Experiences of physiotherapists considering virtual reality for shoulder rehabilitation: A focus group study

Introduction

Shoulder pain is common and associated with substantial morbidity. Different treatment strategies are being prescribed with equivocal results. Virtual reality (VR) is a novel technology and emerging research suggests that VR may be a promising alternative to current treatments. Prior to effectiveness research or any large-scale introduction, VR-applications require appropriate scrutiny including feasibility- and acceptability of clinicians and patients. Therefore, the aim of this study was to collect experiences of physiotherapists after using immersive VR.

Methods

A qualitative interpretive design was used to explore physiotherapists' experiences related to the use of VR for people with shoulder symptoms. 17 physiotherapists were asked to use VR at home for five days prior to a focus group interview. Data from the focus group interviews were analyzed using a six-phase process of thematic analysis.

Results

Three main themes were identified, each divided into subthemes. The main themes were: 1. VR as an extension of contemporary physiotherapy care: physiotherapists were positive about the potential of VR and its applicability in daily care. 2. Physiotherapist uncertainties of future care using VR: participants expressed concerns about their professional identity, particularly as patients engage in independent home exercises. 3. Physiotherapist's requirements for implementation of VR: participants shared their needs for evidence regarding the effectiveness and parameters such as frequency, dosage and intensity of the VR intervention.

Conclusion

Physiotherapists were positive about VR as an intervention tool. However, they felt more knowledge is needed about parameters of VR. The findings of this study inform researchers and technology developers about optimal design of interventions and applications using VR.

The concurrent validity and reliability of virtual reality to measure shoulder flexion and scaption range of motion

BACKGROUND

Shoulder pain commonly has a detrimental impact on patient's work and social activities. Although pain is the most common reason for seeking care, a reduction in shoulder range of motion (ROM) is another common impairment. ROM assessment is used as an evaluation tool and multiple methods are available to measure shoulder ROM. Virtual reality (VR) has been introduced into shoulder rehabilitation, mostly when exercise and ROM measurement is indicated. This study evaluated the concurrent validity and system reliability of active ROM measurements of VR for people with and without shoulder pain.

METHODS

Forty volunteers participated in this study. Virtual goniometry was used to assess active shoulder ROM. Participants performed flexion and scaption to six predetermined angles. Measurements from the VR goniometer and smartphone inclinometers were recorded simultaneously. To assess reliability, two identical test sequences were performed.

RESULTS

The concurrent validity ICCs were 0.93 for shoulder flexion and 0.94 for shoulder scaption. The VR goniometer application on average systematically overestimated the ROM compared to the smartphone inclinometer. The mean difference between goniometer values was -11.3 degrees for flexion and -10.9 for scaption. The system reliability was excellent with an overall ICC of 0.99 for the flexion movements and 0.99 for the scaption movements.

CONCLUSION

Although the VR system demonstrated excellent reliability, and high ICC's for concurrent validity, the large range between the lower and upper 95% CI limits suggests it lacks measurement precision. This suggests VR, as used in this study, should not be used interchangeably with other measurement tools. CONTRIBUTION OF THE PAPER.

Using beat frequency in music to adjust running cadence in recreational runners: A randomized multiple baseline design

Running with music has been shown to acutely change cadence. However, it is unclear if the increased cadence remains long-term when running without music in an in-field situation. The aim of this 12-week study was to investigate the effect of a 4-week music running program on cadence, speed and heartrate during and after the music running program. Seven recreational runners with a cadence of <170 steps per minute were randomly assigned to a baseline and post-intervention period of different durations. During the intervention phase, the participants ran with a musical beat that was 7.5-10% higher than their mean cadence at the start of the study. Cadence, heartrate and running speed were measured twice a week during a 5-kilometer run with a watch, and were analyzed using randomization tests and visual data inspection. Two participants dropped-out due to shortage of time (n = 1) and an acute calf injury (n = 1). Cadence significantly increased during the intervention period (+8.5%), and remained elevated during the post-intervention period (+7.9% (p = .001)) in comparison with the baseline period. Heartrate and running speed did not significantly change during any period. This study among five participants shows that four weeks of running with a musical beat that is 7.5-10% higher than the preferred cadence may be an effective and feasible intervention to increase running cadence. Importantly, the increased cadence occurred without simultaneous increases in running speed and heartrate, hereby potentially reducing mechanical loading without increasing metabolic load.HighlightsRunning with a musical rhythm that is higher than the preferred cadence leads to an increased running cadence, without increasing heartrate and running speed.This cadence remains elevated for at least three to five weeks after the music intervention period.All individuals showed a practically relevant increase in cadence during and after the intervention.