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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.
Evaluation of a blended learning approach on stratified care for physiotherapy bachelor students
(2023)
Background: Stratified models of care are valuable for addressing psychosocial factors which influence the outcome of patients with musculoskeletal disorders. Introducing such models in undergraduate training has the potential to propagate this knowledge with evidence and foster its implementation. The objective of this paper is to explore the perception and changes in the fear-avoidance beliefs of physiotherapy students participating in a developed blended learning course on stratified care.
Methodology: A mixed-methods with a convenient sample of two consecutive cohorts were given a blended learning course on stratified care for patients with low back pain. The blended learning course comprised scientific rudiments and application of stratified care in clinical practice conceptualised using the KERN’ 6-step approach. The exam scores, perceptions, performance on self-reflection-tests and pre- and post-scores on The Tampa Scale for Kinesiophobia for Physiotherapists’ (TSK-PT) were obtained. After gaining clinical experience, participants were invited to discuss their clinical experiences and perceptions in workshops. The quantitative data was analysed explorative-descriptively. The qualitative data was analysed following an inductive coding system with constant comparisons.
Results: Ninety-one participants consented to the evaluation (mean age = 22.9 ± 1.6 years), 66% were female. Exam scores correlated with time spent in training (r = 0.30) and scores on self-reflection-tests 1 and 2 (r = 0.40 and r = 0.41). Participants in both cohorts described the learning resources as promoting their interest in the subject (72% and 94%), up-to-date (91% and 93%) and helpful (91% and 97%). The fear-avoidance scores for participants decreased from 53.5 (± 9.96) to 40.1 (± 12.4) with a large effect size (d = 1.18). The regression model [F (2, 49) = 1151.2, p < 0.001] suggests that pre-TSK-PT and the interest of participants in the training predicted post-TSK-PT. The workshop participants (n = 62) all worked in clinical practice. Emerging from the analysis were 4 categories (evolving to maturity in practice, perceiving determinants of stratified care, strategising for implementation and adopting an outlook for future practice).
Conclusion: The quality of engagement in learning, training strategy and interest in the subject contributes immensely to learning outcomes. This blended learning course was successful in reducing kinesiophobia and influencing the participants’ attitude towards care with the potential of being translated into long-term practice.
Die Erstellung von technischen Gebäudebestandsaufnahmen im Rahmen von Sanierungsfahrplänen bei der Ingenieurgesellschaft TRAGWERK in Trier erfolgt derzeit handschriftlich auf mehrseitigen PDF-Checklisten. Die handschriftliche Erfassung bringt jedoch den Nachteil mit sich, dass die Notizen in einer Nachbereitungsphase im Büro in eine digitale Form überführt werden, was zeitaufwändig ist. Ebenso führen die handschriftlich ausgefüllten Checklisten teilweise zu ungenauen und unvollständigen Bestandsaufnahmen und erschweren die Zusammenarbeit mehrerer Mitarbeiter an einem Projekt. Das Ziel dieser Bachelorarbeit ist die Entwicklung eines offline-fähigen Softwaresystems zur digitalen Erstellung von technischen Gebäudebestandsaufnahmen. Diese Lösung soll die beschriebenen Probleme eliminieren, die Nutzungsanforderungen erfüllen und nach Abschluss der Arbeit im Arbeitsalltag des Praxispartners verwendet werden können. Um dieses Ziel zu erreichen, wird ein nutzerzentriertes, iteratives Entwicklungsvorgehen angewendet. Durch Feldstudien zur Analyse des Arbeitsablaufs und der Durchführung einer Nutzungskontextanalyse werden Nutzungsanforderungen an die Software abgeleitet. Ein Konzept in Form von Wireframes unterstützt die Implementierung, die schrittweise durch formative Nutzungstests evaluiert und verbessert wird. Die Nutzungskontextanalyse ergab, dass die Mitarbeiter und zukünftigen Nutzer der Software in zwei rollenbasierte Benutzergruppen eingeteilt werden können: Datenerfasser, die vor Ort offline mit einem iPad arbeiten, und Projektbearbeiter, die im Büro am PC den Sanierungsfahrplan erstellen. Die Evaluation durch Nutzungstests zeigte, dass die entwickelte Web- und iOS-App die Effizienz des Prozesses durch strukturierte digitale Formulare mit Handschrifterkennung, Auswahlfeldern, duplizierbaren Formulargruppen und bedingten Feldern erhöht. Dies verbessert die Vollständigkeit und Genauigkeit der Datenerfassung, beschleunigt die Projektbearbeitung im Büro und erleichtert die Zusammenarbeit mehrerer Mitarbeiter an einem Projekt.
Background: Stratified care approach involving use of the STarT-Back tool to optimise care for patients with low back pain is gaining widespread attention in western countries. However, adoption and implementation of this approach in low-and-middle-income countries will be restricted by context-specific factors that need to be addressed. This study aimed to develop with physiotherapists, tailored intervention strategies for the implementation of stratified care for patients with low back pain.
Methods: A two-round web-based Delphi survey was conducted among purposively sampled physiotherapists with a minimum of three years of clinical experience, with post-graduation certification or specialists. Thirty statements on barriers and enablers for implementation were extracted from the qualitative phase. Statements were rated by a Delphi panel with additional open-ended feedback. After each Delphi round, participants received feedback which informed their subsequent responses. Additional qualitative feedback were analysed using qualitative content analysis. The criteria for consensus and stability were pre-determined using percentage agreement (≥ 75%), median value (≥ 4), Inter-quartile range (≤ 1), and Wilcoxon matched-pairs test respectively.
Results: Participants in the first round were 139 and 125 of them completed the study, yielding a response rate of 90%. Participants were aged 35.2 (SD6.6) years, and 55 (39.6%) were female. Consensus was achieved in 25/30 statements. Wilcoxon’s test showed stability in responses after the 5 statements failed to reach consensus: ‘translate the STarT-Back Tool to pidgin language’ 71% (p = 0.76), ‘begin implementation with government hospitals’ 63% (p = 0.11), ‘share knowledge with traditional bone setters’ 35% (p = 0.67), ‘get second opinion on clinician’s advice’ 63% (p = 0.24) and ‘carry out online consultations’ 65% (p = 0.41). Four statements strengthened by additional qualitative data achieved the highest consensus: ‘patient education’ (96%), ‘quality improvement appraisals’ (96%), ‘undergraduate training on psychosocial care’ (96%) and ‘patient-clinician communication’ (95%).
Conclusion: There was concordance of opinion that patients should be educated to correct misplaced expectations and proper time for communication is vital to implementation. This communication should be learned at undergraduate level, and for already qualified clinicians, quality improvement appraisals are key to sustained and effective care. These recommendations provide a framework for future research on monitored implementation of stratified care in middle-income countries.
This paper describes the project “Visual Knowledge Communication”, a joint project that started recently. The partners are psychologists and computer scientists from four universities of the German state Rhineland-Palatinate. The starting point for the project was the fact that visualizations have attracted considerable interest in psychology as well as computer science within the last years. However, psychologists and computer scientists pursued their investigations independently from each other in the past. This project has as its main goal the support and fostering of cooperation between psychologists and computer scientists in several visualization research projects.
The paper sketches the overall project. It then discusses in more detail the authors' subproject which deals with a peer review process for animations developed by students. The basic ideas, the main goals, and the project plan are described.
This paper is a work-in-progress report. Therefore, it does not contain any results.
Background: Deficiency in musculoskeletal imaging (MI) education will pose a great challenge to physiotherapists in clinical decision making in this era of first-contact physiotherapy practices in many developed and developing countries. This study evaluated the nature and the level of MI training received by physiotherapists who graduate from Nigerian universities.
Methods: An online version of the previously validated Physiotherapist Musculoskeletal Imaging Profiling Questionnaire (PMIPQ) was administered to all eligible physiotherapists identified through the database of the Medical Rehabilitation Therapist Board of Nigeria. Data were obtained on demographics, nature, and level of training on MI procedures using the PMIPQ. Logistic regression, Friedman’s analysis of variance (ANOVA) and Kruskal-Wallis tests were used for the statistical analysis of collected data.
Results: The results (n = 400) showed that only 10.0% of the respondents had a stand-alone entry-level course in MI, 92.8% did not have any MI placement during their clinical internship, and 67.3% had never attended a MI workshop. There was a significant difference in the level of training received across MI procedures [χ2 (15) = 1285.899; p = 0.001]. However, there was no significant difference in the level of MI training across institutions of entry-level programme (p = 0.36). The study participants with transitional Doctor of Physiotherapy education were better trained in MI than their counterparts with a bachelor’s degree only (p = 0.047).
Conclusions: Most physiotherapy programmes in Nigeria did not include a specific MI module; imaging instructions were mainly provided through clinical science courses. The overall self-reported level of MI training among the respondents was deficient. It is recommended that stand-alone MI education should be introduced in the early part of the entry-level physiotherapy curriculum.
Background: The extramuscular connective tissue (ECT) has been shown to play a significant role in mechanical force transmission between musculoskeletal structures. Due to this and owing to its tight connection with the underlying muscle, the ECT may be vulnerable to excessive loading. The present study aimed to investigate the effect of eccentric elbow flexor exercise on the morphology of the biceps brachii ECT. In view of the high nociceptive capacity of the ECT, an additional objective was to elucidate the potential relationship between ECT damage and the occurrence of delayed onset muscle soreness (DOMS).
Methods: Eleven healthy participants (♂ = 7; 24 ± 2 years) performed fatiguing dumbbell elbow flexor eccentric exercise (EE) for one arm and concentric exercise (CE) for the other arm in random order and with random arm allocation. Before, immediately after and 24–96 h post-exercise, maximal voluntary isometric contraction torque of the elbow flexors (dynamometer), pressure pain (algometer), palpation pain (100 mm visual analog scale), biceps brachii ECT thickness and ECT/muscle mobility during passive movement (both high-resolution ultrasound) were examined.
Results: Palpation pain, suggestive of DOMS, was greater after EE than CE, and maximal voluntary isometric contraction torque decreased greater after EE than CE (p < .05). Relative to CE, EE increased ECT thickness at 48 (+ 17%), 72 (+ 14%) and 96 (+ 15%) hours post-exercise (p < .05). At 96 h post-EE, the increase in ECT thickness correlated with palpation pain (r = .68; p < .05). ECT mobility was not different between conditions, but compared to CE, muscle displacement increased at 24 (+ 31%), 72 (+ 31%) and 96 (+ 41%) hours post-EE (p < .05).
Conclusion: Collectively, these results suggest an involvement of the ECT changes in delayed onset muscle soreness.
Context: In the framework of studying cosmic microwave background polarization and characterizing its Galactic foregrounds, the angular power spectrum analysis of the thermal dust polarization map has led to intriguing evidence of an E/B asymmetry and a positive TE correlation. The interpretation of these observations is the subject of theoretical and simulation-driven studies in which the correlation between the density structure of the interstellar medium (ISM) and the magnetic field appears to be a key aspect. In this context, and when the magnetized ISM structures are modeled in three dimensions, dust clouds are generally considered to be filamentary structures only, but both filamentary and sheet-like shapes are supported by observational and theoretical evidence.
Aims: We aim to study the influence of the cloud shape and its connection to the local magnetic field, as well as the influence from the viewing angle, on the angular power spectra measured on thermal dust polarization maps; we specifically focus on the dependence of the E/B power asymmetry and TE correlation.
Methods: To this end, we simulated realistic interstellar clouds with both filament-like and sheet-like shapes using the software ASTERION, which also allowed us to generate synthetic maps of thermal dust polarized emission with an area of 400 square degrees. Then, we computed their polarization power spectra in the multipole range ℓ ϵ [100, 500] and focused on the E/B power asymmetry, quantified through the ℛEB ratio, and the correlation coefficient rTE between Τ and Ε modes. We quantified the dependence of ℛEB and rTE values on the offset angle (between the longest cloud axis and local magnetic field lines) and inclination angle (between the line of sight and the magnetic field) for both types of cloud shapes, either embedded in a regular magnetic field or coupled to a nonregular field to mimic turbulence.
Results: We find that both types of cloud shapes cover the same regions of the (ℛEB, rTE) parameter space. The dependence on the inclination and offset angles is similar for both shapes, although sheet-like structures generally show larger scatter than filamentary structures. In addition to the known dependence on the offset angle, we find a strong dependence of ℛEB and rTE on the inclination angle.
Conclusions: The very fact that filament-like and sheet-like structures may lead to polarization power spectra with similar (ℛEB,rTE) values complicates their interpretation. We argue that interpreting them solely in terms of filament characteristics is risky, and in future analyses, this degeneracy should be accounted for, as should the connection to the magnetic field geometry. Our results based on maps of 400 square degrees clarify that the overall geometrical arrangement of the magnetized ISM surrounding the observer leaves its marks on polarization power spectra.
Background: Telerehabilitation can contribute to the maintenance of successful rehabilitation regardless of location and time. The aim of this study was to investigate a specific three-month interactive telerehabilitation routine regarding its effectiveness in assisting patients with physical functionality and with returning to work compared to typical aftercare.
Objective: The aim of the study was to investigate a specific three-month interactive telerehabilitation with regard to effectiveness in functioning and return to work compared to usual aftercare.
Methods: From August 2016 to December 2017, 111 patients (mean 54.9 years old; SD 6.8; 54.3% female) with hip or knee replacement were enrolled in the randomized controlled trial. At discharge from inpatient rehabilitation and after three months, their distance in the 6-minute walk test was assessed as the primary endpoint. Other functional parameters, including health related quality of life, pain, and time to return to work, were secondary endpoints.
Results: Patients in the intervention group performed telerehabilitation for an average of 55.0 minutes (SD 9.2) per week. Adherence was high, at over 75%, until the 7th week of the three-month intervention phase. Almost all the patients and therapists used the communication options. Both the intervention group (average difference 88.3 m; SD 57.7; P=.95) and the control group (average difference 79.6 m; SD 48.7; P=.95) increased their distance in the 6-minute-walk-test. Improvements in other functional parameters, as well as in quality of life and pain, were achieved in both groups. The higher proportion of working patients in the intervention group (64.6%; P=.01) versus the control group (46.2%) is of note.
Conclusions: The effect of the investigated telerehabilitation therapy in patients following knee or hip replacement was equivalent to the usual aftercare in terms of functional testing, quality of life, and pain. Since a significantly higher return-to-work rate could be achieved, this therapy might be a promising supplement to established aftercare.
Background: Improving movement control might be a promising treatment goal during chronic non-specific low back pain (CLBP) rehabilitation. The objective of the study is to evaluate the effect of a single bout of game-based real-time feedback intervention on trunk movement in patients with CLBP.
Methods: Thirteen CLBP patients (8female;41 ± 16 years;173 ± 10 cm;78 ± 22 kg) were included in this randomized cross-over pilot trial. During one laboratory session (2 h), participants performed three identical measurements on trunk movement all including: first, maximum angle of lateral flexion was assessed. Secondly, a target trunk lateral flexion (angle: 20°) was performed. Main outcome was maximum angle ([°]; MA). Secondary outcomes were deviation [°] from the target angle (angle reproduction; AR) and MA of the secondary movement planes (rotation; extension/flexion) during lateral flexion. The outcomes were assessed by an optical 3D-motion-capture-system (2-segment-trunk-model). The measurements were separated by 12-min of intervention and/or resting (randomly). The intervention involved a sensor-based trunk exergame (guiding an avatar through virtual worlds). After carryover effect-analysis, pre-to-post intervention data were pooled between the two sequences followed by analyses of variances (paired t-test).
Results: No significant change from pre to post intervention for MA or AR for any segment occurred for the main movement plane, lateral flexion (p > .05). The upper trunk segment showed a significant decrease of the MA for trunk extension/flexion from pre to post intervention ((4.4° ± 4.4° (95% CI 7.06–1.75)/3.5° ± 1.29° (95% CI 6.22–0.80); p = 0.02, d = 0.20).
Conclusions: A single bout of game-based real-time feedback intervention lead to changes in the secondary movement planes indicating reduced evasive motion during trunk movement.