Objective measurement of muscle mechanical properties using a myometric device in people with Parkinson's disease in a clinical setting in Africa

Objective: to examine the feasibility and reliability of using a myometric device to objectively measure mechanical properties of muscles in people with Parkinson’s disease in an outpatient setting.Background: clinically, muscle stiffness and tone are assessed subjectively by manual passive movements of a limb [1]. An objective clinical measure of muscle stiffness (rigidity) and tone in Parkinson’s disease (PD) is needed. The feasibility and reliability of a novel hand-held myometric device has been established in other populations, mainly in research environments [2,3,4] but yet to be tested in clinical environments and in the African population with PD.Method: thirty adults with Parkinson’s disease [66.3±8.9 (mean±SD) years, range 47-82 years], Hoehn and Yahr Stages I-III, were studied in an outpatient neurology clinic and physiotherapy department of a teaching hospital in Ghana. Biceps brachii (BB), flexor carpi radialis (FCR) and tibialis anterior (TA) were tested in relaxed supine. A hand-held myometric device that measures mechanical properties of muscle recorded three tissue parameters: stiffness (N/m), non-neural tone (frequency, Hz) and elasticity (log decrement). Group means and standard deviations (±SD) were calculated. The intra-rater reliability of two sets of data was examined within the same session using intraclass correlation coefficients (ICCs), to see whether one set would be sufficient.Results: all 30 participants were recruited and studied within eight weeks, and the technology was acceptable to the patients and therapist. The intra-rater reliability was excellent for BB and TA muscles as all ICCs were above 0.92, and good for FCR with ICCs above 0.73 [Table 1]. The device presented real-time data for each parameter and example values for the group (n=30) on the most affected side were: BB stiffness 240±13N/m, tone 13.6±1.5 Hz and elasticity 1.49±0.31 [Table 2].Conclusion: the technique is feasible and can easily be used in the clinical setting in patients with PD. The technology was reliable for measuring two sets of data, indicating that only one set of measurements is sufficient for clinical practice. Further studies are warranted to obtain healthy control data in Ghana and to assess the effects of physiotherapy treatments on muscle parameters

Healthcare professional and commissioners’ perspectives on the factors facilitating and hindering the implementation of digital tools for self-management of long-term conditions within UK healthcare pathways

Physical activity is important in the self-management of long-term conditions (LTCs). However, implementing physical activity into clinical practice is challenging, due to complex barriers including access to programmes, time pressures, and transport costs, for people with comorbidities, managing multiple responsibilities. Various digital tools exist to overcome these barriers and support wide-scale implementation to help people stay physically active.We explored the experiences, needs and preferences of healthcare professionals and commissioners, regarding the use of digital tools to support people with LTCs to self-manage using physical activity. This included barriers and facilitators to implementing digital tools to support people with LTCs in NHS settings.Semi-structured interviews were conducted (April 2021 to January 2022) in Wessex, southern England, UK. Purposive sampling was used to recruit general practitioners and healthcare professionals, and convenience sampling to recruit commissioners (n=15). Transcripts were coded to develop conceptual themes allowing comparisons between and among perspectives, with the Normalisation Process Theory (NPT)’s four constructs used to aid interpretation.Results showed that most digital tools supporting physical activity for LTCs, are not well implemented clinically. Current digital tools were seen to lack condition-specificity, usability/acceptability evidence-base, and voluntary sector involvement (i.e., NPT: coherence or ‘making sense’). Healthcare professionals and commissioners were unlikely to engage with use of digital tools unless they were integrated into health service IT systems and professional networks (i.e., NPT: cognitive participation), or adaptable to the digital literacy levels of service users and staff (i.e., NPT: collective action – needs for implementation). In practice, this meant being technically, easy to use and culturally accessible (i.e., NPT: collective action – promoting healthcare work). COVID-19 changed professional attitudes towards digital tools, in that they saw them being viable, feasible and critical options in a way they had not done before the pandemic. Implementation was also influenced by endorsement and trustworthiness enhancing the perception of them as secure and evidence-based (i.e., NPT: reflective monitoring).Our findings highlight that consideration must be given to ensuring that digital tools are accessible to both healthcare professionals and patients, have usability/acceptability, and are adaptable to specific LTCs. To promote clinical engagement, digital tools must be evidence-based, endorsed by professional networks, and integrated into existing health systems. Digital literacy of patients and professionals is also crucial for cross-service implementation. <br/

Effect of Menstrual Cycle and Hormonal Contraception on Musculoskeletal Health and Performance: Protocol for a Prospective Cohort Design and Cross-Sectional Comparison

Background Women of reproductive age experience cyclical variation in the female sex steroid hormones 17β-estradiol and progesterone during the menstrual cycle that is attenuated by some hormonal contraceptives. Estrogens perform a primary function in sexual development and reproduction but have nonreproductive effects on bone, muscle, and sinew tissues (ie, ligaments and tendons), which may influence injury risk and physical performance. Objective The purpose of the study is to understand the effect of the menstrual cycle and hormonal contraceptive use on bone and calcium metabolism, and musculoskeletal health and performance. Methods A total of 5 cohorts of physically active women (aged 18-40 years) will be recruited to participate: eumenorrheic, nonhormonal contraceptive users (n=20); combined oral contraceptive pill (COCP) users (n=20); hormonal implant users (n=20); hormonal intrauterine system users (n=20); and hormonal injection users (n=20). Participants must have been using the COCP and implant for at least 1 year and the intrauterine system and injection for at least 2 years. First-void urine samples and fasted blood samples will be collected for biochemical analysis of calcium and bone metabolism, hormones, and metabolic markers. Knee extensor and flexor strength will be measured using an isometric dynamometer, and lower limb tendon and stiffness, tone, and elasticity will be measured using a Myoton device. Functional movement will be assessed using a single-leg drop to assess the frontal plane projection angle and the qualitative assessment of single leg loading. Bone density and macro- and microstructure will be measured using ultrasound, dual-energy x-ray absorptiometry, and high-resolution peripheral quantitative computed tomography. Skeletal material properties will be estimated from reference point indentation, performed on the flat surface of the medial tibia diaphysis. Body composition will be assessed by dual-energy x-ray absorptiometry. The differences in outcome measures between the hormonal contraceptive groups will be analyzed in a one-way between-group analysis of covariance. Within the eumenorrheic group, the influence of the menstrual cycle on outcome measures will be assessed using a linear mixed effects model. Within the COCP group, differences across 2 time points will be analyzed using the paired-samples 2-tailed t test. Results The research was funded in January 2020, and data collection started in January 2022, with a projected data collection completion date of August 2024. The number of participants who have consented at the point of manuscript submission is 66. It is expected that all data analysis will be completed and results published by the end of 2024. Conclusions Understanding the effects of the menstrual cycle and hormonal contraception on musculoskeletal health and performance will inform contraceptive choices for physically active women to manage injury risk