Managing Injuries of the Neck Trial (MINT) : design of a randomised controlled trial of treatments for whiplash associated disorders

Background: A substantial proportion of patients with whiplash injuries develop chronic symptoms. However, the best treatment of acute injuries to prevent long-term problems is uncertain. A stepped care treatment pathway has been proposed, in which patients are given advice and education at their initial visit to the emergency department (ED), followed by review at three weeks and physiotherapy for those with persisting symptoms. MINT is a two-stage randomised controlled trial to evaluate two components of such a pathway: 1. use of The Whiplash Book versus usual advice when patients first attend the emergency department; 2. referral to physiotherapy versus reinforcement of advice for patients with continuing symptoms at three weeks. Methods: Evaluation of the Whiplash Book versus usual advice uses a cluster randomised design in emergency departments of eight NHS Trusts. Eligible patients are identified by clinicians in participating emergency departments and are sent a study questionnaire within a week of their ED attendance. Three thousand participants will be included. Patients with persisting symptoms three weeks after their ED attendance are eligible to join an individually randomised study of physiotherapy versus reinforcement of the advice given in ED. Six hundred participants will be randomised. Follow-up is at 4, 8 and 12 months after their ED attendance. Primary outcome is the Neck Disability Index (NDI), and secondary outcomes include quality of life and time to return to work and normal activities. An economic evaluation is being carried out. Conclusion: This paper describes the protocol and operational aspects of a complex intervention trial based in NHS emergency and physiotherapy departments, evaluating two components of a stepped-care approach to the treatment of whiplash injuries. The trial uses two randomisations, with the first stage being cluster randomised and the second individually randomised

Predictive factors of adherence to frequency and duration components in home exercise programs for neck and low back pain: an observational study

<p>Abstract</p> <p>Background</p> <p>Evidence suggests that to facilitate physical activity sedentary people may adhere to one component of exercise prescriptions (intensity, duration or frequency) without adhering to other components. Some experts have provided evidence for determinants of adherence to different components among healthy people. However, our understanding remains scarce in this area for patients with neck or low back pain. The aims of this study are to determine whether patients with neck or low back pain have different rates of adherence to exercise components of frequency per week and duration per session when prescribed with a home exercise program, and to identify if adherence to both exercise components have distinct predictive factors.</p> <p>Methods</p> <p>A cohort of one hundred eighty-four patients with chronic neck or low back pain who attended physiotherapy in eight primary care centers were studied prospectively one month after intervention. The study had three measurement periods: at baseline (measuring characteristics of patients and pain), at the end of physiotherapy intervention (measuring characteristics of the home exercise program) and a month later (measuring professional behaviors during clinical encounters, environmental factors and self-efficacy, and adherence behavior).</p> <p>Results</p> <p>Adherence to duration per session (70.9% ± 7.1) was more probable than adherence to frequency per week (60.7% ± 7.0). Self-efficacy was a relevant factor for both exercise components (p < 0.05). The total number of exercises prescribed was predictive of frequency adherence (p < 0.05). Professional behaviors have a distinct influence on exercise components. Frequency adherence is more probable if patients received clarification of their doubts (adjusted OR: 4.1; p < 0.05), and duration adherence is more probable if they are supervised during the learning of exercises (adjusted OR: 3.3; p < 0.05).</p> <p>Conclusion</p> <p>We have shown in a clinic-based study that adherence to exercise prescription frequency and duration components have distinct levels and predictive factors. We recommend additional study, and advise that differential attention be given in clinical practice to each exercise component for improving adherence.</p

A Reliable and Inexpensive Integration of Virtual Reality and Digital Human Modelling to Estimate Cervical Spine Function

Musculoskeletal disorders present one of the most prominent impact among the work-related diseases. Cervical spine is indeed one of the anatomical regions most affected by these issues; the main impairments concerning the cervical segment inherently limit its ranges of motion (ROMs). In the last years, novel technologies have been developed to support clinicians in assessing and quantifying these limitations, including wearable sensors and Virtual Reality (VR). In this perspective, interest in Digital Human Modeling has been also increasing due to the possibility of using it together with wearable technologies, thus to obtain enhanced information on body dynamics. This study aimed to validate a novel approach, which integrated VR technology and multi-body modelling to reliably estimated the ROMs of the cervical spine during the execution of three specific tasks (i.e. flexion-extension, lateral bending, axial rotation). Comparison with standard optoelectronic system reported strong correlation and good reliability, with an average difference in estimating ROMs of 8.0° and a mean RMSE of 4.7°. Furthermore, a preliminary test in managing different visual cues through VR highlighted interesting trends for future developments. The performed analysis supported the use of the proposed solution for both the clinical settings and telemedicine applications

Experimental evaluation of three interaction channels for accessible digital musical instruments

Accessible Digital Musical instruments (ADMIs) dedicated to people with motor disabilities represent a relevant niche in accessibility research. The designer is often required to exploit unconventional physical interaction channels, different from hands and fingers. Although comprehensive evaluation methods for Digital Musical Instruments in general are found in literature, little has been done both in ADMIs evaluation and the analysis of suitable interaction channels from a Human-Computer Interaction perspective. In this work the performance of breath, gaze pointing and head movements is analyzed, in terms of movement speed and stability, through a simple experiment. These interaction channels could be exploited in the design of ADMIs dedicated to quadriplegic musicians. The proposed experiment has similarities with past Fitts Law evaluation tests. Results are discussed proposing possible mappings between channels and musical performance parameters. These results could also be useful to inform the design of different interface types