BACKGROUND:Knee osteoarthritis (OA) is a debilitating condition that compromises mobility and exacerbates knee pain, necessitating accurate and accessible diagnostic tools. Traditional motion capture technology, while effective, is often cost-prohibitive and limited to laboratory settings. In response, we developed a smartphone-based approach utilizing spatiotemporal analysis of joint angular velocities and angles in sit-to-stand (STS) motion to detect symptomatic knee OA. METHOD:We analyzed 2063 sagittal-viewed sit-to-stand motion videos from 309 participants and proposed a STS-D Index based on a deep learning model, STS Dynamics Net, which provides a nuanced quantification of joint dynamics and temporal interactions in trunk, knee, and ankle angles and velocities for detection of symptomatic knee OA. RESULTS:Here we show that joint angular velocities are a robust spatiotemporal biomarker for symptomatic knee OA detection (AUC 0.7759 ± 0.0219), not only do they outperform the STS pace (AUC 0.6554 ± 0.0268, p = 8.6 × 10-5) and maximum trunk angle (AUC 0.7025 ± 0.0253, p = 2.1 × 10-3) in diagnostic accuracy and rival the performance of gold-standard 3D marker-based systems (AUC 0.7855 ± 0.0229), but they also show significant correlations with WOMAC sub-scores (p < 0.0001). Furthermore, our analysis reveals a significant correlation between angular velocities and muscle volumes and fat-to-muscle ratios in the quadriceps and hamstrings, underscoring the role of muscle weakness in knee OA pathogenesis. CONCLUSIONS:This innovative approach has the potential to revolutionize knee OA detection, enabling reliable, cost-effective, and self-administered assessments in community settings and bridging the gap in accessible healthcare monitoring.

Work-related musculoskeletal disorders (WMSDs) have been a concern among healthcare workers, impacting their well-being and patient safety. Exoskeleton technologies have gained a growing interest as an ergonomic intervention for WMSDs. This scoping review explores exoskeleton effects on WMSDs among healthcare workers. A comprehensive search identified 9 eligible studies published in English between 2013 and 2023. Exoskeletons showed promising effects on objective measures, selectively reducing muscle activation in a task-dependent manner. They also improved force exertion and body posture parameters in specific scenarios. Subjectively, exoskeletons reduced discomfort, pain, fatigue, and received positive perceptions with acceptable usability. However, the impact on perceived exertion varied with tasks. While exoskeletons have shown potential in enhancing healthcare workers' well-being and performance, more work is required to refine their effectiveness and maximise benefits in different healthcare settings. The study revealed the need for standardised methodologies, consideration of participant characteristics, and optimisation of exoskeleton design.

BackgroundClinicians need a validated measure to assess the activity and participation of Chinese people with stroke.ObjectivesTo culturally adapt and psychometrically test the Chinese (Cantonese) version of the International Classification of Functioning, Disability and Health Measure of Participation and Activities (C-IMPACT-S) in community-dwelling people with stroke.MethodsWe followed the standard translation procedures to culturally adapt the C-IMPACT-S. Then we administered the C-IMPACT-S to 100 people with stroke and 50 healthy counterparts for psychometric testing, including the ceiling and floor effects, internal consistency, test - retest, measurement error, minimal detectable change, correlations with other outcome measures, known-group validity and optimal cutoff scores.ResultsThe C-IMPACT-S has no floor effects but ceiling effects in item 5. It has poor to excellent (Cronbach's alpha = 0.56-95) internal consistency and fair to excellent (Intraclass correlation coefficients = 0.58-1.00) test-retest reliability. The overall C-IMPACT-S mean score and activity and participation component mean scores had statistically significant no to weak correlations with the Fugl-Meyer Assessment, the Chinese versions of Geriatric Depression Scale, Fatigue Assessment Scale, Lawton Instrumental Activities of Daily Living Scale and Community Integration Measure. The stroke participants had lower C-IMPACT-S scores then their health counterparts. The optimal cutoff scores of the overall C-IMPACT-S and activity and participation domains were 88.02% (sensitivity 72%, specificity 80%), 80.56% (sensitivity 86%, specificity 68%) and 91.67% (sensitivity 68%, specificity 80%), respectively.ConclusionsC-IMPACT-S is a reliable and valid measure for assessing the levels of activity and participation of people with chronic stroke.

The prevalence of dementia is increasing due to a longer life expectancy and an ageing population. Cognitive impairment affects patients’ daily lives and places a financial and healthcare burden on them and their families. Reminiscence therapy (RT) is a non-pharmacological approach that has been found to enhance the quality of life for older adults with or without dementia. There is an urgent need for more functional and effective treatments, such as virtual reality (VR), which are becoming increasingly popular. VR in RT is a relatively new field, and this paper proposes a conceptual model for developing proof-of-concept virtual reality-based reminiscence therapy (VR-RT) for people with dementia, based on the 4Is: immersion, interaction, imagination, and impression. This model is intended to offer an alternative therapeutic experience for older adults with dementia. This paper demonstrates VR-RT in accordance with the results from the proposed 4Is model, to depict different periods of the olden days of scenes, such as restoring the historical objects and appearance of the citizens. The proposed VR-RT is then evaluated with the occupational therapists (OTs) through pilot testing. The findings reveal that VR-RT based on the proposed model may elicit a positive attitude and motivation in older adults with dementia. The proposed 4Is model serves to offer essential features for VR development, followed by a survey to identify suitable reminiscence materials and themes tailored to older adults with dementia. A pilot test with OTs revealed that VR-RT has the potential to improve the conditions of people with dementia. The research contributes valuable insights and lays the groundwork for future development of VR-RT for people with dementia.

Introduction: Virtual reality (VR) gains attention in construction safety training because it allows users to simulate real activities without the risks of real activities. However, a literary work comprehensively describing the effectiveness of VR in construction safety training and education (CSTE) is lacking. Method: This study provides a systematic review of the research related to VR applications for CSTE over the past decade using meta-analysis techniques. Standardized mean differences between traditional training methods and VR training were grouped by measurement. Potential moderators possibly affecting the effectiveness of VR in CSTE were analyzed. Results: Results showed that VR is significantly more effective in construction training and education than traditional methods. The effectiveness of VR was 0.593, 0.432, and 0.777 higher than that of traditional methods for behaviors, skills, and experience measurements, respectively. The training context and mean work experience of trainees were two important moderators that significantly affected the effectiveness of VR in CSTE (p < 0.001). Practical Applications: The presented results suggested the need for targeted development and management of VR technology in the construction industry and the early promotion of VR for general safety training among young, inexperienced construction workers.

To compare the effect of moderate-intensity aquatic treadmill exercise (ATM) on cerebral blood flow (CBF) and cognitive function in healthy older adults to that of moderate-intensity land-based treadmill exercise (LTM). This randomized controlled trial study was conducted between May 2023 and Oct 2023. Twenty-eight participants aged 60-80 were randomly assigned to either ATM group (N = 14) or LTM group (N = 14). Cognitive function and cerebral blood flow were assessed before and after the exercise. The outcome measures used in this study were the Digit Symbol Substitution Test (DSST) and the Digit Span Test (DST) to assess cognitive performance, and the mean middle cerebral artery blood velocity (MCAvmean) to evaluate CBF. A mixed effects model was used to analyze the within-group and between-group differences in cognitive function and CBF outcomes pre-to-post treadmill by SPSS. The DSST demonstrated a statistically significant improvement within both the ATM [β ± SE: -13.643 ± 2.407, 95 % CI: -18.749, -8.537] and LTM [β ± SE: -19.25 ± 3.66, 95 % CI: -26.424, -12.076] groups, indicating clinical significance in both groups. Both ATM and LTM groups exhibited post-exercise improvements within their respective groups for forward Digit Span Test (FDST) [ATM β ± SE: -0.143 ± 0.362, 95 % CI: -0.92, 0.634; LTM β ± SE: -0.286 ± 0.37, 95 % CI: -1.078, 0.506] and backward Digit Span Test (BDST) (ATM β ± SE: -1.741 ± 5.377, 95 % CI: -13.27, 9.792; LTM β ± SE: -6.729 ± 5.370, 95 % CI: -4.788, 18.24). In terms of MCAvmean, there is a higher improvement of CBF in ATM group [β ± SE: -138.669 ± 67.9217, 95 % CI: -288.164, 10.826] than LTM group [β ± SE: -9.305 ± 70.076, 95 % CI: -153.617, 135.007]. Hence, a single bout of moderate-intensity ATM and LTM can enhance cognitive function and CBF in healthy older adults, suggesting their potential as preventive strategies against age-related declines.

ObjectiveTo investigate the psychometric properties of the Lift and Carry Test (LCT) time in people with stroke.DesignCross-sectional design.SettingUniversity based neurorehabilitation laboratory.ParticipantsTwenty-four people with stroke and 24 healthy controls.Outcome measuresLift and Carry Test (LCT), Fugl-Meyer Assessment of upper extremity and lower extremity, ankle dorsiflexor and plantarflexor muscle strength, Berg Balance Scale (BBS), Timed Up and Go (TUG) and Community Integration Measure.ResultsThe mean LCT time (29.70s) in people with stroke was more than double of that in healthy controls (13.70s). The LCT showed excellent intra-rater, inter-rater and test–retest reliability [intraclass correlation coefficient (ICC) = 0.943–1.000]. The LCT times demonstrated a significant negative correlation with the BBS score (rs = −0.771) and significant positive correlations with the TUG times (rs = 0.933). There was no significant correlation between LCT times and FMA score (p > 0.05). An optimal cut-off LCT time of 15.48 s (sensitivity = 95.8%, specificity = 87.5%) was identified to differentiate between people with stroke and healthy controls (area under the curve = 0.957).ConclusionLCT is an excellent clinical test for examining advanced functional ability in people with stroke and distinguishing people with stroke from healthy controls.

Purpose (the aim of the study): Knee Osteoarthritis (KOA) is a common degenerative disease that causes knee pain and declination of physical function. However, current marker-based approaches require expensive equipment and sophisticated setups, limiting their use for community screening of KOA. Therefore, we aim to develop a simple and cost-effective smartphone camera-based model to comprehensively analyse sit-to-stand motion for symptomatic KOA detection in community settings.

BackgroundThe effects of Aquatic High-Intensity Interval Training (AHIIT) and resistive AHIIT (Resistive AHIIT) to improve metabolic responses were not yet known.ObjectiveThis study was to compare the metabolic responses and perceived effort in young healthy adults in a single session of AHIIT and resistive AHIIT.Methods20 healthy subjects (9 females, 11 males) performed a stationary running at a matched exercise intensity prior AHIIT and resistive AHIIT [10 × 1-min bouts of stationary running at 90% maximum heart rate (HR max) separated by 1-min active recovery] to examine the metabolic and cardiometabolic outcomes. Mixed effects models were applied to analyze the effects of group, time, and the interaction between group and time on both outcomes. The level of correlations between metabolic variables was checked by Pearson's linear correlation.ResultsThere are significant differences on pre and post resting energy expenditure (REE) within both AHIIT and resistive AHIIT groups (p < 0.01) respectively as well as the subjective rate of perceived exertion (RPE) (p < 0.01) within RAHIIT group. A moderate correlation found on respiratory exertional ratio (RER) and RPE in resistive AHIIT (r = 0.534). No significant differences between groups in terms of HR max, mean heart rate (HR mean), peak oxygen consumption (VO2 peak) and total energy expenditure (TEE) (p = 0.50, p = 0.48, p = 0.81, p = 0.59).ConclusionResistive AHIIT provides comparable benefits of metabolic outcomes with AHIIT. Comparable results allowed AHIIT and resistive AHIIT prescriptions precisely.

PURPOSE:To investigate the effects of an 8-wk AHIIT-DWR intervention compared with land-based HIT training (LHIIT) on cardiometabolic health, cognitive, and psychological outcomes in inactive elderly women. METHODS:Seventy inactive elderly women aged 60 yr or above were randomly assigned into two groups: AHIIT-DWR and LHIIT. The AHIIT-DWR group engaged in DWR sessions comprising 30 min of interval training, consisting of ten 2-min exercise bouts at 80%-90% of their maximal heart rate (HR max ), with 1-min active recovery at 70% HR max between bouts, for two sessions per week, for 8 wk. The LHIIT group performed treadmill running at the same intensity. RESULTS:Both groups showed similar cardiovascular fitness, maximal aerobic capacity (V̇O 2max ), HR max , and RER improvement ( P > 0.05), whereas AHIIT-DWR showed a significant improvement in aerobic capacity minute ventilation (V̇E), metabolic equivalents (METs), and O 2 pulse ( P < 0.05) over the 8-wk intervention. Both AHIIT-DWR and LHIIT significantly decreased triglycerides, total cholesterol, HDL, and LDL postintervention ( P < 0.05). No significant group differences were observed for cognitive function assessed by MMSE and MOCA ( P > 0.05). Both groups showed similar enjoyment levels, self-efficacy scores, and high adherence rates (>90%). CONCLUSIONS:Our study suggests that AHIIT-DWR can elicit a similar improvement in cardiorespiratory health, metabolic blood markers, cognitive function assessed by MMSE and MOCA, and psychological responses as LHIIT in inactive elderly women.

Metacognitive abilities, the capacity to think about one’s own thinking processes, offer a range of advantages that may drive their evolution in non-primate animals (NPAs). These advantages include enhancing adaptive decision-making in uncertain situations, efficient resource management, error detection and correction, and facilitating complex social interactions and problem-solving. In this comprehensive study, we have chosen two key paradigms — namely, uncertainty monitoring and information-seeking tasks — to study metacognitive phenomena in NPAs. The first paradigm involves an extensive meta-analysis of existing research, shedding light on how NPAs monitor and respond to uncertainty. We then transition to the second paradigm, which focuses on information-seeking behaviors, employing a different analytical approach. Our study aims to provide a holistic understanding of these cognitive processes in NPAs, contributing valuable insights into their cognitive complexity and ecological contexts. Through a coverage of 30 articles spanning 13 different NPA species, we bridge gaps in our understanding of metacognition beyond primates and explore potential divergent evolutionary paths, challenging assumptions about cognitive capability in NPAs.

Background and Purpose: Parkinson disease (PD) has effects on an individual's balance, and Ai Chi can be used to improve balance and gait performance. The aim of this study was to investigate the effectiveness of Ai Chi in improving the balance and gait of individuals with idiopathic PD. Method: Ten individuals with PD at Hoehn and Yahr stages 1-3 were included in this 6-week study. Participants underwent a structured Ai Chi program (1 hour per session, twice weekly) for 6 weeks (12 sessions in total). Balance was assessed at baseline and week 6 using the Timed Up and Go (TUG) test, the Five Times Sit-to-Stand (FTSTS) test, the Four Square Step Test (FSST), the Ten Meter Walk Test (10MWT), and the Sensory Organization Test (SOT). Gait parameters were measured by inertial measurement units and videotaping for 2-dimentional motion analysis. Surface electromyography was used for measuring muscle activity during gait in the bilateral rectus femoris, biceps femoris, gastrocnemius, and tibialis anterior. Results: In a pre- and postintervention comparison, significant improvements were observed in the FTSTS, FSST, and TUG scores as well as in the composite, vision, and vestibular scores in the 10MWT and SOT ( P < .005). The results indicated improvement in balance. As for the gait analysis, no significant differences were observed in spatiotemporal parameters, including speed, cadence, step length, stride length, step duration, stride duration, swing-phase duration, stance-phase duration, and double support duration. Insignificant changes in the percentage maximum voluntary contraction of all the muscles examined were found, while a significant decrease in maximum voluntary contraction was identified in the left biceps femoris. Conclusions: The Ai Chi program produced a significant improvement in balance in individuals with PD, with insignificant results shown in gait. Ai Chi is an appropriate intervention to improve balance in individuals with PD.

This systematic review is aimed to provide an up-to-date summary and review on the use of surface electromyography (sEMG) in evaluating front crawl (FC) swim performance. Several online databases were searched by different combinations of selected keywords, in total 1956 articles were retrieved, and each article was assessed by a 10-item quality checklist. 16 articles were eligible to be included in this study, and most of the articles were evaluating the muscle activity about the swimming phases and focused on assessing the upper limbs muscles, only few studies have assessed the performance in starts and turns phases. Insufficient information about these two phases despite the critical contribution on final swimming time. Also, with the contribution roles of legs and trunk muscles in swimming performance, more research should be conducted to explore the overall muscle activation pattern and their roles on swimming performance. Moreover, more detailed description in participants’ characteristics and more investigations of bilateral muscle activity and the asymmetrical effects on relevant biomechanical performance are recommended. Lastly, with increasing attention about the effects of muscles co-activation on swimming performance, more in-depth investigations on this topic are also highly recommended, for evaluating its influence on swimmers.

Prolonged electronic screen use can cause digital eye strain. It can be difficult to rectify due to increasing smartphone reliance, potentially leading to serious public health problems. To investigate the association between time spent on smartphones and digital eye strain (DES) among Hong Kong Chinese school-aged children. Of a total of 1,508 students (748 males, 49.6%) from 8 to 14 years old (mean age = 10.91 years, SD = 2.01) who provided valid data on DES, the 1,298 (86%) who completed the DES questionnaire at 1-year follow-up were included in the analysis. DES was measured using a 10-item scale, and the sum of the 10 dichotomised scores was used as the DES total score. The most commonly reported symptoms were eye fatigue (n = 804, 53.3%), blurred vision (changing from reading to distance viewing) (n = 586, 38.9%), and irritated or burning eyes (n = 516, 34.2%). The DES total scores at baseline and 1-year follow-up were 2.91 (SD = 2.90) and 3.20 (SD = 3.19), respectively. Linear regression controlling for demographic and socio-economic confounders showed that participants with baseline smartphone usage of 241 + min/d had a significantly higher baseline total DES score than those with baseline smartphone usage of 0–60 min/d (2.44 vs 3.21, P < 0.001), and participants with baseline smartphone usage of 181–240 min/d had a significantly higher 1-year follow-up total DES score than those with baseline smartphone usage of 0–60 min/d (2.80 vs 3.50, P = 0.003).

COVID-19 vaccination is an effective method for dealing with the COVID-19 pandemic. This study proposed and validated a theoretical intention model for explaining the COVID-19 vaccination intention (CVI) of the public. The theoretical intention model incorporated trust in vaccines, two types of risk perception (risk perception of COVID-19 and risk perception of COVID-19 vaccination), and perceived benefit into a theory of planned behavior (TPB). Structural equation modeling was utilized to test the theoretical intention model with data collected from 816 Chinese adults in China. The results confirmed the crucial role of trust in vaccines, risk perception, and perceived benefit in shaping the CVI of the public. In addition, TPB was found to be applicable in a research context. The theoretical intention model accounted for 78.8% of the variance in CVI. Based on the findings, several practical recommendations for improving COVID-19 vaccination rates were discussed.

Knee and hip osteoarthritis are common disabling conditions globally. Although numerous international clinical practice guidelines exist to guide physiotherapy management, not all recommendations issued from these guidelines can be translated to other contexts without considering the cultural acceptability and clinical implementability of targeted countries. Because the ADAPTE framework provides a robust methodology to adapt guidelines to the local context, this study used its methodology to adapt high-quality guideline recommendations to promote optimal physiotherapy care for knee and hip osteoarthritis in Hong Kong. The ADAPTE framework was used and modified to complete the adaptation process. International clinical practice guidelines were identified from eight guideline clearinghouses and six electronic databases. Two independent reviewers critically appraised the eligible guidelines using the AGREE II tool. We extracted and tabulated recommendations from high-quality guidelines. A voting-based consensus among interdisciplinary experts was conducted to decide on suitable recommendations for the Hong Kong context and whether there was a need to modify them. Pertinent recommendations were then translated into the traditional Chinese language. Our team members suggested modifying four tools and adding one to explore the patient’s feedback on the recommendations, to the ADAPTE framework. The adaptation was performed on three high-quality guidelines. We adapted 28 and 20 recommendations for treating knee and hip osteoarthritis, respectively. We recommend a multimodal treatment for managing knee and hip osteoarthritis. Land- and aquatic-based exercises, patient education, and self-management were strongly recommended for patients with knee osteoarthritis. Land- and aquatic-based exercises were strongly recommended for patients with hip osteoarthritis. This is the first adaptation study in Hong Kong. It provides guidance to local physiotherapists on managing patients with knee and hip osteoarthritis. Future studies should test the effectiveness of implementing this adapted guideline to improve local physiotherapy care in Hong Kong.

(1) Background: Forward step-up (FSU) simulates the stance phase in stair ascension. With the benefits of physical properties of water, aquatic FSU exercise may be more suitable for patients with lower limb weakness or pain. The purpose of this study is to investigate the effect of progressive steps per min on the surface electromyography (sEMG) of gluteus maximus (GM), biceps femoris (BF), rectus femoris (RF), and gastrocnemius (GA), when performing FSU exercise with different steps per min in water and on land. (2) Methods: Participants (N = 20) were instructed to perform FSU exercises at different steps per min (35, 60, and 95 bpm) in water and on land. The sEMG of the tested muscles were collected. The percentage maximum voluntary isometric contraction (%MVIC) of GM, RF, GA and BF at different environments and steps per min was compared. (3) Result: There was a statistically significant difference of %MVIC of RF at all steps per min comparisons regardless of the movement phases and environments (p < 0.01, except for descending phases of 35 bpm vs. 60 bpm). All tested muscles showed a statistically significant lower muscle activation in water (p < 0.05) (4) Conclusion: This study found that the %MVIC of the tested muscle in both investigated environments increase as steps per minute increases. It is also found that the movement pattern of FSU exercise activates RF the most among all the tested muscles. Muscle activation of all tested muscles is also found to be smaller in water due to buoyancy property of water. Aquatic FSU exercise might be applicable to patients with lower limb weakness or knee osteoarthritis to improve their lower limb strength.

Background: The L Test of Functional Mobility (L Test) was developed to assess the advanced mobility, which includes both turning and walking ability. This study aimed to evaluate (1) the intra-rater reliability of the L Test in four turning conditions, (2) the correlation with other stroke-specific impairment for community-dwelling older adults with stroke, and (3) the optimal cut-off completion time of the L Test to distinguish the difference of performance between healthy older adults and people with stroke. Methods: This is a cross-sectional design. Thirty older adults with stroke and healthy older adults were included. The subjects were assessed by L Test along with other stroke-specific outcomes. Results: The L Test showed excellent intra-rater reliability (ICC = 0.945–0.978) for the four turning conditions. There were significant correlations between L Test completion times and Fugl–Meyer Assessment–Lower Extremity (FMA-LE) scores, Fugl–Meyer Assessment–Upper Extremity (FMA-UE) scores, Berg Balance Scale (BBS) score, and Timed Up and Go (TUG) Test scores. The cut-off of the L Test was established as 23.41–24.13 s. Conclusion: The L Test is an easy-to-administer clinical test for assessing the turning ability of people with stroke.

Abstract Background The accuracy of measurement of cardiometabolic functions of individuals is crucial. The objective of this study was to compare the validity and reliability of the PNOE in measuring cardiometabolic outcomes in the expired air of healthy individuals, during a treadmill walking protocol. Methods A total of 21 subjects (15 male, 6 females) aged 22.76 ± 3.85 years took part in this study. Oxygen consumption (VO2), carbon dioxide production (VCO2), respiratory exchange ratio (RER), metabolic equivalent (MET), ventilatory threshold (VT), energy expenditure (EE) was measured by PNOE and COSMED K5 portable systems during a four-stage incremental protocol on a treadmill. Test-retest reliability was tested on separate days with trail repetition. Validity was evaluated by Bland-Altman plots, intraclass correlation coefficients (ICC) and mean percentage difference. Results ICC found in VCO2 is in the good range (0.75–0.90). ICC of RER from level 1–3 and VT of level 2–4 fall in good to excellent reliability. No specific pattern seen on VO2, VCO2 and EE on the changes of CV upon speeds variations. Pearson’s correlation coefficient was moderately high (r = 0.60–0.79) between metabolic variables measured by PNOE and K5 systems. All subjects, except few more cases in VT, lie within the upper and lower 95% confidence intervals acceptance range of the Bland Altman plots. Conclusion PNOE system is a valid and reliable measure for cardiometabolic outcomes and is as comparable to COSMED K5 system.