Effect of Visual Feedback on Force Application in Semmes-Weinstein Monofilament Testing: A Randomized Controlled Trial

Abstract

Objectives: This study aimed to compare the effectiveness of traditional simulation training (TST) and visual feedback training (VFT) in improving force accuracy and consistency during the application of the Semmes-Weinstein Monofilament Test (SWMT) among occupational therapy students. Materials and Methods: A randomized controlled trial was conducted with 52 senior-year occupational therapy students (TST:n = 25; VFT:n = 27). All participants received standardized theoretical instruction before undergoing either TST or VFT. Pre- and post-training assessments were conducted using a high-precision force sensor. Main outcome measures included maximum applied force (MaxF1–3), absolute error, contact duration (T1–3), and inter-application intervals (L1–2). Non-parametric tests and effect sizes (r) were used for statistical comparisons. Results: Post-training comparisons revealed significantly greater force consistency in the VFT group compared to TST: MaxF1 (p = 0.04, r = 0.273), MaxF2 (p = 0.02, r = 0.318), MaxF3 (p = 0.03, r = 0.302). Absolute error increased in TST (MaxF2: +0.25g), while it decreased in VFT (MaxF2: –0.20g). Touch durations (T1–T3) significantly improved only in the VFT group (p < 0.001), with large effect sizes (r= 0.721 to 0.772). No significant improvements were observed in TST. Conclusion: VFT enhanced students’ ability to apply consistent and accurate force during SWMT compared to TST. These findings highlight the value of integrating objective feedback tools into clinical training protocols to improve psychomotor performance in sensory testing. Future studies should investigate the long-term retention of skills and the clinical applicability of this approach in real patient scenarios.

Keywords

• tactile sense
• visual stimulation
• clinical skills
• health education

Semmes-Weinstein Monofilament Testinde Kuvvet Uygulaması Üzerine Görsel Geri Bildirimin Etkisi: Randomize Kontrollü Çalışma

Abstract

Amaç: Bu çalışmada, ergoterapi lisans son sınıf öğrencilerinde Semmes–Weinstein Monofilament Testi (SWMT) uygulaması sırasında kuvvet doğruluğu ve tutarlılığını geliştirmede geleneksel simülasyon eğitimi (TST) ile görsel geri bildirim eğitiminin (VFT) etkililiğini karşılaştırmak amaçlandı. Gereç ve Yöntem: Randomize kontrollü bir çalışma ile 52 ergoterapi son sınıf öğrencisi çalışmaya alındı (TST: n = 25; VFT: n = 27). Tüm katılımcılara standartlaştırılmış teorik eğitim verildikten sonra ilgili eğitimlerden biri uygulandı. Eğitim öncesi ve sonrası değerlendirmeler yüksek hassasiyetli bir kuvvet sensörü kullanılarak yapıldı. Ana sonuç ölçütleri maksimum uygulanan kuvvet (MaxF1–3), mutlak hata, temas süresi (T1–T3) ve uygulamalar arası aralıklar (L1–2) idi. İstatistiksel karşılaştırmalarda parametrik olmayan testler ve etki büyüklükleri (r) kullanıldı. Bulgular: Eğitim sonrası karşılaştırmalarda VFT grubunda kuvvet tutarlılığı TST’ye göre anlamlı derecede daha yüksekti: MaxF1 (p = 0,04, r = 0,273), MaxF2 (p = 0,02, r = 0,318), MaxF3 (p = 0,03, r = 0,302). Mutlak hata TST’de artarken (MaxF2: +0,25 g) VFT’de azaldı (MaxF2: –0,20 g). Temas süreleri (T1–T3) yalnızca VFT grubunda anlamlı iyileşti (p <0,001) ve büyük etki büyüklükleri gösterdi (r = 0,721 ile 0,772). TST grubunda anlamlı bir iyileşme gözlenmedi. Sonuç: Görsel geri bildirim eğitimi, SWMT uygulamasında öğrencilerin daha tutarlı ve doğru kuvvet uygulama becerisini geliştirdi; bu da objektif geri bildirim araçlarının klinik eğitim protokollerine entegrasyonunun faydalı olduğunu göstermektedir. Gelecek çalışmalar becerilerin uzun dönem korunumu ve gerçek hasta uygulamalarındaki geçerliliği üzerine odaklanmalıdır.

Keywords

• taktil duyu
• görsel stimülasyon
• klinik beceriler
• sağlık eğitimi

References

1. Bell-Krotoski, J., Weinstein, S., & Weinstein, C. (1993). Testing sensibility, including touch-pressure, two-point discrimination, point localization, and vibration. Journal of Hand Therapy, 6(2), 114-123. https://doi.org/10.1016/S0894-1130(12)80292-4
2. Bell-Krotoski, J. A., Fess, E. E., Figarola, J. H., & Hiltz, D. (1995). Threshold detection and Semmes-Weinstein monofilaments. Journal of Hand Therapy, 8(2), 155-162. https://doi.org/10.1016/S0894-1130(12)80314-0
3. Booth, J., & Young, M. J. (2000). Differences in the performance of commercially available 10-g monofilaments. Diabetes Care, 23(7), 984-988. https://doi.org/10.2337/diacare.23.7.984
4. Bosse, H. M., Schultz, J.-H., Nickel, M., Lutz, T., Möltner, A., Jünger, J., Huwendiek, S., & Nikendei, C. (2012). The effect of using standardized patients or peer role play on ratings of undergraduate communication training: a randomized controlled trial. Patient Education and Counseling, 87(3), 300-306. https://doi.org/10.1016/j.pec.2011.10.007
5. Boud, D., & Molloy, E. (2013). Rethinking models of feedback for learning: the challenge of design. Assessment & Evaluation in Higher Education, 38(6), 698-712. https://doi.org/10.1080/02602938.2012.691462
6. Cahill, S. M. (2015). Perspectives on the use of standardized parents to teach collaboration to graduate occupational therapy students. The American Journal of Occupational Therapy, 69(Supplement_2), 6912185040p6912185041-6912185040p6912185047. https://doi.org/10.5014/ajot.2015.017103
7. Chikai, M., Ozawa, E., Takahashi, N., Nunokawa, K., & Ino, S. (2015). Evaluation of the variation in sensory test results using Semmes-Weinstein monofilaments. 2015 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).
8. Dellon, A. L., & Kallman, C. H. (1983). Evaluation of functional sensation in the hand. The Journal of Hand Surgery, 8(6), 865-870. https://doi.org/10.1016/S0363-5023(83)80083-5

9. Elendu, C., Amaechi, D. C., Okatta, A. U., Amaechi, E. C., Elendu, T. C., Ezeh, C. P., & Elendu, I. D. (2024). The impact of simulation-based training in medical education: A review. Medicine (Baltimore), 103(27), e38813. https://doi.org/10.1097/md.0000000000038813
10. Gibbs, D. M., Dietrich, M., & Dagnan, E. (2017). Using high fidelity simulation to impact occupational therapy student knowledge, comfort, and confidence in acute care. The Open Journal of Occupational Therapy, 5(1), 10. https://doi.org/10.15453/2168-6408.1225
11. Hecimovich, M., & Volet, S. (2014). Simulated learning in musculoskeletal assessment and rehabilitation education: comparing the effect of a simulation-based learning activity with a peer-based learning activity. BMC Medical Education, 14, 1-12. https://doi.org/10.1186/s12909-014-0253-6
12. Horak, F. B., Wrisley, D. M., & Frank, J. (2009). The balance evaluation systems test (BESTest) to differentiate balance deficits. Physical Therapy, 89(5), 484-498. https://doi.org/10.2522/ptj.20080071
13. Jones, H. E., Baker, S. A., Christensen, J. J., Hutchinson, T., Leany, H. A., Mitchell, U. H., Bowden, A. E., & Fullwood, D. T. (2024). Effects of geometry and supporting silicone layers on the performance of conductive composite high-deflection strain gauges. Journal of Composites Science, 8(11), 467. https://doi.org/10.3390/jcs8110467
14. Kim, S.-U., & Kim, J.-Y. (2023). Comparative performance analysis of inverse phase active vibration cancellation using macro fiber composite (MFC) and vibration absorption of silicone gel for vibration reduction. Polymers, 15(24), 4672. https://doi.org/10.3390/polym15244672
15. Lavery, L. A., Lavery, D. E., Lavery, D. C., LaFontaine, J., Bharara, M., & Najafi, B. (2012). Accuracy and durability of Semmes–Weinstein monofilaments: What is the useful service life? Diabetes Research and Clinical Practice, 97(3), 399-404. https://doi.org/10.1016/j.diabres.2012.04.006
16. Mayfield, J. A., & Sugarman, J. R. (2000). The use of the Semmes-Weinstein monofilament and other threshold tests for preventing foot ulceration and amputation in persons with diabetes. Journal of Family Practice, 49(11).
17. Mallik, R., Patel, M., Atkinson, B., & Kar, P. (2022). Exploring the Role of Virtual Reality to Support Clinical Diabetes Training-A Pilot Study. Journal of Diabetes Science and Technology, 16(4), 844-851. https://doi.org/10.1177/19322968211027847
18. McGaghie, W. C., Issenberg, S. B., Petrusa, E. R., & Scalese, R. J. (2010). A critical review of simulation‐based medical education research: 2003–2009. Medical Education, 44(1), 50-63. https://doi.org/10.1111/j.1365-2923.2009.03547.x
19. Oppici, L., Grütters, K., Bechtolsheim, F., & Speidel, S. (2023). How does the modality of delivering force feedback influence the performance and learning of surgical suturing skills? We don’t know, but we better find out! A review. Surgical Endoscopy, 37(4), 2439-2452. https://doi.org/10.1007/s00464-022-09740-7
20. Owen, H. (2012). Early use of simulation in medical education. Simulation in Healthcare, 7(2), 102-116. https://doi.org/10.1097/SIH.0b013e3182415a91
21. Shafer, R. L., Solomon, E. M., Newell, K. M., Lewis, M. H., & Bodfish, J. W. (2019). Visual feedback during motor performance is associated with increased complexity and adaptability of motor and neural output. Behavioural Brain Research, 376, 112214. https://doi.org/10.1016/j.bbr.2019.112214
22. Sigrist, R., Rauter, G., Riener, R., & Wolf, P. (2013). Augmented visual, auditory, haptic, and multimodal feedback in motor learning: a review. Psychonomic Bulletin & Review, 20, 21-53. https://doi.org/10.3758/s13423-012-0333-8
23. Singh, N., Armstrong, D. G., & Lipsky, B. A. (2005). Preventing foot ulcers in patients with diabetes. Jama, 293(2), 217-228. https://doi.org/10.1001/jama.293.2.217
24. Smit, D., Spruit, E., Dankelman, J., Tuijthof, G., Hamming, J., & Horeman, T. (2017). Improving training of laparoscopic tissue manipulation skills using various visual force feedback types. Surgical Endoscopy, 31, 299-308. https://doi.org/10.1007/s00464-016-4972-0
25. Suda, M., Kawakami, M., Okuyama, K., Ishii, R., Oshima, O., Hijikata, N., Nakamura, T., Oka, A., Kondo, K., & Liu, M. (2021). Validity and reliability of the Semmes-Weinstein Monofilament test and the thumb localizing test in patients with stroke. Frontiers in Neurology, 11, 625917. https://doi.org/10.3389/fneur.2020.625917
26. Tendick, F., Downes, M., Goktekin, T., Cavusoglu, M. C., Feygin, D., Wu, X., Eyal, R., Hegarty, M., & Way, L. W. (2000). A virtual environment testbed for training laparoscopic surgical skills. Presence, 9(3), 236-255. https://doi.org/10.1162/105474600566772
27. van Vuuren, S. (2016). Reflections on simulated learning experiences of occupational therapy students in a clinical skills unit at an institution of higher learning. South African Journal of Occupational Therapy, 46(3), 80-84. https://doi.org/10.17159/2310-3833/2016/v46n3/a13
28. Wang, T., Avraham, G., Tsay, J. S., Thummala, T., & Ivry, R. B. (2024). Advanced feedback enhances sensorimotor adaptation. Current Biology, 34(5), 1076-1085.e1075. https://doi.org/10.1016/j.cub.2024.01.073
29. Winstein, C. J., & Schmidt, R. A. (1990). Reduced frequency of knowledge of results enhances motor skill learning. Journal of Experimental Psychology: Learning, Memory, and Cognition, 16(4), 677.
30. Yamauchi, K., Hagiwara, Y., Iwakura, N., Kubo, S., Sato, A., Ohtsuru, T., Okazaki, K., & Okubo, Y. (2021). Using peer role-playing to improve students’ clinical skills for musculoskeletal physical examinations. BMC Medical Education, 21(1), 322. https://doi.org/10.1186/s12909-021-02742-4
31. Yildirim, P., & Gunduz, O. H. (2015). What is the role of Semmes-Weinstein monofilament testing in the diagnosis of electrophysiologically graded carpal tunnel syndrome? Journal of Physical Therapy Science, 27(12), 3749-3753. https://doi.org/10.1589/jpts.27.3749