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Control rooms play a crucial role in monitoring and managing safety-critical systems, such as power grids, emergency response, and transportation networks. As these systems become increasingly complex and generate more data, the role of human operators is evolving amid growing reliance on automation and autonomous decision-making. This paper explores the balance between leveraging automation for efficiency and preserving human intuition and ethical judgment, particularly in high-stakes scenarios. Through an analysis of control room trends, operator attitudes, and models of human-computer collaboration, this paper highlights the benefits and challenges of automation, including risks of deskilling, automation bias, and accountability. The paper advocates for a hybrid approach of collaborative autonomy, where humans and systems work in partnership to ensure transparency, trust, and adaptability.
Physiotherapists’ knowledge, attitude and practice of clinical prediction rules in low-back pain
(2024)
Background and aim: Clinical prediction rules (CPRs) are mathematical tools that are intended to guide clinicians in clinical decision making or predict a future outcome, but they seem rather unknown, under-utilized, or avoided by clinicians. This study aimed to assess knowledge, attitude, and practice of CPRs in low-back pain (LBP) among physiotherapists.
Methods: A cross-sectional study involving 45 consenting specialist musculoskeletal physiotherapists from three public-funded teaching hospitals in Nigeria was carried out. An adapted validated questionnaire on facilitators and barriers to CPRs utilization, and a socio-demographic proforma were used to collect data. Descriptive and inferential statistics were employed to analyze data. Alpha level was set at p < 0.05.
Results: Respondents were mostly males (71.1%), married (64.4%) and first-degree holders (55.6%). Twenty-eight (62.2%) of the respondents had above-average knowledge of CPRs in LBP. Rates for positive attitude towards, and utilization of CPRs were 37.8% and 15.6%. Knowledge and attitude about CPRs in LBP were not significantly influenced by socio-demographic factors (p > 0.05). However, there was a significant association between the utilization of CPRs and years of experience (χ2 = 10.339 p = 0.016).
Conclusion: Most Nigerian physiotherapists had above-average knowledge, but a negative attitude and low utilization of CPRs in LBP. Clinicians’ years of clinical experience influence the usage of CPR. There is a need to incorporate training in CPRs into undergraduate and continuous professional development programmes.
Local disasters such as the Ahr Valley flood in Germany, the international backdrop of the Russo-Ukrainian War, or the global impact of the COVID-19 pandemic place high demands on the people and organisations that are involved in these situations and contexts to save lives, mitigate damage, provide comfort, or organise reconstruction. Novel technologies are constantly making their way into everyday life, such as artificial intelligence, big data, decentralised networks, internet of things, or virtual reality. Their adaptation, acceptance, usability, usefulness, and legal framework conditions for safety-critical systems must be researched and tested thoroughly. In this special issue, we investigate the use of computer-based solutions in areas and situations of direct relevance to people’s lives and well-being (Usable Safety), as well as contributions to user-oriented resilience concepts of sociotechnical systems concerning potential attacks (Usable Security) and data protection mechanisms (Usable Privacy).
Objectives: To investigate the feasibility and effects of a sensorimotor stabilization exercise intervention with and without behavioral treatment in nonspecific low back pain.
Design: A three-armed multicenter randomized controlled trial.
Setting: Five study sites across Germany (3 orthopedic university outpatient clinics, 1 university sports medicine department, and 1 clinical institution).
Participants: Six hundred and sixty-two volunteers (N=662) (59% females, age 39±13y) with low back pain.
Interventions: Sensorimotor training (SMT), sensorimotor training with behavioral therapy (SMT+BT), and usual care group (UCG; continuation of the already ongoing individual treatment regime). Intervention groups performed a 12-week (3wk center-based, 9wk home-based) program.
Main Outcome Measures: Adherence, dropout rates, adverse events, and intervention effects on pain intensity, disability, and trunk torque (gain scores, repeated measures analysis of variance, α-level<0.05).
Results: In total, 220 participants received SMT, 222 received SMT+BT, and 170 were analyzed as UCG. Dropout rates were 10% for SMT and SMT+BT at week 3, 31% and 30% at week 4, and 49% and 50% at week 12. Adherence rates above 80% were reached in both interventions; 134 adverse events occurred. Intervention effects compared to UCG were found for pain intensity (SMT, P=.011, effect size d=0.41), disability (SMT+BT, P=.020, d=0.41), and peak torque (SMT, P=.045, d=0.38; SMT+BT, P=.019, d=0.44), with overall small effect sizes.
Conclusions: Participants were highly adherent to the sensorimotor exercise, but showed increased dropout rates, particularly during home-based training. Both interventions proved to be feasible, and although only SMT showed an increased effect on pain intensity compared to UCG, the SMT+BT showed positive effects on disability. Both interventions led to increases in strength, indicative of a neuromuscular adaptation.
Introduction: The Evidence-Based Practice Confidence (EPIC) Scale measures health professionals’ self-efficacy associated with evidence-based practice activities. The scale has been cross-culturally translated into German together with physical therapists. To support its use in German-speaking countries, the measurement properties of the scale need to be determined. Therefore, the primary objective of this study was to assess the measurement properties of the German EPIC scale. In a preparatory step, we aimed to evaluate the comprehensibility of the scale among German-speaking occupational therapists, speech and language therapists, and nurses.
Methods: First, semi-structured cognitive interviews were used to evaluate the comprehensibility of the EPIC scale. Second, a longitudinal online survey with repeated measures (baseline and retest survey) was conducted. The target group included physical therapists, occupational therapists, speech and language therapists, and nurses from Germany, Austria, and Switzerland. Reliability, responsiveness, and validity were evaluated using internal consistency, test-retest reliability, standard error of measurement, known-groups method, exploratory factor analysis and the minimal detectable change, respectively.
Results: Comprehensibility of the German EPIC scale was confirmed by eleven health care professionals (four occupational therapists, two speech and language therapists, five nurses). The baseline and the retest surveys were completed by 708 and 222 participants, respectively. The measure demonstrated an internal consistency of .930, with an intraclass correlation coefficient (ICC) for test-retest reliability of .936 (95% CI: .917 to .951). The standard error of measurement was 4.92, and the minimal detectable change at the 95% confidence level was 6.02. All hypotheses in the known-groups method were confirmed, and construct validity was acceptable. Factor analysis revealed two main factors affecting the results of the scale.
Conclusion: The findings provide evidence that supports the use of the German EPIC scale among health professionals. For instance, it can be used to evaluate self-efficacy during EBP training.
Background: Psychoeducation positively influences the psychological components of chronic low back pain (CLBP) in conventional treatments. The digitalization of health care has led to the discussion of virtual reality (VR) interventions. However, CLBP treatments in VR have some limitations due to full immersion. In comparison, augmented reality (AR) supplements the real world with virtual elements involving one’s own body sensory perception and can combine conventional and VR approaches.
Objective: The aim of this study was to review the state of research on the treatment of CLBP through psychoeducation, including immersive technologies, and to formulate suggestions for psychoeducation in AR for CLBP.
Methods: A scoping review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed in August 2024 by using Livivo ZB MED, PubMed, Web of Science, American Psychological Association PsycINFO (PsycArticle), and PsyArXiv Preprints databases. A qualitative content analysis of the included studies was conducted based on 4 deductively extracted categories.
Results: We included 12 studies published between 2019 and 2024 referring to conventional and VR-based psychoeducation for CLBP treatment, but no study referred to AR. In these studies, educational programs were combined with physiotherapy, encompassing content on pain biology, psychological education, coping strategies, and relaxation techniques. The key outcomes were pain intensity, kinesiophobia, pain catastrophizing, degree of disability, quality of life, well-being, self-efficacy, depression, attrition rate, and user experience. Passive, active, and gamified strategies were used to promote intrinsic motivation from a psychological point of view. Regarding user experience from a software development perspective, user friendliness, operational support, and application challenges were recommended.
Conclusions: For the development of a framework for an AR-based psychoeducational intervention for CLBP, the combination of theories of acceptance and use of technologies with insights from health psychological behavior change theories appears to be of great importance. An example of a theory-based design of a psychoeducation intervention in AR for CLBP is proposed and discussed.
Deep learning-based image registration (DLIR) has been widely developed, but it remains challenging in perceiving small and large deformations. Besides, the effectiveness of the DLIR methods was also rarely validated on the downstream tasks. In the study, a multi-scale complexity-aware registration network (MSCAReg-Net) was proposed by devising a complexity-aware technique to facilitate DLIR under a single-resolution framework. Specifically, the complexity-aware technique devised a multi-scale complexity-aware module (MSCA-Module) to perceive deformations with distinct complexities, and employed a feature calibration module (FC-Module) and a feature aggregation module (FA-Module) to facilitate the MSCA-Module by generating more distinguishable deformation features. Experimental results demonstrated the superiority of the proposed MSCAReg-Net over the existing methods in terms of registration accuracy. Besides, other than the indices of Dice similarity coefficient (DSC) and percentage of voxels with non-positive Jacobian determinant (|J(phi)|=<0), a comprehensive evaluation of the registration performance was performed by applying this method on a downstream task of multi-atlas hippocampus segmentation (MAHS). Experimental results demonstrated that this method contributed to a better hippocampus segmentation over other DLIR methods, and a comparable segmentation performance with the leading SyN method. The comprehensive assessment including DSC, |J(phi)|=<0, and the downstream application on MAHS demonstrated the advances of this method.
Background: Physiotherapy education and practice have country-specific peculiarities which may limit globalization in health care. This study aimed to characterize physiotherapy practice and treatment preferences, educational qualifications, and research in Nigeria, with a view of providing vital information for transnational integration and collaboration.
Methods: A cross-sectional survey of 104 Nigerian physiotherapists was conducted. The Physical Therapy Practice Questionnaire and a self-developed proforma were used as survey tools.
Results: The mean age of respondents was 33.5 ± 9.4 years. About two-fifth of all respondents (39.4%) had an MSc and mostly practice as clinicians (51.0%) in teaching hospitals (34.6%). The respondents were mostly involved in general practice (50.0%), with a caseload of 1–10 patients per day (67.3%). Soft tissue mobilization (83%), proprioceptive neuromuscular facilitation (76%), breathing exercises (77%), and transcutaneous electrical neuromuscular stimulation (83%) were commonly used. Respondents were familiar databases and evidence-based resources (81.2%) and mostly utilize PubMed (73.3%). Regular case conferences with professional colleagues (47.6%) and treatment planning of between 11 and 30 min (40.6%) were common. Educators spend 1–3 h planning educational work (91.8%). Clinical decision-making is mostly based on professional experience, while journals are the primary resource for educational information.
Conclusion: Physiotherapy practice in Nigeria is degree based and requires registration board’s licensure. Practitioners deal with a high caseload and utilize a wide range of techniques and modalities and have tendencies to utilize personal experience and research in making clinical decisions. The parity in education and practice with advanced climes inadvertently gives physiotherapy practice in Nigeria a global purview.
This study aimed to investigate whether neurological patients presenting with a bias in line bisection show specific problems in bisecting a line into two equal parts or their line bisection bias rather reflects a special case of a deficit in proportional reasoning more generally. In the latter case, the bias should also be observed for segmentations into thirds or quarters. To address this question, six neglect patients with a line bisection bias were administered additional tasks involving horizontal lines (e.g., segmentation into thirds and quarters, number line estimation, etc.). Their performance was compared to five neglect patients without a line bisection bias, 10 patients with right hemispheric lesions without neglect, and 32 healthy controls. Most interestingly, results indicated that neglect patients with a line bisection bias also overestimated segments on the left of the line (e.g., one third, one quarter) when dissecting lines into parts smaller than halves. In contrast, such segmentation biases were more nuanced when the required line segmentation was framed as a number line estimation task with either fractions or whole numbers. Taken together, this suggests a generalization of line bisection bias towards a segmentation or proportional processing bias, which is congruent with attentional weighting accounts of line bisection/neglect. As such, patients with a line bisection bias do not seem to have specific problems bisecting a line, but seem to suffer from a more general deficit processing proportions.
Reliability of a clinical sensory test battery in patients with spine-related leg and arm pain
(2024)
Background: The current standard to evaluate the presence of somatosensory dysfunctions is quantitative sensory testing, but its clinical utility remains limited. Low-cost and time-efficient clinical sensory testing (CST) batteries have thus been developed. Recent studies show moderate to substantial reliability in populations with neuropathic pain. This study evaluates the inter- and intra-tester reliability of people with spine-related leg and arm pain, representing mixed pain mechanisms.
Methods: Fifty-three patients with spine-related leg (n = 41) and arm pain (n = 12) attended three CST sessions. The CST battery consisted of eleven tests, determining loss and gain of sensory nerve function. CST was performed by the same investigator twice and by an additional investigator to determine inter- and intra-tester reliability. Fleiss' (inter-tester) and Cohen's (intra-tester) kappa were calculated for dichotomized and intraclass correlation coefficients (ICC) for continuous outcomes.
Results: Fleiss' kappa varied among modalities from fair to substantial (κ = 0.23–0.66). Cold, warm, and vibration detection thresholds and cold and pressure pain thresholds reached kappa >0.4 (moderate to substantial reliability). Cohen's kappa ranged from moderate to substantial (κ = 0.45–0.66). The reliability of the windup ratio was poor (ICC <0.18).
Conclusion: CST modalities with moderate to substantial inter-tester reliability could be of benefit as a screening tool. The moderate to substantial intra-tester reliability for all sensory modalities (except windup ratio) supports their potential use in clinical practice and research to monitor somatosensory changes over time in patients with spine-related limb pain of mixed pain mechanisms.
Significance: We already know that most modalities of clinical sensory test (CST) batteries achieve moderate to substantial inter- and intra-tester reliability in populations with neuropathic pain.
This study evaluates the reliability of a CST battery in populations with mixed pain mechanisms. We found inter-tester reliability varied from poor to substantial for sensory modalities, questioning the value of some CST modalities. The CST battery showed moderate to substantial intra-tester reliability, suggesting its usefulness to monitor sensory changes over time in this cohort.