Use of Telemedicine for the Physical Examination of Children With Fetal Alcohol Spectrum Disorders.

BACKGROUND: The fetal alcohol spectrum disorders (FASD) are among the most prevalent causes of neurodevelopmental disorders. The diagnosis is based on assessment of prenatal alcohol exposure, specific physical features identified with a dysmorphology examination, and neurobehavioral assessment. Prompt diagnosis of affected children is necessary to provide early intervention services in a timely manner; however, the availability of diagnostic expertise is limited. We propose telemedicine (TM) as a valid and reliable mode by which the physical phenotype of FASD can be accurately assessed. METHODS: We compared face-to-face (F2F) physical examinations of the 3 key facial features and the resulting physical phenotype of the fetal alcohol syndrome (FAS) and partial FAS (pFAS), as well as 12 additional physical features seen more frequently in children with FAS than in the general population in 61 individuals with 2 different TM methods. These included a Transportable Examination Station system using a precision camera and a laptop and a Zoom secure connection system (ZOOM), using a smart phone and a tablet. We measured the percentages of agreement and the Cohen's K coefficient for each comparison. RESULTS: Agreements for most physical features and for the physical phenotype of FAS and pFAS were in the "almost perfect" range with some exceptions in the "substantial" range. Imprecision in measurement and subjectivity underlie lower agreement for some features, both F2F and using TM. We identified the optimal conditions for the F2F examinations in order to assure reliability using TM. CONCLUSIONS: TM is a valid and reliable method for the examination of the physical features of FAS that may contribute to greater access to an early diagnosis of FASD in children prenatally exposed to alcohol and/or with characteristic neurobehavioral deficits.

Toward Remote Assessment of Physical Frailty Using Sensor-based Sit-to-stand Test.

BACKGROUND: Traditional physical frailty (PF) screening tools are resource intensive and unsuitable for remote assessment. In this study, we used five times sit-to-stand test (5×STS) with wearable sensors to determine PF and three key frailty phenotypes (slowness, weakness, and exhaustion) objectively. MATERIALS AND METHODS: Older adults (n = 102, age: 76.54 ± 7.72 y, 72% women) performed 5×STS while wearing sensors attached to the trunk and bilateral thigh and shank. Duration of 5×STS was recorded using a stopwatch. Seventeen sensor-derived variables were analyzed to determine the ability of 5×STS to distinguish PF, slowness, weakness, and exhaustion. Binary logistic regression was used, and its area under curve was calculated. RESULTS: A strong correlation was observed between sensor-based and manually-recorded 5xSTS durations (r = 0.93, P < 0.0001). Sensor-derived variables indicators of slowness (5×STS duration, hip angular velocity range, and knee angular velocity range), weakness (hip power range and knee power range), and exhaustion (coefficient of variation (CV) of hip angular velocity range, CV of vertical velocity range, and CV of vertical power range) were different between the robust group and prefrail/frail group (P < 0.05) with medium to large effect sizes (Cohen's d = 0.50-1.09). The results suggested that sensor-derived variables enable identifying PF, slowness, weakness, and exhaustion with an area under curve of 0.861, 0.865, 0.720, and 0.723, respectively. CONCLUSIONS: Our study suggests that sensor-based 5×STS can provide digital biomarkers of PF, slowness, weakness, and exhaustion. The simplicity, ease of administration in front of a camera, and safety of 5xSTS may facilitate a remote assessment of PF, slowness, weakness, and exhaustion via telemedicine.

Abdominal aortic calcification is associated with decline in handgrip strength in the U.S. adult population ≥40 years of age.

BACKGROUND AND AIMS: The present study investigated the association between abdominal aortic calcification (AAC) and handgrip strength (HGS) and the ability of HGS to predict an increased AAC phenotype in adults. METHODS AND RESULTS: The analysis consisted of data for 3140 men and women aged ≥40 years (51.7% women) from the 2013-2014 NHANES. Lateral scans of the thoraco-lumbar spine (L1-L4) were scored for AAC using a validated 8-point scale (AAC-8); subjects with a score of ≥3 were considered at increased risk for cardiovascular disease due to a high AAC phenotype. HGS was assessed using a grip dynamometer. The prevalence of severe AAC in the population was 9.0%. Decline in HGS was associated with higher AAC-8 scores in men and women (p < 0.001). General linear model analysis showed that HGS levels were negatively associated with high AAC (p < 0.001) and AAC-8 status for both sexes. Likewise, for each 5-kg higher HGS, there lower odds of a high AAC phenotype (in men OR = 0.73, CI95%, 0.64-0.84) and (women OR = 0.58, CI95%, 0.47-0.70). Receiver operating characteristic curve analysis showed that the HGS threshold value to detect high risk of AAC in adults was ≥37.3 kg (AUC = 0.692) in men and 25.1 kg (AUC = 0.705) in women. CONCLUSION: Lower muscular strength, as measured by HGS, is associated with higher AAC scores in the U.S. population ≥40 years of age. Accordingly, maintenance of muscular strength during aging may protect adults against vascular calcification, an independent predictor of cardiovascular events. HGS measurement seems to be a valid screening tool for detecting a high ACC phenotype in adults.

Evaluation of compensatory hyperhidrosis after sympathectomy: The use of an objective method.

OBJECTIVE: To investigate the prevalence of compensatory hyperhidrosis following videothoracic sympathectomy to treat palmoplantar hyperhidrosis and its effect on sweating in the chest, abdomen, back and thighs. Furthermore, to evaluate the concordance between a subjective and an objective method of assessment for compensatory hyperhidrosis. METHODS: Forty patients with combined palmar and plantar hyperhidrosis who underwent video-assisted thoracoscopic sympathectomy (15 women and 25 men, with a mean age of 25 years) were prospectively followed for 1 year. Subjective and objective parameters were evaluated, using respectively a questionnaire and a sudorometer (Vapometer). RESULTS: In the subjective analysis, in the first month, only 10% of patients did not have compensatory hyperhidrosis, and 70% continued to report it at 1 or more sites after 1 year. In the objective analysis, 35% of the patients did not present compensatory hyperhidrosis after 1 month, and this number persisted stable, with 30% of patients remaining free of compensatory hyperhidrosis after 1 year. The most frequent area affected by compensatory hyperhidrosis was the back in both assessments. There was no positive concordance between the results of the objective and subjective analysis at any time in any of the 4 regions studied. CONCLUSIONS: Compensatory hyperhidrosis is a very common postoperative side effect after videothoracic sympathectomy, occurring early after the procedure and persisting for prolonged periods of time. The most frequently affected body area is the back, and no concordance between objective and subjective assessments was observed.

A novel use of inertial sensors to measure the craniocervical flexion range of motion associated to the craniocervical flexion test: an observational study.

BACKGROUND: The craniocervical flexion test (CCFT) is recommended when examining patients with neck pain related conditions and as a deep cervical retraining exercise option. During the execution of the CCFT the examiner should visually assess that the amount of craniocervical flexion range of motion (ROM) progressively increases. However, this task is very subjective. The use of inertial wearable sensors may be a user-friendly option to measure and objectively monitor the ROM. The objectives of our study were (1) to measure craniocervical flexion range of motion (ROM) associated with each stage of the CCFT using a wearable inertial sensor and to determine the reliability of the measurements and (2) to determine craniocervical flexion ROM targets associated with each stage of the CCFT to standardize their use for assessment and training of the deep cervical flexor (DCF) muscles. METHODS: Adults from a university community able to successfully perform the CCFT participated in this study. Two independent examiners evaluated the CCFT in two separate sessions. During the CCFT, a small wireless inertial sensor was adhered to the centre of the forehead to provide real-time monitoring and to record craniocervical flexion ROM. The intra- and inter-rater reliability of the assessment of craniocervical ROM was calculated. This study was approved by the Research Ethics Committee of CEU San Pablo University (236/17/08). RESULTS: Fifty-six participants (18 males, 23 females; mean [SD] age, 21.8 [3.45] years) were included in the study and successfully completed the study protocol. All interclass correlation coefficient (ICC) values indicated good or excellent reliability of the assessment of craniocervical ROM using a wearable inertial sensor. There was high variability between subjects on the amount of craniocervical ROM necessary to achieve each stage of the CCFT. CONCLUSIONS: The use of inertial sensors is a reliable method to measure the craniocervical flexion ROM associated with the CCFT. The great variability in the ROM limits the possibility to standardize a set of targets of craniocervical flexion ROM equivalent to each of the pressure targets of the pressure biofeedback unit.

Measurement of scapular prominence in symptomatic dyskinesis using a novel scapulometer: reliability and the relationship to shoulder dysfunction.

BACKGROUND: No previous studies have investigated whether the extent of scapular dyskinesis is associated with shoulder dysfunction. This study aimed (1) to establish the reliability of a scapulometer in patients with shoulder pain and (2) to investigate the related factors associated with shoulder dysfunction. METHODS: One hundred participants with symptomatic scapular dyskinesis were recruited. Twenty-one participants were involved in the reliability study to test the intrarater and inter-rater reliabilities of the scapulometer in patients with shoulder pain. After demographic data and self-reported Flexilevel Scale of Shoulder Function (FLEX-SF) scores were recorded, all participants were measured with a scapulometer to determine the posterior displacement of the root of the spine (ROS) and the inferior angle (IFA) of the scapula from the thorax. Next, the participants performed 5 trials of bilateral scapular plane elevation for scapular kinematics and electromyographic (EMG) data collection. Stepwise multiple linear regressions were used to determine the relationships between self-reported FLEX-SF scores and potential factors. In addition to scapular displacement, pain level, scapular kinematics, and EMG data were included as independent variables. RESULTS: The intrarater and inter-rater reliabilities of the scapulometer were excellent (intraclass correlation coefficient [ICC] = 0.93-0.97) and moderate to good (ICC = 0.74-0.81), respectively. The Bland-Altman plots showed no systematic bias between raters in the ROS and IFA measurements. Final stepwise multiple regression models showed that more ROS distance, higher serratus anterior activity, and lower pain level during arm elevation were associated with higher shoulder function (total R2 = 0.253). CONCLUSION: The reliability of the scapulometer in patients with shoulder pain is moderate to excellent. Scapular dyskinesis may be a compensatory strategy to avoid shoulder pain and improve shoulder function.

Onsite telemedicine strategy for coronavirus (COVID-19) screening to limit exposure in ED.

Coronavirus (severe acute respiratory syndrome coronavirus 2) outbreak is a public health emergency and a global pandemic. During the present coronavirus disease (COVID-19) crisis, telemedicine has been recommended to screen suspected patients to limit risk of exposure and maximise medical staff protection. We constructed the protective physical barrier with telemedicine technology to limit COVID-19 exposure in ED. Our hospital is an urban community hospital with annual ED volume of approximately 50 000 patients. We equipped our patient exam room with intercom and iPad for telecommunication. Based on our telemedicine screening protocol, physician can conduct a visual physical examination on stable patients via intercom or videoconference. Telemedicine was initially used to overcome the physical barrier between patients and physicians. However, our protocol is designed to create a protective physical barrier to protect healthcare workers and enhance efficiency in ED. The implementation can be a promising protocol in making ED care more cost-effective and efficient during the COVID-19 pandemic and beyond.

Can the Wii Fit Balance Board be Used as a Fall Risk Assessment Tool among Poststroke Patients?

BACKGROUND: The prevalence of falls can be as high as 73% in the stroke population. Falls occur as a result of multiple factors. Factors such as balance impairments can be improved through physical therapy intervention. However, insurance payers limit the number of visits per patient. It is crucial to find other ways to assess balance after discharge from rehabilitation. PURPOSE: The purpose of this study is to determine if the Nintendo Wii Fit can be used as a fall risk assessment tool among the poststroke population. METHODOLOGY: A sample of 11 stroke survivors were recruited (mean age 63.36 years). Each participant completed a balance and fall risk assessment using the Berg Balance Scale, Timed Up & Go, Four Square Step Test, Five Times Sit-to-Stand and 8-Foot Walk Test. Bivariate correlation will examine the validity of the Nintendo Wii Fit as a fall risk assessment tool in this population. RESULTS: The Nintendo Wii Fit Balance Test was found to be correlated with gait speed measured by the 8-Foot Walk Test. There is no correlation between the Wii Fit Balance Tests and most common standardized fall risk measures. Standardized fall risk outcome measures also significantly correlate with each other. CONCLUSIONS: The study suggests that while there is a potential utility of the game system to be used at home by patient and caregivers, the Wii Fit Balance Test may not be an appropriate substitute to the standardized fall risk assessment tool for stroke patients in the clinical setting.

The Reported Edmonton Frail Scale-Thai version: Development and Validation of a Culturally-Sensitive Instrument.

Frailty may lead to increased vulnerability, disability, and adverse health outcomes in older adults. Early detection has been described as the best approach to manage frailty; however, frailty instruments are not widely available, particularly in the Thai language. The purpose of this cross-sectional study was to develop a culturally adapted Thai version of the Reported Edmonton Frail Scale and to validate the psychometric properties of the new instrument in hospitalized older Thai adults. Reliability and validity were examined. Participants completed questionnaires that included demographic and health information, and the Reported Edmonton Frail Scale-Thai version. Results revealed that the new instrument was reliable and had good content validity. Inter-rater reliability was strong. Confirmatory factor analysis showed a fair fit for the whole model, but most domains were strongly associated with frailty. On average, the instrument was completed under 7 minutes. The Thai version of the frailty instrument may be a practical tool for frailty evaluation, and could inform inpatient care, both locally and internationally; future research is needed to confirm predictability and feasibility in other clinical settings and populations.

Validity of Postural Sway Assessment on the Biodex BioSway™ Compared With the NeuroCom Smart Equitest.

CONTEXT: Current tools for sideline assessment of balance following a concussion may not be sufficiently sensitive to identify impairments, which may place athletes at risk for future injury. Quantitative field-expedient balance assessments are becoming increasingly accessible in sports medicine and may improve sensitivity to enable clinicians to more readily detect these subtle deficits. OBJECTIVE: To determine the validity of the postural sway assessment on the Biodex BioSway™ compared with the gold standard NeuroCom Smart Equitest System. DESIGN: Cross-sectional cohort study. SETTING: Clinical research laboratory. PARTICIPANTS: Forty-nine healthy adults (29 females: 24.34 [2.45] y, height 163.65 [7.57] cm, mass 63.64 [7.94] kg; 20 males: 26.00 [3.70] y, height 180.11 [7.16] cm, mass 82.97 [12.78] kg). INTERVENTION(S): The participants completed the modified clinical test of sensory interaction in balance on the Biodex BioSway™ with 2 additional conditions (head shake and firm surface; head shake and foam surface) and the Sensory Organization Test and Head Shake Sensory Organization Test on the NeuroCom Smart Equitest. MAIN OUTCOME MEASURES: Interclass correlation coefficient and Bland-Altman limits of agreement for Sway Index, equilibrium ratio, and area of 95% confidence ellipse. RESULTS: Fair-good reliability (interclass correlation coefficient = .48-.65) was demonstrated for the stance conditions with eyes open on a firm surface. The Head Shake Sensory Interaction and Balance Test condition on a firm surface resulted in fair reliability (interclass correlation coefficient = .50-.59). The authors observed large ranges for limits of agreement across outcome measures, indicating that the systems should not be used interchangeably. CONCLUSIONS: The authors observed fair reliability between BioSway™ and NeuroCom, with better agreement between systems with the assessment of postural sway on firm/static surfaces. However, the agreement of these systems may improve by incorporating methods that mitigate the floor effect in an athletic population (eg, including a head shake condition). BioSway™ may provide a surrogate field-expedient measurement tool.

Reliability and Validity of an Innovative Device for ACL Testing: The Mobil-Aider™.

BACKGROUND: Knee disorders prevalence is estimated at more than 50% in a lifetime. There are over 250,000 anterior cruciate ligament (ACL) injuries per year in the United States. There are over 175,000 ACL reconstructions annually. This study was a double-blinded design to establish the reliability and validity of a new orthopedic device to measure linear translation of the tibia on the femur (ACL testing). METHODS: A Zeiss Smartzoom microscope was used as the gold standard to assess the ability of the Mobil-Aider™ to measure linear translation. Sixty blinded measures were taken with each of 6 different devices. RESULTS: Both the intraclass correlation and the Pearson correlation were .986. The Cronbach alpha reliability analysis was 0.992. Independent 1-sample t tests were performed on the differences between the Mobil-Aider™ and Zeiss values, and were not found to be significant (P = .42); that is, they were the same. Bland-Altman plot and a linear regression revealed no propositional bias. Finally, with 360 measures over 6 devices, the power of this study was calculated to be 100%. DISCUSSION: This data are the first step in establishing reliability and concurrent validity of a new device. As a result of the current data, the Mobil-Aider™ device is deemed a promising orthopedic tool for use in assessing the laxity of the ACL. Additional testing needs to be performed on both healthy and injured knees. CONCLUSIONS: There is potential for the Mobil-Aider™ to contribute to the assessment of ACL injuries, but additional human testing is needed.

Thoracic kyphosis assessment in postmenopausal women: an examination of the Flexicurve method in comparison to radiological methods.

The Flexicurve ruler is an alternative method to radiographs for measuring thoracic kyphosis (curvature), but it is not certain that it is comparable. This study shows that Flexicurve can estimate radiographic vertebral centroid angles with less error than Cobb angles but that its accuracy would be inadequate for most clinical purposes. INTRODUCTION: The Flexicurve ruler provides a non-radiological method of measuring thoracic kyphosis (TK) that has moderately strong correlations with the gold-standard radiographic Cobb angle method, while consistently underestimating the TK angle. Cobb angles can include measurement errors that may contribute to poor agreement, particularly in older populations. The vertebral centroid angle could be a better radiographic reference method for the validation of Flexicurve. Using two separate radiographic measurements of TK, we examined the validity of Flexicurve. We aimed to ascertain the level of agreement between measures and to empirically explore reasons for between-method differences. METHODS: TK angles determined using Flexicurve and radiographic Cobb and vertebral centroid methods were compared using data from 117 healthy postmenopausal women (mean (SD) age 61.4 (7.0) years). Bland and Altman plots were used to assess differences between methods. Age, bone mineral density and body mass index were examined as characteristics that might explain any differences. RESULTS: Flexicurve angles were scaled prior to analysis. There was no statistically significant difference between angles produced by Flexicurve and vertebral centroid methods (MD - 2.16°, 95%CI - 4.35° to 0.03°) although differences increased proportionally with TK angles. Flexicurve angles were significantly smaller than radiographic Cobb angles and depending on the scaling method used, systematic error ranged between - 2.48° and - 5.19°. Age accounts for some of the differences observed (R2 < 0.08, p < 0.005). CONCLUSIONS: TK measured using the Flexicurve shows better agreement with the radiographic vertebral centroid method, but inaccuracy of the Flexicurve increases with increasing angle of kyphosis.

Reliability of four tests to assess body posture and the range of selected movements in individuals with spinal muscular atrophy.

BACKGROUND: The majority of individuals with spinal muscular atrophy (SMA) experience progressive skeletal deformities which may affect the quality of life and mobility. To date, no studies have evaluated the reliability of tests assessing body posture and joint mobility in SMA patients. The purpose of this study was to assess the reliability of Cervical Rotation test (CR), Supine Angle of Trunk Rotation test (SATR), Hip Extension test (HE) and Pelvic Obliquity test (PO) developed to evaluate the musculoskeletal system in SMA individuals. METHODS: Thirty individuals (12 girls and 18 boys) aged 4-15 with SMA type II (n = 24) and III (n = 6) confirmed by genetic examinations were qualified for the study. The participants were examined twice by three physiotherapists on the same day. The examination included four tests, i.e. CR, SATR, HE and PO tests aimed at assessing ranges of rotation in the cervical spine, chest deformities, ranges of hip extension and pelvis position while sitting. Statistical calculations were made with the use of statistical software IBM SPSS Statistics version 20. Reliability was assessed using the Intraclass Correlation Coefficient (ICC). RESULTS: Intraobserver reliability was excellent for CR (ICC range 0.839-0.911), SATR (ICC range 0.918-0.939 - the upper part of the sternum; ICC range 0.951-0.975 - the lower part of the sternum), HE (ICC range 0.988-0,991) and PO (ICC range 0.896-0.935) tests. The interobserver ICC reached the excellent values in CR (ICC range 0.912-0.920), SATR (ICC = 0.888 - the upper part of the sternum, ICC = 0.951 - the lower part of the sternum), HE (ICC range 0.922-0.923) and PO (ICC = 0.928) tests. CONCLUSIONS: CR, SATR, HE and PO tests are reliable and may be used for examining individuals with SMA. The application of these tests provides a possibility to detect early changes in the musculoskeletal system in children and adolescents and to assess the effectiveness of the implemented pharmacotherapy and rehabilitation.

Comparison of a Novel Handheld Telehealth Device with Stand-Alone Examination Tools in a Clinic Setting.

Background and Objective: Research demonstrates that telemedicine is effective in pediatric settings but little is published to validate the quality of the data acquired by remote peripheral examination devices to accurately inform clinical decision-making.Introduction: The primary aim was to compare a novel Food and Drug Administration (FDA)-cleared multifunctional remote examination device (Tyto) with other stand-alone digital examination devices. The secondary aim was to ascertain whether either device produced images or sounds better able to provide clinical information to clinicians caring for children.Materials and Methods: Otoscopic images and heart and lung sounds from 50 patients of ages 2-18 years were acquired using the novel device and a stand-alone digital otoscope and stethoscope. Data were stored on a secure server for review by physicians (two pulmonary faculty, two general faculty, two cardiology faculty, and two cardiology fellows). Reviewers were blinded and they reviewed images and audio files in a randomized manner. Images and sounds were scored in terms of quality using a Likert scale. Means and standard deviations (and t-tests to compare those means) were calculated. Individual (heart sounds, lung sounds, and otoscopic images) and aggregate scores were compared.Results: The novel device provided higher sound and image quality with less chance of an inability to make a diagnosis than the stand-alone devices. The novel device had a superior mean comparative diagnostic score with a high intra- and inter-reliability of cardiac, pulmonary, and otoscopic diagnosis.Discussion and Conclusions: The novel device outperformed the stand-alone digital stethoscope and otoscope and was better able to provide usable data to support a clinical encounter.

Reliability Testing of Augmented Reality Glasses Technology: Establishing the Evidence Base for Telewound Care.

PURPOSE: To test the fidelity and feasibility of using augmented reality glass (ARG) telehealth technology for comprehensive wound, ostomy, and continence (WOC) service delivery to underserved rural practice settings. DESIGN: Intrarater reliability design focusing on treatment integrity. SAMPLE AND SETTING: Adult patients in a tertiary care hospital and a rural long-term care setting who were scheduled for routine wound care consults. METHODS: Intra- and interrater reliability were assessed using a documentation-based wound assessment tool comprising 6 discrete assessment points. The wound teleassessment was first conducted by the telehealth "hub" WOC nurse remotely in collaboration with a bedside nurse wearing the ARG. The same hub WOC nurse then conducted an assessment at the bedside. Initial assessment points and treatment plans were compared to establish assessment and treatment intrarater reliability. A different WOC nurse, blinded to the first assessment, also conducted a bedside assessment and provided treatment recommendations, which were then compared to the hub WOC nurse's initial remotely ARG-generated treatment plan to establish treatment interrater reliability. RESULTS: Sixteen patients with 21 wounds were assessed. Six wound assessment components were included, yielding a total of 126 total observation points. Intrarater assessment reliability was 98%. Treatment plan interrater reliability was 100%. CONCLUSIONS: Results support further evaluation of ARG technology as a tool to enhance the delivery of wound care services in remote underserved settings. Implementation and evaluation of this technology on clinical and financial outcomes in multiple wound care delivery environments should be determined moving forward. Successful implementation should serve as a template to expand evidence-based WOC nursing care across the globe.

Measuring hand grip strength in rheumatoid arthritis.

Rheumatoid arthritis (RA) is a systemic inflammatory disease with a particular predilection for causing pain, deformity and functional limitation affecting the hands. Measures of the severity of RA, such as the disease activity score with 28 joint count may not fully reflect the regional impact of RA on the hands. Hand grip strength measurements are a form of objective assessment that focuses specifically on the hands in RA. This review explores what is currently known about the assessment of hand grip strength; what it may indicate, how it is measured, some of the practical aspects and challenges associated with performing these tests, and how this information can be applied in a clinical setting. It summarises the role that grip strength has in assessing patients with RA and finishes with some recommendations for how to use grip strength measurements in clinical practice, and what direction future research might take.

Current use of measurement instruments by physiotherapists working in Germany: a cross-sectional online survey.

BACKGROUND: The use of measurement instruments in physiotherapy has been recommended in clinical practice guidelines to improve evidence-based practice. The aims of the study were (a) to describe the current use of measurement instruments by physiotherapists working in Germany and (b) to investigate the facilitators and barriers to use measurement instruments. METHODS: This cross-sectional study used a nationwide online survey, which was accessible to all physiotherapists working in Germany. RESULTS: In total, 522 adult physiotherapists working in Germany completed the questionnaire. The mean age of the respondents was 38 years, 63% were female, and 53% had >10 years of work experience. Thirty-one percent of the respondents used measurement instruments in ≥80% of their patients, and 26% used measurement instruments in ≤20%. Measurement instruments were used for diagnostic and prognostic purposes by 69% and 22% of respondents, respectively. The three most frequently reported measurement instruments were "goniometer" (n = 254), some kind of a "visual/numeric analogue scale" (n = 139), and the "manual examination of muscle-strength" (n = 54). Seven of the 13 most stated measurement instruments measure activities or participation. The most important facilitator was physiotherapists' positive attitudes towards measurement instruments. Two out of three respondents reported having sufficient knowledge and skills to apply measurement instruments in clinical practice. The most pronounced barriers were insufficient additional financial compensations and requiring extra time to document test scores. Seventy-eight percent of the respondents could imagine using an electronic device for a user-friendly patient health record system in clinical practice. CONCLUSIONS: The limited use of measurement instruments reported by physiotherapists working in Germany appears to be due to organisational issues, in combination with a lack of knowledge and skills needed to apply the measurement instruments, rather than due to individual or managerial reasons. To support the use of measurement instruments, sufficient time resources and adequate financial compensation are required. Educational approaches should focus on imparting patient-centred and patient-reported outcomes to quantify activities and participation. Electronic patient health record systems have potential to facilitate the application of standardised measurement instruments if the barriers identified in this survey are addressed properly.

Novel use of video glasses during binocular microscopy in the otolaryngology clinic.

INTRODUCTION: The development of portable, high resolution video displays such as video glasses allows clinicians the opportunity to offer patients an increased ability to visualize aspects of their physical examination in an ergonomic and cost-effective manner. The objective of this pilot study is to trial the use of video glasses for patients undergoing binocular microscopy as well as to better understand some of the potential benefits of the enhanced display option. METHODS: This study was comprised of a single treatment group. Patients seen in the otolaryngology clinic who required binocular microscopy for diagnosis and treatment were recruited. All patients wore video glasses during their otoscopic examination. An additional cohort of patients who required binocular microscopy were also recruited, but did not use the video glasses during their examination. Patients subsequently completed a 10-point Likert scale survey that assessed their comfort, anxiety, and satisfaction with the examination as well as their general understanding of their otologic condition. RESULTS: A total of 29 patients who used the video glasses were recruited, including those with normal examinations, cerumen impaction, or chronic ear disease. Based on the survey results, patients reported a high level of satisfaction and comfort during their exam with video glasses. Patients who used the video glasses did not exhibit any increased anxiety with their examination. Patients reported that video glasses improved their understanding and they expressed a desire to wear the glasses again during repeat exams. CONCLUSION: This pilot study demonstrates that video glasses may represent a viable alternative display option in the otolaryngology clinic. The results show that the use of video glasses is associated with high patient comfort and satisfaction during binocular microscopy. Further investigation is warranted to determine the potential for this display option in other facets of patient care as well as in expanding patient understanding of disease and anatomy.

Correlation between quantitative pivot shift and generalized joint laxity: a prospective multicenter study of ACL ruptures.

PURPOSE: To investigate whether an increased magnitude of quantitative rotatory knee laxity is associated with a greater level of generalized joint laxity in ACL-injured and contralateral knees. METHODS: A total of 103 patients were enrolled across four international centers to undergo anatomic ACL reconstruction. Rotatory knee laxity was evaluated preoperatively, both in the awake state and under anesthesia, using the standardized pivot shift test. Two devices were used to quantify rotatory knee laxity; an inertial sensor, measuring the joint acceleration, and an image analysis system, measuring the lateral compartment translation of the tibia. The presence of generalized joint laxity was determined using the Beighton Hypermobility Score. The correlation between the level of generalized joint laxity and the magnitude of rotatory knee laxity was calculated for both the involved knee and the non-involved knee. Further, patients were dichotomized into low (0-4) or high (5-9) Beighton Score groups. Alpha was set at < 0.05. RESULTS: Ninety-six patients had complete datasets, 83 and 13 in the low and high Beighton Score groups respectively. In anesthetized patients, there was a significant correlation between the degree of Beighton Score and quantitative pivot shift when analyzing the non-involved knee using the image analysis system (r = 0.235, p < 0.05). When analyzing the same knee, multivariate analysis adjusted for meniscal injury, age and gender revealed an increased odds ratio for patients with increased lateral compartment translation to be part of the high Beighton Score group (OR 1.86, 95% CI 1.10-3.17, p < 0.05). No other correlation was significant. When analyzing the dichotomized subgroups, no significant correlations could be established. CONCLUSION: The findings in this study suggest that there is a weak correlation between generalized joint laxity and the contralateral healthy knee, indicating increased rotatory knee laxity in these patients. Generalized joint laxity does not appear to correlate with rotatory knee laxity in ACL-injured knees. LEVEL OF EVIDENCE: Prospective cohort study; level of evidence, 2.

Feasibility of sub-dermal soft tissue deformation assessment using B-mode ultrasound for pressure ulcer prevention.

Pressure Ulcer (PU) prevention remains a main public health issue. The physio-pathology of this injury is not fully understood, and a satisfactory therapy is currently not available. Recently, several works suggested that mechanical strains are responsible of deformation-induced damage involved in the initiation of Deep Tissue Injury (DTI). A better assessment of the internal behavior could allow to enhance the modeling of the transmission of loads into the different structures composing the buttock. A few studies focused on the experimental in vivo buttock deformation quantification using Magnetic Resonance Imaging (MRI), but its use has important drawbacks. In clinical practice, ultrasound imaging is an accessible, low cost, and real-time technic to study the soft tissue. The objective of the present work was to show the feasibility of using B-mode ultrasound imaging for the quantification of localised soft-tissue strains of buttock tissues during sitting. An original protocol was designed, and the intra-operator reliability of the method was assessed. Digital Image Correlation was used to compute the displacement field of the soft tissue of the buttock during a full realistic loading while sitting. Reference data of the strains in the frontal and sagittal planes under the ischium were reported for a population of 7 healthy subjects. The average of shear strains over the region of interest in the fat layer reached levels up to 117% higher than the damage thresholds previously quantified for the muscular tissue in rats. In addition, the observation of the muscles displacements seems to confirm previous results which already reported the absence of muscular tissue under the ischium in the seated position, questioning the assumption commonly made in Finite Element modeling that deep tissue injury initiates in the muscle underlying the bone.