Shawn C. Roll PhD, OTR/L, RMSKS, FAOTA, FAIUM

Objectives. Stiff shoulder, including primary and secondary types, poses diagnostic challenges due to vague definitions and criteria. This study evaluates the diagnostic potential of ultrasound-measured axillary recess (AR) thickness in shoulder stiffness.

Designs. In this cross-sectional study, 35 patients with unilateral shoulder stiffness were assessed. AR thickness was measured using high-resolution ultrasound. Parameters like passive range of motion (PROM), Numerical Rating Scale (NRS), and Constant-Murley (CM) score were evaluated to find correlations with AR thickness.

Results. The average age was 50.7 years, and mean BMI was 22.7. AR thickness in stiff shoulders (average 3.19 mm) was significantly higher than in unaffected shoulders (average 1.93 mm, p < 0.001). A cutoff of 3.0 mm for AR thickness yielded 73.3% sensitivity and 84.6% specificity for primary stiffness; 2.6 mm cutoff resulted in 57.9% sensitivity and 88.2% specificity for secondary stiffness. Significant correlations were found between AR thickness and PROM, especially in shoulder external rotation and extension.

Conclusion. AR thickness measured by ultrasound might serve as a valuable diagnostic and evaluation parameter in shoulder stiffness.

Objective. To describe the state of W&I occupational therapy practice and to identify challenges and opportunities in this specialty practice area.

Design. Cross-sectional survey conducted June 12 to July 17, 2020.

Setting. Online survey distributed through direct email invitations and online platforms (i.e., CommunOT, LinkedIn).

Participants. One hundred twenty occupational therapy practitioners who had worked in W&I within the most recent 5 yr.

Outcomes and Measures. We used 30 multiple-choice, Likert-scale, and free-response questions across three topics: (1) training, resources, and research; (2) challenges and barriers; and (3) opportunities.

Results. Most respondents were occupational therapy practitioners working in clinical settings with >5 yr of experience; 29.2% identified as male. The most frequently provided services were ergonomic consultation and worksite evaluation; clinic-based W&I services were less frequently provided. Workplace injury prevention, management of psychosocial issues, and employee wellness programs were ranked as the top opportunities for occupational therapy in W&I. A shortage of accessible training and resources to support W&I practice was found, particularly mentoring and occupational therapy–focused research evidence. Maintaining referrals, competition from other professions, and limited support from professional organizations were key challenges.

Conclusions and Relevance. This study illustrates the evolution of W&I occupational therapy practice and highlights an urgent need for increased professional recognition and educational support to maintain occupational therapy’s presence in this practice area.

Carpal tunnel syndrome (CTS) is highly prevalent, resulting in decreased function and increased need for costly healthcare services. External wrist ratio (depth/width >0.70) is a strong predictor of the development of CTS and has been suggested to be a proxy for internal carpal tunnel (CT) shape. Conversely, sonography can more directly evaluate CT shape. The purpose of our study was to explore the relationship between wrist ratio and sonographic CT measurements to (1) evaluate the reliability of sonographic CT measurements and (2) explore how external wrist measures relate to anthropometric features of the CT. We used sonographic imaging on a sample of healthy participants (n = 226) to measure CT cross-sectional area, depth, width, and depth/width ratio. We conducted exploratory correlation and regression analyses to identify relationships of these measures with external wrist ratio. Reliability for dominant and nondominant sonographic CT measures ranged from good to excellent (0.79–0.95). Despite a moderate correlation between CT width and depth and their external wrist counterparts (0.33–0.41, p < 0.001), wrist ratio and CT ratio demonstrated weak to no correlation (dominant: r = 0.12, p = 0.053; nondominant: r = 0.20, p = 0.002) and the mean CT ratio was far lower than the mean wrist ratio (0.45 vs. 0.71 bilaterally). Supporting this, we observed several key differences in the relationship between external wrist measures compared to corresponding CT measures. Additionally, regression analyses combining participant factors and CT measurements produced models accounting for less than 15% of the variability in external wrist ratio (linear models) or correctly predicting less than 68% of wrist ratio-based risk categorization (logistic models). Overall, among healthy young adults, wrist shape is not an adequate proxy for CT shape.

Objective. Burnout in sonographers is a prevalent and complex professional hazard associated with poorer quality of work life, productivity, and patient outcomes. This study aimed to understand the prevalence of and work systems factors associated with burnout among a large sample of sonographers.

Materials and Methods. Research study registry participants (n = 3659) were invited to complete a follow-up survey about personal and work environment factors, including work hours, break time, coworker and supervisor support, and job satisfaction, overall health, and sleep quality. The Copenhagen Burnout Inventory assessed personal, work-related, and client burnout. Simple and multiple linear regressions were used to identify work systems factors associated with burnout.

Results. Of 1389 respondents, over half reported moderate-to-severe personal and work-related burnout, while one-quarter reported moderate-to-severe client burnout. Higher work-related burnout was associated with younger age, working in the Western United States, working full-time, taking fewer weekly break hours, poorer overall health and sleep quality, and lower supervisor support and job satisfaction. Client burnout was associated with poorer sleep quality and lower job satisfaction.

Conclusion. Burnout was prevalent in a large sample of sonographers. Multilevel work systems factors are associated with burnout, suggesting collaboration among sonographers, administrators, and organizations is needed to address burnout.

The involvement of occupational therapy (OT) providers in work and industry (W&I) has noticeably diminished despite the historical and ontological connection between work and occupation. Clear career expectations are necessary to introduce and retain the OT workforce in this underrepresented yet essential practice area. This study aimed to describe OT practitioners’ experiences exploring and developing careers in the W&I practice area. We used an inductive thematic analysis in a multi-step, iterative process to explore experiences shared through comments and stories in response to an open-ended question in a cross-sectional online survey. Four semantic-level themes emerged, including career pathways, accumulation of expertise, professional identity, and challenges in W&I practice. Novel career paths revealed in the article underlined the limited recognition of W&I practice in OT. Structured career planning support is needed to promote the growth of this practice area.

With the exponential rise in the prevalence of automation, trust in such technology has become more critical than ever before. Trust is confidence in a particular entity, especially in regard to the consequences they can have for the trustor, and calibrated trust is the extent to which the judgments of trust are accurate. The focus of this paper is to reevaluate the general understanding of calibrating trust in automation, update this understanding, and apply it to worker’s trust in automation in the workplace. Seminal models of trust in automation were designed for automation that was already common in workforces, where the machine’s “intelligence” (i.e., capacity for decision making, cognition, and/or understanding) was limited. Now, burgeoning automation with more human-like intelligence is intended to be more interactive with workers, serving in roles such as decision aid, assistant, or collaborative coworker. Thus, we revise “calibrated trust in automation” to include more intelligent automated systems.

Keywords. trust, automation, calibrated trust, workers

Stress experiences can have dire consequences for worker performance and well-being, and the social environment of the workplace is a key contributor to worker experience. This study investigated the relationship between hybrid workers’ self-ratings of productivity, mood, and stress with perceptions of positive (eustress) and negative (distress) stress states. We hypothesized that self-ratings would vary across combinations of eustress and distress experiences and that these differences would differ based on the social context. Ecological momentary assessments (EMA) were used to obtain ecologically valid data at four data points each workday across a 4-month study period in a cohort of seven office workers. Findings aligned with the Yerkes–Dodson law, such that higher states of arousal were associated with greater self-perceived productivity, and higher stress magnitudes were found when distress existed. Compared to other states, eustress was associated with higher productivity in work-related activities and better mood across all activity types.

Study Design. This study was a scoping review.

Background. Continued advances in musculoskeletal sonography technology and access have increased the feasibility of point-of-care use to support day-to-day clinical care and decision-making. Sonography can help improve therapeutic outcomes in upper extremity (UE) rehabilitation by enabling clinicians to visualize underlying structures during treatment.

Purpose of the Study. This study aimed to (1) evaluate the growth, range, extent, and composition of sonography literature supporting UE rehabilitation; (2) identify trends, gaps, and opportunities with regard to anatomic areas and diagnoses examined and ultrasound techniques used; and (3) evaluate potential research and practice utility.

Methods. Searches were completed in PubMed, CINAHL, SPORTDiscus, PsycINFO, and BIOSIS. We included data-driven articles using ultrasound imaging for upper extremity structures in rehabilitation-related conditions. Articles directly applicable to UE rehabilitation were labeled direct articles, while those requiring translation were labeled indirect articles. Articles were further categorized by ultrasound imaging purpose. Article content between the two groups was descriptively compared, and direct articles underwent an evaluation of evidence levels and narrative synthesis to explore potential clinical utility.

Results. Average publication rates for the final included articles (n = 337) steadily increased. Indirect articles (n = 288) used sonography to explore condition etiology, assess measurement properties, inform medical procedure choice, and grade condition severity. Direct articles (n = 49) used sonography to assess outcomes, inform clinical reasoning, and aid intervention delivery. Acute UE conditions and emerging sonography technology were rarely examined, while tendon, muscle, and soft tissue conditions and grayscale imaging were common. Rheumatic and peripheral nerve conditions and Doppler imaging were more prevalent in indirect than direct articles. Among reported sonography service providers, there was a high proportion of nonradiologist clinicians.

Conclusion. Sonography literature for UE rehabilitation demonstrates potential utility in evaluating outcomes, informing clinical reasoning, and assisting intervention delivery. A large peripheral knowledge base provides opportunities for clinical applications; however, further research is needed to determine clinical efficacy and impact for specific applications.

Keywords. Ultrasound imaging; Sonography; Upper extremity; Musculoskeletal; Scoping review

Previous studies have solely focused on establishing Machine Learning (ML) models for automated detection of stress arousal. However, these studies do not recognize stress appraisal and presume stress is a negative mental state. Yet, stress can be classified according to its influence on individuals; the way people perceive a stressor determines whether the stress reaction is considered as eustress (positive stress) or distress (negative stress). Thus, this study aims to assess the potential of using an ML approach to determine stress appraisal and identify eustress and distress instances using physiological and behavioral features. The results indicate that distress leads to higher perceived stress arousal compared to eustress. An XGBoost model that combined physiological and behavioral features using a 30 second time window had 83.38% and 78.79% F₁-scores for predicting eustress and distress, respectively. Gender-based models resulted in an average increase of 2-4% in eustress and distress prediction accuracy. Finally, a model to predict the simultaneous assessment of eustress and distress, distinguishing between pure eustress, pure distress, eustress-distress coexistence, and the absence of stress achieved a moderate F₁-score of 65.12%. The results of this study lay the foundation for work management interventions to maximize eustress and minimize distress in the workplace.

Objective. This systematic review aims to determine the extent, scope, and nature of research using the sonographic measurement of intraneural blood flow within the median nerve and to identify, characterize, and compare image acquisition and analysis protocols that have been reported as potential candidate techniques for standardizing research and clinical applications.

Materials and Methods. This systematic review summarizes image acquisition protocols and analysis methodologies from 52 current research studies using Doppler ultrasound to examine median nerve intraneural blood flow.

Results. Four types of Doppler technologies were identified: power Doppler, color Doppler, spectral Doppler, and Superb Microvascular Imaging, but there were inconsistencies in how images were acquired and analyzed. Intraneural blood flow measurements were categorized into four types based on a combination of measurement level (e.g., binary, ordinal, continuous) and type of flow indicator (e.g., pixel count, intensity, velocity).

Conclusion. Standardized imaging protocols and reporting guidelines are needed to improve consistency. Future studies should evaluate the accuracy and reliability of different image acquisition methods and analysis measurements.

Objective. Work-related injuries have a major effect on worker health and well-being. This is particularly true in sonography, where work-related musculoskeletal disorders (WRMSDs) are common. In response to the current challenge of understanding strategy implementation across social and organizational dimensions, this research captured sonographers’, echocardiographers’, and vascular technologists’ perceptions of critical administrative, organizational, and general health and training challenges, and potential solutions for improving worker health and well-being.

Materials and Methods. A survey invitation was sent to the WRMSD Grand Challenge longitudinal study registry participants. Open-ended questions on the online questionnaire allowed respondents to share comments, ideas, or potential solutions to improve worker health and well-being regarding the administrative and organizational environment or through training and general health interventions. There were 377 free-text responses that were qualitatively analyzed using a grounded theory approach to generate overarching themes and identify emerging theory, supported by initial coding, focused coding, and reflexive memoing. A member check was conducted by interviewing four participants to refine and confirm the findings.

Results. Five themes were identified: “Limits and Guidelines,” “Injury Education,” “Ergonomics Training Constraints,” “Resources and Equipment,” and “Individual Habits.” Participant suggestions within these themes were categorized and mapped onto a sociotechnical systems model that was developed previously to study the healthcare system(s) in which sonography users work. This conceptual mapping revealed how these solutions were situated to impact different levels of the work environment. The themes and mapping supported an emerging grounded theory: Risk Reduction Relies on Proper Employee Representation.

Conclusion. These qualitative findings align with contemporary guidelines and recommendations for mitigating injuries in sonographers, illuminating challenges and solutions targeting levels of influence beyond the staff sonographers’ scope. The need for representation of sonographers at higher-level administrative levels has not heretofore been addressed by WRMSD guidelines.

Teleoperated robots are increasingly being used in construction sites, but there is still a need for better human-robot interfaces. Auditory feedback using sonification has commonly been used to complement visual feedback in teleoperation applications. However, it is not yet well understood how operational and environmental sounds can support operators in complex tasks such as construction machine operations. In this paper, we describe the development of a virtual environment to assess the impacts of operational and environmental sounds on operators’ performances and cognitive loads during teleoperated demolition. Our goal is to examine whether different levels of operational and environmental sounds can increase the workers’ situation awareness, operational efficiency, and safety performance. Alternatively, we anticipate that some environmental noises may negatively affect the operators’ performances by increasing their mental workload and stress levels. Consequently, we plan to evaluate the effectiveness of including audio filters that minimize unwanted sounds while prioritizing desired sounds.

Previous studies have primarily focused on predicting stress arousal, encompassing physiological, behavioral, and psychological responses to stressors, while neglecting the examination of stress appraisal. Stress appraisal involves the cognitive evaluation of a situation as stressful or non-stressful, and as a threat/pressure or a challenge/opportunity. In this study, we investigated several research questions related to the association between states of stress appraisal (i.e., boredom, eustress, coexisting eustress-distress, distress) and various factors such as stress levels, mood, productivity, physiological and behavioral responses, as well as the most effective ML algorithms and data signals for predicting stress appraisal. The results support the Yerkes-Dodson law, showing that a moderate stress level is associated with increased productivity and positive mood, while low and high levels of stress are related to decreased productivity and negative mood, with distress overpowering eustress when they coexist. Changes in stress appraisal relative to physiological and behavioral features were examined through the lenses of stress arousal, activity engagement, and performance. An XGBOOST model achieved the best prediction accuracies of stress appraisal, reaching 82.78% when combining physiological and behavioral features and 79.55% using only the physiological dataset. The small accuracy difference of 3% indicates that physiological data alone may be adequate to accurately predict stress appraisal, and the feature importance results identified electrodermal activity, skin temperature, and blood volume pulse as the most useful physiologic features. Implementing these models within work environments can serve as a foundation for designing workplace policies, practices, and stress management strategies that prioritize the promotion of eustress while reducing distress and boredom. Such efforts can foster a supportive work environment to enhance employee well-being and productivity.

Workload experienced over the whole day, not just work periods, may impact worker cognitive performance. We hypothesized that experiencing greater than typical whole day workload would be associated with lower visual processing speed and lower sustained attention ability, on the next day. To test this, we used dynamic structural equation modeling to analyze data from 56 workers with type 1 diabetes. For a two-week period, on smartphones they answered questions about whole day workload at the end of each day, and completed cognitive tests 5 or 6 times throughout each day. Repeated smartphone cognitive tests were used, instead of traditional one- time cognitive assessment in the laboratory, to increase the ecological validity of the cognitive tests. Examples of reported occupations in our sample included housekeeper, teacher, physician, and cashier. On workdays, the mean number of work hours reported was 6.58 (SD 3.5). At the within-person level, greater whole day workload predicted decreased mean processing speed the next day (standardized estimate=-0.10, 95% CI -0.18 to -0.01) using a random intercept model; the relationship was not significant and only demonstrated a tendency toward the expected effect (standardized estimate= -0.07, 95% CI -0.15 to 0.01) in a model with a random intercept and a random regression slope. Whole day workload was not found to be associated with next-day mean sustained attention ability. Study results suggested that just one day of greater than average workload could impact next day processing speed, but future studies with larger sample sizes are needed to corroborate this finding.

Keywords. Whole day workload; Sustained attention; Processing speed; Cognitive performance; Type 1 diabetes

Objective. Explore the differing associations of Sonography Work Systems (SWS) model factors with work-related discomfort outcomes among sonographers in four sonographic practice areas.

Materials and Methods. Survey data from a national cross-disciplinary cohort of sonographers was analyzed to explore experiences of work factors and work-related discomfort in sonographers across four practice areas: abdominal (ABD+), adult echocardiography (Echo), obstetrics/gynecology (OB/GYN), and vascular technology (VT). One-way analyses of variance (ANOVAs) and chi-square tests were conducted on SWS factors and work-related discomfort to examine differences across practice area groups. Associative analyses were conducted between upper extremity musculoskeletal discomfort and hand used during sonography examinations. For each practice group, regression analyses examined associations of SWS factors with work-related discomfort (i.e., musculoskeletal and visual discomfort, headaches).

Results. 2924 survey respondents (n = 1747 ABD+, n = 519 Echo, n = 351 VT, and n = 307 OB/GYN) were identified. Descriptive differences were identified in SWS factors and discomfort across practice area groups. Significant differences were noted in distribution of upper extremity pain compared with the hand used to complete sonography examinations (P < .001).

Conclusion. This study identified multiple organizational, tool, and process factors commonly associated with discomfort across specialties, which underscores the need for multidimensional approaches to worker health that include effective administrative and engineering controls.

Associations between various forms of activity engagement (e.g. work, leisure) and the experience of stress in workers have been widely documented. The mechanisms underlying these effects, however, are not fully understood. Our goal was to investigate if perceived whole day workload accounted for the relationships between daily frequencies of activities (i.e. work hours and leisure/rest) and daily stress. We analysed data from 56 workers with type 1 diabetes (T1D) who completed approximately two weeks of intensive longitudinal assessments. Daily whole day workload was measured with an adapted version of the National Aeronautics and Space Administration Task Load Index (NASA-TLX). A variety of occupations were reported, including lawyer, housekeeper and teacher. In multilevel path analyses, day-to-day changes in whole day workload mediated 67% (p < .001), 61% (p < .001), 38% (p < .001), and 55% (p < .001) of the within-person relationships between stress and work hours, rest frequency, active leisure frequency, and day of week, respectively. Our results provided evidence that whole day workload perception may contribute to the processes linking daily activities with daily stress in workers with T1D. Perceived whole day workload may deserve greater attention as a possible stress intervention target, ones that perhaps ergonomists would be especially suited to address.

Keywords. Workload, stress, rest, work hours, type 1 diabetes

This research pioneers the application of a machine learning framework to predict the perceived productivity of office workers using physiological, behavioral, and psychological features. Two approaches were compared: the baseline model, predicting productivity based on physiological and behavioral characteristics, and the extended model, incorporating predictions of psychological states such as stress, eustress, distress, and mood. Various machine learning models were utilized and compared to assess their predictive accuracy for psychological states and productivity, with XGBoost emerging as the top performer. The extended model outperformed the baseline model, achieving an R² of 0.60 and a lower MAE of 10.52, compared to the baseline model’s R² of 0.48 and MAE of 16.62. The extended model’s feature importance analysis revealed valuable insights into the key predictors of productivity, shedding light on the role of psychological states in the prediction process. Notably, mood and eustress emerged as significant predictors of productivity. Physiological and behavioral features, including skin temperature, electrodermal activity, facial movements, and wrist acceleration, were also identified. Lastly, a comparative analysis revealed that wearable devices (Empatica E4 and H10 Polar) outperformed workstation addons (Kinect camera and computer-usage monitoring application) in predicting productivity, emphasizing the potential utility of wearable devices as an independent tool for assessment of productivity. Implementing the model within smart workstations allows for adaptable environments that boost productivity and overall well-being among office workers.

Keywords. productivity; stress; mood; eustress; distress; psychological state; physiological features; behavioral features

We investigated the physiological (heart rate variability) and psychological (state of anxiety, pleasantness, and comfort) effects of ambient bergamot scent on the stress levels of office workers by exposing them to the scent while stressors persisted as the workers continued to work on the office tasks. Forty-eight young adults were randomly assigned to either a control or scent group. Our results show that the stress restoration effect of bergamot scent depends on gender. The change in heart rate variability revealed that bergamot scent increased stress among males but not for females. The reported pleasantness and comfort followed the same trend. Compared to the control groups, females in the scent group thought the office smelled pleasant and felt more comfortable, but males in the scent group reported the opposite. However, no gender effect was found in the level of state anxiety. Specifically, compared to the control groups, both males and females exposed to the bergamot scent self-reported decreasing stress levels. This inconsistency between self-reported stress and physiological measurements is not uncommon, especially among males who are socialized to downplay emotional experiences. Our data suggest that there is indeed a gender difference in the effectiveness of the bergamot scent for reducing stress in office workers.

Background. Active patient engagement and adherence are essential for successful rehabilitation outcomes, particularly in complex cases such as work-related musculoskeletal injuries. Although the therapist-patient relationship is a significant component of successful care coordination, there has been limited examination of this relationship within upper extremity musculoskeletal rehabilitation.

Objective. To explore therapists’ perspectives on how the therapist-patient relationship intersects with engagement and adherence in the provision of holistic and collaborative rehabilitation services.

Methods. Data were collected from four therapists over three months. Descriptive statistics were generated from the Sport Injury Rehabilitation Adherence Scale (SIRAS) and the Rehabilitation Therapy Engagement Scale (RTES) completed by therapists following visits from a sub-sample of patients (n = 14). Weekly semi-structured group interviews (n = 13) were analyzed using an iterative grounded theory-informed process. Emerging themes were identified, refined, and situated within the context of quantitative results.

Results. SIRAS scores averaged 14.4 (SD: 1.0) and RTES scores averaged 42.5 (SD: 3.5), indicating high perceived patient engagement and adherence. Four themes emerged from therapist interviews: (1) dynamic power; (2) co-constructed engagement; (3) emotional states; (4) complementary therapy contexts.

Conclusion. In this engaged and adherent setting, therapist-patient relationships were complex and intimate, and extended beyond education and physical interventions. Careful management of this relationship was central to active patient participation and engagement. Incorporating holistic techniques may provide more structure for managing and communicating these aspects of care. These findings provide a preliminary understanding of the impact of therapeutic relationships on engagement and collaborative care.

Keywords. Qualitative research, occupational therapy, musculoskeletal diseases, return to work

Objective. This study examined the implementation of a Doppler sonography imaging protocol to assess intraneural blood flow, within the median nerve, in healthy individuals.

Materials and Methods. A total of 176 participants were examined, and this involved 717 retrospective observations of the images collected. The implemented imaging protocol was assessed, and the data that were collected were cleaned and checked for fidelity and validity.

Results. A large percentage of missing evidence (11%–35%) across proximal, mid, and distal carpal tunnel locations. Only a quarter of cases with evidence of intraneural blood flow had the strongest evidence of a power Doppler video clip, of which only three-quarters were valid. The study identified potential areas for improving the imaging protocol to reduce missing data and improve data quality.

Conclusion. This study demonstrates the significance of a standardized imaging protocol to guide the sonographic acquisition of Doppler images and provides important insights into potential issues with data quality. The recommendations have the potential to help future studies assess intraneural blood flow in healthy populations in a more rigorous and reliable way. Incorporating the study’s recommendations into a standardized protocol, there is potential to enhance the diagnostic accuracy of carpal tunnel syndrome and improve diagnosis and treatment.

While Indoor Environmental Quality (IEQ) factors in an environment co-exist, the interaction effects of these factors and their impacts on cognitive functioning and perceived comfort have not been comprehensively examined. In this study, the interaction effects between temperature, lighting Correlated Color Temperature (CCT), and noise levels on selective attention, sustained attention, creativity, acoustics, thermal, visual, and overall IEQ comfort of young adults in open-plan offices in North American Mediterranean climate were presented. In a mixed-design controlled experimental setting, 52 young adults were recruited, and their objective cognitive performance and subjective comfort were assessed through statistical analysis. The experimental set points included [20 °C, 25 °C], [2700 K, 6500 K], and [50 dB, 65 dB] for temperature, lighting color, and noise, respectively. Additionally, the work took into consideration the gender and Body Mass Index (BMI) of participants. The results show that temperature moderated the effect of noise level and lighting CCT on selective attention, while no effect of IEQ factors on sustained attention was found. Creativity was influenced by gender and its interaction with the noise level. Concerning perceived comfort, acoustic comfort varied significantly with temperature. Thermal comfort was influenced by the combined moderating effect of lighting CCT and BMI on temperature, while visual comfort was driven by the moderation effect of gender on lighting CCT. Overall comfort was affected by the noise level and temperature. Finally, cognitive performance indicators were correlated with perceived IEQ comfort votes. Based on the findings of this study, considerations of interactions between noise, lighting CCT, temperature, gender, and BMI can shape occupant-centric priorities for enhanced cognitive functioning and comfort.

Objective. This work aimed to explore how the COVID-19 pandemic affected the work of sonographers and vascular technologists.

Materials and Methods. A follow-up questionnaire was sent to an established registry of ultrasonography users who opted into a longitudinal research study examining worker health and wellbeing. Multiple questions related to the general impacts of COVID-19 on sonography work practices, workload, and considerations of remaining or leaving their current job were included; responses to these questions were descriptively tabulated. Participants indicated specific changes that occurred and provided general comments related to COVID-19 impacts in two free-text questions. These comments were qualitatively analyzed by two sonographers who used an interpretive grounded theory approach to formatively code and memo the comments. Four summative interviews were conducted with participants who represented varied practice areas to gain deeper insights into the experiences expressed by the total respondent pool. Qualitative coding of the free-text responses and interview transcripts was completed independently by the two sonographers using the Sonography Work Systems (SWS) framework, and the full research team contributed to the interpretation of the findings.

Results. A total of 1389 ultrasonography users completed the questionnaire. The pandemic changed the ways in which examinations were performed for approximately half of the respondents. A higher or somewhat higher workload was noted by 48% of the sample, while only 10% experienced a lower or somewhat lower workload. Components of the work system were a major concern for respondents, and a lack of support from supervisors and hospital administration was a key finding. Participants felt limited in their ability to provide care, experienced posttraumatic stress, and reported a lack of reciprocity, which were all underscored as undesirable outcomes.

Conclusion. Sonographers and vascular technologists suffered negative consequences during the COVID-19 pandemic. The most marked outcome was the undesirable effects on the work system, which resulted in the need for these workers to engage in herculean efforts over a sustained period. Findings suggest that these health care heroes may have experienced physical and mental harm while trying to provide health care services, despite numerous institutional challenges.

Objective. Establish median nerve cross-sectional area (CSA) reference values and identify patient-level factors impacting diagnostic thresholds.

Materials and Methods. Studies were identified through a robust search of multiple databases, and quality assessment was conducted using a modified version of the National Institute of Health Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A meta-analysis was performed to identify normative values stratified by anatomic location. A meta-regression was conducted to examine heterogeneity effects of age, sex, and laterality.

Results. The meta-analysis included 73 studies; 41 (56.2%) were high quality. The median nerve CSA [95% confidence interval, CI] was 6.46 mm² [6.09–6.84], 8.68 mm² [8.22–9.13], and 8.60 mm² [8.23–8.97] at the proximal forearm, the carpal tunnel inlet, and the proximal carpal tunnel, respectively. Age was positively associated with CSA at the level of proximal carpal tunnel (β = 0.03 mm², P = .047). Men (9.42 mm² [8.06–10.78]) had statistically larger proximal tunnel CSA (P = .03) as compared with women (7.71 mm² [7.01–8.42]). No difference was noted in laterality.

Conclusion. A reference value for median nerve CSA in the carpal tunnel is 8.60 mm². Adjustments may be required in pediatrics or older adults. The diagnostic threshold of 10.0 mm² for male patients should be cautiously applied as the upper limit of normative averages surpasses this threshold.

Objective. Work-related discomfort is a pervasive issue among ultrasonography users. The Sonography Work Systems (SWS) framework was constructed as a means of examining relationships within and across components of the sonography work systems, work processes, and work/worker outcomes. A database of ultrasonography users was established as a foundation for a longitudinal survey study to examine worker health and well-being and explore the most salient work systems and process factors associated with work-related discomfort.

Materials and Methods. An estimated 100 000 unique ultrasonography users were invited to complete the online questionnaire through an e-mail campaign. Snowball sampling occurred through social media posts and encouragement for respondents to share the survey link with colleagues. The questionnaire included items that examined participant demographics, selected constructs from the SWS, and the prevalence of work-related musculoskeletal discomfort, visual discomfort, and headaches. Individual and multi-factorial regression models were conducted to examine SWS factors associated with the likelihood of experiencing the three types of work-related discomfort.

Results. A total of 3659 valid responses were included in the analysis, with 86% of respondents reporting that they regularly experienced musculoskeletal discomfort that they directly attributed to their work. About half (54.2%) of the respondents have engaged in sonography-related ergonomics training, and respondents indicated using adjustable equipment approximately 74% of the time. Workplace culture was rated as primarily positive, but respondents indicated that employers implement only two of seven commonly recommended ergonomic policies and procedures. Working in an organization with more policies, using adjustable equipment more frequently, taking more work breaks, engaging in a positive work culture, and minimizing interruptions to workflow were key factors associated with reduced likelihood of work-related discomfort.

Conclusion. This study provides a new framework for examining and addressing factors that contribute to ultrasonography users’ experience of work-related discomfort. Despite increased participation in ergonomics training and the use of adjustable equipment, the prevalence of work-related discomfort remains high among ultrasonography users. The findings highlight the need for attention to be directed at organizational factors and work processes to identify and implement evidence-based solutions to improve the health and well-being of medical ultrasound users.

Objective. To describe extracurricular activity participation and explore its relationship with college students’ health.

Participants. 159 college students majoring in dental hygiene or occupational therapy.

Methods. Data were collected prospectively at baseline, one- and two-year follow-ups. Self-reported participation in extracurricular activities over the past six months was grouped into eight categories: Fitness, Sports, Creative arts, Leisure, Social, Work, Caregiving, and Animal care. Physical and mental health were measured using SF-36, a valid tool measuring general health.

Results. Participation in fitness, sports, creative arts, and work significantly decreased at one-year and two-year follow-ups (p < 0.01). Work/volunteer activity participation was associated with poorer physical health (β = –1.4, 95% CI: (–2.2, −0.5), p < 0.01), but a change from nonparticipation to some participation in work/volunteer activity was associated with better mental health (β = 2.6, 95% CI (0.3, 4.9), p = 0.04).

Conclusions. Educators should consider the potential impact of maintaining extracurricular activities on college students’ health when designing academic courses.

Keywords. College student; extracurricular activity; health; SF-36; well-being

The prevalence of Work-Related Musculoskeletal Disorders (WRMSDs) among ultrasound professionals has been significant. National and international efforts to create industry standards have focused primarily on injuries in sonographers. In addition, the Centers for Disease Control and Prevention (CDC) and National Institute for Occupational Safety & Health (NIOSH) have published documents related to this occupational exposure. There has also been significant attention on equipment utilization and design to help reduce the prevalence of WRMSDs. The American Institute of Ultrasound in Medicine (AIUM) developed the AIUM Practice Principles for Work-Related Musculoskeletal Disorder in collaboration with other organizations whose members use ultrasound [see Collaborating Societies and Representatives]. This document supports the “Industry Standards for the Prevention of Work-Related Musculoskeletal Disorders in Sonography” and aims to expand on these Standards to include safety practices for all health care professionals who utilize ultrasound. These professionals include members of the scientific community, a wide variety of medical professionals, and dental professionals. These ultrasound users and operators will collectively be referred to in this document as “operator(s)” except in those instances where data addressed those holding a specific job title, such as sonographer. In addition, this document will support guidance for quality improvement specific to preventing and reducing injury rates.

Keywords. Ergonomics; occupational exposure; work-related musculoskeletal disorders; WRMSD

Occupational therapists apply a holistic and transactional approach that differentiates them from other professionals who provide injury prevention services. The study reviewed in this chapter provides one example of how occupational therapists can provide an ergonomics intervention to promote healthy habits and postures, even in non-work settings. Specifically, the study by Feingold and Jacobs describes how a 30-minute ergonomics education session tailored to middle school children resulted in a change in backpack-wearing habits and reports of discomfort. This study is related to a national campaign led by occupational therapists for backpack safety awareness that includes an annual backpack awareness day at the start of each school year in the fall. Additional studies are noted that provide support for occupational therapy’s role in promoting healthy behaviors and reducing occupational and work-related injuries both within the profession and in other areas through ergonomic assessments, education, intervention, and product design.

Keywords. ergonomics, posture, school-aged child, trunk, musculoskeletal, occupational therapy, health education, prevention

We regularly face stress during our everyday activities, to the extent that stress is recognized by the World Health Organization as the epidemic of the 21st century. Stress is how humans respond physically and psychologically to adjustments, experiences, conditions, and circumstances in their lives. While there are many reasons for stress, work and job pressure remain the main cause. Thus, companies are increasingly interested in creating healthier, more comfortable, and stress-free offices for their workers. The indoor environment can induce environmental stress when it cannot satisfy the individual needs for health and comfort. In fact, office environmental conditions (e.g., thermal, and indoor air conditions, lighting, and noise) and interior design parameters (e.g., office layout, colors, furniture, access to views, distance to window, personal control and biophilic design) have been found to affect office workers' stress levels. A line of research based on the stress recovery theory offers new insights for establishing offices that limit environmental stress and help with work stress recovery. To that end, this paper answers ten questions that explore the relation between the indoor office-built environment and stress levels among workers. The answers to the ten questions are based on an extensive literature review to draw conclusions from what has been achieved to date. Thus, this study presents a foundation for future environmental stress related research in offices.

Keywords. Stress; Indoor environmental quality; Stress recovery; Office; Interior design

Human-Building Interaction (HBI) is a convergent field that represents the growing complexities of the dynamic interplay between human experience and intelligence within built environments. This paper provides core definitions, research dimensions, and an overall vision for the future of HBI as developed through consensus among 25 interdisciplinary experts in a series of facilitated workshops. Three primary areas contribute to and require attention in HBI research: humans (human experiences, performance, and well-being), buildings (building design and operations), and technologies (sensing, inference, and awareness). Three critical interdisciplinary research domains intersect these areas: control systems and decision making, trust and collaboration, and modeling and simulation. Finally, at the core, it is vital for HBI research to center on and support equity, privacy, and sustainability. Compelling research questions are posed for each primary area, research domain, and core principle. State-of-the-art methods used in HBI studies are discussed, and examples of original research are offered to illustrate opportunities for the advancement of HBI research.

Keywords. Civil engineering; Environmental impact; Mechanical engineering; Occupational health; Quality of life

This paper seeks to address ten questions that explore the burgeoning field of Human-Building Interaction (HBI), an interdisciplinary field that represents the next frontier in convergent research and innovation to enable the dynamic interplay of human and building interactional intelligence. The field of HBI builds on several existing efforts in historically separate research fields/communities and aims to understand how buildings affect human outcomes and experiences, as well as how humans interact with, adapt to, and affect the built environment and its systems, to support buildings that can learn, enable adaptation, and evolve at different scales to improve the quality-of-life of its users while optimizing resource usage and service availability. Questions were developed by a diverse group of researchers with backgrounds in design, engineering, computer science, social science, and health science. Answers to these questions draw conclusions from what has been achieved to date as reported in the available literature and establish a foundation for future HBI research. This paper aims to encourage interdisciplinary collaborations in HBI research to change the way people interact with and perceive technology within the context of buildings and inform the design, construction, and operation of next-generation, intelligent built environments. In doing so, HBI research can realize a myriad of benefits for human users, including improved productivity, health, cognition, convenience, and comfort, all of which are essential to societal well-being.

Keywords. Building lifecycle; Human-centered; Occupants; Built environment; Well-being; Interaction; Quality of life

Importance. Fibromyalgia is a complex chronic pain condition for which effective nonpharmacological treatment interventions are lacking. Objective: To explore the effects of an occupational therapy intervention for fibromyalgia on client-reported outcomes of pain interference, self-efficacy, mood, and function.

Design. Retrospective cohort study using a chart review method.

Setting. Outpatient clinic.

Participants. Twenty-one adults with fibromyalgia (M age = 54 yr).

Intervention. A 10-wk occupational therapy group intervention using a Lifestyle Redesign® (LRD) approach.

Outcomes and Measures. The Brief Pain Inventory, Pain Self-Efficacy Scale, Beck Depression Inventory (BDI), and the Fibromyalgia Impact Questionnaire (FIQ) or the Revised Fibromyalgia Impact Questionnaire were administered at the first and last sessions of the program.

Results. Between 2015 and 2018, 37 clients entered the program, and 21 completed it. Changes in group averages exceeded the minimal clinically important difference for the BDI and the FIQ. Eighty-one percent of clients who completed the program had a clinically significant improvement on one or more of the outcome measures.

Conclusions and Relevance. The findings demonstrate the potential benefit of occupational therapy as a complementary approach to pharmacological treatment for people with fibromyalgia. Preliminary evidence suggests that a 10-wk occupational therapy group intervention using an LRD approach may reduce symptoms of depression and decrease the impact on daily function for people with fibromyalgia.

Keywords. fibromyalgia, pain, clients, personal satisfaction, self efficacy, life style, depressive disorders

This article discusses the importance of conducting a longitudinal data collection concerning well-being and the risk for work-related musculoskeletal injuries (WRMSI) among sonographers and vascular technologists. There is a need for changes in the manner that sonographic work is done, but this should be nested in empirical evidence. This gives the rational for conducting the study titled Documenting the overall wellness of ultrasound users and the risk of progressive WRMSI: A national longitudinal study. The objective of this longitudinal work is to better understand collective practice patterns and examine the relationship of sonographic work conditions and performance to the user’s health and well-being. This symposium provides the foundational understanding of the strength of this type of study and how it may help to influence behavior and organizational change.

Noise is often considered a distractor; however recent studies suggest that sub-attentive individuals or individuals diagnosed with attention deficit hyperactivity disorder can benefit from white noise to enhance their cognitive performance. Research regarding the effect of white noise on neurotypical adults presents mixed results, thus the implications of white noise on the neurotypical population remain unclear. Thus, this study investigates the effect of 2 white noise conditions, white noise level at 45 dB and white noise level at 65 dB, on the cognitive performance, creativity, and stress levels of neurotypical young adults in a private office space. These conditions are compared to a baseline condition where participants are exposed to the office ambient noise. Our findings showed that the white noise level at 45 dB resulted in better cognitive performance in terms of sustained attention, accuracy, and speed of performance as well as enhanced creativity and lower stress levels. On the other hand, the 65 dB white noise condition led to improved working memory but higher stress levels, which leads to the conclusion that different tasks might require different noise levels for optimal performance. These results lay the foundation for the integration of white noise into office workspaces as a tool to enhance office workers’ performance.

Background. Arthritis is the leading cause of disability in adults, and research shows that people living with arthritis experience work instability, loss of independence, financial difficulties, and overall decreased quality of life. Current nonpharmacological treatments can be beneficial for short term relief; however, the evidence on these long-term treatments is limited. Ergonomic modifications have been used in the workplace to address musculoskeletal conditions to ensure proper fit of one's environment, and research shows that these modifications can decrease pain and injury and increase work productivity. A broader perspective on ergonomic approaches may be important to supporting individuals with arthritis within hand therapy.

Purpose of the Study. This review proposes an expanded perspective on ergonomic approaches within hand therapy and explores published literature to identify potential benefits of applying ergonomic approaches for individuals with upper extremity arthritis.

Methods. A systematic search and screening process was conducted to identify articles that implemented an ergonomic approach for the support of individuals with upper extremity osteoarthritis or rheumatoid arthritis.

Results. A total of 34 articles described interventions that employed ergonomics including task-based or general ergonomics (n = 17), contextualized supports (n = 8), or holistic, lifestyle approaches (n = 9). Only one study focused solely on individuals with osteoarthritis, whereas interventions for individuals with rheumatoid arthritis showed positive outcomes across these categories. Situational learning, building of patient self-efficacy, and development of new habits and routines are vital for carryover and implementation to support performance in daily life.

Conclusion. There is an opportunity for hand therapists to extend the scope of interventions provided as part of an ergonomic approach to supporting patients. Specifically, therapists can consider use of emerging technologies and telehealth that promote contextualization and follow-up for long-term outcomes.

Keywords. Ergonomics, Osteoarthritis, Rheumatoid arthritis

This multimethod study identified four themes within the therapist-patient relationship that affect the provision of holistic and collaborative care. Therapists developed a complex relationship with their patients, leading to high scores on measures of adherence and engagement. These findings provide a preliminary understanding of the impact of therapeutic relationships on engagement and collaborative care to produce effective outcomes.

Purpose. Holistic and collaborative treatment planning and patient care are essential components of best practice occupational therapy (OT). This approach to care must consider patient factors and therapeutic techniques, but success will also be dependent on the therapist-patient relationship itself. There has been limited examination of this relationship within OT settings, particularly related to core concepts such as engagement and adherence. This study identified factors within the therapist-patient relationship that impacted the provision of holistic and collaborative services within an outpatient setting.

Design. A multi-method study design was used to obtain quantitative and qualitative data to describe therapists’ perspectives of their patients’ adherence and engagement, and the relative role of therapist-patient relationship. The study participants were a convenience sample of four OTs working at a hospital-based outpatient upper extremity rehabilitation clinic.

Method. Data were collected over three months. A series of weekly group interviews (n = 13) were conducted using a semi-structured guide. Interviews explored the interaction between therapist and patient roles within the therapeutic environment, including balances of power and barriers/facilitators to therapeutic engagement and adherence. Therapists completed surveys following visits from a sub-sample of patients receiving treatment during the study period (n = 16). Specifically, the Sport Injury Rehabilitation Adherence Scale (SIRAS) and the Rehabilitation Therapy Engagement Scale (RTES) were used to assess therapists’ perspectives of patient adherence and engagement. Descriptive statistics were generated from the survey data. Principles of constructivist grounded theory were used to analyze interview transcripts through an iterative process of initial and focused coding until saturation was reached. Themes connecting the codes were created by the primary coder. Two additional researchers who conceptualized the study and conducted the interviews engaged with the coder in iterative discussions to refine the qualitative themes and situate these findings within the context described by the quantitative results.

Results. Therapists consistently rated their patients highly on SIRAS and RTES measures. SIRAS scores averaged 14.4/15 (SD: 1.0, range: 10-15) and RTES scores averaged 42.5/45 (SD: 3.4, range: 23-45). These high scores may have been facilitated by complex and dynamic interactions across multiple factors within the therapist-patient relationship. Four themes emerged from therapist interviews: (1) Power within the therapist-patient relationship was fluid, often impacted by patient preference, personal contexts, and medical environment restrictions; (2) engagement was reciprocal and co-constructed between the therapist and patient; (3) therapist-patient interaction modulated emotional states to influence mutual engagement; and (4) the therapist-patient relationship is defined by different spatial and temporal contexts within the therapy process.

Conclusion. This study found that, in a highly engaged and adherent treatment setting, the therapist-patient relationships were complex, intimate, and dynamic, and extended beyond patient education and physical interventions. Careful management of this relationship was central to facilitating active patient participation and engagement.

Keywords. arm, outpatients, rehabilitation

We examined the relationships between participation in different extracurricular activities and the overall physical and mental health of OT students across a 2-year period. Participation in certain occupations was associated with positive mental health, and other occupations were linked to poorer physical health. Exploration and promotion of participation in extracurricular occupations may be considered to support OT students’ health.

Purpose. Engagement in meaningful occupations is crucial to achieving health and well-being (Pemberton & Cox, 2015; Stewart, Fischer, Hirji, & Davis, 2016). Occupational therapy (OT) students learn to promote occupational engagement and health in their educational programs. However, support for monitoring and managing OT students’ own occupational participation and health is often overlooked. No literature exists that describes extracurricular activity participation nor examines the effect of occupational participation on health in OT students. Thus, the purpose of this study was to describe changes in OT students’ participation in extracurricular activities and health across their educational programs and explore the relationship between participation and health. DESIGN: A descriptive longitudinal study design was used to obtain data from students who enrolled in a two-year OT program and a comparator group of dental hygiene (DH) students with similar demographics. Students with recent histories of acute injury or ongoing chronic medical conditions were excluded.

Method. Self-reported surveys were completed three times, at program admission and at the end of the first and second academic years. Overall physical and mental health was measured by the 36-Item Short Form Health Survey (SF-36), which resulted in Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. An activity checklist was used to record the total hours of participation in various activities over the past six months. A total of 62 activities were grouped into eight occupational categories: Fitness, Sports, Creative arts, Leisure, Social, Work, Caregiving, and Animal care. Repeated measures analyses of covariance (ANCOVA) were used to analyze changes in PCS and MCS across the three timepoints. Friedman-Kendall-Smith tests analyzed the changes in participation in extracurricular activities across time. Mixed linear models were constructed to examine the relationship of each occupational category with PCS and MCS, as well as the change of participation with the change of PCS and MCS.

Results. Data were obtained from 136 participants, including 51 OT and 85 DH students. MCS significantly decreased over time across all students (50.4, 47.4, and 48.2, p<0.001), and OT students always had a lower MCS than DH students. A decreasing trend in PCS was noted in OT students (58.8, 57.9, 57.1, p = 0.06), compared to increased PCS in DH students (57.0, 58.0, 58.8, p<0.01). While there was no significant change in participation in social, leisure, animal care, and caregiving activity; the average time in sports, fitness, social, and work decreased across time for both groups (all p<0.01). Of these activities, initiating participation in work/volunteer activities was associated with a decrease in PCS and an increase in MCS (both p<0.05), and initiating participation in animal care was associated with a decrease in PCS (p<0.05).

Conclusion. OT students had decreasing physical health across time and worse mental health than DH students. OT students engaged in a smaller variety of activities for shorter durations over the course of their programs. Initiating work/volunteer or animal care activity was associated with worse physical health, while initiating work/volunteer activity was also associated with better mental health.

Keywords. health, personal satisfaction, mental health

Our objective was to investigate the validity of four-item and six-item versions of the National Aeronautics and Space Administration Task Load Index (NASA-TLX, or TLX for short) for measuring workload over a whole day in the repeated measures context. We analyzed data on 51 people with type 1 diabetes from whom we collected ecological momentary assessment and daily diary data over 14 days. The TLX was administered at the last survey of every day. Confirmatory factor analysis fit statistics indicated that neither the TLX-6 nor TLX-4 were a unidimensional representation of whole day workload. In exploratory analyses, another set of TLX items we refer to as TLX-4v2 was sufficiently unidimensional. Raw sum scores from the TLX-6 and TLX-4v2 had plausible relationships with other measures, as evidenced by intra-person correlations and mixed-effects models. TLX-6 appears to capture multiple factors contributing to workload, while TLX-4v2 assesses the single factor of “mental strain.”

Sedentary activity and static postures are associated with work-related musculoskeletal disorders (WMSDs) and worker discomfort. Ergonomic evaluation for office workers is commonly performed by experts using tools such as the Rapid Upper Limb Assessment (RULA), but there is limited evidence suggesting sustained compliance with expert’s recommendations. Assessing postural shifts across a day and identifying poor postures would benefit from automation by means of real-time, continuous feedback. Automated postural assessment methods exist; however, they are usually based on ideal conditions that may restrict users’ postures, clothing, and hair styles, or may require unobstructed views of the participants. Using a Microsoft Kinect camera and open-source computer vision algorithms, we propose an automated ergonomic assessment algorithm to monitor office worker postures, the 3D Automated Joint Angle Assessment, 3D-AJA. The validity of the 3D-AJA was tested by comparing algorithm-calculated joint angles to the angles obtained from manual goniometry and the Kinect Software Development Kit (SDK) for 20 participants in an office space. The results of the assessment show that the 3D-AJA has mean absolute errors ranging from 5.6° ± 5.1° to 8.5° ± 8.1° for shoulder flexion, shoulder abduction, and elbow flexion relative to joint angle measurements from goniometry. Additionally, the 3D-AJA showed relatively good performance on the classification of RULA score A using a Random Forest model (micro averages F1-score = 0.759, G-mean = 0.811), even at high levels of occlusion on the subjects’ lower limbs. The results of the study provide a basis for the development of a full-body ergonomic assessment for office workers, which can support personalized behavior change and help office workers to adjust their postures, thus reducing their risks of WMSDs.

Keywords. Ergonomic assessment; RULA; Engineering office environments; Depth camera; Computer vision; Machine learning

Background. Psychosocial sequelae are common for individuals with physical injuries to the upper extremity. However, psychosocially oriented interventions are not common in this occupational therapy practice area.

Purpose. This study implemented an online survey of hand therapy patients’ psychological symptoms. Second, it explored patients’ interest in one psychosocially oriented intervention: mindfulness meditation.

Methods. The design was a cross-sectional survey of 120 consecutively recruited hand therapy patients. Survey measures included functioning, psychosocial factors, and trait mindfulness.

Findings. Anxiety was prevalent in this sample, and moderately correlated with trait mindfulness (r = −0.542, p < .001). While most participants (77%) indicated mindfulness meditation would be an acceptable intervention, women were 2.8 times as likely to be interested (p = .044).

Implications. Psychosocially oriented interventions are indicated in hand therapy based on the prevalence of these symptoms. Further examination of using mindfulness meditation in hand therapy is warranted due to patient interest.

Background. The paucity of longitudinal clinical studies limits our understanding of the development of shoulder pain with repetitive shoulder tasks, and its association with underlying mind and body mechanisms. Tendon thickening characterizes painful shoulder supraspinatus tendinopathy, and the perception of pain can be affected by the presence of psychological factors such as anxiety and depression. This study determined the incidence of shoulder pain in novice individuals exposed to repetitive shoulder tasks, and the associated change in outcomes of supraspinatus tendon morphology and measures of anxiety and depression.

Methods. We recruited dental hygiene (DH) students (N = 45, novice and exposed to shoulder repetitive tasks) and occupational therapy (OT) students (N = 52, novice, but not exposed to shoulder repetitive tasks), following them over their first year of training. We measured shoulder pain, supraspinatus morphology via ultrasound, psychosocial distress via the Hospital Anxiety and Depression Scale. We compared the incidence of shoulder pain (defined as a change of visual analog pain scale greater than minimal clinically important difference) between DH and OT students using Fisher’s exact test. We used mixed-effects models to longitudinally compare the change in outcomes between three groups: DH students that develop and did not develop shoulder pain, and OT students.

Results. The incidence of shoulder pain is higher in DH students [relative risk = 4.0, 95% confidence interval (CI): 1.4, 11.4]. After one year, DH students with pain had the greatest thickening of the supraspinatus (0.7mm, 95%CI: 0.4, 0.9). The change in supraspinatus thickness of DH students with pain was greater than both DH students with no pain (0.4mm, 95%CI: 0.1, 0.8) and OT students (0.9mm, 95%CI: 0.5, 1.2). Anxiety score increased 3.8 points (95%CI: 1.6, 5.1) in DH students with pain, and 43% of DH students with pain had abnormal anxiety score at one-year (relative risk = 2.9, 95%CI: 1.0; 8.6).

Conclusion. Our results provide support for the theoretical model of repetitive load as a mechanism of tendinopathy. The supraspinatus tendon thickens in the presence of repetitive tasks, and thickens the most in those who develop shoulder pain. Concurrently, anxiety develops with shoulder pain, indicating a potential maladaptive central mechanism that may impact the perception of pain.

Keywords. supraspinatus; tendinopathy; anxiety; pain; shoulder

Objective. To evaluate the quality of carpal tunnel syndrome (CTS) patient education handouts and identify the best resources for patients and clinicians.

Design. A document content analysis of handouts identified through a systematic internet search using 8 search terms on Google and Bing and a hand search of professional association websites.

Setting. Not Applicable.

Participants. Documents were identified from the top 50 search results across 16 individual searches. Included documents provided general patient education for CTS; descriptive websites, videos, and research studies were excluded.

Interventions. Not applicable.

Main Outcome Measures. Content analysis was conducted using the Information Score (IS) tool to evaluate completeness of information [0%-100%], and misleading treatment recommendations were identified. Design analysis was conducted using the Patient Material Assessment Tool (PEMAT-P) [0-100%] and two widely-used readability formulas, Flesch Reading Ease (FRE) and Flesch Kincaid Grade Level (FKGL). Using these results, all handouts were rated with a summative 12-point scale.

Results. Of 805 unique search results, we included 56 CTS handouts. The average IS was 74.6% ± 17.9%. 78.6% of the handouts mentioned non-evidence-based treatment recommendations. The average PEMAT-P score was 70.2% ± 10.9% and the average readability grade level was 7.7 ± 1.7. Only 3 handouts were identified as high quality based on the 12-point summative scores, while 22 handouts had mixed quality and 17 handouts had low quality on both content and design.

Conclusions. Findings of this study suggest a lack of high-quality and easily understandable CTS patient education handouts. Most handouts contained unreliable treatment information. Improvements are needed to ensure patients’ ability to understand and manage this condition.

Keywords. Carpal Tunnel Syndrome; Health Literacy; Patient Education

Introduction/Aims. There is a lack of consensus regarding median nerve movement in the carpal tunnel during composite finger flexion in healthy individuals. This study aimed to examine the amount and direction of median nerve movement and differentiate nerve mobility between dominant and non-dominant sides in a large healthy young adult cohort.

Methods. Sonographic videos of the median nerve during composite finger motion from extension to full flexion were analyzed in 197 participants without median nerve pathology. Displacement of the nerve’s centroid was calculated based on a change in the relative location of the nerve. Longitudinal nerve sliding was categorized as none, independently from the tendons, or with the tendons.

Results. In short axis, median nerves moved within 1 mm vertically and 3 mm horizontally; no direction was predominant. About half of the nerves (52.5%) slid independently while 26.9% slid with the tendons; 21.3% did not slide at all. On the non-dominant side, median nerves that slid with the tendons had a larger absolute vertical displacement than nerves that slid independently or did not slide at all (p<0.01). Nerves on the dominant side moved in a radial direction more frequently than on the non-dominant side (p=0.02).

Discussion. Transverse nerve movement during composite finger flexion in healthy individuals varies widely with no clear pattern in the direction of transverse movement or amount of longitudinal sliding. These data provide a foundation for future research to better understand the biomechanical contribution of nerve movement to median nerve pathologies.

Carpal tunnel syndrome (CTS) treatment contains ambiguities across and within disciplines. This meta-synthesis of professional guidelines consolidates clinical treatment recommendations for CTS treatment and classifies them by strength of evidence. We conducted a search of Google, Google Scholar, and PubMed for published clinical treatment recommendations for CTS. A systematic hand search was completed to identify additional professional organizations with published recommendations. We extracted any mentioned treatment from all sources but developed our final consolidated clinical treatment recommendations only from select rigorous guidelines based on the Institute of Medicine (IOM) criteria for trustworthy guidelines. We translated rating systems of the primary guidelines into a universal rating system to classify recommendations for consolidated clinical treatment recommendations. Our search yielded 30 sources that mentioned a total of 55 CTS treatments. Six of the sources met the IOM inclusion criteria. These primary guidelines provided recommendations for 46 of the 55 treatments, which were consolidated into 12 broad treatment categories. Surgery, positioning, and steroids were strongly supported. Conservative treatments provided by rehabilitation professionals were conditionally supported. Pharmaceuticals, supplements, and alternative treatments were not generally supported. CTS is a complex condition with a wide variety of treatments provided by a multitude of disciplines. Our consolidated clinical treatment recommendations offer a comprehensive outline of available treatments for CTS and contributes to the process of developing best practices for its treatment.

Keywords. Carpal tunnel syndrome; Guideline; Rehabilitation; Systematic review

The outbreak of SARS-CoV-2 virus forced office workers to conduct their daily work activities from home over an extended period. Given this unique situation, an opportunity emerged to study the satisfaction of office workers with indoor environmental quality (IEQ) factors of their houses where work activities took place and associate these factors with mental and physical health. We designed and administered a questionnaire that was open for 45 days during the COVID-19 pandemic and received valid data from 988 respondents. The results show that low satisfaction with natural lighting, glare and humidity predicted eye related symptoms, while low satisfaction with noise was a strong predictor of fatigue or tiredness, headaches or migraines, anxiety, and depression or sadness. Nose and throat related symptoms and skin related symptoms were only uniquely predicted by low satisfaction with humidity. Low satisfaction with glare uniquely predicted an increase in musculoskeletal discomfort. Symptoms related to mental stress, rumination or worry were predicted by low satisfaction with air quality and noise. Finally, low satisfaction with noise and indoor temperature predicted the prevalence of symptoms related to trouble concentrating, maintaining attention or focus. Workers with higher income were more satisfied with humidity, air quality and indoor temperature and had better overall mental health. Older individuals had increased satisfaction with natural lighting, humidity, air quality, noise, and indoor temperature. Findings from this study can inform future design practices that focus on hybrid home-work environments by highlighting the impact of IEQ factors on occupant well-being.

Stay-at-home mandates following the COVID-19 pandemic increased work from home (WFH). While WFH offers many benefits, navigating work in nontraditional contexts can be a challenge. The objective of this study was to explore the benefits and challenges of WFH during COVID-19 to identify supports and resources necessary. Comments from two free-response questions on a survey regarding experiences of WFH (N = 648, N = 366) were analyzed using inductive qualitative content analysis. Four themes emerged: time use, considerations of working in the home space, intersections between work-life and home-life, and temporality of WFH as situated within a pandemic. Across all themes were concerns related to participation in both work and home roles, work performance, and well-being. Findings highlight the importance of support during times of disruption of occupational patterns, roles, and routines. Despite challenges, many individuals hoped to continue WFH. Organizations should consider the complex intersections of work-life and home-life to develop supportive policies and resources.

Keywords. work; survey; context; health; occupational balance

Occupational health and safety is experiencing a paradigm shift from focusing only on health at the workplace toward a holistic approach and worker well-being framework that considers both work and non-work factors. Aligned with this shift, the purpose of this pilot study was to examine how, within a person, frequencies of high-workload and recovery activities from both work and non-work periods were associated with same day well-being measures. We analyzed data on 45 workers with type 1 diabetes from whom we collected activity data 5–6 times daily over 14 days. More frequent engagement in high-workload activities was associated with lower well-being on multiple measures including higher stress. Conversely, greater recovery activity frequency was mostly associated with higher well-being indicated by lower stress and higher positive affect. Overall, our results provide preliminary validity evidence for measures of high-workload and recovery activity exposure covering both work and non-work periods that can inform and support evaluations of worker well-being.

Keywords. workload; recovery; ecological momentary assessment; type 1 diabetes; workweek; healthy work design and well-being; future of work

Background. With the COVID-19 pandemic, organizations embraced Work From Home (WFH). An important component of transitioning to WFH is the effect on workers, particularly related to their productivity and work experience.

Objectives. The objective of this study is to examine how worker-, workspace-, and work-related factors affected productivity and time spent at a workstation on a typical WFH day during the pandemic.

Methods. An online questionnaire was designed and administered to collect the necessary information. Data from 988 respondents were included in the analyses.

Results. Overall perception of productivity level among workers did not change relative to their in-office productivity before the pandemic. Female, older, and high-income workers were likely to report increased productivity. Productivity was positively influenced by better mental and physical health statuses, having a teenager, increased communication with coworkers and having a dedicated room for work. Number of hours spent at a workstation increased by approximately 1.5 hours during a typical WFH day. Longer hours were reported by individuals who had school age children, owned an office desk or an adjustable chair, and had adjusted their work hours.

Conclusion. The findings highlight key factors for employers and employees to consider for improving the WFH experience.

Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.

OTs have a major role in the conservative care of carpal tunnel syndrome (CTS) before surgery; however, best treatment practices are unclear as a result of conflicting recommendations among professional disciplines. We collected and analyzed professional guideline recommendations to construct a consolidated guideline with clear ratings for the available treatments. This guideline will inform treatment procedures and develop more universal best practices for remedying CTS.

Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.

This study systematically located and evaluated 56 patient education handouts for carpal tunnel syndrome. Handouts were reviewed for overall quality on the basis of completeness and accuracy of the content and readability for patients. Our findings point to strengths and limitations of educational materials and identified the best patient resources for OT practitioners.

Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.

This study explored office workers' perspectives on including artificial intelligence (AI) in their office workspace. Following an iterative analysis of six focus-group interviews with a total of 45 participants, three constructs emerged. Rich discussions demonstrated how acceptability of an AI workstation is complex and affected by the person, context, and their occupations.

Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.

Although multiple robust ergonomics tools are available to assess postural risk, these tools are often too general and do not consider nuances of specific jobs. This study examined the concurrent validity of a postural assessment tool tailored to dental professionals. Findings provide support for use of this tool to assess risk and identify areas for intervention by OT practitioners.

Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.

Repetitive wrist and hand movement is a risk factor for carpal tunnel syndrome. During daily functional hand use, some people develop carpal tunnel syndrome. However, the exact mechanism of injury remains unknown. We evaluated the effect of functional hand use on the median nerve and assessed the compression and displacement of the median nerve using state-of-the-art sonography.

Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.

We examined the relationships between participation in different extracurricular activities and the overall physical and mental health in college students across a 2-year period. Participation in certain occupations was associated with positive mental health, whereas other occupations were linked to poorer physical health. Exploration and promotion of participation in extracurricular occupations should be considered to support student health.

Background. Work-related musculoskeletal disorders are prevalent in dental hygienists. Although engineering controls and ergonomic training is available, it is unclear why this intransigent problem continues. One possible barrier is that a comprehensive, standardized protocol for evaluating dental hygiene work does not exist.

Objective. This study aimed to generate a valid and reliable observational protocol for the assessment of dental hygiene work.

Methods. An iterative process was used to establish and refine an ecologically valid video acquisition and observation protocol to assess key activities, tasks, and performance components of dental hygiene work.

Results. Good inter-rater reliability was achieved across all variables when the final coding scheme was completed by three independent raters.

Conclusions. This work provides an exemplar of the process required to generate a comprehensive protocol for evaluating the work components of a particular job, and provides standardized nomenclature for use by scientists and practitioners interested in understanding and addressing the pervasive issue of work-related disorders in dental hygienists.

Keywords. Dental hygienists; clinical; ergonomics; research protocol.

Background. Carpal tunnel syndrome (CTS) symptoms are problematic especially when signs and symptoms are not substantial enough to require surgical intervention. Conservative treatments have mixed effectiveness, yet are one of the best options for mild to moderate CTS. Kinesio tape is an emerging modality, as it provides biomechanical support while allowing movement.

Purpose. The purpose of this study was to determine the efficacy of dorsal application of Kinesio tape on occupational performance as measured by pain and function in individuals with mild to moderate CTS, as compared with the accepted nonsurgical intervention of general cockup orthosis and lumbrical stretching exercises versus sham tape.

Study Design. Single-blind randomized controlled trial.

Methods. Forty-four participants (68 wrists) with CTS were randomized to one of three interventions: Kinesio tape group, sham group, or standard protocol group. Each completed baseline and four subsequent measurements of numeric pain rating scale, visual analog scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), grip and pinch, with application of intervention every three days. Daily symptom journals were completed, standard protocol group recorded wearing schedule and exercises.

Results. In the forearm and wrist, a significant reduction in median numeric pain rating scale pain scores in Kinesio tape group was observed (r = 0.76, P = .01; r = 0.77, P = .01; respectively), but not in the standard protocol group (r = 0.51, P = .17; r = 0.53, P = .11) and sham group (r = 0.46, P = .30; r = 0.39, P = .43) with a minimal clinically important difference of 1.0. In the Kinesio tape group, the forearm (24%) and wrist (36%) reached the clinical significance as compared with the standard protocol forearm (18%) and wrist (32%).

The minimal clinically important difference for pain reduction on the visual analog scale was 1.64. Kinesio tape and sham group had significant improvement in function, but not the standard protocol group.

Discussion. This study provides promising evidence for the use of Kinesio tape as a possible conservative intervention for management of symptoms in individuals with mild to moderate CTS. The study also illuminates new considerations of younger, active individuals reporting signs and symptoms of CTS as well as mechanism of effects on pain reduction.

Conclusions. Kinesio tape provided additional improvement in pain and function as compared to the standard approach.

Keywords. Carpal tunnel syndrome, Kinesio tape, Conservative interventions, Functional performance

Heating, ventilation, and air conditioning (HVAC) systems account for 43% of building energy consumption, yet only 38% of commercial building occupants are satisfied with the thermal environment. The primary reasons for low occupant satisfaction are that HVAC operations do not integrate occupant comfort requirements nor control the thermal environment at the individual level. Personal comfort systems (PCS) enable local control of the thermal environment around each occupant. However, full manual control of PCS can be inefficient, and fully automated PCS reduces an occupant’s perceived control over the environment, which can then lead to lower satisfaction. A better solution might lie somewhere between fully manual and fully automated environmental control. In this paper, we describe the development and implementation of an internet of things (IoT) based intelligent agent that learns individual occupant comfort requirements and controls the thermal environment using PCS (i.e., a local fan and a heater). We tested different levels of automation where control is shared between an intelligent agent and the end user. Our results show that PCS use improves occupant satisfaction and including some level of automation can improve occupant satisfaction further than what is possible with manually operated PCS. Among the levels of automation investigated, Inquisitive Automation, where the user approves/declines the control actions of the intelligent agent before execution, led to highest occupant satisfaction with the thermal environment.

Keywords. building automation, thermal comfort, smart systems, smart buildings, indoor environments

Objective. To understand impacts of social, behavioral and physical factors on well-being of office workstation users during COVID-19 work from home (WFH).

Methods. A questionnaire was deployed from April 24 to June 11, 2020 and 988 responses were valid. Linear regression, multinomial logistic regression and chi-square tests were used to understand factors associated with overall physical and mental health statuses and number of new physical and mental health issues.

Results. Decreased overall physical and mental well-being after WFH were associated with physical exercise, food intake, communication with coworkers, children at home, distractions while working, adjusted work hours, workstation set-up and satisfaction with workspace indoor environmental factors.

Conclusion. This study highlights factors that impact workers’ physical and mental health well-being while WFH and provides a foundation for considering how to best support a positive WFH experience.

Keywords. COVID-19 pandemic, home office, mental well-being, physical well-being, work from home

Workplace environments have a significant impact on worker performance, health, and well-being. With machine learning capabilities, artificial intelligence (AI) can be developed to automate individualized adjustments to work environments (e.g., lighting, temperature) and to facilitate healthier worker behaviors (e.g., posture). Worker perspectives on incorporating AI into office workspaces are largely unexplored. Thus, the purpose of this study was to explore office workers’ views on including AI in their office workspace. Six focus group interviews with a total of 45 participants were conducted. Interview questions were designed to generate discussion on benefits, challenges, and pragmatic considerations for incorporating AI into office settings. Sessions were audio-recorded, transcribed, and analyzed using an iterative approach. Two primary constructs emerged. First, participants shared perspectives related to preferences and concerns regarding communication and interactions with the technology. Second, numerous conversations highlighted the dualistic nature of a system that collects large amounts of data; that is, the potential benefits for behavior change to improve health and the pitfalls of trust and privacy. Across both constructs, there was an overarching discussion related to the intersections of AI with the complexity of work performance. Numerous thoughts were shared relative to future AI solutions that could enhance the office workplace. This study’s findings indicate that the acceptability of AI in the workplace is complex and dependent upon the benefits outweighing the potential detriments. Office worker needs are complex and diverse, and AI systems should aim to accommodate individual needs.

Keywords. workspace; office work; computer workstations; artificial intelligence

Objectives. This study developed a musculoskeletal ultrasound (MSUS) protocol to evaluate rehabilitation outcomes in systemic sclerosis.

Materials and Methods. Three MSUS methods (gray-scale, Doppler, strain elastography) and two acquisition techniques (long- vs short-axis; transducer on skin vs floating on gel) were examined in the forearm before and after rehabilitation treatment. For gray-scale, tissue thickness measures and intrarater and interrater reliability were calculated (intraclass correlation coefficients [ICCs]), and paired t tests examined differences among techniques.

Results. Five people with diffuse cutaneous systemic sclerosis participated. The most valid and reliable gray-scale technique was with the transducer in long-axis, floating on gel. Doppler and strain elastography did not detect changes. Both dermal and subcutaneous thickness measurement error was small; intrarater and interrater reliability was good to excellent. Preliminary data indicate that treatment may lead to dermal thinning.

Conclusion. A replicable protocol was established and may be an adjunct to rehabilitation outcome measurement in systemic sclerosis.

Keywords. musculoskeletal ultrasound, scleroderma, rehabilitation, protocol

Purpose. Dental hygiene graduates often experience significant psychological stress while transitioning from the educational setting to clinical practice environments. The purpose of this study was to characterize the duration of dental hygiene activities and tasks and explore efficiency within appointments, by students in educational programs.

Methods. Right-handed female dental hygiene students were recruited from two dental hygiene education programs. Each participant was video recorded while providing patient care during 3 sessions, once per term, over 3 consecutive terms. Activities, tasks, and student postures and positions were coded across the patient visit. Descriptive analyses were conducted to characterize overall durations and distributions across each category. Time spent on non-dental hygiene related activities was compared to other durations, as well as across the education/training time points and by patient type.

Results. Fifty-three videos were analyzed from nineteen participants. The average patient visit length was 155.06 ± 35.63 minutes; approximately half the visit was dedicated to instrumentation activities. Nearly 20% of the visit was categorized as activities or tasks unrelated to education or patient care. Although most participants completed the patient visit more quickly by the third time point, the percentage of non-dental hygiene activities did not decrease, and there were no associations between patient category type and the duration of the patient visit.

Conclusion. Patient visits were roughly three times the length of the typical dental hygiene care appointment, indicating a disconnect between training and practice. In addition to spending more time on hand scaling tasks, participants spent a lot of time on equipment setup and interacting with or waiting for faculty members. These findings have implications for improving efficiency in educational settings, particularly to facilitate a successful transition to clinical practice.

Importance. Head-mounted displays for virtual reality (HMD–VR) may be used as a therapeutic medium in physical rehabilitation because of their ability to immerse patients in safe, controlled, and engaging virtual worlds.

Objective. To explore how HMD–VR has been used in adult physical rehabilitation.

Data Sources. A systematic search of MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, PsycINFO, and ERIC produced 11,453 abstracts, of which 777 underwent full-text review.

Study Selection and Data Collection. This scoping review includes 21 experimental studies that reported an assessment or intervention using HMD–VR in a physical rehabilitation context and within the scope of occupational therapy practice.

Findings. HMD–VR was used for assessment and intervention for patients with a range of disorders, including stroke, multiple sclerosis, spinal cord injury, and Parkinson’s disease.

Conclusions and Relevance. HMD–VR is an emerging technology with many uses in adult physical rehabilitation. Higher quality clinical implementation studies are needed to examine effects on patient outcomes.

What This Article Adds. We review existing research on how immersive virtual reality (e.g., using head-mounted displays) has been used for different clinical populations in adult physical rehabilitation and highlight emerging opportunities in this field for occupational therapists.

Introduction. Translational evidence for mind–body interventions in hand therapy is limited. This pilot study aimed to determine potential benefits of including a mindful body scan or sonographic biofeedback at the outset of a hand therapy session on key psychological states.

Methods. A randomized, repeated-measures, cross-over design was used to evaluate a mindful body scan and sonographic biofeedback at the outset of a hand therapy session. Measures of pain, anxiety, and stress (i.e. salivary cortisol) were obtained from 21 hand therapy patients at the start, after 20 min, and at the end of each of three 60-min treatments. Trends were examined, and mixed-effects regression compared effects across time within and across the sessions for each of the outcome measures.

Results. For all intervention types, anxiety and stress decreased across the treatment session (p < 0.001); no statistically significant changes were noted in pain. Using either mind–body intervention before standard care resulted in a meaningful decrease and statistical trend toward improvement in stress. The use of a mindful body scan produced an immediate, statistically significant reduction in anxiety (β = − 0.14, p = 0.03), a lowered level that was maintained throughout the therapy session.

Discussion. These data provide preliminary support for integrating mind–body interventions as preparatory activities in hand therapy. Mindful body scans may prepare patients for therapeutic interventions by more quickly reducing anxiety, and the use of either intervention may reduce patient stress more than would occur during a standard care session. These effects should be evaluated in an adequately powered clinical trial.

Keywords. Therapeutics, integrative health, sonography, mindfulness.

Purpose. This study aimed to develop a subjective categorization of nerve shape and to examine the relationship of shape categorizations to measurement of nerve circularity.

Methods. Wrists were evaluated with sonography in healthy participants. Images of the median nerve were obtained in the transverse plane at the level of pisiform with the fingers resting, gripping, and pinching. Nerves were categorized as ovoid, angular, or irregular, and the cross-sectional area and perimeter were measured to calculate nerve circularity.

Results. Across 167 participants, the median nerve shifted from being primarily ovoid at rest to angular shaped when the fingers were in a full fist or pinching. Approximately three-quarters of subjects exhibited a shape change during dynamic movement. Irregular nerves had the lowest circularity values; however, the majority of nerves had similar circularity measures despite having different shapes.

Conclusions. Subjective categorization of shape has the potential to be a valid technique for evaluation of the median nerve using sonography, and this evaluation may provide additional information regarding nerve compression that is not fully captured by a circularity measure. Further investigation is needed to determine how these two techniques may be best used individually or together to advance clinical diagnosis, prevention, and rehabilitative interventions.

Keywords. sonography, carpal tunnel syndrome, median nerve, circularity

Mind–body interventions are a viable holistic approach to rehabilitation; however, evidence for mind–body approaches in hand therapy is lacking. This study explored the experiences of clients with musculoskeletal disorders undergoing two mind–body interventions within hand therapy. Qualitative data were obtained from clients who received mindfulness meditation and sonographic biofeedback as part of hand therapy. Semi-structured interviews conducted after four therapy sessions elicited participants’ experiences and acceptability. Emergent themes were identified through an iterative, qualitative descriptive process. The following three themes emerged as results: insight on the body, relaxation and relief, and I am in control. A fourth theme was identified in the acceptability data, that is, mindfulness as a meaningful activity. At least one of the interventions was acceptable to each participant. Positive participant experiences support further consideration of mind–body interventions as a useful holistic approach in hand therapy to support wellness, quality of care, and participation in recovery.

Keywords. therapeutics, hand therapy, integrative medicine, mindfulness, biofeedback

Introduction. The Rapid Upper Limb Assessment (RULA) is an ergonomic assessment tool used to screen for risk of musculoskeletal injury due to working posture. The RULA is traditionally applied once during a work task to approximate overall risk. No method exists for estimating a RULA score for work requiring frequent shifts in posture across an extended period of time.

Purpose. The goal of this study was to identify an optimal sampling method for applying the RULA across a long time-period that accurately represents overall risk.

Methods. Four right-handed female dental hygiene students were video recorded from three angles while performing hand scaling during patient clinic visits (88.97 minutes on average). RULA was continuously scored across the entire session, updating the score when a significant postural shift lasting for more than 15 seconds occurred. A time-weighted average (TWA) RULA score was calculated. Three sampling methods were evaluated: equivalent interval samples, random samples, and random samples selection weighted within “clock positions.” Each method was compared to the TWA using a paired samples t-test and percent difference.

Results. TWA RULA across the four students ranged from 3.4 to 4.3. Preliminary sampling averages using 10 samples were all within 0.2 of the TWA. Further iterations evaluating various sample sizes is ongoing.

Discussion. Preliminary results suggest that all three sampling methods provide a reasonably accurate approximation of the TWA score at the sampling rate tested. Future iterations of this analysis will be continued to identify the minimum required sampling rate to meet our TWA criterion.

Background. The authors’ objective in this systematic review was to describe the evidence for preventive and rehabilitative interventions for musculoskeletal disorders in oral health care.

Types of Studies Reviewed. The authors conducted systematic search, screening, and eligibility processes to identify experimental, quasiexperimental, observational, and survey research studies in which the investigators either directly evaluated or predicted the effects of preventive or rehabilitative interventions on the reduction of musculoskeletal symptoms in oral health care professionals.

Results. The authors identified and screened 3,571 unique abstracts, assessed 256 full-text articles for eligibility, and included 34 articles in the review. Investigators in 17 experimental studies described the results of preventive or rehabilitation interventions and in 17 survey research studies predicted or correlated preventive or protective techniques to a reduction in musculoskeletal symptoms. The primary techniques evaluated in the studies included equipment modification, ergonomic training, and physical exercise.

Conclusions and Practical Implications. The evidence suggests that magnification loupes and indirect-vision techniques have a positive effect on the reduction of musculoskeletal symptoms. In terms of evaluating intervention efficacy, other techniques have mixed evidence or are limited by low-level study design.

Keywords. Ergonomics; injury prevention; musculoskeletal disorders; dentists; dental hygienists

Introduction. Kinesio tape is an alternative non-surgical treatment approach for addressing symptoms of carpal tunnel syndrome. The purpose of the study was to investigate individuals’ experiences with the dorsal application of Kinesio tape for carpal tunnel syndrome management and its impact on pain and function.

Method. The study design was a limited phenomenological design study embedded in a randomized controlled trial. Daily symptom journals and semi-structured interviews were completed with 15 participants who were purposefully recruited and randomly allocated to the intervention group of a single blind randomized controlled trial. Kinesio tape was applied dorsally on the affected forearm, wrist, and digits for a duration of two weeks. Transcribed data were analyzed using descriptive coding, coding schemes, and frequency charts to identify emerging themes.

Results. Three themes emerged: Kinesio tape was positively perceived to be effective on decreasing pain, increasing self-efficacy, and improving daily functional performance on tasks previously avoided or abandoned. The most common problem identified was maintaining Kinesio tape on the hands and fingers, to which the majority of participants expressed a desire to learn application.

Discussion. Results of this study suggest that Kinesio tape is a positively perceived intervention for decreasing pain and increasing function for individuals with carpal tunnel syndrome and warrants further consideration as an alternative conservative intervention for carpal tunnel syndrome.

Keywords. Carpal tunnel syndrome, Kinesio tape, qualitative, functional performance

People spend most of their day in buildings, and a large portion of the energy in buildings is used to control the indoor environment for creating acceptable conditions for occupants. However, majority of the building systems are controlled based on a ‘one size fits all’ scheme which cannot account for individual occupant preferences. This leads to discomfort, low satisfaction and negative impacts on occupants’ productivity, health and well-being. In this paper, we describe our vision of how recent advances in Internet of Things (IoT) and machine learning can be used to add intelligence to an office desk to personalize the environment around the user. The smart desk can learn individual user preferences for the indoor environment, personalize the environment based on user preferences, and act as an intelligent support system for improving user comfort, health and productivity. We briefly describe the recent advances made in different domains that can be leveraged to enhance occupant experience in buildings and describe the overall framework for the smart desk. We conclude the paper with a discussion of possible avenues for further research.

Keywords: Personalized environments, Smart desks, IoT (internet of things), Smart buildings, Indoor environment quality (IEQ)

Background. Median nerve cross-sectional area (CSA) is the primary sonographic parameter for assessing and diagnosing median nerve pathology, such as carpal tunnel syndrome. However, variability in the sensitivity of diagnostic thresholds exists, which may be due to a lack of standardized normative reference values. Current estimates of normal median nerve CSA stem largely from small studies using a local pool of healthy controls. A systematic review and meta-analysis will be conducted to identify all available data for median nerve CSA in healthy, asymptomatic individuals to create a comprehensive set of normative reference values.

Methods. Articles that include sonographic measures of median nerve CSA will be identified through a rigorous search of published evidence, a hand search through tables of contents of key journals, and the gray literature, including ClinicalTrials.gov and conference abstracts. Each abstract and full text will be reviewed by multiple raters to identify studies from 2000 to present that include original data. Any study that provides median nerve CSA values from healthy individuals will be included (e.g., reference value study, control participants in a diagnostic study). Studies will be assessed for quality using a modified version of the National Institute of Health Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, with primary focus on the use of a detailed and acceptable image acquisition and analysis protocol. Using data from included studies, reference values will be calculated for median nerve CSA by anatomical regions, including the distal forearm, wrist, and carpal tunnel at the level of the pisiform. Reference values will be stratified by gender, ethnicity, and age based upon the specificity of the data provided by the included articles.

Discussion. A comprehensive set of normative reference values of median nerve CSA will reduce variability across studies, allowing future research to more accurately evaluate and establish diagnostic thresholds. Additionally, normative values can serve as a reference for evaluating treatment outcomes and provide a means to investigate and understand minor nuances in CSA changes that may be indicative of preclinical stages of median nerve pathology.

Systematic review registration. PROSPERO 2016 CRD42016037286

Keywords. Meta-analysis, Systematic review, Musculoskeletal sonography, Median nerve, Reference values

Musculoskeletal sonography is being widely used for evaluation of structures within the carpal tunnel. While some anatomical variants, such as bifurcated median nerves and persistent median arteries, have been well documented, limited literature describes the sonographic appearance of aberrant muscle bellies within the carpal tunnel. Multiple examples of the sonographic appearance of flexor digitorum superficialis and lumbrical muscle bellies extending into the carpal tunnel are provided. Techniques for static image acquisition and analysis are discussed, and the use of dynamic imaging to confirm which specific muscle belly is involved is described. Knowledge of the potential presence of muscle bellies in these images and ability to identify these structures is vital to avoid misclassification or misdiagnosis as abnormal pathology. The case examples are situated among current published evidence regarding how such anomalies may be related to the development of pathologies, such as carpal tunnel syndrome.

Keywords. carpal tunnel, aberrant muscle, musculoskeletal sonography

Study Design. Mapping review.

Introduction. Although published literature and evidence to support medical practice is becoming more abundant, it is not known how well available evidence supports the full spectrum of hand therapy practice.

Purpose of the Study. The aim of this mapping review was to identify strengths and/or gaps in the available literature as compared with the hand therapy scope of practice to guide future research.

Methods. A systematic search and screening was conducted to identify evidence published from 2006 to 2015. Descriptive data from 191 studies were extracted, and the diagnoses, interventions, and outcomes used in the literature were compared with the hand therapy scope of practice.

Results. Osteoarthritis, tendon surgeries, and carpal tunnel syndrome were most frequently studied. Exercise, education, and orthotic interventions were most common, each used in more than 100 studies; only 12 studies used activity-based interventions. Primary outcome measures included range of motion, pain/symptoms, strength, and functional status.

Discussion. Abundant high-quality research exists for a portion of the hand therapy scope of practice; however, there is a paucity of evidence for numerous diagnoses and interventions.

Conclusions. More evidence is needed for complex diagnoses and activity-based interventions as well as behavioral and quality-of-care outcomes.

Level of Evidence. Not applicable.

This randomized, crossover pilot study explored the acute effects of mindfulness and visual biofeedback on pain, stress, and anxiety in hand therapy. Reduction in anxiety and trending reduction in stress within the experimental conditions indicate that a future, fully powered trial is warranted.

This mapping review describes the scope of literature published over 10 years on the rehabilitation of upper extremity musculoskeletal disorders. Cross comparisons of diagnoses, interventions, and outcomes illuminate priorities for future work (e.g., occupation-based interventions and outcomes).

This study explored the experiences of eight patients with upper extremity disorders who participated in mind–body interventions in outpatient rehabilitation. Using a qualitative descriptive method, four themes emerged, alluding to multiple benefits of holistic practice.

Upper extremity musculoskeletal injuries are common in dental hygienists. To enhance prevention, an ecologically valid observational technique for evaluating risks in dental hygiene practice is needed. This study describes a new video observation technique and reliability results.

Background/Purpose. Sonography is used to evaluate inflammation, identify joint changes, and measure morphology; dynamic assessment of tissue movement is an additional benefit. Dynamic sonographic identification of median nerve entrapment at the wrist during finger motion could improve understanding of carpal tunnel syndrome (CTS) etiology, as well as inform strategies to avert secondary CTS in patients with inflammatory conditions. This study aimed to evaluate a method for identifying and characterizing median nerve entrapment during functional grasp.

Methods. Healthy participants sat with their forearm on a table, palm up, and fingers in a relaxed position. A 12-MHz, linear transducer was placed in cross-section of the wrist at the level of the pisiform. Dynamic videos were obtained while the participant flexed the fingers until the tips touched the palm. Any compression of the median nerve was noted, nerve shape was identified at beginning and end of motion, and direction and distance of nerve displacement was measured. Frequencies/averages were calculated and chi-square/t-tests were used to compare right to left hands.

Results. Participants (N=51) were predominantly right-handed (92.5%) females (88.7%) with an average age of 24.4 years (SD, 3.5). During gripping, 72.5%/68.6% of participants had compression of the nerve in the right/left hands. From rest to grip, the frequency of angular or irregular shapes nearly doubled from 13.7% to 25.4%. Maximum nerve movement (mm) ranged from 0.76-1.08, 2.70-4.02, and 0.06-4.07 for vertical, horizontal, and endpoint displacement respectively; in 20% of hands, essentially no movement occurred. There were no significant differences between left and right, and no direction of movement predominated.

Conclusion. Despite being young and healthy, most participants had nerve compression during finger movement; some with significant entrapment (e.g., angular/irregular shapes). Longitudinal studies are needed to determine if these measures are a CTS predictor or risk factor. These methods can also be translated to clinical practice to inform personalized care for reducing or preventing symptoms in individuals with CTS and other inflammatory conditions.

There is a significantly high rate of work-related musculsokeletal injuries in sonography professionals. To date, assessment of risk factors for work- related injuries in sonographers has been based primarily on surveys, subjective reports, and observational methods. There is a need to develop quantitative techniques to better understand risk factors and develop preventive interventions.

Objective. We pilot tested a high-resolution force-measuring probe capable of precisely measuring forces applied through the transducer by sonographers and used this novel direct measurement technique to evaluate forces during abdominal imaging.

Methods. Twelve sonographers with varied experience, ranging from 1-33 years, performed routine abdominal scans on 10 healthy volunteers who had varied body mass indices (BMI). Imaging was conducted using the force-measuring probe, which provided real-time measurement of forces, and angles. Data were compared by sonographer years of experience and subject BMI.

Results. In total, 47 abdominal examinations were performed as part of this study, and all images met standards for clinical diagnostic quality. The mean contact force applied across all exams was 8.2±4.3 Newtons (N) (range: 1.2-36.5 N). For subjects in the high BMI group (BMI>25, n = 4) the mean force was 10.5 N (range: 8.9-13.2 N) compared to 7.9 N (range: 5.9-10.9 N) for subjects with normal BMI (BMI = 18.5-25, n = 6). Similarly, the mean maximum force applied for subjects with high BMI (25.3 N) was significantly higher than force applied for subjects with normal BMI (17.4 N). No significant difference was noted in the amount of force applied by sonographers with more than 5 years of experience (n = 6) at 8.2 N (Range: 5.1-10.0 N) compared to less experienced sonographers (n = 6), whose forces averaged 8.1 N (Range: 5.8-10.0 N).

Conclusions. It is feasible to directly measure forces applied by sonographers using a high-resolution force measurement system. Forces applied during abdominal imaging vary widely, are significantly higher when scanning subjects with high BMI, and are not related to sonographer years of experience. This force measurement system has the potential to provide an additional quantitative data point to explore the impact of applied forces on sonographer related musculoskeletal injury, particularly in conjunction with various body positions, exam types and force durations.

Background. There is a significantly high rate of work-related musculsokeletal injuries in sonography professionals. To date, assessment of risk factors for work-related injuries in sonographers has been based primarily on surveys, subjective reports, and observational methods. There is a need to develop quantitative techniques to better understand risk factors and develop preventive interventions.

Objective. We pilot tested a high-resolution force-measuring probe capable of precisely measuring forces applied through the transducer by sonographers and used this novel direct measurement technique to evaluate forces during abdominal imaging.

Methods. Twelve sonographers with varied experience, ranging from 1-33 years, performed routine abdominal scans on 10 healthy volunteers who had varied body mass indices (BMI). Imaging was conducted using the force-measuring probe, which provided real-time measurement of forces, and angles. Data were compared by sonographer years of experience and subject BMI.

Results. In total, 47 abdominal examinations were performed as part of this study, and all images met standards for clinical diagnostic quality. The mean contact force applied across all exams was 8.2±4.3 Newtons (N) (range: 1.2-36.5N). For subjects in the high BMI group (BMI>25, n=4) the mean force was 10.5N (range: 8.9-13.2N) compared to 7.9N (range: 5.9-10.9N) for subjects with normal BMI (BMI=18.5-25, n=6). Similarly, the mean maximum force applied for subjects with high BMI (25.3N) was significantly higher than force applied for subjects with normal BMI (17.4N). No significant difference was noted in the amount of force applied by sonographers with more than 5 years of experience (n=6) at 8.2N (Range: 5.1-10.0N) compared to less experienced sonographers (n=6), whose forces averaged 8.1N (Range: 5.8-10.0N).

Conclusions. It is feasible to directly measure forces applied by sonographers using a high-resolution force measurement system. Forces applied during abdominal imaging vary widely, are significantly higher when scanning subjects with high BMI, and are not related to sonographer years of experience. This force measurement system has the potential to provide an additional quantitative data point to explore the impact of applied forces on sonographer related musculoskeletal injury, particularly in conjunction with various body positions, exam types and force durations.

People with musculoskeletal disorders of the shoulder commonly experience pain, decreased strength, and restricted range of motion (ROM) that limit participation in meaningful occupational activities. The purpose of this systematic review was to evaluate the current evidence for interventions within the occupational therapy scope of practice that address pain reduction and increase participation in functional activities. Seventy-six studies were reviewed for this study-67 of Level I evidence, 7 of Level II evidence, and 2 of Level III evidence. Strong evidence was found that ROM, strengthening exercises, and joint mobilizations can improve function and decrease pain. The evidence to support physical modalities is moderate to mixed, depending on the shoulder disorder. Occupational therapy practitioners can use this evidence to guide daily clinical decision making.

Occupational therapy practitioners are key health care providers for people with musculoskeletal disorders of the distal upper extremity. It is imperative that practitioners understand the most effective and efficient means for remediating impairments and supporting clients in progressing to independence in purposeful occupations. This systematic review provides an update to a previous review by summarizing articles published between 2006 and July 2014 related to the focused question, What is the evidence for the effect of occupational therapy interventions on functional outcomes for adults with musculoskeletal disorders of the forearm, wrist, and hand? A total of 59 articles were reviewed. Evidence for interventions was synthesized by condition within bone, joint, and general hand disorders; peripheral nerve disorders; and tendon disorders. The strongest evidence supports postsurgical early active motion protocols and splinting for various conditions. Very few studies have examined occupation-based interventions. Implications for occupational therapy practice and research are provided.

Work-related musculoskeletal disorders are a significant burden; however, no consensus has been reached on how to maximize occupational rehabilitation programs for people with these disorders, and the impact of simulating work tasks as a mode of intervention has not been well examined. In this retrospective cohort study, the authors used logistic regression to identify client and program factors predicting success for 95 clients in a general occupational rehabilitation program and 71 clients in a comprehensive occupational rehabilitation program. The final predictive model for general rehabilitation included gender, number of sessions completed, and performance of work simulation activities. Maximum hours per session was the only significant predictor of success in the comprehensive rehabilitation program. This study identifies new factors associated with success in occupational rehabilitation, specifically highlighting the importance of intensity (i.e., session length and number of sessions) of therapy and occupation-based activities for this population.

Musculoskeletal sonography is rapidly extending beyond radiology; however, best practices for successful integration into new practice contexts are unknown. This study explored non-physician experiences with the processes of training and integration of musculoskeletal sonography into rehabilitation. Qualitative data were captured through multiple sources, and iterative thematic analysis was used to describe two occupational therapists' experiences. The dominant emerging theme was competency, in three domains: technical, procedural, and analytical. In addition, three practice considerations were illuminated: (a) understanding imaging within the dynamics of rehabilitation, (b) navigating nuances of interprofessional care, and (c) implications for post-professional training. Findings indicate that sonography training for rehabilitation providers requires multi-level competency development and consideration of practice complexities. These data lay a foundation on which to explore and develop best practices for incorporating sonographic imaging into the clinic as a means for engaging clients as active participants in the rehabilitation process to improve health and rehabilitation outcomes.

Musculoskeletal conditions are the second greatest cause of disability worldwide, and chronic musculoskeletal conditions affect nearly the same percentage of the general population as chronic circulatory and respiratory conditions combined. Moreover, people with musculoskeletal conditions experience a significant decline in independence with daily activities and occupational performance, key areas targeted by occupational therapy interventions. This special issue of the American Journal of Occupational Therapy provides comprehensive summaries of evidence for the care of common musculoskeletal conditions, highlights important implications that support evidence-informed practice, and proposes ways to advance the practice of occupational therapy to improve the lives of people with musculoskeletal conditions.

This scoping review describes how mindfulness interventions are being used for rehabilitation of physical disorders. Mindfulness interventions fit within the scope of occupational therapy for physical disorders, but there is a dearth of research translating this to practice-based settings.

A scoping review was conducted to describe how mindfulness is used in physical rehabilitation, identify implications for occupational therapy practice, and guide future research on clinical mindfulness interventions. A systematic search of four literature databases produced 1,524 original abstracts, of which 16 articles were included. Although only 3 Level I or II studies were identified, the literature included suggests that mindfulness interventions are helpful for patients with musculoskeletal and chronic pain disorders and demonstrate trends toward outcome improvements for patients with neurocognitive and neuromotor disorders. Only 2 studies included an occupational therapist as the primary mindfulness provider, but all mindfulness interventions in the selected studies fit within the occupational therapy scope of practice according to the American Occupational Therapy Association's Occupational Therapy Practice Framework: Domain and Process. Higher-level research is needed to evaluate the effects of mindfulness interventions in physical rehabilitation and to determine best practices for the use of mindfulness by occupational therapy practitioners.

Background. Musculoskeletal sonography use in point-of-care physical medicine and rehabilitation is rapidly expanding, not only by physiatrists, but also by non-physician rehabilitation providers.

Aim. To evaluate the current range, extent and nature of literature and to identify emerging areas of evidence for the use of musculoskeletal sonography involving non-physician rehabilitation providers to guide research and clinical practice.

Design. Scoping Review

Setting. Inpatient, Outpatient, Other

Population. Musculoskeletal conditions

Methods. Five databases were searched and 578 unique abstracts were identified and screened for eligibility. Three raters independently read 68 full texts and 36 articles that reported on applied uses of sonography by non-physician rehabilitation providers were included.

Results. Eighteen studies described direct clinical use, primarily for outcomes measurement (n=12) or as a biofeedback intervention (n=10). Twelve laboratory studies were included that related morphology to patient reports or validated clinical interventions. Six additional studies, although not involving non-physician providers, were included as they presented potential valuable uses that were not noted in the other included studies, such as monitoring bone healing, tendon repair, and evaluation of idiopathic symptom reports or non-specific primary diagnoses.

Conclusion. This review indicates that non-physician rehabilitation providers use sonography for outcomes measurement and biofeedback interventions. Research is needed to evaluate effects of these uses on patient outcomes and to explore additional potential uses for clinical reasoning, treatment planning, and monitoring of tissue healing related to intervention.

Clinical Rehabilitation Impact. Implementation of musculoskeletal sonography by non-physician rehabilitation providers has the potential to be a critically advantageous addition to improve care.

Sonography is a relatively inexpensive imaging modality that provides real-time, dynamic views of anatomical structures. This session will discuss the results of a qualitative descriptive study that revealed a wide range of uses for sonography by occupational therapists.

Introduction. Ultrasonography may be valuable in staging carpal tunnel syndrome severity, especially by combining multiple measures. This study aimed to develop a preliminary severity staging model using multiple sonographic and clinical measures.

Methods. Measures were obtained in 104 participants. Multiple categorization structures for each variable were correlated to diagnostic severity based on nerve conduction. Goodness-of-fit was evaluated for models using iterative combinations of highly correlated variables. Using the best-fit model, a preliminary scoring system was developed, and frequency of misclassification was calculated.

Results. The severity staging model with best fit (Rho 0.90) included patient-reported symptoms, functional deficits, provocative testing, nerve cross-sectional area, and nerve longitudinal appearance. An 8-point scoring scale classified severity accurately for 79.8% of participants.

Discussion. This severity staging model is a novel approach to carpal tunnel syndrome evaluation. Including more sensitive measures of nerve vascularity, nerve excursion, or other emerging techniques may refine this preliminary model.

Objective. To identify the potential utility of musculoskeletal sonographic imaging in upper-extremity rehabilitation.

Method. Two occupational therapists in an outpatient hand rehabilitation clinic were recruited by convenience, were trained in the use of sonography, and implemented sonographic imaging in their clinical practice. Qualitative data were obtained during and after the implementation period by means of questionnaires and interviews. Data collection, analysis, and interpretation were completed in an iterative process that culminated in a thematic analysis of the therapists' perceptions.

Results. The data indicate four potential areas of utility for musculoskeletal sonography in upper-extremity rehabilitation: (1) mastering anatomy and pathology, (2) augmenting clinical reasoning, (3) supplementing intervention, and (4) building evidence.

Conclusion. Numerous potential uses were identified that would benefit both therapist and client. Further exploration of complexities and efficacy for increasing patient outcomes is recommended to determine best practices for the use of musculoskeletal sonography in upper-extremity rehabilitation.

Occupational therapy practice is grounded in the delivery of occupation-centered, patient-driven treatments that engage clients in the process of doing to improve health. As emerging technologies, such as medical imaging, find their way into rehabilitation practice, it is imperative that occupational therapy practitioners assess whether and how these tools can be incorporated into treatment regimens that are dually responsive to the medical model of health care and to the profession's foundation in occupation. Most medical imaging modalities have a discrete place in occupation-based intervention as outcome measures or for patient education; however, sonographic imaging has the potential to blend multiple occupational therapy practice forms to document treatment outcomes, inform clinical reasoning, and facilitate improved functional performance when used as an accessory tool in direct intervention. Use of medical imaging is discussed as it relates to occupational foundations and the professional role within the context of providing efficient, effective patient-centered rehabilitative care.

Objectives. Non-physician rehabilitation providers (e.g., occupational/physical therapists) have requisite expertise for effective use of point-of-care musculoskeletal sonography (MSKUS); however, professional curriculums provide only introductory-level image interpretation, at best. This multi-method study evaluated post-professional competency development and the complexities of clinical integration of MSKUS by non-physician rehabilitation providers.

Methods. Three occupational therapists (OTs) received weekly, 2-3 hour, hands-on training from a RMSK-credentialed OT for 3 months. Training included ultrasound physics, imaging protocols, image acquisition, optimization and analysis. Prior to implementing MSKUS in the hand therapy clinic, minmum competency for selecting protocols, acquiring and interpreating images was determined using patient scenerios. During a 10-month implementation, therapists self-rated competency in image acquisition and interpretation on a 10-point visual analogue scale following each MSKUS use. Data were divided into early, mid, and late time periods to evaluate competency development. Semi-structured interviews throughout and following implementation provided deeper understanding of the complexities of clinical integration. Three researchers identified themes through interative anlaysis of interview transcripts and multiple consensus meetings.

Results. Competency for acquiring images significantly increased (p < .05) between the early and mid phase (4.9 to 6.9), whereas competency for image interpretation did not show a significant increase until the late phase (5.8 to 7.6). Qualitative themes included numerous technical competencies nested within real-time interaction with the client, as well as perceived clinical use and professional constraints.

Conclusions. Utilization of MSKUS by non-physician rehabilitation providers diverged from diagnostic techniques to patient-centered applications (e.g., education, biofeedback). Post-professional MSKUS training programs for these providers will require an unique approach to address the various nested competencies and clinical considerations that differ from training provided to physicians and sonographers.

Objectives. Rigorous reliability and validity data for emerging male pelvic floor imaging protocols has not been reported. This study validated and examined reliability of a novel linear-array, transperineal sonographic approach for evaluating superficial male pelvic floor structures.

Methods. The superficial pelvic muscles (bulbospongiosus (BS), ischiocavernosus (IC), bony landmarks, and the bulb of the penis were identified via dissection of two embalmed male cadavers. Relative depth and orientation of these structures were compared to sonograms obtained from two male participants, resulting in standardization of the imaging protocol and providing face validity for image analysis. Transverse images were then obtained from 20 male participants (GE Logiq E9, 11-Linear) at two time points. Three raters measured cross-sectional area (CSA) and linear thickness of the bulb of the penis, urethra, BS and IC muscles in three seperate trials for each of 38 images (2 participants lost to follow-up). Two-way, mixed effects intra-class correlation coefficients (ICC) were calculated within repeated trials by rater (intra-rater) and across raters (inter-rater). Minimum acceptable reliability for this study was set at 0.60.

Results. Measures of the bulb of the penis had excellent reliability (ICC > 0.90), CSA of all muscles had good reliability (ICC [0.70-0.92]), and thickness of the BS near its central tendon had good reliability (ICC > 0.80). For rater identified thickest region of the muscles and all urethra measures, reliability was poor-to-fair (ICC [0.50-0.85]) and varied widely, with most lower bounds of confidence intervals falling below the acceptability threshold (<0.60). Intra-rater reliability was similar across the three raters who had varied sonography experience and pelvic knoweldge.

Conclusions. The superficial structures of the male pelvic floor can validly identified and CSAs can be reliably measured using this sonographic approach. This approach can be used to advance knoweldge and practice for patients with pelvic disorders through the investigation of morphologic differences from healthy controls and the evaluation of clinical intervention effects.

This study evaluated reliability of measures for superficial structures of the male pelvic floor (PF) obtained via transperineal sonography. Two embalmed cadavers were dissected to identify positioning of muscles on and around the bulb of the penis and to confirm the PF protocol. Cross-sectional area (CSA) and linear thickness of the bulb of the penis, urethra, bulbospongiosus (BS) muscles, and ischiocavernosus (IC) muscles were measured on 38 transverse images from 20 male patients by three raters with varied study knowledge and sonographic experience. Intra- and inter-rater reliability were calculated with two-way, mixed effects intra-class correlation coefficients. Measures of the bulb of the penis had the best reliability. CSA of all muscles and sagittal thickness of the BS near the central tendon had good reliability. Reliability varied for rater-identified thickest muscle region and measures of the urethra. Our study suggests that structures of the male PF can be reliably evaluated using a transperineal sonographic approach.

Objectives. The purpose of this study was to provide clinical evidence of the use of contrast-enhanced sonography in detecting and quantifying changes in intraneural vascularity due to median mononeuropathy.

Methods. Five Macaca fascicularis monkeys were exposed to 20 weeks of repetitive work to increase their risk of developing median mononeuropathy. Contrast-enhanced sonograms were obtained in 30-second increments for 7 minutes while a contrast agent was being delivered. Data were collected immediately at the conclusion of the 20-week work exposure and then again during a recovery phase approximately 3 months after the completion of work. Quantitative analysis and trend graphs were used to analyze median nerve perfusion intensity. This study also compared the use of both manual counting of pixels and semiautomatic measurement using specialized software.

Results. Based on the average data, maximum intensity values were identified as the best indicators of nerve hyperemia. Paired t tests demonstrated significantly higher maximum intensities in the working stage for 4 of the 5 subjects (P < .01).

Conclusions. This study provides preliminary evidence that (1) in a controlled exposure model, a change in intraneural vascularity of the median nerve between working and recovery can be observed; (2) this vascular change can be measured using an objective technique that quantifies the intensity of vascularity; and (3) contrast-enhanced sonography may improve the ability to reliably capture and measure low-flow microvascularity.

Background. Musculoskeletal pain and discomfort due to work exposure is experienced by 90% of sonographers. Survey research has provided a wealth of information to document this problem, but few studies have attempted to directly measure and identify the source of these disorders.

Objective. This pilot observational study was conducted to obtain direct measures of the relationship of sonographers to their environment during the completion of sonographic examinations.

Methods. The Rapid Upper Limb Assessment (RULA) was used to evaluate the positions of five sonographers during 24 sonographic examinations. The observed positions were compared among the various examinations and the association of these observed postures to discomfort, sonographer height, and exam table height was evaluated.

Results. All participants reported an increase in musculoskeletal discomfort at the end of the workday. Overall RULA scores ranged from 3.11 to 5.00 with upper extremity venous Doppler and transvaginal pelvic examinations averaging the highest. Increasingly poor upper extremity positioning was positively associated with increased musculoskeletal discomfort (r = 0.53, p < 0.01).

Conclusions. Regardless of the examination being performed, sonographers are working in positions that require further evaluation and intervention. Longitudinal studies are needed that evaluate the inter-relationship of biopsychosocial risk factors of musculoskeletal injuries.

In the study described here, we examined the feasibility of a longitudinal design to measure sonographically swelling of the median nerve caused by controlled exposure to a work task and to evaluate the relationship of changes in morphology to diagnostic standards. Fifteen macaques, Macaca fascicularis, pinched a lever in various wrist positions at a self-regulated pace (8 h/d, 5 d/wk, 18–20 wk). Nerve conduction velocity (NCV) and cross sectional area (CSA) were measured every 2 wk from baseline through working and a 6-wk recovery. Trending across all subjects revealed that NCV slowed and CSA at the carpal tunnel increased in the working arm, whereas no changes were observed in CSA either at the forearm or for any measure in the non-working arm. There was a small negative correlation between NCV and CSA in the working arm. This study provides validation that swelling can be observed using a longitudinal design. Longitudinal human studies are needed to describe the trajectory of nerve swelling for early identification of median nerve pathology.

This preclinical study was conducted to develop discrete sonographic instrumentation settings and also safe contrast dosing that would consistently demonstrate perineural vascularity along the median nerve. This set of imaging studies was conducted with a convenience cohort of young adult female monkeys (Macaca fascicularis). Sonographic equipment settings and dosing were refined throughout the imaging series to ensure consistent contrast-enhanced ultrasound imaging. A mechanical index of 0.13 was consistently used for imaging. Perineural vessels were imaged with a suspension solution of 0.04 mL Definity/0.96 mL saline introduced over 5 minutes for a total dose of 0.8 mL of contrast solution. Blinded studies of high and low dose contrast, along with saline injections, were correctly identified by two experienced sonographers. This preclinical study established adequate equipment settings and dosing that allowed for a valid demonstration of vascularity surrounding the median nerve.

Significant data exist for the personal, environmental, and occupational risk factors for carpal tunnel syndrome. Few data, however, explain the interrelationship of tissue morphology to these factors among patients with clinical presentation of median nerve pathology. Therefore, our primary objective was to examine the relationship of various risk factors that may be predictive of subjective reports of symptoms or functional deficits accounting for median nerve morphology. Using diagnostic ultrasonography, we observed real-time median nerve morphology among 88 participants with varying reports of symptoms or functional limitations resulting from median nerve pathology. Body mass index, educational level, and nerve morphology were the primary predictive factors. Monitoring median nerve morphology with ultrasonography may provide valuable information for clinicians treating patients with symptoms of median nerve pathology. Sonographic measurements may be a useful clinical tool for improving treatment planning and provision, documenting patient status, or measuring clinical outcomes of prevention and rehabilitation interventions.

Idiopathic chronic male pelvic pain is difficult to diagnose and treat. Currently, diagnosis relies on subjective symptoms; objective measures of neuromuscular mechanisms have not been investigated. Sonographic imaging has been used to investigate these neuromuscular mechanisms in the female pelvic floor, but neither research nor books describe sonography evaluation of the male pelvic floor. The purpose of this study was to develop and evaluate a perineal sonographic technique for the examination of the male pelvic floor muscles. Anatomic landmarks were identified with images collected from two subjects, one with intermittent reports of pelvic pain and one with no history of pain in the pelvic region. A description of the equipment settings, the examination protocol, and the resulting comparative image analysis is included. A validated protocol such as this may be useful in documenting differences in the soft tissue structures between asymptomatic individuals and patients with chronic pelvic pain to aid in diagnosis and treatment. This is the first known study to report sonographic findings of the individual muscles in the male pelvic floor, and additional research is needed to validate the techniques that have been deemed feasible.

Objective. Three-fourths of diagnostic medical sonographers (DMS) and vascular technologists (VT) experiencing discomfort due to job demands indicate having discomfort in the shoulder region. An analysis of factors related to shoulder discomfort highlighted salient factors requiring further investigation and intervention.

Methods. The responses of 2,163 DMS and VT from a survey of a representative sample were analyzed to determine personal factors, work demands, and workstation design characteristics of those experiencing discomfort in the shoulder region. Frequencies and response distributions were calculated and cross tabulation with chi-square analysis was completed.

Results. A majority of respondents with shoulder discomfort have co-morbid reports of discomfort in other locations. While overall sonographer discomfort is linked to age and years of experience, shoulder discomfort was also noted to be linked to specific workstation characteristics. A lack of adjustability in equipment, PACS workstations, and positions required to complete bedside exams contributes to discomfort due to sustained and repetitive shoulder abduction and twisting of the neck and trunk.

Conclusions. There is a need for studies investigating redesign of equipment and workstations or interventions with DMS and VT specifically focused on improving adjustability and improved positioning of sonographers in order to reduce shoulder discomfort while performing job demands.

Objectives. The purpose of this study was to document and analyze intraneural vascular flow within the median nerve using power and spectral Doppler sonography and to determine the relationship of this vascular flow with diagnosis of carpal tunnel syndrome based on electrodiagnostic testing.

Methods. Power and spectral Doppler sonograms in the median nerve were prospectively collected in 47 symptomatic and 44 asymptomatic subjects. Doppler studies were conducted with a 12-MHz linear transducer. Strict inclusion criteria were established for postexamination assessment of waveforms; routine quality assurance was completed; electrodiagnostic tests were conducted on the same day as sonographic measurements; and the skin temperature was controlled. Included waveforms were categorized by location and averaged by individual for comparative analysis to electrodiagnostic testing.

Results. A total of 416 waveforms were collected, and 245 were retained for statistical analysis based on strict inclusion criteria. The mean spectral peak velocity among all waveforms was 4.42 (SD, 2.15) cm/s. At the level of the pisiform, the most consistent data point, mean peak systole, was 3.75 cm/s in symptomatic patients versus 4.26 cm/s in asymptomatic controls. Statistical trending showed an initial increase in the mean spectral peak velocity in symptomatic but diagnostically negative cases, with decreasing velocity as diagnostic categories progressed from mild to severe.

Conclusions. An inverse relationship may exist between intraneural vascular flow in the median nerve and an increasing severity of carpal tunnel syndrome based on nerve conduction results. Randomized controlled trials are needed to determine whether spectral Doppler sonography can provide an additive benefit for diagnosing the severity of carpal tunnel syndrome.

A prospective cohort of 47 symptomatic patients who reported for nerve conduction studies and 44 asymptomatic controls was examined with sonography to evaluate the median nerve. Doppler studies of the median nerve were collected with handheld sonography equipment and a 12-MHz linear broadband transducer. Strict inclusion criteria were established for assessing 435 waveforms from 166 wrists. Two sonographers agreed that 245 waveforms met the a priori criteria and analyzed the corresponding data. Spectral Doppler waveforms provided direct quantitative and qualitative data for comparison with indirect provocative testing results. These Doppler data were compared between the recruitment groups. No statistical difference existed in waveforms between the groups (P < .05). Trending of the overall data indicated that as the number of positive provocative tests increased, the mean peak systolic velocity within the carpal tunnel (mid) also increased, whereas the proximal mean peak systolic velocity decreased. However, by using multiple provocative tests as an indirect comparative measure, researchers may find mean peak spectral velocity at the carpal tunnel inlet a helpful direct measure in identifying patients with carpal tunnel syndrome.

Objective. The use of ultrasonography in musculoskeletal research and clinical applications is increasing; however, measurement techniques for diagnosing carpal tunnel syndrome (CTS) with ultrasonography continue to be inconsistent. Novel methods of measurement utilizing internal comparisons to identify swelling of the median nerve (MN) require investigation and comparison to currently used techniques.

Methods. Flattening ratio of the MN, bowing of the flexor retinaculum, and cross-sectional area (CSA) of the MN were collected at the forearm, at the radio-carpal joint, and at the level of the pisiform in both symptomatic patients and asymptomatic controls. Electrodiagnostic testing (EDX) was completed in symptomatic patients as a diagnostic standard.

Results. MN measurements were collected from 166 wrists of symptomatic and asymptomatic subjects. Flattening ratio did not show any correlation to EDX and was identical between both symptomatic and asymptomatic subjects. Moderate to strong correlations were noted between EDX results and ultrasonographic measures of CSA at the pisiform, retinacular bowing, and both ratio and change of CSA between the forearm and pisiform. Area under the curve was large for all receiver operating curves for each measure [.759-.899] and sensitivity was high [80.4%-82.4%].

Conclusions. Measurement of swelling through a ratio or absolute change had similar diagnostic accuracy as individual measurement of CSA within the carpal tunnel. These measures may be useful to improve accuracy in more diverse clinical populations. Further refinement of protocols to identify the largest CSA within the carpal tunnel region and statistical methods to analyze clustered, multi-level outcome data is recommended to improve diagnostics.

A plethora of research evaluates the utility of ultrasonography versus electrodiagnostic testing for diagnosis of carpal tunnel syndrome. Two limited reviews of literature were completed, but a full, systematic review has not been completed. We identified 582 abstracts published 1999-2009 through database searches, hand searches, and communication with authors, resulting in 23 high quality studies that met our inclusion criteria based on a rigorous, independent review. Significant discrepancies and methodological limitations in the description of ultrasonography protocols and diagnostic thresholds limited the ability to combine data and identify specific thresholds. The cross-sectional area of the median nerve within the carpal tunnel is the most stable measure and has high potential to correctly diagnose severe carpal tunnel syndrome. Further investigation of measures, especially those that can diagnose mild cases of CTS, is needed. Suggestions for clinical protocols and the utility of ultrasonography as a screening tool to compliment electrodiagnostic testing are reviewed.

Purpose. To identify dosing and instrumentation while conducting contrast sonography to visualize perineural vascular flow, within the median nerve, in a group of Macaca fascicularis recovering from carpal tunnel syndrome (CTS).

Material & Methods. A pilot dosing study was conducted with Macaca fascicularis, which were trained to complete a repetitive task. Nerve conduction and gray-scale sonography data were collected on 8 subjects with documented CTS. The dosing study facilitated the capture of vascular fill time within both large and small vessels. Dosing and instrumentation were set using the subclavian and radial artery, to determine a mean vascular fill time. The Doppler studies were conducted with a GE Logiq 9 and a 9 MHz linear array transducer. Definity(R) was mixed with saline to provide an infusion contrast injection. Four injections and booster shots were administered while the subject was closely monitored.

Results. A transmit frequency of 6.0 MHz, MI of 0.13, and 7% output power was coupled with an infusion of 0.04 ml of Definity(R) and 0.8 ml saline. Booster infusions of 0.05 facilitated the capture of a vascular fill time of 1:30 mins in the subclavian and radial artery. The perineural vascular fill time was similar with these same infusion and equipment settings.

Conclusion. Although data was collected on 8 subjects, more subject results would provide convincing results on the vascular fill time associated with perineural vascular flow, post CTS diagnosis.

Purpose. To document and analyze perineural vascular flow within the median nerve utilizing power Doppler (PD) and spectral Doppler (SD) to determine a relationship with a nerve conduction study (NCS), for carpal tunnel syndrome (CTS) screening.

Material & Methods: PD and SD in the median nerve were prospectively collected with 47 symptomatic and 44 asymptomatic subjects. Doppler studies were conducted using GE Logiq i ultrasound equipment and a 12 MHz linear transducer. Strict inclusion criteria were established for post-examination assessment of waveforms. Median systolic peak measurements taken proximal, mid, and distal to the carpal tunnel inlet were categorized by location and averaged by individual for comparative analysis to NCS results.

Results. The data from all groups were statistically comparable with 27 waveforms at proximal, 42 at the mid, and 54 at the distal portion of the wrist. Control and negative NCS subjects had a mean spectral peak of 4.0 cm/sec. and severe NCS subjects had a spectral peak of 2.3 cm/sec. Statistical trending demonstrated that mean spectral peak data dropped as the diagnostic categories progressed from negative to severe.

Conclusion. An inverse relationship may exist between perineural vascular flow in the median nerve and increasing severity of nerve conduction, at the carpal tunnel inlet and distally. Further research is needed to determine if SD is a non-invasive alternative for diagnosing the severity of CTS.

Purpose. Numerous anthropometric measures, demographic characteristics, and occupational exposures have been suggested as contributory factors in development of carpal tunnel syndrome (CTS). This study investigated the relationship of these factors and physiologic changes in the median nerve (MN) measured with grey-scale ultrasonography (US) to symptoms of MN pathology.

Material & Methods. Age, gender, body mass index (BMI), wrist ratio, education, occupation, and MN US measures were collected (n = 88). The Boston Carpal Tunnel Questionnaire (BCTQ) identified complaints of MN pathology. Binary stepwise logistic regression was used to determine the contribution of US measures of cross-sectional area at the pisiform (CSAp), CSA change (forearm-pisiform), and retinacular bulge when considered with known factors in a model for predicting CTS complaints.

Results. Symptoms of MN pathology were reported by 56 subjects. BMI, education and CSAp were significant predictors of complaints in this exploratory regression model (r² = 0.26, p = 0.001). CSAp odds ratio was 1.35 (p = .001) and BMI odds ratio was 1.10 (p = .04). Odds of complaints decreased as subjects moved from high school education to graduate education (0.535, p = .08).

Conclusion. This preliminary study indicates that changes in US measures of the MN nerve may provide more relevant information for predicting MN pathology than other previously studied factors. While larger homogeneous samples are required to validate these findings, these data provide evidence for continued investigation of US as a screening tool for MN pathology.

Bifid median nerve and persistent median arteries are natural anatomic variants that exist in a small percentage of the population. This case describes a young woman who was referred for electrodiagnostic (EDX) testing of her right upper extremity because of a one-year history of numbness, tingling, and discomfort in her right upper extremity consistent with carpal tunnel syndrome. Careful sonographic scanning (gray scale and power Doppler) and dynamic investigation revealed a bifid median nerve and associated persistent median artery (PMA). The awareness of a bifid median nerve and PMA is important when evaluating patients sonographically for diagnosis of upper extremity pathology, including enlargement due to carpal tunnel syndrome. Furthermore, as musculoskeletal sonography increases in clinical practice, it is important to raise awareness of this dual anatomic variant to ensure that appropriate evaluation and treatment are provided. The sonographic presentation of anatomic variations in this case along with a review of these anomalies is provided for translational clinical use.

A cross-sectional representative sample of 1722 sonographers and vascular technologists was analyzed using quantitative/qualitative methods to reveal that 60% are experiencing wrist-hand-finger discomfort, believed to be from work-related repetitive injury. The years of scanning accumulated by the participants was chosen as a variable to determine the relationship to the range of discomforts reported. A strong statistical correlation was noted between years of experience and the side of discomfort as well as the severity of hand-wrist-finger discomfort. In this study, a strong statistical association was also noted between increasing years of scanning and decreasing aggravation due to the transducer. A complete linkage between work-related exposure and hand-wrist-finger discomfort is difficult to make because of the contribution of leisure-time activities. A controlled experimental study is needed to determine the contribution that grip and pushing on the transducer may have on the incidence of hand-wrist-finger discomfort, leading to diagnoses such as carpal tunnel syndrome.

A pilot study was conducted to gather holistic data points on female sonographers who executed neonatal neurosonography over four portable scanning sessions. The hypothesis was that specific risk factors contributed to work-related musculoskeletal distress in the hand and wrist as a result of neonatal neurosonography. A preexperimental pre-post research design was used to gather data on work demands, self-rated physical and mental health, posture/position during scanning, physiologic change, and pain scores. No statistically significant changes were detected between pre-post measures for work demands, physical and mental health, or pain scores as a result of portable scanning sessions. The physiologic changes, between scanning sessions, were recorded with the use of a hand-carried sonographic unit. Sonographic measures were less than the published criteria for carpal tunnel syndrome with a proximal cross-sectional area ≥10 mm² and an anterior bulge of the retinaculum of >4 mm. Sonography documented a statistically significant cross-sectional area change, within the median nerve, at the distal radius only after the first scanning session. Power and spectral Doppler was used to document perineural vascular flow within the median nerve, but it was not consistently obtained to allow for a rigorous comparison between pre- and post-scanning sessions. This is the first pilot study to explore using a hand-carried sonographic unit to document change in the median nerve for an isolated sonographic examination. The results are only reflective of these particular participants, but much larger N and shorter scanning sessions are needed to confirm the hypothesis proposed.

Literature indicates a significant history of workr-elated musculoskeletal disorders (WRMSD) among diagnostic medical sonographers (DMS) and vascular technologist (VTs). To gather current data related to this historical trend, the authors administered a survey to a random and convenient sample of 5200 registered DMS and VTs. The invitation to complete the survey on a secure Web site yielded the largest participant sample to date of 2963 completed surveys (57% response). Data relative to the prevalence of WRMSD were analyzed and compared to other WRMSD research over the past decade. Results indicated that 90% of respondents were scanning in pain, a 9% increase since the last large scale survey in 1997. Across all demographics, shoulder pain is most common, with older and more experienced sonographers having more finger, hand, and wrist pain than other groups. Pain continues to be related to pressure applied to the transducer, abduction of the arm, and twisting of the neck and trunk. Ergonomic equipment and education are provided by application specialists, but the incidence of WRMSD appears to be unabated. Higher order research, including randomized trials, with education and ergonomic interventions is needed to protect DMS and VTs who are necessary to meet increasing health care demands.

Numerous research studies describe the prevalence of work-related musculoskeletal disorders (WRMSD) in diagnostic medical sonographers, but little research has investigated contributing factors and biological changes in symptomatic individuals. Improved image quality and portability, combined with lower cost and dynamic capabilities, have led to increased use of sonography over magnetic resonance imaging (MRI) in musculoskeletal evaluations. The purpose of this pilot study was to develop a valid and reliable sonographic protocol for the evaluation of work-related median nerve pathology with a hand-carried sonographic unit. A GE Logiq I (Milwaukee, Wisconsin) hand-carried unit with a 12-MHz linear transducer was used to collect nine longitudinal and transverse images of the median nerve at various anatomical locations in the distal upper extremity of three healthy volunteers. Doppler waveforms were also collected in the median nerve sheath. Qualitative review indicated high-quality images with well-defined structures, resulting in valid measures between multiple researchers of anteriorposterior diameter, cross-sectional area, anterior transverse carpal ligament bulge, and Doppler flow. The use of a hand-carried sonographic unit appears to be a feasible alternative to MRI to detect musculoskeletal changes in symptomatic sonographers. Additional basic and clinical studies are necessary to validate the use of hand-carried sonography as a measure of biological changes in longitudinal WRMSD research.