一种用于手部感觉运动功能的新型临床测试——开发与初步验证
A new clinical test for sensorimotor function of the hand - development and preliminary validation.
作者信息
Röijezon Ulrik, Faleij Ragnar, Karvelis Petros, Georgoulas George, Nikolakopoulos George
机构信息
Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.
Laboratory of Knowledge and Intelligent Computing, Department of Computer Engineering, Technological Educational Institute of Epirus, Arta, Greece.
出版信息
BMC Musculoskelet Disord. 2017 Sep 26;18(1):407. doi: 10.1186/s12891-017-1764-1.
BACKGROUND
Sensorimotor disturbances of the hand such as altered neuromuscular control and reduced proprioception have been reported for various musculoskeletal disorders. This can have major impact on daily activities such as dressing, cooking and manual work, especially when involving high demands on precision and therefore needs to be considered in the assessment and rehabilitation of hand disorders. There is however a lack of feasible and accurate objective methods for the assessment of movement behavior, including proprioception tests, of the hand in the clinic today. The objective of this observational cross- sectional study was to develop and conduct preliminary validation testing of a new method for clinical assessment of movement sense of the wrist using a laser pointer and an automatic scoring system of test results.
METHODS
Fifty physiotherapists performed a tracking task with a hand-held laser pointer by following a zig-zag pattern as accurately as possible. The task was performed with left and right hand in both left and right directions, with three trials for each hand movement. Each trial was video recorded and analysed with a specifically tailored image processing pipeline for automatic quantification of the test. The main outcome variable was Acuity, calculated as the percent of the time the laser dot was on the target line during the trial.
RESULTS
The results showed a significantly better Acuity for the dominant compared to non-dominant hand. Participants with right hand pain within the last 12 months had a significantly reduced acuity (p < 0.05), and although not significant there was also a similar trend for reduced Acuity also for participants with left hand pain. Furthermore, there was a clear negative correlation between Acuity and Speed indicating a speed-accuracy trade off commonly found in manual tasks. The repeatability of the test showed acceptable intra class correlation (ICC) values (0.68-0.81) and standard error of measurement values ranging between 5.0-6.3 for Acuity.
CONCLUSIONS
The initial results suggest that the test may be a valid and feasible test for assessment of the movement sense of the hand. Future research should include assessments on different patient groups and reliability evaluations over time and between testers.
背景
已报道多种肌肉骨骼疾病会出现手部的感觉运动障碍，如神经肌肉控制改变和本体感觉减退。这可能对穿衣、烹饪和体力劳动等日常活动产生重大影响，尤其是在对精度要求较高时，因此在手部疾病的评估和康复中需要予以考虑。然而，目前临床上缺乏用于评估手部运动行为（包括本体感觉测试）的可行且准确的客观方法。这项观察性横断面研究的目的是开发一种使用激光指针和测试结果自动评分系统对腕部运动感觉进行临床评估的新方法，并进行初步验证测试。
方法
50名物理治疗师手持激光指针尽可能准确地沿着之字形图案执行跟踪任务。该任务分别用左手和右手在左右两个方向上进行，每个手部动作进行三次试验。每次试验都进行视频记录，并使用专门定制的图像处理流程进行分析，以自动量化测试。主要结果变量是敏锐度，计算方法是试验期间激光点在目标线上的时间百分比。
结果
结果显示，优势手的敏锐度明显优于非优势手。在过去12个月内有右手疼痛的参与者敏锐度显著降低（p < 0.05），尽管对于有左手疼痛的参与者敏锐度降低的趋势不显著，但也有类似趋势。此外，敏锐度与速度之间存在明显的负相关，表明在手动任务中常见的速度 - 准确性权衡。测试的重复性显示组内相关系数（ICC）值可接受（0.68 - 0.81），敏锐度的测量标准误值在5.0 - 6.3之间。
结论
初步结果表明，该测试可能是一种评估手部运动感觉的有效且可行的测试。未来的研究应包括对不同患者群体的评估以及随时间和不同测试者之间的可靠性评估。
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