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PubMed2004

The evaluation of multimedia learning packages in the education of health professionals: experience of a musculoskeletal examination package.

The last 20 years have seen rapid technological developments within the field of information technology. The internet, sophisticated software packages and increased accessibility to computers have all opened opportunities for educators. Against this background, increasing numbers of multimedia learning packages are available to the health professional. In this paper, Pirashanthie Vivekananda-Schmidt, Andrew Hassell and Monica McLean discuss the methodological issues relating to the evaluation of such multimedia based learning tools, using the example of a specific package, Virtual Rheumatology. They discuss the reasons for the increasing interest in the area of computer-based learning, the available evidence supporting the use of such tools in education, and issues about the design and production of this CD. They then discuss the evaluation of the package to illustrate the considerable methodological difficulties in the research and evaluation of Computer Assisted Learning (CAL) packages generally.

Attitude of Health Personnel↗
PubMed2000

The development and validation of a Greek version of the short-form McGill Pain Questionnaire.

BACKGROUND: The short form of the McGill Pain Questionnaire (SFMPQ) is a widely used instrument for assessing the quality of pain where use of the full form is not possible. To date however, this instrument has not been translated into the Greek language. AIMS: It is the aim of this study to validate an adopted Greek version of the short form of the McGill Pain Questionnaire. METHODS: A systematic translation procedure was followed before development of the final version. Sixty spinal and osteoarthritis chronic musculoskeletal pain patients completed the questionnaire. A large percentage of the subjects (43%) was of elementary educational level. RESULTS: The analysis of the results indicated that an internally consistent (Cronbach's alpha = 0.71) and content valid (all 15 descriptors were used at least by the 33% of the subjects) instrument has been developed. It has been shown to be suitable, easy to understand and administer for this sample of chronic musculoskeletal patients. CONCLUSIONS: A Greek version of the SFMPQ (the GR-SFMPQ) has been constructed which has the properties of internal validity and consistency. It is easy to administer, easy to understand even for an elementary educational level and it is capable of describing multidimensionally the pain experience of chronic musculoskeletal pain patients.

Adult↗
PubMed1987

Osteoarthritis associated with a ball-and-socket ankle joint. A case report.

A ball-and-socket joint is an unusual disturbance of normal ankle development. Previous reports have noted good function and the absence of osteoarthritic change in ankles with this configuration. A 50-year-old man with no history of injury developed an osteoarthritic ball-and-socket deformity of the ankle joint. Associated musculoskeletal anomalies included toe syndactylization, genu valgum deformity, and tarsal coalition, a condition that may predispose to the development of this ankle anomaly. Associated valgus deformity of the ankle contributed to the osteoarthritic changes. The conspicuous absence of osteoarthritis in other joints of patients previously reported with this abnormality may be explained by the lack of long-term follow-up examinations.

Ankle Joint↗
PubMedDate not supplied

Validation of an experimental model of fetal limb growth and development: practical applications for the study of fetal defects associated with therapeutic agents in pregnant women.

Numerous musculoskeletal disorders which occur during pregnancy require an effective, nonpharmacological treatment that is known to have no adverse effects on fetal development. The present report describes morphological and histological changes occurring in fetal mouse limbs maintained in a serum-free organ culture system. Limbs maintained in this organ culture system show a progressive rise in limb dimensions including surface area, perimeter, and limb length. Histological analysis of serial cross sections of the limbs revealed a statistically significant increase in histological scores of limb development, thickness of epidermal layer, and amount of collagen deposited in the bone and dermis of limbs by Day 4 of culture. Therefore, this in vitro model combined with contemporary computer image analysis represents an excellent experimental model which can be used readily to examine the effects of therapeutic modalities on the growth and development of many different organ systems.

Abnormalities, Drug-Induced↗
PubMed1999

Musculoskeletal abnormalities in chronic headache: a controlled comparison of headache diagnostic groups.

The presence of postural, myofascial, and mechanical abnormalities in patients with migraine, tension-type headache, or both headache diagnoses was compared to a headache-free control sample. Twenty-four control subjects were obtained from a convenience sampling and each was matched by age and sex to three patients with headache (one with migraine [with or without aura], one with tension-type headache, and one with diagnoses of both migraine and tension-type headache [combined diagnosis]) who had been previously assessed by a physical therapist at a headache clinic. Physical therapy assessment findings were compared among the four groups. There was a significant difference in the presence of postural abnormalities between the controls and the patients, with posture abnormalities more likely to be present in those with headache. The patients were also significantly more likely to have active trigger points and trigger points in the neck than were the control subjects. There were no significant group differences identified in the mechanical measures, nor were there any significant differences among the three headache categories. Determination of the clinical significance of these musculoskeletal abnormalities in patients with headache will require the development and testing of further standardized assessments as well as physical therapy treatment programs.

Adult↗
PubMed2002

Standardized outcome evaluation after blunt multiple injuries by scoring systems: a clinical follow-up investigation 2 years after injury.

OBJECTIVE: The objective of this study was to evaluate the state of rehabilitation in patients with blunt multiple injuries 2 years after their initial injuries, using several standardized scales and a recently described comprehensive scoring system, by means of a prospective clinical multicenter study. METHODS: Two years after the initial injury, patients with blunt multiple injuries (Injury Severity Score > or = 16) underwent a clinical follow-up in 5 German Level I trauma centers. The reassessment included a complete head-to-toe examination of the musculoskeletal system and a neurologic examination. The following patient-assessed health status scores were used to determine the quality of life: Short-Form 12, Functional Independence Measurement, and Musculoskeletal Function Assessment. Moreover, a comprehensive scoring system developed in our department (Hannover Score for Polytrauma Outcome [HASPOC]) was used that includes provider-report (physician's examination) and self-report (score systems) criteria. RESULTS: Two hundred fifty-four of 312 patients who had been injured between January 1995 and July 1996 were reexamined between January 1, 1997, and July 1, 1998. Among the remaining 58 patients, 9 had died by the time of follow-up, and 49 patients had not accepted the invitation. The mean age of those patients who underwent reexamination was 36 +/- 13 years, the mean Injury Severity Score was 24 +/- 6, and the mean initial Glasgow Coma Scale score was 11 +/- 4 (Abbreviated Injury Scale (AIS) head score of 3.3 +/- 1.1; AIS face, 1.4 +/- 0.1; AIS chest, 3.0 +/- 0.8; AIS abdomen, 1.7 +/- 0.6; and AIS extremities, 3.4 +/- 0.8). The general outcome (Short-Form 12) was as follows: grade I, 9%; grade II, 25%; grade III, 29%; grade IV, 25%; grade V, 6%; and grade VI, 6%. The outcome of the injured extremity demonstrated moderate or severe restrictions according to the Musculoskeletal Function Assessment in 41% of injuries of the lower extremity and in 16% of injuries of the upper extremity. Among patients with injuries to the lower extremity, 52% experienced pain or impaired ability to walk related to an injury of the foot or ankle, 31% indicated pain after a knee or thigh injury, and 27% indicated pain after a femoral or hip injury. The most severe deficits in the range of motion occurred in the foot and the ankle region (13.4% deficit of range of motion < 20% of normal range, p < 0.05 to other injuries). The results of the outcome obtained by self-report correlated with the clinical examination when a scoring system was used that was described recently, the HASPOC. CONCLUSION: In a standardized multicenter reexamination of patients with blunt multiple injuries, the general outcome was usually fair or good. Both the complaints and the objective results of specific extremity areas demonstrated that most limitations were because of injuries below the knee. These results were adequately reflected by a comprehensive scoring system, combining self-report and provider report (HASPOC).

Adult↗
PubMed2003

Efficacy of telemedicine in the initial management of orthopedic trauma.

In order to determine the clinical usefulness of teleradiology in the initial treatment of musculoskeletal injury, a panel of orthopedic trauma surgeons developed a survey that was presented to participants at the annual meeting of the Orthopedic Trauma Association. Selected orthopedic trauma cases from a level-1 trauma and a tertiary care center were presented orally (including a description and interpretation of the radiographic findings) to volunteer participants. Questions related to treatment and patient management were then asked prior to and following the participants' viewing of digital radiographic images. Overall, 90% of respondents found telemedicine useful. They disagreed with the verbal radiographic report 49% of the time. Respondents changed their mind with regard to the need for admission 17% of the time; surgical indications, 22% of the time; and need for more information, 30% of the time.

Decision Making↗
PubMed2002

An ergonomic questionnaire survey on the use of computers in schools.

A questionnaire was sent out to elementary, junior high and high schools in Yokohama and Kawasaki Cities from January to March 1998 regarding the use of personal computers by pupils and students. The survey included the questions that asked how often and in what environment computers are used, whether any instructions are given as to their use, children's working posture, and the effect on health. The results show that most schools are slow to develop instructive programs from the environmental or ergonomic point of view. So far there are not many children who complain of any serious symptoms such as pain in the neck, head or shoulders, but a future increase in the number of classes which involve computing, as well as the widespread popularity of home computers, will surely arouse a legitimate concern about the health of pupils and students, since they will spend more and more time operating the devices. An effective way to anticipate the problem is to provide young students with adequate knowledge of easy-on-body usage and environmental design, and now there is an urgent need for specific guidelines to protect them.

Adolescent↗
PubMed2006

Musculoskeletal symptoms in support staff in a large telecommunication company.

PRIMARY OBJECTIVE: The primary objective of this study was to determine the extent and severity of the musculoskeletal problems in office workers in a telecommunication company. RESEARCH DESIGN: A questionnaire survey was conducted to assess the prevalence of musculoskeletal disorders' symptoms, their perceived intensity and interaction with ability to work among office workers. METHODS AND PROCEDURES: The Cornell Musculoskeletal Discomfort Questionnaire and Cornell Hand Discomfort Questionnaire developed by the Human Factors and Ergonomics Laboratory at Cornell University were used on a sample of 140 office workers in a telecommunication company. MAIN OUTCOMES AND RESULTS: Discomfort/pain/ache at the wrist level was reported by 86.5% for the left side and 95.5% for the right side. Additionally, discomfort/pain/ache was reported by 77.5% of the sample for neck and 31% of the sample for the left and 50% for the right shoulder region. At the hand site, the area in the distal proximity of the wrist was the most affected site being indicated in 90% of cases for left side and 95% of cases for the right side. CONCLUSIONS: An overview of problems associated with the body parts in office work may allow targeted prevention and intervention.

Adult↗
PubMed2006

Improving management of musculoskeletal disorders in primary care: the Joint Adventures Program.

Musculoskeletal disorders represent a large and growing clinical challenge to primary care clinicians. Unfortunately, there appears to be a gap in current training and continuing education to meet this challenge. We used script concordance within a continuing medical education program entitled "Joint Adventures" to assist family physicians to acquire the knowledge, skills, and tools they need to improve their management of musculoskeletal disorders. Program workshops were coordinated through a national continuing education program of the College of Family Physicians of Canada. A group of 54 experts in musculoskeletal disorders including family physicians, rheumatologists, and orthopedists developed cases for six areas of management that were identified by family physicians during a needs survey delivered at a national scientific congress in primary care. Script concordance methodology was used in the Joint Adventures workshop to address knowledge gaps or lack of group consensus in the six areas including (1) diagnosis of osteoarthritis, (2) treatment and management of osteoarthritis, (3) treatment and management of rheumatoid arthritis, (4) diagnosis and treatment of back pain, (5) diagnosis and treatment of fibromyalgia and diagnosis, and (6) treatment of shoulder pain. Each workshop session included 5-30 family physicians, a specialist expert, and a family physician facilitator. Before each session, a group needs assessment was conducted to identify which one or two of the six cases would be used. Perceived knowledge and skill acquisition, self-assessed change in practice, and satisfaction with the program were measured at the conclusion of each session and again at 3 months post program. All programs were delivered from March 2003 to September 2005. Six hundred and fifty family physicians from across Canada completed the program. In general, participants reached concordance with each case. Measures of knowledge and skill acquisition and self-assessed change in practice were significantly improved with high rates of program satisfaction. The Joint Adventures program provided family physicians with knowledge and skills that changed their care of musculoskeletal disorders. This was achieved using consensus that was sensitive to local needs. Further use should be evaluated in other areas of medical practice as well.

Canada↗
PubMed1984

Developing physical fitness for the elderly through sport and exercise.

For maintaining and developing motor mobility in old age motor activity is essential. We can take from the phylogenesis and ontogenesis of the human being how important physical activity is for personality development and for maintaining physical fitness in old age. Many phenomena, which have so far been thought to be due to natural consequences of the ageing process, can now be traced back to lack of physical activity. These findings are illustrated by examples referring to the most important subsystems of our organism (such as the central nervous system, the cardiovascular system, etc.). To keep these subsystems and with them our organism as a whole functioning as well as possible, we must improve their specific adaptability through sports and exercise. Sports and exercise for the elderly as well as gymnastics for senior citizens should therefore adequately improve co-ordinative skills, the ability of the muscles to relax, joint flexibility, muscle strength, endurance, vegetative adaptability, stress tolerance, controlling body-weight, and resistance to infections.

Adult↗
PubMed1998

Comparison of total and regional body composition in adolescent patients with anorexia nervosa and pair-matched controls.

Body composition in 31 adolescent girls suffering from anorexia nervosa (AN) was measured at the time of hospitalization in order to assess the muscle/bone relationship as a potential source of the development of osteopenia. Differences in lean tissue, fat and bone mass in total body, weight bearing and non weight bearing limbs were estimated in AN and pair-matched controls aged 14.2 +/- 1.8 years (range: 9-17 years). Further, it was investigated if bone mineral density (BMD) better reflects the muscle/bone relationship than bone mineral content (BMC). At the distal radius parameters measured by peripheral quantitative computed tomography (pQCT) were used to estimate the association of volumetric bone density to bone strength and lean body mass. The correspondence to the same and different body regions was assessed. Total lean mass in the controls was closely related to total body bone mineral content (TBBMC), as was lean tissue and bone mass of the limb subregions (r = 0.82 to 0.93). In contrast, the correlation was significantly lower in AN (r = 0.33 to 0.77). In the controls, the pQCT-derived bone strength was correlated with muscle mass of the forearm (r = 0.78, p < 0.001), but only moderately in AN (r = 0.47, n.s.). Regional lean tissue was 11-20% and fat mass was 56-66% lower in AN (p < 0.01). After adjustment for height, TBBMC was different at p = 0.01. Within the limbs subregions, BMC (but not BMD) was different in both groups only in the upper arm and the thigh. BMC reflected the bone/muscle relationship better than BMD. Intra- and between group regressions gave no significant differences between weight bearing and non weight bearing limbs. In conclusion, the assessment of musculoskeletal factors may be a useful tool to develop individual preventive measures for therapy after recovery of our patients.

Adolescent↗
PubMed2006

[Musculoskeletal diseases, work and lifestyle among public workers at a health institution].

This is a cross-sectional study developed with 651 workers of various occupations. They answered a questionnaire covering general, labor and lifestyle data, in addition to the Work Ability Index, which has been developed by researchers from Finland. In terms of sociodemographics, the analysis of the factors associated with the occurrence of musculoskeletal disorder revealed them to be female, older, and with low level of schooling. As for labor characteristics, the disease was associated with those individuals with physically demanding work, longer working hours on a second job and longer working hours at the institution itself. Regarding lifestyle, the characteristics associated with the occurrence of the disease were obesity, long housework hours and absence of leisure activities.

Adult↗
PubMed1994

Reliability of an ambulatory electromyographic activity device for musculoskeletal pain disorders.

A number of investigators in recent years have called for the development of devices that can monitor surface EMG levels in individuals' normal environments for use with patients who suffer from disorders in which the etiology or maintenance of the pathology is presumed to be due at least in part to musculoskeletal dysfunction, such as low back pain, phantom limb pain and tension headache. This study examined the test-retest reliability of just such a device. Twenty-six healthy controls wore a lightweight (24 ounce) device which measured bilateral upper trapezius EMG, as well as peak and integral motion, for 5 consecutive days for up to 18 h each day. ANOVAs on the four measures revealed no difference between any of the four measures over the 5 days. Intra-class correlation coefficients for the two EMG variables across 5 days were both significant with alpha levels set at 0.01. The two EMG measures were highly correlated (r = 0.77); the two motion measures were also highly correlated (r = 0.60), but at a lower magnitude than EMG values; the relationship between EMG and motion was significant, but the magnitude of the between EMG motion correlations (0.26 and 0.35) were lower than the within EMG or motion ones. It was concluded that the test-retest reliability of the ambulatory monitoring device is within acceptable limits. Implications for the use of the device with musculoskeletal pain disorders--particularly headache--are discussed.

Adult↗
PubMed2001

Grassroots ergonomics: initiating an ergonomics program utilizing participatory techniques.

The introduction of ergonomics programs throughout the world requires an easy to understand and inexpensive process. Participatory ergonomic intervention techniques have proven to be beneficial in the prevention of musculoskeletal disorders. The participatory approach to ergonomics has also been found to be a useful application within industrialized (developed) countries and industrially developing countries (IDCs). Grassroots Ergonomics principles utilize expertise within a workforce that focuses on participatory ergonomics interpretations of quantitative and qualitative risk and exposure assessment information that in turn results in a peer-developed ergonomics training. Regardless of the intricacy of the exposure assessment tools, workers should fully assist in gathering and analyzing data, then in identifying and implementing solutions. A coordinated and multidisciplinary application of this approach within IDCs would succeed in the creation and sharing of job-specific ergonomics training information for high physical exposure professions, such as agriculture, fishing, forestry, mining, and small-scale enterprises, to initiate ergonomics programs regionally.

Community Participation↗
PubMed2003

Graphic-based musculoskeletal model for biomechanical analyses and animation.

The ability to combine physiology and engineering analyses with computer sciences has opened the door to the possibility of creating the 'Virtual Human' reality. This paper presents a broad foundation for a full-featured biomechanical simulator for the human musculoskeletal system physiology. This simulation technology unites the expertise in biomechanical analysis and graphic modeling to investigate joint and connective tissue mechanics at the structural level and to visualize the results in both static and animated forms together with the model. Adaptable anatomical models including prosthetic implants and fracture fixation devices and a robust computational infrastructure for static, kinematic, kinetic, and stress analyses under varying boundary and loading conditions are incorporated on a common platform, the VIMS (Virtual Interactive Musculoskeletal System). Within this software system, a manageable database containing long bone dimensions, connective tissue material properties and a library of skeletal joint system functional activities and loading conditions are also available and they can easily be modified, updated and expanded. Application software is also available to allow end-users to perform biomechanical analyses interactively. This paper details the design, capabilities, and features of the VIMS development at Johns Hopkins University, an effort possible only through academic and commercial collaborations. Examples using these models and the computational algorithms in a virtual laboratory environment are used to demonstrate the utility of this unique database and simulation technology. This integrated system will impact on medical education, basic research, device development and application, and clinical patient care related to musculoskeletal diseases, trauma, and rehabilitation.

Algorithms↗
PubMed2004

Intermingling versus clonal coherence during skeletal muscle development: mosaicism in eGFP/nLacZ-labeled mouse chimeras.

To study the relative contributions of clonal coherence vs. myoblast intermingling to the formation of mammalian skeletal muscles, enhanced green fluorescent protein (eGFP) and nLacZ labels were used to analyze neonatal and adult mouse embryo aggregation chimeras. The eGFP marker allowed us to estimate absolute levels of the eGFP transgenic parental contributions as well as variances of levels within a chimeric individual; nLacZ served as a counter-label in neonatal chimeras. In mature chimeric muscle, free intracellular diffusion of eGFP led to an averaging of the eGFP level in individual myofibers. Chimerism, i.e., differing eGFP levels, was evident between corresponding right and left muscles, between adjacent back, body wall, limb (shank, foot), and extraocular muscles and among myofibers within these muscles. Inhomogeneities in muscles far from their somitic origin indicated unbalanced sampling from small founder pools. The results obtained with adult eGFP<-->0 chimeras were corroborated by neonatal chimeras with complementary eGFP<-->nLacZ labels.

Animals↗