Development of a Biomechanical Device for Parameter Quantification Associated with the Sit-to-Stand Movement

The “sit-to-stand” (STS) movement is essential during activities of daily living (ADL). In individuals with physical-motor diseases, its execution and repetition increases activity levels, which is crucial for a good motor rehabilitation process and daily training. Interestingly, there are no sit-to-stand devices that allow a quantitative assessment of the key variables that happen during STS, and there is a need to come up with a new device. This work presents a developed biomechanical support device that measures the force of the upper limbs during the STS movement, aiming to motivate and encourage people undergoing physical therapy in the lower limbs. The device uses two instrumented beams and allows real-time visualization of both arms’ applied force and it records the data for post-processing. The device was tested with a well-defined protocol on a group of 34 healthy young volunteers and an elderly group of 16 volunteers from a continuing care unit. The system showed robust strength and stiffness, good usability, and a user interface that acquired and recorded data effectively, allowing one to observe force-time during the execution of the movement through the application interface developed and in recording data for post-processing. Asymmetries in the applied forces in the STS movement between the upper limbs were identified, particularly in volunteers of the continuing care unit. From the application and the registered data, it can be observed that volunteers with motor problems in the lower limbs performed more strength in their arms to compensate. As expected, the maximum average strength of the healthy volunteers (both arms: force = 105 Newton) was higher than that of the volunteers from the continuing care unit (right arm: force = 54 Newton; left arm: force = 56 Newton). Among others, moderate correlations were observed between weight-applied and height-applied forces and there was a moderately high correlation between the Sequential Clinical Assessment of Respiratory Function (SCAR-F score) and time to perform the movement. Based on the obtained results, the developed device can be a helpful tool for monitoring the evaluation of a patient with limitations in the upper and lower limbs. In addition, the developed system allows for easy evolution, such as including a barometric platform and implementing serious games that can stimulate the execution of the STS movement

Development of a Biomechanical Device for Parameter Quantification Associated with the Sit-to-Stand Movement

The “sit-to-stand” (STS) movement is essential during activities of daily living (ADL). In individuals with physical-motor diseases, its execution and repetition increases activity levels, which is crucial for a good motor rehabilitation process and daily training. Interestingly, there are no sit-to-stand devices that allow a quantitative assessment of the key variables that happen during STS, and there is a need to come up with a new device. This work presents a developed biomechanical support device that measures the force of the upper limbs during the STS movement, aiming to motivate and encourage people undergoing physical therapy in the lower limbs. The device uses two instrumented beams and allows real-time visualization of both arms’ applied force and it records the data for post-processing. The device was tested with a well-defined protocol on a group of 34 healthy young volunteers and an elderly group of 16 volunteers from a continuing care unit. The system showed robust strength and stiffness, good usability, and a user interface that acquired and recorded data effectively, allowing one to observe force-time during the execution of the movement through the application interface developed and in recording data for post-processing. Asymmetries in the applied forces in the STS movement between the upper limbs were identified, particularly in volunteers of the continuing care unit. From the application and the registered data, it can be observed that volunteers with motor problems in the lower limbs performed more strength in their arms to compensate. As expected, the maximum average strength of the healthy volunteers (both arms: force = 105 Newton) was higher than that of the volunteers from the continuing care unit (right arm: force = 54 Newton; left arm: force = 56 Newton). Among others, moderate correlations were observed between weight-applied and height-applied forces and there was a moderately high correlation between the Sequential Clinical Assessment of Respiratory Function (SCAR-F score) and time to perform the movement. Based on the obtained results, the developed device can be a helpful tool for monitoring the evaluation of a patient with limitations in the upper and lower limbs. In addition, the developed system allows for easy evolution, such as including a barometric platform and implementing serious games that can stimulate the execution of the STS movement

Telerehabilitation of acute musculoskeletal multi-disorders: prospective, single-arm, interventional study

Background: Acute musculoskeletal (MSK) pain is very common and associated with impaired productivity and high economic burden. Access to timely and personalized, evidence-based care is key to improve outcomes while reducing healthcare expenditure. Digital interventions can facilitate access and ensure care scalability. Objective: Present the feasibility and results of a fully remote digital care program (DCP) for acute MSK conditions affecting several body areas. Methods: Interventional single-arm study of individuals applying for digital care programs for acute MSK pain. Primary outcome was the mean change between baseline and end-of-program in self-reported Numerical Pain Rating Scale (NPRS) score and secondary outcomes were change in analgesic consumption, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI-GH) and engagement. Results: Three hundred forty-three patients started the program, of which 300 (87.5%) completed the program. Latent growth curve analysis (LGCA) revealed that changes in NPRS between baseline and end-of-program were both statistically (p < 0.001) and clinically significant: 64.3% reduction (mean − 2.9 points). Marked improvements were also noted in all secondary outcomes: 82% reduction in medication intake, 63% reduction in surgery intent, 40% in fear-avoidance beliefs, 54% in anxiety, 58% in depression and 79% recovery in overall productivity. All outcomes had steeper improvements in the first 4 weeks, which paralleled higher engagement in this period (3.6 vs 3.2 overall weekly sessions, p < 0.001). Mean patient satisfaction score was 8.7/10 (SD 1.26). Strengths and limitations: This is the first longitudinal study demonstrating the feasibility of a DCP for patients with acute MSK conditions involving several body areas. Major strengths of this study are the large sample size, the wide range of MSK conditions studied, the breadth of outcomes measured, and the very high retention rate and adherence level. The major limitation regards to the absence of a control group. Conclusions: We observed very high completion and engagement rates, as well as clinically relevant changes in all health-related outcomes and productivity recovery. We believe this DCP holds great potential in the delivery of effective and scalable MSK care. Trial registration: NCT, NCT04092946. Registered 17/09/2019; © 2021, The Author(s)

Biomechanical Device for Measurement of Adductors Strength and Aid in Self-Catheterisation of Spastic Patients

Intermittent vesical self-catheterisation is a legitimate and safe technique that has been reported since the 1970s as a solution for the treatment and prevention of vesical urinary complications resulting from spinal cord injury. This practice, using clean technology, has been asserting itself as one of the best alternatives for people with neurogenic bladder. However, adherence is not complete due to some barriers imposed to this procedure by the injured, with emphasis on positioning, agility, and visual impairment. The solutions presented today to support self-catheterisation are expensive equipment that does not allow patients with advanced levels of spasticity to have their autonomy. A biomechanical support device was developed to aid self-catheterisation, mainly aimed at women with spasticity, filling the gap in the existing products. Despite the main objective of self-catheterisation, the system’s design made it possible to quantify the strength of the adductors for the sitting position during the execution of the adduction movement, particularly relevant for spastic patients. The device’s production was entirely carried out using the FDM methodology, with 3D printers, and its design and operation were thought to overcome the physical and psychological barriers imposed by the users. The system was first tested with a group of healthy volunteers to obtain a pattern of the adductors force in a sitting position and after with a group of spastic volunteers. The obtained data allows to compare the adductor force data and optimize the system, with particular functionalities for spastic patients, with the implementation of a motorised version and a visualization camera. The system, its developments, and results obtained are present and discussed

Impact of Post-Stroke Recanalization on General and Upper Limb Functioning: A Prospective, Observational Study

The objective of this study is to assess the impact of recanalization (spontaneous and therapeutic) on upper limb functioning and general patient functioning after stroke. This is a prospective, observational study of patients hospitalized due to acute ischemic stroke in the territory of the middle cerebral artery (n = 98). Patients completed a comprehensive rehabilitation program and were followed-up for 24 weeks. The impact of recanalization on patient functioning was evaluated using the modified Rankin Scale (mRS) and Stroke Upper Limb Capacity Scale (SULCS). General and upper limb functioning improved markedly in the first three weeks after stroke. Age, gender, and National Institutes of Health Stroke Scale (NIHSS) score at admission were associated with general and upper limb functioning at 12 weeks. Successful recanalization was associated with better functioning. Among patients who underwent therapeutic recanalization, NIHSS scores ≥16.5 indicate lower general functioning at 12 weeks (sensibility = 72.4%; specificity = 78.6%) and NIHSS scores ≥13.5 indicate no hand functioning at 12 weeks (sensibility = 83.8%; specificity = 76.5%). Recanalization, either spontaneous or therapeutic, has a positive impact on patient functioning after acute ischemic stroke. Functional recovery occurs mostly within the first 12 weeks after stroke, with greater functional gains among patients with successful recanalization. Higher NIHSS scores at admission are associated with worse functional recovery

Inadequate pain relief among patients with primary knee osteoarthritis

ABSTRACT Background: Despite the widespread treatments for osteoarthritis (OA), data on treatment patterns, adequacy of pain relief, and quality of life are limited. The prospective multinational Survey of Osteoarthritis Real World Therapies (SORT) was designed to investigate these aspects. Objectives: To analyze the characteristics and the patient reported outcomes of the Portuguese dataset of SORT at the start of observation. Methods: Patients ≥50 years with primary knee OA who were receiving oral or topical analgesics were eligible. Patients were enrolled from seven healthcare centers in Portugal between January and December 2011. Pain and function were evaluated using the Brief Pain Inventory (BPI) and WOMAC. Quality of life was assessed using the 12-Item Short Form Health Survey (SF-12). Inadequate pain relief (IPR) was defined as a score >4/10 on item 5 of the BPI. Results: Overall, 197 patients were analyzed. The median age was 67.0 years and 78.2% were female. Mean duration of knee OA was 6.2 years. IPR was reported by 51.3% of patients. Female gender (adjusted odds ratio - OR 2.15 [95%CI 1.1, 4.5]), diabetes (OR 3.1 [95%CI 1.3, 7.7]) and depression (OR 2.24 [95%CI 1.2, 4.3]) were associated with higher risk of IPR. Patients with IPR reported worst outcomes in all dimensions of WOMAC (p < 0.001) and in all eight domains and summary components of SF-12 (p < 0.001). Conclusions: Our findings indicate that improvements are needed in the management of pain in knee OA in order to achieve better outcomes in terms of pain relief, function and quality of life

Digital Rehabilitation for Acute Ankle Sprains: Prospective Longitudinal Cohort Study

Background: Ankle sprains are one of the most prevalent soft-tissue injuries worldwide. Physical therapy, especially progressive exercise, has proven effective in improving function, while preventing recurrence. Objective: We aim to present the results of a fully remote and digitally guided rehabilitation program for acute ankle sprains. Methods: We performed a prospective longitudinal cohort study of individuals eligible for workers’ compensation, who were referred for digital rehabilitation therapy for a sprained ankle. Therapeutic exercise sessions were to be performed independently by the patient at home using the biofeedback device provided by SWORD Health. Primary endpoints were the change in self-reported Numerical Pain Rating Scale (NPRS) and Foot and Ankle Ability Measure–activities of daily living (FAAM–ADL) and FAAM–Sports scores. Participants were assessed at baseline, end of the program, and 6 months after program completion. Secondary outcomes included digital therapy dosage, pain and fatigue during sessions, and satisfaction. Results: In total, 93 (89.4%) patients completed the program and 79 (76.0%) were available for follow-up. Changes in the primary outcomes between baseline and the 6-month follow-up were both significant (P<.001) and clinically meaningful: mean difference of –2.72 points (95% CI –3.31 to –2.13) on the NPRS (49.8% reduction), 21.7 points (95% CI 17.13-26.27) on the FAAM–ADL (41.1% increase), and 37.8 points (95% CI 30.45-45.15) on the FAAM-Sports (151.8% increase). Longer waiting periods between the accident date and treatment initiation were found to negatively impact functional status at baseline and at the end of the program, triggering an extension in the program duration. The total training volume (12.5 hours, SD 10.5 hours) was similar to that of other interventions for ankle sprains, but the dosage per week was much higher (2.4 hours per week, SD 0.87 hours per week). The mean patient satisfaction score was 8.8 (SD 1.57) out of 10. Among program completers, 83.9% attained full recovery and were discharged with no residual disability. Conclusions: Being far less demanding in terms of human resources, the digital program presented constituted a viable, clinically effective, and convenient solution for ankle sprain rehabilitation, particularly during the pandemic. This is the first study presenting a fully remote home-based rehabilitation program for acute ankle sprains, with patients achieving sustained long-term results. This was a prospective cohort study and, as such, did not include a control group, but the results appear comparable to those published for face-to-face interventions. Trial Registration: ClinicalTrials.gov NCT04819022; https://clinicaltrials.gov/ct2/show/NCT0481902

Asynchronous and Tailored Digital Rehabilitation of Chronic Shoulder Pain: A Prospective Longitudinal Cohort Study

Background: Chronic shoulder pain (SP) is responsible for significant morbidity, decreased quality of life and impaired work ability, resulting in high socioeconomic burden. Successful SP management is dependent on adherence and compliance with effective evidence-based interventions. Digital solutions may improve accessibility to such treatments, increasing convenience, while reducing healthcare-related costs. Purpose: Present the results of a fully remote digital care program (DCP) for chronic SP. Patients and Methods: Interventional, single-arm, cohort study of individuals with chronic SP applying for a digital care program. Primary outcome was the mean change between baseline and 12 weeks on the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Secondary outcomes were change in pain (NPRS), analgesic consumption, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fearavoidance beliefs (FABQ-PA), work productivity (WPAI) and engagement. Results: From 296 patients at program start, 234 (79.1%) completed the intervention. Changes in QuickDASH between baseline and end-of-program were both statistically (p < 0.001) and clinically significant, with a mean reduction of 51.6% (mean −13.45 points, 95% CI: 11.99; 14.92). Marked reductions were also observed in all secondary outcomes: 54.8% in NPRS, 44.1% ceased analgesics consumption, 55.5% in surgery intent, 37.7% in FABQ-PA, 50.3% in anxiety, 63.6% in depression and 66.5% in WPAI overall. Higher engagement was associated with higher improvements in disability. Mean patient satisfaction score was 8.7/10.0 (SD 1.6). Conclusion: This is the first real-world cohort study reporting the results of a multimodal remote digital approach for chronic SP rehabilitation. High completion and engagement rates were observed, which were associated with clinically significant improvement in all healthrelated outcomes, as well as marked productivity recovery. These promising results support the potential of digital modalities to address the global burden of chronic musculoskeletal pain