Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 6 appraisals
Scientific reports
Influence of a passive shoulder exoskeleton on drilling performance in women- a cross-sectional study
Work-related musculoskeletal disorders are common, especially among women performing repetitive overhead tasks. In a randomized 2 × 2 crossover study with 14 female participants, we investigated the effects of a passive upper-body exoskeleton during an overhead precision task, involving the tightening of 20 bolts into a sensor-based workstation, while muscle activation, task performance, and usability were assessed. The results showed significant reduced M. Trapezius muscle activations during arm lowering (p = .041, 73%), and lower target accuracy (p < .001, 100%) when using the exoskeleton. Subjective strain in the shoulders was significantly lower when using the exoskeleton (p = .035, 15%). The usability was rated as "unacceptable", with users criticizing the complexity and learning effort. While the exoskeleton reduced muscle load, its mechanical limitations impaired precision and usability, especially for women. These results highlight the importance of sex-specific, ergonomic, and adaptive designs to improve exoskeleton effectiveness and acceptance.
11 June 2026
Read appraisal →JMIR human factors
Dynamic Balance Control and Postural Adaptation in Human-Robot Collaborative Manipulation: Within-Subject Experimental Study
BACKGROUND: The integration of robots into industrial settings has rapidly advanced, aiming to reduce human involvement in demanding tasks while improving overall efficiency. As collaborative robots (cobots) become more prevalent, assessing the physical strain during joint tasks is essential to promote long-term well-being in the workplace. OBJECTIVE: This study aimed to investigate how human-robot collaboration influences workers' postural control and musculoskeletal load during manipulation tasks performed in parallel. METHODS: Fourteen healthy male participants performed manipulation tasks under 3 conditions: without robotic assistance, with a cobot providing load support (Robot Free [RF]) and a cobot constrained to horizontal movement (Robot Plane [RP]). Center of pressure trajectories were computed, and nonlinear recurrence quantification analysis indicators (recurrence rate [REC], determinism [DET], and their ratio) were calculated in the anteroposterior, mediolateral, and anteroposterior-mediolateral planes. RESULTS: Statistical analysis showed greater postural sway in robot-assisted conditions compared to Free. Mean distance increased from 1.7 (SD 0.6) cm in Free to 2.4 (SD 0.6) cm in RF (P<.001) and 2.3 (SD 0.6) cm in RP (P<.001). Mean velocity increased from 2.9 (SD 0.9) cm/s in Free to 4.3 (SD 1.4) cm/s in RF and RP. Confidence ellipse area increased from 7.6 (SD 4.1) cm2 in Free to 24.9 (SD 14.2) cm2 in RF and 23.1 (SD 13.4) cm2 in RP. Sway area increased from 1.5 (SD 0.7) cm2/s in Free to 2.9 (SD 1.2) cm2/s in RF and RP. Nonlinear metrics revealed lower recurrence rates in robot-assisted conditions, decreasing from 0.31 (SD 0.08) in Free to 0.2 (SD 0.08) in RF and 0.2 (SD 0.04) in RP in the anteroposterior-mediolateral plane (P<.001), from 0.33 (SD 0.08) in Free to 0.28 (SD 0.07) in RF (P=.02) and 0.16 (SD 0.03) in RP (P=.007) in the mediolateral direction, and from 0.36 (SD 0.07) in Free to 0.3 (SD 0.06) in RF (P=.009) and 0.26 (SD 0.03) in RP (P<.001) in the anteroposterior direction. Determinism remained stable (values close to 1), leading to higher determinism-to-recurrence ratios for robot-assisted conditions, increasing from 3.41 (SD 0.87) in Free to 5.41 (SD 1.69) in RF and 5.51 (SD 1.11) in RP in the anteroposterior-mediolateral plane (P<.001), from 3.11 (SD 0.63) in Free to 3.64 (SD 0.72) in RF (P=.02) and 3.92 (SD 0.48) in RP (P=.007) in the mediolateral direction, and from 2.82 (SD 0.48) in Free to 3.47 (SD 0.57) in RF (P=.009) and 3.46 (SD 0.45) in RP (P<.001) in the anteroposterior direction. No significant differences were found between the robot-assisted conditions. CONCLUSIONS: Interaction increases postural sway, indicating reduced stability and higher physical demand. This could reflect impaired balance or adaptation. Nonlinear analysis reveals that postural control remains structured. Results also suggest that the mere presence of the cobot is the primary driver of these postural changes.
26 Apr 2026
Read appraisal →Acta orthopaedica
Migration patterns of uncemented femoral stems in hip replacement: a systematic review and meta-analysis of clinical radiostereometric analysis cohort studies
BACKGROUND AND PURPOSE: We conducted a systematic review and meta-analysis of radiostereometric analysis studies of primary uncemented femoral stems to investigate their subsidence and retroversion patterns and the migration patterns according to implant, patient, and study characteristics. METHODS: A systematic search of PubMed, Web of Science, Cochrane, and Embase databases to identify all radiostereometric analysis studies on femoral stem migration following primary uncemented total hip replacement was performed. Clinical studies with 2 or more postoperative radiostereometric measurements within 2 years were included. Subsidence and retroversion at 6 weeks, 3 and 6 months, 1, 2, 5, and 10 years were included for analysis. Extracted implant characteristics included implant design, coating, and surgical approach. Data was analyzed using a random effects model. RESULTS: 73 studies on 120 cohorts and 2,970 uncemented stems were included. 119 cohorts reported on subsidence and 91 on retroversion. The pooled subsidence at 3 months was 0.29 mm (95% confidence interval [CI] 0.19-0.39) and 0.32 mm (CI 0.21-0.43) at 2 years. The pooled retroversion at 3 months was 0.51° (CI 0.33-0.70) and 0.70° (CI 0.48-0.93) at 2 years. Hydroxyapatite-coated stems showed the least migration (subsidence 0.26 mm; CI 0.13-0.40; retroversion 0.51°; CI 0.22-0.80) among different coating types. The anterior approach showed more migration (subsidence 1.04 mm, CI 0.53-1.55; retroversion 1.52°, CI 1.08-1.95) than other surgical approaches. CONCLUSION: Our study shows that most subsidence and retroversion of uncemented femoral stems occurs during the first 3 months. Stabilization of subsidence occurred after 3 months, and retroversion stabilized after 2 years. Migration patterns differ based on stem type, coating, surgical approach, the time period when inclusion started, and timing of baseline measurement.
18 Apr 2026
Read appraisal →PloS one
Effect of different velocity loss thresholds during a resistance training program on jump and sprint performances in trained female athletes
This study aimed to explore the effects of velocity-based resistance training (VBT) using different velocity loss (VL) thresholds on jump and sprint performance in trained female athletes. Fifteen college-level female basketball players completed an 8-week VBT program (2 sessions/week), involving parallel back squats performed at a target mean propulsive velocity of 0.7 m/s. Participants were randomly assigned to two groups: VL10% (n = 8) and VL20% (n = 7), where training sets were terminated when the target velocity-loss threshold was exceeded for the second time within the same set. Performance tests, including one-repetition maximum (1RM), squat jump (SJ), countermovement jump (CMJ), and 20-m sprint (SP20) with split times recorded at 5 m (SP5) and 10 m (SP10), were conducted pre- and post-intervention. The VL10% group showed significant improvements in SJ (p = 0.048, d = 1.30), SP10 (p = 0.004, d = 0.62), SP20 (p = 0.002, d = 0.67), and 1RM (p = 0.002, d = 0.29). The VL20% group also showed improvements in SP10 (p = 0.004, d = 0.42), SP20 (p = 0.002, d = 0.56), and 1RM (p = 0.002, d = 0.62), although SJ did not significantly improve. Despite no significant interaction effects, effect sizes suggest possible differences that require verification in adequately powered trials. VBT using low VL thresholds may be useful for maintaining movement velocity with lower training volume; however, between-group differences were not statistically significant and CMJ did not show clear improvement. Larger-scale studies are needed to confirm these trends.
14 Apr 2026
Read appraisal →Medicine
Influence of alteration of foot progression angle on three-dimensional pelvic kinematics in individuals with knee osteoarthritis during walking: A randomized crossover study
BACKGROUND: Foot progression angle (FPA) modification trials during walking have been used to reduce knee adduction moments in medial compartment knee osteoarthritis. However, few studies have confirmed the impact of FPA modification as a clinical intervention on pelvic segment kinematics. METHODS: Kinematic pelvic data were obtained from 37 participants with medial knee osteoarthritis using a three-dimensional motion capture system under varying FPA walking conditions. A repeated-measures analysis of variance was conducted to assess the influence of each FPA condition on kinematic values. RESULTS: During maximal internal foot rotation gait trials, participants exhibited decreased depression, reduced external rotation, and increased internal rotation of the pelvis compared to the free walking condition (P < .05). In contrast, under the maximal external foot rotation condition, significantly less internal rotation and increased external rotation of the pelvis were observed compared to the free walking condition (P < .05). CONCLUSION: The findings of this study suggest that additional musculoskeletal dysfunctions and clinical implications, including back pain and pelvic instability, should be considered when implementing FPA modification gait in individuals with medial compartment knee osteoarthritis.
11 Apr 2026
Read appraisal →PloS one
Prediction of on-field rugby scrummaging contact forces from videos using artificial neural networks
Rugby is a contact sport with a high risk of injury. Scrums are a key component of the game and represent a collision event associated with serious injuries, especially to the cervical spine. Traditional methods for measuring scrum forces rely on both pressure sensors and scrum machines, but these have limitations for on-field monitoring. Thus, this study investigates the feasibility of using a machine learning approach to predict contact forces in rugby scrummaging during real-game situations, based on only anatomical landmarks of players extracted from video footage. A recurrent neural network (RNN) model was trained to predict contact forces from velocity signals. A dataset of eleven rugby teams (22 forward packs, n = 176 players) during on-field scrum engagements was used. Data augmentation techniques using a generative adversarial network and the Mixup technique were applied to increase the size of the training dataset. The RNN was trained using time-dependent data, with 2D trajectories from video landmarks as inputs and force signals from pressure sensors as outputs. The RNN´s prediction results showed good to excellent agreement between the predicted and measured time-dependent normal contact force signals, with a mean correlation of 0.95 ± 0.05. The mean normalized RMSE was 9.3 ± 4.3% and the mean normalized absolute difference in peak force was 6.7 ± 5.5%. This study demonstrated the feasibility of using RNNs to quantify contact forces in rugby scrummaging using only single-camera video, without players wearing sensors. In combination with a 2D human pose estimation model, the ANN trained in this study could support performance analysis, coaching, technique correction, and injury prediction using in-game data.
9 Apr 2026
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