OBJECTIVE: A hands-on-wall (HOW) position for low-dose stereoradiography of adolescent idiopathic scoliosis (AIS) patients would allow for skeletal maturity assessment of the hand and wrist. Our aims were twofold: confirm the reliability and validity of skeletal maturity assessment using the HOW radiographs and compare the spinal and pelvic 3D parameters to those of standard hands-on-cheeks (HOC) stereoradiographs.
METHODS: Seventy AIS patients underwent two successive stereoradiographs and a standard hand and wrist radiograph on the same day. Patients were randomly assigned to begin with HOW and follow with HOC, or vice versa. Raters assessed digital skeletal age (DSA), Sanders Simplified Skeletal Maturity (SSMS) and Thumb Ossification Composite Index (TOCI). 3D reconstructions of the spine and pelvis bones were performed for each stereoradiograph to measure nine clinically relevant spinal and pelvic 3D parameters.
RESULTS: Inter-rater and intra-rater reliabilities were excellent for DSA, SSMS and TOCI with both standard radiographs and HOW (ICC > 0.95). Strong correlation was found between ratings of both imaging types (ICC > 0.95). In the 3D reconstructions, kyphosis and sacral slope were slightly decreased in the HOW position, but within the clinical margin of error. All other parameters did not differ significantly between positions (p < 0.05).
CONCLUSIONS: The results suggest that HOW stereoradiographs allow clinicians to assess skeletal maturity of the hand and wrist with adequate reliability and validity. We recommend that scoliosis clinics adopt the HOW position to assess skeletal maturity because there is no significant clinical impact on the spinal and pelvic evaluation, and on radiation exposure, cost or time.

Background and Objectives: Acute and chronic injuries are frequent in volleyball. Biomechanics of sport-specific tasks can influence the risk of injury, which is also related to specific court positions. We investigated posture at raster-stereography, balance, and dynamic tasks using inertial motion units to find differences between roles, which can be predictive of a higher risk of injury. Materials and Methods: We cross-sectionally evaluated amateur volleyball athletes. Participants were divided into roles as outside hitters, setters, middle blockers, and opposite hitters. We excluded the \"libero\" position from our analysis. Results: Sixteen players were included in the analysis. A statistically significant difference was found in left lower limb stiffness among the outside hitter and setter groups. Conclusions: Differences in stiffness might be related to the different training and the different abilities among the two groups. Raster-stereography is extending its indications and should be implemented for non-invasive postural analysis. The use of inertial motion units provides objective measurements of variables that could go unrecognized within a clinical evaluation; its use should be considered in injury preventive programs.

OBJECTIVE: To investigate the cross-sectional association between deep and superficial diabetic neuropathy, postural impairment assessed by wearable inertial sensors, and the risk of fall among patients with diabetic foot.
METHODS: Diabetic patients attending a University Podiatric Clinic were evaluated for the presence of deep and superficial peripheral neuropathy in sensory tests. Postural impairment was assessed using a wearable inertial sensor, and the evaluation of balance/gait and risk of fall was determined by the Tinetti Scale and Downton Index, respectively. Glycemic control was measured by glycated haemoglobin concentration and fasting glycaemia. The postural parameters measured were the anteroposterior and medio-lateral sway of the center of mass (CoM) and the sway area (area traveled by the CoM per second). The results were analyzed through a logistic regression model to assess those posture variables mostly significantly associated with neuropathy and risk of fall scales.
RESULTS: A total of 85 patients were evaluated. Spearman\'s rank correlation coefficients showed a strong and significant relationship (p < 0.05) between deep diabetic neuropathy assessed by Semmes-Weinstein monofilament, diapason and biothensiometer and postural alterations, whereas no significant correlations between superficial (painful sensitivity) neuropathy and the postural parameters. The sway path of the displacement along the anterior-posterior axis recorded during tests performed with eyes open and feet close together were significantly (p < 0.05) correlated with a poor glycemic (glycated haemoglobin concentration) control and each other with all diabetic neuropathy tests, fall risk scales, muscular weakness, ankle joint limitation and history of ulcers.
CONCLUSIONS: The results support the existence of a strong association between alterations of the deep somato-sensitive pathway (although depending on the tool used to measure peripheral neuropathy), glycemic control and balance impairments assessed using a wearable sensors. Wearable-based postural analysis might be part of the clinical assessment that enables the detection of balance impairments and the risk of fall in diabetic patients with diabetic peripheral neuropathy.

BACKGROUND: Musculoskeletal risks (MSRs) are a major concern among construction warehouse workers due to the lifting, carrying and lowering of heavy loads.
OBJECTIVE: The objective of this study was to reduce MSRs among warehouse workers in the construction industry using virtual modelling and analysis of activities.
METHODS: A preliminary study was carried out using the Standard Nordic Questionnaire. Biomechanical analysis, Ovako Working posture Assessment System (OWAS) and Rapid Upper Limb Assessment (RULA) were used to analyse the material handling activities. Virtual modelling was used develop the manikins with autoclaved aerated concrete (AAC) blocks at different carriage modes and stacking heights for the analysis.
RESULTS: The preliminary study results revealed a higher prevalence of risk at their lower back (73.24%) among the construction warehouse workers. Biomechanical analysis showed a higher risk at L4-L5 joint of lumbar spine during overhead and bending postures for stacking the blocks. Posture analysis results of OWAS indicated a lower risk in overhead carriage mode. Detailed analysis with RULA confirms this result. Mean compressive force values at stacking heights were showed a significant difference (p < 0.05) in 8, 13, 18 and 21 kg AAC blocks. However, stacking height with a range of 120-140 cm was found as safer to the workers by considering all block sizes.
CONCLUSIONS: An ergonomic intervention based on safer stacking heights was developed to reduce MSRs to an acceptable range. It improves productivity of handling the AAC blocks by reducing the cycle time. The intervention can be adapted for handling of similar materials in the construction industry.

BACKGROUND: The prevalence of musculoskeletal disorders is high among teachers. Poor posture when writing on whiteboards is considered among the important causes of these disorders.
OBJECTIVE: The present study aimed to evaluate an electromechanical rolling whiteboard for educational environments as an ergonomic intervention.
METHODS: Thirty university lecturers volunteered to take part in the study. Participants performed a 5-minute writing task on a regular board and on the newly modified whiteboard in random order. The comfort and effectiveness of the boards and the perceived physical effort and posture of the participants were evaluated and compared by applying the verbal rating scale, Borg\'s rating of physical exertion scale, and rapid entire body assessment, respectively.
RESULTS: A total of 83.2% of participants reported the new whiteboard to be comfortable or more comfortable to use than the regular whiteboard, and 76.6% of them found the new whiteboard to be higher or much higher in effectiveness and usefulness in comparison with the regular whiteboard. The comfort and posture ratings revealed that exertion was significantly less and posture improved while writing on the new board as compared to its counterpart (p < 0.0001).
CONCLUSIONS: The new whiteboard increased user comfort, reduced physical effort, and improved posture, hopefully leading to a decreased number of work-related musculoskeletal disorders.

The prevalence of musculoskeletal disorders is very high amongmidwives resulting in sickness absenteeism, functional limitation and staff shortages. There are several contributory risk factors having impact on the development of MSDs. This study aimed to (1) explore midwives\' experiences and views about work-related MSDs and contributing risk factors, and (2) analyse working postures for musculoskeletal injury risks. A mixed method approach was used with interviews/focus group (n = 15/7) and observations (n = 22) of specific tasks (during birth and after birth) using the posture analysis observational method (Rapid Entire Body Assessment, REBA). The participants were midwives who had an active role in the United Kingdom (UK) National Health Services (NHS). It was found that MSDs were often attributed to the physical (working in awkward positions), organisational (longer shift hours, fewer staff, increased work load), psychosocial (defensive practice, higher demand) challenges of midwifery. All postures had very high to medium REBA risk levels with action categories indicating that action or further assessment is definitely necessary to reduce MSDs. This research provides a holistic approach by analysing risk factors and interactions in the work context to inform the development of risk management strategies. Midwifery working conditions have a big impact on developing musculoskeletal symptoms. Management of such symptoms will improve staff wellbeing, mother and baby safety, individuals\' life trajectories and staff shortages.

Wearables are devices worn on the human body and are able to measure various health parameters, such as physical activity, energy expenditure and gait. With the advancement of technology, the general population are now spending more hours craning our necks and slouching over smartphones, tablets and computers, et cetera. Bodily posture is representative of physical and mental health. Poor posture can lead to spinal complications and the same can be said vice versa. As the standard of living increases, there is an increase in consumerism and the expectation to maintain such a lifestyle even in the aging population. Therefore, many are able to afford small luxuries in life, such as a piece of technology that could potentially improve their health in the long run. Wearable technology is a promising alternative to laboratory systems for movement and posture analysis. This article reviews commercial wearable devices with a focus on postural analysis. The clinical applicability of posture wearables, particularly in preventing, monitoring and treating spinal and musculoskeletal conditions, along with other purposes in healthcare, will be discussed.

This study applied the posturography framework on five static standing tasks from the Berg Balance Scale (BBS). Thirteen participants were recruited and the trajectory data of the center of pressure (CoP) were collected. To analyze the postural performance, two approaches were taken: the scores from the BBS and statistical analysis. For the statistical analysis, Spearman\'s method was applied to determine the correlation of CoP parameters. The results revealed the correlations between CoP parameters in the anterior-posterior (AP) and medial-lateral (ML) directions, and on the statokinesgram (SK) plane for all tasks. To obtain the in-depth detail between normal weight and overweight groups, the differences in the postural control mechanism were defined by correlations of CoP parameters. The Mann-Whitney U test was conducted to define the difference in postural control in terms of difference in weight gain and standing task factors, while Cohen\'s d was used to investigate the influence of the difference in standing tasks and weight gain on postural control. The results showed that the correlations of CoP parameters could distinguish the balance impairment in the overweight condition from the normal postural control. Otherwise, the scores of BBS, the Mann-Whitney U test and Cohen\'s d did not separate this slightly compensatory movement during equilibrium. Therefore, the correlations of CoP parameters could provide more information to analyze the balance function in each individual, especially in terms of slight compensation.

UNASSIGNED: Observational study.
UNASSIGNED: The purpose of this study is to analyze the surgeon\'s neck postures while performing lumbar spinal surgeries.
UNASSIGNED: Lumbar spinal surgeries are on rising trend, and with increase in number of procedures, the average time spent by a spine surgeon performing surgical procedures is also increasing. The effect of operating posture on the surgeon\'s neck is largely unknown. From the studies conducted on usage of smartphones, abnormal neck postures, especially the forward head posture (FHP), were found to adversely affect the cervical spine of individuals. The present study analyzes the neck position of spine surgeons during lumbar spine surgeries.
UNASSIGNED: Sixty video recordings (25 open transforaminal lumbar interbody fusions [TLIFs] and 35 lumbar decompression [LD] procedures - 15 with headlight and 20 with operating microscope) of surgeries performed by three spine surgeons of different heights were analyzed. Running videos of the surgeries were recorded concentrating on the surgeons with reflective markers taped to their surface landmarks corresponding to C7 spinous process, tragus of the ear, and outer canthus of the eye. Video recordings were standardized by a fixed video recorder in the same operating theater. Snapshots from the video were obtained whenever the surgeon changes the position. Head flexion angle (HFA), neck flexion angle (NFA), and cervical angle (CA) were measured and analyzed.
UNASSIGNED: During TLIF, HFA and NFA were significantly higher during the phases of decompression and fusion (P < 0.05). The average CA of all surgeons was lower, thereby adversely affecting the cervical spine (20.15° ± 5.05°). During LD, CA showed significant difference between usage of microscope and headlight (P < 0.001).
UNASSIGNED: Surgeon\'s FHP is frequently caused by a compromise between the need to perform surgery with hands, without elevating the arms, and simultaneous control of gaze at surgical field. The usage of microscope was found to reduce the stress on neck while performing surgery.

One-stage bilateral total hip arthroplasty (THA) implies similar complication rate and hospitalization time to unilateral THA, but no studies have evaluated the functional and postural recovery in these patients. The aim of this study was to assess short-term functional and postural recovery in patients after one-stage bilateral or unilateral THA. Forty patients undergoing bilateral (n = 20) or unilateral (n = 20) THA were assessed by Timed Up and Go (TUG), Numeric Rating Scale (NRS), Tampa Scale of Kinesiophobia (TSK) and Body Weight Distribution Symmetry Index (BWDSI) during stand-to-sit (STS). Centre of Pressure (CoP) parameters and BWDSI during standing with eyes open (EO) and closed (EC) were also assessed. Data were collected one day before surgery, at three and seven days. No between-group differences were found for TUG, NRS and TSK at any time-point, showing similar mobility, pain and fear of movement in both groups. BWDSI during STS (P = 0.001) and standing (OE P = 0.007; CE P = 0.012) revealed differences over time in favor of patients with bilateral THA, who showed better symmetry in weight distribution. Shorter CoP path length was observed during standing in patients with unilateral THA (OE P = 0.023; CE P = 0.018), who mainly used their non-affected limb to maintain balance.