Evaluation of Automated Fracture Risk Assessment Based on the Canadian Association of Radiologists and Osteoporosis Canada Assessment Tool.

Fracture risk assessments are not always clearly communicated on bone mineral density (BMD) reports; evidence suggests that structured reporting (SR) tools may improve report clarity. The aim of this study is to compare fracture risk assessments automatically assigned by SR software in accordance with Canadian Association of Radiologists and Osteoporosis Canada (CAROC) recommendations to assessments from experts on narrative BMD reports. Charts for 500 adult patients who recently received a BMD exam were sampled from across University of Toronto's Joint Department of Medical Imaging. BMD measures and clinical details were manually abstracted from charts and were used to create structured reports with assessments generated by a software implementation of CAROC recommendations. CAROC calculations were statistically compared to experts' original assessments using percentage agreement (PA) and Krippendorff's alpha. Canadian FRAX calculations were also compared to experts', where possible. A total of 25 (5.0%) reported assessments did not conform to categorizations recommended by Canadian guidelines. Across the remainder, the Krippendorff's alpha relating software assigned assessments to physicians was high at 0.918; PA was 94.3%. Lower agreement was associated with reports for patients with documented modifying factors (alpha = 0.860, PA = 90.2%). Similar patterns of agreement related expert assessments to FRAX calculations, although statistics of agreement were lower. Categories of disagreement were defined by (1) gray areas in current guidelines, (2) margins of assessment categorizations, (3) dictation/transcription errors, (4) patients on low doses of steroids, and (5) ambiguous documentation of modifying factors. Results suggest that SR software can produce fracture risk assessments that agree with experts on most routine, adult BMD exams. Results also highlight situations where experts tend to diverge from guidelines and illustrate the potential for SR software to (1) reduce variability in, (2) ameliorate errors in, and (3) improve clarity of routine adult BMD exam reports.

Capture of osteoporosis and fracture information in an electronic medical record database from primary care.

In a large database of EMR records, we explore: 1) completeness in capture of bone mineral density (BMD) T-scores required for diagnosis of osteoporosis; 2) concordance of BMD exam information with other osteoporosis information; and 3) evidence of osteoporosis screening among fracture patients. To explore completeness of exam capture, BMD exams in the EMR were related to a provincial billing database. To explore concordance of information and screening rates, 7500 EMR records were reviewed for osteoporosis and fracture details. Results show that 98% of exams billed to the province for EMR patients were found in the EMR. However, documented osteoporosis was substantiated with BMD results only 55.8% of the time. Of 151 charts for fragility fracture patients, 1 in 4 contained no evidence of osteoporosis investigation. In summary, while EMR information about osteoporosis is of variable quality, EMR records shed light on osteoporosis management indicators and completely capture BMD results.

Robust tracking of the upper limb for functional stroke assessment.

We present a robust 3-D parts-based (PB) tracking system designed to follow the upper limb of stroke survivors during desktop activities. This system fits a probabilistic model of the arm to sequences of images taken from multiple angles. The arm model defines shapes and colors of limbs and limb configurations that are more or less likely. We demonstrate that the system is 1) robust to cluttered scenes and temporary occlusions, 2) accurate relative to a commercial motion capture device, and 3) capable of capturing kinematics that correlate with concurrent measures of post-stroke limb function. To evaluate the PB system, the functional motion of seven stroke survivors was measured concurrently with the PB system and a commercial motion capture system. In addition, functional motion was assessed by an expert using the Fugl-Meyer Assessment (FMA) and related to recorded kinematics. Standard deviation of differences in measured elbow angles between systems was 5.7°; deviation in hand velocity estimates was 2.6 cm/s. Several statistics, moreover, correlated strongly with FMA scores. Standard deviation in shoulder velocity had a significant correlation coefficient with FMA score below -0.75 when measured with all systems.

Recent trends in the development and evaluation of assistive robotic manipulation devices.

This review explores recent trends in the development and evaluation of assistive robotic arms, both prosthetic and externally mounted. Evaluations have been organized according to the CATOR taxonomy of assistive device outcomes, which takes into consideration device effectiveness, social significance, and impact on subjective well-being. Questions that have informed the review include: (1) Are robotic arms being comprehensively evaluated along axes of the CATOR taxonomy? (2) Are definitions of effectiveness in accordance with the priorities of users? (3) What gaps in robotic arm evaluation exist, and how might these best be addressed? (4) What further advances can be expected in the next 15 years? Results highlight the need for increased standardization of evaluation methods, increased emphasis on the social significance (i.e., social cost) of devices, and increased emphasis on device impact on quality of life. Several open areas for future research, in terms of both device evaluation and device development, are also discussed.