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Ergonomic measures (joint protection, energy conservation and the use of devices) are part of basic treatment in rheumatoid arthritis (RA). It is of increasing importance that Health Care is based on evidence. Therefore, attention should be paid to the assessment of ergonomic performance in clinical practice and in studies on the effects of formal patient education. We describe a first step in developing a practical test for joint protection performance. The inter- and intraobserver reliability of this test was high in a preliminary shady among 15 RA patients. The presented test is reliable and easy to perform. There is a need to determine the validity of the test. [ABSTRACT FROM AUTHOR]

Background: Inconsistent descriptions of Lumbar multifidus (LM) morphology were previously identified, especially in research applying ultrasonography (US), hampering its clinical applicability with regard to diagnosis and therapy. The aim of this study is to determine the LM-sonoanatomy by comparing high-resolution reconstructions from a 3-D digital spine compared to standard LM-ultrasonography., Methods: An observational study was carried out. From three deeply frozen human tissue blocks of the lumbosacral spine, a large series of consecutive photographs at 78 μm interval were acquired and reformatted into 3-D blocks. This enabled the reconstruction of (semi-)oblique cross-sections that could match US-images obtained from a healthy volunteer. Transverse and oblique short-axis views were compared from the most caudal insertion of LM to L1., Results: Based on the anatomical reconstructions, we could distinguish the LM from the adjacent erector spinae (ES) in the standard US imaging of the lower spine. At the lumbosacral junction, LM is the only dorsal muscle facing the surface. From L5 upwards, the ES progresses from lateral to medial. A clear distinction between deep and superficial LM could not be discerned. We were only able to identify five separate bands between every lumbar spinous processes and the dorsal part of the sacrum in the caudal anatomical cross-sections, but not in the standard US images., Conclusion: The detailed cross-sectional LM-sonoanatomy and reconstructions facilitate the interpretations of standard LM US-imaging, the position of the separate LM-bands, the details of deep interspinal muscles, and demarcation of the LM versus the ES. Guidelines for electrode positioning in EMG studies should be refined to establish reliable and verifiable findings. For clinical practice, this study can serve as a guide for a better characterisation of LM compared to ES and for a more reliable placement of US-probe in biofeedback., (© 2022. The Author(s).)

Background: Since the contribution of the lumbar multifidus(LM) is not well understood in relation to non-specific low back pain(LBP), this may limit physiotherapists in choosing the most appropriate treatment strategy., Objectives: This study aims to compare clinical characteristics, in terms of LM function and morphology, between subacute and chronic LBP patients from a large clinical practice cohort compared to healthy controls., Design: Multicenter case control study., Method: Subacute and chronic LBP patients and healthy controls between 18 and 65 years of age were included. Several clinical tests were performed: primary outcomes were the LM thickness from ultrasound measurements, trunk range of motion(ROM) from 3D kinematic tests, and median frequency and root mean square values of LM by electromyography measurements. The secondary outcomes Numeric Rating Scale for Pain(NRS) and the Oswestry Disability Index(ODI) were administered. Comparisons between groups were made with ANOVA, p-values<0.05, with Tukey's HSD post-hoc test were considered significant., Results: A total of 161 participants were included, 50 healthy controls, 59 chronic LBP patients, and 52 subacute LBP patients. Trunk ROM and LM thickness were significantly larger in healthy controls compared to all LBP patients(p < 0.01). A lower LM thickness was found between subacute and chronic LBP patients although not significant(p = 0.11-0.97). All between-group comparisons showed no statistically significant differences in electromyography outcomes (p = 0.10-0.32). NRS showed no significant differences between LBP subgroups(p = 0.21). Chronic LBP patients showed a significant higher ODI score compared to subacute LBP patients(p = 0.03)., Conclusions: Trunk ROM and LM thickness show differences between LBP patients and healthy controls., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Purpose: To analyze progression of changes in kinematics and work physiology during progressive lifting in healthy adults., Methods: Healthy participants were recruited. A standardized lifting test from the WorkWell Functional Capacity Evaluation (FCE) was administered, with five progressive lifting low series of five repetitions. The criteria of the WorkWell observation protocol were studied: changes in muscle use (EMG), heart rate (heart rate monitor), base of support, posture and movement pattern (motion capture system). Repeated measures ANOVA's were used to analyze changes during progressive workloads., Results: 18 healthy young adults participated (8 men, 10 women; mean age 22 years). Mean maximum weight lifted was 66 (±3.2) and 44 (±7.4) kg for men and women, respectively. With progressive loads, statistically significant (p < 0.01) differences were observed: increase in secondary muscle use at moderate lifting, increase of heart rate, increase of base of support and movement pattern changes were observed; differences in posture were not significant., Conclusions: Changes in 4 out of 5 kinematic and work physiology parameters were objectively quantified using lab technology during progressive lifting in healthy adults. These changes appear in line with existing observation criteria., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Many patients visiting physiotherapists for musculoskeletal disorders face psychosocial challenges which may form a large barrier to recover. There are only a limited number of evidence based psychosocial therapies, but they are mainly based on breathing exercises., Objective: to study which respiration frequency would lead to the highest relaxation, reflected in vagal tone derived from the heart rate variability (HRV) in healthy subjects., Methods: A randomized controlled cross sectional study was performed. Respiration cycles of four, five, six, seven and eight breaths per minute (BPM) were delivered in randomized order for two minutes each. HRV metrics were measured during the sessions with electrocardiogram (ECG). Repeated Measures ANOVA's were performed to analyze differences between breathing frequencies., Results: 100 healthy volunteers were included (40 male). Standard Deviation of inter beat intervals (SDNN) values were significantly highest at 5 BPM, whereas the Root Mean Square of Successive Differences (RMSSD) values appeared highest at 7 breaths per minute (p< 0.01). High Frequency (HF) power was lowest at 4 BPM, whereas Low Frequency (LF) power was not significantly influenced by respiration frequency., Conclusions: Breathing at a frequency of 5 to 7 breaths per minute leads to highest HRV values, but there is no single respiration ratio that maximizes all metrics. Physiotherapists may use five to seven BPM as guidance to determine ideal breathing frequencies.

Purpose Computer algorithms and Machine Learning (ML) will be integrated into clinical decision support within occupational health care. This will change the interaction between health care professionals and their clients, with unknown consequences. The aim of this study was to explore ethical considerations and potential consequences of using ML based decision support tools (DSTs) in the context of occupational health. Methods We conducted an ethical deliberation. This was supported by a narrative literature review of publications about ML and DSTs in occupational health and by an assessment of the potential impact of ML-DSTs according to frameworks from medical ethics and philosophy of technology. We introduce a hypothetical clinical scenario from a workers' health assessment to reflect on biomedical ethical principles: respect for autonomy, beneficence, non-maleficence and justice. Results Respect for autonomy is affected by uncertainty about what future consequences the worker is consenting to as a result of the fluctuating nature of ML-DSTs and validity evidence used to inform the worker. A beneficent advisory process is influenced because the three elements of evidence based practice are affected through use of a ML-DST. The principle of non-maleficence is challenged by the balance between group-level benefits and individual harm, the vulnerability of the worker in the occupational context, and the possibility of function creep. Justice might be empowered when the ML-DST is valid, but profiling and discrimination are potential risks. Conclusions Implications of ethical considerations have been described for the socially responsible design of ML-DSTs. Three recommendations were provided to minimize undesirable adverse effects of the development and implementation of ML-DSTs.

Background: Lumbar multifidus (LM) is regarded as the major stabilizing muscle of the spine. The effects of exercise therapy in low back pain (LBP) are attributed to this muscle. A current literature review is warranted, however, given the complexity of LM morphology and the inconsistency of anatomical descriptions in the literature., Methods: Scoping review of studies on LM morphology including major anatomy atlases. All relevant studies were searched in PubMed (Medline) and EMBASE until June 2019. Anatomy atlases were retrieved from multiple university libraries and online. All studies and atlases were screened for the following LM parameters: location, imaging methods, spine levels, muscle trajectory, muscle thickness, cross-sectional area, and diameter. The quality of the studies and atlases was also assessed using a five-item evaluation system., Results: In all, 303 studies and 19 anatomy atlases were included in this review. In most studies, LM morphology was determined by MRI, ultrasound imaging, or drawings - particularly for levels L4-S1. In 153 studies, LM is described as a superficial muscle only, in 72 studies as a deep muscle only, and in 35 studies as both superficial and deep. Anatomy atlases predominantly depict LM as a deep muscle covered by the erector spinae and thoracolumbar fascia. About 42% of the studies had high quality scores, with 39% having moderate scores and 19% having low scores. The quality of figures in anatomy atlases was ranked as high in one atlas, moderate in 15 atlases, and low in 3 atlases., Discussion: Anatomical studies of LM exhibit inconsistent findings, describing its location as superficial (50%), deep (25%), or both (12%). This is in sharp contrast to anatomy atlases, which depict LM predominantly as deep muscle. Within the limitations of the self-developed quality-assessment tool, high-quality scores were identified in a majority of studies (42%), but in only one anatomy atlas., Conclusions: We identified a lack of standardization in the depiction and description of LM morphology. This could affect the precise understanding of its role in background and therapy in LBP patients. Standardization of research methodology on LM morphology is recommended. Anatomy atlases should be updated on LM morphology.

Background: The aim of this study was to test the inter- and intrarater reliability and the concurrent validity of the Gyko Microgate for the assessment of lumbar range of motion., Methods: A cross-sectional study was carried out with two groups of healthy participants. The first group, consisting of 91 subjects, was tested to determine the inter- and intrarater reliability. Concurrent validity was assessed with comparisons with an optical motion system (Vicon) in a second group of 20 subjects. Lumbar range of motion in flexion, extension, left and right lateral flexion were performed. Intraclass correlation coefficient (ICC) was calculated for both analyses. Measurement error was calculated with standard error of the measurement (SEM), smallest detectable change (SDC) and Limits of Agreement (LoA). ICCs were considered good when ICC ≥0.80 and excellent with ICC ≥0.90., Results: Interrater reliability was good to excellent with ICCs ranging from 0.82 to 0.94. Intrarater reliability was good to excellent with ICCs ranging from 0.84 to 0.95. Concurrent validity was excellent with ICCs varying from 0.90 to 0.95. LoA were highest in interrater reliability and smallest in concurrent validity. SEM ranged from 2.2 to 4.0° in lateral flexion left and flexion respectively. SDC varied from 6.1 to 11.1°., Conclusion: Gyko has good inter- and intrarater reliability and excellent concurrent validity compared to the optical motion system for lumbar range of motion. Gyko may be considered as objective measure to measure range of motion for clinical purposes, however trials with patients are currently lacking., Competing Interests: Declaration of competing interest None declared., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Purpose To evaluate the 5-year course of physical work capacity of participants with early symptomatic osteoarthritis (OA) of the hip and/or the knee; to identify trajectories and explore the relationship between trajectories and covariates. Methods In a prospective cohort study, physical work capacity was measured at baseline, using a test protocol (functional capacity evaluation) consisting of work-related physical activities. Participants were invited to participate in 1, 2 and 5 year follow-up measurements. Multilevel analysis and latent classes analysis were performed, in models with test performances as dependent variables and age, sex, work status, self-reported function (Western Ontario McMasters Arthritis Scale-WOMAC), body mass index (BMI) and time as independent variables. Multiple imputation was used to control for the influence of missing data. Results At baseline and after 1, 2 and 5 years there were 96, 64, 61 and 35 participants. Mean (SD) age at baseline was 56 (4.9) years, 84% were females. There was no statistically significant change in test performances (lifting low and high, carrying, static overhead work, repetitive bending, repetitive rotations) between the 4 measurements. Male sex, younger age and better self-reported function were statistically significant (p < 0.05) determinants of higher performance on most of the tests; having a paid job, BMI and progression of time were not. Three trajectories were identified: 'weak giving way', 'stable and able', and 'strong with decline'. Discussion In subgroups of participants with early symptomatic OA, determined by age, sex and self-reported function, physical work capacity seems to be a stable characteristic over 5 years.

Objectives: The aim of this study was to study measurement properties of the Dutch Language Version of the Brief Resilience Scale (BRS-DLV) in blue and white collar workers employed at multiple companies and to compare the validity and factor structure to other language versions., Methods: Workers (n = 1023) were assessed during a cross-sectional health surveillance. Construct validity was tested with exploratory and confirmatory factor analyses (EFA and CFA) and hypothesis testing. Reliability was tested with Cronbach's alpha., Results: A two-factor structure of the BRS-DLV had good model fit in both EFA and CFA, which could be explained by difficulties of workers with reversed order items. After excluding these inconsistent answering patterns, a one-factor structure showed good model fit resembling the original BRS (χ 2  = 16.5; CFI & TLI = 0.99; SRMR = 0.02;RMSEA = 0.04). Internal consistency is sufficient (Cronbach's α = 0.78). All five hypotheses were confirmed, suggesting construct validity., Conclusions: Reliability of the BRS-DLV is sufficient and there is evidence of construct validity. Inconsistent answering, however, caused problems in interpretation and factor structure of the BRS-DLV. This can be easily detected and handled because item 2, 4 and 6 are in reversed order. Other language versions differ in factor structure, most likely because systematic errors are not corrected for. To collect valid data, it is advised to be aware of inconsistent answering of respondents., (© 2019 The Authors. Journal of Occupational Health published by John Wiley & Sons Australia, Ltd on behalf of The Japan Society for Occupational Health.)

Background: Diagnosing an anterior cruciate ligament (ACL) rupture based on a physical examination remains a challenge for both surgeons and physical therapists. The lever sign test was developed to overcome the practical limitations of other tests and to optimize diagnosis. An evaluation of the measurement properties of the lever sign test is needed to make adequate interpretations in practice., Purpose: To evaluate the reliability and diagnostic value of the lever sign test., Study Design: Cohort study (diagnosis); Level of evidence, 2., Methods: A total of 94 patients were recruited between November 2014 and July 2016. Patients were included if they were at least 16 years old, suffered from knee trauma, and had indications for knee arthroscopic surgery. Lever sign, anterior drawer, Lachman, and pivot-shift test outcomes were examined by an orthopaedic/trauma surgeon and a physical therapist. A test-retest design was used to investigate interrater reliability. Moreover, the lever sign test outcomes, alone and in combination with the other diagnostic tests, were compared with arthroscopic results, which served as the gold standard for the test's diagnostic value., Results: The lever sign test and pivot-shift test had kappa values exceeding 0.80 for interrater reliability. The kappa values for the anterior drawer test and Lachman test were 0.80 and 0.77, respectively. The lever sign test showed the highest specificity (100%) and the lowest sensitivity (39%) when compared with the other 3 tests. Moreover, its positive and negative predictive values were 100% and 65%, respectively, while an accuracy of 71% was calculated. Clustering the lever sign test parallel with the other 3 tests resulted in the highest accuracy of 91%., Conclusion: The lever sign test appears to have high interrater reliability and is the most specific test, showing a maximal positive predictive value. A positive lever sign test result indicates an ACL rupture. These results support the added value of the lever sign test for diagnosing ACL ruptures., Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution.

Background: The prevalence of dementia is expected to increase rapidly, and institutionalization is a common consequence of the disease. Dependence in activities of daily living (ADL) is a predictor for institutionalization and a determinant for the quality of life (QoL). A promising method to increase functional independence in nursing homes is a restorative care or function focused care (FFC) approach. Movement-oriented restorative care (MRC) is derived from the concept of FFC and restorative care and focuses on the integration of physical activity in the daily lives of nursing home residents with dementia using a multidisciplinary approach. The objective of this study was to assess the effectiveness of MRC in preservation of ADL independence and QoL in nursing home residents with dementia., Methods: In this quasi-experimental 12-month study, the effects of MRC were compared to care as usual in 61 nursing home residents with moderate to severe dementia. The outcome measures were ADL independence and QoL. These outcomes were measured five times (i.e. at baseline, and after 3, 6, 9, and 12 months). Additionally, data was collected regarding the degree of implementation, and the barriers to the implementation process. The effect of the intervention was analyzed using linear mixed model analyses., Results: There was no significant overall intervention effect on ADL independence and QoL. A significant group-by-time interaction was found for the QoL subscale positive self-image: after a 12 month intervention period, the MRC group scored significantly better than the control group on positive self-image. Regarding the other subscales and the total score of the QoL, as well as ADL, no significant group-by-time interactions were found., Conclusions: MRC did not demonstrate significant improvements in ADL or QoL. After a 12-month intervention period, residents who received MRC showed higher scores on positive self-image compared to the control group. This study contributes to the limited research regarding the effect of MRC on resident outcomes. Further large-scale studies are recommended., Trial Registration: The trial was retrospectively registered in http://clinicaltrials.gov on February 2, 2017: NCT03001232 .