Aliaa Rehan Youssef, PhD

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.

BACKGROUND: Chronic ankle instability (CAI) is associated with defective posture control and balance; thus, a proper assessment of these impairments is necessary for effective clinical decision-making. There is a need for portable, valid, and reliable methods to facilitate the easy collection of real-world data, such as mobile phones.

RESEARCH QUESTION: Is the smartphone "MyAnkle" application valid and reliable in assessing balance in patients with CAI and healthy volunteers?

METHODS: This was a cross-sectional study. Sixty-five participants completed two assessment sessions, including 31 patients (n = 41 ankles with CAI and 21 asymptomatic ankles) and 34 healthy volunteers (n = 68 ankles). In each session, dynamic single-leg stance balance was measured simultaneously using the "MyAnkle" application and the Biodex balance system (BBS) version 3. Testing was conducted at three levels of BBS difficulty-4 (D4, hard, loose platform), 6 (D6, moderate), and 8 (D8, easy, stiffer platform)-and repeated with opened and closed eyes. Both limbs were tested in a random order by two independent blinded assessors.

RESULTS: The two devices showed significant poor-to-moderate correlations when eyes were closed (p < 0.05). For discriminant validity, the application did not distinguish the two study groups in all tested conditions (p > 0.05), whereas the BBS weakly to moderately distinguished the dominant limbs in the two groups at all difficulty levels with eyes-open and at D8 with eyes-closed regardless to limb dominance. For reliability, a significantly poor to moderate inter-session reliability was noted for the two devices.

SIGNIFICANCE: "MyAnkle" application is valid in assessing balance in patients with CAI when the eyes are closed. However, similarly to BBS, its one-week test-retest reliability may be insufficient for accurate follow-up of balance changes and need to be interpreted with caution. Future studies need to establish its inter-tester reliability and its usefulness in telerehabilitation.

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.

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.

OBJECTIVES: To identify and critically appraise studies evaluating psychometric properties of functionally oriented diagnostic classification systems for Non-Specific Chronic Low Back Pain (NS-CLBP).

METHODS: This review employed methodology consistent with PRISMA guidelines. Electronic databases and journals: (PubMed, EMBASE, Cochrane, PEDro, CINAHL, Index to chiropractic literature, ProQuest, Physical Therapy, Journal of Physiotherapy, Canadian Physiotherapy and Physiotherapy Theory and Practice) were searched from inception until January 2020. Included studies evaluated the validity and reliability of NS-CLBP diagnostic classification systems in adults. Risk of bias was assessed using a Critical Appraisal Tool.

RESULTS: Twenty-two studies were eligible: Five investigated inter-rater reliability, and 17 studies analyzed validity of O'Sullivan's classification system (OCS, n = 15), motor control impairment (MCI) test battery (n = 1), and Pain Behavior Assessment (PBA, n = 1). Evidence from multiple low risk of bias studies demonstrates that OCS has moderate to excellent inter-rater reliability (kappa > 0.4). Also, two low risk of bias studies support of OCS-MCI subcategory. Three tests within the MCI test battery show acceptable inter- and intra-rater reliability for clinical use (the "sitting knee extension," the "one leg stance," and the "pelvic tilt" tests). Evidence for the reliability and validity of the PBA is limited to one high bias risk study.

CONCLUSIONS: Multiple low risk of bias studies demonstrate strong inter-rater reliability for OCS classification specifically OCS-MCI subcategory. Future studies with low risk of bias are needed to evaluate reliability and validity of the MCI test battery and the PBA.