Reliability and measurement error of sensorimotor tests in patients with neck pain: a systematic review.

BACKGROUND: Neck pain is one of the leading causes of years lived with disability, and approximately half of people with neck pain experience recurrent episodes. Deficits in the sensorimotor system can persist even after pain relief, which may contribute to the chronic course of neck pain in some patients. Evaluation of sensorimotor capacities in patients with neck pain is therefore important. No consensus exists on how sensorimotor capacities of the neck should be assessed in physiotherapy. The aims of this systematic review are: (a) to provide an overview of tests used in physiotherapy for assessment of sensorimotor capacities in patients with neck pain; and (b) to provide information about reliability and measurement error of these tests, to enable physiotherapists to select appropriate tests. METHODS: Medline, CINAHL, Embase and PsycINFO databases were searched for studies reporting data on the reliability and/or measurement error of sensorimotor tests in patients with neck pain. The results for reliability and measurement error were compared against the criteria for good measurement properties. The quality of evidence was assessed according to the modified GRADE method proposed by the COSMIN group. RESULTS: A total of 206 tests for assessment of sensorimotor capacities of the neck were identified and categorized into 18 groups of tests. The included tests did not cover all aspects of the sensorimotor system; tests for the sensory and motor components were identified, but not for the central integration component. Furthermore, no data were found on reliability or measurement error for some tests that are used in practice, such as movement control tests, which apply to the motor component. Approximately half of the tests showed good reliability, and 12 were rated as having good (+) reliability. However, tests that evaluated complex movements, which are more difficult to standardize, were less reliable. Measurement error could not be evaluated because the minimal clinically important change was not available for all tests. CONCLUSION: Overall, the quality of evidence is not yet high enough to enable clear recommendations about which tests to use to assess the sensorimotor capacities of the neck.

First Steps Towards a Risk of Bias Corpus of Randomized Controlled Trials.

Risk of bias (RoB) assessment of randomized clinical trials (RCTs) is vital to conducting systematic reviews. Manual RoB assessment for hundreds of RCTs is a cognitively demanding, lengthy process and is prone to subjective judgment. Supervised machine learning (ML) can help to accelerate this process but requires a hand-labelled corpus. There are currently no RoB annotation guidelines for randomized clinical trials or annotated corpora. In this pilot project, we test the practicality of directly using the revised Cochrane RoB 2.0 guidelines for developing an RoB annotated corpus using a novel multi-level annotation scheme. We report inter-annotator agreement among four annotators who used Cochrane RoB 2.0 guidelines. The agreement ranges between 0% for some bias classes and 76% for others. Finally, we discuss the shortcomings of this direct translation of annotation guidelines and scheme and suggest approaches to improve them to obtain an RoB annotated corpus suitable for ML.

Systematic Review of Incidence Studies of Pneumonia in Persons with Spinal Cord Injury.

Pneumonia continues to complicate the course of spinal cord injury (SCI). Currently, clinicians and policy-makers are faced with only limited numbers of pneumonia incidence in the literature. A systematic review of the literature was undertaken to provide an objective synthesis of the evidence about the incidence of pneumonia in persons with SCI. Incidence was calculated per 100 person-days, and meta-regression was used to evaluate the influence of the clinical setting, the level of injury, the use of mechanical ventilation, the presence of tracheostomy, and dysphagia. For the meta-regression we included 19 studies. The incidence ranged from 0.03 to 7.21 patients with pneumonia per 100 days. The main finding of this review is that we found large heterogeneity in the reporting of the incidence, and we therefore should be cautious with interpreting the results. In the multivariable meta-regression, the incidence rate ratios showed very wide confidence intervals, which does not allow a clear conclusion concerning the risk of pneumonia in the different stages after a SCI. Large longitudinal studies with a standardized reporting on risk factors, pneumonia, and detailed time under observation are needed. Nevertheless, this review showed that pneumonia is still a clinically relevant complication and pneumonia prevention should focus on the ICU setting and patients with complete tetraplegia.

Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs.

OBJECTIVE: To investigate the effectiveness of conservative interventions for pain, function and range of motion in adults with shoulder impingement. DESIGN: Systematic review and meta-analysis of randomised trials. DATA SOURCES: Medline, CENTRAL, CINAHL, Embase and PEDro were searched from inception to January 2017. STUDY SELECTION CRITERIA: Randomised controlled trials including participants with shoulder impingement and evaluating at least one conservative intervention against sham or other treatments. RESULTS: For pain, exercise was superior to non-exercise control interventions (standardised mean difference (SMD) -0.94, 95% CI -1.69 to -0.19). Specific exercises were superior to generic exercises (SMD -0.65, 95% CI -0.99 to -0.32). Corticosteroid injections were superior to no treatment (SMD -0.65, 95% CI -1.04 to -0.26), and ultrasound guided injections were superior to non-guided injections (SMD -0.51, 95% CI -0.89 to -0.13). Nonsteroidal anti-inflammatory drugs (NSAIDS) had a small to moderate SMD of -0.29 (95% CI -0.53 to -0.05) compared with placebo. Manual therapy was superior to placebo (SMD -0.35, 95% CI -0.69 to -0.01). When combined with exercise, manual therapy was superior to exercise alone, but only at the shortest follow-up (SMD -0.32, 95% CI -0.62 to -0.01). Laser was superior to sham laser (SMD -0.88, 95% CI -1.48 to -0.27). Extracorporeal shockwave therapy (ECSWT) was superior to sham (-0.39, 95% CI -0.78 to -0.01) and tape was superior to sham (-0.64, 95% CI -1.16 to -0.12), with small to moderate SMDs. CONCLUSION: Although there was only very low quality evidence, exercise should be considered for patients with shoulder impingement symptoms and tape, ECSWT, laser or manual therapy might be added. NSAIDS and corticosteroids are superior to placebo, but it is unclear how these treatments compare to exercise.

Use of Rasch analysis to investigate structural validity of a set of movement control tests for the neck.

BACKGROUND: Movement control abilities are often reduced in persons with neck pain. In physiotherapeutic practice observational tests are frequently used to assess the impaired abilities. Several tests for movement control abilities are available, but no evidence exists on how to combine and interpret them. OBJECTIVE: The aim was to investigate structural validity of a set of movement control tests with Rasch analysis. DESIGN: Cross-sectional study. METHODS: Thirty persons with and thirty without neck pain were recruited for this study. All persons performed ten movement control tests. A partial credit model was applied to investigate item fit, ordering of the item response functions, dimensionality and hierarchy of the tests. RESULTS: The majority of persons with neck pain had moderate disabilities and the mean value in the Neck disability index was 10.7. Functioning of the movement control tests to measure the construct "movement control abilities" was adequate for the majority of tests. Three movement control tests showed considerable misfit. Possible explanations were a reactive movement control instead of an active control and a more challenging test position. Test difficulties and person abilities could be estimated for the complete sample. The most difficult test was "sitting rocking forward" (1.13 logits) and the least difficult test was "lifting the right arm" (-1.30 logits). The highest person ability estimate was 3.61 logits indicating that movement control tests are missing to evaluate persons with moderate neck disabilities. CONCLUSION: Modifying the existing set of tests is required to evaluate the complete spectrum of persons with neck pain.

Effect of clinical parameters on the control of myoelectric robotic prosthetic hands.

Improving the functionality of prosthetic hands with noninvasive techniques is still a challenge. Surface electromyography (sEMG) currently gives limited control capabilities; however, the application of machine learning to the analysis of sEMG signals is promising and has recently been applied in practice, but many questions still remain. In this study, we recorded the sEMG activity of the forearm of 11 male subjects with transradial amputation who were mentally performing 40 hand and wrist movements. The classification performance and the number of independent movements (defined as the subset of movements that could be distinguished with >90% accuracy) were studied in relationship to clinical parameters related to the amputation. The analysis showed that classification accuracy and the number of independent movements increased significantly with phantom limb sensation intensity, remaining forearm percentage, and temporal distance to the amputation. The classification results suggest the possibility of naturally controlling up to 11 movements of a robotic prosthetic hand with almost no training. Knowledge of the relationship between classification accuracy and clinical parameters adds new information regarding the nature of phantom limb pain as well as other clinical parameters, and it can lay the foundations for future "functional amputation" procedures in surgery.

Effectiveness of physical and occupational therapy on pain, function and quality of life in patients with trapeziometacarpal osteoarthritis - A systematic review and meta-analysis.

INTRODUCTION: Trapeziometacarpal osteoarthritis is associated with more pain and restrictions than other hand osteoarthritis due to the functional importance of the thumb. While the effectiveness of surgical and pharmacological interventions has been widely examined, there is a lack of specific evidence about conservative non-pharmacological trapeziometacarpal osteoarthritis therapies. The objective of this systematic review was to provide evidence-based knowledge on the effectiveness of physiotherapy and occupational therapy on pain, function and quality of life. METHODS: A literature search of Medline, CINAHL, PEDro, OTseeker, EMB Dare Cochrane Database of Systematic Reviews and Cochrane CENTRAL was performed. Randomized and quasi-randomized controlled trials and corresponding systematic reviews, observational studies, pragmatic studies and case-control studies were included. The risk of bias was assessed. RESULTS: Out of 218 studies, 27 were retained. A narrative summary and a series of meta-analyses were performed. Concerning pain reduction, the meta-analysis showed parity of pre-fabricated neoprene and custom-made thermoplastic splints: standardized mean difference (SMD) -0.01 (95%CI -0.43, 0.40) (p=0.95). Multimodal interventions are more effective on pain compared to single interventions: standardized mean difference -3.16 (95%CI -5.56, -0.75) (p = 0.01). DISCUSSION: Physical and occupational therapy-related interventions, especially multimodal interventions, seem to be effective to treat pain in patients with trapeziometacarpal osteoarthritis. Pre-fabricated neoprene splints and custom-made thermoplastic splints may reduce pain equally. Single interventions seem not to be effective. Significant evidence for effectiveness on function and quality of life could not be found.

A systematic review and meta-analysis of selected motor learning principles in physiotherapy and medical education.

BACKGROUND: Learning of procedural skills is an essential component in the education of future health professionals. There is little evidence on how procedural skills are best learnt and practiced in education. There is a need for educators to know what specific interventions could be used to increase learning of these skills. However, there is growing evidence from rehabilitation science, sport science and psychology that learning can be promoted with the application of motor learning principles. The aim of this review was to systematically evaluate the evidence for selected motor learning principles in physiotherapy and medical education. The selected principles were: whole or part practice, random or blocked practice, mental or no additional mental practice and terminal or concurrent feedback. METHODS: CINAHL, Cochrane Central, Embase, Eric and Medline were systematically searched for eligible studies using pre-defined keywords. Included studies were evaluated on their risk of bias with the Cochrane Collaboration's risk of bias tool. RESULTS: The search resulted in 740 records, following screening for relevance 15 randomised controlled trials including 695 participants were included in this systematic review. Most procedural skills in this review related to surgical procedures. Mental practice significantly improved performance on a post-acquisition test (SMD: 0.43, 95% CI 0.01 to 0.85). Terminal feedback significantly improved learning on a transfer test (SMD: 0.94, 95% CI 0.18 to 1.70). There were indications that whole practice had some advantages over part practice and random practice was superior to blocked practice on post-acquisition tests. All studies were evaluated as having a high risk of bias. Next to a possible performance bias in all included studies the method of sequence generation was often poorly reported. CONCLUSIONS: There is some evidence to recommend the use of mental practice for procedural learning in medical education. There is limited evidence to conclude that terminal feedback is more effective than concurrent feedback on a transfer test. For the remaining parameters that were reviewed there was insufficient evidence to make definitive recommendations.

Effects of prosthesis use on the capability to control myoelectric robotic prosthetic hands.

The natural control of robotic prosthetic hands with non-invasive techniques is still a challenge: myoelectric prostheses currently give some control capabilities; the application of pattern recognition techniques is promising and recently started to be applied in practice but still many questions are open in the field. In particular, the effects of clinical factors on movement classification accuracy and the capability to control myoelectric prosthetic hands are analyzed in very few studies. The effect of regularly using prostheses on movement classification accuracy has been previously studied, showing differences between users of myoelectric and cosmetic prostheses. In this paper we compare users of myoelectric and body-powered prostheses and intact subjects. 36 machine-learning methods are applied on 6 amputees and 40 intact subjects performing 40 movements. Then, statistical analyses are performed in order to highlight significant differences between the groups of subjects. The statistical analyses do not show significant differences between the two groups of amputees, while significant differences are obtained between amputees and intact subjects. These results constitute new information in the field and suggest new interpretations to previous hypotheses, thus adding precious information towards natural control of robotic prosthetic hands.

Characterization of a benchmark database for myoelectric movement classification.

In this paper, we characterize the Ninapro database and its use as a benchmark for hand prosthesis evaluation. The database is a publicly available resource that aims to support research on advanced myoelectric hand prostheses. The database is obtained by jointly recording surface electromyography signals from the forearm and kinematics of the hand and wrist while subjects perform a predefined set of actions and postures. Besides describing the acquisition protocol, overall features of the datasets and the processing procedures in detail, we present benchmark classification results using a variety of feature representations and classifiers. Our comparison shows that simple feature representations such as mean absolute value and waveform length can achieve similar performance to the computationally more demanding marginal discrete wavelet transform. With respect to classification methods, the nonlinear support vector machine was found to be the only method consistently achieving high performance regardless of the type of feature representation. Furthermore, statistical analysis of these results shows that classification accuracy is negatively correlated with the subject's Body Mass Index. The analysis and the results described in this paper aim to be a strong baseline for the Ninapro database. Thanks to the Ninapro database (and the characterization described in this paper), the scientific community has the opportunity to converge to a common position on hand movement recognition by surface electromyography, a field capable to strongly affect hand prosthesis capabilities.

Sensorimotor tests, such as movement control and laterality judgment accuracy, in persons with recurrent neck pain and controls. A case-control study.

Assessing sensorimotor abilities, such as movement control, becomes increasingly important for the management of patients with neck pain because of the potential contribution to the development of chronic neck pain. Our aim was to evaluate whether sensorimotor tests could discriminate between persons with neck pain and persons without neck pain and to assess correlations among the assessments. A matched case-control study with 30 persons with recurrent neck pain and 30 controls was conducted. We tested two-point discrimination (TPD), joint position error (JPE), muscle activation with the craniocervical flexion test (CCFT), laterality judgment accuracy and movement control (MC). We administered the Fear Avoidance Beliefs Questionnaire (FABQ), the Neck Disability Index (NDI) and the painDetect questionnaire. According to the areas under the curve (AUC), tests for the JPE (0.69), CCFT (0.73), MC (0.83) and laterality judgment accuracy (0.68) were able to discriminate between persons with and without neck pain. Among the five tests, laterality judgment accuracy exhibited moderate to large correlations with the JPE and MC, and moderate correlations were observed between the TPD and CCFT (r between -0.4 and -0.5). We recommend the assessment of various aspects of sensorimotor ability and of central representation of the body schema, even in patients with mild neck pain. For clinical practice, we recommend the craniocervical flexion test, testing of laterality judgment accuracy and three movement control tests (cervico-thoracic extension, protraction-retraction of the head and quadruped cervical rotation).

Electromyography data for non-invasive naturally-controlled robotic hand prostheses.

Recent advances in rehabilitation robotics suggest that it may be possible for hand-amputated subjects to recover at least a significant part of the lost hand functionality. The control of robotic prosthetic hands using non-invasive techniques is still a challenge in real life: myoelectric prostheses give limited control capabilities, the control is often unnatural and must be learned through long training times. Meanwhile, scientific literature results are promising but they are still far from fulfilling real-life needs. This work aims to close this gap by allowing worldwide research groups to develop and test movement recognition and force control algorithms on a benchmark scientific database. The database is targeted at studying the relationship between surface electromyography, hand kinematics and hand forces, with the final goal of developing non-invasive, naturally controlled, robotic hand prostheses. The validation section verifies that the data are similar to data acquired in real-life conditions, and that recognition of different hand tasks by applying state-of-the-art signal features and machine-learning algorithms is possible.