Physical Medicine & Rehabilitation

Assessment of Usability and Task Load Demand Using a Robotic Assisted Transfer Device Compared to a Hoyer Advance for Dependent Wheelchair Transfers Objective Manual lifting can be burdensome for people who care for power wheelchair users. Though technologies used for dependent transfers are helpful, they have shortcomings of their own. This study compares the usability and task load demand of a novel robotic assisted transfer device to a clinical standard when performing dependent transfers. Design A cross-sectional study was conducted to assess caregivers (N=21) transferring a 56 kg mannequin with the Strong Arm and Hoyer Advance at three transfer locations. Feedback was gathered through qualitative surveys. Results Usability was significant in multiple areas important for transfers. Caregiver fatigue and discomfort intensity were reduced, and the Strong Arm was preferred at the three transfer locations. Device ease and efficiency favored Strong Arm at two stations as was discomfort frequency. Additionally, physical demand, frustration, and effort were significantly lower using Strong Arm compared to the Hoyer Advance. Conclusion Compared to the Hoyer, participants favored Strong Arm for transfer usability and task load demand. However, further Strong Arm developments are needed. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Evaluating the influence of social engagement on cognitive impairment and mobility outcomes within the Boston RISE cohort study OBJECTIVE We investigated the associations between mild cognitive impairment (MCI), social engagement (SE) and mobility. DESIGN We evaluated data from a cohort study of older adult primary care patients (N=430). Outcomes included self-reported function (Late-Life Function Instrument-LLFI) and performance based mobility (Short Physical Performance Battery score-SPPB). Linear regression models evaluated the association between MCI and mobility, MCI and SE, mobility measures and SE, and whether SE mediated the association between MCI status and mobility. RESULTS Participants with MCI had significantly lower mobility and lower SE as compared to those without MCI (LLFI: 53.5 vs. 56.9, p<.001; SPPB: 7.9 vs. 9.3, p<.001; SE score 44.9 vs. 49.0, p<.001). MCI was significantly associated with both LLFI and SPPB (LLFI β=-2.93, p= <.001; SPPB β=-1.26, p= <.001) and SE (β=-3.20, p= <.001). SE was significantly associated with both LLFI and SPPB (LLFI β=0.22; p= <.001; SPPB β=0.08; p= <.001). There was a positive association between SE and mobility (p-value <0.05). A mediator effect of SE was supported when evaluating the association between MCI and mobility. CONCLUSION Among older adult primary care patients at risk for mobility decline, higher levels of SE mitigate the association between MCI and mobility. Corresponding Author: Hannah Steere, MD, Spaulding Rehabilitation Hospital, 300 1st Ave, 2nd floor, Charlestown, MA, 02129, USA, Tel: 617-952-5243 | Fax: 617-952-5934 | Email: steere.hannah@gmail.com Author Disclosures: There are no competing interests or financial benefits to the authors to disclose. This work was supported by the National Institute on Aging (R01 AG032052-03), Eunice Kennedy Shriver National Institute of Child Health and Human Development (1K24HD070966-01), and the National Center for Research Resources in a grant to the Harvard Clinical and Translational Science Center (1 UL1 RR025758-01). The main results of this study have been presented as a poster presentation at the 2017 American Congress of Rehabilitation Medicine conference. This study has not been previously submitted to any journal. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Exercise training guidelines for multiple sclerosis, stroke, and Parkinson's disease: Rapid review and synthesis The translation of knowledge from exercise training research into the clinical management of multiple sclerosis (MS), stroke, and Parkinson's disease (PD) requires evidence-based guidelines that are uniformly recognizable by healthcare practitioners and patients/clients with these diseases. This paper synthesized resources that reported aerobic and resistance training guidelines for people with MS, stroke, and PD. Systematic searches yielded 25 eligible resources from electronic databases and websites or textbooks of major organizations. Data were extracted (exercise frequency, intensity, time, and type) and synthesized into recommendations per disease. Exercise guidelines for MS consistently recommended 2-3 days/week of aerobic training (10-30 minutes at moderate-intensity) and 2-3 days/week of resistance training (1-3 sets between 8-15 repetition maximum (RM)). Exercise guidelines for stroke recommended 3-5 days/week of aerobic training (20-40 minutes at moderate-intensity) and 2-3 days/week of resistance training (1-3 sets between 8-15 repetitions between 30-50% 1-RM). Exercise guidelines for PD recommended 3-5 days/week of aerobic training (20-60 minutes at moderate-intensity), and 2-3 days/week of resistance training (1-3 sets of 8-12 repetitions between 40-50% of 1-RM). This harmonization of exercise guidelines provides a prescriptive basis for healthcare providers, exercise professionals, and people with these diseases regarding disease-specific exercise programming. Correspondence to: Yumi Kim, MS, University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, 4000 Ridgeway Drive, Birmingham, AL 35209, USA; email: yumikim@uab.edu Authorship: YK: Article selection/screening, data extraction/synthesis, writing, editing, BL: Data cross-check, exercise guideline summary, writing, editing, TM: Reviewing, editing, MT: Reviewing, editing, SP: Reviewing, editing, JH: Exercise guideline summary, reviewing, writing, editing, RM: Exercise guideline summary, reviewing, writing, editing All the authors approved and critically revised the manuscript. FUNDING: This work was supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (grant number 90REGE0002-01-00). The National Institute on Disability, Independent Living, and Rehabilitation Research is a Centre within the Administration for Community Living, Department of Health and Human Services. The contents of this manuscript do not necessarily represent the policy of these groups and you should not assume endorsement by the US Federal Government. CONFLICT OF INTEREST: The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

A Short History of Medical Expert Guidelines and How They Pertain to Tracheostomy Tubes and Physical Medicine and Rehabilitation Continuous noninvasive ventilatory support (CNVS) and mechanical insufflation exsufflation (MIE) have been used since 1953 to spare patients with ventilatory pump failure from ever requiring tracheostomy tubes for ventilatory support or secretion management. Today there are patients with spinal muscular atrophy type 1 who are 25 years old and CNVS dependent since 4 months or age, post-polio survivors CNVS dependent for 64 years, Duchenne muscular dystrophy patients over age 45 CNVS dependent for over 25 years, high level spinal cord injured patients CNVS dependent for over 20 years, and even lung disease patients dependent on CNVS. All these patients, although unweanable from ventilatory support and with little or no measurable vital capacity, can also be extubated to CNVS and MIE without resort to tracheotomies when necessary to continue CNVS. However, for various reasons, this is not cited in academic society expert guidelines. This article considers the extent of the damage being caused by this. This work was not funded. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Artificial Intelligence and Applications in PM&R Artificial intelligence methods are being applied broadly in society and increasingly in healthcare and research. Machine learning, a subset of artificial intelligence, represents the study of algorithms that improve automatically with experience. This article provides a basic overview of artificial intelligence, machine learning categories, common applications in the business sphere, advantages and disadvantages of utilizing this technology, and example applications in rehabilitation and other fields for contextual purposes. The study and implementation of machine learning and artificial intelligence can function to improve patient care and represents a burgeoning area of research. Correspondence: Dustin Anderson, MD. 12631 E 17th Ave, Aurora, CO 80045. dustin.anderson@ucdenver.edu Author Disclosures: None Competing Interests: None Funding or grants or equipment provided for the project from any source: None Financial benefits to the authors: None Details of any previous presentation of the research, manuscript, or abstract in any form: None Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Randomized Trial on Comparison of the Efficacy of Extracorporeal Shock Wave Therapy and Dry Needling in Myofascial Trigger Points Objectives To compare the efficacy of radial extracorporeal shock wave therapy (ESWT) and dry needling (DN) in the treatment of myofascial trigger points (MTrPs) in the upper trapezius muscle. Design A total of 65 patients with MTrPs were randomly divided into ESWT group (n=32) and DN group (n=33). Patients received 3 weeks of treatment at one-week intervals in both groups Visual analogue scale (VAS), pressure pain threshold (PPT), Neck Disability Index (NDI) and shear modulus were evaluated pre-treatment, immediately post the first therapy, 1-month and 3-month after the completion of the third therapy. Results Significant improvements of VAS, PPT, NDI scores were observed at all time points post-treatment (p<0.01) in both treatment groups. The shear modulus of MTrPs was reduced in both DN group (p<0.05) and ESWT group (p<0.01) immediately after the first treatment. Significant reductions in shear modulus were maintained up to 3-month post-treatment in both groups (p<0.01). There were no significant differences between the radial ESWT group and DN group. Conclusions The ESWT is as effective as DN for relieving pain, improving function and reducing shear modulus for patients with MTrPs following a series of three treatments. Shuo Luan and Zhi-min Zhu contributed equally to this work. Co-Corresponding authors: Chao Ma and Shaoling Wu are both corresponding authors of this article. All correspondence should be addressed to: Chao Ma, MD, PhD and Shaoling Wu, MD, PhD, Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, No.107 Yanjiang West Road, Guangzhou, 510120, China Disclosures: This study was supported by a grant from National Natural Science Foundation of China (81771201, 81671088), Natural Science Foundation of Guangdong (2016A030311045), Guangzhou science and technology plan projects (201807010050) and Sun Yat-Sen Clinical Research Cultivating Program (SYS-C-201704). Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Understanding measures of association: A primer with examples from rehabilitation research Understanding measures of associations, how they are calculated, what they mean, and how to compare them is an important part of understanding clinical and health research. The relative risk (RR) and odds ratio (OR) are the two most common used measures of association in medical research. The appropriate use of these statistics to estimate the association between treatment or risk factor and outcome in research studies depends on the methodology and design of the study. The aim of this article is to cover basics of odds ratio and relative risk as the most important measures for the association between an exposure and an outcome. We use a clinical scenario as an example of their uses and demonstrate their calculation. Corresponding author: Dinesh Kumbhare, MD, PhD, FRCPC, FAAPMR, 550 University Avenue, Suite 7-131, Toronto, Ontario M5G 2A2, dinesh.kumbhare@uhn.ca, Telephone: 416-597-3422 x 4612 Author Disclosures: All the authors report no conflict of interest for the completion of this manuscript. Also, no funding was received. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Exercise-induced bilateral rectus femoris injury No abstract available

Minimal Clinically Important Difference of Shoulder Outcome Measures and Diagnoses: A Systematic Review Objective Patient-reported outcome scales determine response to treatment. The minimal clinically important difference (MCID) of these scales is a measure of responsiveness: the smallest change in a score associated with a clinically important change to the patient. This study sought to summarize the literature on MCID for the most commonly reported shoulder outcome scales. Design A literature search of PubMed and EMBASE databases identified 193 citations, twenty-seven of which met the inclusion/exclusion criteria. Results For rotator cuff tears, a MCID range of 9-26.9 was reported for American Shoulder and Elbow Surgeons (ASES), 8 or 10 for Constant, and 282.6-588.7 for the Western Ontario Rotator Cuff Index (WORC). For patients who underwent arthroplasty, a MCID range of 6.3-20.9 was reported for ASES, 5.7-9.4 for Constant, and 14.1-20.6 for the Shoulder Pain and Disability Index (SPADI). For proximal humeral fractures, a MCID range of 5.4-11.6 was reported for Constant and 8.1-13.0 for Disability of the Arm, Shoulder, and Hand (DASH). Conclusion A wide range of MCID values was reported for each patient population and instrument. In the future, a uniform outcome instrument and MCID will be useful to measure clinically meaningful change across practices and the spectrum of shoulder diagnoses. Corresponding Author: Nitin B. Jain, MD, MSPH, Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, 2201 Children's Way, Suite 1318, Nashville, TN 37212, United States of America, Phone: (615) 936-8508; Fax: (615) 322-7454, Email: nitin.jain@vanderbilt.edu Source of Funding: Dr. Jain is/was supported by funding from NIAMS 1K23AR059199 and 1U34AR069201. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Assessing the Accuracy of Ultrasound Guided Needle Placement in Sacroiliac Joint Injections Objective The aim of this study was to assess the accuracy of ultrasound guided needle placement for sacroiliac joint injections. Design Institutional Review Board (IRB) approval was gained for a prospective cohort study of fifty patients (N=50). Study patients who were referred for sacroiliac joint injections for sacroiliac joint mediate pain, and met inclusion/exclusion criteria, were enrolled in the study. Each patient underwent needle placement with ultrasound guidance in the procedure suite. After the needle was placed with the ultrasound guidance, fluoroscopy was utilized to confirm correct placement via contrast injection confirming a sacroiliac joint arthrogram. The arthrogram was confirmed via the performing physician and radiologist. Results The placement of the needle with ultrasound guidance into the sacroiliac joint was confirmed successful in 96% (48/50) patients by fluoroscopic arthrogram. The two patients with unsuccessful arthrograms following initial placement of the needle with ultrasound were morbidly obese. There was intra-vascular uptake during the arthrogram of one patient who had a successful arthrogram. Conclusions Ultrasound-guided injection of the sacroiliac joint is successful and accurate upon confirmation of fluoroscopic arthrogram and should be utilized as an imaging modality for needle guidance. Correspondence: Arthur Jason De Luigi, DO, MHSA, 10825 N. 140th Way, Scottsdale, AZ 85259, 301793-2136, ajweege@yahoo.com Competing Interests-None for any author Funding or grants or equipment provided for the project from any source-None for any author Financial benefits to the authors-None to any author Details of any previous presentation of the research, manuscript, or abstract in any form: None Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.