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Background Oscillating Positive Expiratory Pressure (OPEP) devices are important adjuncts to airway clearance therapy in patients with cystic fibrosis (CF). Current devices are typically reusable and require daily, or often more frequent, cleaning to prevent risk of infection by acting as reservoirs of potentially pathogenic organisms. In response, a daily disposable OPEP device, the UL-OPEP, was developed to mitigate the risk of contamination and eliminate the burdensome need for cleaning devices. Methods A convenience sample of 36 participants, all current OPEP device users, was recruited from a paediatric CF service. For one month, participants replaced their current OPEP device with a novel daily disposable device. Assessment included pre- and post-intervention lung function by spirometry, as well as Lung Clearance Index. Quality of life was assessed using the Cystic Fibrosis Questionnaire – Revised, while user experience was evaluated with a post-study survey. Results 31 participants completed the study: 18 males; median age 10 years, range 4–16 years. Lung function (mean difference ± SD, %FEV1 = 1.69 ± 11.93; %FVC = 0.58 ± 10.04; FEV1: FVC = 0.01 ± 0.09), LCI (mean difference ± SD, 0.08 ± 1.13), six-minute walk test, and CFQ-R were unchanged post-intervention. Participant-reported experiences of the device were predominantly positive. Conclusions The disposable OPEP device maintained patients’ lung function during short term use (≤ 1 month), and was the subject of positive feedback regarding functionality while reducing the risk of airway contamination associated with ineffective cleaning. Registration The study was approved as a Clinical Investigation by the Irish Health Products Regulatory Authority (CRN-2209025-CI0085).

During the first surge of the coronavirus disease 2019 (COVID-19) there was a tremendous global response from three-dimensional (3D) printing communities and individuals to support local health care systems and staff. The responses involved a range of 3D printer users from amateur makers to conglomerate manufacturers creating personal protective equipment (PPE) and other supplies of which there were shortages. These new supply chains resulted from the democratization of 3D printing, open source file sharing, mass production of desktop machines, and the relatively cheap cost of 3D printers. The democratized state of 3D printing facilitated an altruistic movement of makers with ranging experience, to work alongside traditional manufacturers to make medical supplies. With the critical nature of the shortages and the sharp increase in COVID-19 infections, many standards and regulations were bypassed, and good manufacturing processes disregarded, in cases. The outcomes from this article is a set of six lessons learned from the authors perspective regarding the use of 3D printing during the initial phase of the COVID-19 pandemic. We note challenges experienced around volume manufacturing, infection control requirements of produced parts and the cleanability of devices, mechanical strength considerations, good manufacturing practices, product and intellectual property (IP) liability, and the role of involving clinical stakeholders.

Until recently, three-dimensional (3D) printing/additive manufacturing has not been used extensively to create medical devices intended for actual clinical use, primarily on patient safety and regulatory grounds. However, in recent years there have been advances in materials, printers, and experience, leading to increased clinical use. The aim of this study was to perform a structured systematic review of 3D-printed medical devices used directly in patient treatment. A search of 13 databases was performed to identify studies of 3D-printed medical devices, detailing fabrication technology and materials employed, clinical application, and clinical outcome. One hundred and ten papers describing one hundred and forty medical devices were identified and analyzed. A considerable increase was identified in the use of 3D printing to produce medical devices directly for clinical use in the past 3 years. This is dominated by printing of patient-specific implants and surgical guides for use in orthopedics and orthopedic oncology, but there is a trend of increased use across other clinical specialties. The prevailing material/3D-printing technology used were titanium alloy/electron beam melting for implants, and polyamide/selective laser sintering or polylactic acid/fused deposition modeling for surgical guides and instruments. A detailed analysis across medical applications by technology and materials is provided, as well as a commentary regarding regulatory aspects. In general, there is growing familiarity with, and acceptance of, 3D printing in clinical use.

Background Extrinsic warming of contrast media (CM) to 37 °C before angiographic procedures is performed to improve bolus kinetics and avoid potential adverse effects. Extrinsically warmed CM readily loses temperature after removal from the warming cabinet, but the extent of its cooling has not been previously investigated. Purpose To assess temperature loss of extrinsically warmed CM in tubing of traditional angiographic manifolds during simulated angiography. Material and Methods In total, 35 scheduled diagnostic angiographic procedures were observed in a hospital setting. Relevant time points of CM use during the procedures were recorded. The shortest, median, and longest procedures were then simulated in the experimental laboratory to measure CM temperatures at specific times at three locations along the tubing system. Results The angiographic procedures lasted 7.0–26.6 min (median = 11.7 min), with the total duration dependent primarily on the time from contrast being removed from the warming cabinet to the commencement of imaging. During the simulated procedures, consistent patterns of temperature loss were observed. By the last simulated angiographic run, injected CM temperature decreased by 7.4–16.4 °C, depending on procedure length. Most of the heat loss occurred in the tubing between the CM bottle and coronary control syringe. Conclusion During angiographic procedures, prewarmed CM loses its temperature rapidly with the duration of exposure to ambient room temperature. If no additional measures are employed to maintain its temperature outside of the warming cabinet, extrinsic warming has limited impact on injected CM temperature.

Background Handheld oscillating positive expiratory pressure (OPEP) devices have been a mainstay of treatment for patients with hypersecretory conditions such as cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD) since the 1970s. Current devices are reusable and require regular cleaning and disinfection to prevent harbouring potentially pathogenic organisms. Adherence to cleaning regimens for respiratory devices is often poor and in response to this, a prototype disposable OPEP device—the ‘UL-OPEP’ (University of Limerick—Oscillating Positive Expiratory Pressure device)—was developed to mitigate the risk of contamination by pathogens. The device was previously evaluated successfully in a group of paediatric CF patients. The aim of the current study was to initially evaluate the safety of the prototype in patients with COPD over a period of 1 month to ensure no adverse events, negative impacts on lung function, exercise tolerance, or quality of life. Data on user experience of the device were also collected during post-study follow-up. Methods A sample of 50 volunteer participants were recruited from pulmonary rehabilitation clinics within the local hospital network. The patients were clinically stable, productive, and not current or previous users of OPEP devices. Participants were invited to use a prototype disposable OPEP device daily for a period of 1 month. Pre- and post-study lung function was assessed with standard spirometry, and exercise tolerance with the 6-min-walk-test (6MWT). Quality of life was assessed using the St. George’s Respiratory Questionnaire (SGRQ), and user experience of the prototype device evaluated using a post-study questionnaire. Results 24 Participants completed the study: 9 were female. Overall median age was 67.5 years, range 53–85 years. Lung function, 6-min walk test, and SGRQ scores showed no significant change post-study. User feedback was positive overall. Conclusions The results indicate that the UL-OPEP is safe to use in patients with COPD. No adverse events were recorded during the study or in the follow-up period of 2 weeks. The device did not negatively impact patients’ lung function, exercise tolerance, or quality of life during short term use (1 month), and usability feedback received was generally positive. Larger, longer duration studies will be required to evaluate efficacy. Registration The study was approved as a Clinical Investigation by the Irish Health Products Regulatory Authority (CRN-2209025-CI0085).

Summary Background Positive expiratory pressure (PEP) devices are an important element of the management of cystic fibrosis, and of other respiratory diseases. Whereas there have been reports in the literature of contamination of airway clearance devices and their surfaces by microbial pathogens, there is little evidence available regarding such contamination and its contribution to respiratory infection. Aim To establish whether pathogenic bacteria can contaminate PEP devices in the context of normal cleaning and maintenance practices. Methods Patients' home-use clearance devices were brought to a routine clinic appointment and collected for microbiology sampling and analysis. The patients were provided with replacement devices. Nineteen such devices were collected from 17 patients, reflecting use of multiple devices by some patients. Swabs were taken and cultured from each patient's used device, the patient's airway, as well as from new unopened and unused devices that acted as controls. Results Seven of 19 devices (37%) tested positive for presence of pathogenic bacteria. Device-cleaning methods varied among patients and non-sterilization methods were found to be ineffective at removing pathogens. Microbial species found on the devices did not correlate with those identified from airway swabs. Conclusion This study demonstrates the presence of pathogens on positive expiratory pressure devices. The potential for transmission of these pathogens to the patient's airway and the risk of infection remains unclear and requires further study.

The aim of this study was to quantify laparoscopic instrument use and actions of both limbs during a sample of common colorectal surgical procedures. A method was devised using Observer XT software to code video recordings. Anonymised HD video recordings of nine laparoscopic colorectal procedures performed by a single surgeon were analysed. We determined the percentage and frequency of instrument use and limb actions throughout the total laparoscopic surgical duration, as well as the duration of instrument inactivity. Seven instruments and seven actions were studied across nine surgical procedures. Manoeuvring, blunt dissection, and tenting up tissues accounted for the longest amount of total surgical time (non-dominant hand (NDH) 29%, dominant hand (DH) 39%), followed by grasping (NDH 33%, DH 9%), and cauterising (NDH

Peristomal skin complications are a common problem for persons with an ileostomy. PURPOSE The purpose of this pilot study was to solicit user feedback and perform an initial assessment of the performance of a new barrier seal designed to decrease the risk of chemical-induced dermatitis. METHODS Seven (7) potential participants who were at least 18 years of age, >6 months post surgery, with an end or loop ileostomy and unbroken peristomal skin, and who were capable of changing their appliance themselves or had the availability of care assistance were identified and recruited by the stoma care nurse at the University Hospital, Limerick, Ireland. At the initial visit and after 1 and 2 weeks, participants were asked to rate device comfort, security, and handling; skin condition was assessed by the research nurse using the Ostomy Skin Tool. Descriptive statistics were used to tabulate the results. RESULTS Five (5) participants completed the study. Discoloration, erosion, and tissue overgrowth scores improved in 3 of 5 patients, and the mean Ostomy Skin Tool score decreased from 5.4 ± 2.19 at the initial assessment to 4 ± 1.87 at the week 2 visit. Comfort, handling, and security ratings increased from a median of 8 at the beginning of the study to 10 at week 2. CONCLUSION Initial patient feedback regarding the new product was positive, and skin assessment results suggest the new seal may help improve peristomal skin condition. Larger studies with longer patient follow-up are needed to confirm the results of this pilot evaluation.

This study is an updated systematic review of papers published in the last 5 years on industrial back-support exoskeletons. The research questions were aimed at addressing the recent findings regarding objective (e.g. body loading, user performance) and subjective evaluations (e.g. user satisfaction), potential side effects, and methodological aspects of usability testing. Thirteen studies of active and twenty of passive exoskeletons were identified. The exoskeletons were tested during lifting and bending tasks, predominantly in laboratory settings and among healthy young men. In general, decreases in participants' back-muscle activity, peak L5/S1 moments and spinal compression forces were reported. User endurance during lifting and static bending improved, but performance declined during tasks that required increased agility. The overall user satisfaction was moderate. Some side effects were observed, including increased abdominal/lower-limb muscle activity and changes in joint angles. A need was identified for further field studies, involving industrial workers, and reflecting actual work situations. Practitioner summary: Due to increased research activity in the field, a systematic review was performed of recent studies on industrial back-support exoskeletons, addressing objective and subjective evaluations, side effects, and methodological aspects of usability testing. The results indicate the efficiency of exoskeletons in back-load reduction and a need for further studies in real work situations. Abbrevaitions: BB: biceps brachii; BF: biceps femoris; CoM: centre of mass; DA: deltoideus anterior; EMG: electromyography; ES: erector spinae; ES-C: erector spinae-cervical; ESI: erector spinae iliocostalis; ESI-L: erector spinae iliocostalis-lumborum; ESL: erector spinae longissimus; ES-L: erector spinae-lumbar; ESL-L: erector spinae longissimus-lumborum; ESL-T: erector spinae longissimus-thoracis; ES-T: erector spinae-thoracic; GM: glutaeus maximus; LBP: low back pain; LD: latissimus dorsi; LPD: local perceived discomfort scale; LPP: local perceived pressure scale; MS: multifidus spinae; MSD: musculoskeletal disorder; M-SFS: modified spinal function sort; NMV: no mean value provided; OA: obliquus abdominis (internus and externus); OEA: obliquus externus abdominis; OIA : obliquus internus abdominis; RA: rectus abdominis; RF: rectus femoris; RoM: range of motion; SUS: system usability scale; T: trapezius (pars Ascendens and Descendens); TA: trapezius pars ascendens; TC: mid-cervical trapezius; TD: trapezius pars descendens; VAS: visual analog scale; VL: vastus lateralis; VM: vastus medialis.

peer-reviewed There is a growing international interest in developing soft wearable robotic devices to improve mobility and daily life autonomy as well as for rehabilitation purposes. Usability, comfort and acceptance of such devices will affect their uptakes in mainstream daily life. The XoSoft EU project developed a modular soft lower-limb exoskeleton to assist people with low mobility impairments. This paper presents the bio-inspired design of a soft, modular exoskeleton for lower limb assistance based on pneumatic quasi-passive actuation. The design of a modular reconfigurable prototype and its performance are presented. This actuation centers on an active mechanical element to modulate the assistance generated by a traditional passive component, in this case an elastic belt. This study assesses the feasibility of this type of assistive device by evaluating the energetic outcomes on a healthy subject during a walking task. Human-exoskeleton interaction in relation to task-based biological power assistance and kinematics variations of the gait are evaluated. The resultant assistance, in terms of overall power ratio (Λ) between the exoskeleton and the assisted joint, was 26. 6% for hip actuation, 9.3% for the knee and 12.6% for the ankle. The released maximum power supplied on each articulation, was 113.6% for the hip, 93.2% for the knee, and 150.8% for the ankle.

Objective To establish the relationship between circumferential compression on the lower limb during simulated ramp and staircase profile loading, and the resultant relationship with discomfort/pain and tissue oxygenation. Background Excessive mechanical loading by exoskeletons on the body can lead to pressure-related soft tissue injury. Potential tissue damage is associated with objective oxygen deprivation and accompanied by subjective perception of pain and discomfort. Method Three widths of pneumatic cuffs were inflated at the dominant thigh and calf of healthy participants using two inflation patterns (ramp and staircase), using a computer-controlled pneumatic rig. Participants rated discomfort on an electronic visual analog scale and deep tissue oxygenation was monitored using near infrared spectroscopy. Results Circumferential compression with pneumatic cuffs triggered discomfort and pain at lower pressures at the thigh, with wider cuffs, and with a ramp inflation pattern. Staircase profile compression caused an increase in deep tissue oxygenation, whereas the ramp profile compression decreased it. Conclusion Discomfort and pain during circumferential compression at the lower limb is related to the width of pneumatic cuffs, the inflation pattern, and the volume of soft tissue at the assessment site. The occurrence of pain is also possibly related to the decrease in deep tissue oxygenation during compression. Application Our findings can be used to inform safe and comfortable design of soft exoskeletons to avoid discomfort and possible soft tissue injury.

peer-reviewed The full text of this article will not be available in ULIR until the embargo expires on the 30/03/2021 There is a lack of data and guidance on soft exoskeleton pressure contact with the body. The purpose of this research was to study the relationship between circumferential loading at the knee and discomfort/pain, to inform the design of soft exoskeletons/exosuits. The development of discomfort and pain was studied during standing and walking with circumferential compression using a pneumatic cuff. Our results show higher tolerance for intermittent than continuous compression during standing. Discomfort was triggered at pressures ranging from 13.7 kPa (continuous compression) to 30.4 kPa (intermittent compression), and pain at 52.9 kPa (continuous compression) to 60.6 kPa (intermittent compression). During walking, cyclic compression caused an increase in discomfort with time. Higher cuff inflation pressures caused an earlier onset and higher end intensities of discomfort than lower pressures. Cyclic cuff inflation of 10 kPa and 20 kPa was reasonably well tolerated. Practitioner summary Soft exoskeleton compression of the knee was simulated during static and dynamic compression cycles. The results can be used to understand how users tolerate pressure at the knee, and also to understand the levels at which discomfort and pain are experienced. Abbreviations: BMI: body mass index; DDT: discomfort detection threshold; EndVAS: end of experiment rating on visual analog discomfort scale; PDT: pain detection threshold; SD: standard deviation; SE: standard error; TSP: temporal summation of pain; VAS: visual analogue scale

Aim This study explored and interpreted insights expressed by a cohort of older adults related to their life experience, their experiences using or assisting someone with assistive devices, and their perceptions of robots and robotic assistive devices, including lower limb exoskeletons. Method A grounded theory study was undertaken with 24 older adult participants over five months. Each participant participated in a structured interviewed regarding their experiences with technologies and in particular their perceptions of assistive technologies. Themes from the interviews were coded using Nvivo software. Results Five main themes emerged from this study - (1) Aging & life stage experiences, (2) Quality of Life, (3) Assistive Technologies, (4) Health Conditions & Care, (5) Products & Service Systems. These have influenced new constructs for a hybrid design tool that incorporates stages of Usability and TAMs (Technology Acceptance Models) to gauge (a) Perception, (b) Experience and (c) Perceived Impact by older adults of lower limb exoskeletons. Conclusions: Emerging technologies such as robotic assistive devices require a specific enquiry to understand how best to optimise acceptance by older adults and avoid feelings by them of frustration, embarrassment and ultimately abandonment of these devices. Implications for rehabilitation Older adults frequently require rehabilitation and assistance with ambulation Exoskeletons are forms of assistive technologies for rehabilitation, and they are moving from clinical use to more day care use, including as part of daily living These results help explain factors related to the perception of exoskeletons by older adults, which if considered during exoskeleton design, could improve the technology uptake and compliance with this technology use by these users.

There is a paucity of methods to model soft anatomical tissues. Accurate modelling of these tissues can be difficult with current medical imaging technology. The aim of this research was to develop a methodology to model non-intestinal colorectal tissues that are not readily identifiable radiologically to enhance contextual understanding of these tissues and inform medical device design. The models created were used to inform the design of a novel medical device to separate the mesocolon from the retroperitoneum during resection of the colon. We modelled the peritoneum and the mesentery. The mesentery was used to indicate the location of Toldt’s fascia. We generated a point cloud dataset using cryosection images as the target anatomy is more visible than in CT or MRI images. The thickness of the mesentery could not be accurately determined as point cloud data do not have thickness. A denser point cloud detailing the mesenteric boundaries could be used to address this. Expert anatomical and surgical insight and point cloud data modelling methods can be used to model soft tissues. This research enhances the overall understanding of the mesentery and Toldt’s fascia in the human specimen which is necessary for medical device innovations for colorectal surgical procedures.

Background Injury prevalence data commonly indicate trends of higher rates of work-related musculoskeletal disorders in older workers over their younger counterparts, and for females more than males. The purpose of this study was to investigate age and sex-related differences in manifestations of shoulder muscle fatigue in a cohort of young and older working age males and females, in a single experiment design allowing for direct comparison of the fatigue effects between the target groups. Methods We report upper trapezius muscle fibre Conduction Velocity (CV) as an indicative measure of muscle fatigability, and isometric endurance time, at three levels of shoulder abduction lifting force set relative to participants’ maximal strength. Results Upper trapezius conduction velocity was significantly different between the young and old groups (p = 0.002) as well as between males and females (p = 0.016). Shoulder abduction endurance time was affected by age (P = 0.024) but not sex (p = 0.170). Conclusions The study identified age-related improvement in muscle fatigue resistance and increased resistance for females over males, contrary to injury prevalence trends. The muscle fatigue effects are most likely explained by muscle fibre type composition. Experimental fatigue treatments of the upper trapezius were tested at exposures relative to the participants’ strength. Absolute strength is higher when young and is generally higher for males. The findings of this study point towards age and sex-related differences in strength rather than in muscle fatigue resistance as a primary cause for the differences in the injury trends.

Background Musculoskeletal disorders (MSDs) are particularly common in the shoulder/neck region for some tasks that involve low force exertions, for example computer work. It has been demonstrated that muscle activity may be stimulated by cognitively demanding tasks. There is a lack of studies on the relationship between qualitative levels of cognitive loading, level of muscle activity, and muscle fatigue. Aims To investigate the effects of quantitative levels of cognitive loading on conduction velocity changes and isometric endurance times for the upper trapezius. Methods Participants performed a combination of three levels of a cognitively demanding computer task (0, 1.59 and 3 Bits) while simultaneously performing either of two isometric endurance tests (20 and 40% MVC) for the upper trapezius. Results Information load had a significant effect (P < 0.05) on normalized conduction velocity slopes for the 40% but not for the 20% maximum voluntary contraction conditions. Information load had a highly significant effect on endurance times for both exertion levels (P < 0.01). Conclusions This study found that performing a high-difficulty cognitive task while simultaneously performing increasingly higher levels of static isometric shoulder abduction exertions, fatigued the trapezius muscle quicker than performing an equivalent exertion with low cognitive load. This is particularly relevant to workplaces with increasing levels of automation that require high levels of decision making and computer use.

We report a case of three-dimensional (3D) printing being used to solve a difficult bedside clinical problem and avoidance of substantial risk associated with alternative solutions. A 15-year-old male with advanced cystic fibrosis developed a small (~1mm) linear tear in his Percutaneous Endoscopic Gastrostomy (PEG) tube, approximately 40 mm from the skin surface. The patient’s advanced condition precluded replacement of the PEG tube under general anaesthetic. Attempts to manage the tear with adhesive tapes yielded limited success. 3D printing was used to create a bespoke sealing device overnight, rectifying the leak and allowing enteral feeding to recommence unimpeded. The device is functioning well, several months post-discharge of the patient.

BACKGROUND Cognitive demands in the form of sustained attention are prevalent in automated manufacturing where operators undertake monitoring tasks for prolonged periods. Sustained attention tasks are stressful and could have potential health consequences for employees including contributing to Work Related Musculoskeletal Disorders (WRMSDs). OBJECTIVE The study investigates if lowered task engagement (low task motivation/focus) is a mediator of the relationship between sustained attention and musculoskeletal complaints. METHOD A structural equation modelling technique was used to determine if task engagement mediates the relationship between attention demand/attention supply and self-reported musculoskeletal complaints (MSCs) in manufacturing employees (n = 235). RESULTS Study participants were 5.16 times (OR, odds ratio) more likely to have neck complaints, 7.27 (OR) times more likely to have upper back complaints and 3.9 (OR) times more likely to report lower back complaints (OR 2.05) when attention demands were high and task engagement was low. When task engagement was introduced as a mediator between attention supply and MSCs, odds ratios decreased for neck (from 1.01 to 0.60), shoulder (from 0.95 to 0.47) (p

Methods: A convenience sample of 36 participants, all current OPEP device users, was recruited from a paediatric CF service. For a period of one month, participants replaced their current OPEP device (used daily for up to 6 months) with the SoloPep device (daily disposable). Lung function was assessed immediately before and after adopting the new device using Spirometry. Lung Clearance Index (LCI) was assessed via multiple-breath nitrogen washout. User experience of SoloPep was evaluated with a post-study questionnaire, rated on five-point Likert scales. All participants were trained at the first clinic visit to use the SoloPep device. This was performed using a proprietary software program. Results: 31 participants completed the study: 13 females; median age 10 years, range 4-16 years. Lung function (%FEV1, mean ± SD; baseline = 83.26 ± 19.63, follow-up = 86.31 ± 20.95) and LCI (mean ± SD; baseline = 10.05 ± 2.86, follow-up = 9.66 ± 2.10) were unchanged post-intervention. The majority of participants believed that SoloPep was easy to use (72% Strongly Agree; 24% Agree; 4% Neutral), dealt with issues they had with cleaning of their current OPEP device (72% Strongly Agree; 16% Agree; 12% Neutral), and encouraged them to perform OPEP therapy more regularly (52% Strongly Agree; 28% Agree; 16% Neutral, 4% Strongly Disagree). All agreed that they would adopt SoloPep as their usual OPEP device (76% Strongly Agree; 24% Agree). No adverse device-related events were reported during SoloPep use. Conclusion: SoloPep demonstrated equivalence to existing OPEP devices in this cohort and may be a useful adjunct to aid airway clearance, reducing risk of cross-contamination.

peer-reviewed The full text of this article will not be available in ULIR until the embargo expires on the 28/03/2022 Soft exoskeletons apply compressive forces at the limbs via connection cuffs to actuate movement or stabilise joints. To avoid excessive mechanical loading, the interface with the wearer's body needs to be carefully designed. The purpose of this study was to establish the magnitude of circumferential compression at the lower limb during walking that causes discomfort/pain. It was hypothesized that the thresholds differ from those during standing. A cohort of 21 healthy participants were tested using two sizes of pneumatic cuffs, inflated at the thigh and calf in a tonic or phasic manner. The results showed lower inflation pressures triggering discomfort/pain at the thigh, with tonic compression, and wider pneumatic cuffs. The thresholds were lower during walking than standing still. Deep tissue oxygenation increased during phasic compression and decreased during tonic compression. According to the findings, circumferential compression by soft exoskeletons is preferably applied at anatomical sites with smaller volumes of soft tissue, using narrow connection cuffs and inflation pressures below 14 kPa. peer-reviewed

Objectives To evaluate use of a novel disposable Oscillating Positive Expiratory Pressure (OPEP) device (SoloPep) by children with CF. Methods A convenience sample of 36 participants, all current OPEP device users, was recruited from a paediatric CF service. For one month, participants replaced their current OPEP devices (typically used daily for up to 6 months) with the SoloPep device (daily disposable), and followed their existing OPEP regimen. Lung function was assessed on the day that use of the new device was adopted and following completion of the test period using the EasyOne Air Spirometer (NDD Medzintechnik AG, Switzerland). Lung Clearance Index (LCI) was assessed via multiple-breath nitrogen washout (Exhalyser D, Eco Medics, Switzerland). User experience of SoloPep was evaluated with a post-study questionnaire, rated on five-point Likert scales. All participants were trained at the first clinic visit to use the SoloPep device utilising a proprietary software program. Results 31 participants completed the study: 13 females; median age 10 years, range 4–16 years. Lung function (mean ± SD;%FEV1, baseline = 83.26 ± 19.63, follow-up = 86.31 ± 20.95;%FVC, baseline = 92.65 ± 16.02, follow-up = 94.32 ± 16.82; FEV1: FVC, baseline = 0.79 ± 0.11, follow-up = 0.80 ± 0.10) and LCI (mean ± SD; baseline = 10.05 ± 2.86, follow-up = 9.66 ± 2.10) were unchanged post-intervention. Most participants felt that SoloPep was easy to use (72% Strongly Agree; 24% Agree; 4% Neutral), addressed issues they had with cleaning their current OPEP device (72% Strongly Agree; 16% Agree; 12% Neutral), and encouraged them to perform their OPEP therapy more regularly (52% Strongly Agree; 28% Agree; 16% Neutral, 4% Strongly Disagree). All participants agreed that they would like to use SoloPep as their usual OPEP device (76% Strongly Agree; 24% Agree). No adverse device-related events were reported during SoloPep use. Conclusion SoloPep was developed as a daily disposable OPEP device to reduce the risk of infection due to poor device cleaning. It is a convenient, user-friendly alternative to currently available OPEP devices. Over the course of the study, lung function was maintained, no adverse events were reported, and positive user experiences of the device were reported. Therefore, SoloPep may be a useful adjunct to aid airway clearance in children with CF.

BACKGROUND: Oscillating positive expiratory pressure devices aid removal of excess secretions and reduce gas trapping in patients with hypersecretory pulmonary diseases, for example, cystic fibrosis. Oscillating positive expiratory pressure works when the patient exhales actively against a fixed resistor, which generates mean intrapulmonary pressures of 10–20 cm H 2 O with rapid fluctuations of at least 1 cm H 2 O from the mean. In this study, we evaluated the performance of oscillating positive expiratory pressure therapy by pediatric subjects with cystic fibrosis to determine adherence to target therapeutic pressures. METHODS: Twenty-one pediatric subjects were recruited. Each had a history of using an oscillating positive expiratory pressure device twice daily and had received standardized training and instructions from the same specialist physiotherapist. Performance was evaluated by using a flow and pressure sensor placed in-line between the participant9s mouth and the device. The participants performed expirations as per their normal routine. RESULTS: None of the participants achieved target therapeutic pressure ranges during expiration. The mean ± SD pressure generated was 16.2 ± 6.8 cm H 2 O, whereas mean ± SD flow was 31.3 ± 8.9 L/min. The mean ± SD expiration length was 2.5 ± 1.4 s. CONCLUSIONS: Despite standardized instruction, the results demonstrated considerable variation among the participants and overall poor technique during use. Outcomes of this study indicated that airway clearance effects of oscillating positive expiratory pressure were compromised due to poor technique.

Objective This pilot study proposed and performs initial testing with Exoscore, a design evaluation tool to assess factors related to acceptance of exoskeleton by older adults, during the technology development and testing phases. Background As longevity increases and our aging population continues to grow, assistive technologies such as exosuits and exoskeletons can provide enhanced quality of life and independence. Exoscore is a design and prototype stage evaluation method to assess factors related to perceptions of the technology, the aim being to optimize technology acceptance. Method In this pilot study, we applied the three-phase Exoscore tool during testing with 11 older adults. The aims were to explore the feasibility and face validity of applying the design evaluation tool during user testing of a prototype soft lower limb exoskeleton. Results The Exoscore method is presented as part of an iterative design evaluation process. The method was applied during an exoskeleton research and development project. The data revealed the aspects of the concept design that rated favorably with the users and the aspects of the design that required more attention to improve their potential acceptance when deployed as finished products. Conclusion Exoscore was effectively applied to three phases of evaluation during a testing session of a soft exoskeleton. Future exoskeleton development can benefit from the application of this design evaluation tool. Application This study reveals how the introduction of Exoscore to exoskeleton development will be advantageous when assessing technology acceptance of exoskeletons by older adults.

Wearable devices are fast evolving to address mobility and autonomy needs of elderly people whowould benefit from physical assistance. Recent developments in soft robotics provide importantopportunities to develop soft exoskeletons (also called exosuits) to enable both physical assistanceand improved usability and acceptance for users. The XoSoft EU project has developed a modularsoft lower limb exoskeleton to assist people with low mobility impairments. In this paper, we presentthe design of a soft modular lower limb exoskeleton to improve person’s mobility, contributing toindependence and enhancing quality of life. The novelty of this work is the integration of quasi-passive elements in a soft exoskeleton. The exoskeleton provides mechanical assistance for subjectswith low mobility impairments reducing energy requirements between 10% and 20%. Investigationof different control strategies based on gait segmentation and actuation elements is presented. A firsthip–knee unilateral prototype is described, developed, and its performance assessed on a post-strokepatient for straight walking. The study presents an analysis of the human–exoskeleton energy pat-terns by way of the task-based biological power generation. The resultant assistance, in terms ofpower, was 10.9% ±2.2% for hip actuation and 9.3% ±3.5% for knee actuation. The control strat-egy improved the gait and postural patterns by increasing joint angles and foot clearance at specificphases of the walking cycle., This work has received funding from the European Union’s Horizon 2020 framework programme forresearch and innovation under grant agreement no. 688175.

BackgroundWe report a case of using 3D printing to create a bespoke eye cover for an 18-year-old man with left maxillary alveolar rhabdomyosarcoma. Further, the patient had proptosis causing chemosis and subsequent conjunctival abrasions. This had been managed by taping a large dressing around the eye for a number of weeks previously.MethodsA 3D scanner was used to capture the surface topography of the patients face. The data were imported into a CAD package and used as a guide to create a bespoke eye cover. The final design was 3D printed in a biocompatible material for use by the patient.ResultsThe scan, modelling, and printing of the bespoke cover was completed successfully in less than 72 hours.Conclusion3D printing offers a method to create bespoke solutions for patients in palliative care to meet rare and difficult clinical challenges.

BACKGROUND Within the international literature, no studies have been identified that compare prevalence rates of low back pain (LBP) in chartered physiotherapists, physical and athletic therapists and those in the national working population, making it unclear whether such therapists are an occupational group at high risk of developing LBP. AIMS To establish the prevalence of LBP among therapists (both employed and self-employed) in Ireland, to compare the employment status-, gender- and age-specific LBP prevalence rates between therapists and the national working population and to estimate the adjusted odds of developing LBP among therapists relative to the national working population. METHODS An analysis of data from the Health In Hand Intensive Tasks and Safety (HITS) study and the third national Survey on Lifestyle, Attitudes and Nutrition (SLAN). The HITS study was a cross-sectional study investigating work-related musculoskeletal disorders in practising therapists. The SLAN 2007 was a face-to-face interview study of adults. RESULTS LBP prevalence in therapists was 49% with no significant difference by employment status. Therapists had a much higher prevalence compared with the national working population across all demographic strata, with therapists nearly five times more likely to suffer from LBP than the national working population after careful adjustment for differences in sociodemographic factors. CONCLUSIONS Therapists in Ireland are an occupational group at high risk of developing LBP, warranting further research into their physical and psychosocial work-related risk factors.

Background: OPEP devices are indicated to remove excess secretions and reduce gas trapping in patients with hypersecretory pulmonary diseases e.g. Cystic Fibrosis (CF), bronchiectasis, chronic bronchitis. OPEP works by actively exhaling to functional residual capacity via a fixed resistor, to generate mean pressures of 10-20 cmH2O at a flow rate of 10-20 L/min, with an Inspiration: Expiration (I:E) ratio of 1:3 or 1:4. The current study sought to evaluate user behaviour during OPEP therapy in paediatric CF patients. Methods: 21 paediatric patients were recruited at the CF unit in University Hospital Limerick, Ireland. Each subject used an OPEP device twice daily and received standardised training and instructions from the same specialist physiotherapist. Use behaviour was evaluated using a flow and pressure sensor placed in-line between the subject’s mouth and OPEP device. Each subject was asked to perform ten expirations as per their normal routine. Each expiration was recorded separately for analysis. Results: None of the subjects achieved the specified therapeutic ranges during expiration (Figure 1). Mean pressure = 16.19 cmH2O [SD=6.78], with a mean flow = 31.28 L/min [SD=8.85]. Mean Expiration length = 2.53s [SD=1.36], with mean I:E ratio = 1:1.24 [range: 1:0.36 – 1:2.42]. Interpretation: Despite standardised instruction and good adherence to twice daily OPEP therapy, subjects demonstrated poor technique and large variance during use. Multiple cofounding factors may contribute to this phenomenon.

This article presents an investigation into the mechanical properties of porcine mesocolon, small intestinal mesentery, fascia, and peritoneum tissues to generate a preliminary database of the mechanical characteristics of these tissues as surrogates for human tissue. No study has mechanically characterised porcine tissue correlates of the mesentery and associated structures. The samples were tested to determine the strength, stretch at failure, and stiffness of each tissue. The results indicated that porcine mesenteric and associated tissues visually resembled corresponding human tissues and had similar tactile characteristics, according to an expert colorectal surgeon. Stiffness values ranged from 0.088 MPa to 6.858 MPa across all tissues, with fascia being the weakest, and mesentery and peritoneum being the strongest. Failure stress values ranged from 0.336 MPa to 6.517 MPa, and failure stretch values ranged from 1.766 to 3.176, across all tissues. These mechanical data can serve as reference baseline data upon which future work can expand.

peer-reviewed In this article, we report on a systematic review of the literature on pressure-pain thresholds induced and assessed by computerized cuff pressure algometry (CPA). The motivation for this review is to provide design guidance on pressure levels for wearable soft exoskeletons and similar wearable robotics devices. In our review, we focus on CPA studies of patients who are candidates for wearable soft exoskeletons, as pain-related physiological mechanisms reportedly differ significantly between healthy subjects and patients with chronic pain. The results indicate that circumferential limb compression in patients most likely becomes painful at approximately 10-18 kPa, and can become unbearable even below 25 kPa. The corresponding ranges for healthy control subjects are 20-42 kPa (painful limits) and 34-84 kPa (unbearable levels). Also, the increase of pain with time tends to be significantly higher, and the adaptation to pain significantly lower, than in healthy subjects. The results of this review provide guidance to designers of wearable robotics for populations with chronic pain regarding rates and magnitudes of tissue compression that may be unacceptable to users.

Objective: The objective of this study was to investigate if a breathing technique could counteract the effects of hyperventilation due to a sustained attention task on shoulder muscle activity. Background: The trend towards higher levels of automation in industry is increasing. Consequently, manufacturing operators often monitor automated process for long periods of their work shift. Prolonged monitoring work requires sustained attention, which is a cognitive process that humans are typically poor at and find stressful. As sustained attention becomes an increasing requirement of manufacturing operators’ job content, the resulting stress experienced could contribute to the onset of many health problems, including work related musculoskeletal disorders (WRMSDs). Methods: The SART attention test was completed by a group of participants before and after a breathing intervention exercise. The effects of the abdominal breathing intervention on breathing rate, upper trapezius muscle activity and end-tidal CO2 were evaluated. Results: The breathing intervention reduced the moderation effect of end-tidal CO2 on upper trapezius muscle activity. Conclusions: Abdominal breathing could be a useful technique in reducing the effects of sustained attention work on muscular activity. Application: This research can be applied to highly-automated manufacturing industries, where prolonged monitoring of work is widespread and could, in its role as a stressor, be a potential contributor to WRMSDs.

peer-reviewed The aim of this study was to evaluate the effect of an industrial exoskeleton on muscle activity, perceived musculoskeletal effort, measured and perceived contact pressure at the trunk, thighs and shoulders, and subjective usability for simple sagittal plane lifting and lowering conditions. Twelve male participants lifted and lowered a box of 7.5 kg and 15 kg, respectively, from mid-shin height to waist height, five times, both with and without the exoskeleton. The device significantly reduced muscle activity of the Erector Spinae (12%-15%) and Biceps Femoris (5%). Ratings of perceived musculoskeletal effort in the trunk region were significantly less with the device (9.5%-11.4%). The measured contact pressure was highest on the trunk (91.7 kPa-93.8 kPa) and least on shoulders (47.6 kPa-51.7 kPa), whereas pressure was perceived highest on the thighs (35-44% of Max LPP). Six of the users rated the device usability as acceptable. The exoskeleton reduced musculoskeletal loading on the lower back and assisted with hip extensor torque during lifting and lowering. Contact pressures fell below the Pain Pressure Threshold. Perceived pressure was not exceptionally high, but sufficiently high to cause discomfort if used for long durations. peer-reviewed

Active exoskeletons are potentially more effective and versatile than passive ones, but designing them poses a number of additional challenges. An important open challenge in the field is associated to the assistive strategy, by which the actuation forces are modulated to the user's needs during the physical activity. This paper addresses this challenge on an active exoskeleton prototype aimed at reducing compressive low-back loads, associated to risk of musculoskeletal injury during manual material handling (i.e., repeatedly lifting objects). An analysis of the biomechanics of the physical task reveals two key factors that determine low-back loads. For each factor, a suitable control strategy for the exoskeleton is implemented. The first strategy is based on user posture and modulates the assistance to support the wearer's own upper body. The second one adapts to the mass of the lifted object and is a practical implementation of electromyographic control. A third strategy is devised as a generalized combination of the first two. With these strategies, the proposed exoskeleton can quickly adjust to different task conditions (which makes it versatile compared to using multiple, task-specific, devices) as well as to individual preference (which promotes user acceptance). Additionally, the presented implementation is potentially applicable to more powerful exoskeletons, capable of generating larger forces. The different strategies are implemented on the exoskeleton and tested on 11 participants in an experiment reproducing the lifting task. The resulting data highlights that the strategies modulate the assistance as intended by design, i.e., they effectively adjust the commanded assistive torque during operation based on user posture and external mass. The experiment also provides evidence of significant reduction in muscular activity at the lumbar spine (around 30%) associated to using the exoskeleton. The reduction is well in line with previous literature and may be associated to lower risk of injury. © 2018 Toxiri, Koopman, Lazzaroni, Ortiz, Power, de Looze, O'Sullivan and Caldwell.

The aim of this study was to evaluate the effect of a passive upper body exoskeleton on muscle activity, perceived musculoskeletal effort, local perceived pressure and subjective usability for a static overhead task. Eight participants (4 male, 4 female) held a load (0 kg and 2 kg) three times overhead for a duration of 30 s each, both with and without the exoskeleton. Muscle activity was significantly reduced for the Biceps Brachii (49%) and Medial Deltoid (62%) by the device for the 2 kg load. Perceived effort of the arms was significantly lower with the device for the 2 kg load (41%). The device did not have a significant effect on trunk or leg muscle activity (for the 2 kg load) or perceived effort. Local perceived pressure was rated below 2 (low pressure levels) for all contact areas assessed. Half of the participants rated the device usability as acceptable. The exoskeleton reduced muscle activity and perceived effort by the arms, and had no significant negative effect on the trunk and lower body with regards to muscle activity, perceived effort and localised discomfort. © 2018 Elsevier Ltd

Background Multiple dimensions across the biopsychosocial spectrum are relevant in the management of nonspecific chronic low back pain (NSCLBP). Cognitive functional therapy is a behaviorally targeted intervention that combines normalization of movement and abolition of pain behaviors with cognitive reconceptualization of the NSCLBP problem while targeting psychosocial and lifestyle barriers to recovery. Objective The purpose of this study was to examine the effectiveness of cognitive functional therapy for people with disabling NSCLBP who were awaiting an appointment with a specialist medical consultant. Design A multiple case-cohort study (n=26) consisting of 3 phases (A1–B–A2) was conducted. Methods Measurement phase A1 was a baseline phase during which measurements of pain and functional disability were collected on 3 occasions over 3 months for all participants. During phase B, participants entered a cognitive functional therapy intervention program involving approximately 8 treatments over an average of 12 weeks. Finally, phase A2 was a 12-month, no-treatment follow-up period. Outcomes were analyzed using repeated-measures analysis of variance or Friedman test (with post hoc Bonferroni correction) across 7 time intervals, depending on normality of data distribution. Results Statistically significant reductions in both functional disability and pain were observed immediately postintervention and were maintained over the 12-month follow-up period. These reductions reached clinical significance for both disability and pain. Secondary psychosocial outcomes, including depression, anxiety, back beliefs, fear of physical activity, catastrophizing, and self-efficacy, were significantly improved after the intervention. Limitations The study was not a randomized controlled trial. Although primary outcome data were self-reported, the assessor was not blinded. Conclusions These promising results suggest that cognitive functional therapy should be compared with other conservative interventions for the management of disabling NSCLBP in secondary care settings in large randomized clinical trials.

This study presents data on self-reported prevalence of Musculo-Skeletal Disorder (MSD) symptoms and psychosocial risk exposures by age and gender among a group of office based University workers who use their computers for at least 25% of their workday. Employees in two academic organisations received an invitation to participate in an on-line questionnaire. A total of n = 852 office workers participated in this study; yet respondents who were employed for greater than 12 months were only included in the study cohort. Furthermore, participants were only considered for further analysis if they spent 50% or more of their workday in their office, and of this time at least 50% was spent on computer work (n = 569). The study indicates that self-reported symptoms of MSDs for these workers were highest in the neck, shoulder and lower back. Neck, shoulder and back MSDs were higher for females than males, yet age differences within genders were not evident for these symptoms. For neck disorders, symptomatic individuals reported significantly higher levels of office work (p Relevance to industry This study presents prevalence data on age and gender differences in self-reported symptoms of MSDs and psychosocial risk exposures in a group of sedentary workers.

A high incidence of Musculoskeletal Disorders (MSDs) has been reported in the construction sector. The use of ladders in the workplace has long been identified as a significant risk that can lead to workplace accidents. However, it is unclear if platform types have an effect on the physical risk factors for MSDs in overhead work. The aim of this study is to perform a pilot study on the effects of hand activity on both shoulder muscle loading and task performance while working on ladders versus Mobile Elevated Working Platforms (MEWPs). It is hypothesised that work on ladders would result in greater muscle loading demands, increased levels of discomfort, and reduced performance due to the restrictions on postures that could be adopted. A field study (n = 19) of experienced electricians on a construction site found that workers spent approximately 28% of their working time on ladders versus 6% on MEWPs. However, the durations of individual tasks were higher on MEWPs (153 s) than on ladders (73 s). Additionally, maximum levels of perceived discomfort (on a VAS 0-100) were reported for the shoulders (27), neck (23), and lower regions of the body (22). A simulated study (n = 12) found that task performance and discomfort were not significantly different between platform types (ladder vs. MEWP) when completing either of three tasks: cabling, assembly and drilling. However, platform and task had significant effects (p

The aim of this research was to develop a replicated colorectal region for use in laparoscopic instrument innovation.Testing of both surgical skills and laparoscopic surgical instruments takes place in a controlled lab setting. Cadaverous tissue or laparoscopic simulators are the tools of choice for skill testing.However, in the instance of colorectal surgery, porcine intestines remain the gold standard for laparoscopic testing(Lamata et al. 2004). There exists data in current literature which discuss the use of anatomical simulators (also known as simulator boxes) for both researching surgical methods, and testing laparoscopic instruments. There is little focus in the literature on the materials used to create surrogate environments which mimic those of the real world. Simulator boxes exist, and are of high fidelity, but can be quite cumbersome, with some being left in storage areas indefinitely, with some remaining inaccessible for many centers around the world. There are also many peripheral devices which need to accompany these simulators, such as laparoscopes and external monitoring equipment for recording and review. As they are highly specialized pieces of research equipment, in the majority of cases, they are not designed to be portable or readily reconfigurable. These limitations make high end laparoscopic simulators inappropriate choices for early stage HFE (Human Factors Engineering) studies.The authors propose the creation of a laparoscopic simulator which contains anatomically accurate, 3D printed colorectal sections for use in both surgical training and instrument innovation. The colon is modeled from high quality CT data in DICOM format, using the Material Mimics Innovation Suite (Materialise, 2013). By creating virtual models of the internal anatomical structure of the colorectal region, it allows for a more accurate depiction of the anatomy encountered in a surgical setting. A maximum level of realism is required for a simulator to be effective(Lamata et al. 2004).The future application of this work lies in the validation of the 3D printed anatomy which will lead to innovation of new instruments or approaches to laparoscopic surgery.

This systematic review investigated the effectiveness of manual handling training on achieving training transfer, leading to a positive change in employee's manual handling behaviour and a reduction of work-related musculoskeletal disorders (WRMSDs) following training. Six electronic databases were searched for randomised controlled trials, non-randomised controlled trials or cohort studies with a control and/or comparison group that investigated the effectiveness of manual handling training. Thirteen articles met the inclusion and exclusion criteria. Following quality assessment, nine of the included articles were found to be of high quality. This systematic review suggests that there has been very little research focusing on the effectiveness of manual handling training on training transfer to employees and the associated behavioural change. This review indicates that whilst employees report understanding and awareness following training, this does not always lead to the expected behavioural change. This review also suggests it cannot be demonstrated that training transfer will lead to a reduction of WRMSDs.

peer-reviewed Letter to Editior

Physiotherapists perceive upright, lordotic sitting postures to be important in the management of non-specific chronic low back pain (NSCLBP). Little is known about the perceptions of the wider community about seated posture, despite this being an important consideration before attempting to change seated posture. This study investigated perceptions of the best and worst sitting postures among members of the community, both with (n = 120) and without (n = 235) NSCLBP. Participants with NSCLBP perceived posture to be more important (p 0.001), and reported thinking about their posture significantly more frequently (p 0.001), than those without NSCLBP. 54% of participants selected a "neutral" lordotic sitting posture as their best posture, which was more frequent than any other posture (p 0.001). Sitting postures which were "straight", and were perceived to keep the head, neck and shoulders in good alignment were preferred. However, what people considered "straight" varied considerably. 78% selected a slumped sitting posture as their worst posture, which was more frequent than any other posture (p 0.001). The choice of best and worst sitting postures was not significantly influenced by gender, the presence of NSCLBP, or measures of pain, disability or back pain beliefs. Interestingly, a very upright sitting posture was the second most popular selection as both the best (19%) and worst (15%) posture. Overall, lordotic lumbar postures were strongly favoured among members of the community, which is broadly in line with the previously reported perceptions of physiotherapists.

No study has examined the effectiveness of prescribing seating modifications according to the individual clinical presentation of people with low back pain (LBP). A dynamic, forward-inclined chair ('Back App') can reduce seated paraspinal muscle activation among pain-free participants. This study examined 21 participants whose LBP was specifically aggravated by prolonged sitting and was eased by standing. Low back discomfort (LBD) and overall body discomfort (OBD) were assessed every 15 min while participants sat for 1 h on both the dynamic, forward-inclined chair and a standard office chair. LBD increased significantly more (p = 0.005) on the standard office chair, with no significant difference (p = 0.178) in OBD between the chairs. The results demonstrate that, in a specific flexion-related subgroup of people with LBP, increased LBD during sitting can be minimised through modifying chair design. Mechanisms that minimise seated discomfort may be of relevance in LBP management, as part of a biopsychosocial management plan.This study examined low back discomfort (LBD) during a typing task among people with low back pain (LBP). Sitting on a dynamic, forward-inclined chair resulted in less seated LBD than sitting on a standard office chair. Further research is required to examine the long-term effectiveness of ergonomics interventions in LBP.

Musculoskeletal Disorders (MSDs), especially those of the upper limb are a common concern in modern industry, and physical risk factors such as force and posture are linked to their causation. The effects of the combination of forceful gripping or grasping (especially pinch grips) and awkward postures should be considered in the causation of MSDs. Current guidelines recommend that wherever possible a power grip should be used instead of a pinch grip. However, in an industrial context these grip types are not easily interchangeable. There is a force-precision trade-off; more powerful grip types are less precise, so the selection of an incorrect grip type will affect quality and performance of a task. There are further negative implications for quality and performance where task factors such as precision, speed and repetition are present. The purpose of this study was to investigate the effects of wrist posture, force and grip type on operator muscle activity, endurance and task performance. A laboratory study was devised to test three hypothesises: 1. grip type (2 precision & 1 power grip) and wrist posture (neutral & flexed) affect forearm muscle (ECU, ECR, FCU, FCR) activity; 2. grip type and posture deviations affect grip endurance; 3. grip type, wrist posture and grip exertion level affect task performance. ANOVA revealed grip type had a significant effect on muscle activity ( p = 0.0001) for all 4 muscles studied. For 50% MVC exertions, muscle activity was highest for power grip, followed by chuck, followed by pulp pinch. Posture and the posture × grip type two way interaction both had significant effects on endurance time ( p = 0.01 and p = 0.021 respectively) with higher times for the neutral wrist. Grip type and posture had significant effects on precision performance ( p Relevance to industry In many industrial tasks, precision and productivity/performance are of critical importance, but are often contradictory. Higher precision requirements often slow tasks and reduce output. In repetitive industrial tasks grip type has important effects on precision but also maximum strength and hence risk of injury. The results from this study highlight the effects of grip type in combination with deviated wrist postures, on forearm muscle loading and precision task performance.

Background: Negative low back pain (LBP) beliefs have been associated with greater disability among patients with LBP. The LBP beliefs of health care professionals (HCPs) are associated with the LBP beliefs of their patients. Intensive (8-day) education improves both the LBP beliefs of HCPs, and their stated management of LBP. However, it is unclear if shorter (2–3 day) educational workshops can effectively change the LBP beliefs of HCPs. This study examined whether educational, biopsychosocial workshops improve the LBP beliefs of physiotherapists. In addition, the study aimed to identify which LBP beliefs are modified, which factors facilitate these changes, and to compare LBP beliefs between countries. Methods: 150 physiotherapists attending a LBP workshop in one of three countries (Ireland, England or Germany) participated. LBP beliefs were evaluated using the Back Beliefs Questionnaire (BBQ) before and after the workshops. A small sample (n = 12) of participating physiotherapists identified the key perceived mediators of change in their LBP beliefs, and this data were analysed using thematic analysis. Results: Significant differences in LBP beliefs existed between countries, both at baseline and follow-up. BBQ scores across all three countries were significantly increased (p < 0.001), after the workshop. Combining the scientific evidence with live patient presentations were identified as important mediators of changing LBP beliefs. Conclusions: Biopsychosocially-orientated educational workshops improved the LBP beliefs of physiotherapists. Future studies should examine if LBP management changes after such educational workshops

While sitting is a common aggravating factor in low back pain (LBP), the best sitting posture remains unclear. This study investigated the perceptions of 295 physiotherapists in four different European countries on sitting posture. Physiotherapists selected their perceived best sitting posture from a sample of nine options that ranged from slumped to upright sitting, as well as completing the back beliefs questionnaire (BBQ). 85% of physiotherapists selected one of two postures as best, with one posture being selected significantly more frequently than the remainder (p < 0.05). Interestingly, these two most frequently selected postures were very different from each other. Those who selected the more upright sitting posture had more negative LBP beliefs on the BBQ (p < 0.05). The choice of best sitting posture also varied between countries (p < 0.05). Overall, disagreement remains on what constitutes a neutral spine posture, and what is the best sitting posture. Qualitative comments indicated that sitting postures which matched the natural shape of the spine, and appeared comfortable and/or relaxed without excessive muscle tone were often deemed advantageous. Further research on the perceptions of people with LBP on sitting posture are indicated.

Low back pain (LBP) is a common musculoskeletal disorder and prolonged sitting often aggravates LBP. A novel dynamic ergonomic chair ('Back App'), which facilitates less hip flexion while sitting on an unstable base has been developed. This study compared lumbar posture and trunk muscle activation on this novel chair with a standard backless office chair. Twelve painfree participants completed a typing task on both chairs. Lumbar posture and trunk muscle activation were collected simultaneously and were analysed using paired t-tests. Sitting on the novel dynamic chair significantly (p0.05) reduced both lumbar flexion and the activation of one back muscle (Iliocostalis Lumborum pars Thoracis). The discomfort experienced was mild and was similar (p0.05) between chairs. Maintaining lordosis with less muscle activation during prolonged sitting could reduce the fatigue associated with upright sitting postures. Studies with longer sitting durations, and in people with LBP, are required.Sitting on a novel dynamic chair resulted in less lumbar flexion and less back muscle activation than sitting on a standard backless office chair during a typing task among pain-free participants. Facilitating lordotic sitting with less muscle activation may reduce the fatigue and discomfort often associated with lordotic sitting postures.

Many factors are associated with low back pain (LBP), including provocative spinal postures. Consequently, lumbo-pelvic posture is commonly assessed in LBP patients. A novel wireless monitor (BodyGuard™) can monitor lumbo-pelvic sagittal plane movements reliably, and has demonstrated concurrent validity during non-functional tasks. This study evaluated the concurrent validity of this monitor during functional tasks, as a precursor to LBP field studies. Twelve painfree participants performed a series of postural tasks (in sitting and standing) three times. Simultaneous postural measurements were obtained by the wireless monitor and a laboratory-based system (CODA™). Postural measurements were strongly correlated (r(s) = 0.88, r(2) = 0.78). The mean difference observed was small (10% lumbo-pelvic ROM), however some tasks displayed greater error. The results support the concurrent validity of the wireless monitor for analysing lumbo-pelvic posture during functional tasks. Specific limitations of the monitor for certain postural tasks were identified, and should be considered before implementation in future field studies.

This study investigated the combined effects of forearm rotation, radial/ulnar deviation and flexion/extension on discomfort score for two levels of frequency (10 exertions/min and 20 exertions/min) in a repetitive wrist flexion task with a force of 10 N. There were three levels of wrist deviation (neutral, 35%ROM in radial and ulnar), three levels of wrist flexion/extension (neutral, 35%ROM in flexion and extension) and three levels of forearm rotation (neutral, 60%ROM in prone and supine). The dependent variable was discomfort on a Visual Analogue Scale. ANOVA results showed that there were highly significant effects of all the main factors (p Relevance to industry: The results of the study will be beneficial for the design of work places, hand tools and task design in repetitive industrial manual work, for example, in assembly work requiring a light force and a frequency of about 10–20 exertions per minute.