You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Wearable IMU for Shoulder Injury Prevention in Overhead Sports
Abstract 1:
Body-worn inertial sensors have enabled motion capture outside of the laboratory setting . In this work , an inertial measurement unit was attached to the upper arm to track and discriminate between shoulder motion gestures in order to help prevent shoulder over-use injuries in athletics through real-time preventative feedback . We present a detection and classification approach that can be used to count the number of times certain motion gestures occur . The application presented involves tracking baseball throws and volleyball serves , which are common overhead movements that can lead to shoulder and elbow overuse injuries . Eleven subjects are recruited to collect training , testing , and r and omized validation data , which include throws , serves , and seven other exercises that serve as a large null class of similar movements , which is analogous to a realistic usage scenario and requires a robust estimator


Title 2:
Shoulder Physiotherapy Exercise Recognition: Machine Learning the Inertial Signals from a Smartwatch
Abstract 2:
OBJECTIVE Participation in a physical therapy program is considered one of the greatest predictors of successful conservative management of common shoulder disorders . However , adherence to these protocol s is often poor and typically worse for unsupervised home exercise programs . Currently , there are limited tools available for objective measurement of adherence in the home setting . The goal of this study was to develop and evaluate the potential for performing home shoulder physiotherapy monitoring using a commercial smartwatch . APPROACH Twenty healthy adult subjects with no prior shoulder disorders performed seven exercises from an evidence -based rotator cuff physiotherapy protocol , while 6-axis inertial sensor data was collected from the active extremity . Within an activity recognition chain ( ARC ) framework , four supervised learning algorithms were trained and optimized to classify the exercises : k-nearest neighbor ( k-NN ) , r and om forest ( RF ) , support vector machine classifier ( SVC ) , and a convolutional recurrent neural network ( CRNN ) . Algorithm performance was evaluated using 5-fold cross-validation stratified first temporally and then by subject . MAIN RESULTS Categorical classification accuracy was above 94 % for all algorithms on the temporally stratified cross validation , with the best performance achieved by the CRNN algorithm ( 99.4 % ) . The subject stratified cross validation , which evaluated classifier performance on unseen subjects , yielded lower accuracies scores again with CRNN performing best ( 88.9 % ) . SIGNIFICANCE This proof of concept study demonstrates the technical feasibility of a smartwatch device and supervised machine learning approach to more easily monitor and assess the at-home adherence of shoulder physiotherapy exercise protocol


Title 3:
Objective evaluation of shoulder function using body-fixed sensors: a new way to detect early treatment failures?
Abstract 3:
BACKGROUND Variable definitions of outcome ( Constant score , Simple Shoulder Test [ SST ] ) have been used to assess outcome after shoulder treatment , although none has been accepted as the universal st and ard . Physicians lack an objective method to reliably assess the activity of their patients in dynamic conditions . Our purpose was to clinical ly vali date the shoulder kinematic scores given by a portable movement analysis device , using the activities of daily living described in the SST as a reference . The secondary objective was to determine whether this device could be used to document the effectiveness of shoulder treatments ( for glenohumeral osteoarthritis and rotator cuff disease ) and detect early failures . METHODS A clinical trial including 34 patients and a control group of 31 subjects over an observation period of 1 year was set up . Evaluations were made at baseline and 3 , 6 , and 12 months after surgery by 2 independent observers . Miniature sensors ( 3-dimensional gyroscopes and accelerometers ) allowed kinematic scores to be computed . They were compared with the regular outcome scores : SST ; Disabilities of the Arm , Shoulder and H and ; American Shoulder and Elbow Surgeons ; and Constant . RESULTS Good to excellent correlations ( 0.61 - 0.80 ) were found between kinematics and clinical scores . Significant differences were found at each follow-up in comparison with the baseline status for all the kinematic scores ( P < .015 ) . The kinematic scores were able to point out abnormal patient outcomes at the first postoperative follow-up . CONCLUSION Kinematic scores add information to the regular outcome tools . They offer an effective way to measure the functional performance of patients with shoulder pathology and have the potential to detect early treatment failures


Title 4:
Wearable and Implantable Sensors: The Patient’s Perspective
Abstract 4:
There has been a rising interest in wearable and implantable biomedical sensors over the last decade . However , many technologies have not been integrated into clinical care , due to a limited underst and ing of user-centered design issues . Little information is available about these issues and there is a need to adopt more rigorous evidence st and ards for design features to allow important medical sensors to progress quicker into clinical care . Current trends in patient preferences need to be incorporated at an early stage into the design process of prospect i ve clinical sensors . The first comprehensive patient data set , discussing mobile biomedical sensor technology , is presented in this paper . The study population mainly consisted of individuals suffering from arthritis . It was found that sensor systems needed to be small , discreet , unobtrusive and preferably incorporated into everyday objects . The upper extremity was seen as the favored position on the body for placement , while invasive placement yielded high levels of acceptance . Under these conditions most users were willing to wear the body-worn sensor for more than 20 h a day . This study is a first step to generate research based user-orientated design criteria ’s for biomedical sensors


Title 5:
Alteration and recovery of arm usage in daily activities after rotator cuff surgery.
Abstract 5:
BACKGROUND The objective measurement of dominant/nondominant arm use proportion in daily life may provide relevant information on healthy and pathologic arm behavior . This prospect i ve case-control study explored the potential of such measurements as indicators of upper limb functional recovery after rotator cuff surgery . METHODS Data on dominant/nondominant arm usage were acquired with body-worn sensors for 7 hours . The postsurgical arm usage of 21 patients was collected at 3 , 6 , and 12 months after rotator cuff surgery  in the sitting , walking , and st and ing postures and compared with a reference established with 41 healthy subjects . The results were calculated for the dominant and nondominant surgical side subgroups at all stages . The correlations with clinical scores were calculated . RESULTS Healthy right-h and ed and left-h and ed dominant arm usage was 60.2 % ( ±6.3 % ) and 53.4 % ( ±6.6 % ) , respectively . Differences in use of the dominant side were significant between the right- and left-h and ed subgroups for sitting ( P = .014 ) and st and ing ( P = .009 ) but not for walking ( P = .328 ) . The patient group showed a significant underuse of 10.7 % ( ±8.9 % ) at 3 months after surgery ( P < .001 ) . The patients recovered normal arm usage within 12 months , regardless of surgical side . The arm underuse measurement was weakly related to function and pain scores . CONCLUSION This study provided new information on arm recovery after rotator cuff surgery using an innovative measurement method . It highlighted that objective arm underuse measurement is a valuable indicator of upper limb postsurgical outcome that captures a complementary feature to clinical scores


Title 6:
Objective outcome evaluation using inertial sensors in subacromial impingement syndrome: a five-year follow-up study.
Abstract 6:
Shoulder-related dysfunction is the second most common musculoskeletal disorder and is an increasing burden on health-care systems . Commonly used clinical question naires suffer from subjectivity , pain dominance and a ceiling effect . Objective functional measurement has been identified as a relevant issue in clinical rehabilitation . Inertia based motion analysis ( IMA ) is a new generation of objective outcome assessment tool ; it can produce objective movement parameters while being fast , cheap and easy to operate . In this prospect i ve study , an inertial sensor comprising a three-dimensional accelerometer and gyroscope is attached at the humerus to measure shoulder movements during two motion tasks in patients with subacromial impingement syndrome at baseline and at five-year after treatment . One hundred healthy subjects served as healthy reference data base and 15 patients were measured pre- and post-treatment . IMA was better able to detect improvement in shoulder movements compared to the clinical question naires ( Disability of Arm , Shoulder and H and ( DASH ) and Simple Shoulder Test ( SST ) ; p < 0.05 ) and was hardly correlated with the clinical question naires ( Pearson R = 0.39 ) . It may therefore add an objective functional dimension to outcome assessment . The fast assessment ( t < 5 min ) of a simple motion test makes it suitable for routine clinical follow-up


Title 7:
Feasibility and efficacy of wearable devices for upper limb rehabilitation in patients with chronic stroke: a randomized controlled pilot study.
Abstract 7:
BACKGROUND Wearable devices based on inertial measurement units through wireless sensor networks have many applications such as real-time motion monitoring and functional outcome assessment of stroke rehabilitation . However , additional investigations are warranted to vali date their clinical value , particularly in detecting the synergy patterns of movements after stroke . AIM The aim of this study was to explore the feasibility and efficacy of wearable devices for upper limb rehabilitation in patients with chronic stroke and to compare the intervention effects ( e.g. , neurological recovery , active range of motion , and deviation angle ) with those in a control group . DESIGN A single-blind , r and omized-controlled pilot study . SETTING Rehabilitation ward . METHODS A total of 18 patients with chronic stroke were r and omly distributed into a device group and control group . Both groups received conventional rehabilitation ; nevertheless , the device group was additionally subjected to 15 daily sessions at least three times a week for 5 weeks . The outcome measures included the upper extremity subscores of the Fugl-Meyer assessment , active range of motion , and deviation angle . These measurements were performed pre- and post-treatment . RESULTS All five Fugl-Meyer assessment subscores improved in both the device and control groups after intervention ; in particular , the " shoulder/elbow/forearm " subscore ( P=0.02 , 0.03 ) and " total score " ( P=0.03 , 0.03 ) substantially improved . The active range of motion of shoulder flexion and abduction substantially improved at pre-post treatment in both the device ( P=0.02 , 0.03 ) and control ( P=0.02 , 0.03 ) groups . The deviation angle of shoulder external rotation during shoulder abduction substantially improved in the device group ( P=0.02 ) , but not in the control group . CONCLUSIONS The design ed wearable devices are practical and efficient for use in chronic patients with stroke . CLINICAL REHABILITATION IMPACT Wearable devices are expected to be useful for future internet-of-things rehabilitation clinical trials at home and in long-term care institutions


Title 8:
Patient-Reported and Objectively Measured Function Before and After Reverse Shoulder Arthroplasty
Abstract 8:
Background and Purpose : Documenting functional outcomes after  reverse shoulder arthroplasty ( RSA )  is critical to advancing patient care . The interplay been self-reported and objective ly measured outcome measures has not been widely described . The utilization of wearable devices to document upper extremity limb activity is a new approach for objective ly measuring outcomes . Therefore , the purpose of this study was to evaluate changes in pain , and self-reported function and objective ly measured limb activity after RSA . We also assessed the influence of pain on self-reported function and objective ly measured limb activity to determine the impact of pain on outcomes after RSA . Material s : This study implemented a prospect i ve , repeated- measures design . Fourteen patients undergoing RSA underwent testing before surgery , and 2 and 12 months after surgery . Patient-reported instruments included pain , Disabilities of Arm , Shoulder and h and s ( DASH ) , and physical component summary ( PCS ) of the 36-Item Short Form Health Survey . Objective limb activity ( mean activity value , m/s2/min epoch ; inactive time , % ; low activity , % ; and high activity , % ) was captured with triaxial accelerometers worn on the upper and lower arm . A repeated- measures ANOVA tested for differences across time . The Spearman rank-order correlation was calculated to evaluate the influence of pain on DASH , PCS scores , and mean limb activity . Results : Patient-reported measures improved after surgery ( pain , P < .01 ; DASH , P < .01 ; PCS , P = .01 ) . No change in limb activity was found at 1 year compared with preoperative values for mean ( forearm , P = 1.00 ; arm , P = .36 ) , inactivity ( forearm , P = .33 ; arm , P = .22 ) , low ( forearm , P = .77 ; arm , P = .11 ) or high ( forearm , P = 1.00 ; arm , P = .20 ) activity . There was a relationship between pain and DASH scores 1 year after surgery ( P = .04 ) but not before surgery ( P = .16 ) , or 2 months after surgery ( P = .30 ) . There was no relationship between pain and PCS scores at any time point ( preoperative , P = .97 ; 2 months , P = .21 ; 1 year , P = .08 ) nor pain and limb activity ( forearm : preoperative , P = .36 ; 2 months , P = .67 ; 1 year , P = .16 ; arm : preoperative , P = .97 ; 2 months , P = .59 ; 1 year , P = .51 ) . Conclusions : RSA reduced pain and enhanced patient-perceived function . Objective ly measured upper extremity limb activity is not different 1 year after surgery compared with preoperative levels . Level of Evidence : III
The results showed that magneto and /or inertial sensors are the most used .
Wearable sensors  measuring upper limb and /or shoulder kinematics have been proposed to be applied in patients with different pathological conditions such as stroke , multiple sclerosis , osteoarthritis , rotator cuff tear .
Conclusions Wearable systems are a promising solution to provide quantitative and meaningful clinical information about progress in a rehabilitation pathway and to extrapolate meaningful parameters in the diagnosis of shoulder pathologies .