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THE BARRIERS AND FACILITATORS FOR WIDESPREAD USING SURFACE ELECTROMYOGRAPHY IN CLINICAL PRACTICE: A CROSS-SECTIONAL STUDY IN TURKIYE

Year 2025, Volume: 36 Issue: 1, 79 - 91, 25.04.2025
https://doi.org/10.21653/tjpr.1382424

Abstract

Purpose: Surface electromyography (sEMG) is a non-invasive tool for understanding the mechanisms of neuromuscular systems, which provides very useful and important quantitative electrophysiological information as part of evidence-based practice. The sEMG has many applications across a wide variety of fields (e.g., in neurophysiology, physiotherapy, biofeedback, gait analysis, ergonomics, occupational medicine, neurorehabilitation, etc.). Although there are a great number of publications, books, tutorials, and advancements in sEMG, there remains a gap characterized by its lack of clinical acceptance. This study aimed to investigate facilitators and barriers to the widespread use of sEMG among clinicians.
Methods: An online survey with 46 items was conducted to potential practitioners of sEMG including medical doctors, physiotherapists, and non-clinical researchers. Descriptive statistics and cross-tabulation tests were employed.
Results: This study found that sEMG did not have high clinical acceptance despite a common perception of its clinical potential and benefits. It has been commonly used for research purposes. The major barriers were found as a lack of knowledge and experience about sEMG signals and systems due to the poor educational background of sEMG. When comparing the purpose of using sEMG, there were statistical differences in diagnosis (p=0.002) and research (p=0.004) but no differences in treatment (p=0.103). Significant statistical differences were also found among participants who took an sEMG course and those who did not (p=0.009).
Conclusion: The findings indicate that multidisciplinary bachelor's and master's programs, like a Dutch Model, are needed because advances in sEMG require new professional skills with medical and technical knowledge.

Ethical Statement

We received ethical approval for this online survey from Tarsus University Human Research Ethical Committee with reference no: 2020/44 and date: 26/10/2020.

Thanks

We thank Prof. Robert Merletti for the encouragement of this research on such an important subject and the contributions he made to this research.

References

  • Medved V, Medved S, Kovač I. Critical Appraisal of Surface Electromyography (sEMG) as a Taught Subject and Clinical Tool in Medicine and Kinesiology. Front Neurol. 2020;11:560363.
  • Merletti R, Farina D. Surface Electromyography: Physiology, Engineering, and Applications. Hoboken, NJ: Wiley-IEEE Press; 2016.
  • Feldner HA, Howell D, Kelly VE, McCoy SW, Steele KM. “Look, your muscles are firing!”: A qualitative study of clinician perspectives on the use of surface electromyography in neurorehabilitation. Arch Phys Med Rehabil. 2019;100:663–75.
  • Campanini I, Disselhorst-Klug C, Rymer WZ, Merletti R. SEMG in clinical assessment and neurorehabilitation: barriers limiting its use. Front Neurol. 2020;11:934.
  • Merletti R, Disselhorst-Klug, Rymer WZ. Editorial: Surface Electromyography: Barriers Limiting Widespread Use of sEMG in Clinical Assessment and Neurorehabilitation. Front Neurol. 2021;12:642257.
  • Merletti R, Muceli S. Tutorial. SEMG detection in space and time: Best practices. J Electromyogr Kinesiol. 2019;49:102363.
  • Pilkar R, Momeni K, Ramanujam A, Ravi M, Garbarini E, Forrest GF. Use of SEMG in Clinical Rehabilitation of Individuals With SCI: Barriers and Future Considerations. Front Neurol. 2020;11:578559.
  • Goffredo M, Infarinato F, Pournajaf S, Romano P, Ottaviani M, Pellicciari L, et al. Barriers to sEMG Assessment During Overground Robot-Assisted Gait Training in Subacute Stroke Patients. Front Neurol. 2020;11:564067.
  • Manca A, Cereatti A, Bar-On L, Botter A, Della Croce U, Knaflitz M, et al. A Survey on the Use and Barriers of Surface Electromyography in Neurorehabilitation. Front Neurol. 2020;11:573616
  • Eysenbach G. Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Int Res. 2004;6(3):e34
  • Duncan EAS, Murray J. The barriers and facilitators to routine outcome measurement by allied health professionals in practice: a systematic review. BMC Health Serv Res. 2012;12:96.
  • Meekins GD, So Y, Quan D. American Association of Neuromuscular & Electrodiagnostic Medicine evidenced-based review: use of surface electromyography in the diagnosis and study of neuromuscular disorders. Muscle Nerve. 2008;38:1219–24.
  • Alcan V, Canal MR, Zinnuroğlu M. Using fuzzy logic for diagnosis and classification of spasticity. Turk J Med Sci. 2017;47(1):148-160.
  • Cappellini G, Sylos-Labini F, Assenza C, Libernini L, Morelli D, Lacquaniti F, et al. Clinical Relevance of State-of-the-Art Analysis of Surface Electromyography in Cerebral Palsy. Front Neurol. 2020;11:583296.
  • McManus L, De Vito G, Lowery MM. Analysis and Biophysics of SEMG for Physiotherapists and Kinesiologists: Toward a Common Language With Rehabilitation Engineers. Front Neurol. 2020;11:576729.
  • Agostini V, Ghislieri M, Rosati S, Balestra G, Knaflitz M. Surface Electromyography Applied to Gait Analysis: How to Improve Its Impact in Clinics? Front Neurol. 2020;11:994.
  • De la Fuente C, Machado ÁS, Kunzler MR, Carpes FP.Winter School on sEMG Signal Processing: An Initiative to Reduce Educational Gaps and to Promote the Engagement of Physiotherapists and Movement Scientists With Science. Front Neurol. 2020;11:509.
  • Delft University. Delft University of Technology. [cited 2023 Nov 23]. Avaliable from: https://www.tudelft.nl/en/education/programmes/bachelors/kt/bachelor-of-clinical-technology/
  • Twente University. TechMed Centre. [cited 2023 Nov 23]. Avaliable from: https://www.utwente.nl/en/techmed/
  • Rau G, Schulte E, Disselhorst-Klug C. From cell to movement: to what answers does EMG contribute? J Electromyogr Kinesiol. 2004;14:611–617.
  • Farina D. Interpretation of the surface electromyogram in dynamic contractions. Exerc and Sport Sci Rev. 2006;34:121–7.
  • Merletti R, Cerone GL. Tutorial. Surface EMG detection, conditioning, and pre-processing: best practices. J Electromyogr and Kinesiol. 2020;54:10244011
  • Mondelli M, Aretini A, Greco G. Knowledge of electromyography (EMG) in patients undergoing EMG examinations. Funct Neurol. 2014;29(3):195-200

YÜZEY ELEKTROYOGRAFİSİNİN KLİNİK UYGULAMADA YAYGIN KULLANIMINA YÖNELİK ENGELLER VE KOLAYLAŞTIRICI FAKTÖRLER: TÜRKİYE'DE KESİTSEL BİR ÇALIŞMA

Year 2025, Volume: 36 Issue: 1, 79 - 91, 25.04.2025
https://doi.org/10.21653/tjpr.1382424

Abstract

Amaç: Yüzey elektromiyografisi (sEMG), nöromüsküler sistemlerin mekanizmalarını anlamaya yönelik kanıta dayalı uygulamanın bir parçası olarak çok yararlı ve önemli niceliksel elektrofizyolojik bilgiler sağlayan invazif olmayan bir araçtır. sEMG'nin çok çeşitli alanlarda (örneğin nörofizyoloji, fizyoterapi, biyolojik geri bildirim, yürüyüş analizi, ergonomi, mesleki tıp, nörorehabilitasyon vb.) birçok uygulaması vardır. SEMG'de çok sayıda yayın, kitap, eğitim ve ilerleme bulunmasına rağmen klinik kabulündeki eksikliği ile karakterize edilen bir boşluk bulunmaktadır. Bu çalışma, sEMG'nin klinisyenler arasında yaygın olarak kullanılmasının önündeki kolaylaştırıcı ve engelleyici faktörleri araştırmayı amaçlamıştır.
Yöntemler: Tıp doktorları, fizyoterapistler ve klinik dışı araştırmacılar da dâhil olmak üzere potansiyel sEMG uygulayıcılarına 46 maddelik çevrimiçi bir anket uygulandı. Tanımlayıcı istatistikler ve çapraz tablolama testleri kullanıldı.
Sonuçlar: Bu çalışma, sEMG'nin klinik potansiyeli ve faydalarına ilişkin ortak algıya rağmen yüksek klinik kabulüne sahip olmadığını buldu. Yaygın olarak araştırma amacıyla kullanılmıştır. En büyük engellerin, sEMG'nin zayıf eğitim geçmişi nedeniyle sEMG sinyalleri ve sistemleri hakkında bilgi ve deneyim eksikliği olduğu bulundu. sEMG kullanım amacı karşılaştırıldığında, tanı (p=0,002) ve araştırma (p=0,004) açısından istatistiksel farklılıklar vardı ancak tedavide herhangi bir farklılık yoktu (p=0,103). sEMG kursu alan ve almayan katılımcılar arasında da anlamlı istatistiksel farklılıklar bulundu (p=0,009).
Tartışma: Bulgular Hollanda Modeli gibi multidisipliner lisans ve yüksek lisans programlarına ihtiyaç duyulduğunu göstermiştir. Çünkü sEMG'deki ilerlemelerin tıbbi ve teknik bilgi ile birlikte yeni mesleki beceriler gerektirdiğini göstermektedir.

References

  • Medved V, Medved S, Kovač I. Critical Appraisal of Surface Electromyography (sEMG) as a Taught Subject and Clinical Tool in Medicine and Kinesiology. Front Neurol. 2020;11:560363.
  • Merletti R, Farina D. Surface Electromyography: Physiology, Engineering, and Applications. Hoboken, NJ: Wiley-IEEE Press; 2016.
  • Feldner HA, Howell D, Kelly VE, McCoy SW, Steele KM. “Look, your muscles are firing!”: A qualitative study of clinician perspectives on the use of surface electromyography in neurorehabilitation. Arch Phys Med Rehabil. 2019;100:663–75.
  • Campanini I, Disselhorst-Klug C, Rymer WZ, Merletti R. SEMG in clinical assessment and neurorehabilitation: barriers limiting its use. Front Neurol. 2020;11:934.
  • Merletti R, Disselhorst-Klug, Rymer WZ. Editorial: Surface Electromyography: Barriers Limiting Widespread Use of sEMG in Clinical Assessment and Neurorehabilitation. Front Neurol. 2021;12:642257.
  • Merletti R, Muceli S. Tutorial. SEMG detection in space and time: Best practices. J Electromyogr Kinesiol. 2019;49:102363.
  • Pilkar R, Momeni K, Ramanujam A, Ravi M, Garbarini E, Forrest GF. Use of SEMG in Clinical Rehabilitation of Individuals With SCI: Barriers and Future Considerations. Front Neurol. 2020;11:578559.
  • Goffredo M, Infarinato F, Pournajaf S, Romano P, Ottaviani M, Pellicciari L, et al. Barriers to sEMG Assessment During Overground Robot-Assisted Gait Training in Subacute Stroke Patients. Front Neurol. 2020;11:564067.
  • Manca A, Cereatti A, Bar-On L, Botter A, Della Croce U, Knaflitz M, et al. A Survey on the Use and Barriers of Surface Electromyography in Neurorehabilitation. Front Neurol. 2020;11:573616
  • Eysenbach G. Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Int Res. 2004;6(3):e34
  • Duncan EAS, Murray J. The barriers and facilitators to routine outcome measurement by allied health professionals in practice: a systematic review. BMC Health Serv Res. 2012;12:96.
  • Meekins GD, So Y, Quan D. American Association of Neuromuscular & Electrodiagnostic Medicine evidenced-based review: use of surface electromyography in the diagnosis and study of neuromuscular disorders. Muscle Nerve. 2008;38:1219–24.
  • Alcan V, Canal MR, Zinnuroğlu M. Using fuzzy logic for diagnosis and classification of spasticity. Turk J Med Sci. 2017;47(1):148-160.
  • Cappellini G, Sylos-Labini F, Assenza C, Libernini L, Morelli D, Lacquaniti F, et al. Clinical Relevance of State-of-the-Art Analysis of Surface Electromyography in Cerebral Palsy. Front Neurol. 2020;11:583296.
  • McManus L, De Vito G, Lowery MM. Analysis and Biophysics of SEMG for Physiotherapists and Kinesiologists: Toward a Common Language With Rehabilitation Engineers. Front Neurol. 2020;11:576729.
  • Agostini V, Ghislieri M, Rosati S, Balestra G, Knaflitz M. Surface Electromyography Applied to Gait Analysis: How to Improve Its Impact in Clinics? Front Neurol. 2020;11:994.
  • De la Fuente C, Machado ÁS, Kunzler MR, Carpes FP.Winter School on sEMG Signal Processing: An Initiative to Reduce Educational Gaps and to Promote the Engagement of Physiotherapists and Movement Scientists With Science. Front Neurol. 2020;11:509.
  • Delft University. Delft University of Technology. [cited 2023 Nov 23]. Avaliable from: https://www.tudelft.nl/en/education/programmes/bachelors/kt/bachelor-of-clinical-technology/
  • Twente University. TechMed Centre. [cited 2023 Nov 23]. Avaliable from: https://www.utwente.nl/en/techmed/
  • Rau G, Schulte E, Disselhorst-Klug C. From cell to movement: to what answers does EMG contribute? J Electromyogr Kinesiol. 2004;14:611–617.
  • Farina D. Interpretation of the surface electromyogram in dynamic contractions. Exerc and Sport Sci Rev. 2006;34:121–7.
  • Merletti R, Cerone GL. Tutorial. Surface EMG detection, conditioning, and pre-processing: best practices. J Electromyogr and Kinesiol. 2020;54:10244011
  • Mondelli M, Aretini A, Greco G. Knowledge of electromyography (EMG) in patients undergoing EMG examinations. Funct Neurol. 2014;29(3):195-200
There are 23 citations in total.

Details

Primary Language English
Subjects Physiotherapy
Journal Section Araştırma Makaleleri
Authors

Veysel Alcan 0000-0002-7786-8591

Murat Zinnuroğlu 0000-0003-1077-6753

Abdulvahap Kahveci 0000-0002-2611-2372

Hilmi Uysal This is me 0000-0002-6063-377X

Erdem Demir 0000-0002-0247-9006

Hakan Tüzün 0000-0002-6376-8979

Early Pub Date May 15, 2025
Publication Date April 25, 2025
Submission Date October 28, 2023
Acceptance Date April 14, 2025
Published in Issue Year 2025 Volume: 36 Issue: 1

Cite

APA Alcan, V., Zinnuroğlu, M., Kahveci, A., Uysal, H., et al. (2025). THE BARRIERS AND FACILITATORS FOR WIDESPREAD USING SURFACE ELECTROMYOGRAPHY IN CLINICAL PRACTICE: A CROSS-SECTIONAL STUDY IN TURKIYE. Türk Fizyoterapi Ve Rehabilitasyon Dergisi, 36(1), 79-91. https://doi.org/10.21653/tjpr.1382424
AMA Alcan V, Zinnuroğlu M, Kahveci A, Uysal H, Demir E, Tüzün H. THE BARRIERS AND FACILITATORS FOR WIDESPREAD USING SURFACE ELECTROMYOGRAPHY IN CLINICAL PRACTICE: A CROSS-SECTIONAL STUDY IN TURKIYE. Turk J Physiother Rehabil. April 2025;36(1):79-91. doi:10.21653/tjpr.1382424
Chicago Alcan, Veysel, Murat Zinnuroğlu, Abdulvahap Kahveci, Hilmi Uysal, Erdem Demir, and Hakan Tüzün. “THE BARRIERS AND FACILITATORS FOR WIDESPREAD USING SURFACE ELECTROMYOGRAPHY IN CLINICAL PRACTICE: A CROSS-SECTIONAL STUDY IN TURKIYE”. Türk Fizyoterapi Ve Rehabilitasyon Dergisi 36, no. 1 (April 2025): 79-91. https://doi.org/10.21653/tjpr.1382424.
EndNote Alcan V, Zinnuroğlu M, Kahveci A, Uysal H, Demir E, Tüzün H (April 1, 2025) THE BARRIERS AND FACILITATORS FOR WIDESPREAD USING SURFACE ELECTROMYOGRAPHY IN CLINICAL PRACTICE: A CROSS-SECTIONAL STUDY IN TURKIYE. Türk Fizyoterapi ve Rehabilitasyon Dergisi 36 1 79–91.
IEEE V. Alcan, M. Zinnuroğlu, A. Kahveci, H. Uysal, E. Demir, and H. Tüzün, “THE BARRIERS AND FACILITATORS FOR WIDESPREAD USING SURFACE ELECTROMYOGRAPHY IN CLINICAL PRACTICE: A CROSS-SECTIONAL STUDY IN TURKIYE”, Turk J Physiother Rehabil, vol. 36, no. 1, pp. 79–91, 2025, doi: 10.21653/tjpr.1382424.
ISNAD Alcan, Veysel et al. “THE BARRIERS AND FACILITATORS FOR WIDESPREAD USING SURFACE ELECTROMYOGRAPHY IN CLINICAL PRACTICE: A CROSS-SECTIONAL STUDY IN TURKIYE”. Türk Fizyoterapi ve Rehabilitasyon Dergisi 36/1 (April 2025), 79-91. https://doi.org/10.21653/tjpr.1382424.
JAMA Alcan V, Zinnuroğlu M, Kahveci A, Uysal H, Demir E, Tüzün H. THE BARRIERS AND FACILITATORS FOR WIDESPREAD USING SURFACE ELECTROMYOGRAPHY IN CLINICAL PRACTICE: A CROSS-SECTIONAL STUDY IN TURKIYE. Turk J Physiother Rehabil. 2025;36:79–91.
MLA Alcan, Veysel et al. “THE BARRIERS AND FACILITATORS FOR WIDESPREAD USING SURFACE ELECTROMYOGRAPHY IN CLINICAL PRACTICE: A CROSS-SECTIONAL STUDY IN TURKIYE”. Türk Fizyoterapi Ve Rehabilitasyon Dergisi, vol. 36, no. 1, 2025, pp. 79-91, doi:10.21653/tjpr.1382424.
Vancouver Alcan V, Zinnuroğlu M, Kahveci A, Uysal H, Demir E, Tüzün H. THE BARRIERS AND FACILITATORS FOR WIDESPREAD USING SURFACE ELECTROMYOGRAPHY IN CLINICAL PRACTICE: A CROSS-SECTIONAL STUDY IN TURKIYE. Turk J Physiother Rehabil. 2025;36(1):79-91.