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Lee JH, Woo HJ, Lee JH, Kim JI, Jang JS, Na YC, Kim KR, Park TY. Comparison of concordance between chuna manual therapy diagnosis methods (palpation, X-ray, artificial intelligence program) in lumbar spine: An exploratory, cross-sectional, prospective observational study protocol. Medicine (Baltimore) 2021; 100:e28177. [PMID: 34941072 PMCID: PMC8701932 DOI: 10.1097/md.0000000000028177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Chuna manual therapy (CMT) is a type of manual medicine practiced by Korean medical doctors in South Korea. Spinal diagnosis in CMT uses a system that applies manual diagnostic and X-ray tests to detect specific vertebral malpositions, based on the relative alignment across vertebral bodies. Recently, artificial intelligence (AI) programs have been developed to assist in the radiological diagnosis of CMT using X-ray images. Nevertheless, a few clinical studies have reported on the concordance between diagnosticians, diagnostics methodologies, and the use of AI programs for diagnosing CMT. At present, the evidence to support CMT diagnosis is insufficient. This study thus aims to overcome such limitations by collecting and comparing CMT diagnostic data from experts and non-experts through manual diagnosis, X-ray test, and images obtained using an AI program. The study aims to search for CMT diagnosis methods with more outstanding rationality and consistency and to explore the potential use of AI-based CMT diagnosis programs. METHODS/DESIGN This study will be conducted as an exploratory, cross-sectional, prospective observational study that will recruit 100 non-specialist subjects. Each subject will submit a signed consent after the screening test and undergo L-spine standing AP & lateral X-ray imaging. Manual CMT diagnosis will be performed by 3 CMT experts according to the standard operation procedure (SOP). The X-ray images of the 100 subjects will subsequently be used to make the CMT radiological diagnoses according to the same SOP by the CMT expert group (n = 3) and CMT non-expert group (n = 3). Among the subjects, those in the non-expert group will receive another CMT radiological diagnosis with spinal data obtained using the AI program, approximately 1 month from after initial diagnosis.Based on the collected diagnostic data, within- and between-group concordance levels will be assessed for each diagnostic method. The verified level of concordance will be used to test the potential use of CMT diagnostic method and CMT AI programs with high levels of rationality and consistency. ETHICS AND DISSEMINATION This trial has received complete ethical approval from the Wonkwang University Korean Medicine Hospital (IRB 2021-8). We intend to submit the results of the trial to a peer-reviewed journal and/or conferences. TRIAL REGISTRATION https://cris.nih.go.kr/cris/search/detailSearch.do?search_lang=E&search_page=M&pageSize=10&page=undefined&seq=20613&status=5&seq_group=20613, Identifier: KCT0006707.
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Affiliation(s)
- Jin-Hyun Lee
- Institute for Integrative Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea
| | - Hyeon-Jun Woo
- Department of Korean Rehabilitation Medicine, Wonkwang University College of Korean Medicine, Iksan, South Korea
| | - Jung-Han Lee
- Department of Korean Rehabilitation Medicine, Wonkwang University College of Korean Medicine, Iksan, South Korea
| | - Joong-Il Kim
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Jun-Su Jang
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Young Cheol Na
- Department of Neurosurgery, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea
| | - Kwang-Ryeol Kim
- Department of Neurosurgery, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea
| | - Tae-Yong Park
- Institute for Integrative Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea
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de Best RF, Coppieters MW, van Trijffel E, Compter A, Uyttenboogaart M, Bot JC, Castien R, Pool JJM, Cagnie B, Scholten-Peeters GGM. Interexaminer Agreement and Reliability of an Internationally Endorsed Screening Framework for Cervical Vascular Risks Following Manual Therapy and Exercise: The Go4Safe Project. Phys Ther 2021; 101:6309589. [PMID: 34174073 PMCID: PMC8494014 DOI: 10.1093/ptj/pzab166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 03/25/2021] [Accepted: 05/27/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Clinicians are recommended to use the clinical reasoning framework developed by the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) to provide guidance regarding assessment of the cervical spine and potential for cervical artery dysfunction prior to manual therapy and exercise. However, the interexaminer agreement and reliability of this framework is unknown. This study aimed to estimate the interexaminer agreement and reliability of the IFOMPT framework among physical therapists in primary care. METHODS Ninety-six patients who consulted a physical therapist for neck pain or headache were included in the study. Each patient was tested independently by 2 physical therapists, from a group of 17 physical therapists (10 pairs) across The Netherlands. Patients and examiners were blinded to the test results. The overall interexaminer agreement, specific agreement per risk category (high-, intermediate-, and low-risk), and interexaminer reliability (weighted κ) were calculated. RESULTS Overall agreement was 71% (specific agreement in high-risk category = 63%; specific agreement in intermediate-risk category = 38%; specific agreement in low-risk category = 84%). Overall reliability was moderate (weighted κ = 0.39; 95% CI = 0.21-0.57) and varied considerably between pairs of physical therapists (κ = 0.14-1.00). CONCLUSION The IFOMPT framework showed an insufficient interexaminer agreement and fair interexaminer reliability among physical therapists when screening the increased risks for vascular complications following manual therapy and exercise prior to treatment. IMPACT The IFOMPT framework contributes to the safety of manual therapy and exercise. It is widely adopted in clinical practice and educational programs, but the measurement properties are unknown. This project describes the agreement and reliability of the IFOMPT framework.
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Affiliation(s)
- Rogier F de Best
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - Michel W Coppieters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands,Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
| | - Emie van Trijffel
- SOMT University of Physiotherapy, Amersfoort, The Netherlands,Department of Experimental Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Annette Compter
- Department of Neuro-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maarten Uyttenboogaart
- Department of Neurology and Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joost C Bot
- Department of Radiology, Amsterdam University Medical Center, The Netherlands
| | - Rene Castien
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - Jan J M Pool
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Gwendolyne G M Scholten-Peeters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands,Address all correspondence to Dr Scholten-Peeters at:
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Functional postural-stabilization tests according to Dynamic Neuromuscular Stabilization approach: Proposal of novel examination protocol. J Bodyw Mov Ther 2020; 24:84-95. [DOI: 10.1016/j.jbmt.2020.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 12/09/2019] [Accepted: 01/27/2020] [Indexed: 11/17/2022]
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Clohesy NC, Schneiders AG, Eaton S. Utilization of Low Back Pain Patient Reported Outcome Measures Within Chiropractic Literature: A Descriptive Review. J Manipulative Physiol Ther 2018; 41:628-639. [DOI: 10.1016/j.jmpt.2017.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 10/23/2017] [Accepted: 11/14/2017] [Indexed: 01/19/2023]
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Oostendorp RAB. Credibility of manual therapy is at stake 'Where do we go from here?'. J Man Manip Ther 2018; 26:189-192. [PMID: 30083042 DOI: 10.1080/10669817.2018.1472948] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Rob A B Oostendorp
- Emeritus Professor, Radboud University Medical Centre, Nijmegen, The Netherlands.,Emeritus Professor, Vrije Universiteit Brussel, Brussels, Belgium
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Oostendorp RA, Elvers H, van Trijffel E, Rutten GM, Scholten-Peeters GG, Heijmans M, Hendriks E, Mikolajewska E, De Kooning M, Laekeman M, Nijs J, Roussel N, Samwel H. Has the quality of physiotherapy care in patients with Whiplash-associated disorders (WAD) improved over time? A retrospective study using routinely collected data and quality indicators. Patient Prefer Adherence 2018; 12:2291-2308. [PMID: 30519001 PMCID: PMC6233472 DOI: 10.2147/ppa.s179808] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To develop valid quality indicators (QIs) for physiotherapy care based on best available evidence, and to use these QIs to explore trends in the quality of physiotherapy care of patients with Whiplash-associated disorders (WAD) using guideline-based routinely collected data (RCD) gathered between 1996 and 2011. MATERIALS AND METHODS The study consisted of two phases: 1) development of QIs and 2) analysis of patient records. A set of QIs was developed based on recommendations in the scientific literature and the Dutch Clinical Practice Guideline (CPG) "Physiotherapy Management and WAD". QIs were expressed as percentages, allowing target performance levels to be defined (≥80% or ≤30% depending on whether desired performance required a high or low score on a QI). We then analyzed WAD patient data (N = 810) collected over a period of 16 years in two physiotherapy practices, separating patients into two groups defined as before (Group A 1996-2002; n = 353) and after (Group B 2003-2011; n = 457) implementation and transition to the Dutch CPG "Physiotherapy Management and WAD". RESULTS Using an iterative process and input from both experts and users, 28 QIs were developed and subsequently classified per step of the clinical reasoning process for physiotherapy care. Based on 16 years of RCD, we found that the clinical reasoning process differed significantly (P ≤ 0.05) between the groups, in favor of Group B. Twelve of the 25 indicators (48.0%) in Group A and 19 of 26 indicators (73.1%) in Group B met predetermined performance targets. The number of target indicators also differed significantly between groups, favoring Group B (P ≤ 0.05). CONCLUSION A preliminary set of novel QIs was developed. Using RCD and these QIs, we conclude that physiotherapy care in our study setting improved over the period 1996-2011. Furthermore, the QIs met the performance targets set for the clinical reasoning process after the transition to the Dutch CPG "Physiotherapy Management and WAD".
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Affiliation(s)
- Rob Ab Oostendorp
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands,
- Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium,
- Pain in Motion International Research Group, Free University Brussels, Brussels, Belgium,
- Practice Physiotherapy and Manual Therapy, Heeswijk-Dinther, the Netherlands,
| | - Hans Elvers
- Department of Public Health and Research, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Methodological Health-Skilled Institute, Beuningen, the Netherlands
| | - Emiel van Trijffel
- SOMT University of Physiotherapy, Amersfoort, the Netherlands
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Free University Brussels, Brussels, Belgium
| | - Geert M Rutten
- Institute of Health Studies, Faculty of Health and Social Studies, HAN University of Applied Science, Nijmegen, the Netherlands
- Faculty of Science and Engineering, University College Venlo, Maastricht University, Maastricht, the Netherlands
| | - Gwendolyne Gm Scholten-Peeters
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marcel Heijmans
- Practice Physiotherapy and Manual Therapy, Heeswijk-Dinther, the Netherlands,
| | - Erik Hendriks
- Department of Epidemiology, Center of Evidence-Based Physiotherapy, Maastricht University, Maastricht, the Netherlands
- Practice Physiotherapy 'Klepperheide', Druten, the Netherlands
| | - Emilia Mikolajewska
- Department of Physiotherapy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
- Neurocognitive Laboratory, Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University, Toruń, Poland
| | - Margot De Kooning
- Pain in Motion International Research Group, Free University Brussels, Brussels, Belgium,
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Free University Brussels, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Marjan Laekeman
- Department of Nursing Sciences, Faculty of Health, University Witten/Herdecke, Witten, Germany
| | - Jo Nijs
- Pain in Motion International Research Group, Free University Brussels, Brussels, Belgium,
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Free University Brussels, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Nathalie Roussel
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Han Samwel
- Department of Medical Psychology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
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Few promising multivariable prognostic models exist for recovery of people with non-specific neck pain in musculoskeletal primary care: a systematic review. J Physiother 2018; 64:16-23. [PMID: 29289589 DOI: 10.1016/j.jphys.2017.11.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 10/30/2017] [Accepted: 11/08/2017] [Indexed: 12/12/2022] Open
Abstract
QUESTION Which multivariable prognostic model(s) for recovery in people with neck pain can be used in primary care? DESIGN Systematic review of studies evaluating multivariable prognostic models. PARTICIPANTS People with non-specific neck pain presenting at primary care. DETERMINANTS Baseline characteristics of the participants. OUTCOME MEASURES Recovery measured as pain reduction, reduced disability, or perceived recovery at short-term and long-term follow-up. RESULTS Fifty-three publications were included, of which 46 were derivation studies, four were validation studies, and three concerned combined studies. The derivation studies presented 99 multivariate models, all of which were at high risk of bias. Three externally validated models generated usable models in low risk of bias studies. One predicted recovery in non-specific neck pain, while two concerned participants with whiplash-associated disorders (WAD). Discriminative ability of the non-specific neck pain model was area under the curve (AUC) 0.65 (95% CI 0.59 to 0.71). For the first WAD model, discriminative ability was AUC 0.85 (95% CI 0.79 to 0.91). For the second WAD model, specificity was 99% (95% CI 93 to 100) and sensitivity was 44% (95% CI 23 to 65) for prediction of non-recovery, and 86% (95% CI 73 to 94) and 55% (95% CI 41 to 69) for prediction of recovery, respectively. Initial Neck Disability Index scores and age were identified as consistent prognostic factors in these three models. CONCLUSION Three externally validated models were found to be usable and to have low risk of bias, of which two showed acceptable discriminative properties for predicting recovery in people with neck pain. These three models need further validation and evaluation of their clinical impact before their broad clinical use can be advocated. REGISTRATION PROSPERO CRD42016042204. [Wingbermühle RW, van Trijffel E, Nelissen PM, Koes B, Verhagen AP (2018) Few promising multivariable prognostic models exist for recovery of people with non-specific neck pain in musculoskeletal primary care: a systematic review. Journal of Physiotherapy 64: 16-23].
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Dewitte V, Peersman W, Danneels L, Bouche K, Roets A, Cagnie B. Subjective and clinical assessment criteria suggestive for five clinical patterns discernible in nonspecific neck pain patients. A Delphi-survey of clinical experts. ACTA ACUST UNITED AC 2016; 26:87-96. [PMID: 27507590 DOI: 10.1016/j.math.2016.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 04/21/2016] [Accepted: 07/12/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Nonspecific neck pain patients form a heterogeneous group with different musculoskeletal impairments. Classifying nonspecific neck pain patients into subgroups based on clinical characteristics might lead to more comprehensive diagnoses and can guide effective management. OBJECTIVE To establish consensus among a group of experts regarding the clinical criteria suggestive of a clinical dominance of 'articular', 'myofascial', 'neural', 'central' and 'sensorimotor control' dysfunction patterns distinguishable in patients with nonspecific neck pain. STUDY DESIGN Delphi study. METHODS A focus group with 10 academic experts was organized to elaborate on the different dysfunction patterns discernible in neck pain patients. Consecutively, a 3-round online Delphi-survey was designed to obtain consensual symptoms and physical examination findings for the 5 distinct dysfunction patterns resulting from the focus group. RESULTS A total of 21 musculoskeletal physical therapists from Belgium and the Netherlands experienced in assessing and treating neck pain patients completed the 3-round Delphi-survey. Respectively, 33 (response rate, 100.0%), 27 (81.8%) and 21 (63.6%) respondents replied to rounds 1, 2 and 3. Eighteen 'articular', 16 'myofascial', 20 'neural', 18 'central' and 10 'sensorimotor control' clinical indicators reached a predefined ≥80% consensus level. CONCLUSION These indicators suggestive of a clinical dominance of 'articular', 'myofascial', 'neural', 'central', and 'sensorimotor control' dysfunction patterns may help clinicians to assess and diagnose patients with nonspecific neck pain. Future validity testing is needed to determine how these criteria may help to improve the outcome of physical therapy interventions in nonspecific neck pain patients.
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Affiliation(s)
- Vincent Dewitte
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, De Pintelaan 185 (3B3), 9000 Ghent, Belgium.
| | - Wim Peersman
- Department of Family Medicine and Primary Health Care, Ghent University, De Pintelaan 185 (6K3), 9000 Ghent, Belgium.
| | - Lieven Danneels
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, De Pintelaan 185 (3B3), 9000 Ghent, Belgium.
| | - Katie Bouche
- Centre for Musculoskeletal and Neurological Rehabilitation, Ghent University Hospital, De Pintelaan 185 (K7), 9000 Ghent, Belgium.
| | - Arne Roets
- Department of Developmental, Personality and Social Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium.
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, De Pintelaan 185 (3B3), 9000 Ghent, Belgium.
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Rossettini G, Rondoni A, Lovato T, Strobe M, Verzè E, Vicentini M, Testa M. Intra- and inter-rater reliability of 3D passive intervertebral motion in subjects with nonspecific neck pain assessed by physical therapy students: A pilot study. J Back Musculoskelet Rehabil 2016; 30:BMR718. [PMID: 27284851 DOI: 10.3233/bmr-160718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Passive Intervertebral Movements (PIVMs) are commonly used to assess and treat patients with nonspecific neck pain. Only very few studies have investigated 3D movements until now. OBJECTIVE This study assessed intra- and inter-rater reliability of three-dimensional (3D) cervical PIVMs performed by physical therapy students in patients with nonspecific neck pain. METHODS Thirty-one patients, mean age 47.2 ± 7.2 years, were independently evaluated by 2 physical therapy students. The raters (A and B) assessed mobility, end-feel and pain provocation performing bilaterally the 3D cervical segmental side-bending test (3D CSSB) from levels C2-C3 to C6-C7. Percentage agreement (raw, positive and negative), Cohen's kappa (95% CI), prevalence index and bias index were calculated to estimate intra- and inter-reliability. RESULTS Intra-rater reliability showed kappa values ranging between fair and substantial (k 0.29-0.80) for pain provocation, mobility and end-feel, with percentage agreements between 61%-90%. Inter-rater reliability presented kappa values ranging between fair and substantial (k 0.22-0.62) for pain provocation, mobility and end-feel, with percentage agreements between 61% and 80%. CONCLUSIONS Intra-rater reliability of 3D PIVMs was superior to inter-rater reliability in patients with nonspecific neck pain. The most repeatable evaluation parameter was pain. However overall poor reliability suggests avoiding the use of these techniques alone to examine patients and measure their outcome. Further studies are needed to investigate PIVMs reliability in combination with other assessment procedure in symptomatic patients.
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Affiliation(s)
- Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Italy
| | - Angie Rondoni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Italy
| | | | - Marco Strobe
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Italy
| | | | | | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Italy
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