Eva María Gómez-Trullén

Scalable tools for Parkinson's disease (PD) detection are needed beyond laboratory-bound assessments. We present and evaluate a deliberately minimalist approach: a single six-axis IMU per shoe coupled with a lightweight 1D-CNN, tested during a six-minute walk test (6MWT) conducted indoors and outdoors under semi-controlled conditions. Eighty-nine participants (44 PD; 45 healthy controls) were instrumented bilaterally at 50 Hz. Signals (accelerometer and gyroscope) were standardized to a common shoe-referenced frame and ingested as raw time series using 0.5-s non-overlapping windows. The network used three tapered convolutional blocks (32-16-8 filters) with global average pooling (2,818 parameters). Evaluation employed participant-level, stratified 5-fold cross-validation repeated across seeds. At the foot level, overall accuracy was 80.58% (sensitivity 74.76%, specificity 85.55%). Applying a clinically motivated one-foot-positive criterion (OFPC), classifying a participant as PD if either foot was positive, improved patient-level performance to 82.1% accuracy, with 84.78% sensitivity and 80.29 specificity. Indoor performance (accuracy 81.48%, sensitivity 91.89%, specificity 72.73%,) exceeded outdoor sensitivity, whereas outdoor testing maintained higher specificity (accuracy 82.17%, sensitivity 80%, specificity 83.91%), reflecting expected context variability. Compact architecture and short, non-overlapping windows minimize memory, computation and latency, supporting on-device deployment on resource-constrained wearables. These results indicate that a foot-mounted, single-modality IMU set-up combined with a compact CNN can deliver clinically meaningful PD discrimination under ecologically relevant conditions, providing a practical pathway toward real-time case identification and follow-up in routine care while preserving scalability and usability.

Introduction: This case series explores a novel methodology for identifying myofascial trigger points (MTrPs) by integrating Doppler and B-mode ultrasound with externally applied vibratory stimulation. The study aims to address the current lack of accessible and objective tools for MTrP assessment in clinical settings. Case presentation: Five participants were included: four healthy individuals and one post-stroke patient. A custom-designed vibration device was developed to apply mechanical stimulation to the gastrocnemius medialis muscle, while ultrasound imaging was collected using a standardized setup. To optimize vibration signal detection within muscle tissue, different configurations of the electrodes transmitting the vibration and the Doppler modes (Color Doppler and Power Doppler Imaging (PDI)) were tested. Results: PDI demonstrated superior sensitivity to vibration-induced muscle responses compared to conventional Color Doppler. A consistent pattern was identified among healthy participants. This pattern consisted of well-defined, non-vibratory zones surrounded by vibratory regions, corresponding to hypoechoic areas on B-mode ultrasound. These findings are suggestive of MTrPs and distinct from other stiff anatomical structures, such as fascia, tendons, or fibrotic tissue, which appear hyperechoic. In the stroke patient, pathological muscle adaptations reduced the consistency and visibility of vibratory stimulus propagation; however, MTrP-compatible areas were still identified. Notably, dry needling altered the Doppler signal in this case, attenuating the previously observed pattern. Conclusions: This proof-of-concept study demonstrates the feasibility and reproducibility of a cost-effective assessment protocol that uses conventional ultrasound modes. Combining PDI, B-mode, and vibration may improve the objective identification of MTrPs and expand capabilities in musculoskeletal practice.

Background and objectives: Myofascial pain syndrome, provoked by myofascial trigger points (MTrPs), is a common cause of musculoskeletal pain. Accurate identification of MTrPs remains difficult due to its subjective clinical assessment. B-mode ultrasound (US) offers a promising alternative for characterizing MTrPs, although its clinical utility remains uncertain. This study aimed to evaluate the evidence supporting B-mode US to characterize MTrPs, assess changes in muscle architecture, and analyze the impact of physiotherapeutic interventions. Methods: A systematic review was registered in PROSPERO following PRISMA guidelines (CRD42024596408). PubMed, Scopus and Web of Science databases were searched in October 2024. Variables of interest included MTrP characteristics (hypo/hyperechoic areas, dimensions, and morphology), muscle architecture (e.g., muscle thickness or pennation angle), and ecotexture analysis (first-, second-, and higher-order features). Results: From 28 eligible studies and 929 participants, MTrPs were consistently identified as predominantly hypoechoic nodules with heterogeneous echotexture and elliptical shapes, with areas from 0.02 to 3.4 cm². Variations in muscle architecture, such as reduced thickness, and echotexture, mainly characterized by reduced echogenicity, were frequent in affected muscles by MTrPs. Physiotherapy interventions showed variable efficacy in altering MTrP characteristics depending on the intervention type and population. Methodological quality ranged from poor/low to good/high, with a moderate risk of bias. Discussion: This review highlights the potential of B-mode US as an assessment tool for MTrPs. However, inconsistencies in imaging protocols, limited quantitative analyses, and the intrinsic characteristics of the included study designs, make it difficult to draw definitive conclusions. Conclusions: Although B-mode US shows promise in characterizing MTrPs, methodological limitations highlight the need for further studies of higher methodological quality. Standarizing US assessment protocols for MTrPs could improve diagnostic accuracy and treatment monitoring and benefit clinical practice.

Low back pain (LBP) is a potential complication after total hip arthroplasty (THA). However, some studies suggest that THA not only alleviates joint pain but also resolves LBP in up to 88.2% of patients. Most of these observations are limited to short-term follow-up. This study investigates the long-term relationship between THA and LBP, challenging the notion that THA resolves LBP. A retrospective review was conducted on 236 patients who underwent THA (2010–2020). Multiple statistical models were applied, including unadjusted unmatched, adjusted unmatched, adjusted matched, and target trial emulation with 7887 subjects, to evaluate LBP incidence. Of the 236 patients, 119 developed postoperative LBP. The unadjusted unmatched analysis showed a relative risk (RR) of 2.23(95%CI:1.5–3.2). Adjusting for age, sex, BMI, and recruitment period reduced the RR to 1.64(95%CI:1.0–2.6). Adjusted matched analysis showed an RR of 1.09(95%CI:0.4–3.0), while the target trial emulation simulated an RR of 1.03(95%CI:0.7–1.8), indicating no significant differences. Despite an apparent initial association, adjusted analyses do not support a significant long-term relationship between THA and LBP. No reduction in postoperative LBP incidence was observed, suggesting THA is safe regarding LBP risk but lacks a curative effect. Rigorous confounding adjustment is essential in retrospective studies.

Chronic non-specific low back pain (CNSLBP) is a highly prevalent musculoskeletal condition that has a great socioeconomic impact on health systems. Instead of focusing on mechanical causes and direct workload in the development of CNSLBP, genetics, psychosocial environment, lifestyle and quality of life are coming to the forefront in its approach. The main objective was to analyze whether interventions aimed at modifying lifestyle can be effective in improving pain intensity and functional disability in CNSLBP. A search in PubMed, Web of Science, Scopus and SportDiscus databases was performed. Both a univariate and a multivariate network meta-analysis were applied with the difference pre/post-treatment. A total of 20 studies were included for qualitative analysis, of which 16 were randomized clinical trials with a moderate–high methodological quality and were part of the quantitative analysis. The interventions that had the greatest effect in reducing pain intensity were cognitive therapy combined with functional exercise programs, lumbar stabilization exercise and resistance exercise; meanwhile, for functional disability, they were functional exercise programs, aerobic exercise and standard care. In conclusion, a multimodal intervention aimed at changing one’s lifestyle that encompasses cognitive, behavioral, and physical aspects seems to be highly effective in improving pain intensity and functional disability caused by CNSLBP; however, it is not yet known if these improvements are maintained in the long term.

Background: Within the exploration of human gait, key focal points include the examination of functional rockers and the influential role of tendon behavior in the intricate stretch–shortening cycle. To date, the possible relationship between these two fundamental factors in the analysis of human gait has not been studied. Therefore, this study aimed to analyze the relationship between the morphology of the patellar and Achilles tendons and plantar fascia with respect to the duration of the rockers. Methods: Thirty-nine healthy men (age: 28.42 ± 6.97 years; height: 173 ± 7.17 cm; weight: 67.75 ± 9.43 kg) were included. Data of the rockers were recorded using a baropodometric platform while participants walked over a 10 m walkway at a comfortable velocity. Before the trials, the thickness and cross-sectional area were recorded for the patellar tendon, Achilles tendon and plantar fascia using ultrasound examination. The relationship between the morphology of the soft tissue and the duration of the rockers was determined using a pairwise mean comparison (t-test). Results: A significant difference was found for rocker 1 duration, where a longer duration was found in the group of subjects with thicker patellar tendons. Regarding the Achilles tendon and plantar fascia, no significant differences were observed in terms of tendon morphology. However, subjects with thicker Achilles tendons showed a longer duration of rocker 1. Conclusions: The findings underscore a compelling association, revealing that an increased thickness of the patellar tendon significantly contributes to the extension of rocker 1 duration during walking in healthy adults.