Objective. To develop and evaluate process indicators relevant to biopsychosocial history taking in patients with chronic back and neck pain. Methods. The SCEBS method, covering the Somatic, Psychological (Cognition, Emotion, and Behavior), and Social dimensions of chronic pain, was used to evaluate biopsychosocial history taking by manual physical therapists (MPTs). In Phase I, process indicators were developed while in Phase II indicators were tested in practice. Results. Literature-based recommendations were transformed into 51 process indicators. Twenty MTPs contributed 108 patient audio recordings. History taking was excellent (98.3%) for the Somatic dimension, very inadequate for Cognition (43.1%) and Behavior (38.3%), weak (27.8%) for Emotion, and low (18.2%) for the Social dimension. MTPs estimated their coverage of the Somatic dimension as excellent (100%), as adequate for Cognition, Emotion, and Behavior (60.1%), and as very inadequate for the Social dimension (39.8%). Conclusion. MTPs perform screening for musculoskeletal pain mainly through the use of somatic dimension of (chronic) pain. Psychological and social dimensions of chronic pain were inadequately covered by MPTs. Furthermore, a substantial discrepancy between actual and self-estimated use of biopsychosocial history taking was noted. We strongly recommend full implementation of the SCEBS method in educational programs in manual physical therapy.

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AbstractThe restoring of motor functions in adults through brain-computer interface applications is widely studied in the contemporary literature. But there is a lack of similar analyses and research on the application of brain-computer interfaces in the neurorehabilitation of children. There is a need for expanded knowledge in the aforementioned area. This article aims at investigating the extent to which the available opportunities in the area of neurorehabilitation and neurological physiotherapy of children with severe neurological deficits using brain-computer interfaces are being applied, including our own concepts, research and observations.

PurposeTo develop valid quality indicators (QIs) for physiotherapy care based on best available evidence, and to use these QIs to explore trends in the quality of physiotherapy care of patients with Whiplash-associated disorders (WAD) using guideline-based routinely collected data (RCD) gathered between 1996 and 2011.Materials and methodsThe study consisted of two phases: 1) development of QIs and 2) analysis of patient records. A set of QIs was developed based on recommendations in the scientific literature and the Dutch Clinical Practice Guideline (CPG) “Physiotherapy Management and WAD”. QIs were expressed as percentages, allowing target performance levels to be defined (≥80% or ≤30% depending on whether desired performance required a high or low score on a QI). We then analyzed WAD patient data (N = 810) collected over a period of 16 years in two physiotherapy practices, separating patients into two groups defined as before (Group A 1996–2002; n = 353) and after (Group B 2003–2011; n = 457) implementation and transition to the Dutch CPG “Physiotherapy Management and WAD”.ResultsUsing an iterative process and input from both experts and users, 28 QIs were developed and subsequently classified per step of the clinical reasoning process for physiotherapy care. Based on 16 years of RCD, we found that the clinical reasoning process differed significantly (P ≤ 0.05) between the groups, in favor of Group B. Twelve of the 25 indicators (48.0%) in Group A and 19 of 26 indicators (73.1%) in Group B met predetermined performance targets. The number of target indicators also differed significantly between groups, favoring Group B (P ≤ 0.05).ConclusionA preliminary set of novel QIs was developed. Using RCD and these QIs, we conclude that physiotherapy care in our study setting improved over the period 1996–2011. Furthermore, the QIs met the performance targets set for the clinical reasoning process after the transition to the Dutch CPG “Physiotherapy Management and WAD”.

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Background: Quality indicators (QIs) are measurable elements of practice performance and may relate to context, process, outcome and structure. A valid set of QIs have been developed, reflecting the clinical reasoning used in primary care physiotherapy for patients with whiplash-associated disorders (WAD). Donabedian's model postulates relationships between the constructs of quality of care, acting in a virtuous circle. Aim: To explore the relative strengths of the relationships between context, process, and outcome indicators in the assessment of primary care physiotherapy in patients with WAD. Materials and Methods: Data on WAD patients (N=810) were collected over a period of 16 years in primary care physiotherapy practices by means of patients records. This routinely collected dataset (RCD-WAD) was classified in context, process, and outcome variables and analyzed retrospectively. Clinically relevant variables were selected based on expert consensus. Associations were expressed, using zero-order, as Spearman rank correlation coefficients (criterion: r s >0.25 [minimum: fair]; α-value = 0.05). Results: In round 1, 62 of 85 (72.9%) variables were selected by an expert panel as relevant for clinical reasoning; in round 2, 34 of 62 (54.8%) (context variables 9 of 18 [50.0%]; process variables 18 of 34 [52.9]; outcome variables 8 of 10 [90.0%]) as highly relevant. Associations between the selected context and process variables ranged from 0.27 to 0.53 (p≤0.00), between selected context and outcome variables from 0.26 to 0.55 (p≤0.00), and between selected process and outcome variables from 0.29 to 0.59 (p≤0.00). Moderate associations (r s >0.50; p≤0.00) were found between "pain coping" and "fear avoidance" as process variables, and "pain intensity" and "functioning" as outcome variables. Conclusion: The identified associations between selected context, process, and outcome variables were fair to moderate. Ongoing work may clarify some of these associations and provide guidance to physiotherapists on how best to improve the quality of clinical reasoning in terms of relationships between context, process, and outcome in the management of patients with WAD.

BackgroundVitamin D influences the immune system significantly. Previous studies have found that vitamin D deficiency in adolescence can play a significant role in increasing the risk of developing autoimmune diseases including multiple sclerosis. The aim of this study was to investigate the relationship between the vitamin D status in serum and clinical and radiological outcomes in a treated population in Poland.MethodsInclusion criteria met 83 adult patients aged 20–61 years with diagnosis of relapsing‐remitting multiple sclerosis, who underwent immunomodulatory treatment which lasted at least 12 months. Levels of serum 25‐hydroxyvitamin D were determined using radio‐immuno assay. Magnetic resonance imaging of the brain and cervical part of a spinal cord was performed each time after 12 months of the treatment. Patients were assessed neurologically after 12 months of treatment, the level of disability was also assessed using Extended Disability Status Scale.ResultsThe largest group (63.8%) showed significant vitamin D deficiency (<20 ng/ml), 21.7% showed the suboptimal level of vitamin D (20–30 ng/ml). The normal level of 25(OH)D (>30 ng/ml) was observed in 14.5% of the patients. Statistically significant correlation was observed between the vitamin D status and frequency of relapses.ConclusionsOur findings confirm that deficiency of vitamin D in patients with MS is correlated with clinical and radiological course of the disease.

Currently, there is an intensive development of bipedal walking robots. The most known solutions are based on the use of the principles of human gait created in nature during evolution. Modernbipedal robots are also based on the locomotion manners of birds. This review presents the current state of the art of bipedal walking robots based on natural bipedal movements (human and bird) as well as on innovative synthetic solutions. Firstly, an overview of the scientific analysis of human gait is provided as a basis for the design of bipedal robots. The full human gait cycle that consists of two main phases is analysed and the attention is paid to the problem of balance and stability, especially in the single support phase when the bipedal movement is unstable. The influences of passive or active gait on energy demand are also discussed. Most studies are explored based on the zero moment. Furthermore, a review of the knowledge on the specific locomotor characteristics of birds, whose kinematics are derived from dinosaurs and provide them with both walking and running abilities, is presented. Secondly, many types of bipedal robot solutions are reviewed, which include nature-inspired robots (human-like and birdlike robots) and innovative robots using new heuristic, synthetic ideas for locomotion. Totally 45 robotic solutions are gathered by thebibliographic search method. Atlas was mentioned as one of the most perfect human-like robots, while the birdlike robot cases were Cassie and Digit. Innovative robots are presented, such asslider robot without knees, robots with rotating feet (3 and 4 degrees of freedom), and the hybrid robot Leo, which can walk on surfaces and fly. In particular, the paper describes in detail the robots’ propulsion systems (electric, hydraulic), the structure of the lower limb (serial, parallel, mixed mechanisms), the types and structures of control and sensor systems, and the energy efficiency of the robots. Terrain roughness recognition systems using different sensor systems based on light detection and ranging or multiple cameras are introduced. A comparison of performance, control and sensor systems, drive systems, and achievements of known human-like and birdlike robots is provided. Thirdly, for the first time, the review comments on the future of bipedal robots in relation to the concepts of conventional (natural bipedal) and synthetic unconventional gait. We critically assess and compare prospective directions for further research that involve the development of navigation systems, artificial intelligence, collaboration with humans, areas for the development of bipedal robot applications in everyday life, therapy, and industry.