@Article{info:doi/10.2196/67921,
author="Colwell, Rebecca
and Gullickson, Mitchell
and Cutlan, Jonathan
and Stratman, Erik",
title="Cutaneous Atrophy Following Corticosteroid Injections for Tendonitis: Report of Two Cases",
journal="JMIR Dermatol",
year="2025",
month="Feb",
day="13",
volume="8",
pages="e67921",
keywords="lipoatrophy",
keywords="cutaneous atrophy",
keywords="corticosteroid",
keywords="adverse effects",
keywords="tendonitis",
keywords="musculoskeletal",
doi="10.2196/67921",
url="https://derma.jmir.org/2025/1/e67921"
}


@Article{info:doi/10.2196/55730,
author="Houzangbe, Samory
and Lemay, Martin
and Levac, E. Danielle",
title="Toward Physiological Detection of a ``Just-Right'' Challenge Level for Motor Learning in Immersive Virtual Reality: Protocol for a Cross-Sectional Study",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="23",
volume="13",
pages="e55730",
keywords="virtual reality",
keywords="pediatric rehabilitation",
keywords="physiological data",
keywords="engagement",
keywords="just-right challenge",
abstract="Background: Motor learning, a primary goal of pediatric rehabilitation, is facilitated when tasks are presented at a ``just-right'' challenge level---at the edge of the child's current abilities, yet attainable enough to motivate the child in persistent efforts for success. Immersive virtual reality (VR) may be ideally suited for ``just-right'' task challenges because it enables precise adjustments of task parameters in motivating environments. Rehabilitation-specific VR tasks often use dynamic difficulty algorithms based on task performance to personalize task difficulty. However, these approaches do not consider relevant cognitive processes that could also impact ``just-right'' challenges, such as attention and engagement. Objective physiological measurement of these cognitive processes using wearable sensors could support their integration within ``just-right'' challenge detection and prediction algorithms. As a first step, it is important to explore relationships between objectively and subjectively measured psychophysiological states at progressively challenging task difficulty levels. Objective: This study aims to (1) evaluate the performance of wearable sensors in a novel movement-based motor learning immersive VR task; (2) evaluate changes in physiological data at 3 task difficulty levels; and (3) explore the relationship between physiological data, task performance, and self-reported cognitive processes at each task difficulty level. Methods: This study uses the within-participant experimental design. Typically developing children and youth aged 8-16 years will be recruited to take part in a single 90-minute data collection session. Physiological sensors include electrodermal activity, heart rate, electroencephalography, and eye-tracking. After collecting physiological data at rest, participants will play a seated unimanual immersive VR task involving bouncing a virtual ball on a virtual racket. They will first play for 3 minutes at a predefined medium level of difficulty to determine their baseline ability level and then at a personalized choice of 3 progressive difficulty levels of 3 minutes each. Following each 3-minute session, participants will complete a short Likert-scale questionnaire evaluating engagement, attention, cognitive workload, physical effort, self-efficacy, and motivation. Data loss and data quality will be calculated for each sensor. Repeated-measures ANOVAs will evaluate changes in physiological response at each difficulty level. Correlation analyses will determine individual relationships between task performance, physiological data, and self-reported data at each difficulty level. Results: Research ethics board approval has been obtained, and data collection is underway. Data collection was conducted on December 12, 2023, and April 12, 2024, with a total of 15 typically developing children. Data analysis has been completed, and results are expected to be published in the fall of 2024. Conclusions: Wearable sensors may provide insights into the physiological effects of immersive VR task interaction at progressive difficulty levels in children and youth. Understanding the relationship between physiological and self-reported cognitive processes is a first step in better identifying and predicting ``just-right'' task challenges during immersive VR motor learning interventions. International Registered Report Identifier (IRRID): DERR1-10.2196/55730 ",
doi="10.2196/55730",
url="https://www.researchprotocols.org/2024/1/e55730"
}


@Article{info:doi/10.2196/52964,
author="Vincent, Rapha{\"e}l
and Charron, Maxime
and Lafrance, Simon
and Cormier, Audrey-Anne
and Kairy, Dahlia
and Desmeules, Fran{\c{c}}ois",
title="Investigating the Use of Telemedicine by Health Care Providers to Diagnose and Manage Patients With Musculoskeletal Disorders: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="23",
volume="26",
pages="e52964",
keywords="telemedicine",
keywords="musculoskeletal diseases",
keywords="physical examination",
keywords="diagnosis",
keywords="treatment",
keywords="health care",
keywords="telecare",
keywords="meta-analysis",
keywords="systematic review",
keywords="telehealth",
keywords="orthopedic",
keywords="test",
keywords="musculoskeletal disorder",
keywords="MSKD",
keywords="older adult",
keywords="older adults",
keywords="older person",
keywords="older people",
keywords="aging",
keywords="musculoskeletal",
keywords="mobile phone",
abstract="Background: Access to care is a major challenge for patients with musculoskeletal disorders (MSKDs). Telemedicine is one of the solutions to improve access to care. However, initial remote diagnosis of MSKDs involves some challenges, such as the impossibility of touching the patient during the physical examination, which makes it more complex to obtain a valid diagnosis. No meta-analysis has been performed to date to synthesize evidence regarding the initial assessment including a physical evaluation using telemedicine to diagnose patients with MSKDs. Objective: This study aims to appraise the evidence on diagnostic and treatment plan concordance between remote assessment using synchronous or asynchronous forms of telemedicine and usual in-person assessment for the initial evaluation of various MSKDs. Methods: An electronic search was conducted up to August 2023 using terms related to telemedicine and assessment of MSKDs. Methodological quality of studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Random-effect model meta-analyses were performed. The Grading of Recommendations, Assessment, Development, and Evaluations framework was used to synthesize the quality and certainty of the evidence. Results: A total of 23 concordance studies were eligible and included adult participants (N=1493) with various MSKDs. On the basis of high certainty, pooled $\kappa$ and prevalence-adjusted and bias-adjusted $\kappa$ for the diagnostic concordance between remote and in-person assessments of MSKDs were 0.80 (95\% CI 0.72-0.89; 7 studies, 353 patients) and 0.83 (95\% CI 0.76-0.89; 6 studies, 306 patients). On the basis of moderate certainty, pooled Gwet AC1 for treatment plan concordance between remote and in-person assessments of MSKDs was 0.90 (95\% CI 0.80-0.99; 2 studies, 142 patients). Conclusions: The diagnostic concordance for MSKDs is good to very good. Treatment plan concordance is probably good to excellent. Studies evaluating the accuracy to detect red and yellow flags as well as the potential increase in associated health care resources use, such as imaging tests, are needed. ",
doi="10.2196/52964",
url="https://www.jmir.org/2024/1/e52964"
}


@Article{info:doi/10.2196/54116,
author="Martinsen, Lars
and {\O}ster{\aa}s, Nina
and Moseng, Tuva
and Tveter, Therese Anne",
title="Usage, Attitudes, Facilitators, and Barriers Toward Digital Health Technologies in Musculoskeletal Care: Survey Among Primary Care Physiotherapists in Norway",
journal="JMIR Rehabil Assist Technol",
year="2024",
month="Sep",
day="16",
volume="11",
pages="e54116",
keywords="physiotherapy",
keywords="physiotherapist",
keywords="physiotherapists",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="application",
keywords="applications",
keywords="digital health",
keywords="smartphone",
keywords="smartphones",
keywords="ehealth",
keywords="telemedicine",
keywords="tele-medicine",
keywords="family medicine",
keywords="primary care",
keywords="primary health care",
keywords="musculoskeletal",
keywords="musculoskeletal care",
keywords="muscle",
keywords="skeleton",
keywords="musculoskeletal disorders",
keywords="MSD",
keywords="MSDs",
keywords="internet survey",
keywords="internet surveys",
keywords="online survey",
keywords="online surveys",
keywords="web-based survey",
keywords="web-based surveys",
keywords="survey",
keywords="surveys",
keywords="mobile phone",
abstract="Background: Work burden increases for physiotherapists in the primary health care sector as the prevalence of musculoskeletal disorders (MSDs) increases. Digital health technologies (DHTs) are proposed as a viable solution to secure the sustainability of the health care system and have shown promising results in a range of conditions. However, little is known about use of DHTs among physiotherapists in the primary health care sector in Norway. Objective: This study aimed to investigate the use of and attitudes toward DHTs among physiotherapists treating patients with MSDs in primary care, and potential facilitators or barriers for adopting DHTs in clinical practice. Methods: An author-developed web-based questionnaire was distributed to physiotherapists in all Norwegian municipalities in March 2023. The questionnaire included items regarding use of technologies, attitudes, suitability, and factors influencing adoption of DHT. Suitability and agreement on statements were scored on an 11-point numeric rating scale (0=very unsuitable or strongly disagree, 10=very suitable or strongly agree). Differences across employment sites and users versus nonusers of DHT were analyzed using the $\chi$2 test, Fisher exact test, Student t test, and Mann-Whitney U test. Results: Approximately 5000 physiotherapists were invited to participate, of which 6.8\% (338) completed the questionnaire. A total of 46.2\% (156/338) offered DHTs in their practice, of which 53.2\% (83/156) used it on a weekly basis, mostly telephone consultations (105/156, 67.3\%). A higher proportion of physiotherapists in private practice offered DHT compared with those employed by municipalities (95/170, 55.9\% vs 61/168, 36.3\%; P<.001). A majority (272/335, 81.2\%) were positive about recommending DHTs to their patients. Suitability of DHTs in physiotherapy was rated an average of 6 (SD 2.1). Apps for smartphones or tablets were rated most suitable (mean rating 6.8, SD 2.4). The most frequently reported advantages were flexibility in how physiotherapy is offered (278/338, 82.3\%) and reduced travel time for the patient (235/338, 70\%). The highest rated disadvantages were limited scope for physical examination (252/338, 74.6\%) and difficulty in building rapport with the patient (227/338, 67.2\%). The main facilitators and barriers included a functioning (median rating 10, IQR 8-10) or lack of functioning (median rating 9, IQR 8-10) internet connection, respectively. Lack of training in DHTs was prominent regarding evaluation, diagnosing, and treatment (median rating 0, IQR 0-2), with minor, but significant, differences between nonusers and users (median rating 0, IQR 0-1 vs median rating 1, IQR 0-4); P<.001). Conclusions: Physiotherapists in Norwegian primary care treating patients with MSDs are positive about using DHTs, and almost 50\% (156/338) have adopted them in clinical practice. Concerns are related to lack of a physical examination and technical aspects. Training in the use of DHTs should be addressed in implementation processes. ",
doi="10.2196/54116",
url="https://rehab.jmir.org/2024/1/e54116",
url="http://www.ncbi.nlm.nih.gov/pubmed/39283661"
}


@Article{info:doi/10.2196/49868,
author="van Tilburg, Leendert Mark
and Spin, Ivar
and Pisters, F. Martijn
and Staal, Bart J.
and Ostelo, WJG Raymond
and van der Velde, Miriam
and Veenhof, Cindy
and Kloek, JJ Corelien",
title="Barriers and Facilitators to the Implementation of Digital Health Services for People With Musculoskeletal Conditions in the Primary Health Care Setting: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="27",
volume="26",
pages="e49868",
keywords="eHealth",
keywords="primary health care",
keywords="musculoskeletal problems",
keywords="implementation science",
keywords="systematic review",
keywords="mobile phone",
abstract="Background: In recent years, the effectiveness and cost-effectiveness of digital health services for people with musculoskeletal conditions have increasingly been studied and show potential. Despite the potential of digital health services, their use in primary care is lagging. A thorough implementation is needed, including the development of implementation strategies that potentially improve the use of digital health services in primary care. The first step in designing implementation strategies that fit the local context is to gain insight into determinants that influence implementation for patients and health care professionals. Until now, no systematic overview has existed of barriers and facilitators influencing the implementation of digital health services for people with musculoskeletal conditions in the primary health care setting. Objective: This systematic literature review aims to identify barriers and facilitators to the implementation of digital health services for people with musculoskeletal conditions in the primary health care setting. Methods: PubMed, Embase, and CINAHL were searched for eligible qualitative and mixed methods studies up to March 2024. Methodological quality of the qualitative component of the included studies was assessed with the Mixed Methods Appraisal Tool. A framework synthesis of barriers and facilitators to implementation was conducted using the Consolidated Framework for Implementation Research (CFIR). All identified CFIR constructs were given a reliability rating (high, medium, or low) to assess the consistency of reporting across each construct. Results: Overall, 35 studies were included in the qualitative synthesis. Methodological quality was high in 34 studies and medium in 1 study. Barriers (--) of and facilitators (+) to implementation were identified in all 5 CFIR domains: ``digital health characteristics'' (ie, commercial neutral [+], privacy and safety [--], specificity [+], and good usability [+]), ``outer setting'' (ie, acceptance by stakeholders [+], lack of health care guidelines [--], and external financial incentives [--]), ``inner setting'' (ie, change of treatment routines [+ and --], information incongruence (--), and support from colleagues [+]), ``characteristics of the healthcare professionals'' (ie, health care professionals' acceptance [+ and --] and job satisfaction [+ and --]), and the ``implementation process'' (involvement [+] and justification and delegation [--]). All identified constructs and subconstructs of the CFIR had a high reliability rating. Some identified determinants that influence implementation may be facilitators in certain cases, whereas in others, they may be barriers. Conclusions: Barriers and facilitators were identified across all 5 CFIR domains, suggesting that the implementation process can be complex and requires implementation strategies across all CFIR domains. Stakeholders, including digital health intervention developers, health care professionals, health care organizations, health policy makers, health care funders, and researchers, can consider the identified barriers and facilitators to design tailored implementation strategies after prioritization has been carried out in their local context. ",
doi="10.2196/49868",
url="https://www.jmir.org/2024/1/e49868",
url="http://www.ncbi.nlm.nih.gov/pubmed/39190440"
}


@Article{info:doi/10.2196/58989,
author="McKee, Hayley
and Eder, Lihi
and Jerome, Dana
and Mirza, D. Reza
and Obetta, Chikaodili
and Pek, Elisabeth
and Piguet, Vincent
and Alhusayen, Raed",
title="Prevalence of Musculoskeletal Symptoms in Patients With Hidradenitis Suppurativa and Associated Factors: Cross-Sectional Study",
journal="JMIR Dermatol",
year="2024",
month="Aug",
day="22",
volume="7",
pages="e58989",
keywords="hidradenitis suppurativa",
keywords="cross sectional",
keywords="skin",
keywords="musculoskeletal symptoms",
keywords="morning stiffness",
keywords="arthralgia",
keywords="comorbidities",
keywords="musculoskeletal",
keywords="comorbidity",
keywords="stiff",
keywords="stiffness",
keywords="muscle",
keywords="muscles",
keywords="muscular",
keywords="prevalence",
keywords="incidence",
keywords="epidemiology",
keywords="epidemiological",
keywords="factor",
keywords="factors",
keywords="dermatology",
keywords="dermatological",
doi="10.2196/58989",
url="https://derma.jmir.org/2024/1/e58989"
}


@Article{info:doi/10.2196/55625,
author="Armfield, Nigel
and Elphinston, Rachel
and Liimatainen, Jenna
and Scotti Requena, Simone
and Eather, Chloe-Emily
and Edirippulige, Sisira
and Ritchie, Carrie
and Robins, Sarah
and Sterling, Michele",
title="Development and Use of Mobile Messaging for Individuals With Musculoskeletal Pain Conditions: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Aug",
day="14",
volume="12",
pages="e55625",
keywords="musculoskeletal",
keywords="pain",
keywords="SMS text messaging",
keywords="mobile health",
keywords="mHealth",
keywords="intervention design",
keywords="design",
keywords="scoping review",
keywords="musculoskeletal pain",
keywords="development",
keywords="mobile messaging",
keywords="behavior change",
keywords="efficacy",
keywords="effectiveness",
keywords="messaging",
keywords="implementation",
keywords="sustainability",
keywords="mobile phone",
abstract="Background: Population studies show that musculoskeletal conditions are a leading contributor to the total burden of healthy life lost, second only to cancer and with a similar burden to cardiovascular disease. Prioritizing the delivery of effective treatments is necessary, and with the ubiquity of consumer smart devices, the use of digital health interventions is increasing. Messaging is popular and easy to use and has been studied for a range of health-related uses, including health promotion, encouragement of behavior change, and monitoring of disease progression. It may have a useful role to play in the management and self-management of musculoskeletal conditions. Objective: Previous reviews on the use of messaging for people with musculoskeletal conditions have focused on synthesizing evidence of effectiveness from randomized controlled trials. In this review, our objective was to map the musculoskeletal messaging literature more broadly to identify information that may inform the design of future messaging interventions and summarize the current evidence of efficacy, effectiveness, and economics. Methods: Following a prepublished protocol developed using the Joanna Briggs Institute Manual for Evidence Synthesis, we conducted a comprehensive scoping review of the literature (2010-2022; sources: PubMed, CINAHL, Embase, and PsycINFO) related to SMS text messaging and app-based messaging for people with musculoskeletal conditions. We described our findings using tables, plots, and a narrative summary. Results: We identified a total of 8328 papers for screening, of which 50 (0.6\%) were included in this review (3/50, 6\% previous reviews and 47/50, 94\% papers describing 40 primary studies). Rheumatic diseases accounted for the largest proportion of the included primary studies (19/40, 48\%), followed by studies on multiple musculoskeletal conditions or pain sites (10/40, 25\%), back pain (9/40, 23\%), neck pain (1/40, 3\%), and ``other'' (1/40, 3\%). Most studies (33/40, 83\%) described interventions intended to promote positive behavior change, typically by encouraging increased physical activity and exercise. The studies evaluated a range of outcomes, including pain, function, quality of life, and medication adherence. Overall, the results either favored messaging interventions or had equivocal outcomes. While the theoretical underpinnings of the interventions were generally well described, only 4\% (2/47) of the papers provided comprehensive descriptions of the messaging intervention design and development process. We found no relevant economic evaluations. Conclusions: Messaging has been used for the care and self-management of a range of musculoskeletal conditions with generally favorable outcomes reported. However, with few exceptions, design considerations are poorly described in the literature. Further work is needed to understand and disseminate information about messaging content and message delivery characteristics, such as timing and frequency specifically for people with musculoskeletal conditions. Similarly, further work is needed to understand the economic effects of messaging and practical considerations related to implementation and sustainability. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-048964 ",
doi="10.2196/55625",
url="https://mhealth.jmir.org/2024/1/e55625"
}


@Article{info:doi/10.2196/57865,
author="Zhen, Deng
and Haibin, Shang
and Youli, Ai
and Weian, Yuan
and Huihao, Wang
and Hongsheng, Zhan
and Guozhong, Li
and Ren, Ding
and Zhibi, Shen",
title="Efficacy and Safety of Shi Cervical Rotational Manipulation in Patients With Atlantoaxial Joint Subluxation: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Aug",
day="13",
volume="13",
pages="e57865",
keywords="atlantoaxial joint subluxation",
keywords="Shi cervical rotational manipulation",
keywords="efficacy",
keywords="safety",
keywords="randomized controlled trial",
abstract="Background: The clinical diagnosis of atlantoaxial joint subluxation (AJS) in traditional Chinese medicine (TCM) is characterized by an unequal distance between the lateral mass of the atlas and the odontoid process on imaging, resulting in neck pain accompanied by symptoms such as dizziness, headache, and limited cervical mobility. In Shanghai, Shi cervical rotational manipulation (SCRM) is a commonly employed TCM manual therapy for treating this condition. Nevertheless, there is a lack of evidence-based medical information regarding the clinical efficacy and safety of this technique. Objective: The principal aim of this study is to evaluate the efficacy and safety of SCRM in patients diagnosed with AJS. Methods: This study is a prospective randomized controlled clinical trial that will be conducted at a single center and that has a follow-up period of 24 weeks. A total of 96 patients diagnosed with AJS will be recruited from outpatient and inpatient clinics at Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine. These patients will be randomly assigned to either the experimental group (SCRM) or the comparison group (basic cervical manipulation [BCM]). Treatment sessions consisting of SCRM or BCM will be administered twice a week for a duration of 4 weeks. Clinical monitoring indicators include the presence or absence of clinical symptoms as recorded on a symptom recording form, cervical imaging examination findings using cervical computed tomography, degree of neck pain measured by a visual analog scale (VAS), cervical range of motion assessed through cervical mobility measurement, degree of vertigo evaluated using the Vertigo Symptoms Scale-Chinese Version (VSS-C), and adverse events that may occur during the follow-up period. The time points for data collection and follow-up are baseline and postintervention (weeks 4, 8, 12, 16, 20, and 24). Results: This paper presents an overview of the reasoning and structure of a prospective randomized controlled trial with the objective of investigating the clinical efficacy and safety of SCRM in patients with AJS by assessing improvements in clinical symptoms, neck pain severity, and vertigo severity and evaluating changes in cervical imaging findings. Recruitment was started in March 2023. By the end of May 2024, 76 patients were included in this project. The last follow-up data are predicted to be collected by the end of February 2025. Conclusions: This investigation will yield dependable evidence regarding the efficacy and safety of SCRM in patients with AJS. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300068510; https://www.chictr.org.cn/showprojEN.html?proj=186883 International Registered Report Identifier (IRRID): DERR1-10.2196/57865 ",
doi="10.2196/57865",
url="https://www.researchprotocols.org/2024/1/e57865"
}


@Article{info:doi/10.2196/53084,
author="Bass, Alec
and Morin, N. Suzanne
and Guidea, Michael
and Lam, T. Jacqueline T. A.
and Karelis, D. Antony
and Aubertin-Leheudre, Myl{\`e}ne
and Gagnon, H. Dany
and ",
title="Potential Effects of an Exoskeleton-Assisted Overground Walking Program for Individuals With Spinal Cord Injury Who Uses a Wheelchair on Imaging and Serum Markers of Bone Strength: Pre-Post Study",
journal="JMIR Rehabil Assist Technol",
year="2024",
month="Jan",
day="1",
volume="11",
pages="e53084",
keywords="assistive technology",
keywords="bone architecture",
keywords="bone turnover",
keywords="osteoporosis",
keywords="rehabilitation",
keywords="spinal cord injuries",
keywords="SCI",
keywords="spinal cord injury",
keywords="assistive device",
keywords="wheelchair",
keywords="exoskeleton device",
keywords="locomotion",
keywords="bone strength",
keywords="risk",
keywords="fracture",
abstract="Background: As many as 60\% of individuals use a wheelchair long term after a spinal cord injury (SCI). This mode of locomotion leads to chronic decline in lower-extremity weight-bearing activities and contributes to the development of severe sublesional osteoporosis and high rates of fragility fracture. Overground exoskeleton-assisted walking programs provide a novel opportunity to increase lower-extremity weight bearing, with the potential to improve bone health. Objective: The aim of the study is to measure the potential effects of an exoskeleton-assisted walking program on lower-extremity bone strength and bone remodeling biomarkers in individuals with chronic (?18 months) SCI who use a wheelchair. Methods: In total, 10 participants completed a 16-week exoskeleton-assisted walking program (34 individualized 1-hour sessions, progressing from 1 to 3 per week). Bone mineral density and bone strength markers (dual-energy x-ray absorptiometry: total body, left arm, leg, total hip, and femoral neck and peripheral quantitative computed tomography: 25\% of left femur and 66\% of left tibia) as well as bone remodeling biomarkers (formation=osteocalcin and resorption=C-telopeptide) were measured before and after intervention and compared using nonparametric tests. Changes were considered significant and meaningful if the following criteria were met: P<0.1, effect size ?0.5, and relative variation >5\%. Results: Significant and meaningful increases were observed at the femur (femoral neck bone mineral content, bone strength index, and stress-strain index) and tibia (cortical cross-sectional area and polar moment of inertia) after the intervention (all P<.10). We also noted a decrease in estimated femoral cortical thickness. However, no changes in bone remodeling biomarkers were found. Conclusions: These initial results suggest promising improvements in bone strength markers after a 16-week exoskeleton-assisted walking program in individuals with chronic SCI. Additional research with larger sample sizes, longer interventions (possibly of greater loading intensity), and combined modalities (eg, pharmacotherapy or functional electrical stimulation) are warranted to strengthen current evidence. Trial Registration: ClinicalTrials.gov NCT03989752; https://clinicaltrials.gov/ct2/show/NCT03989752 International Registered Report Identifier (IRRID): RR2-10.2196/19251 ",
doi="10.2196/53084",
url="https://rehab.jmir.org/2024/1/e53084",
url="http://www.ncbi.nlm.nih.gov/pubmed/38163294"
}


@Article{info:doi/10.2196/47590,
author="Lei, Mingxing
and Wu, Bing
and Zhang, Zhicheng
and Qin, Yong
and Cao, Xuyong
and Cao, Yuncen
and Liu, Baoge
and Su, Xiuyun
and Liu, Yaosheng",
title="A Web-Based Calculator to Predict Early Death Among Patients With Bone Metastasis Using Machine Learning Techniques: Development and Validation Study",
journal="J Med Internet Res",
year="2023",
month="Oct",
day="23",
volume="25",
pages="e47590",
keywords="bone metastasis",
keywords="early death",
keywords="machine learning",
keywords="prediction model",
keywords="local interpretable model--agnostic explanation",
abstract="Background: Patients with bone metastasis often experience a significantly limited survival time, and a life expectancy of <3 months is generally regarded as a contraindication for extensive invasive surgeries. In this context, the accurate prediction of survival becomes very important since it serves as a crucial guide in making clinical decisions. Objective: This study aimed to develop a machine learning--based web calculator that can provide an accurate assessment of the likelihood of early death among patients with bone metastasis. Methods: This study analyzed a large cohort of 118,227 patients diagnosed with bone metastasis between 2010 and 2019 using the data obtained from a national cancer database. The entire cohort of patients was randomly split 9:1 into a training group (n=106,492) and a validation group (n=11,735). Six approaches---logistic regression, extreme gradient boosting machine, decision tree, random forest, neural network, and gradient boosting machine---were implemented in this study. The performance of these approaches was evaluated using 11 measures, and each approach was ranked based on its performance in each measure. Patients (n=332) from a teaching hospital were used as the external validation group, and external validation was performed using the optimal model. Results: In the entire cohort, a substantial proportion of patients (43,305/118,227, 36.63\%) experienced early death. Among the different approaches evaluated, the gradient boosting machine exhibited the highest score of prediction performance (54 points), followed by the neural network (52 points) and extreme gradient boosting machine (50 points). The gradient boosting machine demonstrated a favorable discrimination ability, with an area under the curve of 0.858 (95\% CI 0.851-0.865). In addition, the calibration slope was 1.02, and the intercept-in-large value was ?0.02, indicating good calibration of the model. Patients were divided into 2 risk groups using a threshold of 37\% based on the gradient boosting machine. Patients in the high-risk group (3105/4315, 71.96\%) were found to be 4.5 times more likely to experience early death compared with those in the low-risk group (1159/7420, 15.62\%). External validation of the model demonstrated a high area under the curve of 0.847 (95\% CI 0.798-0.895), indicating its robust performance. The model developed by the gradient boosting machine has been deployed on the internet as a calculator. Conclusions: This study develops a machine learning--based calculator to assess the probability of early death among patients with bone metastasis. The calculator has the potential to guide clinical decision-making and improve the care of patients with bone metastasis by identifying those at a higher risk of early death. ",
doi="10.2196/47590",
url="https://www.jmir.org/2023/1/e47590",
url="http://www.ncbi.nlm.nih.gov/pubmed/37870889"
}


@Article{info:doi/10.2196/47970,
author="Billington, Olive Emma
and Hasselaar, M. Charley
and Kembel, Lorena
and Myagishima, C. Rebecca
and Arain, A. Mubashir",
title="Effectiveness and Cost of Using Facebook Recruitment to Elicit Canadian Women's Perspectives on Bone Health and Osteoporosis: Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="29",
volume="25",
pages="e47970",
keywords="osteoporosis",
keywords="bone health",
keywords="bone mineral density",
keywords="fracture",
keywords="survey",
keywords="Facebook",
keywords="advertisement",
keywords="recruitment",
keywords="women's health",
keywords="social media",
keywords="bone",
keywords="perspective",
abstract="Background: Surveys can help health researchers better understand the public's perspectives and needs regarding prevalent conditions such as osteoporosis, which affects more than two-thirds of postmenopausal women. However, recruitment of large cohorts for survey research can be time-consuming and expensive. With 2.9 billion active users across the globe and reasonable advertising costs, Facebook (Meta Platforms, Inc) has emerged as an effective recruitment tool for surveys, although previous studies have targeted young populations (<50 years of age) and none have focused on bone health. Objective: We assessed the effectiveness and cost of using Facebook to recruit Canadian women aged ?45 years to share their perspectives on bone health and osteoporosis via a web-based survey. Methods: We developed a 15-minute web-based survey with the goal of eliciting perspectives on bone health and osteoporosis. A Facebook advertisement was placed for 2 weeks in February 2022, during which time it was shown to women of age ?45 years who resided in Canada, inviting them to participate and offering a chance to win 1 of 5 CAD \$100 gift cards (at the time of this study [February 14, 2022], a currency exchange rate of CAD \$1=US \$0.79 was applicable). Those who clicked on the advertisement were taken to an eligibility screening question on the survey home screen. Individuals who confirmed eligibility were automatically directed to the first survey question. All individuals who answered the first survey question were considered participants and included in the analyses. We determined the survey reach, click rate, cooperation rate, completion rate, cost per click, and cost per participant. Sociodemographic characteristics of respondents were compared with data from the 2021 Canadian Census. Results: The Facebook advertisement was shown to 34,086 unique Facebook users, resulting in 2033 link clicks (click rate: 6.0\%). A total of 1320 individuals completed the eligibility screening question, 1195 started the survey itself (cooperation rate: 58.8\%), and 966 completed the survey (completion rate: 47.5\%). The cost of the advertising campaign was CAD \$280.12, resulting in a cost per click of CAD \$0.14 and a cost per participant of CAD \$0.23. The 1195 participants ranged in age from 45-89 years (mean 65, SD 7 years), 921 (93.7\%) were of White ethnicity, 854 (88.3\%) had completed some postsecondary education, and 637 (65.8\%) resided in urban areas. Responses were received from residents of all 10 Canadian provinces and 2 of 3 territories. When compared to 2021 Canadian Census data, postsecondary education and rural residence were overrepresented in our study population. Conclusions: Facebook advertising is an efficient, effective, and inexpensive way of recruiting large samples of older women for participation in web-based surveys for health research. However, it is important to recognize that this modality is a form of convenience sampling and the benefits of Facebook recruitment must be balanced with its limitations, which include selection bias and coverage error. ",
doi="10.2196/47970",
url="https://www.jmir.org/2023/1/e47970",
url="http://www.ncbi.nlm.nih.gov/pubmed/37773625"
}


@Article{info:doi/10.2196/42964,
author="Patnaik, Rajashree
and Jannati, Shirin
and Sivani, Mohan Bala
and Rizzo, Manfredi
and Naidoo, Nerissa
and Banerjee, Yajnavalka",
title="Efficient Generation of Chondrocytes From Bone Marrow--Derived Mesenchymal Stem Cells in a 3D Culture System: Protocol for a Practical Model for Assessing Anti-Inflammatory Therapies",
journal="JMIR Res Protoc",
year="2023",
month="Jul",
day="28",
volume="12",
pages="e42964",
keywords="chondrocytes",
keywords="bone marrow--derived mesenchymal stem cell",
keywords="BMSC",
keywords="tumor necrosis factor-$\alpha$",
keywords="TNF-$\alpha$",
keywords="vitamin D",
keywords="curcumin",
keywords="resveratrol",
keywords="enzyme-linked immunosorbent assay",
keywords="ELISA",
keywords="inflammation",
keywords="anti-inflammation",
keywords="proinflammation",
keywords="3D culture system",
abstract="Background: Chondrocytes are the primary cells responsible for maintaining cartilage integrity and function. Their role in cartilage homeostasis and response to inflammation is crucial for understanding the progression and potential therapeutic interventions for various cartilage-related disorders. Developing an accessible and cost-effective model to generate viable chondrocytes and to assess their response to different bioactive compounds can significantly advance our knowledge of cartilage biology and contribute to the discovery of novel therapeutic approaches. Objective: We developed a novel, streamlined protocol for generating chondrocytes from bone marrow--derived mesenchymal stem cells (BMSCs) in a 3D culture system that offers significant implications for the study of cartilage biology and the discovery of potential therapeutic interventions for cartilage-related and associated disorders. Methods: We developed a streamlined protocol for generating chondrocytes from BMSCs in a 3D culture system using an ``in-tube'' culture approach. This simple pellet-based 3D culture system allows for cell aggregation and spheroid formation, facilitating cell-cell and cell--extracellular matrix interactions that better mimic the in vivo cellular environment compared with 2D monolayer cultures. A proinflammatory chondrocyte model was created by treating the chondrocytes with lipopolysaccharide and was subsequently used to evaluate the anti-inflammatory effects of vitamin D, curcumin, and resveratrol. Results: The established protocol successfully generated a large quantity of viable chondrocytes, characterized by alcian blue and toluidine blue staining, and demonstrated versatility in assessing the anti-inflammatory effects of various bioactive compounds. The chondrocytes exhibited reduced inflammation, as evidenced by the decreased tumor necrosis factor-$\alpha$ levels, in response to vitamin D, curcumin, and resveratrol treatment. Conclusions: Our novel protocol offers an accessible and cost-effective approach for generating chondrocytes from BMSCs and for evaluating potential therapeutic leads in the context of inflammatory chondrocyte--related diseases. Although our approach has several advantages, further investigation is required to address its limitations, such as the potential differences between chondrocytes generated using our protocol and those derived from other established methods, and to refine the model for broader applicability and clinical translation. ",
doi="10.2196/42964",
url="https://www.researchprotocols.org/2023/1/e42964",
url="http://www.ncbi.nlm.nih.gov/pubmed/37505889"
}


@Article{info:doi/10.2196/38619,
author="Le Du, Katell
and Septans, Anne-Lise
and Maloisel, Fr{\'e}d{\'e}ric
and Vanquaethem, H{\'e}l{\`e}ne
and Schmitt, Anna
and Le Goff, Marielle
and Clavert, Aline
and Zinger, Marie
and Bourgeois, Hugues
and Dupuis, Olivier
and Denis, Fabrice
and Bouchard, St{\'e}phane",
title="A New Option for Pain Prevention Using a Therapeutic Virtual Reality Solution for Bone Marrow Biopsy (REVEH Trial): Open-Label, Randomized, Multicenter, Phase 3 Study",
journal="J Med Internet Res",
year="2023",
month="Feb",
day="15",
volume="25",
pages="e38619",
keywords="virtual reality",
keywords="VR",
keywords="bone marrow",
keywords="biopsy",
keywords="pain",
keywords="digital therapeutics",
keywords="digital health",
keywords="eHealth",
keywords="RCT",
keywords="randomized controlled trial",
keywords="clinical trial",
keywords="distraction",
keywords="imagery",
keywords="imagination",
keywords="imaginary",
keywords="immersive environment",
keywords="interactive environment",
keywords="head-mounted display",
keywords="medical procedure",
keywords="satisfaction",
keywords="safety",
keywords="efficacy",
keywords="effectiveness",
abstract="Background: Evidence regarding the analgesic effect of distraction through immersion in virtual reality (VR) for care-induced pain has been documented in several phase 2 trials, but comparison with standard treatments in large, randomized studies is needed. Objective: In this open-label, multicenter, randomized, phase 3 trial, we evaluated the safety and efficacy of a novel VR therapy solution for distraction in the context of bone marrow biopsy. Methods: Bliss is a VR software with 4 imaginary interactive environments in 3 dimensions with binaural sound (head-mounted display). Efficacy regarding pain intensity was evaluated using a visual analog scale (VAS; score from 0 to 10) immediately after the biopsy. Secondary end points were anxiety and tolerance. Modified intention-to-treat analysis was performed. Results: Overall, 126 patients with previously documented untreated or suspected malignant hemopathy between September 6, 2018, and May 18, 2020, were randomly assigned in a 1:1 ratio to receive pain prevention with a mixture of nitrous oxide/oxygen (MEOPA; n=63) or VR (n=63) before and during the bone marrow biopsy. We excluded 8 patients from the final analysis (3 in the MEOPA group and 5 in the VR group). All patients received local anesthesia (lidocaine) before biopsy. Follow-up was limited to 1 month after the biopsy. Participants' median age was 65.5 (range 18-87) years, and 54.2\% (64/118) of patients were male. The average pain intensity was 3.5 (SD 2.6, 95\% CI --1.6 to 8.6) for the MEOPA group and 3.0 (SD 2.4, 95\% CI --1.7 to 7.7) for the VR group, without any significant differences in age, sex, center, and hemopathy (P=.26). Concerning anxiety, 67.5\% (79/117; fear of pain questionnaire) of the patients were afraid before the biopsy, and anxiety scores were moderate to very high in 26.3\% (30/114; revised Spielberger State-Trait Anxiety Inventory questionnaire) of the patients before the biopsy and 9.0\% (10/114) after the biopsy for all patients, without a significant difference between the 2 groups (P=.83). Immersion in VR was well tolerated by the majority (54/57, 95\%) of patients in the VR group. Conclusions: The intensity of pain did not significantly differ between both arms. VR was well tolerated, and the satisfaction of patients, nurses, and physicians was very high. VR could be an alternative treatment in case of contraindication or intolerance to MEOPA. Trial Registration: ClinicalTrials.gov NCT03483194; https://clinicaltrials.gov/ct2/show/NCT03483194 ",
doi="10.2196/38619",
url="https://www.jmir.org/2023/1/e38619",
url="http://www.ncbi.nlm.nih.gov/pubmed/36790852"
}


@Article{info:doi/10.2196/41812,
author="Daugherty, C. Emily
and Mascia, Anthony
and Zhang, Yong
and Lee, Eunsin
and Xiao, Zhiyan
and Sertorio, Mathieu
and Woo, Jennifer
and McCann, Claire
and Russell, Kenneth
and Levine, Lisa
and Sharma, Ricky
and Khuntia, Deepak
and Bradley, Jeffrey
and Simone II, B. Charles
and Perentesis, John
and Breneman, John",
title="FLASH Radiotherapy for the Treatment of Symptomatic Bone Metastases (FAST-01): Protocol for the First Prospective Feasibility Study",
journal="JMIR Res Protoc",
year="2023",
month="Jan",
day="5",
volume="12",
pages="e41812",
keywords="bone metastases",
keywords="FLASH",
keywords="proton therapy",
keywords="external beam radiotherapy",
keywords="palliative radiotherapy",
keywords="extremities",
keywords="pain relief",
keywords="ultra-high dose rate",
keywords="radiation therapy",
keywords="cancer treatment",
keywords="toxicity",
keywords="oncology",
keywords="radiotherapy",
abstract="Background: In preclinical studies, FLASH therapy, in which radiation delivered at ultrahigh dose rates of ?40 Gy per second, has been shown to cause less injury to normal tissues than radiotherapy delivered at conventional dose rates. This paper describes the protocol for the first-in-human clinical investigation of proton FLASH therapy. Objective: FAST-01 is a prospective, single-center trial designed to assess the workflow feasibility, toxicity, and efficacy of FLASH therapy for the treatment of painful bone metastases in the extremities. Methods: Following informed consent, 10 subjects aged ?18 years with up to 3 painful bone metastases in the extremities (excluding the feet, hands, and wrists) will be enrolled. A treatment field selected from a predefined library of plans with fixed field sizes (from 7.5 cm {\texttimes} 7.5 cm up to 7.5 cm {\texttimes} 20 cm) will be used for treatment. Subjects will receive 8 Gy of radiation in a single fraction---a well-established palliative regimen evaluated in prior investigations using conventional dose rate photon radiotherapy. A FLASH-enabled Varian ProBeam proton therapy unit will be used to deliver treatment to the target volume at a dose rate of ?40 Gy per second, using the plateau (transmission) portion of the proton beam. After treatment, subjects will be assessed for pain response as well as any adverse effects of FLASH radiation. The primary end points include assessing the workflow feasibility and toxicity of FLASH treatment. The secondary end point is pain response at the treated site(s), as measured by patient-reported pain scores, the use of pain medication, and any flare in bone pain after treatment. The results will be compared to those reported historically for conventional dose rate photon radiotherapy, using the same radiation dose and fractionation. Results: FAST-01 opened to enrollment on November 3, 2020. Initial results are expected to be published in 2022. Conclusions: The results of this investigation will contribute to further developing and optimizing the FLASH-enabled ProBeam proton therapy system workflow. The pain response and toxicity data acquired in our study will provide a greater understanding of FLASH treatment effects on tumor responses and normal tissue toxicities, and they will inform future FLASH trial designs. Trial Registration: : ClinicalTrials.gov NCT04592887; http://clinicaltrials.gov/ct2/show/NCT04592887 International Registered Report Identifier (IRRID): DERR1-10.2196/41812 ",
doi="10.2196/41812",
url="https://www.researchprotocols.org/2023/1/e41812",
url="http://www.ncbi.nlm.nih.gov/pubmed/36206189"
}


@Article{info:doi/10.2196/33221,
author="Soret, Lou
and Gendron, Nicolas
and Rivet, Nadia
and Chocron, Richard
and Macraigne, Laure
and Clausse, Darless
and Cholley, Bernard
and Gaussem, Pascale
and Smadja, M. David
and Darnige, Luc",
title="Pain Assessment Using Virtual Reality Facemask During Bone Marrow Aspiration: Prospective Study Including Propensity-Matched Analysis",
journal="JMIR Serious Games",
year="2022",
month="Oct",
day="12",
volume="10",
number="4",
pages="e33221",
keywords="bone marrow aspiration",
keywords="pain assessment",
keywords="virtual reality facemask",
keywords="anxiety",
keywords="hematology",
keywords="virtual reality",
keywords="VR",
keywords="haematology",
keywords="haematological",
keywords="hematological",
keywords="hematological disorder",
keywords="pain",
keywords="pain scale",
keywords="medical procedure",
keywords="bone marrow",
keywords="facemask",
keywords="diagnosis",
keywords="monitoring",
abstract="Background: Bone marrow aspiration (BMA) is a medical procedure necessary to the diagnosis and monitoring of patients with hematological or nonhematological disorders. This procedure is considered painful, and patients are generally anxious before and during BMA. Objective: This study assesses the effect of immersive virtual reality on pain during BMA. Methods: This observational prospective and monocentric study enrolled 105 consecutive patients who underwent sternal BMA with lidocaine anesthesia. The study was carried on during 2 periods. First, virtual reality facemask (VRF) was proposed to all patients in the absence of exclusion criteria. During the second period, BMA was performed without the VRF. For all patients, pain intensity after the procedure was assessed using a 10-point numerical pain rating scale (NPRS). All analyses were performed on propensity score--matched cohort (with or without VRF) to evaluate efficacy on NRPS levels. Results: The final matched cohort included 12 patients in the VRF group and 24 in the control group. No difference in anxiety level before BMA evaluated by the patient and by the operator was observed between groups (P=.71 and .42 respectively). No difference of NPRS was observed using VRF when compared to control group (median NPRS 3.8, IQR 2.0-6.3 vs 3.0, IQR 1.9-3.0, respectively; P=.09). Conclusions: Our study did not prove the efficacy of VRF to reduce pain during BMA. ",
doi="10.2196/33221",
url="https://games.jmir.org/2022/4/e33221",
url="http://www.ncbi.nlm.nih.gov/pubmed/36222814"
}


@Article{info:doi/10.2196/34887,
author="Bromer, Duch Frederik
and Brent, Bo Mikkel
and Thomsen, Skovhus Jesper
and Br{\"u}el, Annemarie",
title="Drill-Hole Bone Defects in Animal Models of Bone Healing: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2022",
month="Jul",
day="18",
volume="11",
number="7",
pages="e34887",
keywords="systematic review",
keywords="animal models",
keywords="preclinical",
keywords="bone defect",
keywords="drill-hole",
keywords="fracture model",
keywords="bone",
keywords="bone healing",
keywords="protocol",
keywords="bone fracture",
keywords="animal model",
keywords="healing",
keywords="laboratory",
keywords="laboratory animal",
abstract="Background: Bone fractures are common conditions of the musculoskeletal system. Several animal models of bone fractures have been established to help elucidate the complex process of bone healing. In the last decades, drill-hole bone defects have emerged as a method to study bone healing. Animal models of drill-hole defects are easy to standardize and do not require external fixation of the bone. However, current studies of drill-hole bone defects lack detailed descriptions of techniques and interstudy standardization. Objective: This systematic review aims to present a detailed description of the different methods used to induce drill-hole bone defects in long bones of laboratory animals and to provide a comprehensive overview of their methodology and potential for investigation of bone healing. Methods: A systematic search of PubMed and Embase will be performed of abstracts containing variations of the following four keywords: ``long bone,'' ``drill-hole,'' ``regeneration,'' and ``animal model.'' Abstract screening and full-text screening will be performed independently by 2 reviewers, and data will be extracted to a predesigned extraction protocol. The primary outcome of the included studies is the technique used to create the drill-hole bone defect, and secondary outcomes are any measurements or analyses of bone defect and regeneration. A narrative synthesis will be used to present the primary outcome, while information on secondary outcomes will be displayed graphically. The study protocol follows the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-analysis Protocols) guidelines. Results: Abstract and full-text screening is ongoing and is expected to be completed by October 2022. Data extraction will commence immediately after, and the manuscript is expected to be completed by December 2023. The systematic review will follow the PRISMA statement. Conclusions: The strength of this systematic review is that it provides a comprehensive methodological overview of the different drill-hole methods and their advantages and disadvantages. This will assist researchers in choosing which model to use when studying different aspects of bone healing. Trial Registration: International Prospective Register of Systematic Reviews CRD42020213076; https://tinyurl.com/bp56wdwe International Registered Report Identifier (IRRID): PRR1-10.2196/34887 ",
doi="10.2196/34887",
url="https://www.researchprotocols.org/2022/7/e34887",
url="http://www.ncbi.nlm.nih.gov/pubmed/35849443"
}


@Article{info:doi/10.2196/30131,
author="Ilesanmi-Oyelere, Lilian Bolaji
and Roy, C. Nicole
and Kruger, C. Marlena",
title="Modulation of Bone and Joint Biomarkers, Gut Microbiota, and Inflammation Status by Synbiotic Supplementation and Weight-Bearing Exercise: Human Study Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Oct",
day="26",
volume="10",
number="10",
pages="e30131",
keywords="synbiotic (prebiotic+probiotic)",
keywords="weight-bearing exercise",
keywords="gut microbiota",
keywords="inflammation",
keywords="BMD",
keywords="cytokines",
keywords="bone and joint biomarkers",
abstract="Background: There is strong evidence suggesting that prebiotics and probiotics regulate gut microbiota, reducing inflammation and thereby potentially improving bone health status. Similarly, mechanistic evidence suggests that either low-impact or high-impact weight-bearing exercises improve body composition and consequently increase bone mineral density in individuals with osteoporosis and osteoarthritis. Objective: This study aims to investigate the effects of a synbiotic (probiotic+prebiotic) supplementation, an exercise intervention, or a combination of both on gut microbiota, inflammation, and bone biomarkers in postmenopausal women. Methods: A total of 160 postmenopausal women from New Zealand will be recruited and randomized to one of four interventions or treatments for 12 weeks: control, synbiotic supplementation, exercise intervention, or synbiotic supplementation and exercise. The primary outcome measure is the bone and joint biomarkers at baseline and week 12, whereas the gut microbiota profile and inflammatory cytokine measurements will serve as the secondary outcome measures at baseline and week 12. Baseline data and exercise history will be used to assess, allocate, and stratify participants into treatment measures. Results: Recruitment of participants will begin in September 2021, and the anticipated completion date is June 2022. Conclusions: To the best of our knowledge, this will be the first randomized controlled trial to analyze the effects of both a synbiotic supplement and an exercise intervention in postmenopausal women. On the basis of the results obtained, a combination of synbiotic supplements and exercise might serve as a noninvasive approach to manage and/or improve body composition and bone health in postmenopausal women. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000998943p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380336\&isClinicalTrial=False ",
doi="10.2196/30131",
url="https://www.researchprotocols.org/2021/10/e30131",
url="http://www.ncbi.nlm.nih.gov/pubmed/34698648"
}


@Article{info:doi/10.2196/18777,
author="Smith, Cassandra
and Lin, Xuzhu
and Scott, David
and Brennan-Speranza, C. Tara
and Al Saedi, Ahmed
and Moreno-Asso, Alba
and Woessner, Mary
and Bani Hassan, Ebrahim
and Eynon, Nir
and Duque, Gustavo
and Levinger, Itamar",
title="Uncovering the Bone-Muscle Interaction and Its Implications for the Health and Function of Older Adults (the Wellderly Project): Protocol for a Randomized Controlled Crossover Trial",
journal="JMIR Res Protoc",
year="2021",
month="Apr",
day="9",
volume="10",
number="4",
pages="e18777",
keywords="acute exercise",
keywords="clinical trial",
keywords="bone",
keywords="adult",
keywords="aging",
keywords="osteocalcin",
keywords="muscles",
keywords="sarcopenia",
keywords="progenitor cells",
keywords="stem cells",
abstract="Background: Bone and muscle are closely linked anatomically, biochemically, and metabolically. Acute exercise affects both bone and muscle, implying a crosstalk between the two systems. However, how these two systems communicate is still largely unknown. We will explore the role of undercarboxylated osteocalcin (ucOC) in this crosstalk. ucOC is involved in glucose metabolism and has a potential role in muscle maintenance and metabolism. Objective: The proposed trial will determine if circulating ucOC levels in older adults at baseline and following acute exercise are associated with parameters of muscle function and if the ucOC response to exercise varies between older adults with low muscle quality and those with normal or high muscle quality. Methods: A total of 54 men and women aged 60 years or older with no history of diabetes and warfarin and vitamin K use will be recruited. Screening tests will be performed, including those for functional, anthropometric, and clinical presentation. On the basis of muscle quality, a combined equation of lean mass (leg appendicular skeletal muscle mass in kg) and strength (leg press; one-repetition maximum), participants will be stratified into a high or low muscle function group and randomized into the controlled crossover acute intervention. Three visits will be performed approximately 7 days apart, and acute aerobic exercise, acute resistance exercise, and a control session (rest) will be completed in any order. Our primary outcome for this study is the effect of acute exercise on ucOC in older adults with low muscle function and those with high muscle function. Results: The trial is active and ongoing. Recruitment began in February 2018, and 38 participants have completed the study as of May 26, 2019. Conclusions: This study will provide novel insights into bone and muscle crosstalk in older adults, potentially identifying new clinical biomarkers and mechanistic targets for drug treatments for sarcopenia and other related musculoskeletal conditions. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12618001756213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375925. International Registered Report Identifier (IRRID): DERR1-10.2196/18777 ",
doi="10.2196/18777",
url="https://www.researchprotocols.org/2021/4/e18777",
url="http://www.ncbi.nlm.nih.gov/pubmed/33835038"
}


@Article{info:doi/10.2196/25607,
author="Stephens, Alastair
and Rudd, Hannah
and Stephens, Emilia
and Ward, Jayne",
title="Secondary Prevention of Hip Fragility Fractures During the COVID-19 Pandemic: Service Evaluation of ``MRS BAD BONES''",
journal="JMIR Aging",
year="2020",
month="Dec",
day="22",
volume="3",
number="2",
pages="e25607",
keywords="osteoporosis",
keywords="fragility fracture",
keywords="guideline",
keywords="mnemonic",
keywords="acronym",
keywords="COVID-19",
keywords="bone",
keywords="morbidity",
keywords="mortality",
keywords="fracture",
keywords="elderly",
keywords="older adults",
keywords="geriatrics",
keywords="audit",
keywords="prevention",
abstract="Background: Management of osteoporosis is an important consideration for patients with femoral neck fractures due to the morbidity and mortality it poses. The input of orthogeriatric teams is invaluable in coordinating secondary fragility fracture prevention. The COVID-19 pandemic resulted in the rapid restructuring of health care teams and led to the redeployment of orthogeriatricians. Objective: This study aimed to determine the impact COVID-19 had on the secondary prevention of fragility fractures among patients with femoral neck fractures, and to optimize management in this population. Methods: A retrospective audit was conducted of patients with femoral neck fractures before and after the lockdown in response to the COVID-19 pandemic in the United Kingdom. A reaudit was conducted following the development of our new mnemonic, ``MRS BAD BONES,'' which addressed key factors in the assessment and management of osteoporosis: medication review, rheumatology/renal advice, smoking cessation; blood tests, alcohol limits, DEXA (dual energy X-ray absorptiometry) scan; bone-sparing medications, orthogeriatric review, nutrition, exercise, supplements. The Fisher exact test was used for comparison analyses between each phase. Results: Data for 50 patients were available in each phase. The orthogeriatric team reviewed 88\% (n=44) of patients prelockdown, which fell to 0\% due to redeployment, before recovering to 38\% (n=19) in the postintervention period. The lockdown brought a significant drop in the prescription of vitamin D/calcium supplements from 81.6\% (n=40) to 58.0\% (n=29) (P=.02); of bone-sparing medications from 60.7\% (n=17) to 18.2\% (n=4) (P=.004), and DEXA scan requests from 40.1\% (n=9) to 3.6\% (n=1) (P=.003). Following the implementation of our mnemonic, there was a significant increase in the prescription of vitamin D/calcium supplements to 85.7\% (n=42) (P=.003), bone-sparing medications to 72.4\% (n=21) (P<.001), and DEXA scan requests to 60\% (n=12) (P<.001). Conclusions: The redeployment of the orthogeriatric team, due to the COVID-19 pandemic, impacted the secondary prevention of fragility fractures in the study population. The ``MRS BAD BONES'' mnemonic significantly improved management and could be used in a wider setting. ",
doi="10.2196/25607",
url="https://aging.jmir.org/2020/2/e25607",
url="http://www.ncbi.nlm.nih.gov/pubmed/33326412"
}


@Article{info:doi/10.2196/22550,
author="Almog, Adar Yasmeen
and Rai, Angshu
and Zhang, Patrick
and Moulaison, Amanda
and Powell, Ross
and Mishra, Anirban
and Weinberg, Kerry
and Hamilton, Celeste
and Oates, Mary
and McCloskey, Eugene
and Cummings, R. Steven",
title="Deep Learning With Electronic Health Records for Short-Term Fracture Risk Identification: Crystal Bone Algorithm Development and Validation",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="16",
volume="22",
number="10",
pages="e22550",
keywords="fracture",
keywords="bone",
keywords="osteoporosis",
keywords="low bone mass",
keywords="prediction",
keywords="natural language processing",
keywords="NLP",
keywords="machine learning",
keywords="deep learning",
keywords="artificial intelligence",
keywords="AI",
keywords="electronic health record",
keywords="EHR",
abstract="Background: Fractures as a result of osteoporosis and low bone mass are common and give rise to significant clinical, personal, and economic burden. Even after a fracture occurs, high fracture risk remains widely underdiagnosed and undertreated. Common fracture risk assessment tools utilize a subset of clinical risk factors for prediction, and often require manual data entry. Furthermore, these tools predict risk over the long term and do not explicitly provide short-term risk estimates necessary to identify patients likely to experience a fracture in the next 1-2 years. Objective: The goal of this study was to develop and evaluate an algorithm for the identification of patients at risk of fracture in a subsequent 1- to 2-year period. In order to address the aforementioned limitations of current prediction tools, this approach focused on a short-term timeframe, automated data entry, and the use of longitudinal data to inform the predictions. Methods: Using retrospective electronic health record data from over 1,000,000 patients, we developed Crystal Bone, an algorithm that applies machine learning techniques from natural language processing to the temporal nature of patient histories to generate short-term fracture risk predictions. Similar to how language models predict the next word in a given sentence or the topic of a document, Crystal Bone predicts whether a patient's future trajectory might contain a fracture event, or whether the signature of the patient's journey is similar to that of a typical future fracture patient. A holdout set with 192,590 patients was used to validate accuracy. Experimental baseline models and human-level performance were used for comparison. Results: The model accurately predicted 1- to 2-year fracture risk for patients aged over 50 years (area under the receiver operating characteristics curve [AUROC] 0.81). These algorithms outperformed the experimental baselines (AUROC 0.67) and showed meaningful improvements when compared to retrospective approximation of human-level performance by correctly identifying 9649 of 13,765 (70\%) at-risk patients who did not receive any preventative bone-health-related medical interventions from their physicians. Conclusions: These findings indicate that it is possible to use a patient's unique medical history as it changes over time to predict the risk of short-term fracture. Validating and applying such a tool within the health care system could enable automated and widespread prediction of this risk and may help with identification of patients at very high risk of fracture. ",
doi="10.2196/22550",
url="http://www.jmir.org/2020/10/e22550/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32956069"
}


@Article{info:doi/10.2196/18846,
author="Dallora, Luiza Ana
and Kvist, Ola
and Berglund, Sanmartin Johan
and Ruiz, Diaz Sandra
and Boldt, Martin
and Flodmark, Carl-Erik
and Anderberg, Peter",
title="Chronological Age Assessment in Young Individuals Using Bone Age Assessment Staging and Nonradiological Aspects: Machine Learning Multifactorial Approach",
journal="JMIR Med Inform",
year="2020",
month="Sep",
day="21",
volume="8",
number="9",
pages="e18846",
keywords="chronological age assessment",
keywords="bone age",
keywords="skeletal maturity",
keywords="machine learning",
keywords="magnetic resonance imaging",
keywords="radius",
keywords="distal tibia",
keywords="proximal tibia",
keywords="distal femur",
keywords="calcaneus",
abstract="Background: Bone age assessment (BAA) is used in numerous pediatric clinical settings as well as in legal settings when entities need an estimate of chronological age (CA) when valid documents are lacking. The latter case presents itself as critical as the law is harsher for adults and granted rights along with imputability changes drastically if the individual is a minor. Traditional BAA methods have drawbacks such as exposure of minors to radiation, they do not consider factors that might affect the bone age, and they mostly focus on a single region. Given the critical scenarios in which BAA can affect the lives of young individuals, it is important to focus on the drawbacks of the traditional methods and investigate the potential of estimating CA through BAA. Objective: This study aims to investigate CA estimation through BAA in young individuals aged 14-21 years with machine learning methods, addressing the drawbacks of research using magnetic resonance imaging (MRI), assessment of multiple regions of interest, and other factors that may affect the bone age. Methods: MRI examinations of the radius, distal tibia, proximal tibia, distal femur, and calcaneus were performed on 465 men and 473 women (aged 14-21 years). Measures of weight and height were taken from the subjects, and a questionnaire was given for additional information (self-assessed Tanner Scale, physical activity level, parents' origin, and type of residence during upbringing). Two pediatric radiologists independently assessed the MRI images to evaluate their stage of bone development (blinded to age, gender, and each other). All the gathered information was used in training machine learning models for CA estimation and minor versus adult classification (threshold of 18 years). Different machine learning methods were investigated. Results: The minor versus adult classification produced accuracies of 0.90 and 0.84 for male and female subjects, respectively, with high recalls for the classification of minors. The CA estimation for the 8 age groups (aged 14-21 years) achieved mean absolute errors of 0.95 years and 1.24 years for male and female subjects, respectively. However, for the latter, a lower error occurred only for the ages of 14 and 15 years. Conclusions: This study investigates CA estimation through BAA using machine learning methods in 2 ways: minor versus adult classification and CA estimation in 8 age groups (aged 14-21 years), while addressing the drawbacks in the research on BAA. The first achieved good results; however, for the second case, the BAA was not precise enough for the classification. ",
doi="10.2196/18846",
url="http://medinform.jmir.org/2020/9/e18846/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32955457"
}


@Article{info:doi/10.2196/15963,
author="Wu, Yi-Ying
and Huang, Tzu-Chuan
and Ye, Ren-Hua
and Fang, Wen-Hui
and Lai, Shiue-Wei
and Chang, Ping-Ying
and Liu, Wei-Nung
and Kuo, Tai-Yu
and Lee, Cho-Hao
and Tsai, Wen-Chiuan
and Lin, Chin",
title="A Hematologist-Level Deep Learning Algorithm (BMSNet) for Assessing the Morphologies of Single Nuclear Balls in Bone Marrow Smears: Algorithm Development",
journal="JMIR Med Inform",
year="2020",
month="Apr",
day="8",
volume="8",
number="4",
pages="e15963",
keywords="artificial intelligence",
keywords="bone marrow examination",
keywords="leukemia",
keywords="myelodysplastic syndrome",
keywords="deep learning",
abstract="Background: Bone marrow aspiration and biopsy remain the gold standard for the diagnosis of hematological diseases despite the development of flow cytometry (FCM) and molecular and gene analyses. However, the interpretation of the results is laborious and operator dependent. Furthermore, the obtained results exhibit inter- and intravariations among specialists. Therefore, it is important to develop a more objective and automated analysis system. Several deep learning models have been developed and applied in medical image analysis but not in the field of hematological histology, especially for bone marrow smear applications. Objective: The aim of this study was to develop a deep learning model (BMSNet) for assisting hematologists in the interpretation of bone marrow smears for faster diagnosis and disease monitoring. Methods: From January 1, 2016, to December 31, 2018, 122 bone marrow smears were photographed and divided into a development cohort (N=42), a validation cohort (N=70), and a competition cohort (N=10). The development cohort included 17,319 annotated cells from 291 high-resolution photos. In total, 20 photos were taken for each patient in the validation cohort and the competition cohort. This study included eight annotation categories: erythroid, blasts, myeloid, lymphoid, plasma cells, monocyte, megakaryocyte, and unable to identify. BMSNet is a convolutional neural network with the YOLO v3 architecture, which detects and classifies single cells in a single model. Six visiting staff members participated in a human-machine competition, and the results from the FCM were regarded as the ground truth. Results: In the development cohort, according to 6-fold cross-validation, the average precision of the bounding box prediction without consideration of the classification is 67.4\%. After removing the bounding box prediction error, the precision and recall of BMSNet were similar to those of the hematologists in most categories. In detecting more than 5\% of blasts in the validation cohort, the area under the curve (AUC) of BMSNet (0.948) was higher than the AUC of the hematologists (0.929) but lower than the AUC of the pathologists (0.985). In detecting more than 20\% of blasts, the AUCs of the hematologists (0.981) and pathologists (0.980) were similar and were higher than the AUC of BMSNet (0.942). Further analysis showed that the performance difference could be attributed to the myelodysplastic syndrome cases. In the competition cohort, the mean value of the correlations between BMSNet and FCM was 0.960, and the mean values of the correlations between the visiting staff and FCM ranged between 0.952 and 0.990. Conclusions: Our deep learning model can assist hematologists in interpreting bone marrow smears by facilitating and accelerating the detection of hematopoietic cells. However, a detailed morphological interpretation still requires trained hematologists. ",
doi="10.2196/15963",
url="http://medinform.jmir.org/2020/4/e15963/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32267237"
}


@Article{info:doi/10.2196/formative.9435,
author="Subasinghe, Kokila Asvini
and Garland, Marie Suzanne
and Gorelik, Alexandra
and Tay, Ilona
and Wark, Dennis John",
title="Using Mobile Technology to Improve Bone-Related Lifestyle Risk Factors in Young Women With Low Bone Mineral Density: Feasibility Randomized Controlled Trial",
journal="JMIR Form Res",
year="2019",
month="Feb",
day="25",
volume="3",
number="1",
pages="e9435",
keywords="behavior therapy methods",
keywords="mobile phones",
keywords="health behavior",
keywords="primary prevention methods",
keywords="self-care methods",
abstract="Background: Poor bone health in adolescent and young adult females is a growing concern. Given the widespread use of mobile phones in this population, mobile health (mHealth) interventions may help improve health behaviors related to bone health in young women. Objective: The goal of the study was to determine the acceptability and feasibility of an mHealth intervention called Tap4Bone in improving health behaviors associated with the risk of osteoporosis in young women. Methods: The Tap4Bone mHealth intervention comprised the use of mobile phone apps, short messaging service (text messaging), and Web emails to encourage health behavior changes. The education group received osteoporosis prevention education leaflets. Changes in the bone health--related behaviors exercise, smoking, and calcium intake were assessed. User experiences and acceptance of the app were collected through focus group interviews. Results: A total of 35 (22 completed, mean age 23.1 [SD 1.8] years) were randomized to either the mobile phone (intervention n=18) or education (control n=17) group. Although there were trends toward improvement in calcium intake, sports activity, and smoking behaviors in the mHealth intervention group compared to the education group, these were not statistically significant. Conclusions: The Tap4Bone mHealth intervention was shown to be acceptable and feasible in subsets of the participants. The intervention should be improved upon using participant feedback to improve functionality. Findings from this study may aid in the development and modification of health care apps to reduce participant attrition. ",
doi="10.2196/formative.9435",
url="http://formative.jmir.org/2019/1/e9435/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30801253"
}


@Article{info:doi/10.2196/ijmr.8555,
author="Suzuki, Teppei
and Shimoda, Tomoko
and Takahashi, Noriko
and Tsutsumi, Kaori
and Samukawa, Mina
and Yoshimura, Sadako
and Ogasawara, Katsuhiko",
title="Factors Affecting Bone Mineral Density Among Snowy Region Residents in Japan: Analysis Using Multiple Linear Regression and Bayesian Network Model",
journal="Interact J Med Res",
year="2018",
month="May",
day="22",
volume="7",
number="1",
pages="e10",
keywords="health care promotion",
keywords="Bayesian network",
keywords="health behavior change",
abstract="Background: As the onset of osteoporosis leads to reduced activities of daily living and may result in patients being bedridden, efforts to prevent decreased bone density are necessary. Various studies on the relationship between sex, age, nutrients, and exercise habits and bone mineral density have been conducted to date. However, for snowy region residents, the magnitude of influence of various factors affecting bone mineral density and the influence level have not been clarified. Objective: This study aimed to clarify the degree of influence and factors influencing bone mineral density based on survey results on health conditions and lifestyle habits in heavy snow areas. Methods: A total of 354 citizens who visited a drugstore in the target area were included in a study that included using the brief-type self-administered diet history questionnaire on lifestyle and exercise habits. Height, weight, body composition, and bone densitometer values were analyzed using multiple regression to calculate their association with bone mineral density. In addition, a Bayesian network model was used to determine the influence level of each factor as a conditional probability. Results: Multiple regression analysis revealed that age, sex, fracture, and calcium intake significantly influenced bone mineral density. In addition, the result of Bayesian network analysis suggested that age and sex affected bone mineral density, whereas nutrients and exercise habits might not have a direct impact. However, calcium intake and the T-score were significant factors affecting the presence or absence of fracture experiences, suggesting that adequate calcium intake is essential for preventing fractures. Conclusions: In the multiple regression analysis, age, sex, fracture, and calcium intake were selected as factors; however, in the Bayesian analysis, only age and sex affected bone mineral density while nutrients did not. In addition, the fact that calcium intake and the T-score were shown to affect bone fracture history suggests that calcium intake is an important measure that can prevent bone fractures. Overall, these results suggest that measures such as ensuring a bone fracture--free environment and providing nutritional advice for calcium intake can be effective in preventing bone loss. ",
doi="10.2196/ijmr.8555",
url="http://www.i-jmr.org/2018/1/e10/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29789280"
}


@Article{info:doi/10.2196/resprot.4585,
author="Domaschenz, Renae
and Vlahovich, Nicole
and Keogh, Justin
and Compton, Stacey
and Hughes, C. David
and ",
title="Exercise-Induced Tendon and Bone Injury in Recreational Runners: A Test-Retest Reliability Study",
journal="JMIR Res Protoc",
year="2015",
month="Oct",
day="07",
volume="4",
number="4",
pages="e117",
keywords="exercise",
keywords="genetics",
keywords="injury",
keywords="reliability",
keywords="survey",
abstract="Background: Long-distance runners are prone to injuries including Achilles tendinopathy and medial tibial stress syndrome. We have developed an Internet comprehensive self-report questionnaire examining the medical history, injury history, and running habits of adult recreational runners. Objective: The objective of the study was to evaluate two alternative forms of test-retest reliability of a comprehensive self-report Internet questionnaire retrospectively examining the medical history, injury history, and running habits among a sample of adult recreational runners.  This will contribute to the broad aims of a wider study investigating genetics and running injury. Methods: Invitations to complete an Internet questionnaire were sent by email to a convenience pilot population (test group 1). Inclusion criteria required participants to be a recreational runner age 18 or over, who ran over 15 km per week on a consistent basis. The survey questions addressed regular running habits and any injuries (including signs, symptoms, and diagnosis) of the lower limbs that resulted in discontinuation of running for a period of 2 consecutive weeks or more, within the last 2 years. Questions also addressed general health, age, sex, height, weight, and ethnic background. Participants were then asked to repeat the survey using the Internet platform again after 10-14 days. Following analysis of test group 1, we soft-launched the survey to a larger population (test group 2), through a local running club of 900 members via email platform. The same inclusion criteria applied, however, participants were asked to complete a repeat of the survey by telephone interview after 7-10 days. Selected key questions, important to clarify inclusion or exclusion from the wider genetics study, were selected to evaluate test-retest reliability. Reliability was quantified using the kappa coefficient for categorical data. Results:                         In response to the invitation, 28 participants accessed the survey from test group 1, 23 completed the Internet survey on the first occasion, and 20 completed the Internet retest within 10-21 days. Test-retest reliability scored moderate to almost perfect (kappa=.41 to .99) for 19/19 of the key questions analyzed. Following the invitation, 122 participants accessed the survey from test group 2, 101 completed the Internet survey on the first occasion, and 50 were randomly selected and contacted by email inviting them to repeat the survey by telephone interview. There were 33 participants that consented to the telephone interview and 30 completed the questionnaire within 7-10 days. Test-retest reliability scored moderate to almost perfect for 18/19 (kappa=.41 to .99) and slight for 1/19 of the key questions analyzed.                     ",
doi="10.2196/resprot.4585",
url="http://www.researchprotocols.org/2002/4/e117/",
url="http://www.ncbi.nlm.nih.gov/pubmed/36262008"
}