1
|
Albright L, Ko W, Buvanesh M, Haraldsson H, Polubriaginof F, Kuperman GJ, Levy M, Sterling MR, Dell N, Estrin D. Opportunities and Challenges for Augmented Reality in Family Caregiving: Qualitative Video Elicitation Study. JMIR Form Res 2024; 8:e56916. [PMID: 38814705 PMCID: PMC11176885 DOI: 10.2196/56916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/27/2024] [Accepted: 04/26/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Although family caregivers play a critical role in care delivery, research has shown that they face significant physical, emotional, and informational challenges. One promising avenue to address some of caregivers' unmet needs is via the design of digital technologies that support caregivers' complex portfolio of responsibilities. Augmented reality (AR) applications, specifically, offer new affordances to aid caregivers as they perform care tasks in the home. OBJECTIVE This study explored how AR might assist family caregivers with the delivery of home-based cancer care. The specific objectives were to shed light on challenges caregivers face where AR might help, investigate opportunities for AR to support caregivers, and understand the risks of AR exacerbating caregiver burdens. METHODS We conducted a qualitative video elicitation study with clinicians and caregivers. We created 3 video elicitations that offer ways in which AR might support caregivers as they perform often high-stakes, unfamiliar, and anxiety-inducing tasks in postsurgical cancer care: wound care, drain care, and rehabilitative exercise. The elicitations show functional AR applications built using Unity Technologies software and Microsoft Hololens2. Using elicitations enabled us to avoid rediscovering known usability issues with current AR technologies, allowing us to focus on high-level, substantive feedback on potential future roles for AR in caregiving. Moreover, it enabled nonintrusive exploration of the inherently sensitive in-home cancer care context. RESULTS We recruited 22 participants for our study: 15 clinicians (eg, oncologists and nurses) and 7 family caregivers. Our findings shed light on clinicians' and caregivers' perceptions of current information and communication challenges caregivers face as they perform important physical care tasks as part of cancer treatment plans. Most significant was the need to provide better and ongoing support for execution of caregiving tasks in situ, when and where the tasks need to be performed. Such support needs to be tailored to the specific needs of the patient, to the stress-impaired capacities of the caregiver, and to the time-constrained communication availability of clinicians. We uncover opportunities for AR technologies to potentially increase caregiver confidence and reduce anxiety by supporting the capture and review of images and videos and by improving communication with clinicians. However, our findings also suggest ways in which, if not deployed carefully, AR technologies might exacerbate caregivers' already significant burdens. CONCLUSIONS These findings can inform both the design of future AR devices, software, and applications and the design of caregiver support interventions based on already available technology and processes. Our study suggests that AR technologies and the affordances they provide (eg, tailored support, enhanced monitoring and task accuracy, and improved communications) should be considered as a part of an integrated care journey involving multiple stakeholders, changing information needs, and different communication channels that blend in-person and internet-based synchronous and asynchronous care, illness, and recovery.
Collapse
Affiliation(s)
- Liam Albright
- Department of Information Science, Cornell University, New York, NY, United States
| | - Woojin Ko
- Department of Computer Science, Cornell Tech, New York, NY, United States
| | - Meyhaa Buvanesh
- Department of Information Science, Jacobs Technion-Cornell Institute, Cornell Tech, New York, NY, United States
| | | | - Fernanda Polubriaginof
- Digital Informatics and Technology Solutions (DigITS), Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Gilad J Kuperman
- Digital Informatics and Technology Solutions (DigITS), Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Michelle Levy
- Digital Informatics and Technology Solutions (DigITS), Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Madeline R Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Nicola Dell
- Department of Information Science, Jacobs Technion-Cornell Institute, Cornell Tech, New York, NY, United States
| | - Deborah Estrin
- Department of Computer Science, Cornell Tech, New York, NY, United States
| |
Collapse
|
2
|
Johansen SK, Kanstrup AM, Haseli K, Stenmo VH, Thomsen JL, Rathleff MS. Exploring User Visions for Modeling mHealth Apps Toward Supporting Patient-Parent-Clinician Collaboration and Shared Decision-making When Treating Adolescent Knee Pain in General Practice: Workshop Study. JMIR Hum Factors 2023; 10:e44462. [PMID: 37115609 PMCID: PMC10182461 DOI: 10.2196/44462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Long-standing knee pain is one of the most common reasons for adolescents (aged 10-19 years) to consult general practice. Generally, 1 in 2 adolescents will continue to experience pain after 2 years, but exercises and self-management education can improve the prognosis. However, adherence to exercises and self-management education interventions remains poor. Mobile health (mHealth) apps have the potential for supporting adolescents' self-management, enhancing treatment adherence, and fostering patient-centered approaches. However, it remains unclear how mHealth apps should be designed to act as tools for supporting individual and collaborative management of adolescents' knee pain in a general practice setting. OBJECTIVE The aim of the study was to extract design principles for designing mHealth core features, which were both sufficiently robust to support adolescents' everyday management of their knee pain and sufficiently flexible to act as enablers for enhancing patient-parent collaboration and shared decision-making. METHODS Overall, 3 future workshops were conducted with young adults with chronic knee pain since adolescence, parents, and general practitioners (GPs). Each workshop followed similar procedures, using case vignettes and design cards to stimulate discussions, shared construction of knowledge and elicit visions for mHealth designs. Young adults and parents were recruited via social media posts targeting individuals in Northern Jutland. GPs were recruited via email and cold calling. Data were transcribed and analyzed thematically using NVivo (QSR International) coding software. Extracted themes were synthesized in a matrix to map tensions in the collaborative space and inform a conceptual model for designing mHealth core-features to support individual and collaborative management of knee pain. RESULTS Overall, 38% (9/24) young adults with chronic knee pain since adolescence, 25% (6/24) parents, and 38% (9/24) GPs participated in the workshops. Data analysis revealed how adolescents, parents, and clinicians took on different roles within the collaborative space, with different tasks, challenges, and information needs. In total, 5 themes were identified: adolescents as explorers of pain and social rules; parents as supporters, advocates and enforcers of boundaries; and GPs as guides, gatekeepers, and navigators or systemic constraints described participants' roles; collaborative barriers and tensions referred to the contextual elements; and visions for an mHealth app identified beneficial core features. The synthesis informed a conceptual model, outlining 3 principles for consolidating mHealth core features as enablers for supporting role negotiation, limiting collaborative tensions, and facilitating shared decision-making. CONCLUSIONS An mHealth app for treating adolescents with knee pain should be designed to accommodate multiple users, enable them to shift between individual management decision-making, take charge, and engage in role negotiation to inform shared decision-making. We identified 3 silver-bullet principles for consolidating mHealth core features as enablers for negotiation by supporting patient-GP collaboration, supporting transitions, and cultivating the parent-GP alliance.
Collapse
Affiliation(s)
- Simon Kristoffer Johansen
- Center for General Practice (CAM-AAU), Department of Clinical Medicine, Aalborg University, Aalborg East, Denmark
| | | | - Kian Haseli
- Center for General Practice (CAM-AAU), Department of Clinical Medicine, Aalborg University, Aalborg East, Denmark
| | - Visti Hildebrandt Stenmo
- Center for General Practice (CAM-AAU), Department of Clinical Medicine, Aalborg University, Aalborg East, Denmark
| | - Janus Laust Thomsen
- Center for General Practice (CAM-AAU), Department of Clinical Medicine, Aalborg University, Aalborg East, Denmark
| | - Michael Skovdal Rathleff
- Center for General Practice (CAM-AAU), Department of Clinical Medicine, Aalborg University, Aalborg East, Denmark
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
3
|
Abstract
An objective technological solution for tracking adherence to at-home shoulder physiotherapy is important for improving patient engagement and rehabilitation outcomes, but remains a significant challenge. The aim of this research was to evaluate performance of machine-learning (ML) methodologies for detecting and classifying inertial data collected during in-clinic and at-home shoulder physiotherapy exercise. A smartwatch was used to collect inertial data from 42 patients performing shoulder physiotherapy exercises for rotator cuff injuries in both in-clinic and at-home settings. A two-stage ML approach was used to detect out-of-distribution (OOD) data (to remove non-exercise data) and subsequently for classification of exercises. We evaluated the performance impact of grouping exercises by motion type, inclusion of non-exercise data for algorithm training, and a patient-specific approach to exercise classification. Algorithm performance was evaluated using both in-clinic and at-home data. The patient-specific approach with engineered features achieved the highest in-clinic performance for differentiating physiotherapy exercise from non-exercise activity (area under the receiver operating characteristic (AUROC) = 0.924). Including non-exercise data in algorithm training further improved classifier performance (random forest, AUROC = 0.985). The highest accuracy achieved for classifying individual in-clinic exercises was 0.903, using a patient-specific method with deep neural network model extracted features. Grouping exercises by motion type improved exercise classification. For at-home data, OOD detection yielded similar performance with the non-exercise data in the algorithm training (fully convolutional network AUROC = 0.919). Including non-exercise data in algorithm training improves detection of exercises. A patient-specific approach leveraging data from earlier patient-supervised sessions should be considered but is highly dependent on per-patient data quality.
Collapse
Affiliation(s)
- Philip Boyer
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- Sunnybrook Research Institute, Toronto, Canada
| | - David Burns
- Harborview Medical Center, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
| | - Cari Whyne
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- Sunnybrook Research Institute, Toronto, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| |
Collapse
|
4
|
Azin Z, Kamali F, Salehi Dehno N, Abolahrari-Shirazi S. Comparison of Manual Therapy Technique to Therapeutic Exercise in the Treatment of Patients With Subacromial Impingement Syndrome: A Randomized Clinical Trial. J Manipulative Physiol Ther 2023; 46:98-108. [PMID: 37777940 DOI: 10.1016/j.jmpt.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/22/2023] [Accepted: 06/26/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the effects of manual therapy to therapeutic exercise on shoulder pain, disability, and range of motion (ROM) in patients with subacromial impingement syndrome (SAIS). METHODS Sixty patients with SAIS were randomly assigned into the manual therapy (MT) and therapeutic exercise (TE) groups. Patients in the MT group were treated with joint mobilization, which was applied to the glenohumeral, acromioclavicular, sternoclavicular and scapulothoracic joints, and trigger point (TrP) inactivation using ischemic compression. Patients in the TE group performed therapeutic exercises. Shoulder pain, disability and active ROM (elevation, external rotation, and internal rotation) were assessed by the visual analog scale, the Shoulder Pain and Disability Index, and a goniometer, respectively. The outcomes were measured at baseline, after the intervention, and 1 month after the intervention. RESULTS After the treatment, both groups had significant improvements in shoulder pain, disability, and ROM (P < .05). The MT group experienced a greater reduction in shoulder pain than the TE group (P < .001). However, in disability and ROM, both groups exhibited similar improvements in post-treatment and follow-up periods. CONCLUSION Both MT and TE were effective in improving shoulder pain, disability, and ROM in patients with SAIS. Greater improvement in shoulder pain was observed in the MT group.
Collapse
Affiliation(s)
- Zeynab Azin
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fahimeh Kamali
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Salehi Dehno
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Abolahrari-Shirazi
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
5
|
Persons AK, Middleton C, Parker E, Carroll W, Turner A, Talegaonkar P, Davarzani S, Saucier D, Chander H, Ball JE, Elder SH, Simpson CL, Macias D, Burch V. RF. Comparison of the Capacitance of a Cyclically Fatigued Stretch Sensor to a Non-Fatigued Stretch Sensor When Performing Static and Dynamic Foot-Ankle Motions. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22218168. [PMID: 36365868 PMCID: PMC9661536 DOI: 10.3390/s22218168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 05/26/2023]
Abstract
Motion capture is the current gold standard for assessing movement of the human body, but laboratory settings do not always mimic the natural terrains and movements encountered by humans. To overcome such limitations, a smart sock that is equipped with stretch sensors is being developed to record movement data outside of the laboratory. For the smart sock stretch sensors to provide valuable feedback, the sensors should have durability of both materials and signal. To test the durability of the stretch sensors, the sensors were exposed to high-cycle fatigue testing with simultaneous capture of the capacitance. Following randomization, either the fatigued sensor or an unfatigued sensor was placed in the plantarflexion position on the smart sock, and participants were asked to complete the following static movements: dorsiflexion, inversion, eversion, and plantarflexion. Participants were then asked to complete gait trials. The sensor was then exchanged for either an unfatigued or fatigued plantarflexion sensor, depending upon which sensor the trials began with, and each trial was repeated by the participant using the opposite sensor. Results of the tests show that for both the static and dynamic movements, the capacitive output of the fatigued sensor was consistently higher than that of the unfatigued sensor suggesting that an upwards drift of the capacitance was occurring in the fatigued sensors. More research is needed to determine whether stretch sensors should be pre-stretched prior to data collection, and to also determine whether the drift stabilizes once the cyclic softening of the materials comprising the sensor has stabilized.
Collapse
Affiliation(s)
- Andrea Karen Persons
- The Ohio State Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, OH 43202, USA
| | - Carver Middleton
- Department of Human Factors & Athlete Engineering, Human Performance Lab, Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS 39759, USA
- Department of Electrical & Computer Engineering, Mississippi State University, Starkville, MS 39762, USA
| | - Erin Parker
- Department of Human Factors & Athlete Engineering, Human Performance Lab, Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS 39759, USA
- Department of Electrical & Computer Engineering, Mississippi State University, Starkville, MS 39762, USA
| | - Will Carroll
- Department of Human Factors & Athlete Engineering, Human Performance Lab, Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS 39759, USA
- Department of Electrical & Computer Engineering, Mississippi State University, Starkville, MS 39762, USA
| | - Alana Turner
- Department of Human Factors & Athlete Engineering, Human Performance Lab, Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS 39759, USA
- Department of Kinesiology, Mississippi State University, Starkville, MS 39762, USA
| | - Purva Talegaonkar
- Department of Human Factors & Athlete Engineering, Human Performance Lab, Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS 39759, USA
- Department of Industrial & Systems Engineering, Mississippi State University, Starkville, MS 39762, USA
| | - Samaneh Davarzani
- Department of Human Factors & Athlete Engineering, Human Performance Lab, Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS 39759, USA
- Department of Industrial & Systems Engineering, Mississippi State University, Starkville, MS 39762, USA
| | - David Saucier
- Department of Human Factors & Athlete Engineering, Human Performance Lab, Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS 39759, USA
| | - Harish Chander
- Department of Human Factors & Athlete Engineering, Human Performance Lab, Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS 39759, USA
- Department of Kinesiology, Mississippi State University, Starkville, MS 39762, USA
| | - John E. Ball
- Department of Human Factors & Athlete Engineering, Human Performance Lab, Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS 39759, USA
- Department of Electrical & Computer Engineering, Mississippi State University, Starkville, MS 39762, USA
| | - Steven H. Elder
- Department of Agricultural and Biological Engineering, Mississippi State University, Starkville, MS 39762, USA
| | - Chartrisa LaShan Simpson
- Department of Agricultural and Biological Engineering, Mississippi State University, Starkville, MS 39762, USA
| | - David Macias
- OrthoVirginia, 1920 Ballenger Ave., Alexandria, VA 22314, USA
| | - Reuben F. Burch V.
- Department of Human Factors & Athlete Engineering, Human Performance Lab, Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS 39759, USA
- Department of Industrial & Systems Engineering, Mississippi State University, Starkville, MS 39762, USA
| |
Collapse
|
6
|
Kaji Y, Yamaguchi K, Nomura Y, Oka K, Nakamura O, Ishibashi Y, Yamamoto T. Postoperative early and proactive grip strength training program for distal radius fractures promotes earlier recovery of grip strength: A retrospective study. Medicine (Baltimore) 2022; 101:e29262. [PMID: 35583536 PMCID: PMC9276271 DOI: 10.1097/md.0000000000029262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 03/21/2022] [Indexed: 01/04/2023] Open
Abstract
The use of volar locking plates (VLPs) for distal radius fractures has remarkably improved clinical outcomes; however, there are some reports of delayed recovery of grip strength. Since January 2019, we have been conducting an early and proactive grip strength training program (EGTP). In this program, 20 minutes of grip strength training-using a gripper with a load of 0.7 kg-was initiated from 2 weeks after surgery; the load was then gradually increased. From 6 weeks postsurgery, daily home grip strength training was performed using a gripper with a load of 5 kg, provided to the patient.We investigated whether the introduction of the EGTP could lead to earlier recovery of grip strength. We also examined whether the EGTP caused postoperative correction loss at the fractured site, or contributed to the early improvement of wrist function.Thirty-nine patients who underwent surgery using VLPs for distal radius fractures were included in this study; 20 followed the EGTP (EGTP group) and 19 patients did not (NGTP group). For these patients, grip strength and range of motion of the wrist joint were evaluated both 3 and 6 months postoperatively. The Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) scores were also evaluated 6 months postoperatively. Additionally, corrective losses of radial inclination (RI), palmar tilt (PT), and ulnar variance (UV)-occurring from immediately postsurgery to 6 months after surgery-were evaluated.At both 3 and 6 months postoperatively, the grip strength of the EGTP group was significantly higher than that of the NGTP group. Regarding range of motion, only palmar flexion was significantly improved in the EGTP group at 3 months postoperatively. Conversely, no differences in corrective losses of RI, PT, and UV, or in qDASH scores, were observed between the two groups.The results of this study suggest that the EGTP can provide early recovery of grip strength and palmar flexion of the wrist without causing corrective loss at the fracture site.
Collapse
Affiliation(s)
- Yoshio Kaji
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Konosuke Yamaguchi
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Yumi Nomura
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Kunihiko Oka
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Osamu Nakamura
- Department of Orthopedic Surgery, Kagawa Prefectural Shirotori Hospital, Mastubara, Higashikagawa City, Kagawa, Japan
| | - Yoichi Ishibashi
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Tetsuji Yamamoto
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| |
Collapse
|
7
|
Mitchell UH, Lee H, Dennis HE, Seeley MK. Quality of knee strengthening exercises performed at home deteriorates after one week. BMC Musculoskelet Disord 2022; 23:164. [PMID: 35183152 PMCID: PMC8857831 DOI: 10.1186/s12891-022-05120-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/15/2022] [Indexed: 01/28/2023] Open
Abstract
Background To compare the performance (as determined by lower extremity kinematics) of knee exercises in healthy middle-aged and older individuals immediately after instruction and one week later. Methods This is a cross-sectional study in a laboratory setting. Nineteen healthy volunteers (age [y] 63.1 ± 8.6, mass [kg] 76.3 ± 14.7, height [m] 1.7 ± 0.1) participated in this study. High speed video and reflective markers were used to track motion during four exercises. The exercises were knee flexion, straight leg raise, and “V “in supine position, and hip abduction in side lying position. All participants received verbal and tactile cues during the training phase and the therapist observed and, if necessary, corrected the exercises. Upon return a week later the participants performed the same exercises without any further instructions. Knee and hip sagittal and rotational angles were extracted from the motion capture. A repeated measures t-test was used to compare the motions between two visits. Results Participants demonstrated more knee flexion during straight leg raise and “V in” exercises at the 2nd visit compared to the 1st visit (both p < 0.05). During the “V out” exercise, they performed more external rotation (p < 0.05) while they showed more internal rotation during the “V in” exercise at the 2nd visit compared to the 1st visit. Conclusions Exercise performance declined significantly in healthy middle-aged and older individuals one week after instruction. This decline occurred despite an instructional exercise sheet being given to every participant. Other approaches designed to help individuals retain the ability to perform rehabilitative exercises correctly need to be explored.
Collapse
|
8
|
Schydlowsky P, Szkudlarek M, Madsen OR. Comprehensive supervised heavy training program versus home training regimen in patients with subacromial impingement syndrome: a randomized trial. BMC Musculoskelet Disord 2022; 23:52. [PMID: 35033043 PMCID: PMC8760780 DOI: 10.1186/s12891-021-04969-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 12/17/2021] [Indexed: 12/05/2022] Open
Abstract
Background There is no consensus on the best training regimen for subacromial impingement syndrome (SIS). Several have been suggested, but never tested. The purpose of the study is to compare a comprehensive supervised training regimen (STR) based on latest evidence including heavy slow resistance training with a validated home-based regimen (HTR). We hypothesized that the STR would be superior to the HTR. Methods Randomised control trial with blinded assessor. 126 consecutive patients with SIS were recruited and equally randomised to 12 weeks of either supervised training regimen (STR), or home-based training regimen (HTR). Primary outcomes were Constant Score (CS) and Shoulder Rating Questionnaire (SRQ) from baseline and 6 months after completed training. Results were analyzed according to intention-to treat principles. The study was retrospectively registered in ClinicalTrials.gov. Date of registration: 07/06/2021. Identification number: NCT04915430. Results CS improved by 22.7 points for the STR group and by 23,7 points for the HTR (p = 0.0001). The SRQ improved by 17.7 and 18.1 points for the STR and the HTR groups respectively (p = 0.0001). The inter-group changes were non-significant. All secondary outcomes (passive and active range of motion, pain on impingement test, and resisted muscle tests) improved in both groups, without significant inter-group difference. Conclusion We found no significant difference between a comprehensive supervised training regimen including heavy training principles, and a home-based training program in patients with SIS.
Collapse
Affiliation(s)
| | - Marcin Szkudlarek
- Reumatologiklinikken i Værløse, Bymidten 11,1, 3500, Værløse, Denmark.,Department of Rheumatology, Zealand University Hospital at Køge, Køge, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ole Rintek Madsen
- Department of Rheumatology and Spine Diseases, Gentofte University Hospital and Rigshospitalet, DK-2900, Hellerup, Denmark
| |
Collapse
|
9
|
González-Rosalén J, Medina-Mirapeix F, Cuerda-Del Pino A, Moreno-Segura N, Gacto-Sánchez M, Martín-San Agustín R. Analysis of Compliance with Time under Tension and Force during Strengthening Exercises with Elastic Bands. Diagnostics (Basel) 2021; 11:diagnostics11112016. [PMID: 34829363 PMCID: PMC8620485 DOI: 10.3390/diagnostics11112016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 11/16/2022] Open
Abstract
Quantifying training variables of a physical exercise modality is essential for an appropriate dosage. In training with elastic bands, time under tension (TUT) and force represent the duration and intensity of this force-training modality. The aims of this study were to evaluate the degree of compliance to TUT prescription for three different scenarios of two exercises and the comparison of the force values obtained versus the estimate values. A total of 29 healthy volunteers were evaluated in a clinical environment under controlled conditions in 3 different scenarios (different velocities or ROMs) of both shoulder abduction and knee extension in 2 sets of 10 repetitions per scenario within a single session. Concentric and isometric phases showed a higher degree of compliance for their TUTs than the eccentric phase TUTs for all scenarios of both exercises, whereas the degree of compliance was higher for the total TUT than for the phases’ TUTs. Additionally, the eccentric phase showed a general tendency to develop for longer time periods than prescribed, whilst the fast scenario showed a higher degree of compliance for isometric phase TUTs and total TUTs than the extant two scenarios in both exercises. On the other hand, the force of the elastic bands tends to be overestimated according to the estimates of the manufacturers. These findings, both those related to the degree of compliance with TUTs and the force analysis, can be used by physiotherapists and other exercise professionals as a reference to achieve a good dosage of routine exercises with elastic bands.
Collapse
Affiliation(s)
- Javier González-Rosalén
- Department of Physiotherapy, University of Valencia, CP 46010 Valencia, Spain; (J.G.-R.); (A.C.-D.P.); (N.M.-S.)
| | | | - Alba Cuerda-Del Pino
- Department of Physiotherapy, University of Valencia, CP 46010 Valencia, Spain; (J.G.-R.); (A.C.-D.P.); (N.M.-S.)
| | - Noemi Moreno-Segura
- Department of Physiotherapy, University of Valencia, CP 46010 Valencia, Spain; (J.G.-R.); (A.C.-D.P.); (N.M.-S.)
| | - Mariano Gacto-Sánchez
- Department of Physiotherapy, University of Murcia, CP 30100 Murcia, Spain; (F.M.-M.); (M.G.-S.)
| | - Rodrigo Martín-San Agustín
- Department of Physiotherapy, University of Valencia, CP 46010 Valencia, Spain; (J.G.-R.); (A.C.-D.P.); (N.M.-S.)
- Correspondence:
| |
Collapse
|
10
|
Burton I. Autoregulation in Resistance Training for Lower Limb Tendinopathy: A Potential Method for Addressing Individual Factors, Intervention Issues, and Inadequate Outcomes. Front Physiol 2021; 12:704306. [PMID: 34421641 PMCID: PMC8375597 DOI: 10.3389/fphys.2021.704306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/06/2021] [Indexed: 01/08/2023] Open
Abstract
Musculoskeletal disorders, such as tendinopathy, are placing an increasing burden on society and health systems. Tendinopathy accounts for up to 30% of musculoskeletal disorders, with a high incidence in athletes and the general population. Although resistance training has shown short-term effectiveness in the treatment of lower limb tendinopathy, more comprehensive exercise protocols and progression methods are required due to poor long-term outcomes. The most common resistance training protocols are predetermined and standardized, which presents significant limitations. Current standardized protocols do not adhere to scientific resistance training principles, consider individual factors, or take the importance of individualized training into account. Resistance training programs in case of tendinopathy are currently not achieving the required intensity and dosage, leading to high recurrence rates. Therefore, better methods for individualizing and progressing resistance training are required to improve outcomes. One potential method is autoregulation, which allows individuals to progress training at their own rate, taking individual factors into account. Despite the finding of their effectiveness in increasing the strength of healthy athletes, autoregulation methods have not been investigated in case of tendinopathy. The purpose of this narrative review was 3-fold: firstly, to give an overview and a critical analysis of the individual factors involved in tendinopathy and current resistance training protocols and their limitations. Secondly, to give an overview of the history, methods, and application of autoregulation strategies both in sports performance and physiotherapy. Finally, a theoretical adaptation of a current tendinopathy resistance training protocol using autoregulation methods is presented, providing an example of how the method could be implemented in clinical practice or future research.
Collapse
Affiliation(s)
- Ian Burton
- National Health Service (NHS) Grampian, Aberdeen, United Kingdom
| |
Collapse
|
11
|
Lackinger C, Grabovac I, Haider S, Kapan A, Winzer E, Stein KV, Dorner TE. Adherence Is More Than Just Being Present: Example of a Lay-Led Home-Based Programme with Physical Exercise, Nutritional Improvement and Social Support, in Prefrail and Frail Community-Dwelling Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4192. [PMID: 33920981 PMCID: PMC8071284 DOI: 10.3390/ijerph18084192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/07/2021] [Accepted: 04/10/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Little is known about the implementation of lifestyle interventions in frail, community-dwelling people. This study highlights different domains of adherence to explain an effectively delivered home-based intervention. METHODS Eighty prefrail and frail persons (≥65 years) participated in a physical training, nutritional, and social support intervention over 24 weeks. A detailed log book was kept for comprehensive documentation in order to assess adherence and further organizational, exercise, and nutritional parameters. RESULTS Participants reached an adherence rate (performed home visits/number of planned visits) of 84.0/80.5% from week 1-12/13-24. Out of those, 59% carried out ≥75% of the offered visits. Older age was associated with a higher adherence rate. A mean of 1.5 (0.6) visits/week (2 were planned) were realized lasting for a mean of 1.5 (0.9) hours (154% of the planned duration). Per visit, 1.2 (0.6) circuits of strength training were performed (60.5% of the planned value) and 0.5 (0.3) nutritional interventions (47%). After twelve months, 4.2% still carried out the home visits regularly and 25.0% occasionally. CONCLUSION Adherence is much more than "being there". Adherence rate and category are limited parameters to describe the implementation of a complex lifestyle intervention, therefore a comprehensive documentation is needed.
Collapse
Affiliation(s)
- Christian Lackinger
- Karl-Landsteiner Institute for Health Promotion Research, 3454 Sitzenberg-Reidling, Austria; (K.V.S.); (T.E.D.)
- Social Insurance Fund for Public Service, Railway and Mining Industries, Gesundheitseinrichtung Sitzenberg-Reidling, 3454 Sitzenberg-Reidling, Austria
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1080 Vienna, Austria; (I.G.); (S.H.); (A.K.); (E.W.)
| | - Sandra Haider
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1080 Vienna, Austria; (I.G.); (S.H.); (A.K.); (E.W.)
| | - Ali Kapan
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1080 Vienna, Austria; (I.G.); (S.H.); (A.K.); (E.W.)
| | - Eva Winzer
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1080 Vienna, Austria; (I.G.); (S.H.); (A.K.); (E.W.)
| | - K. Viktoria Stein
- Karl-Landsteiner Institute for Health Promotion Research, 3454 Sitzenberg-Reidling, Austria; (K.V.S.); (T.E.D.)
- Social Insurance Fund for Public Service, Railway and Mining Industries, Gesundheitseinrichtung Sitzenberg-Reidling, 3454 Sitzenberg-Reidling, Austria
| | - Thomas E. Dorner
- Karl-Landsteiner Institute for Health Promotion Research, 3454 Sitzenberg-Reidling, Austria; (K.V.S.); (T.E.D.)
- Social Insurance Fund for Public Service, Railway and Mining Industries, Gesundheitseinrichtung Sitzenberg-Reidling, 3454 Sitzenberg-Reidling, Austria
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1080 Vienna, Austria; (I.G.); (S.H.); (A.K.); (E.W.)
| |
Collapse
|
12
|
Van de Winckel A, Nawshin T, Byron C. Combining a Hudl App With Telehealth to Increase Home Exercise Program Adherence in People With Chronic Diseases Experiencing Financial Distress: Randomized Controlled Trial. JMIR Form Res 2021; 5:e22659. [PMID: 33640865 PMCID: PMC8075043 DOI: 10.2196/22659] [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: 07/20/2020] [Revised: 09/25/2020] [Accepted: 02/27/2021] [Indexed: 11/30/2022] Open
Abstract
Background Patients with chronic diseases often need to adhere to long-term individualized home exercise programs (HEPs). Limited adherence to long-term exercise given during physical therapy (PT) visits reduces the capacity of exercise to manage or improve symptoms related to chronic disease. In addition, a lower socioeconomic status negatively impacts exercise adherence. To mitigate this, apps that motivate people to exercise could be a viable option. Using an app through telehealth may help adults with chronic diseases to achieve long-term HEP adherence. However, because apps for rehabilitation are an emerging field, the feasibility of the app needs to be evaluated. Objective To address HEP adherence in participants with chronic diseases who are experiencing financial distress, we aim to evaluate the feasibility of and satisfaction with the Hudl Technique app and telehealth and satisfaction with PT care and to monitor HEP adherence and compliance (ie, percentage of participant-recorded videos sent) in participants using the app with telehealth compared with those using standard HEPs on paper. Methods We recruited patients scheduled for outpatient PT. We performed a randomized controlled trial in which the experimental group received weekly HEP demonstrations through app videos on a tablet with feedback on their self-recorded HEP video performance from the telehealth physical therapist. The control group received HEPs on paper without feedback, as is customary in PT practice. Demographic, clinical, and health coverage information was collected for screening and baseline measurements. Adherence and compliance were evaluated. Both groups completed surveys at 8 and 24 weeks on their satisfaction with PT care, and the experimental group also completed a survey on their satisfaction with the app with telehealth use. Descriptive and nonparametric statistics were used for within-group and between-group comparisons and analyzed with JMP, version 13. Results Overall, 45 adults with chronic diseases who were experiencing financial distress were randomized into experimental (23/45, 51%) and control (22/45, 49%) groups, with 74% (17/23) and 86% (19/22) participants completing the 24-week HEP, respectively. The experimental group had an HEP adherence frequency of 4 (SD 2) to 5 (SD 2) times per week at 8 and 24 weeks (P=.14), whereas HEP adherence decreased in the control group from 4 (SD 2) to 3 (SD 2) times per week (P=.07), with a significant difference (P=.01) between groups at 24 weeks. Of the total participants, 68% (15/22) sent videos. They sent 68% (16/24) of the requested number of videos on average. The average score for PT care satisfaction was maintained at 87% in the experimental group (P=.99), whereas it decreased from 89% at 8 weeks to 74% at 24 weeks (P=.008) in the control group. App-related adverse events were not observed. Conclusions The Hudl app/telehealth platform is feasible for delivering HEPs and maintaining HEP adherence in participants with chronic diseases who are experiencing financial distress. Trial Registration ClinicalTrials.gov NCT02659280; https://clinicaltrials.gov/ct2/show/NCT02659280
Collapse
Affiliation(s)
- Ann Van de Winckel
- Division of Physical Therapy, Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Tanjila Nawshin
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Casey Byron
- Hennepin County Medical Center, Minneapolis, MN, United States
| |
Collapse
|
13
|
Burns D, Boyer P, Razmjou H, Richards R, Whyne C. Adherence Patterns and Dose Response of Physiotherapy for Rotator Cuff Pathology: Longitudinal Cohort Study. JMIR Rehabil Assist Technol 2021; 8:e21374. [PMID: 33704076 PMCID: PMC8082948 DOI: 10.2196/21374] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/19/2020] [Accepted: 12/12/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Physiotherapy is considered to be essential for the successful operative and nonoperative management of rotator cuff pathology; however, the extent to which patients adhere to assigned physiotherapy activities and how this impacts recovery is unknown. OBJECTIVE The purpose of this study was to measure the rate and patterns of participation in physiotherapy for rotator cuff disorders, assess the dose response between physiotherapy activity and recovery, and explore patient factors predictive of physiotherapy participation. METHODS We report a prospective longitudinal study of 42 patients undergoing physiotherapy for symptomatic rotator cuff pathology. The patients were issued a smartwatch that recorded inertial sensor data while they performed physiotherapy exercises both in the clinic and in the home setting. A machine learning approach was used to assess total physiotherapy participation from smartwatch inertial data. Primary outcomes were the Disabilities of the Arm Shoulder and Hand and numeric pain rating scale assessed every 4 weeks until 12 weeks follow-up. The relationships between participation, outcomes, and clinical patient variables were assessed in univariable analyses. RESULTS Mean physiotherapy exercise participation in clinic and at home were 11 minutes per week and 33 minutes per week, respectively, with patients participating in physiotherapy on 41% of days assigned to treatment. Home physiotherapy participation decreased significantly over time (P=.03). There was a statistically significant and clinically meaningful relationship between cumulative physiotherapy participation and recovery demonstrated by pain scores at 8 weeks (P=.02) and 12 weeks (P=.05) and disability scores at 8 weeks (P=.04) and 12 weeks (P=.04). Low patient expectations and self-efficacy were associated with low rates of physiotherapy participation. CONCLUSIONS There was a low rate of participation in home shoulder physiotherapy exercise, and a statistically and clinically significant dose response of physiotherapy on treatment outcome in patients with rotator cuff pathology. The findings highlight the opportunity to develop novel methods and strategies to improve the participation in and efficacy of physiotherapy exercises for rotator cuff disorders. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/17841.
Collapse
Affiliation(s)
- David Burns
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Philip Boyer
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Helen Razmjou
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Working Condition Program, Holland Orthopedic and Arthritic Centre, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Robin Richards
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Cari Whyne
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
14
|
Spinal Manipulation and Electrical Dry Needling in Patients With Subacromial Pain Syndrome: A Multicenter Randomized Clinical Trial. J Orthop Sports Phys Ther 2021; 51:72-81. [PMID: 32857944 DOI: 10.2519/jospt.2021.9785] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To compare the effects of spinal thrust manipulation and electrical dry needling (TMEDN group) to those of nonthrust peripheral joint/soft tissue mobilization, exercise, and interferential current (NTMEX group) on pain and disability in patients with subacromial pain syndrome (SAPS). DESIGN Randomized, single-blinded, multicenter parallel-group trial. METHODS Patients with SAPS were randomized into the TMEDN group (n = 73) or the NTMEX group (n = 72). Primary outcomes included the Shoulder Pain and Disability Index and the numeric pain-rating scale. Secondary outcomes included the global rating of change scale (GROC) and medication intake. The treatment period was 6 weeks, with follow-ups at 2 weeks, 4 weeks, and 3 months. RESULTS At 3 months, the TMEDN group experienced greater reductions in shoulder pain and disability (P<.001) compared to the NTMEX group. Effect sizes were large in favor of the TMEDN group. At 3 months, a greater proportion of patients within the TMEDN group achieved a successful outcome (GROC score of 5 or greater) and stopped taking medication (P<.001). CONCLUSION Cervicothoracic and upper-rib thrust manipulation combined with electrical dry needling resulted in greater reductions in pain, disability, and medication intake than nonthrust peripheral joint/soft tissue mobilization, exercise, and interferential current in patients with SAPS. The effects were maintained at 3 months. J Orthop Sports Phys Ther 2021;51(2):72-81. Epub 28 Aug 2020. doi:10.2519/jospt.2021.9785.
Collapse
|
15
|
Teljigovic S, Søgaard K, Sandal LF, Dalager T, Nielsen NO, Sjøgaard G, Holm L. Individualised physical exercise training and enhanced protein intake in older citizens during municipality-based rehabilitation: protocol for a randomised controlled trial. BMJ Open 2020; 10:e041605. [PMID: 33243811 PMCID: PMC7692977 DOI: 10.1136/bmjopen-2020-041605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/21/2020] [Accepted: 10/28/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Successful rehabilitation of the growing number of older citizens receiving healthcare services can lead to preservation of functional independence and improvement in quality of life. Adequate intake of dietary protein and physical training are key factors in counteracting the age-related decline in strength performance and physical function. However, during rehabilitation, many older people/persons have insufficient protein intake, and difficulties in performing exercise training with sufficient intensity and volume. The primary aim of this trial is to investigate if individualised physical exercise training programmes combined with increased protein intake (IPET+P) can improve measures on all International Classification of Functioning, Disability and Health levels, such as strength, gait speed and health-related quality of life, when compared with care as usual in municipality-based rehabilitation alone (usual care, UC) or care as usual in combination with increased protein intake (UC+P). Further, the trial investigates whether UC+P will potentiate more significant improvements in outcome measures than UC. METHODS AND ANALYSIS The trial is a three-armed multicentre, block-randomised controlled trial consisting of a 12-week intervention period with a 1-year follow-up. Citizens above 65 years referred to rehabilitation in the municipality without restricting comorbidities are eligible. Participants are randomised to either a UC group, a UC group with protein supplementation receiving 27.5 g protein/day (UC+P), or an IPET+P supplementation of 27.5 g protein/day. The Short Musculoskeletal Function Assessment questionnaire is the primary outcome. ETHICS AND DISSEMINATION Approvals from The Ethics Committee in Region Zealand, Denmark (SJ-758), and the General Data Protection Regulation at the University of Southern Denmark, Odense (10.330) have been obtained. TRIAL REGISTRATION NUMBER NCT04091308.
Collapse
Affiliation(s)
- Sanel Teljigovic
- Department of Physiotherapy, University College Absalon, Naestved, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Louise Fleng Sandal
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Tina Dalager
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | - Gisela Sjøgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lars Holm
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
16
|
COVID-19 and Social Isolation: A Case for Why Home-Based Resistance Training Is Needed to Maintain Musculoskeletal and Psychosocial Health for Older Adults. J Aging Phys Act 2020; 29:353-359. [PMID: 32796139 DOI: 10.1123/japa.2020-0131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/26/2020] [Accepted: 06/17/2020] [Indexed: 11/18/2022]
Abstract
The coronavirus disease outbreak in China has become the world's leading health headline and is causing major panic and public concerns. Public health guidelines in many countries are suggesting that people stay at home to avoid human-to-human transmission of the virus, which may lead to reduced physical activity and greater feelings of isolation. Such effects may be particularly problematic in older adults due to their reduced physical capacities and their potential for increased mental health issues, such as anxiety and depression. A potential way to minimize many of these side effects of stay-at-home guidelines may be progressive home-based resistance training. A simple way to provide progressive overload in home-based resistance training may involve elastic resistance, which has been demonstrated to provide similar benefits to traditional resistance training equipment typically found in gymnasiums. Recommendations on how older adults can safely and effectively perform elastic resistance training at home are provided.
Collapse
|
17
|
Chen YP, Lin CY, Tsai MJ, Chuang TY, Lee OKS. Wearable Motion Sensor Device to Facilitate Rehabilitation in Patients With Shoulder Adhesive Capsulitis: Pilot Study to Assess Feasibility. J Med Internet Res 2020; 22:e17032. [PMID: 32457026 PMCID: PMC7413285 DOI: 10.2196/17032] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/04/2020] [Accepted: 05/14/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Adhesive capsulitis (AC) of the shoulder is a common disorder that painfully reduces the shoulder range of motion (ROM) among middle-aged individuals. Although physical therapy with home-based exercises is widely advised to restore ROM in the treatment of AC, clinical results vary owing to inconsistent patient compliance. OBJECTIVE In this study, we aimed to verify the feasibility of a treatment model that involves applying a wearable motion sensor device to assist patients conduct home-based exercises to improve training compliance and the accuracy of exercises, with the ultimate goal of improving the functional recovery of patients with AC. METHODS The motion sensor device was comprised of inertial measurement unit-based sensors and mobile apps for patients and physicians, offering shoulder mobility tracing, home-based exercise support, and progress monitoring. The interrater reliability of shoulder mobility measurement using the motion sensor device on 10 healthy participants and 15 patients with AC was obtained using an intraclass correlation coefficient analysis and compared with the assessments performed by two highly experienced physicians. A pilot prospective control trial was then carried out to allocate the 15 patients with AC to two groups: home-based exercise group and motion sensor-assisted rehabilitation group. Changes in active and passive shoulder ROM, pain and functional scores, and exercise completion rates were compared between the groups during a treatment period of 3 months. RESULTS Shoulder ROM, as measured using the motion sensor device, exhibited good to excellent reliability based on the comparison with the measurements of two physicians (intraclass correlation coefficient range, 0.771 to 0.979). Compared with patients with AC in the home-based exercise group, those in the motion sensor-assisted rehabilitation group exhibited better shoulder mobility and functional recovery and a higher exercise completion rate during and after 3 months of rehabilitation. CONCLUSIONS Motion sensor device-assisted home-based rehabilitation for the treatment of AC is a useful treatment model for telerehabilitation that enhances the compliance of patients through training, thus improving functional recovery. This helps overcome important obstacles in physiotherapy at home by providing comprehensible and easily accessible exercise instructions, enhancing compliance, ensuring the correctness of exercise, and monitoring the progress of patients.
Collapse
Affiliation(s)
- Yu-Pin Chen
- Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan.,Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chung-Ying Lin
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, China (Hong Kong)
| | - Ming-Jr Tsai
- Department of Orthopedic Surgery, Puli Christian Hospital, Nantou, Taiwan
| | - Tai-Yuan Chuang
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Oscar Kuang-Sheng Lee
- Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan.,Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan
| |
Collapse
|
18
|
Burns D, Razmjou H, Shaw J, Richards R, McLachlin S, Hardisty M, Henry P, Whyne C. Adherence Tracking With Smart Watches for Shoulder Physiotherapy in Rotator Cuff Pathology: Protocol for a Longitudinal Cohort Study. JMIR Res Protoc 2020; 9:e17841. [PMID: 32623366 PMCID: PMC7381014 DOI: 10.2196/17841] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/26/2020] [Accepted: 04/26/2020] [Indexed: 12/12/2022] Open
Abstract
Background Physiotherapy is essential for the successful rehabilitation of common shoulder injuries and following shoulder surgery. Patients may receive some training and supervision for shoulder physiotherapy through private pay or private insurance, but they are typically responsible for performing most of their physiotherapy independently at home. It is unknown how often patients perform their home exercises and if these exercises are performed correctly without supervision. There are no established tools for measuring this. It is, therefore, unclear if the full benefit of shoulder physiotherapy treatments is being realized. Objective The proposed research will (1) validate a smartwatch and machine learning (ML) approach for evaluating adherence to shoulder exercise participation and technique in a clinical patient population with rotator cuff pathology; (2) quantify the rate of home physiotherapy adherence, determine the effects of adherence on recovery, and identify barriers to successful adherence; and (3) develop and pilot test an ethically conscious adherence-driven rehabilitation program that individualizes patient care based on their capacity to effectively participate in their home physiotherapy. Methods This research will be conducted in 2 phases. The first phase is a prospective longitudinal cohort study, involving 120 patients undergoing physiotherapy for rotator cuff pathology. Patients will be issued a smartwatch that will record 9-axis inertial sensor data while they perform physiotherapy exercises both in the clinic and in the home setting. The data collected in the clinic under supervision will be used to train and validate our ML algorithms that classify shoulder physiotherapy exercise. The validated algorithms will then be used to assess home physiotherapy adherence from the inertial data collected at home. Validated outcome measures, including the Disabilities of the Arm, Shoulder, and Hand questionnaire; Numeric Pain Rating Scale; range of motion; shoulder strength; and work status, will be collected pretreatment, monthly through treatment, and at a final follow-up of 12 months. We will then relate improvement in patient outcomes to measured physiotherapy adherence and patient baseline variables in univariate and multivariate analyses. The second phase of this research will involve the evaluation of a novel rehabilitation program in a cohort of 20 patients. The program will promote patient physiotherapy engagement via the developed technology and support adherence-driven care decisions. Results As of December 2019, 71 patients were screened for enrollment in the noninterventional validation phase of this study; 65 patients met the inclusion and exclusion criteria. Of these, 46 patients consented and 19 declined to participate in the study. Only 2 patients de-enrolled from the study and data collection is ongoing for the remaining 44. Conclusions This study will provide new and important insights into shoulder physiotherapy adherence, the relationship between adherence and recovery, barriers to better adherence, and methods for addressing them. International Registered Report Identifier (IRRID) DERR1-10.2196/17841
Collapse
Affiliation(s)
- David Burns
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada.,Holland Bone and Joint Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Helen Razmjou
- Holland Bone and Joint Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Working Condition Program, Holland Orthopedic and Arthritic Centre, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - James Shaw
- Women's College Research Institute, Toronto, ON, Canada.,Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada
| | - Robin Richards
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada.,Holland Bone and Joint Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Stewart McLachlin
- Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Michael Hardisty
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada.,Holland Bone and Joint Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Patrick Henry
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada.,Holland Bone and Joint Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Cari Whyne
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada.,Holland Bone and Joint Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| |
Collapse
|
19
|
Abate M, Di Carlo L, Belluati A, Salini V. Factors associated with positive outcomes of platelet-rich plasma therapy in Achilles tendinopathy. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:859-867. [PMID: 32112184 DOI: 10.1007/s00590-020-02642-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/22/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The efficacy of platelet-rich plasma in the treatment for Achilles tendinopathy is debated. Therefore, it is important to know which factors, related to the subjects and/or the disease, are associated with positive or negative outcomes. Aim of this study was to evaluate in a large cohort of patients with Achilles mid-portion tendinopathy which variables were independently associated with a positive outcome after platelet-rich plasma treatment. MATERIAL AND METHODS Eighty-four subjects with Achilles tendinopathy were evaluated by means of VISA-A score and ultrasound and treated with a single platelet-rich plasma injection once a week for 3 weeks. Afterward, a rehabilitation program, based on eccentric training, was implemented. At 3 and 6 months, the relationship between the mean VISA-A score and the following putative predictors was evaluated: sex, age, physical activity, sport, smoking, metabolic risk factors, BMI, symptoms duration, tendon damage, neovessels, adherence to eccentric training. Finally, the percentage of clinically evident positive outcomes (defined as an increase in VISA-A score ≥ 20 points) related to each variable was computed. RESULTS At final follow-up, using the General Linear Model for Repeated Measures procedure, male sex (0.02), age ≤ 40 (0.05) and adequate eccentric training (0.02) were found to be independently associated with a significant increase in the mean VISA-A score. Moreover, the clinically evident positive outcomes, as previously defined, were significantly associated with male sex (0.01), age ≤ 40 (0.000), BMI ≤ 25 (0.001), symptoms duration ≤ 12 months (0.02) and good adherence to eccentric training (0.004). CONCLUSION Younger age, male sex and good adherence to eccentric training can be considered predictors of better results after platelet-rich plasma therapy in Achilles tendinopathy.
Collapse
Affiliation(s)
- Michele Abate
- Department of Medicine and Science of Aging, University G. D'Annunzio, Chieti-Pescara, Via dei Vestini 31, 66013, Chieti Scalo, CH, Italy.
| | - Luigi Di Carlo
- Department of Medicine and Science of Aging, University G. D'Annunzio, Chieti-Pescara, Via dei Vestini 31, 66013, Chieti Scalo, CH, Italy
| | - Alberto Belluati
- Division of Orthopedics and Traumatology, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Vincenzo Salini
- Division of Orthopedics and Traumatology, San Raffaele Hospital, Milan, Italy
| |
Collapse
|
20
|
Yang J, Xu H, Liang J, Jeong J, Xu T. Monitoring the training dose and acute fatigue response during elbow flexor resistance training using a custom-made resistance band. PeerJ 2020; 8:e8689. [PMID: 32140314 PMCID: PMC7047867 DOI: 10.7717/peerj.8689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/05/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Home-based resistance training offers an alternative to traditional, hospital-based or rehabilitation center-based resistance training and has attracted much attention recently. However, without the supervision of a therapist or the assistance of an exercise monitoring system, one of the biggest challenges of home-based resistance training is that the therapist may not know if the patient has performed the exercise as prescribed. A lack of objective measurements limits the ability of researchers to evaluate the outcome of exercise interventions and choose suitable training doses. OBJECTIVE To create an automated and objective method for segmenting resistance force data into contraction phase-specific segments and calculate the repetition number and time-under-tension (TUT) during elbow flexor resistance training. A pilot study was conducted to evaluate the performance of the segmentation algorithm and to show the capability of the system in monitoring the compliance of patients to a prescribed training program in a practical resistance training setting. METHODS Six subjects (three male and three female) volunteered to participate in a fatigue and recovery experiment (5 min intermittent submaximal contraction (ISC); 1 min rest; 2 min ISC). A custom-made resistance band was used to help subjects perform biceps curl resistance exercises and the resistance was recorded through a load cell. The maximum and minimum values of the force-derivative were obtained as distinguishing features and a segmentation algorithm was proposed to divide the biceps curl cycle into concentric, eccentric and isometric contraction, and rest phases. Two assessors, who were unfamiliar with the study, were recruited to manually pick the visually observed cut-off point between two contraction phases and the TUT was calculated and compared to evaluate performance of the segmentation algorithm. RESULTS The segmentation algorithm was programmatically implemented and the repetition number and contraction-phase specific TUT were calculated. During isometric, the average TUT (3.75 ± 0.62 s) was longer than the prescribed 3 s, indicating that most subjects did not perform the exercise as prescribed. There was a good TUT agreement and contraction segment agreement between the proposed algorithm and the assessors. CONCLUSION The good agreement in TUT between the proposed algorithm and the assessors indicates that the proposed algorithm can correctly segment the contraction into contraction phase-specific parts, thereby providing clinicians and researchers with an automated and objective method for quantifying home-based elbow flexor resistance training. The instrument is easy to use and cheap, and the segmentation algorithm is programmatically implemented, indicating good application prospect of the method in a practical setting.
Collapse
Affiliation(s)
- Jingjing Yang
- Faculty of Civil Aviation and Aeroautics, Kunming University of Science and Technology, Kunming, China
| | - Hongbin Xu
- College of Mechanical Engineering, Chongqing University of Technology, Chongqing, China
| | - Juke Liang
- College of Mechanical Engineering, Chongqing University of Technology, Chongqing, China
| | - Jongyeob Jeong
- Graduate School of Sciences and Technology for Innovation, Yamaguchi University, Ube, Japan
| | - Taojin Xu
- College of Mechanical Engineering, Chongqing University of Technology, Chongqing, China
- Graduate School of Sciences and Technology for Innovation, Yamaguchi University, Ube, Japan
| |
Collapse
|
21
|
Riel H, Jensen MB, Olesen JL, Vicenzino B, Rathleff MS. Self-dosed and pre-determined progressive heavy-slow resistance training have similar effects in people with plantar fasciopathy: a randomised trial. J Physiother 2019; 65:144-151. [PMID: 31204294 DOI: 10.1016/j.jphys.2019.05.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/13/2019] [Accepted: 05/24/2019] [Indexed: 12/15/2022] Open
Abstract
QUESTION For people with plantar fasciopathy, is a 12-week self-dosed heavy-slow resistance training program more beneficial than a 12-week pre-determined heavy-slow resistance training program? DESIGN A randomised trial with concealed allocation, partial blinding, and intention-to-treat analysis. PARTICIPANTS Seventy people with plantar fasciopathy confirmed on ultrasonography. INTERVENTION Both groups performed a repeated heel raise exercise in standing for 12 weeks. Participants in the experimental group were self-dosed (ie, they performed as many sets as possible with as heavy a load as possible, but no heavier than 8 repetition maximum). The exercise regimen for the control group was pre-determined (ie, it followed a standardised progressive protocol). OUTCOME MEASURES The primary outcome was the Foot Health Status Questionnaire pain domain. Secondary outcomes included: a 7-point Likert scale of Global Rating of Change dichotomised to 'improved' or 'not improved'; Patient Acceptable Symptom State defined as when participants felt no further need for treatment; and number of training sessions performed. RESULTS There was no significant between-group difference in the improvement of Foot Health Status Questionnaire pain after 12 weeks (adjusted MD -6.9 points, 95% CI -15.5 to 1.7). According to the Global Rating of Change, 24 of 33 in the experimental group and 20 of 32 in the control group were improved (RR = 1.16, 95% CI 0.83 to 1.64). Only four participants achieved Patient Acceptable Symptom State: three of 35 in the experimental group and one of 35 in the control group. No significant between-group difference was found in the number of training sessions that were performed (MD -2 sessions, 95% CI -8 to 3). CONCLUSION Self-dosed and pre-determined heavy-slow resistance exercise programs are associated with similar effects on plantar fasciopathy pain and other outcomes over 12 weeks. Advising people with plantar fasciopathy to self-dose their slow-heavy resistance training regimen did not substantially increase the achieved dose compared with a pre-determined regimen. These regimens are not sufficient to achieve acceptable symptom state in the majority of people with plantar fasciopathy. REGISTRATION ClinicalTrials.govNCT03304353.
Collapse
Affiliation(s)
- Henrik Riel
- Center for General Practice at Aalborg University, Aalborg, Denmark.
| | | | | | - Bill Vicenzino
- Sports Injury Rehabilitation and Prevention for Health Research Unit, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Michael Skovdal Rathleff
- Center for General Practice at Aalborg University, Aalborg, Denmark; Department of Physical and Occupational Therapy, Aalborg University Hospital, Brisbane, Australia; SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
| |
Collapse
|
22
|
Clausen MB, Bandholm T, Rathleff MS, Christensen KB, Zebis MK, Graven-Nielsen T, Hölmich P, Thorborg K. The Strengthening Exercises in Shoulder Impingement trial (The SExSI-trial) investigating the effectiveness of a simple add-on shoulder strengthening exercise programme in patients with long-lasting subacromial impingement syndrome: Study protocol for a pragmatic, assessor blinded, parallel-group, randomised, controlled trial. Trials 2018; 19:154. [PMID: 29499710 PMCID: PMC5833202 DOI: 10.1186/s13063-018-2509-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/25/2018] [Indexed: 01/26/2023] Open
Abstract
Background Subacromial impingement syndrome (SIS) is a painful, and often long lasting, shoulder condition affecting patient function and quality of life. In a recent study, we observed major strength impairments in shoulder external rotation and abduction (~30%) in a population of patients with pronounced and long-lasting SIS. However, the current rehabilitation of such strength impairments may be inadequate, with novel rehabilitation programmes including exercise therapy only improving external rotation strength by 4–13%. As these previous studies are the basis of current practice, this suggests that the strengthening component could be inadequate in the rehabilitation of these patients, and it seems likely that more emphasis should be placed on intensifying this part of the rehabilitation. The purpose of this study is to investigate the effectiveness of a programme consisting of progressive home-based resistance training using an elastic band, aimed at improving shoulder external rotation and abduction strength, added to usual care and initiated shortly after diagnosis has been established. Methods A pragmatic randomised controlled superiority trial will be conducted, including 200 patients with pronounced and long-lasting SIS, diagnosed using predefined criteria. Participants will be randomised to receive either an add-on intervention of progressive home-based resistance training using an elastic band in addition to usual care or usual care alone in a 1:1 allocation ratio. The randomisation sequence is computer generated, with permuted blocks of random sizes. The primary outcome will be change in Shoulder Pain And Disability Index (SPADI) score from baseline to 16 weeks follow-up. Outcome assessors are blinded to group allocation. Intervention receivers will be kept blind to treatment allocation through minimal information about the content of the add-on intervention and control condition until group allocation is final. Analyses are performed by blinded data analysts. Discussion If effective, the simple shoulder strengthening exercise programme investigated in this trial could easily be added to usual care. The usefulness of the trial is further supported by the magnitude of the problem, the information gained from the study and the pragmatism, patient centeredness and transparency of the trial. Trial registration The trial is pre-registered at ClinicalTrials.gov with the ID NCT02747251 on April 19, 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2509-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Mikkel Bek Clausen
- Department of Physiotherapy and Occupational Therapy, Faculty of Health and Technology, Metropolitan University College, Sigurdsgade 26, DK-2200, Copenhagen N, Denmark. .,Sports Orthopaedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegårds Allé 30, DK-2650, Hvidovre, Denmark. .,Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital, Amager-Hvidovre, Kettegårds Allé 30, DK-2650, Hvidovre, Denmark.
| | - Thomas Bandholm
- Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital, Amager-Hvidovre, Kettegårds Allé 30, DK-2650, Hvidovre, Denmark.,Clinical Research Centre (056), Copenhagen University Hospital, Amager-Hvidovre, Kettegårds Allé 30, 2650, Hvidovre, Denmark
| | - Michael Skovdal Rathleff
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Health Science and Technology, Faculty of Medicine, Center for Sensory-Motor Interaction (SMI), Aalborg University, Aalborg, Denmark
| | | | - Mette Kreutzfeldt Zebis
- Department of Physiotherapy and Occupational Therapy, Faculty of Health and Technology, Metropolitan University College, Sigurdsgade 26, DK-2200, Copenhagen N, Denmark
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7, Aalborg, Denmark
| | - Per Hölmich
- Sports Orthopaedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegårds Allé 30, DK-2650, Hvidovre, Denmark
| | - Kristian Thorborg
- Sports Orthopaedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegårds Allé 30, DK-2650, Hvidovre, Denmark.,Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital, Amager-Hvidovre, Kettegårds Allé 30, DK-2650, Hvidovre, Denmark
| |
Collapse
|
23
|
RIEL HENRIK, MATTHEWS MARK, VICENZINO BILL, BANDHOLM THOMAS, THORBORG KRISTIAN, RATHLEFF MICHAELSKOVDAL. Feedback Leads to Better Exercise Quality in Adolescents with Patellofemoral Pain. Med Sci Sports Exerc 2018; 50:28-35. [DOI: 10.1249/mss.0000000000001412] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
24
|
Rathleff CR, Bandholm T, Spaich EG, Jorgensen M, Andreasen J. Unsupervised progressive elastic band exercises for frail geriatric inpatients objectively monitored by new exercise-integrated technology-a feasibility trial with an embedded qualitative study. Pilot Feasibility Stud 2017; 3:56. [PMID: 29158914 PMCID: PMC5683376 DOI: 10.1186/s40814-017-0202-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 10/30/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Frailty is a serious condition frequently present in geriatric inpatients that potentially causes serious adverse events. Strength training is acknowledged as a means of preventing or delaying frailty and loss of function in these patients. However, limited hospital resources challenge the amount of supervised training, and unsupervised training could possibly supplement supervised training thereby increasing the total exercise dose during admission. A new valid and reliable technology, the BandCizer, objectively measures the exact training dosage performed. The purpose was to investigate feasibility and acceptability of an unsupervised progressive strength training intervention monitored by BandCizer for frail geriatric inpatients. METHODS This feasibility trial included 15 frail inpatients at a geriatric ward. At hospitalization, the patients were prescribed two elastic band exercises to be performed unsupervised once daily. A BandCizer Datalogger enabling measurement of the number of sets, repetitions, and time-under-tension was attached to the elastic band. The patients were instructed in performing strength training: 3 sets of 10 repetitions (10-12 repetition maximum (RM)) with a separation of 2-min pauses and a time-under-tension of 8 s. The feasibility criterion for the unsupervised progressive exercises was that 33% of the recommended number of sets would be performed by at least 30% of patients. In addition, patients and staff were interviewed about their experiences with the intervention. RESULTS Four (27%) out of 15 patients completed 33% of the recommended number of sets. For the total sample, the average percent of performed sets was 23% and for those who actually trained (n = 12) 26%. Patients and staff expressed a general positive attitude towards the unsupervised training as an addition to the supervised training sessions. However, barriers were also described-especially constant interruptions. CONCLUSIONS Based on the predefined criterion for feasibility, the unsupervised training was not feasible, although the criterion was almost met. The patients and staff mainly expressed positive attitudes towards the unsupervised training. As even a small training dosage has been shown to improve the physical performance of geriatric inpatients, the proposed intervention might be relevant if the interruptions are decreased in future large-scale trials and if the adherence is increased. TRIAL REGISTRATION ClinicalTrials.gov: NCT02702557, February 29, 2016. Data Protection Agency: 2016-42, February 25, 2016. Ethics Committee: No registration needed, December 8, 2015 (e-mail correspondence).
Collapse
Affiliation(s)
- C. R. Rathleff
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7-D3, 9220 Aalborg, Denmark
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - T. Bandholm
- Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Department of Orthopedic Surgery, Clinical Research Center, Amager-Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - E. G. Spaich
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7-D3, 9220 Aalborg, Denmark
| | - M. Jorgensen
- Center for PREdiction and prevention of FALLs (PREFALL) Department of Geriatrics, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
| | - J. Andreasen
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| |
Collapse
|
25
|
Stütz T, Emsenhuber G, Huber D, Domhardt M, Tiefengrabner M, Oostingh GJ, Fötschl U, Matis N, Ginzinger S. Mobile Phone-Supported Physiotherapy for Frozen Shoulder: Feasibility Assessment Based on a Usability Study. JMIR Rehabil Assist Technol 2017; 4:e6. [PMID: 28729234 PMCID: PMC5544899 DOI: 10.2196/rehab.7085] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 12/09/2016] [Accepted: 04/29/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with frozen shoulder show limited shoulder mobility often accompanied by pain. Common treatment methods include physiotherapy, pain medication, administration of corticosteroids, and surgical capsulotomy. Frozen shoulder often lasts from months to years and mostly affects persons in the age group of 40 to 70 years. It severely reduces the quality of life and the ability to work. OBJECTIVE The objective of this study was to evaluate the feasibility of a mobile health (mHealth) intervention that supports patients affected by "stage two" frozen shoulder. Patients were supported with app-based exercise instructions and tools to monitor their training compliance and progress. These training compliance and progress data supplement the patients' oral reports to the physiotherapists and physicians and can assist them in therapy adjustment. METHODS In order to assess the feasibility of the mHealth intervention, a pilot study of a newly developed app for frozen shoulder patients was conducted with 5 patients for 3 weeks. The main function of the app was the instruction for exercising at home. Standardized questionnaires on usability such as System Usability Scale (SUS) and USE (Usefulness, Satisfaction, and Ease of use), and Technology Acceptance Model-2 (TAM-2) were completed by the study participants at the end of the study. Additionally, a nonstandardized questionnaire was completed by all patients. The correctness of the exercises as conducted by the patients was assessed by a physiotherapist at the end of the study. The mobility of the shoulder and pain in shoulder movement was assessed by a physiotherapist at the start and the end of the study. RESULTS The pilot study was successfully conducted, and the app was evaluated by the patients after 3 weeks. The results of the standardized questionnaires showed high acceptance (TAM-2) and high usability (SUS) of the developed app. The overall usability of the system as assessed by the SUS questionnaire was very good (an average score of 88 out of 100). The average score of the TAM-2 questionnaire on the intention to further use the app was 4.2 out of 5, which indicated that most patients would use the app if further available. The results of the USE questionnaires highlighted that the patients learned how to use the app easily (an average score of 4.2 out of 5) and were satisfied with the app (an average score of 4.7 out of 5). The frequency of app usage and training was very high based on patient reports and verified by analysis of the usage data. The patients conducted the exercises almost flawlessly. CONCLUSIONS Our results indicate the feasibility of the mHealth intervention, as the app was easy to use and frequently used by the patients. The app supported the patients' physiotherapy by providing clear exercising instructions.
Collapse
Affiliation(s)
- Thomas Stütz
- SmartHealthCheck Project, Department of Multimedia Technology, University of Applied Sciences Salzburg, Puch / Salzburg, Austria
| | - Gerlinde Emsenhuber
- SmartHealthCheck Project, Department of Multimedia Technology, University of Applied Sciences Salzburg, Puch / Salzburg, Austria
| | - Daniela Huber
- SmartHealthCheck Project, Department of Physiotherapy, University of Applied Sciences Salzburg, Puch / Salzburg, Austria
| | - Michael Domhardt
- SmartHealthCheck Project, Department of Multimedia Technology, University of Applied Sciences Salzburg, Puch / Salzburg, Austria
| | - Martin Tiefengrabner
- SmartHealthCheck Project, Department of Multimedia Technology, University of Applied Sciences Salzburg, Puch / Salzburg, Austria
| | - Gertie Janneke Oostingh
- SmartHealthCheck Project, Department of Biomedical Sciences, University of Applied Sciences Salzburg, Puch / Salzburg, Austria
| | - Ulrike Fötschl
- SmartHealthCheck Project, Department of Biomedical Sciences, University of Applied Sciences Salzburg, Puch / Salzburg, Austria
| | - Nicholas Matis
- Ambulatory Shoulder Care, Department of Orthopedics and Traumatology, University Hospital Salzburg (SALK), Salzburg, Austria
| | - Simon Ginzinger
- SmartHealthCheck Project, Department of Multimedia Technology, University of Applied Sciences Salzburg, Puch / Salzburg, Austria
| |
Collapse
|
26
|
Kearns C. Prescription play: A primer on innovative use of video games technology in healthcare. J Vis Commun Med 2017; 38:152-63. [PMID: 26828542 DOI: 10.3109/17453054.2015.1100981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
As technology evolves it becomes increasingly accessible to the masses to own, develop for, and distribute global healthcare solutions with. In this paper the author presents a series of project case examples exemplifying current medical applications of new media and technology, with suggestions for potential areas of further research and development. The author encourages a multi-disciplinary approach for designing effective and engaging games to optimise delivery of medically useful content and therapeutic strategies.
Collapse
|
27
|
Amis J. The Split Second Effect: The Mechanism of How Equinus Can Damage the Human Foot and Ankle. Front Surg 2016; 3:38. [PMID: 27512692 PMCID: PMC4961717 DOI: 10.3389/fsurg.2016.00038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/14/2016] [Indexed: 01/03/2023] Open
Abstract
We are currently in the process of discovering that many, if not the majority, of the non-traumatic acquired adult foot and ankle problems are caused by a singular etiology: non-neuromuscular equinus or the isolated gastrocnemius contracture. There is no question that this biomechanical association exists and in time much more will be uncovered. There are three basic questions that must be answered: why would our calves tighten as we normally age, how does a tight calf, or equinus, actually cause problems remotely in the foot and ankle, and how do the forces produced by equinus cause so many seemingly unrelated pathologies in the foot and ankle? The purpose of this paper is to address the second question: how does a tight calf mechanically cause problems remotely in the foot and ankle? There has been little evidence in the literature addressing the biomechanical mechanisms by which equinus creates damaging forces upon the foot and ankle, and as a result, a precise, convincing mechanism is still lacking. Thus, the mere concept that equinus has anything to do with foot pathology is generally unknown or disregarded. The split second effect, described here, defines exactly how the silent equinus contracture creates incremental and significant damage and injury to the human foot and ankle resulting in a wide variety of pathological conditions. The split second effect is a dissenting theory based on 30 years of clinical and academic orthopedic foot and ankle experience, keen clinical observation along the way, and review of the developing literature, culminating in examination of many hours of slow motion video of normal and abnormal human gait. To my knowledge, no one has ever described the mechanism in detail this precise.
Collapse
Affiliation(s)
- James Amis
- Department of Orthopaedic Surgery, University of Cincinnati , Cincinnati, OH , USA
| |
Collapse
|
28
|
Riel H, Matthews M, Vicenzino B, Bandholm T, Thorborg K, Rathleff MS. Efficacy of live feedback to improve objectively monitored compliance to prescribed, home-based, exercise therapy-dosage in 15 to 19 year old adolescents with patellofemoral pain- a study protocol of a randomized controlled superiority trial (The XRCISE-AS-INSTRUcted-1 trial). BMC Musculoskelet Disord 2016; 17:242. [PMID: 27250984 PMCID: PMC4890272 DOI: 10.1186/s12891-016-1103-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 05/27/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Patellofemoral pain is one of the most frequent knee conditions among adolescents with a prevalence of 7 %. Evidence-based treatment consists of patient education combined with hip and quadriceps strengthening. Recent evidence suggests that a large proportion of adolescents does not follow their exercise prescription, performing too few repetitions or too fast below the prescribed time under tension. Live feedback, such as a metronome or exercise games, has previously shown promising results in improving the quality of exercises. The aim of this study is to investigate if live feedback from a sensor (BandCizer™) and an iPad will improve the ability of adolescents with PFP to perform exercises as prescribed. METHODS This study is a randomized, controlled, participant-blinded, superiority trial with a 2-group parallel design. Forty 15 to 19 year old adolescents with patellofemoral pain will be randomized to receive either live visual and auditory feedback on time under tension or no feedback on time under tension during a 6-week intervention period. Adolescents will be instructed to perform three elastic band exercises. Feedback will be provided by BandCizer™ and an iPad. The adolescents perform the exercises twice a week unsupervised and once a week during a supervised group training session. The primary outcome will be the mean deviation of the prescribed time under tension per repetition in seconds during the course of the intervention. DISCUSSION Low compliance is a major problem among adolescents with patellofemoral pain. Providing the adolescents with real time feedback on time under tension from a sensor and an iPad could potentially help the adolescents perform the exercises as prescribed. This may increase the total exercise dosage they receive during treatment which may help improve patient outcomes. TRIAL REGISTRATION Registered at ClinicalTrials.gov (identifier: NCT02674841 ) on February 4(th) 2016.
Collapse
Affiliation(s)
- Henrik Riel
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7D, 9220, Aalborg East, Denmark. .,Research Unit for General Practice in Aalborg and Department of Clinical Medicine, Aalborg University, Fyrkildevej 7, 9220, Aalborg East, Denmark.
| | - Mark Matthews
- School of Health and Rehabilitation Sciences: Physiotherapy: Sports Injury Rehabilitation and Prevention for Health, The University of Queensland, St. Lucia, QLD, 4072, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences: Physiotherapy: Sports Injury Rehabilitation and Prevention for Health, The University of Queensland, St. Lucia, QLD, 4072, Australia
| | - Thomas Bandholm
- Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physical Therapy, Department of Orthopedic Surgery, Clinical Research Centre, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark
| | - Kristian Thorborg
- Sports Orthopedic Research Center - Copenhagen (SORC-C). Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark
| | - Michael Skovdal Rathleff
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7D, 9220, Aalborg East, Denmark.,Research Unit for General Practice in Aalborg and Department of Clinical Medicine, Aalborg University, Fyrkildevej 7, 9220, Aalborg East, Denmark.,Department of occupational therapy and physiotherapy, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark
| |
Collapse
|
29
|
Sanchis-Alfonso V, McConnell J, Monllau JC, Fulkerson JP. Diagnosis and treatment of anterior knee pain. J ISAKOS 2016. [DOI: 10.1136/jisakos-2015-000033] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
30
|
Prevention and rehabilitation of paediatric anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 2016; 24:730-6. [PMID: 26572630 DOI: 10.1007/s00167-015-3856-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 10/27/2015] [Indexed: 01/14/2023]
Abstract
PURPOSE To review the current knowledge on anterior cruciate ligament (ACL) injury prevention and ACL rehabilitation in individuals who have not yet reached musculoskeletal maturity. METHODS This is a narrative review based on a targeted and systematic literature search for paediatric ACL injury risk factors, injury prevention and rehabilitation. RESULTS The search strategies resulted in 119 hits on risk factor studies, 57 hits on prevention and 37 hits on rehabilitation. Modifiable risk factors for ACL injury are largely unknown in the paediatric population. ACL injury prevention using neuromuscular training is highly successful in the adolescent population, and existing injury prevention programmes are cost-effective. The efficacy of ACL injury prevention programmes in children is, however, investigated to a markedly lesser degree. Paediatric ACL injury rehabilitation is poorly described, although supervised active rehabilitation progressed through phases with functional milestones is generally encouraged. CONCLUSION Although limited, current evidence supports implementation of injury prevention programmes in female football players from the age of 12. Supervised active rehabilitation where progression is guided by functional milestones is also advocated. Future identification of modifiable risk factors is needed to design prevention programmes for younger children. There is a need for international multicentre studies on treatment algorithms and rehabilitation to increase knowledge on the short- and long-term outcomes following existing algorithms. STUDY DESIGN Narrative review, level III.
Collapse
|