixty-two people completed the study. Both treatment and control groups improved significantly according to the Canadian Occupational Performance Measure at discharge and the results remained after six months (P<0.001). The subscale 'Interference' on the Multidimensional Pain Inventory was significantly decreased at six months for the treatment group (P<0.001). No differences were found between the two groups for activities of daily living (performance P = 0.586; satisfaction P = 0.988) at follow-up or for pain level (P = 0.914), indicating no additional effect of the surface EMG biofeedback training.

CONCLUSION

In this study there was no support for the effectiveness of surface EMG biofeedback training as a supplement to an interdisciplinary rehabilitation programme for people with long-lasting pain after whiplash.

On functional motor adaptations: from the quantification of motor strategies to the prevention of musculoskeletal disorders in the neck-shoulder region

BACKGROUND

Occupations characterized by a static low load and by repetitive actions show a high prevalence of work-related musculoskeletal disorders (WMSD) in the neck-shoulder region. Moreover, muscle fatigue and discomfort are reported to play a relevant initiating role in WMSD.

AIMS

To investigate relationships between altered sensory information, i.e. localized muscle fatigue, discomfort and pain and their associations to changes in motor control patterns.

MATERIALS & METHODS

In total 101 subjects participated. Questionnaires, subjective assessments of perceived exertion and pain intensity as well as surface electromyography (SEMG), mechanomyography (MMG), force and kinematics recordings were performed.

RESULTS

Multi-channel SEMG and MMG revealed that the degree of heterogeneity of the trapezius muscle activation increased with fatigue. Further, the spatial organization of trapezius muscle activity changed in a dynamic manner during sustained contraction with acute experimental pain. A graduation of the motor changes in relation to the pain stage (acute, subchronic and chronic) and work experience were also found. The duration of the work task was shorter in presence of acute and chronic pain. Acute pain resulted in decreased activity of the painful muscle while in subchronic and chronic pain, a more static muscle activation was found. Posture and movement changed in the presence of neck-shoulder pain. Larger and smaller sizes of arm and trunk movement variability were respectively found in acute pain and subchronic/chronic pain. The size and structure of kinematics variability decreased also in the region of discomfort. Motor variability was higher in workers with high experience. Moreover, the pattern of activation of the upper trapezius muscle changed when receiving SEMG/MMG biofeedback during computer work.

DISCUSSION

SEMG and MMG changes underlie functional mechanisms for the maintenance of force during fatiguing contraction and acute pain that may lead to the widespread pain seen in WMSD. A lack of harmonious muscle recruitment/derecruitment may play a role in pain transition. Motor behavior changed in shoulder pain conditions underlining that motor variability may play a role in the WMSD development as corroborated by the changes in kinematics variability seen with discomfort. This prognostic hypothesis was further, supported by the increased motor variability among workers with high experience.

CONCLUSION

Quantitative assessments of the functional motor adaptations can be a way to benchmark the pain status and help to indentify signs indicating WMSD development. Motor variability is an important characteristic in ergonomic situations. Future studies will investigate the potential benefit of inducing motor variability in occupational settings.

Characterization of acute and chronic whiplash-associated disorders

SYNOPSIS

The development of chronic pain and disability following whiplash injury is common and contributes substantially to personal and economic costs related with this condition. Emerging evidence demonstrates the clinical presence of alterations in the sensory and motor systems, including psychological distress in all individuals with a whiplash injury, regardless of recovery. However, individuals who transition to the chronic state present with a more complex clinical picture characterized by the presence of widespread sensory hypersensitivity, as well as significant posttraumatic stress reactions. Based on the diversity of the signs and symptoms experienced by individuals with a whiplash condition, clinicians must take into account the more readily observable/measurable differences in motor, sensory, and psychological dysfunction. The implications for the assessment and management of this condition are discussed. Further review into the pathomechanical, pathoanatomical, and pathophysiological features of the condition also will be discussed.

LEVEL OF EVIDENCE

Level 5.J

Thoracic outlet syndrome: a review

BACKGROUND

: Arterial and venous thoracic outlet syndrome (TOS) were recognized in the late 1800s and neurogenic TOS in the early 1900s. Diagnosis and treatment of the 2 vascular forms of TOS are generally accepted in all medical circles. On the other hand, neurogenic TOS is more difficult to diagnose because there is no standard objective test to confirm clinical impressions.

REVIEW SUMMARY

: The clinical features of arterial, venous, and neurogenic TOS are described. Because neurogenic TOS is by far the most common type, the pathology, pathophysiology, diagnostic tests, differential and associate diagnoses, and treatment are detailed and discussed. The controversial area of objective and subjective diagnostic criteria is addressed.

CONCLUSION

: Arterial and venous TOS are usually not difficult to recognize and the diagnosis can be confirmed by angiography. The diagnosis of neurogenic TOS is more challenging because its symptoms of nerve compression are not unique. The clinical diagnosis relies on documenting several positive findings on physical examination. To date there is still no reliable objective test to confirm the diagnosis, but measurements of the medial antebrachial cutaneous nerve appear promising.

Towards remote monitoring and remotely supervised training

The growing number of elderly and people with chronic disorders in our western society puts such a pressure on our healthcare system that innovative approaches are required to make our health care more effective and more efficient. One way of innovating healthcare can be obtained by introducing new services that support and enable these elderly and people with chronic disorders in a more independent living and in self management with respect to their disorders. Examples of such services are remote monitoring and remotely supervised training (together RMT). Remote monitoring focuses on continuous monitoring of the health status with the assurance of assistance whenever required. Remotely supervised training focuses on efficient and effective individually tailored training anywhere and anytime with intensity not feasible in an intramural setting. It is expected that services of remote monitoring and remotely supervised treatment will become important for at least patients (safety, more in control, convenience), health care insurances (efficiency, cost reduction) and healthcare service providers (more effective care). RMT systems are in general quite complex distributed Information and Communication Technology (ICT) systems. RMT systems integrate ambulant sensing to measure relevant biosignals and (possibly) subject's context information, secure data transport and storage, appropriate decisions support systems to assist in both technical and clinical decision making but also feedback on information to both patients and care providers. Feedback is essential for patients to make them aware of their health status, to give them a feeling of safety and to motivate and enable them to change/improve their health status. Feedback of information to healthcare professionals enables them in making appropriate decisions and to monitor changes/improvements in a patient's health status. Despite this apparent complexity, these systems must be very dependable to be accepted and used in a healthcare setting. During the past years knowledge and experience has been gained with the development of the building blocks of RMT systems. In parallel, experience has been gained with respect to the challenges involved when using RMT systems in a clinical environment. Examples are: activity monitoring in low back pain, monitoring of spasticity, myofeedback in subjects with neck shoulder and lower back pain and post rehabilitation home training. Until now, the main focus has been on the technical realization of the sensing and transportation part of it. The development of intelligent decision support systems is still in its infancy and clinical validation studies and models how to implement these services and how to make them profitable are largely lacking. In conclusion, the combination of Biomedical Engineering with Information and Communication Technology has opened a new extensive area of research and development with a high potential to have substantial impact on our future healthcare.

Changes in cognitive-behavioral factors and muscle activation patterns after interventions for work-related neck-shoulder complaints: relations with discomfort and disability

OBJECTIVES

Knowledge regarding the working mechanism of an intervention is essential for obtaining a better understanding of the intervention and contributes to optimize its outcome. This study aimed at investigating whether changes in cognitive-behavioral factors and muscle activation patterns after myofeedback training and ergonomic counseling were associated with outcome, in subjects with work-related musculoskeletal neck-shoulder complaints.

METHODS

Seventy-nine symptomatic subjects received either myofeedback with ergonomic counseling (Mfb/EC) or ergonomic counseling alone (EC). Outcome measures discomfort and disability, and process factors catastrophizing, pain control, fear-avoidance beliefs, and muscle activation patterns were assessed at baseline, after the interventions (T0), and at 3 months follow-up (T3). Mixed modeling techniques were used for analysis.

RESULTS

Outcome in terms of discomfort and disability was generally comparable between both interventions. Catastrophizing was significantly reduced and fear-avoidance beliefs about work slightly increased after the interventions, but no consistent changes in muscle activation patterns were observed. Changes in discomfort were especially associated with changes in catastrophizing at T0 and T3, but R(2) was low (<0.14). Reduced catastrophizing at T0 and T3, and also reduced fear-avoidance beliefs about work at T3, were related to reduced disability (R(2) between 0.30 and 0.40). No differences between the two intervention groups were observed.

CONCLUSIONS

Intervention effects were generally non-specific and findings suggested that cognitive-behavioral factors underlie the outcome of these interventions rather than changes in muscle activation patterns. Emphasizing these factors during therapy may increase the beneficial outcome of occupational interventions.

The receptiveness toward remotely supported myofeedback treatment

Remotely supported myofeedback treatment (RSMT) is considered to be a potentially valuable alternative to the conventional myofeedback treatment, as it might increase efficiency of care. This study was aimed at examining the receptiveness of potential end users (patients and professionals) with respect to RSMT. By doing so, protocols of RSMT can be developed which fit to the needs of end users and enhance treatment adherence. For both end-user groups, questionnaires were developed focusing on two components of the attitude-social support-self-efficacy (ASE) model. Fifteen patients with neck-shoulder complaints previously treated with conventional myofeedback and 17 professionals participated in the study. Results showed positive attitudes toward RSMT in 53% of the patients, and 67% of them were willing to participate in RSMT. Of the 17 professionals included in the present study 43% reported a positive attitude. In addition, 40% of the patients and 100% of the professionals believed their self-efficacy level to be sufficient for RSMT. In addition to e-consultations, 40% percent of the patients suggested that the optimal frequency of structural in vivo contact with their therapist would be once per 2 weeks, which is less frequent compared to the weekly in vivo contacts in the conventional myofeedback treatment. Professionals emphasized the importance of nonverbal communication and physical interaction (as in in vivo contact) in remote treatment concepts.

Effects of ambulant myofeedback training and ergonomic counselling in female computer workers with work-related neck-shoulder complaints: a randomized controlled trial

OBJECTIVE

To investigate the effects of ambulant myofeedback training including ergonomic counselling (Mfb) and ergonomic counselling alone (EC), on work-related neck-shoulder pain and disability.

METHODS

Seventy-nine female computer workers reporting neck-shoulder complaints were randomly assigned to Mfb or EC and received four weeks of intervention. Pain intensity in neck, shoulders, and upper back, and pain disability, were measured at baseline, immediately after intervention, and at three and six months follow-up.

RESULTS

Pain intensity and disability had significantly decreased immediately after four weeks Mfb or EC, and the effects remained at follow up. No differences were observed between the Mfb and EC group for outcome and subjects in both intervention groups showed comparable chances for improvement in pain intensity and disability.

CONCLUSIONS

Pain intensity and disability significantly reduced after both interventions and this effect remained at follow-up. No differences were observed between the two intervention groups.