Range Of Motion Assessment Research Articles

Effects of passive shoulder-support exoskeleton entity and support force on user range of motion under external loads

This study investigates the effects of a passive shoulder-support exoskeleton entity and support force on the range of motion (ROM) of the shoulder and trunk. Twenty-six healthy participants underwent ROM assessments across three exoskeleton setting conditions (without the exoskeleton; wearing the exoskeleton but the support force deactivated; wearing the exoskeleton with the support force activated) and three external load conditions (0 kg, 3 kg, and 6 kg). Results show that while the exoskeleton entity constrained the shoulder ROM (vertical abduction/adduction, flexion/extension, and horizontal abduction/adduction) and trunk ROM (lateral flexion and rotation), the support force partially alleviated this constraint. External loads primarily restricted the mobility of the shoulder but not the trunk. Interaction effects revealed the complex interplay between external loads and exoskeleton settings on ROM and perceived difficulty, particularly in shoulder vertical abduction/adduction. This study underscores the necessity of considering exoskeleton entity, support force, and external loads in optimizing user joint mobility.The industrial exoskeleton represents a promising solution for enhancing workplace safety and productivity by mitigating work-related musculoskeletal disorders. This study assessed the impact of the exoskeleton's entity and support force on joint mobility across different load scenarios. Joint mobility is critical to perform industrial tasks that require high flexibility and agility.

Total Knee Arthroplasty in Patients Who Have Ankylosed Knees: A 10-Year Retrospective Study

BackgroundKnee ankylosis can result in major functional impairment, and surgical treatment of knee ankylosis is often regarded as a tremendous challenge due to technical difficulties such as difficult joint exposure and a high incidence of complications. The objective of this study was to review the results of preoperative and postoperative functional scores, range of motion (ROM), and complications of total knee arthroplasty (TKA) for the treatment of knee ankylosis. MethodsBetween January 2007 and January 2021, 19 patients (17 patients, 11 women, and 6 men) who had knee ankylosis underwent TKA. The mean age of the patients was 52 years (range, 31 to 71), and the mean follow-up period was 10.2 years (range, 3.1 to 13.9). The surgical procedure involved a TKA, performed via a medial parapatellar approach, a quadriceps snip, and a secondary osteotomy with soft tissue release. The postoperative clinical outcomes and complications were evaluated using a range of methods, including ROM assessment, Hospital for Special Surgery Knee Score, and visual analog scale scores. ResultsAt the final follow-up, the mean Hospital for Special Surgery Knee score improved significantly from the preoperative score of (33.6 ± 8.7) to (88.1 ± 5.2) (P < 0.001), ROM improved from (0 ± 0°) to (100.9 ± 14.1°) (P < 0.001), the visual analog scale score improved from a preoperative score of 0 to (1.0 ± 0.94) (P < 0.001), and radiographs showed no aseptic loosening of the knee. There were 8 knees (42.1%) that had postoperative complications. ConclusionsTotal knee arthroplasty (TKA) in patients who have ankylosing knees resulted in significant improvements in flexion and extension, mobility, and quality of life, despite a high incidence of complications such as skin necrosis.

Introducing a Simple Tool of Patient Self-Assessment of Wrist Range of Motion.

Hand disorders can reduce wrist range of motion (ROM). The SARS-CoV-2 pandemic highlighted challenges in routine follow-up exams, making telemedicine a viable solution. This study evaluates the feasibility and accuracy of patient self-measured wrist ROM using a self-designed goniometer template. The template was designed to measure flexion/extension and radial/ulnar abduction movements. A cohort of 50 adults (25 males/25 females) participated in this prospective study. The exclusion criteria included wrist immobilization and ages outside of 18-65 years. Participants self-assessed their wrist ROM with the goniometer template. Measurements were independently performed by a student and a specialist using standard goniometry, as well as a resident using the self-designed goniometer. The results were blinded for unbiased analysis. Mean differences in ROM varied across movement directions, with minimal differences for ulnar abduction and more substantial deviations for radial abduction, extension and flexion. The patient-specialist comparison showed deviations below 5 degrees for flexion and ulnar abduction in 50% of cases. Telemedicine, expanded by the COVID-19 pandemic, offers significant potential for hand rehabilitation. Current methods of ROM assessment lack cost-effectiveness and simplicity. Our method, demonstrating comparable accuracy for most movements, provides a cost-effective, reliable alternative for remote ROM assessment, enhancing telemedicine practices in hand rehabilitation.

Comparative analysis of tension band wiring and hook plate fixation in ulnar styloid fractures: a focus on fracture type.

Various surgical techniques for ulnar styloid fractures (USFs) fixation have recently been developed, the actual clinical outcomes have not been discussed in detail. This study aimed to compare the outcomes of tension band wiring (TBW) and hook plate fixation in the treatment of USFs and to explore effective management strategies for these fractures. We retrospectively reviewed 109 patients with styloid process fractures from March 2016 to July 2020. Among them, patients aged 21-75 years who required surgical intervention for USFs with distal radioulnar joint (DRUJ) instability, with or without accompanying distal radius fracturs (DRFs), were included. The patients were treated with either TBW (group T) or hook plate fixation (group P). The fractures were classified into four types based on their location and complexity. Postoperative assessments were conducted using radiographic analysis to monitor fracture healing. Clinical evaluations, including range of motion (ROM), grip strength, and patient-reported outcomes using the disabilities of the arm, shoulder, and hand scores and the visual analog scale for pain, were performed, at multiple time points up to a year after surgery. Statistical analyses were conducted to compare outcomes across fracture types and treatment methods. Osseous union was achieved in 96% of the patients. Specifically, the time to union in types 3 and 4 fractures was significantly shorter in group P than in group T. Functionally, ROM assessments showed similar flexion-extension in both groups but better pronation-supination in group T. Grip strength and patient-reported outcomes did not show significant differences between the groups. TBW offers slight ROM benefits for type 2 USFs, whereas hook plate fixation provides superior stability for complex types 3 and 4 USFs. Despite the minimal differences in ROM, the enhanced advantages of the hook plate fixation make it the preferred choice for severe fractures, ensuring faster healing.

Short-Term Outcome of Ultrasound Therapy in Sudanese Patients with Knee Osteoarthritis

Objectives: the aim of this study is to evaluate the short term effectiveness of therapeutic ultrasound therapy modalities in patient with knee OA. Methodology: This is a prospective, double blinded clinical trial, conducted among 45 participants. Participants were divided into three groups each of 15 patients. In Group A – continuous ultrasound was used, in Group B – pulsed ultrasound was used and in Group C – traditional physiotherapy without ultrasound therapy was used. Groups A and B also received traditional physiotherapy in addition to ultrasound. Visual analog scale, WOMAC questionnaire, range of motion assessment, manual muscle test, and circumference were used for evaluation before and after rehabilitation program. Data were analyzed using Statistical Package for the Social Sciences (SPSS) and multiple regression analysis of variables was done. The ethical approval was obtained from the institutional review board at Alneelain University and a verbal and written consent was obtained from the participants before the interview. Result: When comparing the three groups, we Found that no difference in WOMAC score, and there was no differences in the edema and stiffness between the three groups. The only difference was in reduced pain (VAS) in the pulsed group (P-value 0.004*), when compared to the other two groups. Conclusion: Among 45 patients in this study we found that pulsed ultrasound therapy was very effective in reduction of pain, and there was no difference in the WOMAC index score, edema between the three groups at the end of treatment. When comparing the range of motion, Group B showed the greatest improvement in the motion. The traditional physiotherapy group(c) and the two ultrasound therapy groups (A &amp; B) had the same outcomes at the end of treatment programs. Keywords: Knee osteoarthritis, Ultrasound therapy, Pulsed ultrasound, Continuous ultrasound, Traditional physiotherapy, Effect of ultrasound therapy, Outcome of ultrasound therapy.

Beyond Contractures in Spinal Muscular Atrophy: Identifying Lower-Limb Joint Hypermobility.

Background: The natural history of spinal muscular atrophy (SMA) is well understood, with progressive muscle weakness resulting in declines in function. The development of contractures is common and negatively impacts function. Clinically, joint hypermobility (JH) is observed but is poorly described, and its relationship with function is unknown. Methods: Lower-limb ROM (range of motion) assessments of extension and flexion at the hip, knee, and ankle were performed. ROMs exceeding the published norms were included in the analysis. The functional assessments performed included the six-minute walk test (6 MWT) and the Hammersmith Functional Motor Scale-Expanded (HFMSE). Results: Of the 143 participants, 86% (n = 123) had at least one ROM measure that was hypermobile, and 22% (n = 32) had three or more. The HFMSE scores were inversely correlated with hip extension JH (r = -0.60, p = 0.21; n = 6) and positively correlated with knee flexion JH (r = 0.24, p = 0.02, n = 89). There was a moderate, inverse relationship between the 6 MWT distance and ankle plantar flexion JH (r = -0.73, p = 0.002; n = 15). Conclusions: JH was identified in nearly all participants in at least one joint in this study. Hip extension, knee flexion and ankle plantar flexion JH was associated with function. A further understanding of the trajectory of lower-limb joint ROM is needed to improve future rehabilitation strategies.

Cost-effectiveness and cost-utility of the ball-and-socket trapeziometacarpal prosthesis compared to trapeziectomy and ligament reconstruction: study protocol for a randomized controlled clinical trial

BackgroundTrapeziometacarpal (TMC) osteoarthritis (OA) is a common cause of pain and weakness during thumb pinch leading to disability. There is no consensus about the best surgical treatment in unresponsive cases. The treatment is associated with costs and the recovery may take up to 1 year after surgery depending on the procedure. No randomized controlled trials have been conducted comparing ball and socket TMC prosthesis to trapeziectomy with ligament reconstruction.MethodsA randomized, blinded, parallel-group superiority clinical trial comparing trapeziectomy with abductor pollicis longus (APL) arthroplasty and prosthetic replacement with Maïa® prosthesis. Patients, 18 years old and older, with a clinical diagnosis of unilateral or bilateral TMC OA who fulfill the trial’s eligibility criteria will be invited to participate. The diagnosis will be made by experienced hand surgeons based on symptoms, clinical history, physical examination, and complementary imaging tests.A total of 106 patients who provide informed consent will be randomly assigned to treatment with APL arthroplasty and prosthetic replacement with Maïa® prosthesis. The participants will complete different questionnaires including EuroQuol 5D-5L (EQ-5D-5L), the Quick DASH, and the Patient Rated Wrist Evaluation (PRWE) at baseline, at 6 weeks, and 3, 6, 12, 24, 36, 48, and 60 months after surgical treatment. The participants will undergo physical examination, range of motion assessment, and strength measure every appointment. The trial’s primary outcome variable is the change in the visual analog scale (VAS) from baseline to 12 months. A long-term follow-up analysis will be performed every year for 5 years to assess chronic changes and prosthesis survival rate. The costs will be calculated from the provider’s and society perspective using direct and indirect medical costs.DiscussionThis is the first randomized study that investigates the effectiveness and cost-utility of trapeziectomy and ligament reconstruction arthroplasty and Maïa prosthesis. We expect the findings from this trial to lead to new insights into the surgical approach to TMC OA.Trial registrationClinicalTrials.gov NCT04562753. Registered on June 15, 2020.

Feasibility, reliability and validity of self-measurement of knee range-of-motion using an accelerometer-based smartphone application by patients with total knee arthroplasty.

Limited knee range-of-motion (ROM) is common following total knee arthroplasty (TKA). It is associated with functional limitations and patient dissatisfaction. Regular knee ROM assessment is important but accurate testing traditionally requires timely access to trained healthcare professionals. Although accelerometer-based smartphone goniometry has shown to provide reliable and valid joint angles, current evidence of its use still positions healthcare providers as end users instead of patients themselves. Therefore, to maximize the impact of smartphone goniometry on post-TKA care, our study aimed to examine the feasibility, reliability, and validity of patients' self-measurement of knee ROM using an accelerometer-based smartphone goniometry application. Patients were given standard instructions with a practice trial before the actual measurements. Passive knee flexion and extension ROM was measured on 2 sessions in 30 patients with TKA using 4 block-randomized methods: (i) smartphone self-assessment, (ii) long-arm goniometry by physiotherapist, (iii) smartphone assessment by physiotherapist, and (iv) extendable-arm goniometry by physiotherapist with placement adjudication. Feasibility was assessed by the number of participants who could independently perform the self-measurement. To assess intra- and inter-session reliability, we computed intraclass correlation coefficients (ICCs) from random-effects models. To assess intra- and inter-session agreement, we computed mean absolute differences (MADs) and minimum detectable change (MDC). To assess concurrent validity, we designated extendable-arm goniometry as the "gold standard" and compared other methods against it using ICCs and MADs. All patients were able to comprehend and execute the assessment. 87% (n = 26) found the application easy to administer. Smartphone goniometry by patients showed excellent intra- and inter-session reliability (ICCs>0.97) and minimum variability (MAD = 0.9°-3.9°; MDC95 = 3.1°-9.0°). Smartphone or long-arm goniometry by physiotherapists did not outperform patients' self-assessment (ICC = 0.96-0.99, MAD = 0.7°-3.1°; MDC95 = 2.2°-8.0°). Compared against extendable-arm goniometry, smartphone goniometry by patients measured knee flexion and extension ROM with a MAD of 4.5° (ICC, 0.97) and 2.2° (ICC = 0.98), respectively. Our study demonstrates that smartphone goniometry is feasible, reliable and accurate, and can be used with confidence in the self-assessment of knee ROM post-TKA. Future studies should further explore its utility in telemonitored rehabilitation, and its possible integration into mobile health applications to enhance accessibility to care following TKA.

Commonly Practiced Physical Therapy Interventions for the Treatment of Knee Ostoearthritis; A Descriptive Study

Background: Knee Osteoarthritis (OA) is a leading cause of disability, with treatment approaches varying widely based on clinical judgment and patient-specific factors. Despite the availability of clinical guidelines, there is inconsistency in treatment preferences among physical therapists, which may influence patient outcomes. Objective: The study aimed to identify the commonly used treatment modalities for Knee OA by physical therapists in Punjab and to evaluate the adherence to clinical guidelines in practice. Methods: A cross-sectional survey was conducted involving 100 physical therapists from various cities in Punjab, who were selected using convenience sampling. Participants were provided with a standardized questionnaire to capture demographic data, clinical experience, and preferred treatment approaches for Knee OA. Data was collected in a one-time setting across government and private clinical environments over a four-month period. Therapists with a minimum of three years of clinical experience were included if they consented to participate. The data was analyzed using SPSS version 25.0. Results: Of the physical therapists surveyed, 54% were male and 46% were female. The majority (56%) worked in private/primary health centers, with lesser representation in general/specialist hospitals (19%), tertiary/teaching hospitals (17%), and secondary/federal medical centers (8%). Diagnostic preferences showed a reliance on Range of Motion assessments, with other methods such as muscle strength and radiographic findings also utilized. Treatment preferences indicated a predominant use of TENS (87 therapists), followed by ultrasound (61 therapists), and education regarding weight control (47 therapists). Less frequently used treatments included acupuncture (2 therapists) and aerobic exercises (4 therapists). Conclusion: The treatment preferences for Knee OA among physical therapists in Punjab do not consistently align with established clinical guidelines, indicating a need for enhanced guideline education and integration. The predominance of private practice settings may influence these preferences, suggesting a potential area for targeted guideline dissemination.

Concurrent Validity of Cervical Movement Tests Using VR Technology-Taking the Lab to the Clinic.

Reduced cervical range of motion (ROM) and movement velocity are often seen in people with neck pain. Objective assessment of movement characteristics is important to identify dysfunction, to inform tailored interventions, and for the evaluation of the treatment effect. The purpose of this study was to investigate the concurrent validity of a newly developed VR technology for the assessment of cervical ROM and movement velocity. VR technology was compared against a gold-standard three-dimensional optical motion capture system. Consequently, 20 people, 13 without and 7 with neck pain, participated in this quantitative cross-sectional study. ROM was assessed according to right/left rotation, flexion, extension, right/left lateral flexion, and four diagonal directions. Velocity was assessed according to fast cervical rotation to the right and left. The correlations between VR and the optical system for cervical ROM and velocity were excellent, with intraclass correlation coefficient (ICC) values > 0.95. The mean biases between VR and the optical system were ≤ 2.1° for the ROM variables, <12°/s for maximum velocity, and ≤3.0°/s for mean velocity. In conclusion, VR is a useful assessment device for ROM and velocity measurements with clinically acceptable biases. It is a feasible tool for the objective measurement of cervical kinematics in the clinic.

The functional significance of aberrant cervical counts in sloths: insights from automated exhaustive analysis of cervical range of motion.

Besides manatees, the suspensory extant 'tree sloths' are the only mammals that deviate from a cervical count (CC) of seven vertebrae. They do so in opposite directions in the two living genera (increased versus decreased CC). Aberrant CCs seemingly reflect neck mobility in both genera, suggesting adaptive significance for their head position during suspensory locomotion and especially increased ability for neck torsion in three-toed sloths. We test two hypotheses in a comparative evolutionary framework by assessing three-dimensional intervertebral range of motion (ROM) based on exhaustive automated detection of bone collisions and joint disarticulation while accounting for interacting rotations of roll, yaw and pitch. First, we hypothesize that the increase of CC also increases overall neck mobility compared with mammals with a regular CC, and vice versa. Second, we hypothesize that the anatomy of the intervertebral articulations determines mobility of the neck. The assessment revealed that CC plays only a secondary role in defining ROM since summed torsion (roll) capacity was primarily determined by vertebral anatomy. Our results thus suggest limited neck rotational adaptive significance of the CC aberration in sloths. Further, the study demonstrates the suitability of our automated approach for the comparative assessment of osteological ROM in vertebral series.

Arthroscopic capsular release for frozen shoulder: when etiology matters.

No therapeutic intervention is universally accepted for frozen shoulder, and the most effective management to restore motion and diminish pain has yet to be defined. The aim of this study was to investigate functional and psychological outcomes in patients who underwent arthroscopic capsular release for a frozen shoulder. A retrospective study with prospective data collection was conducted with 78 patients suffering from frozen shoulder resistance to conservative treatment. Considering the etiology, there were 36 (46.2%) idiopathic, 31 (39.7%) postoperative, and 11 (14.1%) posttraumatic cases. Preoperatively, each patient was evaluated with the range of motion (ROM) assessment and the Constant-Murley score (CMS). At follow-up, the 4-point subjective satisfaction scale (SSS), the ROM assessment, the SF-12 questionnaire, the numerical rating scale (NRS) for the subjective assessment of pain, the CMS and the Hospital Anxiety and Depression Scale (HADS) were assessed. After a mean follow-up of 54.2 ± 22.3months, ROM and CMS showed a statistically significant improvement between pre- and postoperative values (all p < 0.001). Before surgery, the mean CMS was 36.9% that of sex- and age-matched healthy individuals, and all patients showed a CMS lower than the normative data. At the final follow-up visit, the mean CMS was 99.9% that of sex- and age-matched healthy individuals, and 49 (62.8%) patients showed a CMS equal to or higher than the normative data. The mean increase in the CMS was 56.1 ± 8.3 points. The mean SSS, HADS-A, HADS-D, and NRS were 3.7 ± 0.5, 2.5 ± 1.6, 2.2 ± 1.3, and 2.2 ± 1.0, respectively. All patients returned to their previous level of work and sports activity after 2 and 2.5months, respectively. The multivariate analysis showed the association between a higher postoperative CMS and the idiopathic etiology of a frozen shoulder (p = 0.004, β = 3.971). No intraoperative complications occurred. Postoperatively, four patients (5.1%) were treated with intra-articular steroid injections to manage residual symptoms. One patient (1.3%) with a postoperative frozen shoulder showed persistent symptoms and underwent a new successful arthroscopic capsular release. High patient satisfaction and statistically significant ROM and CMS recovery can be achieved after arthroscopic capsular release to manage frozen shoulder. Better functional outcomes are expected when the etiology is idiopathic. Results can help surgeons identify the patients who will most benefit from surgery and should be discussed with the patient. III.

Comprehensive Meta-Analysis Mulligan's Mobilization with Movement in Knee Osteoarthritis Immediate and Short-term Efficacy on Pain, Function, and Emotional Well-being

Knee osteoarthritis (KOA) poses a significant global health challenge, impacting individuals' overall well-being through pain, compromised balance, and emotional distress. Mulligan's mobilization with movement (MWM) has emerged as a promising intervention, demonstrating immediate benefits in pain reduction and functional improvement. However, a comprehensive understanding of its sustained effects and potential synergies with other modalities remains limited. This meta-analysis aims to evaluate the immediate and short-term efficacy of Mulligan's MWM on pain reduction, physical function, and emotional well-being in KOA patients. Additionally, the study explores the sustained positive effects of MWM and its potential synergies with exercise programs and pharmacological interventions. A systematic literature review spanning 2017 to 2023 was conducted, selecting over 15 peer-reviewed studies from databases such as PubMed, Google Scholar, Cochrane Library, and Mendeley. The analysis focused on pain reduction using the Visual Analogue Scale, improvements in physical function through Time Up and Go Test and range of motion assessments, and emotional well-being evaluated via the Beck Depression Inventory. Longitudinal studies provided insights into sustained effects, and a comparative analysis explored synergies with other therapeutic modalities. Mulligan's MWM demonstrated consistent and substantial pain reduction, validated by Visual Analogue Scale scores. Improvements in physical function were evident through enhanced Time Up and Go Test results and increased range of motion. Emotional well-being saw a notable reduction in depression scores. Longitudinal studies indicated sustained positive effects, while a network meta-analysis suggested comparable efficacy with pharmacological interventions. This meta-analysis supports the immediate and short-term efficacy of Mulligan's MWM in addressing pain, improving physical function, and positively impacting emotional well-being in KOA patients. Sustained positive effects and potential synergies with other therapeutic modalities highlight the versatility of Mulligan's MWM, encouraging its integration into evidence-based guidelines for KOA management.

The use of telephone and video consultations in upper limb musculoskeletal rehabilitation: A scoping review.

In 2020, the COVID-19 pandemic caused a rapid uptake of virtual consultations (VCs) to minimise disease transmission and for this reason, research into telerehabilitation has been expanding. This review aimed to map and synthesize evidence on the use of VCs in upper limb musculoskeletal rehabilitation, describe key characteristics, and identify gaps in the research. This scoping review investigated synchronous rehabilitation consultations performed over VC. All asynchronous, wearable or pre-recorded technology was excluded. CINAHL Complete, Medline, PEDro, Google Scholar and grey literature sources were searched. Screening and data extraction were done by a single researcher. Frequency counts were used to analyse the data. Nineteen studies were identified, with patients with shoulder injury/pain most frequently studied. Most sources (n = 9) used bespoke video programmes. Range of motion (ROM) was the most common assessment (n = 10) and exercise prescription (n = 7) was the most common treatment. Benefits included time and cost savings, maintaining therapeutic relationships and increasing patient independence. Most diagnostic assessments, except joint and nerve tension tests, were found to be reliable and valid. Studies noted increased function in activities, decreased pain and increased ROM after VCs. Limitations included restricted 'hands-on' treatment, resource and training concerns and limiting patient factors. This review mapped available evidence and identified several gaps in the literature. Further robust research into VCs for hand/wrist disorders, ROM assessment and cost-effectiveness is needed.

The concurrent validity and reliability of virtual reality to measure shoulder flexion and scaption range of motion

BackgroundShoulder pain commonly has a detrimental impact on patient's work and social activities. Although pain is the most common reason for seeking care, a reduction in shoulder range of motion (ROM) is another common impairment. ROM assessment is used as an evaluation tool and multiple methods are available to measure shoulder ROM. Virtual reality (VR) has been introduced into shoulder rehabilitation, mostly when exercise and ROM measurement is indicated. This study evaluated the concurrent validity and system reliability of active ROM measurements of VR for people with and without shoulder pain. MethodsForty volunteers participated in this study. Virtual goniometry was used to assess active shoulder ROM. Participants performed flexion and scaption to six predetermined angles. Measurements from the VR goniometer and smartphone inclinometers were recorded simultaneously. To assess reliability, two identical test sequences were performed. ResultsThe concurrent validity ICCs were 0.93 for shoulder flexion and 0.94 for shoulder scaption. The VR goniometer application on average systematically overestimated the ROM compared to the smartphone inclinometer. The mean difference between goniometer values was −11.3 degrees for flexion and −10.9 for scaption. The system reliability was excellent with an overall ICC of 0.99 for the flexion movements and 0.99 for the scaption movements. ConclusionAlthough the VR system demonstrated excellent reliability, and high ICC’s for concurrent validity, the large range between the lower and upper 95% CI limits suggests it lacks measurement precision. This suggests VR, as used in this study, should not be used interchangeably with other measurement tools. Contribution of the paper•Virtual reality is a relatively new technology that is being increasingly adopted in clinical practice including the assessment and treatment of people with shoulder pain.•Virtual reality can support the growing demand for improved efficacy and efficiency of healthcare delivery by enabling physiotherapy assessment and treatment of patients via tele-health services.•The VR system (hardwear and software) tested in this study demonstrated excellent reliability and excellent concurrent validity, however, the wide limits of agreement associated with the VR system suggest that the current VR system should not be used interchangeably with digital inclinometry.

Relationship between pain and range of motion in frozen shoulder

A frozen shoulder (FS) is characterized by pain and limited range of motion (ROM). Although physical assessment of ROM is important for diagnosing and staging FS, ROM cannot be accurately assessed in clinical practice because of pain and muscle contraction. This study aimed to measure changes in shoulder joint ROM before and after anesthesia (ΔROM) in patients with FS and investigate the factors affecting these changes. This study included 54 patients (age, 55.6±9.4 years; 17 males; disease duration, 6.6±3.4 months) with FS before manipulation under transmission anesthesia. FS was defined as having a ROM in external rotation (ER) that was less than 50% of that in the unaffected shoulder. Pain at night and during motion was assessed using a numerical rating scale. Before anesthesia, the passive ROM of forward flexion (FF), abduction (AD), and ER were measured in the supine position. After confirming that the anesthesia was effective, passive ROM was measured again. The ROM in the FF, AD, and ER after anesthesia was significantly higher than that before anesthesia (P<.001). ΔROM in the FF, AD, and ER was significantly correlated with pain at night (r=0.51, P<.001; r=0.45, P<.001; and r=0.39, P=.004, respectively). Furthermore, ΔROM in the ER was significantly correlated with pain during motion (r=0.31, P=.023) and disease duration (r=-0.31, P=.021). The ROM of the FS is susceptible to pain and muscle contraction. Interventions, such as physical therapy, may be recommended after pain relief.

Cervical Range of Motion Analysis Performed with an Accelerometer: A Study of Intersession Reliability for Dental Practice.

During the clinical examination of subjects with temporomandibular disorders (TMDs), the dentist sometimes must evaluate the cervical spine, due to the anatomical and functional connections between the cervical portion of the spine and the stomatognathic apparatus. The accelerometer is a device that evaluates the Range of Motion (ROM) of the main movements of the head on the neck. To date, only a few studies have investigated the repeatability of the use of the accelerometer in the assessment of cervical ROM. Therefore, the present longitudinal observational study analyzed the repeatability of acquired cervical movements on a sample of volunteer subjects who underwent accelerometer testing. A sample of 32 subjects was tested twice within 14 days to assess cervical ROM using a standardized protocol based on a review of existing literature. The results show that the examination is reliable for all the positions of the jaw, except for the parameters regarding the asymmetries of rotation and bending. In conclusion, the accelerometer can be considered a reliable tool for evaluating the active cervical ROM. However, further studies will be necessary to make better evaluations.

Kirschner Wire Fixation Versus Mini Plate Fixation in Multiple Metacarpal Shaft Fractures of Hand to Compare Early Range of Motion in Hand

Background: Metacarpal bone plays vital role in supporting motor functions of the human palm and is subjected to frequent stress. If a fracture of the metacarpal bone occurs, it can destabilize the palm, disrupt muscular-tendon tension, impair functions of palm joints, and have adverse impacts on the daily life and work of the patient. Objectives: To compare early range of motion (ROM) in hand following K-wire fixation versus mini plate fixation in patients with multiple metacarpal shaft fractures. Methods: Cross-sectional analysis of patients with multiple metacarpal shaft fractures was done at Mufti Mehmood Memorial Teaching Hospital, between 2021 and 2022, and comprised 108 patients managed with K-wire Fixation and mini plate fixation. The success rate as well as clinical outcome of both techniques was measured as early ROM in the hand, which was assessed at eight weeks post-surgery using DASH scores. Results: Majority of patients (p&lt;0.05) were males (73.14%), common fractures (p&lt;0.05) were closed type (75.03%), right sided (62.96%) and common cause of injury (p&lt;0.05) was traffic accidents (n=48), industrial accidents (n=13), fall (n=12), agriculture accidents (n=12) and assault (n=10). Our findings revealed that occurrence of complications was significantly higher among the patients of group K-wire fixation (11.11%) than mini wire fixation (6.48%) and assessment of ROM through DASH score system of mini plate fixation was better than K-wire fixation. Practical implication The surgeons will confidently apply mini plate fixation in patients with multiple shaft fractures rather than K-wire fixation after reading this article. Conclusion: Mini plate fixation may be more effective than K-wire fixation in restoring early ROM in the hand following surgery for multiple metacarpal shaft fractures. Keywords: DASH scoring; Palm fracture; Range of motion; Shaft fracture.

TORSIONAL LOAD MEASUREMENT DURING POSTERIOR APPROACH RANGE OF MOTION ASSESSMENT FOR TOTAL HIP ARTHROPLASTY

Range of Motion (ROM) assessments are routinely used during joint replacement to evaluate joint stability before, during and after surgery to ensure the effective restoration of patient biomechanics. This study aimed to quantify axial torque in the femur during ROM assessment in total hip arthroplasty to define performance criteria against which hip instruments can be verified. Longer term, this information may provide the ability to quantitatively assess joint stability, extending to quantitation of bone preparation and quality.Joint loads measured with strain-gaged instruments in five cadaveric femurs prepared using posterior approach were analysed. Variables such as surgeon-evaluator, trial offset and specimen leg and weight were used to define 13 individual setups and paired with surgeon appraisal of joint tension for each setup. Peak torque loads were then identified for specific motions within the ROM assessment.The largest torque measured in most setups was observed during maximum extension and external rotation of the joint, with a peak torque of 13Nm recorded in a specimen weighing 98kg. The largest torque range (19.4Nm) was also recorded in this specimen. Other motions within the trial reduction showed clear peaks in applied torque but with lower magnitude. Relationships between peak torque, torque range and specimen weight produced an R2 value greater than 0.65.The data indicated that key influencers of torsional loads during ROM were patient weight, joint tension and limb motion. This correlation with patient weight should be further investigated and highlights the need for population representation during cadaveric evaluation. Although this study considered a small sample size, consistent patterns were seen across several users and specimens. Follow-up studies should aim to increase the number of surgeon-evaluators and further vary specimen size and weight. Consideration should also be given to alternative surgical approaches such as the Direct Anterior Approach.

Hip Joint Biomechanical Parameters and Their Relationship With the Esthetic Functional Performance of the Développé à la Seconde Movement in Classical Ballet Dancers.

Développé à la seconde is a classic ballet movement that requires the maintenance of a high hip joint range of motion (ROM) and muscle strength. However, the contribution of these hip joint biomechanical parameters to this movement's esthetic performance is unclear. Therefore, this study evaluated hip joint biomechanical characteristics of 21 experienced ballet dancers (15-29y old) and verified the relationship between these variables with the développé à la seconde static and dynamic performance. Correlations between age, ballet practice time, gluteus maximus and gluteus medius thicknesses, ROM, and muscle strength with absolute and relative static and dynamic performances were verified. Flexors, extensors, and internal rotators peak strength and external rotation ROM were highly correlated with absolute and relative static performances (0.5-0.7). Flexors and extensors strength and external and internal rotation ROM showed the highest correlations with the développé dynamic performance (0.49-0.67). Flexor strength and flexor and internal rotation ROM predicted 26% to 41% of this movement's static and dynamic performances. Thus, from a biomechanical perspective, clinical assessment of hip strength and ROM may be used to predict the quality of the ballet dancers' performance of the développé à la seconde and guide classical ballet training.