Biofeedback in Partial Weight Bearing: Usability of Two Different Devices from a Patient's and Physical Therapist's Perspective.

BACKGROUND: Partial weight bearing is frequently instructed by physical therapists in patients after lower-limb trauma or surgery. The use of biofeedback devices seems promising to improve the patient's compliance with weight-bearing instructions. SmartStep and OpenGo-Science are biofeedback devices that provide real-time feedback. For a successful implementation, usability of the devices is a critical aspect and should be tested from a user's perspective. AIM: To describe the usability from the physical therapists' and a patients' perspective of Smartstep and OpenGo-Science to provide feedback on partial weight bearing during supervised rehabilitation of patients after lower-limb trauma or surgery. METHODS: In a convergent mixed-methods design, qualitative and quantitative data were collected. Usability was subdivided into user performance, satisfaction and acceptability. Patients prescribed with partial weight bearing and their physical therapists were asked to use SmartStep and OpenGo-Science during supervised rehabilitation. Usability was qualitatively tested by a think-aloud method and a semi-structured interview and quantitatively tested by the System-Usability-Scale (SUS) and closed questions. For the qualitative data thematic content analyses were used. RESULTS: Nine pairs of physical therapists and their patients participated. The mean SUS scores for patients and physical therapists were for SmartStep 70 and 53, and for OpenGo-Science 79 and 81, respectively. Scores were interpreted with the Curved Grading Scale. The qualitative data showed that there were mixed views and perceptions from patients and physical therapists on satisfaction and acceptability. CONCLUSION: This study gives insight in the usability of two biofeedback devices from the patient's and physical therapist's perspective. The overall usability from both perspectives seemed to be acceptable for OpenGo-Science. For SmartStep, overall usability seemed only acceptable from the patient's perspective. IMPLICATION: The study findings could help clinicians to decide which biofeedback device is appropriate for their given situation and provide information for future development of biofeedback devices.

Biofeedback in Partial Weight Bearing: Validity of 3 Different Devices.

Study Design Controlled laboratory study to assess criterion-related validity, with a cross-sectional within-subject design. Background Patients with orthopaedic conditions have difficulties complying with partial weight-bearing instructions. Technological advances have resulted in biofeedback devices that offer real-time feedback. However, the accuracy of these devices is mostly unknown. Inaccurate feedback can result in incorrect lower-limb loading and may lead to delayed healing. Objectives To investigate validity of peak force measurements obtained using 3 different biofeedback devices under varying levels of partial weight-bearing categories. Methods Validity of 3 biofeedback devices (OpenGo science, SmartStep, and SensiStep) was assessed. Healthy participants were instructed to walk at a self-selected speed with crutches under 3 different weight-bearing conditions, categorized as a percentage range of body weight: 1% to 20%, greater than 20% to 50%, and greater than 50% to 75%. Peak force data from the biofeedback devices were compared with the peak vertical ground reaction force measured with a force plate. Criterion validity was estimated using simple and regression-based Bland-Altman 95% limits of agreement and weighted kappas. Results Fifty-five healthy adults (58% male) participated. Agreement with the gold standard was substantial for the SmartStep, moderate for OpenGo science, and slight for SensiStep (weighted ± = 0.76, 0.58, and 0.19, respectively). For the 1% to 20% and greater than 20% to 50% weight-bearing categories, both the OpenGo science and SmartStep had acceptable limits of agreement. For the weight-bearing category greater than 50% to 75%, none of the devices had acceptable agreement. Conclusion The OpenGo science and SmartStep provided valid feedback in the lower weight-bearing categories, and the SensiStep showed poor validity of feedback in all weight-bearing categories. J Orthop Sports Phys Ther 2016;46(11):-1. Epub 12 Oct 2016. doi:10.2519/jospt.2016.6625.

REPRODUCIBILITY OF THE MODIFIED STAR EXCURSION BALANCE TEST COMPOSITE AND SPECIFIC REACH DIRECTION SCORES.

BACKGROUND: The mSEBT is a screening tool used to evaluate dynamic balance. Most research investigating measurement properties focused on intrarater reliability and was done in small samples. To know whether the mSEBT is useful to discriminate dynamic balance between persons and to evaluate changes in dynamic balance, more research into intra- and interrater reliability and smallest detectable change (synonymous with minimal detectable change) is needed. PURPOSE: To estimate intra- and interrater reliability and smallest detectable change of the mSEBT in adults at risk for ankle sprain. STUDY DESIGN: Cross-sectional, test-retest design. METHODS: Fifty-five healthy young adults participating in sports at risk for ankle sprain participated (mean ± SD age, 24.0 ± 2.9 years). Each participant performed three test sessions within one hour and was rated by two physical therapists (session 1, rater 1; session 2, rater 2; session 3, rater 1). Participants and raters were blinded for previous measurements. Normalized composite and reach direction scores for the right and left leg were collected. Analysis of variance was used to calculate intraclass correlation coefficient values for intra- and interrater reliability. Smallest detectable change values were calculated based on the standard error of measurement. RESULTS: Intra- and interrater reliability for both legs was good to excellent (intraclass correlation coefficient ranging from 0.87 to 0.94). The intrarater smallest detectable change for the composite score of the right leg was 7.2% and for the left 6.2%. The interrater smallest detectable change for the composite score of the right leg was 6.9% and for the left 5.0%. CONCLUSION: The mSEBT is a reliable measurement instrument to discriminate dynamic balance between persons. Most smallest detectable change values of the mSEBT appear to be large. More research is needed to investigate if the mSEBT is usable for evaluative purposes. LEVEL OF EVIDENCE: Level 2.