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In Technology and health care : official journal of the European Society for Engineering and Medicine

BACKGROUND : Force Monitoring Devices (FMDs) reported in the literature to monitor applied force during Joint Mobilization Technique (JMT) possess complex design/bulky which alters the execution of treatment, has poor accuracy and is unable to feel the resistance provided by soft tissues limits its usage in the clinical settings.

OBJECTIVES : This study aims to develop a highly accurate, portable FMD and to demonstrate real-time monitoring of force applied by health professionals during JMT without altering its execution.

METHODS : The FMD was constructed using the FlexiForce sensor, potential divider, ATmega 328 microcontroller, custom-written software, and liquid crystal display. The calibration, accuracy, and cyclic repeatability of the FMD were tested from 0 to 90 N applied load with a gold standard universal testing machine. For practical demonstration, the FMD was tested for monitoring applied force by a physiotherapist while performing Maitland's grade I to IV over the 6th cervical vertebra among 30 healthy subjects.

RESULTS : The obtained Bland-Altman plot limits agreement for accuracy, and cyclic repeatability was -1.57 N to 1.22 N, and -1.26 N to 1.26 N, respectively with standard deviation and standard error of the mean values of 3.77% and 0.73% and 2.15% and 0.23%, respectively. The test-retest reliability of the FMD tested by the same researcher at an interval of one week showed an excellent intra-class correlation coefficient of r= 1.00. The obtained force readings for grade I to IV among 30 subjects ranged from 10.33 N to 45.24 N.

CONCLUSIONS : Appreciable performance of the developed FMD suggested that it may be useful to monitor force applied by clinicians during JMT among neck pain subjects and is a useful educational tool for academicians to teach mobilization skills.

Chia Kau Pui, Li Ooi Ke, Yuong Teh Shyong, Singh Om Prakash, Faudzi Ahmad Athif Bin Mohd, Sornambikai Sundaram, Madhanagopal Jagannathan


Force monitoring device, accuracy, joint mobilization, neck pain, reliability