RESUMO
Purpose: We have previously developed DIGITS, a platform for remote evaluation of range of motion, dexterity, and swelling of fingers for reducing barriers to accessing clinical resources. The current study was aimed at evaluating DIGITS across different devices with varied operating systems and camera resolutions using a single person's hands. Methods: Our team has now developed a web application version of the DIGITS platform, which makes it accessible on any device that is equipped with a camera, including computers, tablets, and smartphones. In the present study, we aimed to validate this web application by comparing flexion and extension measurements on the same person's hands using three different devices with cameras of different resolutions. The absolute difference, SD, standard mean error, and intraclass correlation coefficient were calculated. Additionally, equivalency testing was performed using the confidence interval approach. Results: Our findings indicated that the differences in degree measured between the devices ranged from 2° to 3° when digit extension was assessed (all hand landmarks are visible in the camera's direct view) and from 3° to 8° when digit flexion was assessed (some of the hand landmarks are hidden from view). The intraclass correlation coefficient of individual trials ranged from 0.82 to 0.96 for extension and 0.77 to 0.87 for flexion across all devices. Additionally, within a 90% confidence interval, our data showed equivalency with measurements using three different devices. Conclusions: The absolute differences were within an acceptable 9° tolerance for measurements taken between devices for flexion and extension. Equivalency was observed for measurements of finger range of motion taken using DIGITS, regardless of devices, platforms, or camera resolutions. Clinical relevance: In summary, the DIGITS web application has good test-retest reliability to generate data on finger range of motion for hand telerehabilitation. DIGITS can reduce costs to patients, providers, and health care facilities for conducting postoperative follow-up assessments.
RESUMO
There appears to be increased use of computed tomography angiography (CTA) in the preoperative planning of autologous perforator flap breast reconstruction. Despite the advantages of providing superior anatomical detail, concerns regarding cost and radiation exposure of this technique remain. In the current study, a paper-based survey was distributed to 44 plastic surgeons with a special interest in breast reconstruction at 19 different centres across Canada to collect their perspectives and practice characteristics with respect to the use of CTA as a preoperative imaging modality in breast reconstruction. The response rate of the survey was 75%. The majority of respondents commonly use perforator flap breast reconstruction and CTA in their breast reconstruction practice. Surgeons identified particular benefits of CTA in patients who had previously undergone abdominal surgery. However, more than one-half of the overall cohort was concerned about radiation exposure associated with CTA. A review of the literature suggests that it may be worthwhile to reduce the unnecessary risks of additional radiation exposure to the breast cancer population. A prospective study may help to better define the group of patients in whom CTA will provide optimal benefits in terms of reducing perioperative microvascular morbidity.
On semble utiliser davantage l'angiographie par tomodensitométrie (ATD) lors de la planification préopératoire d'une reconstruction mammaire au moyen d'un lambeau perforant autologue. Malgré les avantages associés à une meilleure précision anatomique, on s'inquiète du coût de cette technique et de l'exposition aux radiations qu'elle entraîne. Dans la présente étude, 44 chirurgiens plasticiens ayant un intérêt pour la reconstruction mammaire provenant de 19 centres du Canada ont reçu un sondage papier afin de colliger leurs points de vue et les caractéristiques de leur pratique à l'égard de l'utilisation de l'ATD comme modalité d'imagerie en prévision d'une reconstruction mammaire. Le sondage a obtenu un taux de réponse de 75 %. La majorité des répondants utilisent souvent la reconstruction mammaire par lambeau perforant et l'ATD dans le cadre de leur pratique de reconstruction mammaire. Les chirurgiens ont souligné les avantages particuliers de l'ATD chez les patients qui avaient déjà subi une opération abdominale. Cependant, plus de la moitié de l'ensemble de la cohorte s'inquiétait de l'exposition aux radiations associée à l'ATD. D'après l'analyse bibliographique, il pourrait être avantageux de réduire les risques inutiles liés à une exposition supplémentaire aux radiations de la population atteinte d'un cancer du sein. Une étude prospective pourrait contribuer à mieux définir le groupe de patients chez qui l'ATD réduit de manière optimale la morbidité microvasculaire périopératoire.