Automatic Body Segment and Side Recognition of an Inertial Measurement Unit Sensor during Gait.

Inertial measurement unit (IMU) sensors are widely used for motion analysis in sports and rehabilitation. The attachment of IMU sensors to predefined body segments and sides (left/right) is complex, time-consuming, and error-prone. Methods for solving the IMU-2-segment (I2S) pairing work properly only for a limited range of gait speeds or require a similar sensor configuration. Our goal was to propose an algorithm that works over a wide range of gait speeds with different sensor configurations while being robust to footwear type and generalizable to pathologic gait patterns. Eight IMU sensors were attached to both feet, shanks, thighs, sacrum, and trunk, and 12 healthy subjects (training dataset) and 22 patients (test dataset) with medial compartment knee osteoarthritis walked at different speeds with/without insole. First, the mean stride time was estimated and IMU signals were scaled. Using a decision tree, the body segment was recognized, followed by the side of the lower limb sensor. The accuracy and precision of the whole algorithm were 99.7% and 99.0%, respectively, for gait speeds ranging from 0.5 to 2.2 m/s. In conclusion, the proposed algorithm was robust to gait speed and footwear type and can be widely used for different sensor configurations.

[Preoperative rehabilitation before lower limb arthroplasty : Knowledge and perspectives]. / Réadaptation préopératoire avant arthroplastie du membre inférieur : connaissances et perspectives.

The shortening of hospital stays implies rethinking the pre- and post-operative management of lower limb arthroplasty. Optimal preparation of the patient and anticipation of the postoperative process are necessary to limit the length of stay and ensure quality, safety and patient satisfaction. This article summarises what is known about preoperative information, education and rehabilitation for primary care physicians. Physical rehabilitation is not recommended in isolation. However, patient-centred information and education is recommended for those at risk of complicated postoperative outcomes. Interdisciplinary collaboration is needed to coordinate the whole process effectively in a context of shortened lengths of stay.

Le raccourcissement des séjours hospitaliers implique de repenser la prise en charge pré et postopératoire après arthroplastie du membre inférieur. Une préparation optimale du patient et une anticipation du processus postopératoire sont nécessaires pour limiter le séjour et assurer la qualité, la sécurité et la satisfaction des patients. Cet article synthétise, à l'intention des médecins de premier recours, les connaissances concernant l'information, l'éducation et la réadaptation préopératoires. Une réadaptation physique n'est pas recommandée isolément. En revanche, l'information et l'éducation centrées sur le patient sont recommandées chez les sujets à risque de suites opératoires compliquées. Une collaboration interdisciplinaire est nécessaire pour coordonner efficacement l'ensemble du processus avec des durées de séjours réduites.

Trajectoires de personnes souffrant de lombalgie chronique : ruptures et reconstructions après un programme de rééducation.

Purpose of research: The objective of this article is to investigate, from the perspective of patients, the disruptions of the biographical trajectories induced by chronic low back pain and the impact of a multidisciplinary rehabilitation program on their reconstruction. METHODS: Based on an interdisciplinary qualitative research, we investigated the experience of 20 participants with chronic low back pain following a three-week rehabilitation program at the hospital. Semi-directive interviews were conducted before and after inclusion in the program. RESULTS: Although affecting each person in a singular way, chronic low back pain induces biographical linearity disruptions related to the apparition of pain, and the disruption of daily and professional activities. For the majority of participants, the rehabilitation program provided a repairative space to restore continuity between past, present and future life. Whether or not there is a significant improvement in pain, most participants report benefits that give them the feeling of getting back to normality. Nevertheless, they identify those more for the domestic, family, and social spheres than at the professional level, effects remaining moderate to mitigated in that area. CONCLUSIONS: The rehabilitation program influences the dynamics of biographical trajectories and promotes a return to what is perceived as normality. By providing individuals with theoretical and practical tools and increasing their functional capacities, it promotes autonomous pain and problem management. Immediate effects are seen as restorative for domestic, family and social activities, but remain limited on the professional level.

[Update on the rehabilitation following anatomic and reverse total shoulder arthroplasty]. / Rééducation après prothèses totales de l'épaule anatomique et inversée.

This article aims to present the principles of rehabilitation following anatomical and reverse total shoulder arthroplasties. The rehabilitation consist of three phases: wound healing and movement initiation (weeks 0-6), movement recovery (7-12), strengthening and return to activity (13-18). At 6 to 12 months follow-up, most patients report a substantial decrease in pain and a return to light to moderate activity level. The rehabilitation of the reverse arthroplasty specifically requires deltoid muscle strengthening and dislocation prevention. The functional outcome is slightly inferior for reverse arthroplasty, which is indicated when musculotendinous lesions are associated to bone lesions, but satisfaction rates are comparable between the two types of implants. The durability of total shoulder arthroplasties is globally satisfying, though shorter in young active patients.

Cet article présente la rééducation après prothèses totales d'épaule anatomique (PTEa) et inversée (PTEi), qui se découpe en 3 phases : cicatrisation et initiation du mouvement (semaines 0-6), récupération du mouvement (7-12), renforcement et retour à l'activité (13-18). Après 6-12 mois, la plupart des patients rapportent une nette diminution des douleurs et une reprise des activités légères à modérées. La rééducation de la PTEi implique spécifiquement de renforcer le muscle deltoïde et de prévenir la luxation. Le résultat fonctionnel est légèrement inférieur pour la PTEi, qui est posée lorsque des lésions musculo-tendineuses sont associées à des lésions osseuses, mais la satisfaction est comparable entre les deux types d'implants. La longévité de ces prothèses, bien que plus courte chez le patient actif jeune, est généralement bonne.

[Chronic low back pain: from the uncertain medical diagnosis to the profane etiologies]. / Lombalgie chronique : du diagnostic médical incertain aux étiologies profanes.

This qualitative research article is based on interviews with 20 participants to a low back pain rehabilitation program in a Swiss hospital. It shows that, in the absence of the obvious cause that can explain pain, patients construct their own interpretations and explanations in order to give meaning to their experience. Their explanatory models mainly include the lifestyle and the physical aspects related to the body function, what leaves little room for the psychosocial component. Their interpretation is consequently discordant with the current medical approach, which considers that chronic low back pain results from bio-psycho-social factors. This discrepancy implies negotiation between patients and professionals about the objectives to achieve in order to treat pain.

Cet article, issu d'une recherche qualitative menée dans un hôpital suisse, est basé sur des entretiens avec 20 participants à un programme de rééducation de la lombalgie. Il montre qu'en l'absence de causes objectivables permettant d'expliquer la douleur, les patients élaborent leurs propres interprétations et explications pour donner sens à leur vécu. Leurs modèles explicatifs incluent principalement le mode de vie et les aspects physiques liés au fonctionnement du corps et laissent peu de place à la composante psychologique. Leur interprétation est, par conséquent, en décalage avec la vision médicale actuelle qui considère que les douleurs dans la lombalgie chronique sont d'origine bio-psychosociale. Ce décalage implique une concertation entre patients et professionnels sur les objectifs à poursuivre pour traiter la douleur.

Effect of Manual Lymphatic Drainage After Total Knee Arthroplasty: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the effects of manual lymphatic drainage (MLD) on knee swelling and the assumed consequences of swelling after total knee arthroplasty (TKA). DESIGN: Randomized controlled trial. SETTING: Primary care hospital. PARTICIPANTS: Two groups of 30 patients were randomized before TKA surgery (N=60; 65% women [39]; mean age, 70.7±8.8y; weight, 77.8±11.3kg; size, 1.64±0.08m; body mass index, 29.9±4.1kg/m(2)). INTERVENTIONS: Participants received either 5 MLD treatments or a placebo, added to rehabilitation, in between the second day and the seventh day after surgery. MAIN OUTCOME MEASURES: Swelling was measured by blinded evaluators before surgery and at second day, seventh day, and 3 months using bioimpedance spectroscopy and volume measurement. Secondary outcomes were active and passive range of motion, pain, knee function, and gait parameters. RESULTS: At seventh day and 3 months, no outcome was significantly different between groups, except for the knee passive flexion contracture at 3 months, which was lower and less frequent in the MLD group (-2.6°; 95% confidence interval, -5.0° to -0.21°; P=.04; absolute risk reduction, 26.6%; 95% confidence interval, 0.9%-52.3%; number needed to treat, 4). The mean pain level decreased between 5.8 and 8.2mm on the visual analog scale immediately after MLD, which was significant after 4 of 5 MLD treatments. CONCLUSIONS: MLD treatments applied immediately after TKA surgery did not reduce swelling. It reduced pain immediately after the treatment. Further studies should investigate whether the positive effect of MLD on knee extension is replicable.

[Update on the postsurgical shoulder rotator cuff rehabilitation]. / Mise au point sur la rééducation après chirurgie de la coiffe des rotateurs de l'épaule.

Primary care physicians play a crucial role in rehabilitation following rotator cuff surgery. This synthesis paper aims to address essential issues of postsurgical rehabilitation, based on recent recommendations. The rehabilitation comprises 4 phases, which are determined by the tendon healing process.For each phase, this article presents the stage of tendon healing, the allowed mechanical constraints, the exercise and physiotherapy modalities, the possible activities and the potential complications. Information and counseling to support the patient implication in the rehabilitation are also detailed. This article contributes to an enhanced comprehension of the healing process, which is a prerequisite for appropriate follow-up and efficient complication detection.

Le médecin de premier recours joue un rôle capital dans la rééducation après chirurgie de la coiffe des rotateurs. Cet article fait le point sur les recommandations concernant la rééducation. Celle-ci comprend quatre phases, conditionnées par la cicatrisation du tendon : 1) cicatrisation et initiation du mouvement (semaines 0-6) ; 2) remodelage et récupération du mouvement (semaines 7-12) ; 3) renforcement et retour à l'activité (semaines 13-18) et 4) reprise du sport et du travail de force (semaines 19-24).Pour chaque phase, cet article présente le stade de cicatrisation, les contraintes autorisées, les exercices et la physiothérapie, les activités envisageables et les complications potentielles, dans le but de contribuer à renforcer la compréhension du processus de récupération, fondamentale pour un suivi adapté et un dépistage efficace des complications.

Bioimpedance spectroscopy for swelling evaluation following total knee arthroplasty: a validation study.

BACKGROUND: The evaluation of swelling is important for the outcome of total knee arthroplasty (TKA) surgery. The circumference or volume measurements are applicable at the bedside of the patient but are altered by muscular atrophy and the post-surgical dressing. Bioimpedance spectroscopy might overcome these limitations; however, it should be validated. This study aimed to explore the validity, the reliability and the responsiveness of bioimpedance spectroscopy for measuring swelling after TKA. METHODS: The degree of swelling in 25 patients undergoing TKA surgery was measured using bioimpedance spectroscopy (BIS R0), knee circumference and limb volume. The measurements were performed on D-1 (day before surgery), D + 2 (2 days after surgery) and D + 8 (8 days after surgery). The BIS R0 measurements were repeated twice, alternating between two evaluators. The percentage of the difference between the limbs was calculated for BIS R0, circumference and volume. The intra- and inter-observer intraclass correlation coefficients (ICCs), limits of agreement (LOA), effect size (Cohen's d), correlations between the methods and diagnostic sensitivity were calculated. RESULTS: BIS R0, circumference and volume detected swelling < 3.5% at D-1. The swelling at D2 and D8 was greater with BIS R0 [mean (SD) 29.9% (±9.8) and 38.27 (±7.8)] than with volume [14.7 (±9.5) and 14.9 (±8.2)] and circumference [11.1 (±5.7) and 11.7 (±4.1)]. The BIS R0 intra- and inter-evaluator ICCs ranged from 0.89 to 0.99, whereas the LOA were < 5.2%. The BIS R0 correlation was 0.73 with volume and 0.75 with circumference. The BIS R0 Cohen's d was 3.32 for the D-1-D2 evolution. The diagnostic sensitivity was 83% D2 and 96% at D8. CONCLUSION: Bioimpedance is a valid method for the evaluation of swelling following TKA. BIS R0 also demonstrated excellent intra- and inter-evaluator reliability. The diagnostic sensitivity and responsiveness is superior to that of concurrent methods. BIS R0 is an efficient method for post-surgical follow up at the bedside of the patient. The measurement of BIS R0 is a straightforward, valid, reliable and responsive method for lower limb swelling following TKA surgery that could be used in clinics and research. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00627770.

Alteration and recovery of arm usage in daily activities after rotator cuff surgery.

BACKGROUND: The objective measurement of dominant/nondominant arm use proportion in daily life may provide relevant information on healthy and pathologic arm behavior. This prospective case-control study explored the potential of such measurements as indicators of upper limb functional recovery after rotator cuff surgery. METHODS: Data on dominant/nondominant arm usage were acquired with body-worn sensors for 7 hours. The postsurgical arm usage of 21 patients was collected at 3, 6, and 12 months after rotator cuff surgery in the sitting, walking, and standing postures and compared with a reference established with 41 healthy subjects. The results were calculated for the dominant and nondominant surgical side subgroups at all stages. The correlations with clinical scores were calculated. RESULTS: Healthy right-handed and left-handed dominant arm usage was 60.2% (±6.3%) and 53.4% (±6.6%), respectively. Differences in use of the dominant side were significant between the right- and left-handed subgroups for sitting (P = .014) and standing (P = .009) but not for walking (P = .328). The patient group showed a significant underuse of 10.7% (±8.9%) at 3 months after surgery (P < .001). The patients recovered normal arm usage within 12 months, regardless of surgical side. The arm underuse measurement was weakly related to function and pain scores. CONCLUSION: This study provided new information on arm recovery after rotator cuff surgery using an innovative measurement method. It highlighted that objective arm underuse measurement is a valuable indicator of upper limb postsurgical outcome that captures a complementary feature to clinical scores.

Measurement properties of the smartphone-based B-B Score in current shoulder pathologies.

This study is aimed at the determination of the measurement properties of the shoulder function B-B Score measured with a smartphone. This score measures the symmetry between sides of a power-related metric for two selected movements, with 100% representing perfect symmetry. Twenty healthy participants, 20 patients with rotator cuff conditions, 23 with fractures, 22 with capsulitis, and 23 with shoulder instabilities were measured twice across a six-month interval using the B-B Score and shoulder function questionnaires. The discriminative power, responsiveness, diagnostic power, concurrent validity, minimal detectable change (MDC), minimal clinically important improvement (MCII), and patient acceptable symptom state (PASS) were evaluated. Significant differences with the control group and significant baseline-six-month differences were found for the rotator cuff condition, fracture, and capsulitis patient groups. The B-B Score was responsive and demonstrated excellent diagnostic power, except for shoulder instability. The correlations with clinical scores were generally moderate to high, but lower for instability. The MDC was 18.1%, the MCII was 25.2%, and the PASS was 77.6. No floor effect was observed. The B-B Score demonstrated excellent measurement properties in populations with rotator cuff conditions, proximal humerus fractures, and capsulitis, and can thus be used as a routine test to evaluate those patients.

In-between duty and hope for recognition, the experience of physiotherapists working in a university hospital during the COVID-19 first wave in Switzerland: a qualitative study based on focus groups.

BACKGROUND: Learning more about the physiotherapists' experience, perceived role and perception of events during the COVID-19 crisis, as well as their recovery and projection into the post-crisis future, may be useful to inform stakeholders about the impact of the crisis. The objective of this study was to investigate the experience of physiotherapists working in a university hospital in Switzerland during the 1st wave of the COVID-19 crisis, more specifically their subjective experience, professional involvement, perception of management and perceived implications for the future. METHODS: This interpretative qualitative study investigated the subjective experience of a purposeful sample of 12 physiotherapists using two 2 h semi-directive focus group interviews conducted by a physiotherapist in June 2020. Data were recorded, transcribed, and analysed using a thematic analysis approach. The report was approved by participants and the study was audited by a health anthropologist. RESULTS: The most impressive points were the unprecedented nature of the crisis, the health threat, the hospital's capacity to reorganise on a large scale and the solidarity between colleagues. Participants expressed a high level of commitment to their role despite the potentially serious repercussions at an individual level. Pride and stress coexisted for those directly involved in the crisis, while those working in a reduced activity department felt anxious and idle. The need for immediacy in decision-making and action led to a flattening of hierarchies and an increase of uncertainties. Communication management was seen as the main area for improvement. Physiotherapists hoped that their involvement would improve recognition of the profession but feared that working conditions would deteriorate after the crisis. CONCLUSIONS: The physiotherapists expressed high dedication to their profession and pride to be part of the "war effort" during the crisis. The stress level was partly tempered by the solidarity amongst health professionals and distraction by engaging in action. Despite the mental load, this situation was also seen as an opportunity to grow at a personal and professional level. The healthcare system capacity having not been exceeded in Switzerland, less distress related to death and powerlessness were expressed than in other studies investigating healthcare professionals' experience of the COVID-19 crisis.

Patients' expectations of physiotherapists before and after an intensive chronic low back pain rehabilitation programme: a qualitative study based on semi-structured interviews and observations.

PURPOSE: To investigate the expectations regarding physiotherapists of patients attending an interdisciplinary CLBP rehabilitation programme and the response to these expectations. MATERIALS AND METHODS: A thematic analysis was conducted, based on interviews of working-age patients with CLBP and without significant comorbidities. RESULTS: Twenty patients participated (9 male, 11 female, aged 21-58 years; symptoms duration 4.3 ± 3.0 years; pain VAS 53 ± 21 mm). Patients expected to learn pain and activity management. Expected outcomes were a reduction of pain, increased well-being and a return to normality. A collaborative approach involving therapeutic and relational adaptation was expected. Despite divergences concerning emotional aspects, patients expected a large range of applied psychosocial skills.The programme met the expectations of most patients, especially when its goals matched those reported by the individuals. For most participants, the pain relief was below expectations. Active therapies were valued. After the programme, patients felt more ready to take responsibility for their back. CONCLUSION: The expectation of developing self-management skills was prevalent. Expected treatments were mostly compatible with recommendations. Expectations to resume activities and decrease pain were in line with the rehabilitation goals, although the expected reduction in pain was overestimated. Relational expectations converged towards patient-centred care.

Patient­therapist agreement on rehabilitation goals is central to meeting the expectations of patients following a chronic low back pain (CLBP) rehabilitation programme.Physiotherapists should be aware of the wide range of expectations that patients with CLBP have of them in terms of skills development, relationship and outcome.The treatments expected by patients with CLBP were mostly compatible with scientific treatment recommendations.Since expectations are rarely expressed spontaneously during treatment sessions, physiotherapists should regularly enquire about them and their evolution in the course of rehabilitation.Following the programme, the patients' expectations had shifted from focusing on the physiotherapist to taking responsibility for self-management of the CLBP, although they had some doubt about their ability to achieve this.

Knee adduction moment decomposition: Toward better clinical decision-making.

Knee adduction moment (KAM) is correlated with the progression of medial knee osteoarthritis (OA). Although a generic gait modification can reduce the KAM in some patients, it may have a reverse effect on other patients. We proposed the "decomposed ground reaction vector" (dGRV) model to 1) distinguish between the components of the KAM and their contribution to the first and second peaks and KAM impulse and 2) examine how medial knee OA, gait speed, and a brace influence these components. Using inverse dynamics as the reference, we calculated the KAM of 12 healthy participants and 12 patients with varus deformity and medial knee OA walking with/without a brace and at three speeds. The dGRV model divided the KAM into four components defined by the ground reaction force (GRF) and associated lever arms described with biomechanical factors related to gait modifications. The dGRV model predicted the KAM profile with a coefficient of multiple correlations of 0.98 ± 0.01. The main cause of increased KAM in the medial knee OA group, the second component (generated by the vertical GRF and mediolateral distance between the knee and ankle joint centers), was decreased by the brace in the healthy group. The first peak increased, and KAM impulse decreased with increasing velocity in both groups, while no significant change was observed in the second peak. The four-component dGRV model successfully estimated the KAM in all tested conditions. It explains why similar gait modifications produce different KAM reductions in subjects. Thus, more personalized gait rehabilitation, targeting elevated components, can be considered.

Objective evaluation of shoulder function using body-fixed sensors: a new way to detect early treatment failures?

BACKGROUND: Variable definitions of outcome (Constant score, Simple Shoulder Test [SST]) have been used to assess outcome after shoulder treatment, although none has been accepted as the universal standard. Physicians lack an objective method to reliably assess the activity of their patients in dynamic conditions. Our purpose was to clinically validate the shoulder kinematic scores given by a portable movement analysis device, using the activities of daily living described in the SST as a reference. The secondary objective was to determine whether this device could be used to document the effectiveness of shoulder treatments (for glenohumeral osteoarthritis and rotator cuff disease) and detect early failures. METHODS: A clinical trial including 34 patients and a control group of 31 subjects over an observation period of 1 year was set up. Evaluations were made at baseline and 3, 6, and 12 months after surgery by 2 independent observers. Miniature sensors (3-dimensional gyroscopes and accelerometers) allowed kinematic scores to be computed. They were compared with the regular outcome scores: SST; Disabilities of the Arm, Shoulder and Hand; American Shoulder and Elbow Surgeons; and Constant. RESULTS: Good to excellent correlations (0.61-0.80) were found between kinematics and clinical scores. Significant differences were found at each follow-up in comparison with the baseline status for all the kinematic scores (P < .015). The kinematic scores were able to point out abnormal patient outcomes at the first postoperative follow-up. CONCLUSION: Kinematic scores add information to the regular outcome tools. They offer an effective way to measure the functional performance of patients with shoulder pathology and have the potential to detect early treatment failures.

Changes in physiotherapy students' beliefs and attitudes about low back pain through pre-registration training.

BACKGROUND: Implementation of best-practice care for patients with low back pain (LBP) is an important issue. Physiotherapists' who hold unhelpful beliefs are less likely to adhere to guidelines and may negatively influence their patients' beliefs. Pre-registration education is critical in moving towards a biopsychosocial model of care. This study aimed to investigate the changes in 2nd year physiotherapy students' beliefs about LBP after a module on spinal pain management and determine whether these changes were maintained at the end of academic training. METHODS: During three consecutive calendar years, this longitudinal cohort study assessed physiotherapy students' beliefs with the Back Pain Attitudes Questionnaires (Back-PAQ) in their 1st year, before and after their 2nd year spinal management learning module, and at the end of academic training (3rd year). Unpaired t-tests were conducted to explore changes in Back-PAQ score. RESULTS: The mean response rate after the spinal management module was 90% (128/143 students). The mean (± SD) Back-PAQ score was 87.73 (± 14.21) before and 60.79 (± 11.44) after the module, representing a mean difference of - 26.95 (95%CI - 30.09 to - 23.80, p < 0.001). Beliefs were further improved at the end of 3rd year (- 7.16, 95%CI - 10.50 to - 3.81, p < 0.001). CONCLUSIONS: A spinal management learning module considerably improved physiotherapy students' beliefs about back pain. Specifically, unhelpful beliefs about the back being vulnerable and in need of protection were substantially decreased after the module. Improvements were maintained at the end of academic training one-year later. Future research should investigate whether modifying students' beliefs leads to improved clinical practice in their first years of practice.

Unhelpful beliefs and attitudes about low back pain in the general population: A cross-sectional survey.

BACKGROUND: Unhelpful beliefs about non-specific low back pain (LBP) are associated with poorer coping strategies and unhelpful behaviours. Furthermore, targeting unhelpful beliefs about back pain has been advanced as a major priority to decrease the burden of LBP. Therefore, studies exploring these beliefs are needed to adapt the message delivered to the population. OBJECTIVES: To identify attitudes and beliefs about LBP in the general population in French-speaking Switzerland and to analyse their association with individual characteristics and the belief that exercise is an effective treatment for LBP. DESIGN: Cross-sectional study. METHOD: Attitudes and beliefs were measured with the Back-Pain Attitudes Questionnaire (Back-PAQ). Individual characteristics and participants' beliefs about the effectiveness of exercise for LBP were collected to determine their association with Back-PAQ score. RESULTS: The questionnaire was completed by 1129 participants. Unhelpful beliefs were widespread (mean (SD) Back-PAQ score: 113.2 (10.6)), especially those that the back needs protection, is easy to injure and that the nature of LBP is special. Only 55% of the participants believed exercise to be one of the most effective treatment for LBP. Individual characteristics only explained 4% of the Back-PAQ score variance. CONCLUSION: French-speaking Swiss general population has high levels of unhelpful beliefs and moderate confidence in the effectiveness of exercise for LBP, though the message "staying active is good for LBP" was well understood. The messages to decrease the level of unhelpful beliefs about LBP in the population should specifically target the vulnerability, protection and special nature of LBP, and promote exercise therapy.

Physiotherapists' attitudes and beliefs about low back pain influence their clinical decisions and advice.

BACKGROUND: Physiotherapists' biomedical orientation influences the implementation of evidenced-based care for low back pain (LBP) management. However, information on physiotherapists' own beliefs about their back and LBP and the influence of these on clinical decisions and advice is lacking. OBJECTIVES: To identify attitudes and beliefs about LBP among physiotherapists and to analyse the association of these beliefs with physiotherapists' individual characteristics and clinical decisions and advice. DESIGN: Cross-sectional survey. METHOD: Attitudes and beliefs about LBP were measured with the Back-Pain Attitudes Questionnaire (Back-PAQ) among French-speaking Swiss physiotherapists. Physiotherapists' clinical decisions and advice were assessed with a clinical vignette to determine their association with the Back-PAQ score. RESULTS: The study included 288 physiotherapists. The mean Back-PAQ score (82.7; SD 17.2) indicated the presence of helpful beliefs in general, but unhelpful beliefs in relation to back protection and the special nature of LBP (nature of pain, impact, complexity) were frequently identified. Individual characteristics explained 17% of the Back-PAQ score. Unhelpful beliefs were associated with clinical decisions toward back protection and movement avoidance (r = - 0.47, p < 0.001). CONCLUSIONS: While helpful beliefs and guidelines consistent decisions were generally identified, unhelpful beliefs about back protection and the special nature of LBP were frequently present among physiotherapists. These unhelpful beliefs were associated with less optimal clinical decisions. Educational approaches should challenge unhelpful beliefs and empower physiotherapists to provide explanations and management that increases patients' confidence in the back. Future research should investigate the effect of educational strategies on implementation of best practice for LBP management.

Outcome evaluation in shoulder surgery using 3D kinematics sensors.

A new method of scoring systems for the functional assessment of the shoulder is presented. 3D accelerometers and gyroscopes attached on the humerus were used to differentiate a healthy from a painful shoulder. The method was first tested on 10 healthy volunteer subjects with no shoulder pathology. The system was then tested on 10 patients with unilateral shoulder pathology (rotator cuff disease, osteoarthritis) before and after surgery (3, 6 months). In order to evaluate the system, nine tests based on the Simple Shoulder Test (SST) were performed on each shoulder for each patient. Three scores were defined: the P score was based on the angular velocities and accelerations of the humerus; the RAV score was based only on the angular velocities of the humerus; the M score was based on the sum of all moments of the humerus. Our kinematic scores indicated significant differences between baseline and follow-up (p<0.05) and differentiated between patients with varying severity of the same condition. We demonstrated a reliable technique of evaluating shoulder pathology and the results of surgery.

Heightened clinical utility of smartphone versus body-worn inertial system for shoulder function B-B score.

BACKGROUND: The B-B Score is a straightforward kinematic shoulder function score including only two movements (hand to the Back + lift hand as to change a Bulb) that demonstrated sound measurement properties for patients for various shoulder pathologies. However, the B-B Score results using a smartphone or a reference system have not yet been compared. Provided that the measurement properties are comparable, the use of a smartphone would offer substantial practical advantages. This study investigated the concurrent validity of a smartphone and a reference inertial system for the measurement of the kinematic shoulder function B-B Score. METHODS: Sixty-five patients with shoulder conditions (with rotator cuff conditions, adhesive capsulitis and proximal humerus fracture) and 20 healthy participants were evaluated using a smartphone and a reference inertial system. Measurements were performed twice, alternating between two evaluators. The B-B Score differences between groups, differences between devices, relationship between devices, intra- and inter-evaluator reproducibility were analysed. RESULTS: The smartphone mean scores (SD) were 94.1 (11.1) for controls and 54.1 (18.3) for patients (P < 0.01). The difference between devices was non-significant for the control (P = 0.16) and the patient group (P = 0.81). The analysis of the relationship between devices showed 0.97 ICC, -0.6 bias and -13.2 to 12.0 limits of agreement (LOA). The smartphone intra-evaluator ICC was 0.92, the bias 1.5 and the LOA -17.4 to 20.3. The smartphone inter-evaluator ICC was 0.92, the bias 1.5 and the LOA -16.9 to 20.0. CONCLUSIONS: The B-B Score results measured with a smartphone were comparable to those of an inertial system. While single measurements diverged in some cases, the intra- and inter-evaluator reproducibility was excellent and was equivalent between devices. The B-B score measured with a smartphone is straightforward and as efficient as a reference inertial system measurement.

Evaluation of muscular activity duration in shoulders with rotator cuff tears using inertial sensors and electromyography.

Shoulder disorders, including rotator cuff tears, affect the shoulder function and result in adapted muscle activation. Although these adaptations have been studied in controlled conditions, free-living activities have not been investigated. Based on the kinematics measured with inertial sensors and portable electromyography, the objectives of this study were to quantify the duration of the muscular activation in the upper trapezius (UT), medial deltoid (MD) and biceps brachii (BB) during motion and to investigate the effect of rotator cuff tear in laboratory settings and daily conditions. The duration of movements and muscular activations were analysed separately and together using the relative time of activation (T(EMG/mov)). Laboratory measurements showed the parameter's reliability through movement repetitions (ICC > 0.74) and differences in painful shoulders compared with healthy ones (p < 0.05): longer activation for UT; longer activation for MD during abduction and tendency to shorter activation in other movements; shorter activation for BB. In daily conditions, T(EMG/mov) for UT was longer, whereas it was shorter for MD and BB (p < 0.05). Moreover, significant correlations were observed between these parameters and clinical scores. This study thus provides new insights into the rotator cuff tear effect on duration of muscular activation in daily activity.