Aliaa Rehan Youssef, PhD

PURPOSE OF REVIEW: Assessment of the musculoskeletal system requires consideration of its integrated function with the nervous system. This may be assisted by using valid and reliable methods that simulate real-life situations. Interactive virtual reality (VR) technology may introduce various auditory and visual inputs that mimic real-life scenarios. However, evidence supporting the quality and strength of evidence regarding the adequacy of its psychometric properties in assessing the musculoskeletal function has not been evaluated yet. Therefore, this study reviewed the validity and reliability of VR games and real-time feedback in assessing the musculoskeletal system.

RECENT FINDINGS: Nine studies were included in quality assessment. Based on outcome measures, studies were categorized into range of motion (ROM), balance, reaction time, and cervical motion velocity and accuracy. The majority of the studies were of moderate quality and provided evidence of VR adequate concurrent and, in some cases, known-groups validity. Also, VR showed high intra-rater reliability for most of the measured outcomes. Based on the included studies, there is a limited promising evidence that interactive VR using games or real-time feedback is highly valid and reliable in assessing ROM in asymptomatic participants and patients with chronic neck pain and radial fracture. For the remaining outcomes, evidence is limited to draw a robust conclusion. Future studies are recommended to test VR psychometric properties in different patients' population using a rigor research methodology.

Background: Muscle strain is a common injury with a high recurrence rate. Due to the heterogeneity of strain injuries, experimental animals provide controlled and reproducible models to investigate such injuries. Sciatic Function Index (SFI) is a clinically feasible method to assess hind limb recovery in rodents after induced injuries.

Objectives: To investigate time to recovery of SFI after induced-strain in tibialis anterior (TA) muscle in rats.

Methods: Sixteen adult male Wister rats were randomly and equally divided to a normal control group that received no intervention, and TA induced muscle strain group. Muscle strain was induced using an external weight that corresponded to 150% of the animal body weight. SFI was tested only once in the control group. For the muscle strain group, SFI was tested on the 1, 2, 3, 4, 7, 11, 20 and 24 days after strain induction.

Results: Comparisons between group showed significant difference in SFI on the 1, 2, 3 and 4 days (p= 0.012, 0.012, 0.012 and 0.028, respectively).

Conclusions: In a rat animal model of TA induced muscle strain, functional recovery measured by SFI is evident on the 7 day post-injury, which corresponds to the sub-acute phase of injury.

Level of evidence: V.

BACKGROUND: Quantifying proprioception deficit in patients with osteoarthritis (OA) may be important in evaluating treatment effectiveness. This study investigated the concurrent and known-groups validity as well as test-retest reliability of a smartphone application in assessing joint position sense (JPS) in asymptomatic individuals and patients with knee OA.

METHODS: Sixty-four knees, from 16 asymptomatic controls and 16 patients with bilateral OA, were assessed twice with a 1-week interval in between. The smartphone Goniometer Pro application and isokinetic dynamometer simultaneously quantified JPS, in terms of absolute repositioning error (RE) angle, during active and passive limb movements at selected angles.

RESULTS: Both devices showed moderate to almost perfect correlations in measuring JPS; whether active (intra-class correlation coefficient (ICC) >0.87) or passive (ICC >0.97). The mean RE angle differences between the two devices were <0.77° (passive JPS) and <2.76° (active JPS). Both devices were capable of distinguishing patients and asymptomatic controls at 55° and 80°. The smartphone showed moderate test-retest reliability of active JPS measurement (ICC = 0.51) in the two groups, similar to that of the isokinetic dynamometer (ICC = 0.62), but with a high measurement error.

CONCLUSIONS: Smartphone application is a valid alternative to the isokinetic dynamometer in assessing JPS in patients with knee OA and asymptomatic controls. The two devices could distinguish patients and asymptomatic volunteers during passive JPS measured at 55° and 80°. Both devices have moderate reliability in quantifying active JPS, but reliability results should be considered with caution.

INTRODUCTION: Clinicians increasingly use smartphone medical applications. There is no evidence to support the validity and reliability of applications used to assess the neuromusculoskeletal system. The aim of this study was to systematically review the quality of studies as well as the validity and reliability of using a smartphone as a clinical assessment tool for the neuromusculoskeletal system. Areas covered: PubMed, CINAHL and Embase were searched. A manual search was also conducted. Additionally, forward snowballing of relevant articles was performed in Scopus and Web of Science. Two reviewers independently selected the articles, extracted the data using a standardized form and assessed the articles quality based on a scoring system Expert commentary: Thirty-four articles were found eligible and were categorized into four groups: Range of Motion (ROM), posture and deformity, tremors and reflexes, and gait and mobility. Only the ROM category supported the validity and reliability of using smartphone applications as assessment tools. Regarding quality assessment scores, the articles in ROM and posture and deformity categories ranged from poor to good quality, whereas those in the tremors and reflexes and gait and mobility categories had poor quality.