Purpose: The aim of this study was to assess physiotherapists’ clinical use and acceptance of a novel telemonitoring platform to facilitate the recording of measurements during rehabilitation of patients following anterior cruciate ligament reconstruction. Additionally, suggestions for platform improvement were explored. Methods: Physiotherapists from seven Dutch private physiotherapy practices participated in the study. Data were collected through log files, a technology acceptance questionnaire and focus group meetings using the “buy a feature” method. Data regarding platform use and acceptance (7-point/11-point numeric rating scale) were descriptively analysed. Total scores were calculated for the features suggested to improve the platform, based on the priority rating (1 = nice to have, 2 = should have, 3 = must have). Results: Participating physiotherapists (N = 15, mean [SD] age 33.1 [9.1] years) together treated 52 patients during the study period. Platform use by the therapists was generally limited, with the number of log-ins per patient varying from 3 to 73. Overall, therapists’ acceptance of the platform was low to moderate, with average (SD) scores ranging from 2.5 (1.1) to 4.9 (1.5) on the 7-point Likert scale. The three most important suggestions for platform improvement were: (1) development of a native app, (2) system interoperability, and (3) flexibility regarding type and frequency of measurements. Conclusions: Even though health care professionals were involved in the design of the telemonitoring platform, use in routine care was limited. Physiotherapists recognized the relevance of using health technology, but there are still barriers to overcome in order to successfully implement eHealth in routine care.
DOCUMENT
The wrist allows the hand to combine dorsopalmar flexion and radioulnar deviation, a unique combination of functions that is made possible by a highly complex system of joints. The morphologic features of the carpal bones and of the radiocarpal and intercarpal contacts can be functionally interpreted by the mechanism that underlies the movements of the hand to the forearm. Displacements of the carpals take place in longitudinal articulation chains, with the proximal carpals having the position of an intercalated bone. The three articulation chains, radial, central, and ulnar, have interdependent movements at the radiocarpal and midcarpal levels. The linkage of movements in the longitudinal direction is associated to a transverse linkage by mutual joint contacts and by specific ligamentous interconnections. Kinematic analyses of the carpal joint motions have provided convincing evidence that each motion of the hand to the forearm demonstrates a specific motion pattern of the carpal bones. The stability of the carpus essentially depends on the integrity of the ligamentous system which consists of interwoven fiber bundles that differ in length, direction, and mechanical properties. Distinct separations into morphologic entities are difficult to make. From a functional point of view, the ligamentous interconnections can be regarded as a system that passively restricts movements of the carpals on one another and on the radius, but in a very differentiated way. The ligamentous system controls the linkage of the movements of the carpals, with the geometries of the bones and of the joint surfaces being, first of all, responsible for the kinematic behavior of the carpal joint.
DOCUMENT
Background The plantar intrinsic foot muscles (PIFMs) have a role in dynamic functions, such as balance and propulsion, which are vital to walking. These muscles atrophy in older adults and therefore this population, which is at high risk to falling, may benefit from strengthening these muscles in order to improve or retain their gait performance. Therefore, the aim was to provide insight in the evidence for the effect of interventions anticipated to improve PIFM strength on dynamic balance control and foot function during gait in adults. Methods A systematic literature search was performed in five electronic databases. The eligibility of peer-reviewed papers, published between January 1, 2010 and July 8, 2020, reporting controlled trials and pre-post interventional studies was assessed by two reviewers independently. Results from moderate- and high-quality studies were extracted for data synthesis by summarizing the standardized mean differences (SMD). The GRADE approach was used to assess the certainty of evidence. Results Screening of 9199 records resulted in the inclusion of 11 articles of which five were included for data synthesis. Included studies were mainly performed in younger populations. Low-certainty evidence revealed the beneficial effect of PIFM strengthening exercises on vertical ground reaction force (SMD: − 0.31-0.37). Very low-certainty evidence showed that PIFM strength training improved the performance on dynamic balance testing (SMD: 0.41–1.43). There was no evidence for the effect of PIFM strengthening exercises on medial longitudinal foot arch kinematics. Conclusions This review revealed at best low-certainty evidence that PIFM strengthening exercises improve foot function during gait and very low-certainty evidence for its favorable effect on dynamic balance control. There is a need for high-quality studies that aim to investigate the effect of functional PIFM strengthening exercises in large samples of older adults. The outcome measures should be related to both fall risk and the role of the PIFMs such as propulsive forces and balance during locomotion in addition to PIFM strength measures.
MULTIFILE
