Validity and reliability of range of motion measured on smartphone (mROM)

Background: Nowadays, as internet-based communication is advancing rapidly, it is getting more and more interesting to adapt clinical examination of patients to remote communication. The use of smartphone photographic is presented as a method for studying the measurement of shoulders joint ROM. Objective: To investigate the reliability of smartphone photographic measurements of upper limbs abduction angle through mRom app compared to inertial sensors as the criterion standard. Methods: This cross-sectional involved 28 subjects: 14 healthy persons and 14 persons suffering from shoulder pathology. Descriptive and anthropometric independent variables were included. A physical property was included corresponding to a dependent variable: mobility angle (degrees), which was obtained thought two different devices. On the one hand, as criterion standard, the inertial measurement sensors with two inertial sensors (InertiaCube3™ Intersense Inc., Billerica, Massachusetts) located in the middle third of the humerus slightly posterior and in the flat part of the sternum. It contains an inertial 3 Degree of Freedom orientation tracking system: yaw, pitch, and roll. On the other hand, degrees were also obtained using a smartphone Nexus 4 (LG Electronics INC, Yeouido-dong, Seoul) with an 8 megapixels main camera and a 4.7 inches Corning Gorilla Glass 2 touchscreen. The app used was mROM Lite (Brain Dynamics SL, Málaga, Spain), available in google store. Three photographs were taken by two examiners from 3 independents set of images, and they were taken at the same time as inertial measurement. Participants were placed standing, starting from neutral position, performing shoulder abduction. Results: The mean ± SD age of the healthy participants (8 female, 6 male) was 56.1 ± 9.1 years, and their body mass index (BMI) was 27.12 ± 3.8 Kg/m2. The mean ± SD age of the participants with shoulder pathology (8 female, 6 male) was 54.4 ± 10 years and their average BMI was 28± 6.7 Kg/m2. Intraclass correlation coefficients ICC(2-1) for intrarrater reliability for inertial measurements taken by the first examiner was 0.993 (95%CI: 0.983, 0.998) for subject with pathological shoulders, 0.982 (95%CI: 0.736, 0.962) for healthy subjects and 0.992 (95%CI: 0.984, 0.996) for the total sample. Values for photographic measurements were 0.865 (95%CI: 0.670, 0.953) for healthy subjects, 0.991 (95%CI: 0.977, 0.997) for subjects suffering from shoulder pathology and 0.996 (95%CI: 0.992, 0.998) for the total sample. The ICC(2-1) for measurements taken by two different examiners was 0.711 (95%CI: 0.099, 0.907) for the first photograph, 0.703 (95% CI: 0.076, 0.905) for the second one and 0.892 (95%CI: 0.663, 0.965) for the third one in healthy subject. In subject with pathology it was 0.994 (95% CI: 0.982, 0.998), 0.998 (95% CI: 0.993, 0.999) and 0.996 (95% CI: 0.989, 0.999) respectively. In the total sample it was 0.997 (95%CI: 0.992, 0.998), 0.998 (95%CI: 0.995, 0.999) and 0.998 (95%CI: 0.995, 0.999) respectively. Conclusions: Smartphone photographic measurements of upper limbs abduction angle through mRom app are reliable compared to inertial sensors. This method provides a convenient and precise tool in assessment of shoulder motion.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Validity of the new backache index (BAI) in patients with low back pain

INTRODUCTION: The Backache-Index (BAI) is applied to patients with low back pain (LBP) in order to help doctors/surgeons perform physical examinations easily and it is carried out within a short space of time (< 2 min.) without using inclinometric instruments. PURPOSE/AIM: To explore reliability, validity and responsiveness of the BAI in patients with LBP, which can fulfil the existing need for a reliable routine examination in the clinical environment. MATERIALS & METHODS: In total, 75 patients with subacute LBP participated in a randomized controlled study (1). The BAI consisted of a scoring system that includes pain factors and stiffness estimation at the end of a series of five different lumbar movements of a patient standing in erect position. RESULTS: The (blinded) inter-observer reliability between 2 observers for the BAI was perfect (ICC = 0.96). A BAI change of one unit is able to exclude a measurement error. A significantly good correlation (P < 0.001) was found between BAI at baseline, and Oswestry Disability Index (ODI, R = 0.62) and MPQ-PRIT, as the total degree of pain rating index (R = 0.57). The effect size and discriminative ability were explored after two treatment sessions. The greatest level of distinction was found for MPQ-PRI-T and BAI (AUC > 0.93), followed by ODI (AUC = 0.92). A less distinction was found for MPQ-NWC-T and Visual Analogue Scale (VAS, AUC > 0.82). RELEVANCE: the BAI is available in different languages: English, Spanish, French, Dutch, German, ITALIAN, Portuguese, Russian, Turkish, Hebrew, Chinese, Japanese and Thais. www.roptrotherapy.info CONCLUSIONS: The Backache Index or BAI appears to be a reliable and valid assessment of overall restricted spinal movements in case of LBP and discriminates between successful and unsuccessful treatment outcome. DISCUSSION: The inter-observer reliability after a few minutes for the BAI was sufficient. The validity of the BAI was found to be good with the ODI and moderate with the VAS. A Backache Index change of one unit is able to exclude a measurement error. KEYWORDS: Low back pain; Outcome scales; Reliability; Validity; Impairment; Pain rating scales. IMPLICATIONS: In a Spanish study (2) the test-retest after 3 days of the same group (n=46) revailed that the reliability for the 5 outcome scores was good (ICC=0.73). No significant difference was found between BAI1 (4.65 ± 4.15 ) and BAI2 (4.72 ± 4.20) and the absolute reliability was perfect with an ICC=0.97.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Differences in the biomechanical response between healthy and low back pain patients from a isometric extension test

Purpose: To compare, in healhty subjects and low back pain patients, the erector spinal muscle response in a máximum isometric contraction intensities using simultaneously electromyography and ultrasonography. Participants: 59 subjects: 33 Healthy persons (45% ♀). 26 LBP patients (39% ♀) with a mean age of 30.39 (±7.785). Methods: Cross sectional study. Participants, following a maximal strength test as measured by a load cell, perform an isometric contraction of maximum strength. From sitting, each subject develops a maximum isometric lumbar extension, locked at 45 degrees from vertical. The hip and this of the subject were attached by a strap. After preliminary training, each subject performed three repetitions of described gesture resting for a minute and a half between each attempt. Records were taken throughout the maximum contraction, EMG signal and a ultrasonography image, for each ES (right and left). Measured torque, inclination angle, thickness and electromyography activation (MVC). Analysis: We performed a descriptive analysis of both groups and subsequently made T-Student test for independent data in each of the variables measured. Results: Mean values for groups of healthy subjects and low back pain patients were, respectively: Torque: 61.652 (±20.137); 70.298 (±25.053). Right Angle: 6.48 (±2.181); 7.15 (±2.53). Left Angle: 5.36 (±2.26); 6.38 (±1.86). Right Thickness: 0.031 (±0.005); 0.033 (±0.008). Left Thickness: 0.032 (±0.006); 0.034 (±0.006). Right MVC: 558.64 (±211.029); 576.15 (±267.69). Left MVC: 589.21 (±257.739); 671.15 (±370.722). No significant differences were found in any variable when comparing the results between healthy subjects and low back pain patients. Torque: −8.65 (±9.02) (p = 0.347). Angle: Right: −0.659 (±0.613) (p = 0.280); Left: −1.021 (±0.549) (p = 0.068). Thick-ness: Right: 0.00 (±0.00) (p=0.259); Left: 0.00 (±0.00) (p=0.069). MVC: Right: -17.52 (±62.29) (p=0.780). Left: −81.84 (±81.91) (p = 0.321). Conclusions: Knowing how the erector spinal muscle behaves in a isometric back extension test, noting that biomechanically there are not significant differences in the responses with respect to a healthy subject, physical therapists could perform planning treatment which is the biopsychosocial model supported by the biomechanical model.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Studying upper-limb kinematics using inertial sensors

AIM: The aim of this study was to analyze scapulohumeral rhythm through nine physical properties that correspond to angular mobility, angular velocity, and acceleration in the three axes of space, obtained by inertial sensors. METHODS: This cross-sectional study recruited healthy young adult subjects. Descriptive and anthropometric independent variables related to age, gender, weight, size, and BMI were included. Nine physical properties were included corresponding to three dependent variables for each of three special axes: mobility angle (degrees), angular speed (degrees/second), and lineal acceleration (meters/seconds2), which were obtained thought the inertial measurement sensors with four inertial sensors (InertiaCube3™ Intersense Inc., Billerica, Massachusetts). Inertial sensors were placed in the right half of the body of each subject located in the middle third of the humerus slightly posterior, in the middle third of the upper spine of the scapula, in the flat part of the sternum, and the distal surface of the ulna and radius. RESULTS: Descriptive graphics of analytical tasks performed were obtained (figure 1). The main difference in mobility between the scapula and humerus was found in pitch axis for abduction ( = 107.6°, SD = 9.3°) and flexion ( = 113.1°, SD = 9.3°). CONCLUSION: This study shows how much each body segment contributes to upper-limb motion, and allows us to obtain grades of mobility provided by the scapula. Also, this study identified movement patterns, and supports inertial sensors as a useful device to analyze upper-limb kinematics. However, further studies with subjects with shoulder pathology should be carried out.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Functional and structural of the erector spinae muscle during iso-metric lumbar extension

Study Design: cross-sectional study. Objectives: to compare erector spinae (ES) muscle fatigue between chronic non-specific lower back pain (CNLBP) sufferers and healthy subjects from a biomechanical perspective during fatiguing isometric lumbar extensions. Background: paraspinal muscle maximal contraction and fatigue are used as a functional predictor for disabilities. The simplest method to determine muscle fatigue is by evaluating the evolution during specific contractions, such as isometric contractions. There are no studies that evaluate the evolution of the ES muscle during fatiguing isometric lumbar extensions and analyse functional and architectural variables. Methods: In a pre-calibrated system, participants performed a maximal isometric extension of the lumbar spine for 5 and 30 seconds. Functional variables (torque and muscle activation) and architecture (pennation angle and muscle thickness) were measured using a load cell, surface electromyography and ultrasound, respectively. The results were normalised and a reliability study of the ultrasound measurement was made. Results: The ultrasound measurements were highly reliable, with Cronbach's alpha values ranging from 0.951 0.981. All measured variables shown significant differences before and after fatiguing isometric lumbar extension. Conclusion: During a lumbar isometric extension test, architecture and functional variables of the ES muscle could be analised using ultrasound, surface EMG and load cell. In adition, during an endurance test, ES muscle suffers an acute effect on architectural and functional variables.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech. 25 September 2013 through 28 September 2013; Code 10172

A comparison land-water environment of maximal voluntary isometric contraction during manual muscle testing through surface electromyography

Background The aim of this study was to compare through surface electromyographic (sEMG) recordings of the maximum voluntary contraction (MVC) on dry land and in water by manual muscle test (MMT). Method Sixteen healthy right-handed subjects (8 males and 8 females) participated in measurement of muscle activation of the right shoulder. The selected muscles were the cervical erector spinae, trapezius, pectoralis, anterior deltoid, middle deltoid, infraspinatus and latissimus dorsi. The MVC test conditions were random with respect to the order on the land/in water. Results For each muscle, the MVC test was performed and measured through sEMG to determine differences in muscle activation in both conditions. For all muscles except the latissimus dorsi, no significant differences were observed between land and water MVC scores (p = 0.063–0.679) and precision (%Diff = 7–10%) were observed between MVC conditions in the muscles trapezius, anterior deltoid and middle deltoid. Conclusions If the procedure for data collection is optimal, under MMT conditions it appears that comparable MVC sEMG values were achieved on land and in water and the integrity of the EMG recordings were maintained during wáter immersion

Surface electromyography during physical exercise in water: A systematic review

Background Aquatic exercise has been widely used for rehabilitation and functional recovery due to its physical and physiological benefits. However, there is a high variability in reporting on the muscle activity from surface electromyographic (sEMG) signals. The aim of this study is to present an updated review of the literature on the state of the art of muscle activity recorded using sEMG during activities and exercise performed by humans in water. Methods A literature search was performed to identify studies of aquatic exercise movement. Results Twenty-one studies were selected for critical appraisal. Sample size, functional tasks analyzed, and muscles recorded were studied for each paper. The clinical contribution of the paper was evaluated. Conclusions Muscle activity tends to be lower in water-based compared to land-based activity; however more research is needed to understand why. Approaches from basic and applied sciences could support the understanding of relevant aspects for clinical practice

Parameterisation and reliability of the functional reach test in people who suffer stroke

AIM: The aim of this study is to analyse the reliability, sensitivity and specificity of the parameterisation of FRT using inertial sensors to record kinematic variables in subjects who have had a stroke. Our hypothesis is that the IS will be reliable instruments for kinematic study of the FRT. METHODS: This is a cross-sectional study of 5 subjects over 65 years who suffer of stroke. During the execution of Funtional Reach Test the subjects carried two inertial sensors, one was placed in the lumbar and the other in the trunk. After analysing the data obtained in the kinematic registration by inertial sensors a number of direct and indirect variables were obtained. The variables extracted directly from FRT through the IS were distance, maximun angular lumbosacral/thoracic displacement, time maximun angular lumbosacral/thoracic displacement, time return starting position and total time. Using this data the speed and the acceleration of each one of them were calculated. A descriptive analysis of all kinematic outcomes recorded by the two inertial sensors was developed (trunk and lumbar) and the average range achieved in the FRT. Reliability measures were calculated by analysing the internal consistency the measures with 95% confidence interval of each outcome variable. The reliability was calculated in the functional reach and the outcomes measured by the IS. RESULTS: The values in the the Functional Reach Test obtained in the present study (2.06 ± 12.75cm) are similar to those obtained in other studies with this population and in the same age range. Intrasubject reliability values observed in the use of inertial sensors are all located above 0.820, ranging from 0.829 (time B_C lumbar area) and 0.891 (A_B displacement of the trunk). Likewise, the observed intersubject values range from 0.821 (Time B_C lumbar area) and 0.883 (B_C trunk displacement). On the other hand, the reliability of the FRT was 0.987 (0.983-0.992) and 0.983 (0.979-0.989) intersubject and intrasubject respectively. CONCLUSION: The main conclusion that can be reached is that the inertial sensors are a tool with excellent reliability, validity, sensitivity and specificity in the parameterisation of the Functional Reach Test in people who have had a stroke.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech