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

Öz

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.

Anahtar Kelimeler

• yüzey elektromiyografisi
• klinik kabul edilebilirlik
• tıp teknolojisi
• sağlık profesyonelleri
• sağlık eğitimi

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

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.

Keywords

• surface electromyography
• clinical acceptability
• medical technology
• healthcare professionals
• health education

Kaynakça

1. 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.
2. Merletti R, Farina D. Surface Electromyography: Physiology, Engineering, and Applications. Hoboken, NJ: Wiley-IEEE Press; 2016.
3. 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.
4. Campanini I, Disselhorst-Klug C, Rymer WZ, Merletti R. SEMG in clinical assessment and neurorehabilitation: barriers limiting its use. Front Neurol. 2020;11:934.
5. 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.
6. Merletti R, Muceli S. Tutorial. SEMG detection in space and time: Best practices. J Electromyogr Kinesiol. 2019;49:102363.
7. 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.
8. 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.

9. 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
10. 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
11. 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.
12. 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.
13. Alcan V, Canal MR, Zinnuroğlu M. Using fuzzy logic for diagnosis and classification of spasticity. Turk J Med Sci. 2017;47(1):148-160.
14. 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.
15. 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.
16. 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.
17. 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.
18. 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/
19. Twente University. TechMed Centre. [cited 2023 Nov 23]. Avaliable from: https://www.utwente.nl/en/techmed/
20. Rau G, Schulte E, Disselhorst-Klug C. From cell to movement: to what answers does EMG contribute? J Electromyogr Kinesiol. 2004;14:611–617.
21. Farina D. Interpretation of the surface electromyogram in dynamic contractions. Exerc and Sport Sci Rev. 2006;34:121–7.
22. Merletti R, Cerone GL. Tutorial. Surface EMG detection, conditioning, and pre-processing: best practices. J Electromyogr and Kinesiol. 2020;54:10244011
23. Mondelli M, Aretini A, Greco G. Knowledge of electromyography (EMG) in patients undergoing EMG examinations. Funct Neurol. 2014;29(3):195-200