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Perceived Application and Barriers for Gait Assessment in Physical Therapy Practice in Saudi Arabia. LIFE (BASEL, SWITZERLAND) 2022; 13:life13010050. [PMID: 36675999 PMCID: PMC9862105 DOI: 10.3390/life13010050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Gait is a major function of independence that determines the quality of life, participation, and restriction. Gait assessment in physical therapy practice is fundamental for assessing musculoskeletal conditions. This study planned to determine the extent and barriers of using gait assessment tools by physical therapists in clinical practice in Saudi Arabia. METHOD A cross-sectional design was used. A standardized survey was sent through e-mail and social media to physical therapists working in hospitals, clinics, and rehabilitation centers in different Saudi Arabian regions. RESULTS A total of 320 physical therapists from different regions in Saudi Arabia participated. There was a significant relationship between using gait assessment tools by physical therapists and patient groups (p = 0.002), receiving training (p = 0.001), dealing with patients who suffer from gait problems (p = 0.001), and visiting the gait laboratory (p = 0.001). Physical therapists' use of gait assessment tools for musculoskeletal conditions in clinical practice in Saudi Arabia was limited. The primary barrier preventing physical therapists from using gait assessment methods in clinical practice was a lack of resources, including instruments, space, time, and funds.
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Chamorro-Moriana G, Perez-Cabezas V, Espuny-Ruiz F, Torres-Enamorado D, Ridao-Fernández C. Assessing knee functionality: systematic review of validated outcome measures. Ann Phys Rehabil Med 2021; 65:101608. [PMID: 34808424 DOI: 10.1016/j.rehab.2021.101608] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 08/10/2021] [Accepted: 10/08/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Functional rating scales allow clinicians to document and quantify alterations and progression of recovery processes. There is neither awareness of numerous knee scales nor are they easy to find or compare to select the most suitable. OBJECTIVES We aimed to compile validated knee functional rating tools and analyse the methodological quality of their validation studies. Also, we aimed to provide an operational document of the outcome measures addressing descriptions of parameters, implementations, instructions, interpretations and languages, to identify the most appropriate for future interventions. METHODS A systematic review involved a search of PubMed, Web of Science, CINAHL, Scopus, and Dialnet databases from inception through September 2020. The main inclusion criteria were available functional rating scales/questionnaires/indexes for knees and validation studies. Methodological quality was analyzed with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and COnsensus-based Standards for the selection of health Measurement Instruments Risk of Bias (COSMIN-RB). RESULTS We selected 73 studies. The studies investigated 41 knee rating tools (general, 46%, and specific, 54%) and 71 validations, including 29,742 individuals with knee disorders. QUADAS-2 obtained the best results in patient selection and index test (applicability section). COSMIN-RB showed the highest quality in construct validity (most analyzed metric property). The specific tools were mainly designed for prosthesis and patellofemoral and anterior cruciate ligament injuries. More considered issues were specific function (93%), especially gait, pain/sensitivity (81%), and physical activity/sports (56%). CONCLUSIONS AND IMPLICATIONS We conducted a necessary, useful, unlimited-by-time and feasible compilation of validated tools for assessing knee functional recovery. The methodological quality of the validations was limited. The best validations were for the Copenhagen Knee Range of Motion Scale in osteoarthritis and arthroplasties, Knee Outcome Survey Activities of Daily Living and Lysholm Knee Score for general knee disorders and the Tegner Activity Score for anterior cruciate ligament injuries. The operational document for the scales provides necessary data to identify the most appropriate.
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Chamorro-Moriana G, Sevillano JL, Perez-Cabezas V. Versatile GCH Control Software for Correction of Loads Applied to Forearm Crutches During Gait Recovery Through Technological Feedback: Development and Implementation Study. J Med Internet Res 2021; 23:e27602. [PMID: 34550073 PMCID: PMC8495581 DOI: 10.2196/27602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/24/2021] [Accepted: 07/27/2021] [Indexed: 01/26/2023] Open
Abstract
Background Measuring weight bearing is an essential aspect of clinical care for lower limb injuries such as sprains or meniscopathy surgeries. This care often involves the use of forearm crutches for partial loads progressing to full loads. Therefore, feasible methods of load monitoring for daily clinical use are needed. Objective The main objective of this study was to design an innovative multifunctional desktop load-measuring software that complements GCH System 2.0–instrumented forearm crutches and monitors the applied loads, displaying real-time graphical and numerical information, and enabling the correction of inaccuracies through feedback technology during assisted gait. The secondary objective was to perform a preliminary implementation trial. Methods The software was designed for indoor use (clinics/laboratories). This software translates the crutch sensor signal in millivolts into force units, records and analyzes data (10-80 Hz), and provides real-time effective curves of the loads exerted on crutches. It covers numerous types of extrinsic feedback, including visual, acoustic (verbal/beeps), concurrent, terminal, and descriptive feedback, and includes a clinical and research use database. An observational descriptive pilot study was performed with 10 healthy subjects experienced in bilateral assisted gait. The Wilcoxon matched-pairs signed-rank test was used to evaluate the load accuracy evolution of each subject (ie, changes in the loads exerted on crutches for each support) among various walks, which was interpreted at the 95% confidence level. Results GCH Control Software was developed as a multifunctional desktop tool complementing GCH System 2.0–instrumented forearm crutches. The pilot implementation of the feedback mechanism observed 96/100 load errors at baseline (walk 0, no feedback) with 7/10 subjects exhibiting crutch overloading. Errors ranged from 61.09% to 203.98%, demonstrating heterogeneity. The double-bar feedback found 54/100 errors in walk 1, 28/100 in walk 2, and 14/100 in walk 3. The first walk with double-bar feedback (walk 1) began with errors similar to the baseline walk, generally followed by attempts at correction. The Wilcoxon matched-pairs signed-rank test used to evaluate each subject’s progress showed that all participants steadily improved the accuracy of the loads applied to the crutches. In particular, Subject 9 required extra feedback with two single-bar walks to focus on the total load. The participants also corrected the load balance between crutches and fluency errors. Three subjects made one error of load balance and one subject made six fluctuation errors during the three double-bar walks. The latter subject performed additional feedback with two balance-bar walks to focus on the load balance. Conclusions GCH Control Software proved to be useful for monitoring the loads exerted on forearm crutches, providing a variety of feedback for correcting load accuracy, load balance between crutches, and fluency. The findings of the complementary implementation were satisfactory, although clinical trials with larger samples are needed to assess the efficacy of the different feedback mechanisms and to select the best alternatives in each case.
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Affiliation(s)
- Gema Chamorro-Moriana
- Department of Physiotherapy, Area of Physiotherapy Research Group CTS-305, University of Seville, Seville, Spain
| | - Jose Luis Sevillano
- Department of Architecture and Technology of Computers, Robotics and Technology of Computers Research Group TEP-108, University of Seville, Seville, Spain
| | - V Perez-Cabezas
- Department of Nursing and Physiotherapy, Empowering Health by Physical Activity, Exercise and Nutrition Research Group CTS-1038, University of Cadiz, Cadiz, Spain
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Tamburella F, Lorusso M, Tagliamonte NL, Bentivoglio F, Bigioni A, Pisotta I, Lancini M, Pasinetti S, Ghidelli M, Masciullo M, Saraceni VM, Molinari M. Load Auditory Feedback Boosts Crutch Usage in Subjects With Central Nervous System Lesions: A Pilot Study. Front Neurol 2021; 12:700472. [PMID: 34295303 PMCID: PMC8290055 DOI: 10.3389/fneur.2021.700472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Crutches are the most common walking aids prescribed to improve mobility in subjects with central nervous system (CNS) lesions. To increase adherence to the appropriate level of crutch usage, providing load-related auditory feedback (aFB) may be a useful approach. We sensorized forearm crutches and developed a custom software to provide aFB information to both user and physical therapist (PhT). Aim: Evaluate aFB effects on load control during gait by a self-controlled case series trial. Methods: A single experimental session was conducted enrolling 12 CNS lesioned participants. Load on crutch was recorded during 10 Meter Walk Test performed with and without aFB. In both cases, crutch load data, and gait speed were recorded. Usability and satisfaction questionnaires were administered to participants and PhTs involved. Results: Reliable data were obtained from eight participants. Results showed that compared to the no FB condition, aFB yielded a significant reduction in the mean load on the crutches during gait (p = 0.001). The FB did not influence gait speed or fatigue (p > 0.05). The experience questionnaire data indicated a positive experience regarding the use of aFB from both participants' and PhTs' perspectives. Conclusion: aFB significantly improves compliance with crutch use and does not affect gait speed or fatigue by improving the load placed on crutches. The FB is perceived by users as helpful, safe, and easy to learn, and does not interfere with attention or concentration while walking. Furthermore, the PhTs consider the system to be useful, easy to learn and reliable.
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Affiliation(s)
- Federica Tamburella
- Spinal Rehabilitation Laboratory (SPIRE Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy.,Laboratory of Robotic Neurorehabilitation (NEUROROBOT Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy
| | - Matteo Lorusso
- Spinal Rehabilitation Laboratory (SPIRE Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy.,Laboratory of Robotic Neurorehabilitation (NEUROROBOT Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy
| | - Nevio Luigi Tagliamonte
- Spinal Rehabilitation Laboratory (SPIRE Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy.,Laboratory of Robotic Neurorehabilitation (NEUROROBOT Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy.,Advanced Robotics and Human-Centered Technologies Research Unit, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Francesca Bentivoglio
- Advanced Robotics and Human-Centered Technologies Research Unit, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Alessandra Bigioni
- Spinal Rehabilitation Laboratory (SPIRE Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy.,Laboratory of Robotic Neurorehabilitation (NEUROROBOT Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy
| | - Iolanda Pisotta
- Spinal Rehabilitation Laboratory (SPIRE Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy.,Laboratory of Robotic Neurorehabilitation (NEUROROBOT Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy
| | - Matteo Lancini
- Deptartment of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Simone Pasinetti
- Deptartment of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Marco Ghidelli
- Deptartment of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Marcella Masciullo
- Spinal Rehabilitation Laboratory (SPIRE Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy.,Laboratory of Robotic Neurorehabilitation (NEUROROBOT Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy
| | | | - Marco Molinari
- Spinal Rehabilitation Laboratory (SPIRE Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy.,Laboratory of Robotic Neurorehabilitation (NEUROROBOT Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy
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Aldon-Villegas R, Ridao-Fernández C, Torres-Enamorado D, Chamorro-Moriana G. How to Assess Shoulder Functionality: A Systematic Review of Existing Validated Outcome Measures. Diagnostics (Basel) 2021; 11:845. [PMID: 34066777 PMCID: PMC8151204 DOI: 10.3390/diagnostics11050845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 01/19/2023] Open
Abstract
The objective of this review was to compile validated functional shoulder assessment tools and analyse the methodological quality of their validations. Secondarily, we aimed to provide a comparison of the tools, including parameter descriptions, indications/applications, languages and operating instructions, to choose the most suitable for future clinical and research approaches. A systematic review (PRISMA) was conducted using: PubMed, WoS Scopus, CINHAL, Dialnet and reference lists until 2020. The main criteria for inclusion were that papers were original studies of validated tools or validation studies. Pre-established tables showed tools, validations, items/components, etc. The QUADAS-2 and COSMIN-RB were used to assess the methodological quality of validations. Ultimately, 85 studies were selected, 32 tools and 111 validations. Risk of bias scored lower than applicability, and patient selection got the best scores (QUADAS-2). Internal consistency had the highest quality and PROMs development the lowest (COSMIN-RB). Responsiveness was the most analysed metric property. Modified UCLA and SST obtained the highest quality in shoulder instability surgery, and SPADI in pain. The most approached topic was activities of daily living (81%). We compiled 32 validated functional shoulder assessment tools, and conducted an analysis of the methodological quality of 111 validations associated with them. Modified UCLA and SST showed the highest methodological quality in instability surgery and SPADI in pain.
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Affiliation(s)
- Rocio Aldon-Villegas
- Research Group “Area of Physiotherapy” CTS-305, Department of Physiotherapy, University of Seville, 41009 Seville, Spain; (R.A.-V.); (G.C.-M.)
| | - Carmen Ridao-Fernández
- Research Group “Area of Physiotherapy” CTS-305, Department of Physiotherapy, University of Seville, 41009 Seville, Spain; (R.A.-V.); (G.C.-M.)
| | - Dolores Torres-Enamorado
- Research Group “Women, Well-Being and Citizenship” SEJ066, Department of Nursing, University of Seville, 41930 Bormujos, Spain;
| | - Gema Chamorro-Moriana
- Research Group “Area of Physiotherapy” CTS-305, Department of Physiotherapy, University of Seville, 41009 Seville, Spain; (R.A.-V.); (G.C.-M.)
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Dölp A, Schneider-Momm K, Heiser P, Clement C, Rauh R, Clement HW, Schulz E, Fleischhaker C. Oligoantigenic Diet Improves Children's ADHD Rating Scale Scores Reliably in Added Video-Rating. Front Psychiatry 2020; 11:730. [PMID: 32973571 PMCID: PMC7468497 DOI: 10.3389/fpsyt.2020.00730] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 07/10/2020] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The influence of food intake on behavioural disorders was already described in the early 20th century. Elimination of individually allergenic food items from individual diets ["oligoantigenic diet" (OD)] showed promise to improve attention-deficit/hyperactivity disorder (ADHD) symptoms. However, only few of the positive results were evaluated by blinded symptom rating. Therefore the present study's purpose was to evaluate the reliability of a non-blinded rating of the ADHD Rating Scale IV (ARS) for the assessment of OD effects in comparison to a blinded rating of the ARS based on pseudonymized video recordings. METHODS Ten children (8m/2f) aged 8 to 14 with ADHD according to ICD-10 participated in an uncontrolled, open-label dietary intervention study. Food items, commonly related to intolerances, were eliminated for four weeks. Participants with > 40% improvement in the ARS between T1 (before the diet) and T2 (after the diet) were defined as responders. Nutrients with individual relevance to ADHD symptoms were identified in a following reintroduction phase (T3-T4) lasting 8-16 weeks. The ARS was completed by a non-blinded child and adolescent psychiatrist (T0-T4). Sessions were recorded on video, pseudonymized, and evaluated by three blinded raters. Complete data were captured for eight children. The inter-rater reliability between the non-blinded therapist and every blinded rater was determined by the intra-class correlation coefficient (ICC). Correlations according to Pearson and Spearman between the non-blinded and blinded rating were calculated for each rater. RESULTS Two blinded raters and the non-blinded rater considered 5 of 8 (62.5%) children as responders, whereas one blinded rater disagreed as to the success of one case thus considering only 4 of 8 children as responders to the diet. Inter-rater reliability was assessed after each rater having scored 33 videos: The intra-class coefficients were >.9 for all raters (rater 1: ICC=.997, rater 2: ICC=.996, rater 3: ICC=.996) and the Spearman rho between the raters were high (n=33; rater 1: rho =.989, p<.0001, rater 2: rho=.987, p<.0001, rater 3: rho=.984, p<.0001), respectively. DISCUSSION As both, blinded and non-blinded ratings of the ARS, revealed relevant significant improvement of ADHD scores in children following an OD in this uncontrolled trial, Randomized controlled trials appear as highly desirable in order to replicate these improvements and to establish reliable and unbiased effect sizes thereby fostering further more objective confirmatory measurements.
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Affiliation(s)
- Anna Dölp
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katja Schneider-Momm
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philip Heiser
- Clinic of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, SuedharzHospital Nordhausen, Nordhausen, Germany
| | - Christina Clement
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Reinhold Rauh
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hans-Willi Clement
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Eberhard Schulz
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian Fleischhaker
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Criteria-Based Return to Sport Decision-Making Following Lateral Ankle Sprain Injury: a Systematic Review and Narrative Synthesis. Sports Med 2020; 49:601-619. [PMID: 30747379 DOI: 10.1007/s40279-019-01071-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this systematic review was to identify prospective studies that used a criteria-based return to sport (RTS) decision-making process for patients with lateral ankle sprain (LAS) injury. DESIGN Systematic review and narrative synthesis. DATA SOURCES The PubMed (MEDLINE), Web of Science, PEDro, Cochrane Library, SPORTDiscus (EBSCO), ScienceDirect, and Scopus databases were searched to 23 November 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies were included if they prospectively applied a criteria-based RTS decision-making process for patients with LAS injury, but were excluded if they merely gathered outcome measures at the RTS time point. Studies were also excluded if patients were recovering from ankle fracture, high ankle sprain, medial ankle sprain, chronic ankle instability or complex ankle injury. RESULTS No studies were identified that used a criteria-based RTS decision-making process for patients with LAS injury. We were unable to conduct a quantitative synthesis or meta-analysis, therefore we provide a narrative synthesis of relevant questionnaires, as well as clinical and functional assessments commonly used in studies retrieved in the search. CONCLUSION There are currently no published evidence-based criteria to inform RTS decisions for patients with an LAS injury. Based on our narrative synthesis, we propose a number of variables that could be used to develop a criteria-based RTS decision paradigm. Future research should aim to reach consensus on these variables and apply them to actual RTS decisions within prospective study designs. Furthermore, we suggest that complex systems theory and the RTS continuum could be used to inform the development of an RTS decision-making paradigm for athletes with LAS injury.
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Observational Gait Assessment Scales in Patients with Walking Disorders: Systematic Review. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2085039. [PMID: 31781597 PMCID: PMC6875351 DOI: 10.1155/2019/2085039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 09/01/2019] [Accepted: 09/18/2019] [Indexed: 11/18/2022]
Abstract
Objective To compile and analyze the characteristics and methodological quality of observational gait assessment scales validated to date. Methods PubMed, Scopus, the Cochrane Library, Physiotherapy Evidence Database, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Dialnet, Spanish Medical Index, and Nursing, Physiotherapy, and Podiatry databases were searched up to August 2019. The main inclusion criteria were validated tools based on a conceptual framework developed to evaluate gait, validation design studies of observational scales in their entirety, and articles written in English or Spanish. Evaluators extracted descriptive information of the scales and the metric properties of the studies, which were further analyzed with Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN checklist). Results Eighteen articles based on 14 scales were included. The populations were neurological patients (72.22%), musculoskeletal disorders (11.11%), and other areas such as vestibular disorders (11.11%). The most addressed items were orthopedic aids (64.29%); phases of the gait cycle and kinematics of the leg and trunk (57.14% each one); and spatial and temporal parameters (50%). All studies analyzed criterion validity, and five included content or structural validity (27.78%). Fifteen articles considered reliability (83.33%). Regarding the seven-item scale QUADAS-2, five studies obtained six results on “low” risk of bias or “low” concerns regarding applicability. Nine articles obtained at least a “fair” result on COSMIN checklist. Conclusions A necessary compilation of the observational gait assessment scales validated to date was conducted. Besides, their characteristics and methodological quality were analyzed. Most scales were applied in neurological signs. The most approached topics were orthopedic aids, phases of the gait cycle, and kinematics of the leg and trunk. The scale that demonstrated a higher methodological quality was Visual Gait Assessment Scale, followed by CHAGS, Salford Gait Tool, and Edinburgh Visual Gait Score.
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Instrumented Crutch Tip for Monitoring Force and Crutch Pitch Angle. SENSORS 2019; 19:s19132944. [PMID: 31277380 PMCID: PMC6650966 DOI: 10.3390/s19132944] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/25/2019] [Accepted: 06/30/2019] [Indexed: 02/07/2023]
Abstract
In rehabilitation procedures related to the lower limbs, gait monitoring is an important source of information for the therapist. However, many of the approaches proposed in the literature require the use of uncomfortable and invasive devices. In this work, an instrumented tip is developed and detailed, which can be connected to any crutch. The instrumented tip provides objective data of the crutch motion, which, combined with patient movement data, might be used to monitor the daily activities or assess the recovery status of the patient. For that purpose, the tip integrates a two-axis inclinometer, a tri-axial gyroscope, and a force sensor to measure the force exerted on the crutch. In addition, a novel algorithm to estimate the pitch angle of the crutch is developed. The proposed approach is tested experimentally, obtaining acceptable accuracies and demonstrating the validity of the proposed lightweight, portable solution for gait monitoring.
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Ridao-Fernández C, Ojeda J, Chamorro-Moriana G. Analysis of Spatial and Temporal Step Parameters During Crutch-Assisted Gait as a Dual-Task: A Pilot Study. J Biomech Eng 2018; 140:2679582. [PMID: 30029235 DOI: 10.1115/1.4040020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Indexed: 11/08/2022]
Abstract
The main objective was to analyze the changes in the spatial and temporal step parameters during a dual-task: walking with a forearm crutch to partially unload the body weight of the subject. The secondary objective was to determine the influence of the use of the crutch with the dominant or nondominant hand in the essential gait parameters. Seven healthy subjects performed gait without crutches (GWC) and unilateral assisted gait (UAG) with the crutch carried out by dominant hand (dominant crutch (DC)) and nondominant hand (nondominant crutch (NDC)). Gait was recorded using a Vicon System; the GCH System 2.0 and the GCH Control Software 1.0 controlled the loads. The variables were step length, step period, velocity, step width, and step angle. The Wilcoxon signed-rank test compared GWC and UAG while also analyzing the parameters measured for both legs with DC and NDC in general and in each subject. Wilcoxon test only found significant differences in 1 of the 15 general comparisons between both legs. In the analysis by subject, step length, step period, and velocity showed significant differences between GWC and UAG. These parameters obtained less differences in DC. The effect of a forearm crutch on UAG caused a reduction in step length and velocity, and an increase in step period. However, it did not entail changes in step angle and step width. UAG was more effective when the DC carried the crutch. The unloading of 10% body weight produced an assisted gait which closely matched GWC.
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Affiliation(s)
- Carmen Ridao-Fernández
- Department of Physiotherapy, Research Group "Area of Physiotherapy CTS-305," University of Seville, Seville 41009, Spain e-mail:
| | - Joaquín Ojeda
- Department of Mechanical Engineering and Manufacture, Research Group "Mechanical Engineering," University of Seville, Seville 41092, Spain e-mail:
| | - Gema Chamorro-Moriana
- Department of Physiotherapy, Research Group "Area of Physiotherapy CTS-305," University of Seville, Seville 41009, Spain e-mail:
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Ridao-Fernández C, Chamorro-Moriana G, Ojeda J. Influence of the load exerted over a forearm crutch in spatiotemporal step parameters during assisted gait: pilot study. Biomed Eng Online 2018; 17:98. [PMID: 30021612 PMCID: PMC6052579 DOI: 10.1186/s12938-018-0527-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/10/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Assisted gait with forearm crutches is frequently performed during the recovery of musculoskeletal injuries of the lower limb. The amount of body weight applied to the crutch or crutches depends on the pathology and the treatment phase. The transition from assisted gait with two crutches to a single crutch is usually recommended when the subject is able to load the 50% of the body weight upon the affected member. An altered assisted gait will cause biomechanic alterations and, therefore, longer treatments and relapses. The aim of this study was to analyze the influence of 10, 25 and 50% of body weight applied to a forearm crutch during a unilateral assisted gait in the spatial and temporal step parameters to determine the load that produces alterations in gait biomechanics and the load that does not. METHODS Eleven healthy subjects performed normal gait (NG) and assisted gait with a forearm crutch, in which the applied loads were: comfortable (C), 25 and 50% of their body weight. Vicon System was employed for gait recording. GCH System 2.0 and GCH Control Software 1.0 controlled the loads. The variables were: step length, step period, velocity, step width and step angle. Friedman test compared all the gait modalities: NG and the different loads. Wilcoxon signed-rank test analyzed ipsilateral and contralateral step parameters to the crutch globally and for each subject. RESULTS Friedman test showed significant differences between NG, C, 25 and 50%, especially for step period and velocity. Wilcoxon test had significant differences only in 4 of the 20 general comparisons between ipsilateral and contralateral steps to the crutch. In the analysis by subjects, step length, step period and velocity showed 79/132, 110/132 and 58/66 significant differences, respectively. CONCLUSIONS The increase in the load exerted over a forearm crutch produced an increase in the step period, accompanied by a reduction of step length and gait velocity. Step width and step angle were not modified. The unloading of 25 and 50% of body weight on a single crutch is incorrect from the biomechanical point of view. Two crutches should be employed when the body weight to unload exceeds 10%.
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Affiliation(s)
- Carmen Ridao-Fernández
- Department of Physiotherapy, Research Group “Area of Physiotherapy CTS-305”, University of Seville, C/Avicena s/n, C.P. 41009 Seville, Spain
| | - Gema Chamorro-Moriana
- Department of Physiotherapy, Research Group “Area of Physiotherapy CTS-305”, University of Seville, C/Avicena s/n, C.P. 41009 Seville, Spain
| | - Joaquín Ojeda
- Department of Mechanical Engineering and Manufacture, Research Group “Mechanical Engineering”, University of Seville, Seville, Spain
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Technology-Based Feedback and Its Efficacy in Improving Gait Parameters in Patients with Abnormal Gait: A Systematic Review. SENSORS 2018; 18:s18010142. [PMID: 29316645 PMCID: PMC5795813 DOI: 10.3390/s18010142] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/14/2017] [Accepted: 01/02/2018] [Indexed: 11/16/2022]
Abstract
This systematic review synthesized and analyzed clinical findings related to the effectiveness of innovative technological feedback for tackling functional gait recovery. An electronic search of PUBMED, PEDro, WOS, CINAHL, and DIALNET was conducted from January 2011 to December 2016. The main inclusion criteria were: patients with modified or abnormal gait; application of technology-based feedback to deal with functional recovery of gait; any comparison between different kinds of feedback applied by means of technology, or any comparison between technological and non-technological feedback; and randomized controlled trials. Twenty papers were included. The populations were neurological patients (75%), orthopedic and healthy subjects. All participants were adults, bar one. Four studies used exoskeletons, 6 load platforms and 5 pressure sensors. The breakdown of the type of feedback used was as follows: 60% visual, 40% acoustic and 15% haptic. 55% used terminal feedback versus 65% simultaneous feedback. Prescriptive feedback was used in 60% of cases, while 50% used descriptive feedback. 62.5% and 58.33% of the trials showed a significant effect in improving step length and speed, respectively. Efficacy in improving other gait parameters such as balance or range of movement is observed in more than 75% of the studies with significant outcomes. CONCLUSION Treatments based on feedback using innovative technology in patients with abnormal gait are mostly effective in improving gait parameters and therefore useful for the functional recovery of patients. The most frequently highlighted types of feedback were immediate visual feedback followed by terminal and immediate acoustic feedback.
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Chamorro-Moriana G, Sevillano JL, Ridao-Fernández C. A Compact Forearm Crutch Based on Force Sensors for Aided Gait: Reliability and Validity. SENSORS 2016; 16:s16060925. [PMID: 27338396 PMCID: PMC4934350 DOI: 10.3390/s16060925] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/10/2016] [Accepted: 06/16/2016] [Indexed: 12/26/2022]
Abstract
Frequently, patients who suffer injuries in some lower member require forearm crutches in order to partially unload weight-bearing. These lesions cause pain in lower limb unloading and their progression should be controlled objectively to avoid significant errors in accuracy and, consequently, complications and after effects in lesions. The design of a new and feasible tool that allows us to control and improve the accuracy of loads exerted on crutches during aided gait is necessary, so as to unburden the lower limbs. In this paper, we describe such a system based on a force sensor, which we have named the GCH System 2.0. Furthermore, we determine the validity and reliability of measurements obtained using this tool via a comparison with the validated AMTI (Advanced Mechanical Technology, Inc., Watertown, MA, USA) OR6-7-2000 Platform. An intra-class correlation coefficient demonstrated excellent agreement between the AMTI Platform and the GCH System. A regression line to determine the predictive ability of the GCH system towards the AMTI Platform was found, which obtained a precision of 99.3%. A detailed statistical analysis is presented for all the measurements and also segregated for several requested loads on the crutches (10%, 25% and 50% of body weight). Our results show that our system, designed for assessing loads exerted by patients on forearm crutches during assisted gait, provides valid and reliable measurements of loads.
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Affiliation(s)
| | - José Luis Sevillano
- Department of Computer Technology and Architecture, University of Seville, Sevilla 41012, Spain.
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